Slow road to transform Chris Hani-Baragwanath
Four years ago, Soweto’s Chris Hani Baragwanath Hospital was such a sick institution that one of the workers’ union initiated a transformation programme to address the low staff morale and poor service to patients.
The National Education, Health and Allied Workers Union (Nehwau) enlisted the help of research organisation, Naledi to identify the main problems and to map out some solutions, using the critical surgical department as its pilot.
Today there are some improvements ‘ but progress is being undermined at every level by staff shortages.
The main problems identified by Naledi, says Nehawu official Andile Kolanisi, were that too little money was being allocated to the hospital, the money allocated was not being used efficiently and that there were huge staff shortages.
Although the enormous 2 500-bed hospital operates with an annual budget of almost a billion rand, it spends almost 14% less on each patient than Johannesburg General Hospital.
In addition, there are huge staff shortage ‘ almost 36% among nurses and 30% across all occupational groups.
‘We think that is a challenge that needs to be attended to immediately because it has far-reaching implications,’ says Kolanisi. ‘Firstly, it demoralises the workers. Secondly, it causes stress on the workers. Thirdly, it affects service delivery to the communities.’
Critical management posts were vacant and, in many cases, nurses without management experience were supposed to run departments.
Using the Naledi research as its basis, management, the three other staff unions, the hospital board formed a transformation project.
Since then, the Gauteng health department has become involved. Dr Nandi Diliza, Gauteng health department’s director of hospital programmes, says four ‘pillars’ need urgent attention at the hospital: ‘general management, human resources, finance and the clinical side’.
A key problem is that the referral system is not working.
‘People don’t understand the issue of primary health care,’ says Diliza. ‘Somebody will have a toothache, somebody will have a rash, somebody will have an earache and they will walk into Bara. And according to health economics as soon as you open the corridor of an institution of the size of Bara and get a file, already R500 goes down.
‘So, we have to educate the public to the fact that Chris Hani Bara, Helen Joseph and Johannesburg Hospital are referral centres. People who go there should only be those who are referred by the clinics and also even private doctors.’
The ultimate aim is to reduce the size of the hospital to 1 500, channelling those patients who do not need specialist care to the Lillian Ngoyi Health Centre alongside CHB, which is to be upgraded and expanded to become a Level 1 hospital.
Diliza says there is a provincial shortage of 5 000 nurses and that CHB is struggling to attract nurses.
‘As you know, health care professionals are a rarity in the country. We’re bleeding to the private sector and we’re bleeding to overseas countries. But the state of vacancies is not as bad as has been cited before in previous forums,’ says Diliza.
‘We are even in the process of inviting retired nurses who are under 70 years of age to come back to the public service where they would assist.
‘We advertise posts for, say, 50 nurses and get 20 responses. There are no pharmacists in the country; your specialised nurses; your allied health professionals, that is, your physiotherapists, occupational therapists and so on. You cannot find them because they go to the private sector.’
But she says that ‘there are people at Chris Hani Baragwanath who are very dedicated’.
‘You’ve got professors who are world class who could get jobs anywhere ‘ in the country and in the world ‘ but they’ve decided that they want to serve that community. So there is dedication on the one side, but of course, in any scenario there’ll always be rotten potatoes.’
‘Some of our members were part of those problems,’ admits Nehawu shop steward Heather Mchunu. ‘We were having problems of people who don’t want to work, people who drink during working hours, people who are leaving the institution during working hours to go outside, theft was overwhelming.’
Diliza says there is recognition that ‘there is no equity if you look at Chris Hani Bara and Johannesburg Hospital’
To address this, the hospital management has been asked to ‘start a zero-based budget or activity based budget, where they don’t just take the previous year’s budget and add an inflation rate. We’ve said look at your activities, cost them and then tell us what you need, and then as a province we’ll look into that and address equity’.
However, staff shortages ‘ particularly the inability to attract accountants ‘ means that the systems are not yet in place to be able to do this zero-based budget.
The hospital has also tried to introduce unit managers in different departments to deal with management issues such as human resources, freeing the medical staff to concentrate on patients.
But, says Jabu Buthelezi, also a Nehawu shop steward, ‘Unfortunately, due to shortage of staff these managers end up not doing managerial duties. They end doing beds and giving medicines and so on, because they can’t leave everything and continue with managing without making sure that patients are taken care of.’
In addition, says Buthelezi, unit managers lack the confidence to tackle problematic staff.
‘They are afraid of taking disciplinary action against those workers that are actually found to be doing wrong things. Some of them don’t actually know what their powers are. They end up asking us as shops-stewards.’
A steering committee for CHB’s transformation is now being such up under the auspices of the Gauteng Health Department’s Chief of Operations. It will consist of senior members from Finance, human resources and services.
This will link up with a project team at the hospital, and could include experts from the private sector.
Diliza believes that a new management team that came into being in 2003 is starting to make a difference.
‘They would over-spend by over R100 million. I’m told this year that they are just about R30 ‘ R40 million over budget, which is really an indication that the plans of current management are beginning to bear fruit.
‘And it’s not that services have decreased. But they’ve just made sure that the sheets stay there, the paper stays there, the drugs stay there, they don’t disappear.’
Head office is looking at fast-tracking people to fill vacancies, and some ‘quick wins’ such as using agency nurses to fill posts.
‘A very phenomenal thing has happened at Chris Hani Baragwanath. Workers themselves are saying: ‘What has happened to discipline? People have become a law unto themselves. People do as they please. Why are you not disciplining us?’ And we really welcome that with open hands where workers themselves are asking management to strengthen their fist, so to say.’
E-mail Khopotso Bodibe
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