Implications and possible responses to the effects of staffing moratoria on organisational performance at Ngwelezana tertiary hospital in KwaZulu-Natal.

Abstract

The government is committed to improving the health system by providing universal coverage to all South Africans as articulated in national health policies. The biggest threats facing the health sector today are the shortage of well-trained healthcare workers, the increasing costs and demand for healthcare services. The global crisis of 2008/2009 forced the government to implement cost-cutting measures to reduce public expenditure and resolve budgetary pressures, including in the health sector. The study aimed to examine the implications and possible responses to staffing moratoria, implemented as an austerity measure, on the organisational performance of a public hospital – Ngwelezana Tertiary Hospital in KwaZulu-Natal. The objectives of the study were to examine the impact of staffing moratoria on healthcare service delivery; assess the working conditions and the challenges faced by healthcare workers; and discuss the effect of task-shifting on healthcare service delivery at the hospital. The study employed a mixed-method design in order to yield both quantitative and qualitative data. The quantitative approach was dominant in this study, where a sequential embedded mixed method design was adopted as the most appropriate cross-sectional survey method. The survey yielded a total of 177 respondents. The qualitative approach provided rich information on the perceptions of nine [9] key informants who were interviewed regarding staffing moratoria. Quantitative data was analysed using descriptive statistics, Chi-square tests of association and the Cramer’s V test whilst qualitative data was analysed using thematic analysis. The results show that staffing moratoria at Ngwelezana Hospital resulted in severe staff shortages and the deterioration of working conditions as a result of excessive working hours, job enlargement, limited personal development opportunities, increased administrative and housekeeping burdens on professionals, employee burnout and stress. It also promoted distrust between employees and management that furthered job dissatisfaction at the workplace. Whilst task-shifting was adopted to address staff shortages, delays in serving patients, long waiting periods for patients, increased risks of error and patient mortality was observed. Task-shifting presented its own challenges such as legal and professional risks and staff morale issues. The study proposed a framework that empowers hospitals to implement staffing moratoria based on the supply and demand of labour in order to manage staffing budgets. The study, recommends that staffing moratoria should be supported by a decentralised multi-dimensional approach in planning and implementation to ensure a collective consultative process that involves all relevant stakeholders.