The state of public hospital governance and management in a South African hospital: A case study

Purpose: The purpose of this paper is to examine the operations and management of a public hospital in South Africa in the light of recent organizational reforms. Management of public hospitals in South Africa is often seen as fragmented, impacting on their operations. Management processes are dominated by hierarchy and poor communication and interaction. They are also poorly linked to patients’ needs and experiences. In this paper, we examine the operations and management of a district hospital in North West Province to ascertain the extent to which the nature of hierarchy, communication, and interaction in the management process (meetings, establishing guidelines and others) impact on the efficient and effective governance of the hospital, especially in the light of recent organizational reforms.Methods: A qualitative case study approach involving 15 in-depth interviews were conducted at three management levels. All interviews were conducted in English, and were digitally audio-recorded and professionally transcribed. Management and organization of data were done with NVivo 10 software, while analyses were based on pattern-building and emerging themes.Results: By and large the hospital was constrained by hierarchical control and rule-following. While hierarchy and dysfunction still shape communication and interaction, there is some optimism with regards to strategic planning. Key features of hospital governance and its functionality, involving financial management or stewardship, strategic planning, performance management and appraisal, and clinical governance are emphasized.Conclusions: For effective public hospital governance in South Africa, management must be guided in practice by the key principles set out in the national policy on management of public hospitals.