A thesis completed by published work Submitted to the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Doctor of Philosophy Johannesburg, South Africa 25 November 2016 / Background: In South Africa, nurses form the backbone of the health system, because of their numerical dominance, their skills and training, their close contact with patients and communities and their prominence in managerial and leadership roles at all levels of the health system. Objective: The aim of this PhD was to analyse the nature and dynamics of nursing management at primary health care (PHC) clinics in two South African provinces. The specific objectives were to: describe the social-demographic characteristics of selected PHC nursing managers; determine their job satisfaction levels; examine the work environment; determine the functionality of PHC support systems; and assess their managerial competencies. Methods: In 2012, a mixed methods cross-sectional study was conducted in Gauteng and Free State Provinces. Using stratified random sampling, 111 PHC nursing managers working in eight hour clinics were selected. After obtaining informed consent, these managers were invited to participate in three surveys: job satisfaction, facility assessment and a 360 degree competency evaluation. A sub-set of these managers (n=22) was requested to keep a diary for six weeks. STATA® was used to do quantitative data analysis, while the qualitative data was analysed using thematic content analysis. Results: A 95% response rate was obtained for all surveys. The majority of PHC clinic nursing managers were female (92%), black, married, with a mean age of 49 years (SD = 7.9), 90% were in permanent positions, and 36% had between 21-30 years of professional nursing experience. The overall job satisfaction scores for Gauteng and Free State PHC clinic nursing managers were 142.80 (SD± 24.3) and 143.41 (SD± 25.6) out of a possible score of 215. The predictors of their job satisfaction were: working in a clinic of choice (RRR = 3.10), being tired at work (RRR = 0.19) and experience of verbal abuse (RRR = 0.18). The facility assessment found that none of the selected clinics obtained scores of 100% for the vital elements of the National Core Standards. Overall, clinic nursing managers rated themselves high on the domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was the financial management domain where the nursing managers gave lower ratings (7.94). Health system deficiencies, human resources challenges, leadership and governance, and unsupportive management dominated the diary entries, and coalesced to produce many negative emotions experienced by these PHC clinic nursing managers. Conclusion: This PhD study has underscored the importance of PHC nursing managers, and has generated new knowledge on the overall levels and predictors of job satisfaction, the perceived competencies of these managers, together with information on the work environment and support systems. The successful implementation of PHC revitalisation and universal health coverage reforms cannot be achieved without addressing the concerns of PHC nursing managers and the health system issues affecting them. / MT2017

Thesis (MTech. degree in Architecture: Professional)--Tshwane University of Technology, 2012. / The proposal for a mental wellness facility is intended to act as a mechanism through which the intellectually disabled can be accepted into a community.

M.Tech. Business Administration. Business School.

The research problem addressed in this study was to develop a comprehensive marketing plan that would help an emergency medical service (EMS) in the Nelson Mandela Metropolitan Municipality (NMMM), capture a significant market share and gain a competitive advantage over competitors. To achieve this object, a literature study to determine the key components of a marketing plan was undertaken and used as a theoretical model in developing an actual marketing plan. In addition to the literature study, an empirical study was conducted to identify the key issues critical to the development of a marketing plan for the EMS. The survey method used, based on the key components gained from the literature study, consisted of an in-depth scan of the macro-environment and thorough market investigation of the target industry. The investigation involved the general management and senior personnel from the local emergency medical industry, medical aid schemes and private hospitals and clinics delimited in the study. The results of the above literature study were finally combined with the results of the empirical study and a marketing plan for an emergency medical service was developed. This study concludes with recommendations applicable for the implementation of the actual marketing plan.

M.Com. (Business Management) / As insignificant as it might be considered, career management is a vital framework for human capital utilisation in any organisation. This relatively new concept, especially in the South African public service context, has moderately proved to enable organisations to achieve a competitive advantage in the modern global business landscape. Theoretically, many organisations regard employees as the most important asset and strive to position themselves as the employer of choice in the labour market. However, it seems this ideology has not been implemented as well it could have been in public service, through career management practices and programmes, which were the focus of this research. The purpose of the study was thus to explore the value proposition of career management practices in a government department through the implementation process. A literature study was conducted in an effort to gain an understanding of career management as well as related human resource management concepts underpinning people utilisation. As an empirical study, the research employed both quantitative and qualitative methodological data collection techniques. The mixed method approach enabled data to be triangulated. Through the usage of the research methodology, primary data was collected through semi-structured interviews and a self-administered questionnaire. The questions were aligned with the aim and objectives of the research. An analysis of the data revealed a severe lack of understanding of the value proposition of career management efforts. There is a need to review current policies and programmes, which are in place. The sentiments expressed by the interviewed respondents in the management hierarchy were echoed by those respondents on salary levels one to 12 in the data obtained through the questionnaire.

