An assessment of organisational values, culture and performance in Cape Town's primary healthcare services

Abstract

IntroductionDistrict healthcare services in South Africa face many challenges with regard to attempts to offer effective primary healthcare services. Demand for services from uninsured communities is high. There is a quadruple burden of disease characterised by human immunodeficiency virus/ acquired immune deficiency syndrome and tuberculosis; interpersonal violence and trauma, poverty-related diseases, such as diarrhoea and pneumonia; and an emerging epidemic of noncommunicable chronic diseases. The number of service providers is often inadequate to cope with the workload. Healthcare workers are inequitably distributed. For example, doctors are found in greater numbers in urban areas, the private sector and hospitals, rather than in the communities. The district health system itself is a relatively new structure and many district-, subdistrict-and facility-level managers are still being appointed. Poor leadership and governance is one of the identified challenges that faces the new health districts. 3According to the Department of Health, primary healthcare workers are expected to be caring and compassionate at the coalface, and yet becoming patient-centred and improving the quality of care in this context is a challenge: 4 "The department renders a large and complex service every day of the year, and the clinical environment is often stressful. Staff attitudes are a common source of complaints. A key issue is how greater commitment and engagement from staff can be promoted on a daily basis, moving towards a more client-centred service with a greater focus on quality improvement". Results: In total, 154 staff members completed the survey. Participants reported personal values that are congruent with a move towards more patient-centred care. The top 10 current organisational values were not sharing information, cost reduction, community involvement, confusion, control, manipulation, blame, power, results orientation, hierarchy, long hours and teamwork. Desired organisational values were open communication, shared decision-making, accountability, staff recognition, leadership development and professionalism. Organisational entropy was high at 36% of all values. Only teamwork and community involvement were found in both the current and desired culture. The organisational scorecard showed a lack of current focus on finances, evolution and patient experience. Conclusion:The organisational culture of the Metro District Health Services is currently not well aligned with the values expressed in Vision 2020, and the goal of delivering patient-centred care.Peer reviewed.

Examining the effects of a mindfulness-based distance learning professional training module on personal and professional functioning: a qualitative study

“…This is a particularly pressing issue in South Africa given the harsh, stressful and often traumatic conditions in the healthcare environment, especially in public sector facilities [14, 15]. Intensive training in mindfulness enhances self-regulation, resilience and compassion, with the consequent enhanced capacity to manage stress and reduce burnout [16].…”

A reflection on the practical implementation of the clinical governance framework in the Cape Winelands District of the Western Cape

“…A fourth strategy in implementing the clinical governance framework in the CWD was to assist FPs with developing their roles as clinical leaders, and for sub-district managers to support their leadership by creating an enabling environment for clinical governance, while at the same time ensuring a system of accountability. 2,10 The FP is required both to lead the team and be a part of it, as well as to encourage openness and the ability to learn from mistakes while still holding people accountable for the quality of their care. 11 The managers were to support the FP in their supervisory HR functions of the team of doctors.…”

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Subindo a escada da inovação sustentável com o modelo da pirâmide Asteca

“…Diferentes fatores foram observados, tais como as questões de priorização, divergência entre interesses e preocupações individuais e coletivas, que podem ser chamadas de "entropia organizacional". Tais condições interferem contra a incorporação de práticas novas e mais complexas na organização, mas não são específicas do ecodesign ou sustentabilidade e podem desempenhar um papel importante em qualquer questão de mudança(Mash et al, 2013).De acordo comFrazier (1996), que estudou Design for Environment na Xerox, um desafio chave seria superar a resistência da gestão intermediária para a mudança estratégica, pois este grupo tem um papel fundamental no processo de implementação, mas é o mais difícil de convencer da necessidade de prosseguir uma estratégia particular.Se o estudo não fornece tais evidências conclusivas, a gestão intermediária pode ser exposta a tensões importantes, na intersecção da pressão estratégica de cima para baixo e experimentações de baixo para cima, frente aos desafios de desempenho sustentável. O novo paradigma da empresa sustentável traz uma justaposição de metas ambientais e financeiras, com possíveis conflitos em curto prazo, com a pressão constante impostas pelos mercados competitivos.Do conhecimento formal ao tácitoNo entanto, tais resistências e barreiras invisíveis são difíceis de identificar e gerenciar.…”