The leadership trinity: examining the interplay between healthcare organisational context, collective leadership and leadership effectiveness in the health sector - a multiple case study of district hospitals in the Western Cape Province, South Africa

To address the current leadership challenges within the South African health system, it is important to understand what influences the nature and practice of leadership within healthcare organisations. This thesis presents research about the interlinkages between context, leadership practices and staff satisfaction and morale – as indicators of leadership effectiveness - in district hospitals. The study represents one of the few detailed empirical inquiries into these issues in South Africa and adds to the still limited body of relevant empirical evidence in low- and middle-income countries. The research specifically drew on organisational and leadership theory to shape its strategies of data collection and analysis. It was conducted in two case study, district-level, hospitals. Multiple sources of data were collected, including document reviews, non-participant observations, and in-depth qualitative interviews. Data from staff satisfaction surveys carried out separately from this study were also considered. The in-depth interviews involved the three broad cadres of clinical, nursing, and administrative staff working within the hospitals, including those with and without formal managerial roles. Thematic analysis was applied in analysing experience in each case study hospital and also in cross-case analysis. This analysis involved iterative inductive, deductive, and abductive processes. The thesis generates insights about the leadership practices experienced in the case study hospitals that may both engender (positive practices) or undermine (negative practices) staff satisfaction and morale. Positive leadership practices also nurtured the collective leadership that itself enhanced teamworking and influenced the hospital context to spread collective leadership more widely. These leadership practices were, in turn, influenced by contextual elements internal and external to the hospital, some of which themselves had possible consequences for staff satisfaction and morale. Critical features of hospital external context included hospitals' histories and backgrounds, as well as the wider bureaucratic context of rigidity in which they are situated. Key features of hospital internal context influencing collective leadership were, meanwhile, internal power structures and processes, professional identity, and cross-professional relationships. This analysis of the interactions between hospital context, collective leadership and staff satisfaction and morale illuminates the complex dynamics of hospitals. This Leadership Trinity offers insights of relevance to health system reform in South Africa, and more specifically, to implementation of current National Health Insurance proposals.

Grantor

Department of Public Health and Family Medicine

Year dc:date.issued

2021

Author dc:creator

• Okello, Dickson Rodney Otieno

Advisors dc:contributor.advisor

• Gilson, Lucy
• McGivern, Gerry

• Public Health
• Family Medicine

Handle dc:identifier.uri

http://hdl.handle.net/11427/36030

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/36030