Dissertation submitted in fulfilment of the requirements for the Degree of Master of Technology: Emergency Medical Care, Durban University of Technology, 2012. / Introduction The safe transfer of neonates from one healthcare facility to another is an integral component in the process of neonatal care. Neonates, a term applying specifically to infants during the first 28 days of life, are transferred from medical healthcare facilities which do not have specialist care or intensive care management to more specialised facilities in order to improve their clinical outcome and chance of survival. The transfer system is thus an important aspect of the overall care provided to neonates. The transfer process, however, poses a threat of aggravating the clinical condition of the neonate. Inter-healthcare facility transfer of a neonate requires careful planning, skilled personnel and specialised equipment to maintain the continuum of care, as this directly impacts on the morbidity and mortality of the neonate. Purpose of the study The purpose of the study was to undertake a descriptive analysis of the current neonatal inter-healthcare facility transfer system in the eThekwini Health District of KwaZulu-Natal (KZN). This service is provided by the public sector ambulance service known as the Emergency Medical Rescue Service (EMRS). The study, based on 120 consecutive transfers, assessed the clinical demographics of the neonates, the time taken to complete the transfers, including time sub-intervals, the equipment that was necessary for the transfers and the qualifications and procedures performed by the transfer team. The study also identified any adverse events that were encountered during the transfers. Methodology The study was conducted from 19 December 2011 to 30 January 2012. It used quantitative methodology and a non-experimental prospective design to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District of KwaZulu-Natal. Data collection relied upon two types of questionnaires. A descriptive survey method incorporated logistic and deductive reasoning to evaluate the objectives of this study. Frequency distributions were generated to describe data categories. Bivariate analysis was conducted using chi- square. Results During the study period there were a total of 120 neonatal inter-healthcare facility transfers. All referrals were undertaken by road ambulances. Eighty-three (62.2%), transfers were undertaken by the operational ambulance units, 35 (29.2%) by the obstetric unit and 2 (1.7%) by the planned patient transport units. Thirty one (28.5%) transfers were on Fridays, followed by 24 (20.8%) on Mondays and 20 (16.6%) on weekends. Ninety seven (80.8%) were during the hours of dayshift (07h00-19h00) and 23 (19.2%) were during nightshift (19h00-07h00). Of the 120 neonatal transfers, 29 (24.2%) were specialised transfers, of which 22 (75.9%) were ventilated. With reference to the gestational ages of the neonates being transferred 90 (76.7%), were pre-term, 26 (21.7%) were term and 2 (1.7%) were post-term. There were 11 (9.2%) newborns (from birth to 4 hours), 56 (46.7%) early neonates (from 4 hours to 7 days) and 53 (44.2%) late neonates (from 7 days to 28 days). Of the 120 neonatal transfers, 90 (75.0%) were pre-term having associated co-morbidities and 49 (40.8%) had respiratory problems. The mean time ± standard deviation (SD), taken by EMRS eThekwini to complete an inter-healthcare facility transfer was 3h 49min ± 1h 57min. The minimum time to complete a transfer was 55min and the maximum time was 10h 34min. The mean time ± SD from requests to dispatch was 1h 20min ± 1h 36min. The delays in dispatch were associated with no ambulances being available 70 (58.3%), no ALS personnel available 48 (40.0%), no equipment available 23 (19.2%) and no ILS personnel available 7 (5.8%) to undertake the transfers. Junior or inexperienced personnel in the communication centre also contributed to the time delays by dispatching ALS personnel for non-specialised transfers and requesting neonatal equipment when it had not been requested by the referring personnel for the transfer. The mean time ± SD from the referring hospital to the time mobile to the receiving hospital was 43min ± 26min. Six (5.0%) neonates were clinically unstable at the referring facility for transfer. For 15 (12.5%) transfers, neonates had been inappropriately packaged for transport by the hospital staff, which added to the delays, p. value = 0.018. The necessary equipment was unavailable for 37 (30.8%) of the transfers. The lack of equipment was due to problems such as poor resource allocation, and malfunctioning, inappropriate, insufficient and unsterile equipment. The pre- departure checklist had not been completed in 50 (41.67%) of the transfers. The study identified 10 (8.3%) adverse events related to the physiological state of the neonate and included 1 (0.8%) mortality. Nine (7.5%) neonates suffered serious life threating complications during transportation, 8 (6.7%) of which were due to desaturation, 6 (5.0%) due to respiratory deterioration, 3 (2.5%) due to cardiac deterioration and 1 (0.8%) due to temperature related problems. Eighteen (15.0%) of 120 transfers experienced equipment related adverse events of which 9 (7.5%) were associated with ventilators, 9 (7.5%) with incubators, 3 (2.5%) with the ambulance, 2 (1.7%) with the oxygen supply and 1 (0.8%) with arterial cannulation. Five (33.3%) of the 15 equipment related adverse events contributed directly to life threatening physiologically related adverse events, p. value = 0.007. Conclusion and recommendation The Emergency Medical Rescue Service (EMRS) is involved in the transportation of a significant number of neonates between various healthcare facilities in the eThekwini Health District, some requiring intensive care and some not. This descriptive, prospective study has identified numerous shortfalls in the service provided by the EMRS in the eThekwini District. Inter-healthcare facility transfer of neonates can be safely performed by the transport services if the operations are well co-ordinated and there are dedicated, specialised and trained transport teams armed with appropriate equipment and medication, together with the guidance of policies and quality assurance. Transport teams must be trained to provide this specialised care in various environments, including ground and air ambulances and understand the multiphase neonatal transfer processes. There must be good communication and co-ordination by all role players, which is underpinned by good team work to improve the standards of neonatal care and monitoring. Only then can clinical excellence be achieved when transporting neonates between healthcare facilities.

