What Three Years of Supply Chain Safety Management Data Revealed About Contractor Risk in the New Zealand Health Sector
Making Health Safer — ACC, three District Health Boards and Safe365
From fragmented assurance to system-wide insight
How mature is contractor safety culture and health and safety capability across the system, and is it improving over time?
The Challenge
Managing safety risk beyond hospital walls
New Zealand’s health system relies on an extensive and diverse contractor supply chain. From construction and maintenance to clinical services, cleaning, logistics, and specialist support, contractors play a critical role in day-today operations and patient outcomes.
Yet for many years, health and safety assurance across this supply chain relied heavily on point-in-time checks, self attestation, and fragmented local approaches.
While these mechanisms provided a level of compliance comfort, they offered limited visibility into a more fundamental question:
How mature is contractor health and safety capability across the system, and is it improving over time?
The Making Health Safer programme was established to address this gap. In a partnership between New Zealand’s national insurer ACC, three District Health Boards, and private sector safety culture provider Safe365, a world-first public–private collaboration was formed to measure and improve safety culture performance across a complex health ecosystem.
This partnership became the foundation for a new way of working, moving beyond individual audits toward a system-based understanding of contractor health and safety maturity, shared duty obligations, and assurance effectiveness across the New Zealand health sector.
The model developed through this collaboration is now influencing how organisations globally engage their supply chains to drive measurable improvements in safety performance.
The Opportunity
Turning assurance into insight
Rather than assessing contractors in isolation, the programme took a longitudinal, evidence-based approach. Over three programme years (2019–2022), 600 suppliers and contractors participated in structured health and safety maturity assessments. These assessments were independently moderated and repeated over time, creating one of the most comprehensive datasets on contractor health and safety capability ever generated in the sector.
The objective was not to rank organisations or identify poor performers. Instead, it was to answer bigger, system-level questions:
- • Where are contractors genuinely strong, and where is confidence outpacing capability?
- • How reliable is the assurance data being relied on by leaders and boards?
- • What conditions enable sustained improvement rather than short-term compliance?
What emerged was a clear set of consistent insights that reshaped how contractor safety risk could be governed across the health system. The data exposed systemic weaknesses across the supply chain and pinpointed exactly where performance was being overstated, where accountability was unclear, and where assurance lacked depth. This clarity enabled targeted programmes of work and focused strategy to lift supply chain performance in the areas that mattered most, driving measurable improvement rather than broad compliance activity
The Solution
A longitudinal, moderated approach to maturity
The Making Health Safer supply chain programme combined:
- Structured maturity assessments aligned to contractor governance and assurance expectations
- Independent moderation to test the accuracy of self-assessed capability
- Repeat measurement over multiple years to track change, not just position
- Feedback loops and engagement to support learning and improvement
- Using leading and lag indicators aligned to best practice were used to monitor continuous improvement, impact and ROI
This approach created visibility not just of maturity scores, but of how accurately organisations understood their own systems — and how that understanding evolved over time.
Key Insight 1 – Assurance confidence matters as much as assurance scores
WHAT WE LEARNED
In the first year of the programme, approximately one third of contractor assessments required downward recalibration following independent moderation. The most common gaps appeared in contractor management, assurance processes and performance monitoring, areas where policies and intent existed but evidence of effective control was limited.
Over time, this picture changed. Among contractors who participated in repeat assessments, recalibration rates reduced to around 20 percent by year three, and the gap between perceived and evidenced maturity narrowed significantly.
WHY THIS MATTERS
This shift did not happen because standards were lowered. It happened because organisations developed a clearer understanding of what “good” actually looks like in practice. Improved alignment between perception and evidence became an early signal of genuine maturity. For senior leaders and boards, this highlighted a critical insight: assurance accuracy is itself a capability. Without moderation and repeat measurement, organisations can unknowingly overestimate their level of control, creating false confidence at a governance level.
WHAT WE LEARNED
Across the three-year programme, participation increased steadily, with assessment completions growing from just over 200 in the first year to more than 340 by the third. Importantly, suppliers who completed repeat assessments demonstrated consistent and sustained uplift in maturity scores, typically increasing by 6–8 percentage points. The most engaged cohort, those completing assessments across all three years, showed the strongest improvement and the greatest stability in results.
