'Doing more with less': a qualitative investigation of perceptions of South African health service managers on implementation of health innovations
'Doing more with less': a qualitative investigation of perceptions of South African health service managers on implementation of health innovations
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DOI：
10.1093/heapol/czz017
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发表时间：
2019-03-01
影响因子：
3.2
通讯作者：
Myers, Bronwyn
中科院分区：
文献类型：
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作者：
Brooke-Sumner, Carrie;Petersen-Williams, Petal;Myers, Bronwyn
建立卫生系统的复原力是低收入和中等收入国家的当务之急。卫生服务管理者实施卫生创新的能力可能是初级卫生保健设施弹性的一个关键方面，从而促进适应性和功能性。本研究调查了卫生服务管理者对采用卫生创新的认知和体验。我们的目标是确定人们对收养限制的看法，以及对这些限制做出反应的紧急行为。方便抽样的34个机构，临床服务和分区的管理人员被邀请参加。六个人没有回应，也无法联系到。在参与者工作地点的私人空间对28名参与者进行了深入的个人访谈。采访被录音并逐字转录。NVivo 11用于存储数据和促进框架分析。研究参与者描述了采用创新的制约因素，包括：工作人员对潜在利益缺乏了解；工作人员的个性、态度和行为导致对变革的抵制；与资源限制有关的高工作量和频繁的政策变革导致对变革的抵制；通过卫生系统结构进行的沟通不够理想。管理人员报告说，他们采用了各种策略来缓解这些限制。这些技能包括：(1)技术技能，包括参与性管理技能、沟通技能、社区参与技能和方案监测和评价技能；(2)非技术技能，包括树立榜样积极态度、理解工作人员个性、影响对创新的看法、影响组织气氛和建立信任关系。管理人员在将服务创新嵌入日常实践中发挥着至关重要的作用。我们提出了一个技术和非技术技能的框架，管理者需要这些技能来促进卫生创新的采用。今后建设管理人员实施卫生创新能力的努力应针对这些能力。
Building resilience in health systems is an imperative for low- and middle- income countries. Health service managers' ability to implement health innovations may be a key aspect of resilience in primary healthcare facilities, promoting adaptability and functionality. This study investigated health service managers' perceptions and experiences of adopting health innovations. We aimed to identify perceptions of constraints to adoption and emergent behaviours in response to these constraints. A convenience sample of 34 facility, clinical service and sub-district level managers was invited to participate. Six did not respond and were not contactable. In-depth individual interviews in a private space at participants' place of work were conducted with 28 participants. Interviews were audio recorded and transcribed verbatim. NVivo 11 was used to store data and facilitate framework analysis. Study participants described constraints to innovation adoption including: staff lack of understanding of potential benefits; staff personalities, attitudes and behaviours which lead to resistance to change; high workload related to resource constraints and frequent policy changes inducing resistance to change; and suboptimal communication through health system structures. Managers reported employing various strategies to mitigate these constraints. These comprised (1) technical skills including participatory management skills, communication skills, community engagement skills and programme monitoring and evaluation skills, and (2) non-technical skills including role modelling positive attitudes, understanding staff personalities, influencing perceptions of innovations, influencing organizational climate and building trusting relationships. Managers have a vital role in the embedding of service innovations into routine practice. We present a framework of technical and non-technical skills that managers need to facilitate the adoption of health innovations. Future efforts to build managers' capacity to implement health innovations should target these competencies.