KwaZulu-Natal in 2008..59 Table 9 Standard topics discussed at district hospital board meetings in KwaZulu-Natal. KwaZulu-Natal in 2008..66 Table 12 Forwarding minutes of meetings of district hospital boards in KwaZulu-Natal.
INTRODUCTION
BACKGROUND TO THE RESEARCH
- What is known so far?
- What needs to be known?
- What is the importance of this study?
- How will the study solve the problem?
Hospital boards must contribute to the delivery of better hospital services, and board members and healthcare users must understand the role and functions of the board. Board members should be appointed with sufficient knowledge, competencies and insight into the healthcare sector.
STATEMENT OF THE RESEARCH QUESTION
AIM OF THE RESEARCH
SPECIFIC OBJECTIVES OF THE RESEARCH
ASSUMPTIONS UNDERLYING THE STUDY
OPERATIONAL DEFINITIONS USED IN THE STUDY
ORGANISATION OF THE REPORT
INTRODUCTION
GOVERNANCE
The board of directors and senior management form the backbone of hospital governance in that they direct the overall performance of the hospital by defining its mission and setting broad objectives (Flynn, 2002). The governance of any organization is affected by the composition, size and other social and demographic factors of the board.
POWERS AND FUNCTIONS OF HOSPITAL BOARDS
Third, the support and leadership of the CEO is essential for a board to be successful. Sections nine and ten of the Western Cape Health Facilities Boards Act determine the functions and powers of hospital boards in the province.
COMPOSITION AND SKILLS OF BOARD MEMBERS
Dolan (1996) further states that board members must evaluate their own performance as well as that of the board in general. He adds that the skill mix and background of the board members should be appropriate and be based on the hospital's long-term goals (Gautam, 2003).
LEGISLATION
It includes a section which provides for the appointment of hospital boards by the MEC and outlines the proposed powers and functions of such boards (KwaZulu-Natal Health Care Bill, 2007). Hospital committees have been established and trained, and training manuals and guidelines are available (East Cape Health Act, 2000).
COMMUNITY PARTICIPATION IN GOVERNANCE STRUCTURES
Becker (1993) adds that there should be more direct and prolonged contact with the neediest people in the community. Hospital boards with members residing in the hospital's catchment area are more responsive to the local community (Alexander et al., 2000).
KNOWLEDGE AND INTERACTION OF BOARD MEMBERS
When orienting hospital board members, special attention should be paid to the health problems of the local community. This can be accomplished by outlining their job descriptions and the expectations of the hospital.
INTERACTION BETWEEN THE CEO AND THE BOARD
According to Umbdenstock (2006), the CEO is the main driver of the overall competence and effectiveness of the board. Day and Klein (2005) report that CEOs, rather than governors; set the board's agenda (Day & Klein, 2005).
CONCLUSION TO THE LITERATURE REVIEW
It states that the CEO must provide essential information and leadership to objectively measure and openly report on organizational performance, which will help the board learn, grow and perform better. He concludes by stating that CEOs who facilitate board development and decision-making will directly contribute to its success and thus to the success of the organization (Umbdenstock, 2006).
INTRODUCTION
STUDY DESIGN
TARGET POPULATION
SELECTION OF STUDY POPULATION
STUDY INSTRUMENT
BIAS AND LIMITATIONS
In group discussions, some participants may have felt uncomfortable answering honestly some of the questions posed to them. The researcher is known to some of the CEOs, thus possibly introducing bias into the study, while some of them may not have been completely honest regarding the performance of their boards and/or their relationship with their board.
DATA COLLECTION, ANALYSIS AND STORAGE
ETHICS APPROVAL
INTRODUCTION
PARTICIPANTS OF THE STUDY
COMPOSITION OF HOSPITAL BOARDS
During the focus group discussions it became clear that there is no guiding document, law or regulation that prescribes the composition of hospital boards and that individual hospital CEOs decide how large the board should be, based on their own interpretation and local circumstances.
GENDER, RACIAL AND AGE REPRESENTATION ON HOSPITAL BOARDS.48
The CEOs indicated that out of a total of two hundred and forty-three (243) board members, only three (3) members had a legal background, ten (10) had a financial background, twenty-one (21) had a nursing background and one (1) had a medical qualification . One CEO indicated that it is “impossible” and “unrealistic” for the MEC to expect the hospital to find individuals with legal, financial and other expertise to serve as board members. Even hospitals in the cities and towns where the interviews took place indicated that it is not possible to recruit people with those qualifications.
ADVERTISING OF BOARD VACANCIES
APPOINTMENT OF THE MEMBERS OF HOSPITAL BOARDS
According to CEOs, there are vacancies in seventeen out of twenty-seven (63%) hospitals, and all positions have been vacant for more than three months. In some hospitals there are up to ten vacancies, bringing the total number of vacancies to seventy-one (71). A complete summary of the person serving on the respective boards is presented in tabular format below.
