The purpose of this study was to describe and identify the leadership style that prevails in health care institutions, in order to establish the influence of multilevelleadershipon the effeciveness of hospitals in KwaZulu-Natal. Hunt's extended multilevel leadership Model was used as a conceptual framework. Six institutions were selected by random sampling, categorised into three sizes i.e. large institutions with number of beds above 400, midddle sized between 200-400 and smaller institutions with a bed state below 200. Three categories of leaders were as top, middle and operational leadership. The 8 leaders included the chief medical superintendent, the hospital secretary, the chief nurse manager, two area nurse managers and the three operational nurse managers in each of the six institutions. A total of 48 MLQ instruments designed by Bass and Avolio (1989) focused on leadership style was used to identify transformational, transactional and nonleadership styles. 121 Questionnaires were distributed to staff and community to measure hospital effectiveness. Interviews were carried out on patients and visitors to establish patients' satisfaction. The effectiveness of health care services was described by goal attainment, level of support and system's achievement. The instruments to measure goal attainment and level of support were designed by the researcher. The 6 institutions were measured for system's achievement by using the instrument designed by Beattie, Rispel and Cabral (1995). The criteria used to assess infrastructure, access to the institution, management of personnel, management of resources, patient satisfaction, community outreach programmes and the process of care, was based on the criteria developed by Beattie, Rispel, and Cabral (1995). A correlation was done to establish the relationship between leadership style and hospital effectiveness. Findings; the area manager exhibited the leadership style that is predominantly Transformational, the other four categories identified in the study, revealed a leadership style that was predominently Transactional. Of the six institutions two revealed a transfomational leadership style and three revealed a transactional leadership style. One institution reflected a Laissez-Faire leadership style. The overall leadership style was transactional. On comparing the three effectiveness criteria goal attainment was identified as the most effective area of achievement followed by system's achievement and the least being level of support. A MANOVA multivarate analysis of variance revealed that the relationship between leadership style and goal attainment was not significant. The relationship between leadership style and level of support was significant. On further analysis using the Shetre test, it was found that the level of support was significantly related to transformational leadership. The relationship between leadership style and stystem's achievement was not established, because the sample size of six institutions was too small. The overall relationships between leadership style and hospital effectiveness was significant at p-< 0.01 level. Recommendations; included that all all categoties of leadership at institutions are to increase their diagnostic level of awareness of their leadership styles. Rigorous education and training on leadership and support were essential. A further recommendation was that the methodology used in this study to measure hospital effectiveness be used more widely as a management tool. A common instrument used to evaluate acceptable standards of health care assessment should be used to ensure comparison between and within institutions in KwaZulu- Natal There was a need for further research to establish the influence of leadership style on hospital effectiveness in order to ensure quality care by health care providers and to increase professional efficiency and effectiveness in the hospitals of KwaZulu-Natal. / Thesis (Ph.D.)-University of Natal, Durban. 1998.

Organizations assist employees to deal effectively with demanding work and the work environment, including their personal problems, through an Employee Assistance Programme (EAP). The essence of the EAP is the application of knowledge about behaviour and behavioural health to make accurate assessments, followed by appropriate action to improve the productivity and healthy functioning of the employees. According to the report from the Employee Wellness Directorate of the Eastern Cape, the Employee Assistance Programme Practitioners saw 576 employees in 2010. These statistics only represent a few districts in the Eastern Cape as some districts do not have Employee Assistance Practitioners offering employee assistance, hence this number could be higher. In some instances employees do self-referral, which may increase the number without the managers knowing who is utilizing the EAP. This makes it difficult for the managers to monitor such employees and the effectiveness of the intervention rendered. Managers refer employees but do not have control over whether employees made use of the EAP and on the progress in sessions as they do not always receive the feedback. The Employee Assistance counsellor may receive a written referral from the nursing manager and then consults the referred employee in private. The employee gives consent and then the EAP counsellor addresses the problem at hand. If it is a complex case needing expert intervention arrangements are made. If the intervention requires follow up sessions, the EAP counsellor makes the necessary arrangements through the referring manager until the problem is resolved. The EAP counsellor monitors the employee and asks the manager to support the employee without divulging details of the problem that was being addressed. However, the Nursing Managers do not know how effective the programme is and whether the employees benefit from the use. The above-mentioned problem led the researcher to ask the following questions: • What are the perceptions that Nurse Managers in the Department of Health in the Eastern Cape Province have of the effectiveness of the Employee Assistance Programme? • How can Nurse Managers optimize employees’ use of the EAP? The goal of this study was to identify the perceptions of Nurse Managers of the Employee Assistance Programme in order to determine how the programme’s use can be optimized. The researcher used a qualitative, explorative, descriptive and contextual design. The research population was selected purposively and included the Nursing Managers in the Department of Health in the Chris Hani District, Eastern Cape, who have referred employees to the Employee Assistance Programme. Semi-structured interviews were used during the data gathering process. Interviews were conducted at a venue convenient to the participants. Open-ended questions were asked to enable participants to express their perceptions on the topic. The researcher also used observation and field-notes to ensure that the data gathering provided rich information. The data was analysed using Tesch’s method of data analysis. Trustworthiness was ensured by using Guba’s model of trustworthiness. The ethical strategies of informed consent, confidentiality and anonymity, avoidance of harm and voluntary participation were ensured. Two themes emerged from the data analysis. Theme one showed that the participants had contrasting perceptions regarding the effectiveness of the current Employee Assistance Programme. Some felt that they have benefitted from the programme while others felt differently. Theme two described the participants’ views elated to improving the utilization of the EAP. Positive and negative factors that impacted on the implementation of EAP have been identified. Results show that both the employer and the employees could benefit if EAP is well implemented. Decentralization of EAP could be very cost effective and could save the employer thousands of rands because resources would be utilized better.