WHY THIS MATTERS
Point-in-time assurance provides a snapshot. Longitudinal measurement provides a trajectory. The Making Health Safer data showed that improvement was most evident where organisations could see their progress, understand gaps year on year and align effort accordingly. For governance teams, this reinforced the value of assurance models that enable trend analysis rather than static certification.
WHAT WE LEARNED
Higher engagement correlated strongly with better outcomes. Contractors who actively participated in assessments, workshops and follow-up activity not only improved their maturity scores, but also demonstrated greater accuracy in self-assessment and stronger evidence alignment. Where engagement dropped, visibility of risk reduced.
WHY THIS MATTERS
Engagement is often viewed as a “soft” measure. In practice, it proved to be a leading indicator of system effectiveness. If suppliers disengage from assurance processes, risk does not disappear, it becomes harder to see and harder to manage. For organisations overseeing complex contractor networks, maintaining engagement is not optional. It is fundamental to effective risk governance.
WHAT WE LEARNED
Early feedback from contractors highlighted inconsistent expectations, duplicated assurance requests and unclear definitions of what constituted acceptable evidence. These issues undermined confidence in the process and limited comparability across the system. As expectations became more standardised and clearly communicated, both engagement and assurance quality improved.
WHY THIS MATTERS
When contractors interpret requirements differently, assurance data loses meaning at a system level. Clear, consistent expectations enable comparable results, stronger accountability and more reliable governance insight. This reinforced the importance of aligning contractor management, procurement and assurance frameworks around a shared definition of “what good looks like”.
WHAT WE LEARNED
The programme surfaced recurring gaps in how overlapping PCBU duties were understood and governed. In many cases, contractor safety responsibilities were assumed to sit “somewhere else” in the system, leading to fragmented oversight. In response, the programme supported the development of clearer contractor management frameworks and playbooks to address shared duty risk explicitly.
WHY THIS MATTERS
In shared-duty environments, assumption gaps are one of the most significant contributors to serious harm. Effective governance requires these risks to be designed out of the system, not managed reactively. Boards retain accountability for how these systems are structured, even when day-to-day execution is delegated.
The Strategic Impact: From assurance activity to system insight
By the end of the three-year programme, Making Health Safer delivered more than a dataset. It delivered a new way of seeing contractor risk: one grounded in evidence, trend analysis and system-level insight rather than compliance comfort.
The programme demonstrated that:
- Reliable assurance depends on moderation and repeat measurement
- Visibility improves before performance improves
- Engagement and clarity are critical enablers of maturity
- Governance of shared duty risk must be intentional and explicit
These results reinforced a powerful insight. When safety culture is measured accurately, governed intentionally and improved through targeted strategy, impact extends well beyond compliance. It reduces harm, lowers cost, strengthens system resilience and creates long-term value for all parties across the supply chain.
Key Findings
20 percent uplift in safety culture maturity across contractors within the health sector supply chain
34 percent reduction in workers’ compensation claims made to the national insurer, ACC
Sustained year-on-year reduction in compensation payments over the seven years following implementation, as measured by ACC
Demonstrable return on investmentfor the three principal health organisations, more than 600 contractors, and ACC
Proven global scalability, with the programme model delivering comparable improvements in supply chain safety culture and workplace harm reduction internationally
What this means for your organisation?
If you are managing a complex contractor ecosystem, the Making Health Safer programme shows that meaningful improvement is not driven by more audits, but by better assurance design.
If you are moving beyond compliance, longitudinal maturity measurement provides the insight needed to target effort, prioritise risk and demonstrate progress with confidence.
And if you are responsible for governance, the findings reinforce a simple truth: you can only govern what you can see, and seeing clearly requires the right data, over time.
Ready to embed health and safety culture into your company DNA??
The Making Health Safer programme proves that when contractor safety culture is measured accurately and tracked over time, the impact reaches far beyond compliance, reducing harm, lowering cost and building system resilience across the whole supply chain.
