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

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A Culture of Discontent Within the Free State
Department of Health (FSDoH)
Shirley du Plooy Anthropology Department CHSRD
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Background

• PN in PHC facilities
• Emotional psychological distress
• Negative implications for service delivery
• Necessity to monitor staff wellbeing
• Feedback sessions from such a project

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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

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Results Discussion

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

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Primary findings

• Meaningful relevant retention strategies
• Work re-design measures
• Instilling institutional trust
• Non-clinical training skills development
• Action

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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

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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

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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

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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

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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

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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?

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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

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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

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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

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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

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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

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Recommendations

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

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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