M.Cur. (Nursing Management) / Transformational leadership involves the creation of a motivating climate that enhances growth, development, commitment, goal achievement and enjoyment which encourages behaviour based on a set of shared values (Price, 2006:124). In this study transformational leadership referred to concepts of motivation, and change management with regard to the implementation of the Cervical Cancer Screening Programme in a PRe setting. During support visits in Ekurhuleni Health District, the researcher observed a lack of transformational leadership among facility managers in Primary Health Care Clinics to transform the Cervical Cancer Screening Program in line with relevant health care legislation. It was apparent that the problems in implementing the Cervical Cancer Screening Programme were related to poor motivation and lack of implementation of change management principles in the PHC clinics. From the problem statement the following research questions emerged: To what extent is the facility manager perceived as a transformational leader to implement the Cervical Cancer Screening Programme in a PHC clinic? Which actions should the facility manager take to implement the Cervical Cancer Screening Programme in PHe? From the findings guidelines for the facility managers were described to enable them to implement a Cervical Cancer Screening Programme in a Primary Health Care clinic within legal requirements...

This study was aimed at investigating the attitudes of nurse managers towards quality improvement programmes in the East London Hospital Complex. The research design comprised a qualitative, exploratory and descriptive approach. A purposive sample of 10 nurse managers participated in the study. The data were collected through interviews, using a semi-structured interview guide. Interviews were recorded using audiotape. Data were analysed manually and by using the computer software Atlas ti. Positive and negative themes were identified and ethical consideration was ensured by means of privacy, confidentiality and anonymity. The findings revealed that nurse managers in the East London Hospital Complex had overall positive attitudes towards quality improvement programmes. A few negative attitudes and their contributory factors were also identified. The limitations of the study and recommendations based on the findings of the study are presented

This study investigated the leadership challenges encountered by nurse unit managers and factors enhancing leadership in their units. Currently in South Africa’s private hospitals, nurse unit managers face challenges such as financial management, cultural diversity, new roles and technology. The aim of the study was to develop a support strategy for unit managers to achieve success in their leadership role. This study was conducted at a private hospital in Gauteng Province, South Africa. A qualitative research approach was followed. Data were gathered using semi structured individual interviews with a purposive sample of six operational unit managers with one and more years working experience as unit managers. Qualitative open coding for data analysis methods and presentation were employed. Three themes emerged from the findings namely, factors influencing the leadership role of the unit manager, the challenges encountered by unit managers in their leadership role and the needs of unit managers. The factors influencing the leadership and management roles were related to the challenges encountered by nurse unit managers in running their units. The findings indicate that a key need required of the unit manager is support and direction from executive management. From the needs expressed by the nurse unit managers, ideas were formulated by the researcher to support the development of a strategy to support the unit managers in their leadership role. The strategy includes eight key elements and is presented in the section that follows. / Health Studies / M.A. (Nursing Science)

The purpose of this study was to describe and compare the perceptions of the registered nurses and the nurse managers regarding the role of the registered nurse in integrated primary health care. Quantitative, descriptive research was conducted to determine if there were any discrepancies between role perceptions and role expectations. Data collection was done using structured questionnaires. Two groups of respondents participated in the study. The registered nurse group (n=40) provided direct clinical care in integrated primary health care settings. The second group was composed of nurse managers (n=20) managing integrated primary health care services. The findings revealed that there are some areas where there is lack of congruence between the perceptions of registered nurses and nurse managers regarding the functions that registered nurses perform. These differences may result in confusion and role conflict among registered nurses, which can ultimately impede the attainment of integrated primary health care goals. / Advanced Nursing Sciences / M.A.(Nursing Science)

