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Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district

BACKGROUND: As part of health system strengthening in South Africa (2012–2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending...

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Autores principales: Orgill, Marsha, Marchal, Bruno, Shung-King, Maylene, Sikuza, Lwazikazi, Gilson, Lucy
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992952/
https://www.ncbi.nlm.nih.gov/pubmed/33761911
http://dx.doi.org/10.1186/s12889-021-10546-w
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author Orgill, Marsha
Marchal, Bruno
Shung-King, Maylene
Sikuza, Lwazikazi
Gilson, Lucy
author_facet Orgill, Marsha
Marchal, Bruno
Shung-King, Maylene
Sikuza, Lwazikazi
Gilson, Lucy
author_sort Orgill, Marsha
collection PubMed
description BACKGROUND: As part of health system strengthening in South Africa (2012–2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the health system rather than only of individuals, the research explored the mechanisms triggered in context to produce outputs, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system. METHODS: We conducted a realist evaluation, adopting the case study design, over a two-year period (2013–2015) in the district of focus. The initial programme theory was developed from 10 senior manager interviews and a literature review. To understand the processes and mechanisms triggered in the local context and identify outputs, we conducted 15 interviews with managers in the management team and seven with non-state actors. These were supplemented by researcher notes based on time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome configuration alongside theoretical constructs. RESULTS: The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom-up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justifications for change and setting the scene (a new agenda, distributed leadership). These micro-practices in themselves, and by managers engaging with them, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new practices within a routine meeting. CONCLUSION: District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant ‘bottom-up’ capacity development in district health systems. By drawing on soft skills and the policy resources (hardware) of the system they can influence motivation and buy-in to improve management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-10546-w.
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spelling pubmed-79929522021-03-25 Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district Orgill, Marsha Marchal, Bruno Shung-King, Maylene Sikuza, Lwazikazi Gilson, Lucy BMC Public Health Research Article BACKGROUND: As part of health system strengthening in South Africa (2012–2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the health system rather than only of individuals, the research explored the mechanisms triggered in context to produce outputs, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system. METHODS: We conducted a realist evaluation, adopting the case study design, over a two-year period (2013–2015) in the district of focus. The initial programme theory was developed from 10 senior manager interviews and a literature review. To understand the processes and mechanisms triggered in the local context and identify outputs, we conducted 15 interviews with managers in the management team and seven with non-state actors. These were supplemented by researcher notes based on time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome configuration alongside theoretical constructs. RESULTS: The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom-up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justifications for change and setting the scene (a new agenda, distributed leadership). These micro-practices in themselves, and by managers engaging with them, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new practices within a routine meeting. CONCLUSION: District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant ‘bottom-up’ capacity development in district health systems. By drawing on soft skills and the policy resources (hardware) of the system they can influence motivation and buy-in to improve management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-10546-w. BioMed Central 2021-03-24 /pmc/articles/PMC7992952/ /pubmed/33761911 http://dx.doi.org/10.1186/s12889-021-10546-w Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Orgill, Marsha
Marchal, Bruno
Shung-King, Maylene
Sikuza, Lwazikazi
Gilson, Lucy
Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district
title Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district
title_full Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district
title_fullStr Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district
title_full_unstemmed Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district
title_short Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district
title_sort bottom-up innovation for health management capacity development: a qualitative case study in a south african health district
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7992952/
https://www.ncbi.nlm.nih.gov/pubmed/33761911
http://dx.doi.org/10.1186/s12889-021-10546-w
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