Organizational change and everyday health system resilience: Lessons from Cape Town, South Africa

Abstract

This paper reports a study from Cape Town, South Africa, that tested an existing framework of everyday health system resilience (EHSR) in examining how a local health system responded to the chronic stress of large-scale organizational change. Over two years (2017–18), through cycles of action-learning involving local managers and researchers, the authorial team tracked the stress experienced, the response strategies implemented and their consequences. The paper considers how a set of micro-governance interventions and mid-level leadership practices supported responses to stress whilst nurturing organizational resilience capacities. Data collection involved observation, in-depth interviews and analysis of meeting minutes and secondary data. Data analysis included iterative synthesis and validation processes. The paper offers five sets of insights that add to the limited empirical health system resilience literature: 1) resilience is a process not an end-state; 2) resilience strategies are deployed in combination rather than linearly, after each other; 3) three sets of organizational resilience capacities work together to support collective problem-solving and action entailed in EHSR; 4) these capacities can be nurtured by mid-level managers’ leadership practices and simple adaptations of routine organizational processes, such as meetings; 5) central level actions must nurture EHSR by enabling the leadership practices and micro-governance processes entailed in everyday decision-making.

Bottom up innovation for health management capacity development: a qualitative case study in a South African health district

“…They did, however, nd that intervening in the existing meeting structures created emergent positive changes such as building supportive relationships across organisational silos and improved collective decision making and sensemaking in management meetings. They argue, as we do here, that managers at the local level must be given the exibility to experiment locally and that building relational leadership skills and the use of distributional leadership can improve the practice of decision making (92).…”

“…Challenges faced included senior managers not taking the time to ensure meetings were managed productively and an initial unwillingness to make decisions. These authors note that "institutionalizing the new principles and practices intended to nurture collective problem-solving and collective responsibility for service improvement [takes] time" (92). They did, however, nd that intervening in the existing meeting structures created emergent positive changes such as building supportive relationships across organisational silos and improved collective decision making and sensemaking in management meetings.…”

Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district

“…Gilson et al [ 92 ] present a rare empirical example of bottom-up capacity development. They worked with local managers to implement and co-create an intervention to improve governance at the sub-district level.…”

“…Challenges faced included senior managers not taking the time to ensure meetings were managed productively and an initial unwillingness of meeting participants to make decisions. These authors note that “ institutionalizing the new principles and practices intended to nurture collective problem-solving and collective responsibility for service improvement [takes] time” [ 92 ]. They did, however, find that intervening in the existing meeting structures created emergent and positive changes such as building supportive relationships across organisational silos, as well as improved collective decision making and sensemaking in management meetings.…”

“…They did, however, find that intervening in the existing meeting structures created emergent and positive changes such as building supportive relationships across organisational silos, as well as improved collective decision making and sensemaking in management meetings. They argue, as we do here, that managers at the local level must be given the flexibility to experiment, whilst nurturing relational leadership skills and distributional leadership can improve the practice of decision making [ 92 ].…”