Project Khaedu SMS Action Learning Programme Ngewelezane Hospital - preliminary findings

1. Project Khaedu SMS Action Learning Programme Ngewelezane Hospital - preliminary findings 4 November 2005 Ngwelezane Hospital

2. Agenda • Executive summary • Situation • Complications • Some suggestions Caveat: We have only been here 4 days and could easily have made a mistake or misinterpreted some data…we apologise in advance Ngwelezane Hospital

3. Executive summary and key message Ngwelezane hospital seems to be largely in control of its delivery with high relative standards. However there are challenges with regard to upgrading to a tertiary status. Some improvements are possible in procurement, patient administration, HR and laundry Ngwelezane Hospital

4. Situation Ngwelezane hospital seems to be largely in control of its delivery with high relative standards. However there are challenges with regard to upgrading to a tertiary status. Some improvements are possible in procurement, patient administration, HR and laundry Situation • The Organisational structure in respect of some sections is not properly aligned. • Some positions critical for service delivery remain unfilled • In some sections the workload is heavy whereas in other sections there is a lighter workload • There is limited scope for career growth and advancement particularly for employees at lower levels of the structure • There are a number of constraints with regards to procurement processes • Lack of effective communication strategies • Lack of computerised systems to enhance service delivery in particular, the Patient Administration (including filing system) and procurement • Lack of controls over the movable assets, e.g. laundry etc. • There is an existing strategy to outsource non-core functions • There appears to be no clear strategy in provision of training programmes • The hospital is not optimally maintained Ngwelezane Hospital

5. Many things seem to work well in the Hospital • There is a good and working shift system at the patient administration • There are no long queues at admissions and at the pharmacy • The hospital is generally clean Pharmacy well under control at 3pm • There is a good recruitment and retention strategy for the professional staff • There is a very low relative vacancy rate amongst medical professionals (33%) as compared to other hospitals Ngwelezane Hospital

6. Things working well (cont…) • The existence of a PHC Clinic within the hospital serves to lessen the incidences of patients arriving at the hospital without referrals and hence being turned back • The working relations with the Unizul is good and serves to ensure that the non-zulu speaking officials learn the language to be able to communicate with the clients of the hospital Ngwelezane Hospital

7. Filing system has improved with the introduction of colour coding Ngwelezane Hospital

8. Key resources are critically short… • No hospital cafeteria/ canteen for staff, outpatients and especially the workers staying within the hospital dormitories • Official residences for professional staff • Limited space for mortuary and holding trays often too small for larger corpses • Lack of air-conditioning for wards and administration offices Ngwelezane Hospital

9. Patients are generally happy with the service, except for time taken and value for money Very good Good OK Poor V. poor Ngwelezane Hospital

10. Staff morale appears very low Very good Good OK Poor V. poor Ngwelezane Hospital

11. What are staff saying? “Too much racism…house of whites. We don’t have any say in the building” “Only the whites are benefiting from the principle of Batho Pele. No people first, but whites first” “Shortage of the staff make it so difficult to perform” “There is no communication in the hospital departments e.g. in the human resource department” “Very poor communication – we were not even informed about the renovations taking place” “Because if we need help or if you are sick, there’s no care and privacy as a staff member e.g. HR and to staff doctors” “If you need any help to other department like if you are sick then they don’t take as the staff no care and there is no privacy and there is no good quality of treatment for staff” “Because of the shortage of staff, there is too much of work that you cannot have enough time for one client to apply Batho Pele” “The patients wait in queues for the whole day” Ngwelezane Hospital

12. Complications Ngwelezane hospital seems to be largely in control of its delivery with high relative standards. However there are challenges with regard to upgrading to a tertiary status. Some improvements are possible in procurement, patient administration, HR and laundry Situation Complications • The Organisational structure not properly aligned. • Critical positions remain unfilled • Uneven distribution of workload • There is limited scope for career growth and advancement particularly for employees at lower levels of the structure • There are a number of constraints with regards to procurement processes • Lack of effective communication strategies • Lack of computerised systems to enhance service delivery in particular, the Patient Administration (including filing system) and procurement • Lack of controls over the movable assets, e.g. laundry etc. • There is an existing strategy to outsource non-core functions • There appears to be no clear strategy in provision of training programmes • Sub-optimal maintenance • Not clear that the hospital has the delegation of authority to make organisational structure changes without engaging work study from Head Office • Legacy of moratorium on filling of posts still lingering (severe in stores) • Only medical positions are being increased as the hospital is moving towards being a tertiary hospital and no commensurate increase is considered for non medical staff • Software and training has not been given in conjunction with the provision of computers (e.g. Stores and Patient Admin) • Specification for non-stock items are not clear, delaying procurement process further – everything still manual • The general stock levels are not determined within procurement • There is no forum where the staff and management can meet socially and be able to discuss issues • The unions, although part of decision making, seem not to be informed of the final outcomes and implementation of agreements • Missing laundry issue is out of the direct control of the hospital • Challenges with regard to redeploying staff who have been displaced by outsourcing decision • Misunderstanding / miscommunication regarding access of training for non-professional staff Ngwelezane Hospital

