Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals
Abstract 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...
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| Format: | Article |
| Language: | English |
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BMC
2017-09-01
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| Series: | International Journal for Equity in Health |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12939-017-0659-y |
| _version_ | 1818198560583188480 |
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| author | Ermin Erasmus Lucy Gilson Veloshnee Govender Moremi Nkosi |
| author_facet | Ermin Erasmus Lucy Gilson Veloshnee Govender Moremi Nkosi |
| author_sort | Ermin Erasmus |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-12T02:07:49Z |
| format | Article |
| id | doaj.art-d139b45159dc4f7abe54ab0b9d7e07a2 |
| institution | Directory Open Access Journal |
| issn | 1475-9276 |
| language | English |
| last_indexed | 2024-12-12T02:07:49Z |
| publishDate | 2017-09-01 |
| publisher | BMC |
| record_format | Article |
| series | International Journal for Equity in Health |
| spelling | doaj.art-d139b45159dc4f7abe54ab0b9d7e07a22022-12-22T00:41:59ZengBMCInternational Journal for Equity in Health1475-92762017-09-0116111410.1186/s12939-017-0659-yOrganisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitalsErmin Erasmus0Lucy Gilson1Veloshnee Govender2Moremi Nkosi3Health Policy and Systems Division, School of Public Health and Family Medicine University of Cape TownHealth Policy and Systems Division, School of Public Health and Family Medicine, University of Cape TownAlliance for Health Policy and Systems Research, World Health OrganizationMedschemeAbstract 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.http://link.springer.com/article/10.1186/s12939-017-0659-yOrganisational cultureOrganisational trustPolicy implementationEquitySouth AfricaHardware |
| spellingShingle | Ermin Erasmus Lucy Gilson Veloshnee Govender Moremi Nkosi 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 Organisational culture Organisational trust Policy implementation Equity South Africa Hardware |
| title | Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals |
| title_full | Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals |
| title_fullStr | Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals |
| title_full_unstemmed | Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals |
| title_short | Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals |
| title_sort | organisational culture and trust as influences over the implementation of equity oriented policy in two south african case study hospitals |
| topic | Organisational culture Organisational trust Policy implementation Equity South Africa Hardware |
| url | http://link.springer.com/article/10.1186/s12939-017-0659-y |
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