Leadership and governance: learning outcomes and competencies required of the family physician in the district health system

Mash, Rachel; Blitz, Julia; Malan, Zelra; Pressentin, Klaus B. von

doi:10.1080/20786190.2016.1148338

Cited by 26 publications

(35 citation statements)

References 3 publications

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“…Registrars in family medicine also benefited through growing their experience as leaders in clinical governance activities by including facilitation of the AMS rounds and meetings as part of their learning plans. 27…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in rural districts of South Africa: growing a positive culture

Pressentin

Swanepoel

Opie

et al. 2019

South African Family Practice

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Background: The success of medical specialist-led antimicrobial stewardship activities in urban tertiary health care settings has been well documented. The issue of antimicrobial resistance remains an ongoing concern. This has particular relevance in primary health care communities treated from sub-district health services, which are organised around level-one district hospitals. District hospitals are typically staffed by generalist clinicians or medical officers with minimal access to the medical specialist physicians and pathologists who are available in the urban academic centres. Coordinated team-based activities aimed at implementing the South African Antibiotic Stewardship Programme (SAASP) principles of antimicrobial use are necessary. Methods: This open forum article describes the process of growing an institutional culture around antimicrobial stewardship from the perspective of a 90-bed district hospital and a regional referral hospital located in the rural Garden Route District of the Western Cape province. Results: A team of generalist health workers, inclusive of a family physician and medical officers, pharmacists and nursing colleagues, conducted weekly antimicrobial stewardship ward rounds. A clinical pathologist from the National Health Laboratory Service (NHLS), based at George Regional Hospital, consulted on these ward rounds monthly and provided guidance and advice to medical staff via telephone, email and WhatsApp. Undergraduate medical students and registrars in family medicine also attended these ward rounds and learnt from resulting discussions. This strengthened quality of care for patients and provided a platform for shared ongoing learning. Conclusion: This model can be applied to similar settings within South Africa, and further afield.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in rural districts of South Africa: growing a positive culture

Pressentin

Swanepoel

Opie

et al. 2019

South African Family Practice

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“…On the contrary, they emphasised a managerial role in corporate governance, which has been rejected in some other countries. 15 It is thought that FPs should primarily be clinicians and not managers. It is possible that respondents extrapolated their ideas of what the FP would do by combining their experience of the current roles of the general medical officer in district hospitals with the more managerial roles of the medical superintendent.…”

Section: Discussionmentioning

confidence: 99%

The views of key stakeholders in Zimbabwe on the introduction of postgraduate family medicine training: A qualitative study

Sururu

Mash

2017

Afr. j. prim. health care fam. med.

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BackgroundStrengthening primary health care (PHC) is a priority for all effective health systems, and family physicians are seen as a key member of the PHC team. Zimbabwe has joined a number of African countries that are seriously considering the introduction of postgraduate family medicine training. Implementation of training, however, has not yet happened.AimTo explore the views of key stakeholders on the introduction of postgraduate family medicine training.SettingKey academic, governmental and professional stakeholders in Zimbabwean health and higher education systems.MethodTwelve semi-structured interviews were conducted with purposively selected key stakeholders. Data were recorded, transcribed and analysed using the framework method.ResultsAnticipated benefits: More effective functioning of PHC and district health services with reduced referrals, improved access to more comprehensive services and improved clinical outcomes. Opportunities: International trend towards family medicine training, government support, availability of a small group of local trainers, need to revise PHC policy. Anticipated barriers: Family medicine is unattractive as a career choice because it is largely unknown to newly qualified doctors and may not be recognised in private sector. There is concern that advocacy is mainly coming from the private sector. Threats: Economic conditions, poor remuneration, lack of funding for resources and new initiatives, resistance from other specialists in private sector.ConclusionStakeholders anticipated significant benefits from the introduction of family medicine training and identified a number of opportunities that support this, but also recognised the existence of major barriers and threats to successful implementation.

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“…It is again possible that their influence was greater within the district hospital management structure than in primary health care. 47 Another possibility is that the training of family physicians prepared them better for the district hospital as opposed to the primary health care context, as many training programs are still dominated by hospital-based exposure. 48,49 In South Africa, the need for and deployment of family physicians in district hospitals has been more clearly conceptualized and operationalized than their role and placement in the primary health care team.…”

Section: Discussionmentioning

confidence: 99%

The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study

et al. 2018

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PURPOSE Evidence of the influence of family physicians on health care is required to assist managers and policy makers with human resource planning in Africa. The international argument for family physicians derives mainly from research in high-income countries, so this study aimed to evaluate the influence of family physicians on the South African district health system. METHODSWe conducted a cross-sectional observational study in 7 South African provinces, comparing 15 district hospitals and 15 community health centers (primary care facilities) with family physicians and the same numbers without family physicians. Facilities with and without family physicians were matched on factors such as province, setting, and size.RESULTS Among district hospitals, those with family physicians generally scored better on indicators of health system performance and clinical processes, and they had significantly fewer modifiable factors associated with pediatric mortality (mean, 2.2 vs 4.7, P = .049). In contrast, among community health centers, those with family physicians generally scored more poorly on indicators of health system performance and clinical processes, with significantly poorer mean scores for continuity of care (2.79 vs 3.03; P = .03) and coordination of care (3.05 vs 3.51; P = .02).CONCLUSIONS In this study, having family physicians on staff was associated with better indicators of performance and processes in district hospitals but not in community health centers. The latter was surprising and is inconsistent with the global literature, suggesting that further research is needed on the influence of family physicians at the primary care level.

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Leadership and governance: learning outcomes and competencies required of the family physician in the district health system

Cited by 26 publications

References 3 publications

Antimicrobial stewardship in rural districts of South Africa: growing a positive culture

Antimicrobial stewardship in rural districts of South Africa: growing a positive culture

The views of key stakeholders in Zimbabwe on the introduction of postgraduate family medicine training: A qualitative study

The Influence of Family Physicians Within the South African District Health System: A Cross-Sectional Study

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