Thesis submitted in the fulfilment of Master of Architecture [Professional] to the Faculty of Engineering and the Built Environment at the University of the Witwatersrand, Johannesburg, 2017 / In light of the new National Health Insurance scheme being implemented in South Africa, there is a need for new healthcare infrastructure to be developed to ensure the National Health Insurance healthcare is accessible to the people of the country. This thesis explores: (1) what value a holistic healthcare approach can have on healthcare services, (2) what architecture can be beneficial to patients and staff members in healthcare facilities and (3) what impact advances in medicine have on healthcare design and healthcare practice. The architectural aim of this thesis is to create healthier healthcare spaces for patients and staff members, but to extend the healthcare infrastructure to create healthier spaces within the communities they serve. Furthermore, the thesis explores ways that healthcare facilities can incorporate solutions to help communities with their long term health needs, verses short term health needs. / MT2017

M.Com. (Business Management) / It is a well established fact that the majority of South Africans do not have access to health of a satisfactory quality, and that many have almost no effective access to health care at all. Health care in South Africa today can be characterised as being both inequitable and inefficient. It is inequitable as particular groups enjoy privileged access to health care, whereas others do not have any access at all and it is inefficient because of the existence of over treatment in the private sector and fragmentation in the public sector (Picard, 1992:1). In 1987, according to the best calculations available, South Africa spent R9,2 billion on health care. This figure amounted to 5,8 percent of the Gross National Product (GNP) for that year (De Beer & Broornberg, 1990:1). The private sector accounted for 44 percent of expenditure that year, yet supplied health care to 20 percent of the South African population. On the other hand, the remaining 80 percent of the population had to rely on the public sector where just 56 percent of the total expenditure was located (De Beer & Broornberg, 1990:1). It is clear that the pUblic sector is unable to provide adequate health care for 80 percent of the population on the money presently available. This inability to provide services in the public sector has arisen from fragmentation and duplication of facilities, excessively bureaucratic management structures, undue emphasis on expensive curative care, high technology tests and interventions at the expense of providing basic health services. In addition to this, the public sector has been significantly underfunded. This can be supported by the above figures that show that 3,3 percent of the GNP is spent on public sector health care and this figure is well below the 5 percent target set by the World Health Organisation as a minimum standard ,(De Beer & Broomberg, 1990:1).

