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A Culture of Discontent Within the Free State Department of Health (FSDoH) Shirley du Plooy Anthropology Department & CHSR&D.

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Presentation on theme: "A Culture of Discontent Within the Free State Department of Health (FSDoH) Shirley du Plooy Anthropology Department & CHSR&D."— Presentation transcript:

1 A Culture of Discontent Within the Free State Department of Health (FSDoH) Shirley du Plooy Anthropology Department & CHSR&D

2 2 Background PN in PHC facilities Emotional & psychological distress Negative implications for service delivery Necessity to monitor staff wellbeing Feedback sessions from such a project

3 3 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

4 4 Results & Discussion Valuable insights into burnout & compassion fatigue reported by PNs in FS Overt & latent matters

5 5 Primary findings: 1. Meaningful & relevant retention strategies 2. Work re-design measures 3. Instilling institutional trust 4. Non-clinical training & skills development 5. Action

6 6 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

7 7 continued … Meaningful & relevant retention strategies – Moonlighting Staff shortages a given – Implementing new programmes – Unfilled posts – Heavy reliance on volunteers – “can’t see an increase in training and a concerted effort from the Department of Health to address this issue” – Need to revisit the budget

8 8 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

9 9 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

10 10 continued … Instilling institutional trust – No wellness programme Psychologists – mental health of patients EAP fixed at provincial level –Little faith in EAP personnel –“Confidentiality can’t be guaranteed” Own resourcefulness in seeking counselling or therapy Employer read as unsympathetic, therefore not trusted – Actively engage in reducing absenteeism

11 11 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?”

12 12 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”

13 13 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

14 14 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”

15 15 5.Action Top management must: – Acknowledge the problem – Take decisions – Support lower levels Middle management feel – Don’t 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”

16 16 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

17 17 Recommendations Need to instil & adopt: – Higher levels of organisational moral – Perceived institutional justice – Sense of responsibility & pride Symptomatic relief & wellness

18 18 Acknowledgments Sincere gratitude to the following institutions and individuals: The Free State Department of Health The researchers and fieldworkers of the CHSR&D This project was made possible by: – the Foreign Assistance Agencies of: AusAID DFID USAID UNDP – JEAPP – IDRC – MRC

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