Developing learning diaries for action research on healthcare management in Ghana, Tanzania and Uganda

Mshelia, Comfort; Lê, Gillian; Mirzoev, Tolib; Amon, Samuel; Kessy, Ambrose T.; Baine, Sebastian Olikira; Huss, Reinhard

doi:10.1177/1476750315626780

Cited by 6 publications

(4 citation statements)

References 13 publications

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“…Specifically, this paper draws upon one key aspect of the initial situation analysis that is, the perceived decision-making space of the district managers. More information about the PERFORM project is available in the published literature (Mshelia et al 2013;Mshelia et al 2016) and on the PERFORM website (www.performconsortium.com). The aim of this paper is to improve understanding about how DHMTs perceive and use their decision space for HRM to improve health workforce performance in decentralised health systems.…”

Section: Introductionmentioning

confidence: 99%

Decision space for health workforce management in decentralized settings: a case study in Uganda

Alonso-Garbayo

Raven

Theobald

et al. 2017

Health Policy and Planning

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The aim of this paper is to improve understanding about how district health managers perceive and use their decision space for human resource management (HRM) and how this compares with national policies and regulatory frameworks governing HRM. The study builds upon work undertaken by PERFORM Research Consortium in Uganda using action-research to strengthen human resources management in the health sector. To assess the decision space that managers have in six areas of HRM (e.g. policy, planning, remuneration and incentives, performance management, education and information) the study compares the roles allocated by Uganda's policy and regulatory frameworks with the actual room for decision-making that district health managers perceive that they have. Results show that in some areas District Health Management Team (DHMT) members make decisions beyond their conferred authority while in others they do not use all the space allocated by policy. DHMT members operate close to the boundaries defined by public policy in planning, remuneration and incentives, policy and performance management. However, they make decisions beyond their conferred authority in the area of information and do not use all the space allocated by policy in the area of education. DHMTs' decision-making capacity to manage their workforce is influenced by their own perceived authority and sometimes it is constrained by decisions made at higher levels. We can conclude that decentralization, to improve workforce performance, needs to devolve power further down from district authorities onto district health managers. DHMTs need not only more power and authority to make decisions about their workforce but also more control over resources to be able to implement these decisions.

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Section: Introductionmentioning

confidence: 99%

Decision space for health workforce management in decentralized settings: a case study in Uganda

Alonso-Garbayo

Raven

Theobald

et al. 2017

Health Policy and Planning

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“…Homegrown CD activities allow for longer time frames and can potentially deepen local actor ownership and voluntary commitment to CD strategies, both of which are necessary for sustained capacity (71). We acknowledge that this type of workplace based capacity development can work in combination with other external forms of training and learning such as classroom based learning or e-learning combining theory and practise (86)(87)(88)(89)(90). We also note that some of the general challenges facing innovation in the public service include bureaucratic attitudes, coordination problems, opposition to innovation in general and doubts from stakeholders, given unexpected challenges that may arise slack should be built into the innovation process to deal with challenges (65, 91).…”

Section: Proximal Outputs and Emergent Capacity Developmentmentioning

confidence: 99%

Bottom up innovation for health management capacity development: a qualitative case study in a South African health district

Orgill

Marchal

Shung-King

et al. 2021

Preprint

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Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing management capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Understanding capacity as a property of the health system not only of individuals , the research explored mechanisms triggered in context, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system to produce outputs.Methods We conducted a realist evaluation complemented by a case study approach over a two-year period (2013-2015) in the district. The initial programme theory development included ten senior manager interviews and a literature review. To understand processes and mechanisms triggered in local context and identify outputs we conducted fifteen interviews with managers in the management team and with seven non-state actors, supplemented by researcher notes and time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome-Actor configuration alongside theoretical constructs. Results The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justification for change and setting the scene (a new agenda, distributed leadership). These micro practices and managers engaging with the new practices, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new meeting practices within a routine meeting. Conclusion District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant ‘bottom-up’ capacity development in district health systems. Doing so by drawing on intangible soft skills and tangible policy resources (hardware) of the system to influence motivation and buy-in for improved management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces.

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Section: Proximal Outputs and Emergent Capacity Developmentmentioning

confidence: 99%

Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

Orgill

Marchal

Shung-King

et al. 2020

Preprint

View full text Add to dashboard Cite

Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing managerial capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Using a systems perspective on capacity development, the research explored the initial sensemaking by the district manager, how these homegrown innovations interacted with existing social processes and norms, the mechanisms for change that were triggered and the emergent capacity outputs. Methods We conducted a realist evaluation complemented by a case study approach over a two-year period (2013-2015) in the district. The initial programme theory development included ten senior manager interviews and literature review. To understand processes and mechanisms triggered in local context and identify emergent capacity outputs we conducted fifteen interviews with managers in the management team and with seven non-state actors, supplemented by researcher notes and time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome -Actor configuration alongside theoretical constructs. Results The new district manager drew on complex frames, tacit and experiential knowledge to design bottom up innovations, and collective capacity development was triggered through micro-practices of sensemaking and sense-giving. Sensegiving included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justification for change and setting the scene (a new agenda, distributed leadership). These micro practices, managers engaging with the new practices and social sense-making, influenced the motivation of managers and partners to further participate in new meeting practices, and triggered a generative process of buy-in and emergent capacity in a routine meeting structure. Conclusion District managers are well placed to design local level capacity development innovations and must draw on multiple knowledge forms to enable relevant ‘bottom-up’ capacity development in complex health systems. Managers must draw on their intangible soft skills and the tangible policy resources (hardware) of the system to influence motivation and buy-in for improved management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing in routine spaces, to unleash capacity.

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Developing learning diaries for action research on healthcare management in Ghana, Tanzania and Uganda

Cited by 6 publications

References 13 publications

Decision space for health workforce management in decentralized settings: a case study in Uganda

Decision space for health workforce management in decentralized settings: a case study in Uganda

Bottom up innovation for health management capacity development: a qualitative case study in a South African health district

Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

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