Browsing by Author "De Sa, Angela"

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    An assessment of organisational values, culture and performance in Cape Town's primary healthcare services
    (Medpharm Publications, 2013) Mash, R. J.; Govender, Srini; Isaacs, Abdul-Aziez; De Sa, Angela; Schlemmer, Arina
    Objectives: Improving the quality of primary health care in South Africa is a national priority and the Western Cape Department of Health has identified staff and patient experience as a key component. Its strategic plan, Vision 2020, espouses caring, competence, accountability, integrity, responsiveness and respect as the most important organisational values. This study aimed to measure the personal values of staff, as well as current and desired organisational values. Design: A cross-sectional survey used the cultural values assessment tool. Data were analysed by the Barrett Value Centre. Setting and subjects: Staff and managers at five community health centres in the Cape Town Metropole. Outcome measures: Personal values, current and desired organisational values, organisational entropy and organisational scorecard. Results: In total, 154 staff members completed the survey. Participants reported personal values that are congruent with a move towards more patient-centred care. The top 10 current organisational values were not sharing information, cost reduction, community involvement, confusion, control, manipulation, blame, power, results orientation, hierarchy, long hours and teamwork. Desired organisational values were open communication, shared decision-making, accountability, staff recognition, leadership development and professionalism. Organisational entropy was high at 36% of all values. Only teamwork and community involvement were found in both the current and desired culture. The organisational scorecard showed a lack of current focus on finances, evolution and patient experience. Conclusion: The organisational culture of the Metro District Health Services is currently not well aligned with the values expressed in Vision 2020, and the goal of delivering patient-centred care.
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    Auditing chronic disease care : does it make a difference?
    (AOSIS Publishing, 2015-06) Essel, Vivien; Van Vuuren, Unita; De Sa, Angela; Govender, Srini; Murie, Katie; Schlemmer, Arina; Gunst, Colette; Namane, Mosedi; Boulle, Andrew; De Vries, Elma
    Background: An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa’s Western Cape Province participated in the audit process. Aim: To determine whether clinical audits improve chronic disease care in health districts over time. Setting: Western Cape Province, South Africa. Methods: Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 (‘2012 old’) to districts that started auditing recently (‘2012 new’). Results: The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest, and the overall provincial average seemed worse in 2012 compared to 2011. However, there was an improvement in the ‘2012 old’ districts compared to the ‘2012 new’ districts for both the facility audit and the folder review, including for eight clinical indicators, with ‘2012 new’ districts being less likely to record clinical processes (OR 0.25, 95% CI 0.21–0.31). Conclusion: These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes.
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    How to change organisational culture : action research in a South African public sector primary care facility
    (AOSIS Publishing, 2016) Mash, Robert; De Sa, Angela; Christodoulou, Maria
    ENGLISH SUMMARY : Background: Organisational culture is a key factor in both patient and staff experience of the healthcare services. Patient satisfaction, staff engagement and performance are related to this experience. The department of health in the Western Cape espouses a values-based culture characterised by caring, competence, accountability, integrity, responsiveness and respect. However, transformation of the existing culture is required to achieve this vision. Aim: To explore how to transform the organisational culture in line with the desired values. Setting: Retreat Community Health Centre, Cape Town, South Africa. Methods: Participatory action research with the leadership engaged with action and reflection over a period of 18 months. Change in the organisational culture was measured at baseline and after 18 months by means of a cultural values assessment (CVA) survey. The three key leaders at the health centre also completed a 360-degree leadership values assessment (LVA) and had 6 months of coaching. Results: Cultural entropy was reduced from 33 to 13% indicating significant transformation of organisational culture. The key driver of this transformation was change in the leadership style and functioning. Retreat health centre shifted from a culture that emphasised hierarchy, authority, command and control to one that established a greater sense of cohesion, shared vision, open communication, appreciation, respect, fairness and accountability. Conclusion: Transformation of organisational culture was possible through a participatory process that focused on the leadership style, communication and building relationships by means of CVA and feedback, 360-degree LVA, feedback and coaching and action learning in a co-operative inquiry group.