The purpose of this study was to describe and explore the organisational climate as a cause of job dissatisfaction among nursing staff in selected hospitals within Mpumalanga Province. The major objectives were to determine what organisational climate encompasses; ascertain which factors related to organisational climate can cause dissatisfaction among nurses; determine whether there is a difference in the way nursing management and the nursing staff perceive the existing organisational climate; and make recommendations for health service managers to improve the organisational climate in order facilitate greater job satisfaction among their subordinates. The descriptive exploratory survey method was used. A questionnaire with closed-ended and open-ended questions were distributed and collected from one hundred and fourty (140) respondents. The results indicated that the nursing management and the nursing staff are happy with the intrinsic factors of the job, but dissatisfied with the extrinsic factors of the organisational climate. The outcome of this research affirms that there are extrinsic factors within the work climate that affect the nursing management and the nursing staff negatively. Recommendations are made to promote job satisfaction in selected hospitals within the Mpumalanga province. / Health Studies / M.A. (Nursing Science)

In hierdie beskrywende studie is die belang van sorg in verpleegbestuur ondersoek. Die Nyberg Caring Assessment Scale (Nyberg 1989) is benut om die data in te samel. Die doel van die studie was om die sienings van verpleegbestuurders en die ervarings van verpleegkundiges betreffende sorgkonsepte te bepaal. Die data is deur middel van vraelyste by private hospitale in Pretoria ingesamel. Die data-analise het getoon dat verpleegbestuurders en verpleegkundiges sorg as belangrik in verpleegbestuur beskou. Daar is verskille betreffende die sienings van verpleegbestuurders en die ervarings van verpleegkundiges aangaande sorg in verpleegbestuur waargeneem. Dit blyk dat verpleegbestuurders en verpleegkundiges 'n behoefte aan opleiding betreffende sorg in verpleegbestuur benodig en 'n kort kursus is ontwerp om hierdie behoeftes aan te spreek / In this study the importance of caring in nursing management was researched. The Nyberg Caring Assessment Scale (Nyberg 1989) was used to collect data. The purpose of the study was to investigate viewpoints of nurse managers and experiences of nurses regarding caring concepts. The data was collected by means of questionnaires at private hospitals in Pretoria. It was clear from the data analysis that nurse managers and nurses regard caring important in nursing management. Perceptions of nurse managers and the experiences of nurses on caring in nursing management, differ. It was clear that nurse managers and nurses experience a need for training with regard to caring in nursing management and a short coarse was design to address the need / Health Studies / M.A. (Verpleegkunde)

Patient and public criticism of care in many South African public hospitals has resulted in negative media reports. The purpose of the study was to determine the effect of appointing Quality Assurance Nurse Managers (QANMs) on the provision of quality patient care in selected public hospitals of the Limpopo Province and to make recommendations where appropriate. The study was quantitative, exploratory and descriptive in nature. Data was collected by means of a self-developed questionnaire from 112 respondents, consisting of 10 QANMs and 102 Quality Assurance Team members (QAT). The response rate was 100% for the QANMs and 57% for the QAT members. The study found that most of the ten selected hospitals have a good QA foundation with a vision, mission and goals, QA programme and manual. Moreover, the appointment of the QANMs had a positive impact on the nursing care. Regarding the improvement and change in the provision of nursing care, the majority of the respondents indicated that patients’ complaints about nursing care had declined considerably; the in-service training assisted in improving nursing care, and patients were nursed in totality because of the quality guidelines in the QA manuals. However, the study found that the shortage of equipment, which interferes with the delivery of quality patient care, is a serious problem that hinders the QA programme and needs to be tackled. Recommendations were made for practice and further research. / Health Studies

Patient and public criticism of care in many South African public hospitals has resulted in negative media reports. The purpose of the study was to determine the effect of appointing Quality Assurance Nurse Managers (QANMs) on the provision of quality patient care in selected public hospitals of the Limpopo Province and to make recommendations where appropriate. The study was quantitative, exploratory and descriptive in nature. Data was collected by means of a self-developed questionnaire from 112 respondents, consisting of 10 QANMs and 102 Quality Assurance Team members (QAT). The response rate was 100% for the QANMs and 57% for the QAT members. The study found that most of the ten selected hospitals have a good QA foundation with a vision, mission and goals, QA programme and manual. Moreover, the appointment of the QANMs had a positive impact on the nursing care. Regarding the improvement and change in the provision of nursing care, the majority of the respondents indicated that patients’ complaints about nursing care had declined considerably; the in-service training assisted in improving nursing care, and patients were nursed in totality because of the quality guidelines in the QA manuals. However, the study found that the shortage of equipment, which interferes with the delivery of quality patient care, is a serious problem that hinders the QA programme and needs to be tackled. Recommendations were made for practice and further research. / Health Studies