An exploration of the management and leadership system in a public health hospital in Durban.

Abstract

This is a study on the leadership of health care in a South African Government hospital using systems thinking and specifically Critical Systems Heuristics (CSH) as the key methodology. The aim of the study was to determine whether a deeper understanding of managers and clinicians underlying values and motivators which supported their decision making, could serve as a platform for improving their working relationship towards better health outcomes. Government hospitals are not functioning optimally. Millennium Development Goals have been missed, staff morale is poor, patient care is sub optimal. Instead of exploring conventional management solutions, this study interrogates systemic issues of the working relationship between managers and clinicians. A purposive sampling method was used to select ten key decision makers, five managers and five clinicians, at Wentworth hospital in Kwa-Zulu Natal. In depth interviews were done using a semi-structured questionnaire. Data was compared and synthesised into known systems models. Results showed that each group assigned different levels of importance to sub systems within the overall system. Managers focused more on the pragmatic facts of what is now, while clinicians were focussed more on future possibilities for improvements. This revealed sources of frustration with the decision-making process and identified potential conflict resulting from their different views. Results also indicate that the District Health Office and Provincial Health Department exercise considerable direct control over the hospital decision making system, contrary to the intention of the Government Health Policy Framework. It is recommended that the two groups engage each other from a values perspective with new understanding of underlying motivators and perspectives of what is primary and secondary for each, and to adopt a learning approach which encourages co-operative decision making. Similarly, the DOH need to be engaged on how they can facilitate full use of existing expertise of these two groups instead of imposing unwanted and unhelpful decisions on them. Additional research with a larger sample of hospitals is recommended to test suggested improvements in the system. A systems thinking approach to the interface between DOH and hospitals is also recommended.