Improving efficiency in the public health sector by transferring selected best practices from the private health sector

Pedro, Beverley-Anne (2008-12)

Thesis (MBA (Business Management))--Stellenbosch University, 2008.

Thesis

ENGLISH ABSTRACT: The aim of this research report was to identify a set of strategic tools that can be transferred from the private health sector to the public health sector, to improve efficiency in the public health sector. To attain to this aim, this research report attempted to identify the selected best practices employed by successful private health providers, to determine the most effective modes to transfer these best practices, and to establish key success factors for the identified best practices. Interviews were conducted with opinion-leaders from the health industry in the Western Cape,and inputs gleaned from these individuals were useful in applying the strategic model to the public and private health sector in the Western Cape. Globally the public sector has already embarked on strategic management initiatives, through the implementation of the New Public Management-model. The introduction of NPM in a few selected countries aimed at achieving cost-efficiency, budget accountability and improved customer focus in service delivery. South Africa however still needs a unifying and all encompassing vision for public and development management to advance the ideals of Batho Pele. The use of evidence and the management of intellectual capital in the health care industry are recognised as important in decision-making. The health care trends of five selected countries (United Kingdom, United States of America, Greece, Canada, Slovakia) were researched , and demonstrated that countries face similar challenges (increasing resource demands, aging population, rapidly expanding technological possibilities, better-informed patients, rising expectations). It is recognised that business skills and knowledge, as well as investments in IT can be effective tools in moving an organisation from a reactive approach to a pro-active approach. Managers in the public sector need different competencies than managers in the private sector due to the differences between the two sectors, and thus there is a need to adapt management training. While there are examples of best practices in the South African government, there is still room for improvement. A stable political economy, political leadership, management skills of political office-bearers and the professionalism of civil servants will be decisive in this regard. The White Paper on the Transformation of the Public Service provides a framework for the development of strategies to promote continuous performance improvements in quantity, quality and equity of health service provision. The areas where improvements are necessary are customer and stakeholder satisfaction, processes, organisation results, leadership and people management. The comparison between the current strategic approach in the Western Cape and a model designed for the public sector revealed that some of the steps can be developed further, namely the assessment of the internal and external environments, the development of an effective implementation process, and the reassessment of the strategies and the strategic planning process. The comparison between the current strategic approach in the Western Cape and the global best practices framework established that there is not sufficient balance between the resource and position based views, the decision-making approach is "quite formal", implementation of strategy is not a carefully planned change management process, planning is regarded as the most important part of the strategic planning process, and evaluating strategy implementation involves more than mere financial measures. It was also established that the Western Cape Department of Health's strategic stance is offensive, that it can be regarded as a prospector, that managing multiple stakeholders is a challenge and that the competitive advantage of the department is its people. The industry analysis revealed that there is still a long way to go in terms of reliable information systems to support health services. The need for a strategic approach that can respond rapidly in a turbulent environment, and the re-look strategic processes to ensure delivery of quality health care through optimal use of resources were also established by the industry analysis. It was established that a gap exists in the public health sector in respect of the strategic planning processes, and that the private health sector portrays characteristics compatible with the global best practices framework. Modes for the successful transfer of best practices were explored, namely management consulting, commercialisation and management development. Two key success factors for the transfer of best practices were identified, namely the application of the Batho Pele principles, and the recruitment and retention of suitably qualified staff. From a global strategic management perspective, it was clear that there is a definite need for the public sector to change to private sector strategic approaches. A shift from a reactive to a pro-active approach is also advisable. The global trends in public health care demonstrate the importance of political leadership, competent management, business knowledge and skills, IT investment and the use of evidence in health. It is clear that the provision of public health care in South Africa faces similar challenges to those experienced by the five countries researched. The application of the global best practices framework confirmed that there are in fact best practices employed by the private sector that can be transferred to the public sector. Most of the best practices discussed in this research report are not employed in the public sector, or only on a limited scale. The use of these practices should be explored by the public sector. In order to equip managers in the public sector with the necessary strategic management tools, training and development opportunities must include modules on strategic management.

