The profile of hospital superintendents is changing – although white male doctors still predominate, a new picture is emerging in which more and more women are heading up hospitals.
The 2001 SA Health Review notes that it is nurses and others in the health profession who increasingly are taking the helm.
Most of the superintendents felt they had succeeded in improving the quality of care for their patients. They had been able to bring in additional doctors, they had introduced new services, opened theatres and kept their clinics open for longer hours.
For many, the integration of health services in the district had made a great difference to their work and by working in collaboration with other health services they are able to introduce new projects. There was also a move towards community involvement in the hospital, for example having community members on the hospital board.
Yet there were frustrations everywhere, beginning often with the security of superintendents’ own positions. There were often long delays in being appointed to the post and their salary scales were sometimes seen as unfair.
The way the health services were structured meant that superintendents often did not have the authority to resolve many of the problems they faced in their hospitals. The services were often affected by external demands over which they had little control.
Most had learnt what they needed to know “on the job”. They desperately needed training in many areas.
The other problems that dominated their day-to-day lives were disputes around race and the challenge of discipline. According to those interviewed, a lot of time was spent on disciplinary matters and yet they felt ill-equipped to deal with this issue.
Managers had not received any training in personnel management or labour relations. Some said they had had to learn over many years, often through making mistakes that they wished they could have avoided.
Poor infrastructure provided another source of frustration. There were run down facilities that needed attention, buildings that needed to be upgraded, lack of transport and, in some cases, no ambulances at all.
A further frustration expressed was the lack of consultation by the provincial department with the hospitals in planning the services. One superintendent said “We do not make input into senior management decisions; we do not make input into senior planning decisions and it makes our lives very, very difficult.”
The full text of the SA Health Review can be found at: http://www.hst.org.za/sahr/2001/