The development of a partial South African medical practitioner competency model

Catharina Johanna, Hattingh (2018-03)

Thesis (MCom)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY : South Africa’s healthcare sector is facing a crisis. In order to solve this crisis, the healthcare workforce is also considered to have a responsibility to solve these challenges. Challenges such as staff shortages, mismanagement and chronic diseases are only a few of the daily challenges the health sector faces. The public health sector is responsible for the majority of the country’s health needs. Unfortunately, this task is even more gruelling due to the high pressure and frequent insufficient health resources available to health workers in the public healthcare sector. Dozens of medical staff struggle to cope with the work conditions and ultimately burn out or leave the public sector for the private sector or emigrate overseas. The current situation requires a solution to not only attempt to change the working conditions in itself, but to develop a framework for the support of medical staff in the public healthcare sector. Medical practitioners are considered part of this healthcare workforce. A need exists in South Africa to determine the factors that will ensure the success and improve the functioning of medical practitioners in the South African public health sector. These factors are complex to determine. To successfully address the optimisation of medical practitioners it is necessary to gain a comprehensive understanding of the determinants that influence the competence of medical practitioners. The improvement of the South African medical practitioner workforce will be effective to the extent to which a comprehensive understanding exists of the factors underlying the most favourable medical practitioner performance and the nature in which these factors interact. An in-depth literature study was conducted from which a partial medical practitioner competency model was developed which explains the different competency potential and competency latent variables that constitute medical practitioner performance. It was furthermore indicated how these variables are structurally interconnected. The limited research on this topic within the South African context is worth mentioning. The current study adopted a qualitative research approach in order to explore the competency potential latent variables that are required to develop medical practitioner competence. Subject matter experts were consulted by means of in-depth sessions where the Repertory Grid Technique was applied which allowed the researcher to thoroughly explore their understanding of medical practitioner competency potential. The Repertory Grid Technique contrasts behaviours with regards to medical practitioner competency potential person characteristics that lead to the identification of novel latent variables that did not emerge from the literature study. A sample of ten medical practitioners (including specialists) was consulted for data collection. By means of thematic analysis, twenty-nine distinct first-order themes relating to medical practitioner competency potential was elicited. The themes were compared to the competency potential latent variables that were identified in the literature study and it was confirmed that 10% were additional to the competency potential constructs that were identified from the literature review. The second-order themes were classified into thirteen distinct second-order themes. Finally, a conceptual model is proposed that the hypothesised interrelationships between medical practitioner competency potential and medical practitioner competence. This study contributes to the empirical understanding of medical practitioner competency potential which is suggested to be utilised as guidance for human resource management, recruitment and selection of medical students at tertiary level as well as the recruitment and performance management of medical practitioners in the private and public health sector. However, the current study is of exploratory and qualitative nature and therefore lends itself to quantitative validation of the Partial Medical Practitioner Competency Model.

AFRIKAANSE OPSOMMING : Suid-Afrika se gesondheidsektor staar ’n krisis in die gesig. Die verantwoordelikheid om hierdie krisis aan te spreek lê gedeeltelik by die gesondheidsarbeidsmag. Uitdagings soos personeeltekort, wanbestuur en kroniese siektes is ’n daaglikse realiteit wat die gesondheidsarbeidsmag in die publieke sektor in die gesig staar. Tog is die publieke gesondheidsorg verantwoordelik vir die meerderheid van Suid-Afrikaners se gesondheidsbehoeftes. Ongelukkig bied die publieke sektor nie altyd die hulpbronne aan die werkersmag wat nodig is om hulle werk te doen nie. Talle mediese personeel worstel gevolglik met die werksomgewing in die publieke gesondheidsektor en skuif dikwels na die private sektor of emigreer oorsee. Die huidige situasie vereis ’n oplossing wat nie net die werksomstandighede van die publieke sektor verbeter nie, maar wat ook ’n raamwerk skep vir die effektiewe operasionalisering van mediese personeel in die publieke gesondheidsektor. Mediese praktisyns word beskou as deel van die mediese arbeidsmag. Daar bestaan ’n behoefte in Suid-Afrika om te verstaan watter faktore die sukses van mediese praktisyns in die publieke gesondheidsektor sal optimaliseer. Om die optimalisering van die arbeidsmag aan te spreek is dit belangrik om te verstaan wat mediese praktisyns se sukses bepaal. Hierdie faktore is egter in kompleksiteit vasgevang. As die bogenoemde nie ondersoek en verstaan word nie, word daar geargumenteer dat daar nie verbetering en ondersteuning tot die mediese praktisyns se arbeidsmag aangebring kan word nie. Vanuit ’n in-diepte literatuurstudie is ’n gedeeltelike mediese praktisyn bevoegdheidsmodel ontwikkel wat bestaan uit ’n verskeidenheid latente persoonlikheidskaraktereienskappe en bevoegdheidsveranderlikes. Hierdie model streef daarna om duidelikheid te bied aangaande die latente veranderlikes wat mediese praktisyns se bevoegdheidspotensiaal bepaal wat gevolglik tot mediese praktisyn bevoegdheid lei. Navorsing van die bogenoemde is baie beperk in die Suid-Afrikaanse konteks en daarom is dit noodsaaklik dat mediese praktisyn bevoegdheidspotensiaal binne hierdie konteks verken word. ’n Kwalitatiewe navorsingsbenadering is gevolg sodat bevoegdheidspotensiaal latente veranderlikes wat lei tot mediese praktisyn bevoegdheid ondersoek kon word. Vakkundiges is geraadpleeg deur middel van in-diepte onderhoude waar die repertoirerooster tegniek (‘repertory grid technique’) toegepas is. Dit het die navorser toegelaat om ’n in-diepte begrip van mediese praktisyn bevoegdheidspotensiaal te verkry. Die repertoirerooster tegniek kontrasteer mediese praktisyn bevoegdheidspotensiaal wat die navorser bemagtig het om nuwe latente veranderlikes te identifiseer wat nie in die literatuurstudie na vore gekom het nie. ’n Steekproef van tien mediese praktisyns (insluitend spesialiste) is geraadpleeg gedurende die data-insamelingsproses. ’n Tematiese ontleding is toegepas en nege-en-twintig afsonderlike eerste-orde temas geïdentifiseer met betrekking tot mediese praktisyn bevoegdheidspotensiaal. Die nege-en-twintig temas is vergelyk met die latente veranderlikes wat geïdentifiseer was in die literatuurstudie en gevolglik is 10% van die temas as addisionele temas bevestig wat nie na vore gekom het in die literatuurstudie nie. Die eerste-orde temas is in dertien tweede-orde temas gekategoriseer. ’n Konseptuele model is voorgestel wat die verhoudings tussen mediese praktisyn bevoegdheidspotensiaal en mediese praktisyn bevoegdheid hipotiseer. Die huidige studie dra by tot die empirisie begrip van mediese praktisyn bevoegdheidspotensiaal wat aanbeveel word om menslike hulpbronne te bestuur en die keuring van mediese studente op tersiêre vlak, asook die keuring en prestasiebeoordeling van mediese dokters, te bevorder. Die huidige studie is egter van kwalitatiewe aard en vereis dat die gedeeltelike mediese praktisyn bevoegdheidsmodel kwantitatief gevalideer word.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103689
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