Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals

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dc.contributor.authorErasmus, Ermin
dc.contributor.authorGilson, Lucy
dc.contributor.authorGovender, Veloshnee
dc.contributor.authorNkosi, Moremi
dc.date.accessioned2021-10-08T07:04:18Z
dc.date.available2021-10-08T07:04:18Z
dc.date.issued2017
dc.description.abstractBACKGROUND: This paper uses the concepts of organisational culture and organisational trust to explore the implementation of equity-oriented policies - the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". METHODS: The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust. RESULTS: Regarding the UPFS, the hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the UPFS. The hospitals' PRC paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the PRC, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. CONCLUSIONS: Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected.
dc.identifier.apacitationErasmus, E., Gilson, L., Govender, V., & Nkosi, M. (2017). Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals. <i>International Journal for Equity in Health</i>, 16(1), 174 - 177. http://hdl.handle.net/11427/34475en_ZA
dc.identifier.chicagocitationErasmus, Ermin, Lucy Gilson, Veloshnee Govender, and Moremi Nkosi "Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals." <i>International Journal for Equity in Health</i> 16, 1. (2017): 174 - 177. http://hdl.handle.net/11427/34475en_ZA
dc.identifier.citationErasmus, E., Gilson, L., Govender, V. & Nkosi, M. 2017. Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals. <i>International Journal for Equity in Health.</i> 16(1):174 - 177. http://hdl.handle.net/11427/34475en_ZA
dc.identifier.issn1475-9276
dc.identifier.ris TY - Journal Article AU - Erasmus, Ermin AU - Gilson, Lucy AU - Govender, Veloshnee AU - Nkosi, Moremi AB - BACKGROUND: This paper uses the concepts of organisational culture and organisational trust to explore the implementation of equity-oriented policies - the Uniform Patient Fee Schedule (UPFS) and Patients' Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems' people-centeredness and "software". METHODS: The research entailed semi-structured interviews (Hospital A n = 115, Hospital B n = 80) with provincial, regional, district and hospital managers, as well as clinical and non-clinical hospital staff, hospital board members, and patients; observations of policy implementation, organisational functioning, staff interactions and patient-provider interactions; and structured surveys operationalising the Competing Values Framework for measuring organisational culture (Hospital A n = 155, Hospital B n = 77) and Organisational Trust Inventory (Hospital A n = 185, Hospital B n = 92) for assessing staff-manager trust. RESULTS: Regarding the UPFS, the hospitals' implementation approaches were similar in that both primarily understood it to be about revenue generation, granting fee exemptions was not a major focus, and considerable activity, facility management support, and provincial support was mobilised behind the UPFS. The hospitals' PRC paths diverged quite significantly, as Hospital A was more explicit in communicating and implementing the PRC, while the policy also enjoyed stronger managerial support in Hospital A than Hospital B. Beneath these experiences lie differences in how people's values, decisions and relationships influence health system functioning and in how the nature of policies, culture, trust and power dynamics can combine to create enabling or disabling micro-level implementation environments. CONCLUSIONS: Achieving equity in practice requires managers to take account of "unseen" but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation "hardware" such as putting in place necessary staff and resources, it emphasises "software" implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers' status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected. DA - 2017 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - International Journal for Equity in Health LK - https://open.uct.ac.za PY - 2017 SM - 1475-9276 T1 - Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals TI - Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals UR - http://hdl.handle.net/11427/34475 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34475
dc.identifier.vancouvercitationErasmus E, Gilson L, Govender V, Nkosi M. Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals. International Journal for Equity in Health. 2017;16(1):174 - 177. http://hdl.handle.net/11427/34475.en_ZA
dc.language.isoeng
dc.publisher.departmentAdolescent Health Research Institute
dc.publisher.facultyFaculty of Health Sciences
dc.sourceInternational Journal for Equity in Health
dc.source.journalissue1
dc.source.journalvolume16
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12939-017-0659-y
dc.subject.otherOrganisational culture
dc.subject.otherOrganisational trust
dc.subject.otherPolicy implementation
dc.subject.otherEquity
dc.subject.otherSouth Africa
dc.subject.otherHardware
dc.subject.otherSoftware
dc.subject.otherPeople-centeredness
dc.subject.otherPatients’ rights charter
dc.subject.otherUniform patient fee schedule
dc.titleOrganisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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