The experiences and perceptions of clinical staff about transformational change management at an emergency centre

Adams, Shahnaz (2017-12)

Thesis (MCur)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY : Background: The Community Health Centre - A primary health care facility in the Western Cape that provides a comprehensive package of care, including a 24-hour emergency and maternity services, faced several systemic challenges that attracted an investigation by the Public Protector’s office in 2009. The investigation revealed substantive evidence in support of claims of poor service delivery, bad staff attitude and poor disciplinary conduct, deficient management & control systems, poor team cohesion and low staff morale. In an effort to address these organisational challenges, an improvement strategy based on a transformational change philosophy was initiated in the Emergency Centre. Aim: To explore the clinic staff’s experiences and perceptions of the transformational change management approach introduced in a Community Health Centre. Methods: A qualitative descriptive phenomenological research design was used. Semi-structured interviews and a focus group discussion with 18purposively sampled Emergency Centre staff members. A follow-up focus group discussion done in 2016 to confirm the perceptions of the participants held overtime. The interviews and focus group discussion were transcribed verbatim and analysed manually. A thematic analysis was done and the findings were organised in Donebedian’s framework of structure, process, and outcomes. Results: The results revealed that systems align the structural and processional aspects resulted in the achievement of better outcomes. These outcomes relate to improvement in working environment, the management of critical resources, employee confidence, morale, discipline, commitment, and teamwork. This ultimately led to the creation of a positive work environment, improved service delivery, enhanced quality of care and positive patient outcomes. The role of visionary leadership was deemed key to the transformation process. Conclusion: The study confirmed that transformational change occurred through a strong leadership, which promoted a sense of ownership, the empowerment of workers and capacity building. The transformational change led to the adoption of a shared vision, team learning, and professionalism, which resulted in the delivery of quality emergency care The findings supports the principles espoused by a learning organization. The recommendations include strengthening of values-driven leadership competencies and fostering a learning organization with emphasis on shared vision, systems thinking, personal mastery, and team learning.

AFRIKAANSE OPSOMMING : Die ondervindings en opvattings van Kliniese personeel by n Noodsentrum oor Transformasieveranderingsbestuur Agtergrond: ‘n Primere gemeenskapsgesondheidsorgfasilitieit in die Wes-Kaap wat omvattende gesondheidsorg verskaf, insluitend 24-uur nood- en verloskunde dienste, het verskeie sistemiese uitdagings ervaar wat vervolgens in 2009 gelei het tot ‘n ondersoek deur die Kantoor van die Openbare Beskermer. Dié ondersoek het beduidende getuienis onthul ter ondersteuning van aannames oor swak dienslewering, ongunstige personeelgedrag en swak dissipline, tekortkominge in bestuur en beheerstelsels, swak spaneenheid en ‘n lae moraal onder personeel. In n poging om hierdie organisatoriese uitdagings aan te spreek, is n verbeteringstrategie, gebasseer op ‘n transformasieveranderingsfilosofie, in die Noodeenheid geinisieer. Doel: Om die ondervindinge en persepsies van die kliniese personeel by die Gemeenskapgesondheidsentrum te verken aangaande die instelling van transformasieveranderingsbestuursbenadering. Metodologie: ‘n Kwalitatiewe, beskrywende fenomeologiese navorsingsontwerp is gebruik. Semi-gestruktureerde onderhoude met n doelgerigte steekproef van 18 afsonderlike noodsentrum personeellede, sowel as ’n fokusgroepbespreking is gedoen. Die persepsies van in die onderhoude en tydens die fokusgroepbesprekings, is verbatim afgeneem en geanaliseer.’nTematiese ontleding is gedoen en die bevindinge is gerangskik binne Donabedian (1966) se raamwerk van struktuur, proses en uitkomste. Bevindings: Die bevindings het onthul dat ‘n sisteembenadering beter uitkomste bereik deur die strukturele- en proses aspekte in beter verhouding tot mekaar te stel / te belyn. Hierdie uitkomste verwys het te make met ‘n verbetering in die werksomgewing, die bestuur van noodsaaklike hulpbronne, personeelvertroue, moraal, dissipline, toewyding en spanwerk. Dit het uiteindelik gelei tot die vestiging van ‘n positiewe werksomgewing, verbeterde dienslewering, verbetering in die gehalte van sorg asook positiewe pasiente-uitkomste. Die rol van visionêre leierskap word beskou as belangrik tot die transformasieproses. Afsluiting: Die studie bevestig dat transformative teweeg gebring word deur sterk leierskap. Sterk leierskap lei weer tot eienaarskap, die bemagtiging van werkers en kapasiteitsbou. Transformasionele verandering lei tot eienaarskap in die aanvaarding van n gedeelde visie, n span wat gefokus is op leer en professionalisme wat tot gehalte mediese sorg lei. Die bevindings van die studie bevestig die beginsels wat deur n leergerigte organisasie vergestalt word. Die aanbevelings sluit in die versterking van waardegedrewe leierskapsbevoegdhede en die vestiging van ‘n leerorganisasie met ‘n gedeelde visie, stelseldenke, persoonlike bemeestering en spanleer.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102928
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