The objective of this thesis is to identify and recommend leadership styles and strategies for Kingsway Hospital within the Netcare Group corporate culture to re-dress the unacceptable leadership style currently in operation, a declining business life cycle and a potential threat to financial sustainability. The thesis commences with an in depth discussion of the various leadership theories in context; starting from the rudimentary and culminating in the sophisticated Hersey and Blanchard Situational Behavior theories. Interestingly, the basic leadership dimensions have been retained throughout the years by the different theorists, with each subsequent theorist expanding on the original leadership qualities. This chapter concludes with the author's composite model of leadership, resulting in effective leadership, underpinned by corporate culture. The case study situation is described in detail, using the same criteria as the author's composite model of leadership. The core issue is the current Hospital General Manager's leadership, his behavior and action within the work environment. Two organizational strategies were identified in the case study; albeit they were not being currently implemented. Evaluation of the theory and case study led to the conclusion that are gaps between the current incumbent's skills and the composite model of leadership, posing a potential internal as well as external threat and lost opportunities for Kingsway Hospital. The internal threat is of a human nature; high staff turnover and the external threat could result in potential lost opportunities, patients and competitor threat. The two strategies identified will be presented as the core strategies relevant to Kingsway Hospital. Finally, the recommendations will be given after having completed an in depth evaluation of the case study, identification of the core strategies and assessing the benefits. Most of the recommendations are for immediate implementation, while some span over short to medium term. The recommendations are geared towards retaining the current Hospital General Manager, but with a changed leadership style. However, if there is no change in the status quo, the worst case scenario will be to transfer the Hospital General Manager to a position that does not involve a high degree of people interaction, as is the current situation. Clearly, from this case study, the recommendations contained in this thesis are to be implemented as a matter of urgency to ensure stability, sustainability, continuity and finding a resolution to the problem statement. If staff is the assets of the Netcare Group, then immediate action is necessary to protect them. / Thesis (MBA)-University of Natal, 2003.

Thesis (MBA)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: This study set out to identify the key success factors of Public Private Partnerships (PPPs) in the healthcare sector to be considered by Netcare when exploring possible PPP opportunities. Public Private Partnerships (PPP) presents a means of mobilising private funds for delivering of public services whilst government manages the relationship via a negotiated PPP agreement to ascertain the quality of services rendered. A literature study was performed in order to conceptualize the potential of the application of PPP in the healthcare industry and the factors impacting on the success thereof. PPPs around the world did not develop in unison nor are they uniform in nature. It is this variation in development that led to the formation of a wide variety of different PPP models that define these partnerships. The different PPP models currently applied by Netcare in the UK are similar in their basic characteristics to some of the models described in literature. One of the biggest challenges facing the healthcare industry in South Africa is the unequal split between public and private healthcare sectors. This is not only in terms of number of people serviced but also includes allocation of the available resources. Very limited information is available on application of PPP in the healthcare sector. The private hospital groups primarily involved in PPP in the healthcare industry in SA are Netcare and Medi-Clinic. Netcare has successfully positioned itself not only as the biggest private hospital group in South Africa, but also as the leader in PPP involvement in the healthcare sector in South Africa. The PPP projects undertaken, though still very early days, have been very successful, but do not yield very high returns. The rationale to Netcare for partaking in these extends beyond financial returns. It is mainly strategic in terms of its position in the local market and its potential involvement in the anticipated NHS (National Health System). It is essential that Netcare maintains credibility and goodwill and continues to demonstrate its commitment to address the healthcare industry needs of all in SA. Responding to the limited growth opportunities presented by the local market, Netcare expanded its operations to include international contracts, in particular in the UK, with negotiations under way for contracts in Portugal. The experienced gained through the PPPs in the UK, the country regarded as the leader in PPPs in the healthcare sector, is invaluable to their future participation in PPPs. Governments all over the world want to improve healthcare service delivery and curb healthcare inflation. This presents opportunities to Netcare that could arguably be in the form of a PPP. The ability to evaluate the key success factors that will impact on these PPPs is therefore of great importance to Netcare. The study showed that the actual process involved in forming a PPP depends on various key factors that impact on the outcome thereof. The role of government is essential and it includes the creation of the infrastructure and the legal environment for PPP, to demonstrating competence in managing PPPs, providing the political support and achieving investor confidence. An extensive list of key success factors was identified, but applying these factors to two possible PPP opportunities revealed their shortcomings. It was concluded that the list of factors cannot be applied as the ultimate checklist to pre-determine the outcome of a PPP. This is because various factors will only be revealed in the later stages of the PPP project life. It was also concluded that PPP participation by the company is a priority strategic decision. The strengths and weaknesses of the company relative to the opportunities and threats presented then needs to be evaluated. The list of key success factors provides an important guideline in terms of