1. Roles of the DSCT team members Review of documents available

2. Who is this new kid on the block?

3. Reason for the DSCT existence: “ To ensure equitable access to appropriate and improved quality of care for mothers, newborn babies and children. Responsible for clinical governance and skills development. “

4. Primary role and focus of the DSCT specialist “The primary role of the District Clinical Specialist is supportive supervision and clinical governance and not the direct delivery of clinical services.” “The specific focus of the DSCT is maternal and child health.” DSCT’ s in South Africa : Ministerial Task Team Report 2012

5. Clinical governance: To provide the means of developing the organisational capability to deliver sustainable, accountable, patient focused, quality assured healthcare. '... a framework through which organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.' (Donaldson and Gray, 1998). It's about everything we do to improve the quality of care that people received from us', '...It's everyone business

6. Authority of the DSCT: “ The authority of persons occupying DSCT posts will arise partially from the posts themselves, but more so from their individual credibility based on their knowledge and experience.” DSCT’ s in South Africa : Ministerial Task Team Report 2012

7. Management style Old – functional management with beaurocratic structures New – Matrix management “In matrix management, leaders suddenly find themselves having to master the challenges of managing cross- divisional teams over whom they have little formal authority.” “.organizational management in which people with similar skills are pooled for work assignments.”

8. Matrix management

9. Advert for DSCTposts – 1. Knowledge Own clinical discipline, legislation, regulations and policy QA, programme planning, implementation and evaluation Information management HR and financial management

10. 2. Skills: Leadership Communication Problem solving Computer literacy and the following attributes - self confidence objective, ethical and empathetic

11. 3. Key performance areas (KPAs)of DCST: Deliver quality health care for mothers, new born and children at district level Promote equitable access to the appropriate levels of care Up to 10% of time in clinical care and 10% in research – to maintain competency. (80% in district) Support service delivery a/c discipline at district facilities Promote clinical effectiveness at facilities – outreach, protocols etc

12. KPAs continued: Logistics: work with DMT to establish and maintain systems, surveillance, health information, communication, referral guidelines. Ensure appropriate infrastructure and resources Monitoring and evaluation: Critical event analysis, morbidity and mortality meetings/audits Reporting effectively : to DSCT, community, NGOs, to management structures.

13. JOB DESCRIPTION SPECIALIST DYADS Ministerial Task Team Report: 2011

14. Medical and nurse specialists Presentation to National Health Council 8/2011 on DSCT roles Doctor job description:  General –  Promote equitable access and appropriate care  Assist with strategic & operational planning  Co-ordinate, monitor, support discipline related services  Maintain competency in the discipline Nurse job description:  General  Promote the provision of appropriate primary prevention, promotive and curative health care services  Assist with strategic & operational planning  Clinical leadership & support in the functional areas of expertise

15. Medical and nurse specialists Doctor job description:  Facility support - -Clinical focus - packages, outreach & participation  Organisational support – -Infrastructure, equipment & resources -Staff development, support Nurse job description:  Facility support - -Clinical focus - packages, outreach & participation -Policies & protocols  Organisational support -Infrastructure, equipment & resources -Staff development, support -Unit systems & management

16. Medical and nurse specialists Doctor job description:  Systems and logical support -Information, referral and surveillance  M & E -Quality improvement programmes and reporting systems - Mortality audits Nurse job description:  Systems and logical support -Information, referral and surveillance  M& E -Quality improvement programmes and reporting systems -Appropriate mortality audits

17. Group activity: What is the role of the DCST in the district - go beyond objectives and to state practical priority functions How is the role of the DCST different from other stakeholders on the district management team eg the district managers, MCH and PHC programme managers, operations managers, coordinators and information officers? How do you give the DSCT posts authority? How have you managed these roles thus far? What factors have helped hindered this?

18. Accepted Making a difference together Do we know who we are?