LITERATURE REVIEW
2.3 HUMAN RESOURCES AND POSSIBLE PROBLEMS THEREOF
2.3.4 Staff Altitudes and Behaviour
the added pressures of work in such an environment. An added advantage is that a good rural experience would possibly influence a learner to return in later years.
• The last proposed strategy was to explore the establishment of locum placement agencies to relieve of acute shortages that may develop at rural hospitals. A very successful initiative called the Rural Health Initiative was developed to attract foreign doctors into rural areas.
Although not discussed within the RUDASA strategic plan, it is important that the value of branding is considered in an attempt to attract new doctors to rural areas as part of a good marketing strategy. Keller (2003) suggests that branding can extend beyond products and services to organizations including those that are non- governmental. The following four steps are suggested on how to develop a strong brand (Keller 2003):
• The organization must ensure identification of the brand with customers and this identification must create an association, in the mind of the customer, with a specific product class or customer need.
• Firmly establish the totality of brand meaning in the minds of customers by strategically linking a host of tangible and intangible brand associations with certain properties.
• Elicit the proper customer response to this brand identification and brand meaning
• Convert brand response to create an intense, active loyalty relationship between customers and the brand
By implementing an effective marketing strategy with reasonable incentives, the rural health sector may be able to attract more professionals.
While some health care managers identify a problem with the attitudes of health care workers, others cite a low morale which in turn leads to poor relationships between patients and health care workers as a reason for there being a perception of lesser levels of health care, among patients in the public sector (Klugman, et al., 2000). Reasons for this poor staff morale and attitudes include salaries and conditions of work and the increase in workloads and lack of support systems (Klugman, et al., 2000).
The Central Statistical Service (2000) has cited unsympathetic and rude treatment of patients as one of the factors influencing people's perceptions about the quality of
service. Italso went on to say that the perceived lack of caring by health personnel can be a deterrent to service utilization.
Karl Albrect (Internet 2) identified areas of complaints within service industries which he termed as the "Sins of service". These sins can be extrapolated to all instances where a service is being offered and include the following:
• Apathy: This is where staff display a "don't care attitude" and typically occur in areas where staff are bored with their jobs or lack proper supervision and
management.
• Coldness: This is when staff display a hostile, unfriendly or impatient attitude towards their clients.
• Condescension: Staff display a patronizing attitude towards clients to make them feel child-like.
• The run around approach and the brush off attitude: This is where staff try to shift their responsibilities to other individuals or departments in an attempt to avoid their workload.
• Robotism: Staff display an almost fully mechanized approach to their customers resulting in their interactions being devoid of warmth or individuality.
• The rule book approach: This is a mechanism by which no special requests or favours are granted to clients as they are against the rules of the institute. While it
is essential; to have rules in place to prevent the abuse of resources, an employee should be cognizant of mitigating circumstances.
There is also literature on potential gaps within the service market which has been proposed by Ziethamal, Parasuraman and Berry in the form of the Servqual Model.
However, it extends beyond the scope of this particular research project.
A government initiative to improve the quality of service in all public departments has been implemented and it is known as Batho Pele. This policy on the quality of service provided includes the following (Internet 3):
• Regularly consulting with customers and service users
• The establishing of service standards
• Improving access to services
• Ensuring high levels of courtesy
• Providing more and better information about services
• Increasing openness and transparency about services
• Attempting to remedy failures and mistakes
• Providing the best possible value for money.
However, no proper evaluation of this aspect of service has been conducted.
With regards to the potential dissatisfaction amongst health care workers in rural health care institutes, a study by Thomas (2006) must be cited. This study discussed reasons for possible occupational stress amongst health care workers, as dissatisfactions and
difficulties experienced by the workforce may lead to lower levels of service quality.
This, although not specific to a rural hospital, provides us with possible insight into difficulties that the individual faces while working in a public hospital like St Apollinaris.
Itwas said, that the work environment, while not the only factor impacting on the levels
of occupational stress, was a pivotal one (Thomas 2006). The main sources of stress in the public health care sector were considered to be understaffing, lack of resources, lack of control, difficult work schedules, inadequate security and poor career advancement and salaries (Thomas 2006).
Doctors did not have a good perception of working in public sector hospitals and felt that they had little influence on their performance appraisals and career progression (Thomas 2006). Of the 2113 medical practitioners in the province of KwaZulu-Natal, only 217 were given promotions. This accounts for only 13% of the medical professionals (Department of Health 2006). Only 10.3% of medical practitioners received notch increases in their salaries (Department of Health 2006). This perception leads to poor motivation.
Junior doctors had higher levels ofjob satisfaction and this could have been attributed to youth, enthusiasm and better coping strategies (Thomas 2006).