1. Action Learning Pilot ProgrammeProject Khaedu Greys Hospital - preliminary findings

2. Current situation DPSA Training course material consolidated 2

3. Greys is recognised for service excellence • Greys hospital is considered one of the best hospitals within the province • Recognised as being a flagship hospital • Facilities at Greys hospital are well maintained • Has won numerous awards including • Silver award for good governance (2004) • Best run neo-natal ward in South Africa in 2004 • Accreditation from COHSASA • Health-promoting hospital project • Performance assessment tools for hospital (PATH) Project • Participating in Baby friendly hospital initiative • Has numerous positive initiatives such as: • Asset management • Effective QIP initiatives DPSA Training course material consolidated 2

4. Service excellence is driven by… • Good leadership within Greys • Facilities are of a high standard and well maintained • Processes are strong, especially within OPD • Good level of service delivery • Committed staff “look at that patient as your family member” - ENA DPSA Training course material consolidated 2

5. Financial resources are being well managed… DPSA Training course material consolidated 2

6. Record keeping can be considered as a ‘Best Demonstrated Practice’ Records pre-picked one day before appoint Records placed in Ward/clinic boxes Files issued to patients Patient receives treatment Pharmacy / ward Return file File stored in Pigeon-holes Clerks file according To D.O.B. • Files archived once a year to clear OPD section DPSA Training course material consolidated 2

7. Record keeping can be considered as a ‘Best Demonstrated Practice’ (2 of 2) 1980 – 04 - 26 1973– 04 - 26 1965 – 04 - 26 Day of the month 1943 – 04 - 26 Month of the year DPSA Training course material consolidated 2

8. And many initiatives contribute to continuous improvement at Greys Hospital • Effective QI Programmes • Medical records committee • Good M&E in the medical component • Regular patient surveys • Risk management committee DPSA Training course material consolidated 2

9. Despite this, numerous challenges exist… DPSA Training course material consolidated 2

10. Lack of integration between HO and the hospital in terms of planning, funding and decision-making“to be a tertiary hospital by 2007/08” Illustrative Shortfall Mandate to become a tertiary hospital yet inadequate financial resources exist to staff and equip facilities DPSA Training course material consolidated 2

11. So who will staff this building? Oncology section DPSA Training course material consolidated 2

12. Communication between management and staff must be improved • Unions feel that inadequate communication between management and themselves exist despite a good relationship • A perception exists that information is not effectively being filtered down from senior management and upward reporting mechanisms are not sufficient “I’ve worked here for 26 years and have never been invited to any meeting” – GA DPSA Training course material consolidated 2

13. Challenges also exist in motivating staff due to.. • Staff shortages • Lack of recognition of the work of lower level staff • Staff are sometimes uninformed about critical decisions • Performance appraisals are not being done consistently • Doctors absenteeism after ward rounds • Staff development and training perceived to be inadequate, especially at lower levels • Incoming bridging course student nurses joining Greys from clinics are not sufficiently skilled DPSA Training course material consolidated 2

14. The current organisational structure concerning GA’s should be reviewed Supervisor B Supervisor A Supervisor B GA GA GA GA GA GA GA GA GA GA • Disadvantages of the current structure • Lack of flexibility when deploying GA’s to meet demand • No single manager responsible for representing and managing GA’s DPSA Training course material consolidated 2

15. And filling vacant post remains challenging • Moratorium placed on all non-clinical staff • Insufficient budget for filling vacant positions • No approved organogram • Post approval is a lengthy process Process map for filling structured post Post Creation Post Evaluation Advertise Post Interview and appointment 15 Months DPSA Training course material consolidated 2

16. The following suggestions are made.. DPSA Training course material consolidated 2

17. At macro level, a decision should be made on the mandate for Greys hospital - Finance, staff and support should be provided strategically Illustrative Shortfall DPSA Training course material consolidated 2

18. Initiatives to improve communication • Improving communication between Management and Union reps • Have more frequent IMLC’s • Consider reviewing chair for the IMLC’s to accommodate more frequent meetings • Better adherence to meeting dates – annual planner • Improving communication between management and staff • Ensure that supervisors regularly meet with staff at lower levels • Monthly reports on meetings should be made upwards • Translation of circulars into appropriate languages where relevant • Specific induction programmes for incoming bridging course student nurses from clinics DPSA Training course material consolidated 2

19. Attempt to create a win-win situation for both parties as well as for the efficiency of the hospital Wins for the unions - GA’s will be better represented - GA’s will enjoy a more varied job - Jobs will be rotated Wins for management - GA’s agree to sign PA’s - Unions agree to support change Guidelines for successful communication between Unions and Management – a hypothetical example • Clearly identify the issue • The objective is to pool all GA’s under a single manager • Work out and communicate the consequences of the decision • A post will have to be created to manage the GA’s • The job descriptions of the GA’s will not change • The hours worked and levels of the GA’s will not change DPSA Training course material consolidated 2

20. Despite the challenging work environment, motivating staff is possible through… • Acknowledging excellence - especially of lower-level workers through: • E.g. “GA/Nurse of the month” awards • Certificates and letters of thanks • Gift rewards for “cleaner of the month” • Management by walkabouts • Once a year have motivational meeting with different staff groups – e.g. thanking orderlies for their role in winning the ‘xyz award’ • Regular staff surveys • Displaying letters of thanks and praise from patients on staff notice boards DPSA Training course material consolidated 2

21. GA Manager GA GA GA GA GA GA GA GA GA GA Team A Team B Team C Investigate potential benefits of pooling GA’s Supervisor B Supervisor A Supervisor B GA GA GA GA GA GA GA GA GA GA DPSA Training course material consolidated 2

22. Investigate potential benefits of pooling GA’s Under the new structure: • GA’s would be managed by a single manager • GA’s would still report to unit heads Benefits of pooling • Provides a more flexible workforce to meet demand – especially if GA’s are converted to general orderlies • GA’s have a single manager to monitor development and handle their concerns • Unit heads have recourse to a single manager to handle GA’s issues BUT this has to be well planned and clearly communicated DPSA Training course material consolidated 2

23. Thank you.. DPSA Training course material consolidated 2