TERM OF OFFICE OF BOARD MEMBERS
One of the hospital board members has served up to twenty (20) years and another, eighteen (18) years.
TRAINING OF BOARD MEMBERS
Eighty-seven percent (87%) of all training was done during 2006/7 by consultants/service providers and only thirteen percent (13%) was trained by the hospital where they serve. At a hospital board meeting attended by the researcher, it was discussed that the outgoing board members should "train" and "orientate" the new new members, but this had never happened. One CHB indicated that the predominant language used by the training provider was isiZulu and that he was unable to follow and.
COMMUNITY REPRESENTATION AND MECHANISMS OF COMMUNICATION
In two hospitals, committee members indicated that they oversee clinical health committees and visit clinics located in the catchment area of the hospitals concerned, despite the provincial health law requiring clinical health committees to be established by the relevant MEC for Health (National Health Act , 2004). Again, no minutes of board meetings have been officially forwarded to the mayor's or town manager's office to present at the next local council meeting, and the researcher was unable to find any evidence to support these statements. In none of the hospitals where the interviews took place, it was not possible to find a communication strategy that described how the board formally cooperated with the community, i.e.
ATTENDANCE OF MEETINGS
FREQUENCY AND ATTENDANCE OF BOARD MEETINGS
In all hospitals, the reports compiled by the various managers were only distributed in a meeting or oral reports were given. In addition, in one hospital, a committee member is in charge of fundraising, and in another hospital, a committee member is responsible for overseeing the infrastructure and maintenance parts of the hospital. No written report was produced by any hospital where the CHB stated that it supervises the CEOs.
KNOWLEDGE OF CHAIRPERSONS OF HOSPITAL BOARDS
OPENNESS, TRUST AND CO-OPERATION BETWEEN THE BOARD AND
Eighty-five percent (85%) of CEOs believe there is trust between management and hospital boards, but only 61 percent (61%) of CHBs share the same view.
SUPERVISORY POWERS AND FUNCTIONS OF HOSPITAL BOARDS OR
Four (4) CHBs indicated that hospital boards should be part of the process to advertise, interview and appoint staff. Another chairman wanted to be involved in the allocation of budgets when he declared this. One CHB indicated that "It would be good if everyone (board members) understood their role and functions and could be trained."
REMUNERATION AND REWARDS
A CHB indicated that he is fully aware that volunteering meant performing your civic duties for free. Other interviewed participants indicated that it would be appropriate to pay their actual transportation expenses. A common response was that it would be much easier to attract a better caliber and more committed person if some remuneration was paid.
REFERRAL OF ITEMS DISCUSSED AT HOSPITAL BOARDS TO A HIGHER
Another hospital stated that a meeting with the MEC had led to the opening of a new EMS base station at the hospital and that the committee believed this was due to their intervention. The CHB mentioned that it was only after the letter was forwarded to the MEC that the local police station commander started investigating the allegation of arson at the hospital. Twice the MEC actually met with the local hospital board and only one hospital board indicated that such a meeting had led to an improvement in service delivery in their hospital.
IMPACT OF HOSPITAL BOARDS
A board member said they had successfully negotiated with a bank to install an ATM in their hospital. Another board member indicated that they represent different sectors and provide feedback on them. A board member said that they use their board money to sponsor events and are involved in open days.
PORTFOLIOS OF HOSPITAL BOARDS
A member of the same board mentioned that the hospital has received several additional computers because of their efforts. Board members do not have a good understanding of financial and accounting issues, legal knowledge, knowledge of human resources and the legislative environment. Management, led by the CEO, serve on the hospital's board and do not vote at a board meeting.
INTRODUCTION
RECOMMENDATIONS
- Training, development, capacity building and mentorship of hospital board
- Membership of boards
- Payment of board members
- Attendance of board meetings and other activities
- Powers, functions and responsibilities of boards
- Legislation and governance
The CEO and chairman of the board of directors should be responsible for ensuring that board members receive effective orientation and ongoing training. The chairman and deputy chairman must be selected from the local community the hospital serves. There must be clarity about the respective roles and responsibilities of the CEO, the chairman of the board and the board itself.
CONCLUSION
All KZN hospital boards are interim and not all the current board members have been officially appointed by the MEC. The roles, functions and powers of hospital boards are not clear and there is little evidence that decisions made by boards improve the health status of the communities they represent. Self-funded hospital boards do not have financial statements audited by independent accountants.
RECOMMENDATIONS FOR FURTHER STUDY
LIMITATIONS
There are no mechanisms for community structures and various stakeholders to provide inputs to governance for better service delivery. Do you believe that there is a good relationship between the hospital management and the members of the Board of Directors? Do you believe that the board makes a positive contribution to the vision and mission of the hospital? Poor Weak Average Good Excellent.
Does the committee communicate in your native language and if not, do you follow the discussions and debate properly? Re: Assessment of the implementation and capacity of hospital committees in district hospitals in KwaZulu-Natal in 2008.
