Management of District Hospitals - Suggested elements for improvement

Executive Summary

Interviews were conducted with senior hospital and district management teams of 4 hospitals in 2 rural districts, in KwaZulu-Natal and North West Province. These hospitals were chosen because they were thought to be functioning relatively well. The purpose was to understand some of the factors contributing to their relative success, and share these with other similar institutions.

A number of key factors were identified through this process, which appear to be important in effective functioning of district hospitals. The first group of factors centre on the basic essential component of teamwork, which were seen to be vital. These include the importance of regular meetings, inter-personal relationships based on respect and mutual co-operation, a sense of unity built on a common vision, commitment to this vision and to the team, and continuous communication at all levels of the hospital.

A second group of factors provide the framework for the functioning of the team, i.e. an ethos derived from an historical tradition, a particular approach to problem solving, and a solid underlying structure which provides the systems to implement this approach.

A third group of factors relate to the position of the hospital in the community and the district. These hospitals were clearly positioned within, and integrated into districts. They express a sense of dedicated service to the community involving reaching out beyond the gates, and believe they are answerable to the community with full mutual involvement.

Finally, capacity building, to assist and encourage staff in the process, underpins all these factors.

Examples of these factors are provided throughout the report, using the words of the respondents. The report provides the district hospital management teams with ideas and resources for improving hospital management.