Thesis (M.M. (Business Executive Coaching))--University of the Witwatersrand, Faculty of Commerce, Law and Management, Wits Business School, 2017. / Introduction Public hospitals are complex environments in which healthcare leaders are required to lead effectively in order to provide quality service delivery. The issue is: are clinical managers working in Gauteng hospitals competent to lead? This study measures the competency of clinical managers in public hospitals and considers how coaching can be used to close the competency gap in Gauteng public hospitals. Coaching has been identified as one of the appropriate developmental tools to enhance the skills’ gap of top managers in organisations (West & Milan, 2001). In this study, coaching has been considered to be an appropriate learning and developmental tool to enhance skills for these managers. Methods A self-administered questionnaire was used to conduct the survey among clinical managers in the hospitals in Gauteng. Participants were asked to rate the required management competencies and their proficiency levels against nine management competency categories which include: leadership, communication, life-long learning, consumer responsiveness, political and health environment, conceptual skills, results management, resource management, compliance with standards and coaching in improving management competencies .Likert-scale data was used to measure the top managers’ perceptions of the important competencies required for effective service delivery and their level of proficiency with those competencies. Results Findings show that there is significant gap in management competency of clinical managers, which indicates the need for further development of managers. Most clinical managers’ have a perception that coaching has a role in enhancing their competency gap. Literature supports coaching as a leadership development tool for closing the competency gap of clinical managers. Conclusion There is significant gap in the public health sector managers’ competency level. There is a need for appropriate and further training and development to address the skills gap. There is need to strengthen management capacity to support the strategy of improved and sustainable healthcare service delivery. Coaching is the appropriate leadership developmental and supportive tool to enhance the skills needed by clinic managers. / MT2017

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, Wits School of Governance, 2016 / CEOs of public hospitals in South Africa are often held responsible when their institutions fail to deliver good quality care and are associated with poor health outcomes. Negative perceptions prevail and particularly in the National Department of Health it is held that the CEOs are generally not adequately qualified, inexperienced, incompetent and often inappropriately appointed. This study attempts to articulate the CEOs views (their side of the story) and in particular how they perceive the challenges that they face and what solutions they proffer in improving the running of their institutions. This research is viewed through the lens of the New Public Management paradigm (NPM), in terms of Public Sector Reform and in particular Health Sector Reform in South Africa. Thirty CEOs of public hospitals in South Africa responded to a survey of their opinions. The majority (86%) of them felt they were unable to manage their institutions effectively. A subsequent qualitative study of CEOs and experts in public management using in depth interviews and further focus group discussions with CEOs and senior hospital managers revealed that the major challenges that the CEOs faced were financial, human resources and operational management issues. Procurement and information challenges were linked to financial and human resources deficiencies, lack of accountability mechanisms and the presence of corruption. The Performance Management System currently in place did not work appropriately and was driven by perverse incentives. Political interference was also a pervasive problem. Their recommendations were that they needed clear and unambiguous delegations and the appropriate resources so that they can take full responsibility of their institutions. Clear accountability structures were paramount in achieving better health service management and care according to the advice of experts in public management as well as that of senior hospital managers. This requires the creation of enabling legislation and an appropriate accountability framework. The blanket application of NPM principles is also questioned. Selective application of the tools of NPM should be tested and consideration be given to the dimension of added public value in the South African public hospital context. / GR2018

In the Eastern Cape Department of Health the performance management and development system progress reviews are performed in a summative manner. This happens when a supervisor leaves out all the other progress reviews and conducts a final progress assessment and monitoring at the end of the year. It is worse when the performance agreements are not even signed during the start of a financial year, neither does a newly qualified employee sign. As a result employees are not appraised because there are no progress reviews that are entered on the Persal system. Employees miss an opportunity to be sent for training at the same time they are rewarded late or not at all. It is obvious that the managers do not understand the aims and objectives of the PMDS policy. The research was an assessment of the effectiveness of the performance management and development system in inculcating professional behaviour in the nursing staff in the three Buffalo City hospitals, namely, East London Hospital Complex, Grey and Bisho hospital. The aspects of the policy investigated were the performance reviews, the competency framework and the performance incentive scheme. This research is qualitative in nature. Data was collected using unstructured interviews and open ended questions. The population of this study involved selected Performance Management Managers, Quality Assurance Manager, Area Managers, junior nurses and clerks working in the Buffalo City Hospitals. The respondents of the study were selected using the stratified random sampling technique. Descriptive methods were used to analyse data. Confidentiality was highly maintained and consent form even distributed from the start of the research. The three Buffalo City hospitals are practising a balanced scorecard as a performance measurement tool. It is in the form of workplans that are different for different levels of employees such as the performance workplans, standard framework workplan and individual workplans. ix The study discovered that there is poor compliance in performing the performance reviews. The attention is on the appraisal aspect more than the development aspect. Also, there is a delay in taking the employees for training as a result they end up not being trained. The employees are not rewarded according to their performance. The PMDS policy states that employees that get a score of three are entitled to get a one percent and those that are rated a four or a five qualify for a performance bonus. The study found that the PMDS policy is not implemented well. It is recommended that the performance management manager and the quality assurance manager need to apply a radical strategic transformation and change management to address the challenges.

