Leveraging leadership factors to drive culture change in the Department of Health, Eastern Cape : a case for improved service delivery

Fatsha, Litha M. (2012-12)

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 Stellenbosch University http://scholar.sun.ac.za 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.

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