The purpose of this study was to examine the extent to which human resources capacity of the Ministry of Health and Social Services (MoHSS), Namibia, influences health care services delivery to the Namibian population. A qualitative research model using exploratory and descriptive study designs was adopted. Data were collected through semi-structured interviews with 46 health workers from two referral hospitals and two directorates in Windhoek District. The study found that there is severe staff shortage in the MoHSS, which has resulted in high workload and poor health care. Health worker migration, new services and programmes, emerging diseases, and population growth were reported to have contributed to staff shortage and high workload in the MoHSS. Study findings suggested a need to create more posts to accommodate emerging needs, and to introduce an effective retention strategy to attract and retain health professionals with scarce skills, and those working under difficult conditions. / Public Administration and Management / M. Tech. (Public Management)

Enhetschefer inom offentlig vård- och omsorgsverksamhet spelar en betydelsefull roll i uppdraget att leverera välfärdsarbete av hög kvalitet. Samtidigt präglas enhetschefsbefattningar av höga personalomsättningsnivåer i kommuner runt om i landet. Hur organisatoriska förutsättningar påverkar enhetschefer inom vård och omsorg i valet att avsluta sin anställning är inte fullt förstått. Syftet med föreliggande studie är därför att undersöka tidigare enhetschefers upplevda erfarenhet av att arbeta som enhetschef inom en offentlig vård- och omsorgsverksamhet och hur de organisatoriska förutsättningarna påverkat dem i valet att avsluta sin anställning. Genom en fenomenologisk fallstudie av en vård- och omsorgsverksamhet i en svensk kommun har 17 tidigare chefer intervjuats kring deras upplevelse av sin tidigare roll och anledningar till att ha avslutat sin anställning. Studiens resultat visar att enhetschefer inom vård- och omsorg påverkas av ett samspel mellan en rad organisatoriska faktorer i beslutet att avsluta sin anställning innefattande arbetskontroll, rollotydlighet, kontrollspann, illegitima arbetsuppgifter, kollegialt och organisatoriskt stöd samt logikkonflikter. Praktiska implikationer för att upprätta en hållbar enhetschefsroll inom offentlig vård- och omsorgsverksamhet diskuteras. / Line managers in the public health sector play a vital role in delivering high-quality welfare services. At the same time, the role of line managers demonstrates high turnover rates in municipalities throughout the country. As to how organizational work environment factors influence line managers in their decision to voluntary leave their employment is not fully understood. The purpose of the current study is therefore to investigate previous line managers’ lived experience of what it is like to work as a line manager within the public health sector and how various organizational factors affected them in their decision to leave their role. Through a phenomenological case study of a public health organization in a Swedish municipality, 17 previous line managers were interviewed regarding their lived experience as health sector line managers and reasons for leaving. The results reveal that public health sector line managers are affected by the interaction of various organizational factors in their decision to voluntary leave their employment including job control, role ambiguity, span of control, illegitimate tasks, colleague and organizational support as well as conflict of logics. Practical implications for restituting a sustainable line manager role within public health sector organizations are discussed.

The researcher used the integration of both qualitative and quantitative approaches. The respondents were drawn from three district, one regional, one academic and two private hospitals. Data was collected by means of questionnaires. The open-ended questions in the questionnaire allowed the respondents to respond in their own words (“etic” description). This enhanced the organisation and reduction of the relevant data for analysis as well as the validity and trustworthiness of the study. The study revealed that even though most of the South African government health policies were very advanced and among the best in the world, some crucial policies appeared to have encountered problems with implementation, from conflicting ideologies and opinions from hospital management, different unions, professional associations, the provincial government, the South African Nursing Council (SANC) and patients. Too many groups appeared to have discussed nurses‟ issues with government and made decisions for nurses, leaving nurses disillusioned. The majority of the respondents attributed this to poor representation at government level. Furthermore, some decisions, resolutions and strategies agreed upon between the unions and bargaining councils appeared to have worked against nurses, further dividing RNs and failing to accomplish the intended purpose. Although most of the respondents had hoped that the Occupational Specific Dispensation (OSD) for nurses would address chronic low salaries for all nurses in the PHS, it favoured certain specialty qualifications (which were based on the description of post-basic courses in R212 and R48, which were not clearly delineated). In addition, RNs were not informed about the meaning and implications of the OSD prior to implementation. The study thus found an information gap between government and RNs at the production level, which appeared not to be with the government and the nurses, but in between. Most importantly, nurses seemed to be represented more by unions to government and bargaining councils, as opposed to nurses, while most of the respondents did not favour the division of nurses between professional associations and unions. Decisions in the PHS appeared to have been dominated by leaders who had no experience with pragmatic issues of health care services (HCS), particularly at the operational level, and the dynamics of the nursing profession. The study therefore concluded that, if the right people (nurses, doctors and systems) were put in place, and nurses were represented by nurses at government level, bargaining councils and parliament, discontent among RNs in the PHS could be reduced significantly. Existing strategies were found to deal with the symptoms and not the root cause of discontent among RNs in the PHS. / Health Studies / D. Litt. et Phil. (Health Studies)

