South African public hospital intrapreneurship culture: Unit nurse managers’ governance role

Abstract

The South African healthcare system, transitioning towards Universal Health Coverage achieved through National Health Insurance, still faces several challenges like gross inefficiencies, inequities, and financial insecurity (Rispel et al. 2019). Effective measures aimed at tightening Background: Intrapreneurial public hospitals seeking reform, are favourable platforms enabling the unit nurse managers to promote innovative work cultures enhancing effective governance. The cost-conscious nurse managers consider scientific approaches to improve resources and services by securing seed funding.Aim: To position skilled intrapreneurial unit nurse managers as effective governance leaders who can transform the risk-avert bureaucratic public hospitals' culture into innovation centres to improve services. Setting:The unit nurse managers from three public hospitals constituted the population of the study. Methods:The qualitative study was explorative, descriptive, and contextual. The focus group discussions were convened at different hospitals' private venues. A systematic analysis of data achieved through the Tesch technique culminated into themes and categories. Results:The highly regulated top-down structured public hospitals' culture, which is routinebased, denies potential intrapreneurs to constantly look for new approaches that could improve services through innovation. The four themes highlighted the following participants' concerns: human resource issues, poor communication, concerns around the current incentivised performance, and hospital financial issues. Conclusion:The findings shed light on some participants' willingness to innovate. However, the extreme work pressure and inconsistent incentivised performance are demotivating. Furthermore, the lack of management support for innovative teams, and the lack of seed funding because of restricted budget contribute to a culture of apathy towards innovation. Contribution:The study promotes a transformative intrapreneurial policy supporting favourable public hospital work innovative cultures through recognising the salient contribution of unit nurse managers positioned in the hub of clinical evidence, as potential intrapreneurs making evidence-informed decisions, improving quality care rendered.