‘Doing more with less’: a qualitative investigation of perceptions of South African health service managers on implementation of health innovations

Abstract

Building resilience in health systems is an imperative for low- and middle- income countries. Health service managers’ ability to implement health innovations may be a key aspect of resilience in primary healthcare facilities, promoting adaptability and functionality. This study investigated health service managers’ perceptions and experiences of adopting health innovations. We aimed to identify perceptions of constraints to adoption and emergent behaviours in response to these constraints. A convenience sample of 34 facility, clinical service and sub-district level managers was invited to participate. Six did not respond and were not contactable. In-depth individual interviews in a private space at participants’ place of work were conducted with 28 participants. Interviews were audio recorded and transcribed verbatim. NVivo 11 was used to store data and facilitate framework analysis. Study participants described constraints to innovation adoption including: staff lack of understanding of potential benefits; staff personalities, attitudes and behaviours which lead to resistance to change; high workload related to resource constraints and frequent policy changes inducing resistance to change; and suboptimal communication through health system structures. Managers reported employing various strategies to mitigate these constraints. These comprised (1) technical skills including participatory management skills, communication skills, community engagement skills and programme monitoring and evaluation skills, and (2) non-technical skills including role modelling positive attitudes, understanding staff personalities, influencing perceptions of innovations, influencing organizational climate and building trusting relationships. Managers have a vital role in the embedding of service innovations into routine practice. We present a framework of technical and non-technical skills that managers need to facilitate the adoption of health innovations. Future efforts to build managers’ capacity to implement health innovations should target these competencies.

Task Sharing or Task Dumping: Counsellors Experiences of Delivering a Psychosocial Intervention for Mental Health Problems in South Africa

“…Limited understanding of the importance of mental health counselling by other facility staff and the lack of resources (confidential space and time) required to provide adequate care as key implementation barriers to address during counselling scale up. Prior studies have also identified these as potential barriers to the implementation of mental health counselling in PHC facilities (Brooke-Sumner et al 2019;Myers et al 2019a, b). Strong leadership from facility managers can help staff navigate many of the resource challenges to counselling implementation (Brooke-Sumner et al 2019).…”

Organizational Culture and the Integrated Chronic Diseases Management Model Implementation Fidelity in South Africa

“…Employee involvement has been positively associated with a large number of significant changes in quality care improvements and chronic illness management as engaged employees collaborate, perform at a higher level and are innovative [9,38]. A qualitative study on constraints for adopting health innovations into practice indicated that the hierarchical culture of the South African health system does not support innovation and creating change at facility level [39]. Creating change cultural index also obtained a low score in this study.…”

“…Creating change cultural index also obtained a low score in this study. Decisions on what new innovative interventions to be introduced are usually concluded at higher (district and provincial) management level with very little bottom-up communication or consultation [39]. Adaptability cultural trait is a critical strength in an organization that's undergoing a transformation [11], and this trait would need to be fortified in these PHC clinics as part of the primary healthcare reengineering.…”

“…Some of the recommendations for organizational change in the study clinics to promote effective implementation of the ICDM model could include an emphasis on customer feedback processes and rewarding staff members that demonstrate patient-centered care as part of improving customer focus. A participatory management style has also been recommended as another strategy to facilitate bottom-up communication and consultation and innovations adoption [39].…”

“Moving Forward with Life”: Acceptability of a Brief Alcohol Reduction Intervention for People Receiving Antiretroviral Therapy in South Africa

“…The use of trained counsellors who were not their usual HIV care providers seemed to enhance the acceptability of screening and the brief alcohol reduction intervention. Professional counsellors are, however, absent from the current public health workforce, largely due to the country's chronic shortage of financial and human resources for mental health [32,33]. Implementing screening and brief alcohol reduction interventions on scale, therefore, will require alternative delivery agents.…”