Text in English / The aim of the research was to describe how Generation Y medical doctors working in the South African public health sector at a hospital in the Limpopo Province experienced a coaching intervention for burnout. Generally, there are limited empirically based coaching interventions for burnout, even for at-risk populations such as Generation Y medical doctors working in the South African public health sector. Burnout affects Generation Y medical doctors, the service they offer, private lives, and the recipients of their care. Most research focuses on identifying the risk factors for Generation Y medical doctors working in the debilitating South African public health sector, and rarely on potential intervention. This study offers findings from a coaching intervention that could be incorporated into a bigger burnout intervention strategy in the South African public health sector. This would involve all stakeholders at the different levels to ensure that burnout is combatted on a long-term basis. The study took a phenomenological approach using a collective case study method. The aim was to gather and analyse information to explore the experiences of a coaching intervention for burnout. The study was done in three phases, namely: Phase I – Pre-coaching intervention; Phase II – Coaching intervention; and Phase III – Post-coaching intervention. The study incorporated the Maslach Burnout Inventory to quantify the level of burnout before (Phase I) and after (Phase III) the coaching intervention. The findings emphasised certain structural issues, the impact that neglecting burnout has on medical doctors, including Generation Y medical doctors, and how burnout affects patient care. Certain recommendations were made for the public health sector, future research in the field of coaching psychology, and coaches/consultants working with burnout amongst Generation Y medical doctors. / Psychology / D. Phil. (Consulting Psychology)

The researcher used the integration of both qualitative and quantitative approaches. The respondents were drawn from three district, one regional, one academic and two private hospitals. Data was collected by means of questionnaires. The open-ended questions in the questionnaire allowed the respondents to respond in their own words (“etic” description). This enhanced the organisation and reduction of the relevant data for analysis as well as the validity and trustworthiness of the study. The study revealed that even though most of the South African government health policies were very advanced and among the best in the world, some crucial policies appeared to have encountered problems with implementation, from conflicting ideologies and opinions from hospital management, different unions, professional associations, the provincial government, the South African Nursing Council (SANC) and patients. Too many groups appeared to have discussed nurses‟ issues with government and made decisions for nurses, leaving nurses disillusioned. The majority of the respondents attributed this to poor representation at government level. Furthermore, some decisions, resolutions and strategies agreed upon between the unions and bargaining councils appeared to have worked against nurses, further dividing RNs and failing to accomplish the intended purpose. Although most of the respondents had hoped that the Occupational Specific Dispensation (OSD) for nurses would address chronic low salaries for all nurses in the PHS, it favoured certain specialty qualifications (which were based on the description of post-basic courses in R212 and R48, which were not clearly delineated). In addition, RNs were not informed about the meaning and implications of the OSD prior to implementation. The study thus found an information gap between government and RNs at the production level, which appeared not to be with the government and the nurses, but in between. Most importantly, nurses seemed to be represented more by unions to government and bargaining councils, as opposed to nurses, while most of the respondents did not favour the division of nurses between professional associations and unions. Decisions in the PHS appeared to have been dominated by leaders who had no experience with pragmatic issues of health care services (HCS), particularly at the operational level, and the dynamics of the nursing profession. The study therefore concluded that, if the right people (nurses, doctors and systems) were put in place, and nurses were represented by nurses at government level, bargaining councils and parliament, discontent among RNs in the PHS could be reduced significantly. Existing strategies were found to deal with the symptoms and not the root cause of discontent among RNs in the PHS. / Health Studies / D. Litt. et Phil. (Health Studies)

