How did their change process follow the guidelines in this chapter?

Deviate from the guidelines?

Healthcare for about 500,000 people in Canterbury, New Zealand, the South Island’s largest and most populous region, seemed gridlocked:
Patients consistently were required to wait very long periods in the emergency departments as hospitals there were chronically over capacity. This was a result of many factors, one of which was that many patients came to the hospital for treatment of minor conditions, such as the removal of skin lesions and treatment for heavy menstrual bleeding.
Waiting times for procedures at hospitals had become not only a problem but also a political embarrassment. The issue came to a head in 2006, when the central government introduced regulations to sanction hospitals if they failed to provide treatment to approved patients within six months of their referral. The local district health board responded by arbitrarily removing from its waiting list about 5,000 patients with the longest waits. The local health board justified the removal to the press by saying that if patients could wait for more than six months, they must not need the surgery.