considering the specific opportunities and threats associated with PPPs. These factors should be considered during the various stages of the project development. / AFRIKAANSE OPSOMMING: Die doelwat van die studie is die identifisering van die faktore wat die sukses van Staat Privaat Vennootskappe (SPV) binne die gesondheidsorg industrie sal bepaal, en wat deur Netcare in ag geneem moet word wanneer sodanige vennootskappe oorweeg word. Hierdie vennootskappe bied 'n geleentheid vir die mobilisering van privaat fondse vir publieke dienslewering terwyl die regering deur middel van die onderhandelde PPP ooreenkoms die verhouding bestuur en die kwaliteit van dienslewering monitor. Die literatuurstudie het ondermeer die potensiaal van sodanige vennootskappe in die gesondheidsorg industrie, sowel as die faktore wat die suksesvolle uitkoms daarvan bepaal, ondersoek. Verskeie SPV modelle en tipes vennootskappe bestaan weens die uiteenlopende ontwikkeling van SPVs in die onderskeie lande. Die modelle tans toegepas deur Netcare in Engeland reflekteer die eienskappe van modelle beskryf in literatuur. Een van die gesondheidsorg indrustrie in Suid Afrika (SA) se grootste uitdagings is die oneweredige verdeling tussen publieke en privaat gesondheidsorg, beide in terme van populasie verteenwoordiging en aanwending van die beskikbare hulpbronne. Inligting aangaande die aanwending van SPV in die gesondheidsorg industrie is baie beperk. In die Suid Afrikaanse konteks is Netcare en Medi-Clinic die dominante rolspelers in SPVs in die industrie. Netcare is tans nie net die grootste privaat hospitaalgroep in SA nie, maar ook die leier op SPV betrokkenheid in die gesondheidsorgsektor in SA. Hoewel die huidige SPV's relatief onlangs tot stand gekom het, is daar reeds heelwat sukses behaal. Die opbrengs gerealiseer is egter nie fenominaal nie. Die motivering vir Netcare se betrokkenheid in hierdie vennootskappe strek egter verder as bloot die finansiële opbrengste. Gegewe die potensiële nasionale gesondheidstelsel en die posisionering in die plaaslike mark, is dit noodsaaklik vir Netcare om gesien te word as toegewyd aan 'n oplossing vir die gesondheidsorg uitdaging in Suid Afrika. Netcare se internasionale uitbreiding kan deels toegeskryf word aan die beperkte groei geleenthede in SA. Hulle internasionale kontrakte sluit in Engeland met onderhandeling in Portugal tans onderweg. Die ondervinding opgedoen met die SPV's in Engeland is van onskatbare waarde gegewe Engeland se posisie as leier op die gebied van SPV in die gesondheidsorg industrie. Verskeie lande poog tans om hulle gesondheidsorg dienslewering te verbeter en mediese inflasie te beperk. Dit skep potensiële SPV geleenthede vir Netcare. Die vermoë om die kritiese sukses faktore wat die uitkoms van hierdie SPVs sal bepaal, te kan evalueer, is dus van kardinale belang vir Netcare. Dit blyk uit die studie dat die proses van die ontwikkeling van SPV deur verskeie faktore beinvloed word. Die regering van 'n land speel 'n belangrike rol in die daarstelling van die infrastruktuur, die regsaspektelike omgewing, hulle bevoegdheid in terme van die bestuur van SPV, hulle vermoë om politiese ondersteuning te verleen en hulle vermoë om beleggers se vertrou te wen. 'n Omvattende lys van faktore wat impakteer op die sukses van SPV is identifiseer. Tydens die toepassing daarvan op twee voorbeelde het dit duidelik geblyk dat die lys nie as allesomvattend beskou kan word en aangewend kan word om vooraf die uitkoms van 'n SPV te voorspel nie. Verskeie faktore wat krities is in die sukses van SPV kan eers bepaal word tydens later stadiums van die SPV. Daar is ook tot die slotsom gekom dat die firma strategie die primêre oorweging tydens die evaluering van SPV behoort te wees. Die sterk en swak punte van die firma relatief tot die geleentheide en bedreigings wat die SPV inhou moet evalueer word. Die lys van faktore krities tot die sukses van SPV dien as 'n belangrike riglyn vir die oorwerging van geleenthede en bedreigings geassosieerd met SPV. Hierdie faktore behoort tydens die verskeie stadia van SPV projek ontwikkeling in ag geneem te word.

The neo-liberal restructuring of state assets and facilities, which has taken place internationally over the past three decades, as well as in South Africa, has been a matter of great controversy. Privatisation, in particular, has been a polarising issue, especially when applied to fields like healthcare. Supporters of privatisation view it as cutting costs, mobilising funding, expertise and innovation, resulting in improved delivery, and opening possibilities for a spread of ownership. Critics claim the process involves retrenchments, declining services for the (poorer) majority of people, and a focus on the elites as citizens become transformed into customers, and with any economic empowerment going to the already prosperous. This thesis examines these issues by looking at the privatisation of hospitals in South Africa, with a case study of the Netcare-Settlers Public Private Partnership (PPP) (also known as the Settlers Private Hospital) in Grahamstown, South Africa. Netcare is South Africa’s largest private hospital company, and also has substantial operations in the United Kingdom. The thesis sets out the context: a highly inequitable healthcare system in the country, the rise of privatisation in the apartheid and post-apartheid eras, and healthcare privatisation. In terms of the Netcare-Settlers PPP, the thesis examines how the PPP was structured and developed, focusing on the impact of the PPP on non-clinical operations. The thesis argues that the results of the PPP are mixed, that it has greatly improved areas like facilities, maintenance, cleaning and catering, performed less well in increasing the doctor/ patient ratio or in attracting specialists, and is associated with the widespread and problematic use of outsourcing of service workers like cleaners and security. Overall, the PPP has improved healthcare, with some effective sharing of resources between the public and private parts of the hospital, but also relies on a pool of relatively low waged, under-unionised, labour. In terms of the general debate over privatisation, the Netcare-Settlers PPP shows that both supporters and critics have some valid points, and that privatisation in practice is not an either/ or, black/ white, good/ bad proposition, but something more complex. The success and failure of PPPs depend on the details of the contracts, and these can be used to maximise the performance of both the public and private partners. Better contracts may help avoid the uneven results seen at institutions like the Netcare-Settlers PPP.