Thesis (MBA)--Stellenbosch University, 2012. / Leadership has always been, and always will be, central to human affairs, whether from a
political, societal, religious, business or any other view. Both the need for leadership in
managerial jobs and the difficulty of providing effective leadership in these jobs has grown
considerably more, to include even lower level managerial, technical and professional
employees. An important objective of this research report was to investigate the Eastern
Cape Department of Health’s (ECDoH’s) current business practices and culture, as
perceived by its leadership and management. The aim was to understand and document
reasons for perpetual underperformance and to suggest ways of transforming the
organisation’s culture and practices into a high performing organisation on a sustainable
basis.
To achieve the above objectives, this research report uses the Beehive Model of
Organisational Renewal, developed by Christo Nel of the Village Leadership Consulting,
which looks at seven elements of workplace practices that are benchmarked against
international best practices. These seven elements are strategy execution, change
leadership, structure, business discipline, talent creation, rewards and recognition and
stakeholder value. The Beehive Model of Operational Renewal assumes that it is possible
for any organisation to achieve greatness, to be a high performing organisation based on the
conditions that success is by choice and not by accident; it is a long and winding journey and
requires full executive acceptance, commitment and resolve to achieving a high performance
organisation (HPO) status.
The reviewed literature shows that cultures within successful organisations have
characteristics of adaptability, alignment with external factors and the organisation’s vision
and mission, and are biased towards action. It also suggests that when people are listened
to, respected, supported and appreciated, in exchange they tend to go the extra mile in
executing their jobs, even lifting the performance of individuals previously written off as
mediocre. Depending on the desired type of culture, people behaviours, organisational
symbols and systems will have to be modified to suppport and entrench the values of that
organisation. Establishing a culture in an organisation is primarily a leadership role and
culture and leadership are viewed as two sides of the same coin which cannot be separated.
Literature suggests that long-term organisational change in the public sector is complex and
problematic, because of the many stakeholders and short-term orientation of many political
stakeholders. Change is particularly difficult because it has to overcome a longstanding
tradition, uncertaintly and doubt amongst many people, fear of job loss and inertia and much
Stellenbosch University http://scholar.sun.ac.za
iv
resistance, both visible and subdued. Healthcare staff all over the world face the challenge
of a rapid introduction of technology in the form of electronic patient records, computerbased
decision support tools and hospital information networks which are changing the
traditional ways of doing things. Managing organisational culture is viewed as an essential
part of the health system reform in most countries, where evidence shows that it will be a
complex, multi-level, and uncertain process, requiring strategies unfolding over a period of
years.
For any change to be successful, it requires leadership – in fact, it is argued that leaders
drive change from the top, through people and with people. Successful change is about
leadership getting involved in driving the change at grass roots level, being authentic, honest
and transparent. Leaders must balance the natural resistance people have to change with
the time and space people need to reflect and accept the change and the directives that the
leaders use to put pressure on the employees. In healthcare, many techniques have been
employed to bring about changes to quality healthcare delivery. These include total quality
management (TQM), lean management, learning organisation, business process reengineering
and some leaders have used external consultants to influence change. None of
these techniques was found to be successful without good leadership and a culture that
embraces these changes.
Arguably, people are the only competitive advantage any organisation has. Given that
people are the executors of strategy, it is imperative that they get involved in its
development. The use of systemic ways of developing strategy and making sure of its
implementation using the balanced score card and strategy maps, is recommended. Linking
company values and culture to the strategy leads to far greater organisational success. In
most organisations human resources (HR) practices are still in the traditional back office. In
the new economy, HR practices need to be transformed to deliver a new proposition, which
adds value to the bottom line of the business by satisfying all stakeholder requirements,
aligning people to performance and increasing organisational capabilities for sustainable
performance.
In the last decade, New Public Sector Management (NPSM) has emerged as a major reform
strategy applied in varying degrees in a growing number of public sector organisations. Its
main focus is to improve service delivery and to give rise to new management practices in
the public sector. It emanates from a continued dissatisfaction with the performance of
traditional public sector leadership and bureaucracy, reinforced by claims that the private
sector is more efficient. Three building blocks for NPSM are described to reform public
sector and these are responsibility, accountability and performance. In transforming public
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v
sector organisations, managers have to explicitly introduce policies within each building
block – these policies contain leverage to influence clarity of purpose, agreements, power
over decision-making, individual and team performance, and customer accountability.
There are strong arguments to encourage clinicians to change their mindset and be retrained
to lead the healthcare reform around the world. Some of the arguments are that
clinicians are in the frontline, making decisions that determine quality and efficiency of care,
having the technical knowledge to make sound strategic choices about longer-term patterns
of service delivery. Clinicians are typically intelligent, well-trained and caring people who
expressly choose this career to cure and comfort. A growing body of research supports the
assertion that effective clinical leadership lifts the performance of health care organisations,
as evidenced in a study which found that hospitals with the greatest clinician participation in
management scored about 50% higher on important drivers of performance than hospitals
with low levels of clinical leadership did. In another study, it was found that in 11 cases of
attempted improvement in services, organisations with stronger clinical leadership were
more successful, while another found that Chief Executive Officers (CEO) in the highestperforming
organisations engaged clinicians in dialogue and in joint problem-solving efforts.
The research findings show that the ECDoH is entrenched in the old economy values,
meaning that business practices that were examined using the Beehive Model are rated in
the risk/poor class. All seven elements scored in this poor class, with changed leadership,
structures and talent creation constituting the poorest performers. This implies that the
organisation is led from the top, leaders use power over others, there is widespread
compression and incompetency at all leadership levels. It is unlikely that a single political
head in the form of the Member of Executive (MEC) or a change in the head of department
(HoD) will bring about the required astronomical transformation of the ECDoH. Only when
the collective begins to accept the current predicament, can a total buy-in and commitment
to high performance status begin.
Finally, it is recommended that the ECDoH leadership transform their mindsets and adopt
the new economy values of leading the organisation. They need to leverage on their
positions of power to co-create a new culture, learn and adopt new change leadership skills,
and transform the organisation’s HR proposition inside out. The executives are urged to
consider funding a three to five year project of organisational renewal, using the Beehive
Model and its related tools, to bring about sustainable change in the ECDoH.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/21379 |
| Date | 12 1900 |
| Creators | Fatsha, Litha M. |
| Contributors | Nel, C., Stellenbosch University. Faculty of Economic and Management Sciences. Graduate School of Business. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Rights | Stellenbosch University |
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