A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa

dc.contributor.authorOrgill, Marsha
dc.contributor.authorGilson, Lucy
dc.contributor.authorChitha, Wezile
dc.contributor.authorMichel, Janet
dc.contributor.authorErasmus, Ermin
dc.contributor.authorMarchal, Bruno
dc.contributor.authorHarris, Bronwyn
dc.date.accessioned2019-04-12T11:20:08Z
dc.date.available2019-04-12T11:20:08Z
dc.date.issued2019-03-29
dc.date.updated2019-03-31T03:14:42Z
dc.description.abstractBackground In 2012 the South African National Department of Health (SA NDoH) set out, using a top down process, to implement several innovations in eleven health districts in order to test reforms to strengthen the district health system. The process of disseminating innovations began in 2012 and senior health managers in districts were expected to drive implementation. The research explored, from a bottom up perspective, how efforts by the National government to disseminate and diffuse innovations were experienced by district level senior managers and why some dissemination efforts were more enabling than others. Methods A multiple case study design comprising three cases was conducted. Data collection in 2012 – early 2014 included 38 interviews with provincial and district level managers as well as non- participant observation of meetings. The Greenhalgh et al. (Milbank Q 82(4):581-629, 2004) diffusion of innovations model was used to interpret dissemination and diffusion in the districts. Results Managers valued the national Minister of Health’s role as a champion in disseminating innovations via a road show and his personal participation in an induction programme for new hospital managers. The identification of a site coordinator in each pilot site was valued as this coordinator served as a central point of connection between networks up the hierarchy and horizontally in the district. Managers leveraged their own existing social networks in the districts and created synergies between new ideas and existing working practices to enable adoption by their staff. Managers also wanted to be part of processes that decide what should be strengthened in their districts and want clarity on: (1) the benefits of new innovations (2) total funding they will receive (3) their specific role in implementation and (4) the range of stakeholders involved. Conclusion Those driving reform processes from ‘the top’ must remember to develop well planned dissemination strategies that give lower-level managers relevant information and, as part of those strategies, provide ongoing opportunities for bottom up input into key decisions and processes. Managers in districts must be recognised as leaders of change, not only as implementers who are at the receiving end of dissemination strategies from those at the top. They are integral intermediaries between those at the at the coal face and national policies, managing long chains of dissemination and natural (often unpredictable) diffusion.
dc.identifier.apacitationOrgill, M., Gilson, L., Chitha, W., Michel, J., Erasmus, E., Marchal, B., & Harris, B. (2019). A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa. <i>International Journal for Equity in Health</i>, http://hdl.handle.net/11427/29967en_ZA
dc.identifier.chicagocitationOrgill, Marsha, Lucy Gilson, Wezile Chitha, Janet Michel, Ermin Erasmus, Bruno Marchal, and Bronwyn Harris "A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa." <i>International Journal for Equity in Health</i> (2019) http://hdl.handle.net/11427/29967en_ZA
dc.identifier.citationOrgill, M., Gilson, L., Chitha, W., Michel, J., Erasmus, E., Marchal, B., & Harris, B. (2019). A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa. International Journal for Equity in Health, 18(1), 53.
dc.identifier.ris TY - Journal Article AU - Orgill, Marsha AU - Gilson, Lucy AU - Chitha, Wezile AU - Michel, Janet AU - Erasmus, Ermin AU - Marchal, Bruno AU - Harris, Bronwyn AB - Background In 2012 the South African National Department of Health (SA NDoH) set out, using a top down process, to implement several innovations in eleven health districts in order to test reforms to strengthen the district health system. The process of disseminating innovations began in 2012 and senior health managers in districts were expected to drive implementation. The research explored, from a bottom up perspective, how efforts by the National government to disseminate and diffuse innovations were experienced by district level senior managers and why some dissemination efforts were more enabling than others. Methods A multiple case study design comprising three cases was conducted. Data collection in 2012 – early 2014 included 38 interviews with provincial and district level managers as well as non- participant observation of meetings. The Greenhalgh et al. (Milbank Q 82(4):581-629, 2004) diffusion of innovations model was used to interpret dissemination and diffusion in the districts. Results Managers valued the national Minister of Health’s role as a champion in disseminating innovations via a road show and his personal participation in an induction programme for new hospital managers. The identification of a site coordinator in each pilot site was valued as this coordinator served as a central point of connection between networks up the hierarchy and horizontally in the district. Managers leveraged their own existing social networks in the districts and created synergies between new ideas and existing working practices to enable adoption by their staff. Managers also wanted to be part of processes that decide what should be strengthened in their districts and want clarity on: (1) the benefits of new innovations (2) total funding they will receive (3) their specific role in implementation and (4) the range of stakeholders involved. Conclusion Those driving reform processes from ‘the top’ must remember to develop well planned dissemination strategies that give lower-level managers relevant information and, as part of those strategies, provide ongoing opportunities for bottom up input into key decisions and processes. Managers in districts must be recognised as leaders of change, not only as implementers who are at the receiving end of dissemination strategies from those at the top. They are integral intermediaries between those at the at the coal face and national policies, managing long chains of dissemination and natural (often unpredictable) diffusion. DA - 2019-03-29 DB - OpenUCT DP - University of Cape Town J1 - International Journal for Equity in Health LK - https://open.uct.ac.za PY - 2019 T1 - A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa TI - A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa UR - http://hdl.handle.net/11427/29967 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12939-019-0952-z
dc.identifier.urihttp://hdl.handle.net/11427/29967
dc.identifier.vancouvercitationOrgill M, Gilson L, Chitha W, Michel J, Erasmus E, Marchal B, et al. A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa. International Journal for Equity in Health. 2019; http://hdl.handle.net/11427/29967.en_ZA
dc.language.rfc3066en
dc.rights.holderThe Author(s).
dc.sourceInternational Journal for Equity in Health
dc.source.urihttps://equityhealthj.biomedcentral.com/
dc.titleA qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa
dc.typeJournal Article
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