/ 16 October 2006

Going solo

Chris Hani Baragwanath Hospital, Gauteng

The transformation of Africa’s biggest hospital is being closely watched by trade unions and the Gauteng departments of health and public service and administration to see whether it could be a model for change countrywide.

Empowering hospital CEO Arthur Manning and clinicians to take control of the operation of Chris Hani Baragwanath Hospital is at the heart of the project, with the massive surgical division acting as the guinea pig for a new operating system.

A few months back, Manning was the first public hospital CEO to be given the power to appoint his own staff and draw up his own budget for this massive 2 800-bed hospital.

”The delegation of power [from the province] to the CEO is being further delegated down to the surgical division so that it can take control of procurement, budgeting and cost control, human resources and so on,” says Karl von Holdt, a consultant working on the project. This is possible because of the willingness of new Gauteng Health Minis­ter Brian Hlongwa to adopt an ambitious vision and take bold steps to support it.

The surgical division, with 700 beds in 15 wards, is the size of a medium-sized hospital. The idea is that ”nurses and clinicians are being empowered to take control of the clinical and healthcare domains and manage them effectively”, says Von Holdt.

At present, healthcare at unwieldy Chris Hani is ”a bit of a hit and miss. You can have operations here that you would have in the best hospitals in the world,” says Professor Martin Smith, head of the surgical division and the transformation project. ”But if you get here on the wrong day, when there are not enough nurses in the ward, or you don’t have a bed, or your operation gets cancelled, or the lab hasn’t done the blood results properly, you’re endangering your life.”

Earlier this year, health workers embarked on protest action to save Chris Hani’s transformation project, which was started in 2001 but was stymied by government’s failure to release the R10million it had promised to fund the changes. Since the protests the Gauteng health department has released R5million and appointed trade union think tank Naledi to manage the transformation for a year.

Von Holdt, who is part of Naledi, says the project is back on track and going at full speed.

Chris Hani’s main problems are staff shortages (about a third of posts are vacant), huge workloads for health workers, dysfunctional management and a completely inadequate budget.

The overall aims of the project, which are supported by all staff, including management, are four-fold:

  • To ensure that the department delegates enough power to hospital managers to enable them to fulfil their responsibilities.
  • To develop a human resource strategy to support and develop overburdened staff.
  • To reorganise wards and departments to ensure that staff — management, doctors, nurses and support staff — work together as one unit, rather than in ”silos”.
  • To ensure that the budget is sufficient, based on the needs of the hospital, not on what has historically been allocated to Chris Hani.

The budget is a sore point, says Von Holdt, with apartheid-era inequalities still plaguing the hospital. ”Chris Hani’s budget [two years back] was about R330 000 per bed per annum. But Johannesburg General has a budget of about R730 000 per bed per annum. What this means is that staff are working under appalling and impossible workloads; they are burnt-out, demoralised and frustrated, and they can’t work to full capacity. Many of them resign and leave.”

A number of dramatic changes have taken place in the surgical division, the most important being the appointment of 100 additional nurses funded from vacant posts in the hospital. Sister Ruth Kgesa, chief professional nurse in surgery, says the additional nurses have meant that ”there’s hope at the end of the tunnel”.

Smith believes the changes in the surgery department have made patient care ”far better”. But Fikile Majola, general secretary of health workers’ union Nehawu, says there is still a long way to go. ”What is sad is that we still have patients sleeping on the floors. Patients are being sent back home when they have not been properly treated.”

In addition, there are only 18 intensive care unit beds and eight high-care beds that are always full; 200 critical care beds are needed.

A study by Professor Helen Schneider of the Wits school of public health shows that ”with time, what has happened is that the hospital selects the most ill people for admission. So, if you’ve got mild pneumonia or even have a mild heart attack, your chances of being admitted are slim.”

For a number of years, the province has planned to build district hospitals to alleviate the pressure on Chris Hani, but until that happens staff will continue to feel the pressure of working in one of the busiest hospitals on the continent.