Dans l’ensemble des pays de l’Organisation de coopération et de développement économiques (OCDE), le secteur public de la santé fait face à un environnement complexe qui se caractérise par la rapidité des changements technologiques et scientifiques. Face à une demande accrue des citoyens pour des services fiables, accessibles et efficaces, les organisations publiques de santé se voient aussi contraintes par la rareté des ressources, notamment financières et budgétaires. Pour répondre à la mission publique qui leur est confiée, elles se tournent de plus en plus vers les outils et principes du management stratégique, dont la veille stratégique. Au Québec, la veille stratégique a fait son apparition dans le plan stratégique d’organisations publiques de santé dans le milieu des années 2000. Des initiatives de veille ont également vu le jour, comme en témoigne la Communauté de pratique de veille en santé et services sociaux créée en 2009. Notre thèse a pour but d’explorer ce qu’est la veille stratégique dans le secteur public de la santé au Québec. La recherche a pour objectifs de (1) décrire les caractéristiques de la veille telle qu’elle est implantée dans des organisations publiques de santé du Québec; (2) décrire les finalités de la veille dans les organisations publiques de santé du Québec : (a) décrire les types de soutien qu’apporte la veille à la stratégie des organisations publiques de santé du Québec; (b) décrire les types de soutien qu’apporte la veille à la prise de décision des gestionnaires publics de santé du Québec; (c) décrire, s’il y en a, les autres types de soutien qu’apporte la veille aux organisations publiques de santé du Québec; (3) identifier les caractéristiques d’une veille stratégique dans le secteur public de la santé. Au travers d’une étude de cas multiples, la recherche examine trois projets de veille (cas) autour de quatre composantes, soit le produit de veille, les acteurs de la veille, le processus de veille et les finalités de la veille. En tout, 5 veilleurs et 16 gestionnaires clients de la veille (11 cadres supérieurs et cinq cadres intermédiaires) ont été interrogés, en suivant les principes de la théorie ancrée. D’après nos résultats, une veille serait stratégique si elle est centrée sur les besoins informationnels des gestionnaires clients de la veille et selon l’utilisation que ces derniers font du produit de veille. Un produit de veille stratégique devrait être fortement personnalisé, dynamique et évolutif, concis et attrayant. De plus, il devrait reposer sur des critères de qualité de l’information et sur une analyse et une interprétation de l’information. Le fait d’intégrer un veilleur aux équipes de gestion pourrait contribuer à développer un tel produit de veille stratégique. Le processus de veille stratégique devrait comprendre des étapes d’évaluation / réévaluation des besoins informationnels, identification des sources d’information, traitement, analyse et interprétation de l’information, et diffusion et utilisation du produit de veille. Enfin, la veille stratégique poursuit des finalités de soutien à la prise de décision et de soutien à la planification stratégique. Ces soutiens ont été regroupés en utilités d’apprentissage, d’exploration, d’analyse, symbolique, de comparaison et stratégique. / In every Organisation for Economic Co-operation and Development (OECD) country, the public health sector is facing a complex environment characterized by rapid technological and scientific change. Public health organizations are experiencing increased demand from citizens for reliable, accessible, and efficient services, but are constrained by a shortage of resources — particularly financial and budgetary resources. To meet the public mission that has been entrusted to them, they are increasingly turning to the tools and principles of strategic management, including strategic intelligence. In Quebec, strategic intelligence appeared in the strategic plans of public health organizations in the mid-2000s. Intelligence initiatives have also emerged, as evidenced by the Communauté de pratique de veille en santé et services sociaux, which was established in 2009. The purpose of our thesis is to explore what strategic intelligence is in the public health sector in Quebec. The objectives of the research are (1) to describe the characteristics of strategic intelligence as implemented in public health organizations in Quebec; (2) to describe the purposes of strategic intelligence in public health organizations in Quebec: (a) describe the types of support that intelligence provides to the strategy of public health organizations in Quebec; (b) describe the types of support that intelligence provides to the decision-making process of public health managers in Quebec; (c) describe, if any, other types of support that intelligence provides to public health organizations in Quebec; (3) identify the characteristics of strategic intelligence in the public health sector. Through a multiple case study, the research examines three intelligence projects (cases) involving four components: the intelligence product, its actors, its process, and its goals. In total, five intelligence professionals and sixteen intelligence client managers (eleven senior executives and five middle managers) were interviewed, following the principles of grounded theory. According to our results, intelligence will be strategic if it is focused on the information needs of the intelligence client managers and their use of the intelligence product. A strategic intelligence product should be highly customized, dynamic, scalable, concise, and attractive. In addition, it should be based on information quality criteria and the analysis and interpretation of the information. Embedding intelligence professionals in management teams could contribute to the development of such a strategic intelligence product. The strategic intelligence process should include the following steps: assessment/reassessment of information needs, identification of information sources, information processing, analysis, and interpretation, and the dissemination and use of the intelligence product. Finally, strategic intelligence pursues the goals of supporting decision-making and strategic planning. This support is grouped into learning, explorative, analytical, symbolic, comparative, and strategic uses.