Balancing Management and Leadership in Complex Health Systems Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health"

Kwamie, Aku

doi:10.15171/ijhpm.2015.152

Cited by 18 publications

(30 citation statements)

References 19 publications

(14 reference statements)

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“…Districts are therefore very instrumental in guiding the mentorship process and are a powerful force for advancing the programme. They must be engaged from the start and empowered to lead in order to sustain programme longevity [30, 31]. …”

Section: Discussionmentioning

confidence: 99%

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Ajeani

Ayiasi

Tetui

et al. 2017

Global Health Action

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Background: There is increasing demand for trainers to shift from traditional didactic training to innovative approaches that are more results-oriented. Mentorship is one such approach that could bridge the clinical knowledge gap among health workers. Objectives: This paper describes the experiences of an attempt to improve health-worker performance in maternal and newborn health in three rural districts through a mentoring process using the cascade model. The paper further highlights achievements and lessons learnt during implementation of the cascade model. Methods: The cascade model started with initial training of health workers from three districts of Pallisa, Kibuku and Kamuli from where potential local mentors were selected for further training and mentorship by central mentors. These local mentors then went on to conduct mentorship visits supported by the external mentors. The mentorship process concentrated on partograph use, newborn resuscitation, prevention and management of Post-Partum Haemorrhage (PPH), including active management of third stage of labour, preeclampsia management and management of the sick newborn. Data for this paper was obtained from key informant interviews with district-level managers and local mentors. Results: Mentorship improved several aspects of health-care delivery, ranging from improved competencies and responsiveness to emergencies and health-worker professionalism. In addition, due to better district leadership for Maternal and Newborn Health (MNH), there were improved supplies/medicine availability, team work and innovative local problem-solving approaches. Health workers were ultimately empowered to perform better. Conclusions: The study demonstrated that it is possible to improve the competencies of frontline health workers through performance enhancement for MNH services using locally built capacity in clinical mentorship for Emergency Obstetric and Newborn Care (EmONC). The cascade mentoring process needed strong external mentorship support at the start to ensure improved capacity among local mentors to provide mentorship among local district staff.

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Section: Discussionmentioning

confidence: 99%

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Ajeani

Ayiasi

Tetui

et al. 2017

Global Health Action

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“…Not surprisingly, scholars, policymakers and global health institutions are paying increased attention to the role of leadership in health workers’ performance in LMICs 3 7–14. However, the empirical evidence on leadership effectiveness in LMIC remains weak 15 16.…”

Section: Introductionmentioning

confidence: 99%

Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation

Belrhiti

Damme

Belalia³

et al. 2020

BMJ Open

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ObjectivesThis study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco.DesignWe adopted the realist evaluation approach and used the case study design to test the initial programme theory we formulated on the basis of a scoping review on complex leadership. We used the Intervention-Context-Actors-Mechanism-Outcome Configuration as a heuristic tool to identify plausible causal configurations.SettingsSince 2000, the Ministry of Health in Morocco initiated many reforms in the frame of the governmental deconcentration process called ‘advanced regionalisation’. The implementation of these reforms is hampered by inadequate human resource management capacities of local health system managers. Yet, the National ‘Concours Qualité’, a national quality assurance programme implemented since 2007, demonstrated that there are many islands of excellence. We explore how leadership may play a role in explaining these islands of excellence.ParticipantsWe carried out a document review, 18 individual interviews and 3 group discussions (with doctors, administrators and nurses), and non-participant observations during a 2-week field visit in January–February 2018.ResultsWe confirmed that effective leaders adopt an appropriate mix of transactional, transformational and distributed leadership styles that fits the mission, goals, organisational culture and nature of tasks of the organisation and the individual characteristics of the personnel when organisational culture is conducive. Leadership effectiveness is conditioned by the degree of responsiveness to the basic psychological needs of autonomy, competence and relatedness, perceived organisational support and perceived supervisor support. Transactional and overcontrolling leadership behaviour decreased the satisfaction of the need for autonomy and mutual respect. By distributing leadership responsibilities, complex leaders create an enabling environment for collective efficacy and creative problem solving.ConclusionsWe found indications that in the Moroccan context, well-performing hospitals could be characterised by a good fit between leadership styles, organisational characteristics and individual staff attributes.

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“…Many agree that the management and leadership capacity of the 'o cer' (and her/his team) to steward the DHS is a key cross-functional ingredient for strong health systems functioning (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). District managers (DMs) and their district management teams (DMTs) are the middle managers who "work at the boundaries between senior management and the rest of the workforce" (21).…”

Section: Introductionmentioning

confidence: 99%

“…and softer competencies (communication, trust building, networking etc.) (20,35,36,(39)(40)(41)(42), and intersections with the organisational environment (19,43). The recognition of complexity demands different ways of managing and measuring capacity development interventions.…”

Section: Introductionmentioning

confidence: 99%

“…There are several calls for further research on management and leadership capacity in the DHS. These identify as important the role and capacity of middle managers in bridging policy and practice, how management practices become part of organisational routines, 'how' capacity development interventions work for managers in diverse settings, more knowledge on complex leadership and strategic management of the health workforce and operational research on how to develop capacity in decentralised systems (8,16,20,36,(46)(47)(48).…”

Section: Introductionmentioning

confidence: 99%

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Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

Orgill

Marchal

Shung-King

et al. 2020

Preprint

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Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing managerial capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Using a systems perspective on capacity development, the research explored the initial sensemaking by the district manager, how these homegrown innovations interacted with existing social processes and norms, the mechanisms for change that were triggered and the emergent capacity outputs. Methods We conducted a realist evaluation complemented by a case study approach over a two-year period (2013-2015) in the district. The initial programme theory development included ten senior manager interviews and literature review. To understand processes and mechanisms triggered in local context and identify emergent capacity outputs we conducted fifteen interviews with managers in the management team and with seven non-state actors, supplemented by researcher notes and time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome -Actor configuration alongside theoretical constructs. Results The new district manager drew on complex frames, tacit and experiential knowledge to design bottom up innovations, and collective capacity development was triggered through micro-practices of sensemaking and sense-giving. Sensegiving included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justification for change and setting the scene (a new agenda, distributed leadership). These micro practices, managers engaging with the new practices and social sense-making, influenced the motivation of managers and partners to further participate in new meeting practices, and triggered a generative process of buy-in and emergent capacity in a routine meeting structure. Conclusion District managers are well placed to design local level capacity development innovations and must draw on multiple knowledge forms to enable relevant ‘bottom-up’ capacity development in complex health systems. Managers must draw on their intangible soft skills and the tangible policy resources (hardware) of the system to influence motivation and buy-in for improved management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing in routine spaces, to unleash capacity.

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Balancing Management and Leadership in Complex Health Systems Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health"

Cited by 18 publications

References 19 publications

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

A cascade model of mentorship for frontline health workers in rural health facilities in Eastern Uganda: processes, achievements and lessons

Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation

Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

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