Aim: To investigate why New Zealand registered chiropractors in Canterbury are not participating fully as partners in the recent changes in initiatives, such as the Back Pain Package/Programme, established by the Canterbury Initiative and Canterbury District Health Board (CDHB). In a wider context this might be seen as an exemplar for chiropractic’s poor participation in other regional district health boards in Aotearoa New Zealand and could inform policy at a Ministry of Health (MoH) level. Furthermore, it might also provide insight into why other allied health disciplines are not participating either.

Objectives: First, to investigate why so few chiropractors practising within the region of the CDHB are not participating in the Back Pain Package/Programme and subsequently are not signing up to the ERMS. Second, to identify the barriers on a professional, practice, and system level influencing this lack of participation. Third, to investigate how a broader inclusion of the chiropractic profession in the health care sector in New Zealand could be achieved by way of factors that facilitate and enable participation in the Back Pain Package/Programme. Fourth, investigate the consequences to the profession of chiropractors, of not having an understanding of, the Canterbury Initiative / CDHB policy and not participating in it.

Methods: The research was a mixed method study. It adopted a grounded theory approach to its study design. Fourteen qualitative interviews were conducted using purposeful and snowball sampling which were then subject to thematic analysis. A cross-sectional survey of all 69 chiropractors practicing in the region of the CDHB was conducted. The results of this survey were analysed in two phases; firstly the open ended questions were thematically analysed and compared to the themes and codes of the fourteen interviews to determine the most dominant themes; secondly the closed ended questions were placed into tables for review. Analysis of documents an e-mails was performed. Data was triangulated to inform and support each data set.

Results: The results are examined in three sections: first, an examination of the Canterbury Initiative and the development and implementation of the Back Pain Package/Programme; second, an examination of the barriers that prevented chiropractors participating in this programme; and third, facilitators and enablers for future development. Due to the nature of the mixed method study, both qualitative and quantitative data was used in conjunction when examining the themes of the study. The themes from the data that emerged from this study that acted as barriers to greater chiropractor involvement were: recruitment issues, communication and IT infrastructure issues, blocks in past from joining CDHB programmes, dysfunction in relationships with GPs, the private practice business model, different philosophical paradigms, psychological and behavioural factors, educational factors, and legal considerations. Facilitators and enablers were briefly discussed such as, submitting chiropractic evidence based research under the clinical pathways, relevant to chiropractors scope of practice, within the Allied Healthways system. Furthermore, the research sought feedback on what would allow chiropractors to participate in the Electronic Request Management System (ERMS) and engage with Allied Healthways. If this feedback were implemented then it could change the course of future investment and work in this area.

Conclusion: Kia Whakakatahi Te Hoe O Te Waka, We Paddle Our Waka as One, is not a high ideal but a commitment to work together beyond differences. To come into contact with difference and forge a relationship with it, to meet in the interface, and develop new forms of knowledge that honor both the traditional medical model, and the non-tangible realities of Whānau Ora. The Canterbury Initiative Back Pain Package/Programme had a real opportunity to harmonise with the vison of Whānau Ora and align themselves with professions that have a holistic approach such as chiropractic. Chiropractors for their part could have participated in a patient and whānau centered model. The one team approach has not transpired in the Canterbury Initiative Back Pain Package/Programme and from the chiropractic example, we have shown this is due to factors outside and inside chiropractors’ control. If the legislative framework is suggesting that failures of teamwork are impacting on public safety, then accountability for the barriers which prevent a one team approach, and that are broader systems issues, is necessary, particularly those that are beyond the individual practitioners’ control.

The opportunity for chiropractic to be included into CDHB service provision was a first of its kind for chiropractic both regionally and nationally. This possible inclusion of chiropractic into the Back Pain Package/Programme was in one sense, a miracle moment for the chiropractic profession. The failure to enable chiropractors take up this opportunity as expected by the Canterbury Initiative CDHB, and participate fully as partners is regrettable. Barriers were identified to explain this situation which in some instances may be transferrable to the wider allied health sector in New Zealand. Facilitators and enablers were offered as a solution for future contexts. Some of the barriers and facilitators may also be true of other CDHB programmes that seek to engage the allied health sector in the future. Therefore, this study may be of interest to the Ministry of Health and other regional DHB’s for the betterment of population health in relation to back pain.