A Culture of Discontent Within the Free State Department of Health (FSDoH) - PowerPoint PPT Presentation

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A Culture of Discontent Within the Free State Department of Health (FSDoH)

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Title: A Culture of Discontent Within the Free State Department of Health (FSDoH)


1
A Culture of Discontent Within the Free State
Department of Health (FSDoH)
Shirley du Plooy Anthropology Department CHSRD
2
Background
  • PN in PHC facilities
  • Emotional psychological distress
  • Negative implications for service delivery
  • Necessity to monitor staff wellbeing
  • Feedback sessions from such a project

3
Methodology
  • Six feedback workshops in 2006
  • Five district management
  • One FSDoH top management
  • 173 attendees
  • Purpose Communicate findings opportunity
    to respond
  • Detailed notes observations by researchers

4
Results Discussion
  • Valuable insights into burnout compassion
    fatigue reported by PNs in FS
  • Overt latent matters

5
Primary findings
  1. Meaningful relevant retention strategies
  2. Work re-design measures
  3. Instilling institutional trust
  4. Non-clinical training skills development
  5. Action

6
1. Meaningful relevant retention strategies
  • Workload overload exacerbated by
  • Number of programmes
  • Patients seeking health care interventions
  • Comprehensive range of activities
  • However
  • Remuneration promotion
  • Competitive packages
  • Entry-level remuneration rank promotion
  • Promotion career development
  • Administrative managerial positions

7
continued Meaningful relevant retention
strategies
  • Moonlighting
  • Staff shortages a given
  • Implementing new programmes
  • Unfilled posts
  • Heavy reliance on volunteers
  • cant see an increase in training and a
    concerted effort from the Department of Health to
    address this issue
  • Need to revisit the budget

8
2. Work re-design measures
  • Outsourcing of tasks
  • More non-nursing posts
  • Nurses used to plug up the holes in the system
  • Supervisors overload staff with tasks
  • nurses should be recognised as nurses how
    can they do a proper job, if they are doing so
    much?
  • Devise creative ways to make unbearable tasks
    more bearable
  • Prioritising tasks
  • Clinic-attending behaviour

9
3. Instilling institutional trust
  • Performance appraisal system
  • Standardised performance measures
  • Budget constraints
  • Jealousy
  • Communication, support staff wellness
  • Good at district level
  • Poorer between district local area levels
  • e.g. the ART PHC case

10
continued Instilling institutional trust
  • No wellness programme
  • Psychologists mental health of patients
  • EAP fixed at provincial level
  • Little faith in EAP personnel
  • Confidentiality cant be guaranteed
  • Own resourcefulness in seeking counselling or
    therapy
  • Employer read as unsympathetic, therefore not
    trusted
  • Actively engage in reducing absenteeism

11
continued Instilling institutional trust
  • Broken promises
  • Rural scarce skills allowances
  • Only in two districts it is still on the
    table
  • Devolution process
  • Lost travel allowances accumulated leave
    contribute more to medical aid insurance
    policies
  • the Department of Health broke promises
    before, why will they not do the same now. Why
    should they be believed or trusted now?

12
continued Instilling institutional trust
  • Lack of consultation in decision-making
  • When considered nothing comes of the decisions,
    or the opposite of those decisions (made by
    someone else) is implemented

13
4. Non-clinical training skills development
  • Current curriculum not adequate
  • Needs revision
  • Comprehensive practical vs. theoretical training
  • Orientation programme needed
  • Mentoring (problem already overloaded)
  • Delegation of accountability assertiveness
  • Person-directed training
  • e.g. family matters personal finances

14
continued Non-clinical training skills
development
  • Management-related training
  • e.g. financial management, meeting procedures
    training in the programme they are managing
  • Coping skills
  • Promote management of workload, stress, fatigue
    burnout
  • Minor attempts to relieve stress burnout
  • Once-off workshops sports-days
  • when they nurses return to work, they must do
    double the work to catch up, and that increases
    the stress they experience

15
5. Action
  • Top management must
  • Acknowledge the problem
  • Take decisions
  • Support lower levels
  • Middle management feel
  • Dont have the resources or the influence
  • District facility level actively engaged
  • action needs to follow, stop passing the
    buck, as this has a negative trickle-down
    effect

16
Conclusion
  • Reasons for decision-making paralysis
  • No HOD for 2 years
  • High turnover at top-management levels
  • Acting Heads acting managers
  • Lack commitment to make decisions take action
  • Organisational structure culture
  • District differences not pronounced
  • Well-resourced (staff, incentives equipment)
  • Begs an answer
  • Larger culture of discontent

17
Recommendations
  • Need to instil adopt
  • Higher levels of organisational moral
  • Perceived institutional justice
  • Sense of responsibility pride
  • Symptomatic relief wellness

18
Acknowledgments
  • Sincere gratitude to the following institutions
    and individuals
  • The Free State Department of Health
  • The researchers and fieldworkers of the CHSRD
  • This project was made possible by
  • the Foreign Assistance Agencies of
  • AusAID
  • DFID
  • USAID
  • UNDP
  • JEAPP
  • IDRC
  • MRC
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