A number of key factors were identified through this process, which appear to be important in effective functioning of district hospitals. The first group of factors centres around the basic essential component of teamwork, or working together, which was seen to be vital. These include the importance of regular meetings which involve all sections of the hospital, inter-personal relationships based on respect and mutual co-operation, a sense of unity built on a common vision, commitment to this vision and to the team, and continuous communication at all levels of the hospital.
A second group of issues which were identified provide the framework for the functioning of the team, viz. an ethos derived from an historical tradition, a particular approach to problem solving which seeks always to find a way forward, and a solid underlying structure which provides the systems to implement this approach.
A third group of factors relate to the position of the hospital in the community and the district. The hospitals were clearly positioned within and integrated into districts, express a sense of dedicated service to the community involving reaching out beyond the gates, and believe they are answerable to the community with full mutual involvement.
Finally, capacity building, to assist and encourage staff in the process, undergirds all these factors.
A number of other factors were also mentioned. These include effective personnel management, a neat and clean physical environment, leadership by example and the role of doctors in this, the person of the leader as a competent professional who can also treat the hospital as a patient, and giving attention to patient rights. Working with minimal resources and isolation can both be obstacles or challenges. Demands from head office need to be managed, and this is easier in an enabling environment. Good financial management must be balanced with service needs, just as teamwork needs to be balanced with effective discipline. Ultimately managers need to have the courage to take decisions.
Examples of these factors are provided throughout the report, using the words of the respondents. In this way, district hospital management teams are provided with ideas and resources for improving hospital management. |
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