Exploring the contribution of a leadership development program on the implementation of improvement projects at a South African central hospital

Doctoral Thesis


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Background It is recognized that healthcare leaders of today would need to not only be responsive to the rapid changes around them, but also plan for the future of healthcare by creating a climate that is sensitive to the context of the organization while responding to the service needs. In the South African public healthcare context, where the service demands outweigh the ability to satisfy these needs with limited resources, leadership and leadership development is required to create more adaptive and resilient leaders and leadership. This PhD therefore aimed to study the implementation of a strategy to improve the leadership of the executive team at the hospital through a leadership development program, specifically analysing whether and how the program facilitated their capacity as leaders and their continuing work, with their respective multidisciplinary teams to implement improvement processes across the hospital. Methodology Given the limited knowledge on implementing a leadership development program (LDP) at a large South African central hospital, this study was comprised of two phases. Phase one of the study used a qualitative exploratory design, to explore the experiences and perspectives of the thirteen executive leaders on the LDP and whether these learnings played any role in developing their capacity. This was done by reviewing 242 documents and 13 one on one interviews with the hospital executive leaders, using purposive sampling. The second phase of this study used the insights of phase one to guide the analysis of four improvement processes initiated at the hospital. This phase explored which factors contributed to the success or failure of the implementation of the improvement processes in the executive leaders' respective areas and how their leadership of the process contributed to these factors. This was done by conducting in-depth case studies through focus group interviews with a total number of 36 participants in the respective teams and six one-on-one interviews with key informants (members of the team who had retired, but were integral to the process) that were involved in the improvement processes. Results The results of the study indicated the need for a context specific, practical LDP that provided benefit to the executive leaders, both as individuals and as team leaders. The executives reflected on their growth as leaders through building relationships, developing themselves through self-awareness and developing multidisciplinary teams. The analysis of the case studies in turn showed that leaders who engaged and supported their teams were more successful in their improvement processes. Concluding remarks This research summarized eight major conclusions drawn from the study as a contribution to what is possible in the public sector. Both the leadership development program and the case studies provided a broad conceptual framework of the Individual, the Team and the System as components that can be used to develop leaders, develop teams and improve overall leadership at a hospital. Based on the study learnings, the bottom-up approach and specific tools developed could serve as a basis for other hospitals to implement a leadership development program (LDP) and improvement processes in similar contexts. Further research on LDPs in a South African context could test the findings of this study and assist in enhancing the development of leaders at public sector hospitals.