13. Some Suggestions Ngwelezane hospital seems to be largely in control of its delivery with high relative standards. However there are challenges with regard to upgrading to a tertiary status. Some improvements are possible in procurement, patient administration, HR and laundry Situation Complications Suggestion • The Organisational structure not properly aligned. • Critical positions remain unfilled • Uneven distribution of workload • There is limited scope for career growth and advancement particularly for employees at lower levels of the structure • There are a number of constraints with regards to procurement processes • Lack of effective communication strategies • Lack of computerised systems to enhance service delivery in particular, the Patient Administration (including filing system) and procurement • Lack of controls over the movable assets, e.g. laundry etc. • There is an existing strategy to outsource non-core functions • There appears to be no clear strategy in provision of training programmes • Sub-optimal maintenance • Engagement of work study from Head Office • Legacy of moratorium on filling of posts still lingering • Only medical positions are being increased with move to tertiary hospital • Software and training has not been given with computers • Specification for non-stock items are not clear • General stock levels not determined within procurement • Forum where the staff and management can meet socially • Consultation with unions • Laundry out of control of the hospital • Challenges with regard to redeploying staff who have been displaced by outsourcing decision • Misunderstanding / miscommunication regarding access of training for non-professional staff • Motivate for separation of Finance/Systems post • Fill all critical posts asap now that moratorium is lifted • Urgently encourage the full use of computers (big bang for small buck) • E.g. automate medical records • Strengthen communication • Hospital to District • Hospital to staff (very important) • Consider using private laundry exclusively • Meet with Works to resolve misunderstanding • Consider offering voluntary packages to staff over 50 • Training needs to be structured and not be limited to the NQF level requirements for lower levels • Implement PMDS Ngwelezane Hospital

14. Some Suggestions • Fill all critical posts as soon as possible now that moratorium is lifted • Motivate for separation of disparate components e.g. Finance/Systems post • Request Management Advisory Services to do work study review • Consider appointing an IT specialist • Communication between the district office and the hospital could be strengthened and regular meetings need to take place. • The Provincial Department should consider liaising directly with hospitals and copy communication to the District • The construction of a staff cafeteria/canteen needs to be urgently looked into • To improve on staff relations, there needs to be investigations on the doctor-patient relations concerning the staff who become ill and whose medical conditions are allegedly publicized by the doctors at the hospital • The Department of works and the hospital could meet and iron out issues of roles and responsibilities between the two institutions • Where does the role of the hospital end and that of Works begin? Ngwelezane Hospital

15. Procurement could be improved • The delegation of powers document needs to be communicated to all staff members (e.g. the document indicates that a person in the rank of the Senior Admin Office has powers to order stock up to R100,000 in respect of printing) • Copies of the centrally negotiated contract and Service Level Agreements should be made available to the Hospital • The Head of Procurement should be given powers to determine the stock levels • The procurement processes need to be automated and staff trained to be able to use the electronic procurement system as well as stock level tracking systems Ngwelezane Hospital

16. Outpatients administration is equipped with computers, but they are only used for printing labels Ngwelezane Hospital

17. This is valuable information to have on a database • Simple Microsoft Access / Excel* database could be very cheaply set up • Can then search for file number by surname, name, ID number etc • Log all files out electronically and log back return (only takes a few seconds) • Follow-up daily on logged-out files that have not been returned • Can also consider an addition to the system where files can be scanned at each point of movement *Excel has a limit of 65,500 records; OPD is currently at 43,000 for 2005 Ngwelezane Hospital

18. Many thanks for hosting usSiyabonga Kakhulu Ngwelezane Hospital