AFRIKAANSE OPSOMMING: Die doel van hierdie navorsingsverslag was om 'n stel strategiese benaderings te identifiseer wat van die privaat-gesondheidsektor na die openbare gesondheidsektor oorgedra kan word, om effektiwiteit in die publieke gesondheidsektor te verbeter. Ten einde hierdie doel te bereik, was daar gepoog om geselekteerde beste praktyke wat deur die privaat gesondheidsektor gebruik word te identifiseer, om te bepaal wat die mees effektiewe metodes sou wees om dit oor te dra, en om kritiese suksesfaktore vir die bepaalde beste praktyke te identifiseer. Onderhoude is gevoer met prominente leiers in die gesondheids-industrie in die Wes-Kaap, en hierdie insette was waardevol in die toepassing van die strategiese model op die publieke en privaat-gesondheidsektor in die Wes-Kaap. Op die internasionale front het die publieke sektor reeds strategiese bestuurs-inisiatiewe begin toepas, deur die implementering van die NPM-model. Die implementering van NPM in 'n paar geselekteerde lande was gemik op koste-effektiwiteit, begrotingsverantwoordbaarheid en verbeterde fokus op kliente in dienslewering. Suid Afrika het egter steeds die behoefte aan 'n oorkoepelende, verenigende visie vir publieke- en bestuursontwikkeling om uitvoering te gee aan die ideale van Batho Pele. Die gebruik van uitkomste en die bestuur van intellektuele kapitaal in die gesondheidsindustrie word erken as belangrik vir besluitneming. Die neigings in gesondheidsorg van vyf gekose lande (Verenigde Koninkryke, Verenigde State van Amerika, Griekeland, Kanada en Siovakye) toon dat die uitdagings vir gesondheid ooreenstem (verhoogde vraag na hulpbronne, verouderende bevolking, vinnige ontwikkeling van tegnologie, beter ingeligte pasiente, hoër verwagtinge). Dit word aanvaar dat besigheidsvaardighede en -kennis, sowel as beleggings in inligtingstegnologie effektief aangewend kan word om 'n organisasie van 'n reaktiewe tot 'n pro-aktiewe benadering te beweeg. Bestuurders in die publieke sektor benodig vaardighede wat verskil van bestuurders in die privaatsektor weens verskille tussen die twee sektore; daar is dus 'n behoefte om bestuursopleiding aan te pas. Daar is wel voorbeelde van beste praktyke in die Suid-Afrikaanse regering, maar daar is steeds ruimte vir verbetering. 'n Stabiele politieke ekonomie, politieke leierskap, bestuursvaardighede van politieke ampsdraers en die professionaliteit van staatsamptenare sal deurslaggewend wees in hierdie verband. Die Wit Skrif oor Transformasie van die Openbare Sektor verskaf 'n raamwerk vir die ontwikkeling van strategiee om voortgesette verbeteringe in hoeveelheid, kwaliteit, en gelykheid in die voorsiening van gesondheidsorg te bevorder. Areas vir verbetering sluit in kliente en belanghebbende tevredenheid, prosesse, organisatoriese uitslae, leierskap en bestuur van mense. Die vergelyking van die huidige strategiese benadering in die Wes-Kaap met 'n model wat ontwikkel is vir die publieke sektor toon dat sommige van die stappe verder ontwikkel kan word, naamlik die evaluering van die interne en eksterne omgewing, die ontwikkeling van effektiewe implementeringsprosesse, en die herevaluering van die strategiee en die strategiese beplanningsprooes. Die vergelyking van die huidige strategiese benadering in die Wes-Kaap met die globale beste praktyke raamwerk toon dat daar nie genoeg balans is tussen die posisie- en hulpbrongebaseerde stand nie, dat besluitneming "nogal formeel" is, dat implementering van strategie nie 'n sorgvuldig beplande veranderingsbestuursproses is nie, en dat evaluering van implementering meer behels as slegs finansiele maatstawwe. Dit het ook aan die lig gekom dat die Wes-Kaap departement van gesondheid 'n offensiewe stand het, dat dit as 'n prospektor beskou kan word, en dat die bestuur van veelvuldige belangehebbendes 'n uitdaging is. Die analise van die industrie het getoon dat daar nog baie gedoen kan word in terme van betroubare inligtingstelsels om gesondheidsdienste te ondersteun. Die behoefte aan 'n strategiese benadering om vinnig te reageer in 'n turbulente omgewing, en die her-evaluering van strategiese prosesse om die lewering van kwaliteit gesondheidsdienste deur die optimale gebruik van hulpbronne te verseker, is ook bevind in die analise. Daar is ook bevind dat daar 'n gaping in die publieke gesondheidsektor is wat die strategiese beplanningsproses betref, en dat die privaat-gesondheidsektor kenmerke openbaar wat verenigbaar is met die globale beste praktyke raamwerk. Metodes vir die suksesvolle oordrag van beste praktyke, naamlik bestuurskonsultasie, kommersialisasie en bestuursontwikkeling word beskryf. Twee sleutelsuksesfaktore vir die oordrag van beste praktyke, naamlik die toepassing van die Batho Pele beginsels, en die werwing en behoud van toepaslik gekwalifiseerde personeel is identifiseer. Uit 'n globale strategiese bestuursperspektief was dit duidelik dat daar definitief 'n behoefte is vir die publieke sektor om privaatsektor strategiese benaderings aan te neem. 'n Beweging van 'n reaktiewe tot 'n pro-aktiewe benadering is beslis aan te beveel. Die globale neigings in publieke gesondheidsorg demonstreer die belangrikheid van politieke leierskap, bevoegde bestuur, besigheidskennis en -vaardighede, beleggings in inligtingstegnologie en die gebruik van uitkoms-gebaseerde bewyse. Dit is duidelik dat die voorsiening van publieke gesondheidsorg in Suid-Afrika ooreenstemmende uitdagings het met die vyf lande wat ondersoek is. Die toepassing van die globale beste praktyke raamwerk het bevestig dat daar wel beste praktyke gebruik word deur die privaatsektor, wat oorgedra kan word na die publieke sektor. Meeste van die beste praktyke hier bespreek word nie deur die publieke sektor gebruik nie, of slegs op 'n beperkte basis. Die gebruik van hierdie praktyke moet ondersoek word deur die publieke sektor. Om bestuurders in die publieke sektor toe te rus met die nodige strategiese bestuursvaardighede, moet opleidings- en ontwikkelingsgeleenthede modules insluit oor strategiese bestuur.

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