D.Cur. / The impressive growth in the extent and range of psychiatric services provided by general hospitals in South Africa, creates stress among nurses employed in these settings which manifests its self in the negative attitudes displayed towards mentally ill people, refusal of dual diagnosis patients transferred from medical surgical units and poor intra-institutional relationships between nurses in medical-surgical units and those who are in the psychiatric unit. This has led to the research study aimed at describing a model for support to assist general hospital nurses mobilize appropriate resources in the process of nursing mentally ill people. The research methodology followed the research model in nursing proposed by Botes (1995). A theory generative, qualitative, explorative, descriptive and contextual design was followed. The research methods were dealt with in four steps of theory generation in the following manner: Step 1: Concept analysis: This step was dealt with in two phases which are concept identification and concept definition. During concept identification, a qualitative research strategy which is explorative, descriptive and contextual was used. This was attained through field research conducted in an urban general hospital. A sample of twelve professional was selected from a population of 800 professional nurses employed in a general hospital using a purposive sampling technique. This sample size was determined by saturation of data in themes. Both semi-structured individual phenomenological interviews and observations were used as methods of data collection. The field work was conducted without any preset theoretical framework of reference by using "bracketing" and "intuiting". Giorgi's (1986) method of descriptive data analysis was used. After data analysis, the results were reflected within the Nursing for the Whole Person Theory. Four themes emerged from the results of the study which were:1) the experience with the perception of the mentally ill people, 2) the experience with interpersonal communication patterns, 3) nurses' experience of violence and lastly, 4) the experience of inappropriate patient behaviours. It became clear that the experience of nursing mentally ill people was negative and affected the social, psychological and the physical dimensions of nurses. The results were validated through literature control. The major concept of model was identified as "facilitation of communication". The concept was analysed thoroughly by looking at the dictionary and subject usage. The defining attributes were identified and synthesised through a definition. The other related concepts were identified and classified using a survey list of Dickoff, James & Wiedenbach (1968:430). Step 2: Step 2 dealt with the creation of interrelationship statements between concepts identified in step 1, so that concepts were able to stand in relation to one another. Step 3: dealt with the description of the model using strategies proposed Chin & Kramer (1991). Step 4: dealt with the description of guidelines for model operationalization in practice, education and research. The evaluation of model operationalization will be carried out in future research. To ensure valid results, a model trustworthiness proposed by Guba (Lincoln & Guba, 1985) was used. The following criteria for trustworthiness was applied in all the steps of theory generation: truth value, applicability, consistency and neutrality.

This thesis was born from a concern the researcher had with regard to negative reports in the media emanating from 4 babies that died at Cecilia Makiwane Hospital Peadiatric ICU unit due to power supply failure. The most significant of these negative reports was in 2007 when the Daily Dispatch ran a series of articles regarding what they termed avoidable deaths over the last 14 years. The ease with which staff communicated with the media together with the high absenteeism rate and high turnover was a cause for concern. When the researcher analysed the history of the problem, it immerged from the respondents’ responses that the rationalistion process undertaken by the Eastern Cape Department of Health (ECDoH) was a significant root cause to the problem. The literature review focused on three areas viz.: Organisational Culture, Organisational Change, Foundations of Satisfaction. This focus was used to confine the problem to a manageable project but secondly each of the aspects are interwoven. Routledge (2010) notes that culture is the reflection of the values advocated by a founder or leader by way of his/her day to day actions. This is done by the leader creating a perception or viewpoint that assists the employees to achieve the organisation’s mission, vision and goals. In any organisation change is a constant and it needs to be effectively managed. With government institutions like the East London Hospital Complex (ELHC) directives come from the top and are implemented by an unprepared and untrained leadership and management cadre and clear communication of vision and objective of the desired outcomes never happens. The aim of the research was to: describe the existing Organisational Culture present at ELHC (Perform an organisational diagnosis); describe the impact of change (rationalisation) and to analyze why there was such a high staff turnover. It is clear from the results of the survey conducted that significant dissatisfaction prevailed relating to how the institution was managed. Dissatisfaction amongst the health professionals was general but also specific to the following: leadership and management issues, fairness, remuneration and lack of resources. The recommendations therefore focused on developing management and leadership within the proposal of Dubrin’s model (2001).