Leadership styles in two Ghanaian hospitals in a challenging environment

Abstract

Hospital managers’ power to exercise effective leadership in daily management can affect quality of care directly as well as through effects on frontline workers’ motivation. This paper explores the influence of contextual factors on hospital managers’ leadership styles and the motivation of frontline workers providing maternal and new born care in two public district hospitals in Ghana. It draws on data from an ethnographic study that involved participant observation, conversations and in-depth interviews conducted over 20 months, with frontline health workers and managers. Qualitative analysis software Nvivo 11 was used to facilitate coding, and common patterns emerging from the codes were grouped into themes. Ethical clearance was obtained from the Ghana Health Service Ethical Review Committee. Contextual factors such as institutional rules and regulations and funding constrained managers’ power, and influenced leadership styles and responses to expressed and observed needs of frontline workers and clients. The contextual constraints on mangers’ responses were a source of demotivation to both managers and frontline workers, as it hampered quality health service provision. Knowing what to do, but sometimes constrained by context, managers described ‘feeling sick’ and frustrated. On the other hand in the instances where managers’ were able to get round the constraints and respond effectively to frontline health workers and clients’ needs, they felt encouraged and motivated to work harder. Effective district hospital management and leadership is influenced by contextual factors; and not just individual manager’s knowledge and skills. Interventions to strengthen management and leadership of public sector hospitals in low- and middle-income countries like Ghana need to consider context and not just individual managers’ skills and knowledge strengthening.

Strengthening health system leadership for better governance: what does it take?

“…In contrast, the Ghanaian and Kenyan studies presented here illuminate quite negative pictures of public hospital leadership and management. Comparing two urban district hospitals in Ghana, one with specialist services and one without, Aberese-Ako et al (2018) explore what strategies managers working at all levels of the hospitals used to cope with the contextual constraints they faced. In Kenya, meanwhile, Nzinga et al (2018) working in two county (district) hospitals, reveal the individualized decision-making and often intimidatory leadership practices of mid-level managers, the clinical heads and nurses in charge of inpatient wards.…”

Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions

“…Healthcare managers' sources of power include authority vested in the office of the manager, networks and access to resources [48,53,54]. While Act 525 devolves vertical power to healthcare managers in Ghana, in order to facilitate quality health care provision [47], questions of whether managers have actual resource power and how they make decisions in relation to resources is central to the functioning of the Ghanaian health care system [52,55]. Pfeffer [53,56], argues that there is excessive centralization in both private and public organizations, which leaves managers with very little decision making power.…”

Managing intermittent preventive treatment of malaria in pregnancy challenges: an ethnographic study of two Ghanaian administrative regions

“…Mintzberg [50], de nes power in organizations as "…the capacity to effect (or affect) organizational outcomes." Mintzberg's de nition of power is appropriate for this study, because it enables an interrogation of power in both public and private institutions in developing countries such Ghana [51][52][53][54]. Healthcare managers' sources of power include authority vested in the o ce of the manager, networks and access to resources [50,55,56].…”

“…Healthcare managers' sources of power include authority vested in the o ce of the manager, networks and access to resources [50,55,56]. While Act 525 devolves vertical power to healthcare managers in Ghana, in order to facilitate quality health care provision [49], questions of whether managers have actual resource power and how they make decisions in relation to resources is central to the functioning of the Ghanaian health care system [54]. Pfeffer [55,58], argues that there is excessive centralisation in both private and public organisations, which leaves managers with very little decision making power.…”

“…They are expected to exercise power in the implementation of policies that contribute to the achievement of organizational goals [54,58]. How healthcare managers exercise power in everyday decisions in health facilities shapes how health care is provided and determine the quality of care that clients receive [59][60][61][62].…”