Austerity, resilience and the management of actors in public hospitals: a qualitative study from South Africa

Abstract

BackgroundGlobal economic recession coupled with internal inefficiencies and corruption has led to a period of austerity in the South African healthcare system.This paper examines the strategies used by management in response to austerity in the three public hospitals and their effect on organisational functioning.MethodsWe used a comparative qualitative case study approach, collecting data using a combination of in-depth interviews with managers, and focus group discussion and interviews with shop stewards and staff.ResultsAusterity, imposed by the introduction of a provincial cost containment committee, has led to a reduction in staff, benefits, shortages of equipment and delayed procurement and recruitment processes. Managers in the first hospital maintained training on labour relations for staff and managers, they jointly planned how to cope with reduced staff and initiated a new forum for HR and finance staff. These strategies improved the way actors engaged, enabling them to resolve problems. Good communication ensured that staff understood what was within the hospitals control and what was not. A second hospital relied on absorptive strategies, such as asking staff to do more with less. The result was resistance, and greater use of sick leave. Some staff gave their own money to help feed patients but were angry at management for putting them in this difficult position. Leadership in the third hospital did not manage actors well either; help from the Government’s Expanded Public Works Programme was rejected by the unions, managers did not attend meetings as they felt their contributions were not listened to. Poor communication meant that the managers and staff did not understand what was within the hospital’s control and what was not; a misunderstanding led to a physical fight between managers.ConclusionOrganisational resilience in the face of austerity requires leaders to manage different stakeholders well. Hospital managers who promote democratic or participatory leadership and management, open communication, teamwork and trust among all stakeholders will lead better functioning organisations. A special focus should be placed on such practices to develop the resilience of health systems’ organisations.

Hospitals during economic crisis: a systematic review based on resilience system capacities framework

“…For example, the shortage of resources has led to a decline in evidence-based practice in hospitals [ 38 , 75 ]. In addition, understaffing has led to poor quality and safety of care, patient dissatisfaction [ 38 , 43 , 48 , 52 ], and a higher mortality rate [ 90 ], which is related to increasing staff workload and decreasing adequate skilled staff [ 23 , 73 ].…”

“… Hospital management competencies Hospital management’s competence in addressing internal and external demands and the information and communication network within hospitals affect their response to the economic crisis [ 75 ]. Studies referred to the capacity to manage actors and network interconnectedness as the main factor for improving resilience [ 23 ]. Hospital specialties Differences among hospital departments and specialties also moderate the impact of the economic crisis.…”

“…Hospital management’s competence in addressing internal and external demands and the information and communication network within hospitals affect their response to the economic crisis [ 75 ]. Studies referred to the capacity to manage actors and network interconnectedness as the main factor for improving resilience [ 23 ].…”

Strengthening public financial management in the health sector: a qualitative case study from South Africa

“…Since the 2008 global recession, austerity and the declining health budget that accompanies it, have challenged health systems to ‘do more with less’. 38 The COVID-19 pandemic has further exacerbated these funding shortages, and threatened to push South Africa, and many other LMICs into an even more severe austerity environment. The resulting shortages of staff (clinical and support) and critical goods and services place patients at risk for poor health outcomes and reduce morale among managers.…”

“…The resulting shortages of staff (clinical and support) and critical goods and services place patients at risk for poor health outcomes and reduce morale among managers. 38 If budget ceilings are communicated more timeously to service delivery managers, planning can be better aligned to the (although limited) available resources. 39 However, the cash flow difficulties in the South African setting (and many LMICs) result in budgets that are constantly in flux, requiring regular re-negotiation of spending priorities during the year.…”