D.Tech. (Homoeopathy) / In South Africa, the full time training for Homeopathy consists of a five year Masters Degree programme offered at two tertiary institutions; the University of Johannesburg and Durban University of Technology. An outcome of training states that graduate homeopaths must have competency in establishing a private practice. Graduates in homeopathy invest a minimum of five years, but not uncommonly in excess of seven years before graduating, which has considerable time and cost implications. Research has shown that most graduates struggle to establish viable private practices but unfortunately there is a lack of theoretical or research-generated knowledge available to help address the problem. The purpose of the study is to develop a model to facilitate success when establishing a Homeopathic private practice in South Africa. A theory-generating, qualitative, phenomenological research design that was exploratory, descriptive and contextual was used. The sampling method was purposive, using snowball sampling. The methodology utilised the four step strategy for theory and model development as indicated by Chinn and Kramer (2011). The interviews of eighteen participants, from five provinces in South Africa, who run successful homeopathic practices were transcribed and analysed using Rapley (2011:274-275) and Creswell (2013:193-225) analysis for phenomenological studies and Tesch’s inductive, descriptive coding approach (in Creswell, 1994:155-156). Four themes emerged from the data. In theme one, participants experienced initial start-up anxieties which were exacerbated by a perceived lack of practical experience and they indicated their ability to build expertise and self-confidence through the mobilisation of external and internal resources. In theme two, participants experienced challenges inherent in establishing a new practice and expressed how they developed innovative homeopathic practices by means of diversification, differentiation and service excellence. iv In theme three, participants experience that inter and intrapersonal competencies and professional integrity contribute to generating patient trust and word of mouth referrals. In theme four, participants experience the need to mobilise self-support in order to mitigate pressures associated with creating a successful practice. From the data the central concept was identified as ‘the need to facilitate the personal and professional competencies in homeopaths which lead to the establishment of successful private practices’. This was then conceptualised and together with the theoretical definitions and relationships, forms the foundation of a model to facilitate success when establishing a homeopathic private practice in South Africa. The model is graphically represented and described. Guidelines for the implementation of the model, which unfolds in three phases, namely undergraduate, new graduate and maintenance phase, are given. The model is evaluated according to the criteria given by Chinn and Kramer (2011) and deemed to be clear, simple, general, accessible, and important to homeopaths. In addition to being a frame of reference for graduate homeopaths in South Africa, information gained can potentially be used to augment Homeopathic training. The theory generated from the study can form the foundation for further research in this, or related fields.

Workplace violence is an international problem and has negative consequences for individuals, organizations and communities. For individuals, the effect includes symptoms of fear, stress, irritability, feelings of isolation, insecurity, and low selfesteem. Healthcare organizations incur increased cost due to litigation due to poor quality of care, high staff turnovers and absenteeism, and their brands are negatively affected. Community members, who are the recipients of care, are placed in danger and are indirectly the victims of such workplace violence, which in turn affects their trust in private healthcare organizations or professions to provide the quality health care that they expect and deserve. Workplace violence takes many forms such as incivility, horizontal violence and bullying to name but a few. The perpetrators of such violence are doctors, nurses, patients and relatives. Workplace violence takes place in South Africa however, paucity in research was found by the researcher. The aim of the study was to explore and describe the experiences of professional nurses regarding workplace violence in a private healthcare facility in order to develop guidelines to address workplace violence in such a facility. A qualitative, explorative, contextual and descriptive study was conducted, using the Critical Social Theory as the paradigm. Data were gathered from professional nurses that have experienced workplace violence utilizing narratives. Fourteen narrative interviews were done until data was saturated. The data was transcribed verbatim and Tesch’s method of thematic synthesis was used to analyse the data. The three themes that emerged from the data were: Professional nurses acknowledge the existence of workplace violence where they work, Participants described the effect of workplace violence on themselves, others and the work environment, and Participants discussed their views regarding management of violence in the workplace. A thick description of the data with a literature control was provided. Thereafter inferences were made regarding the main themes of the guidelines and these focussed on: Preventing and addressing workplace violence by Nursing Service Managers; Preventing and addressing workplace violence by Nurse Unit Managers and Empowering professional nurses to address workplace violence. To ensure rigour and trustworthiness of the study, the researcher used Lincoln and Guba’s criteria namely: credibility, dependability, conformability and transferability. To protect the right and dignity of the participants and to safeguard the integrity of the study the researcher complied with the following ethical principles: beneficence, non- maleficence, autonomy, justice, veracity, privacy, and confidentiality. The limitations of this study were that data was collected from only one category of nurses and only one private healthcare facility was used. Recommendations from this study include implementation of the guidelines to establish their effectiveness. The findings of this study can be used to empower professional nurses to deal with workplace violence and to prevent the short and long term effects of workplace violence on the individual, the organization and the community. Nursing education institutions can also incorporate workplace violence into their curriculum to increase the awareness of students regarding this phenomenon.