Changing our ways of working: The Leadership in Action initiative

What does this mean for healthcare services in rural districts?

Imagine how much better patient care would be if we instilled in overworked healthcare staff a constant awareness of their common humanity, mutual respect and patience, with active on-site leadership.

Add to that collaborative teamwork, listening to one another in a more flattened hierarchy and mutually acknowledged best care practice, and you very quickly have a more functional, efficient healthcare system. That’s the working theory, but Prof Louis Jenkins, Head of Family and Emergency Medicine at the Stellenbosch University-linked George Hospital, wants to help turn it into a sustainable leadership development model.

Pragmatic, ethical and values-driven team practices are at the core of the envisaged leadership training.

This George Hospital-based veteran physician has targeted two health districts in the Western Cape for a two-year values-driven Leadership in Action outreach workshop programme to make his vision a reality.

Solid corporate and academic backing

Besides the Discovery Foundation, he has some formidable backing through the Department of Family and Emergency Medicine at University of Stellenbosch, the Academy of Business in Society, the Nottingham Business School, the IBM Corporation, and GlaxoSmithKline Pharmaceuticals.

With Prof Arnold Smit, Head of Social Impact at University of Stellenbosch Business School and Dr Zilla North, the George Hospital medical manager, the team hosted multidisciplinary workshops in the Garden Route and Central Karoo districts over four weekends in 2019. This would have continued in 2020. However, with the COVID-19 epidemic, the plans had to be adapted.

Monthly internet-based district-wide multidisciplinary discussions around ethical dilemmas in healthcare leadership are now taking place. “Many healthcare workers on the frontline and health managers are battling to balance care for patients with SARS-CoV-2, patients with the usual illnesses (which are now relatively neglected), care for colleagues taking strain or losing loved ones, and of course self-care,” Prof Jenkins says. If the programme has the desired impact, the model will be rolled out to other districts, even provinces.

George Regional Hospital serves 10 district hospitals and Prof Jenkins, with his substantial rural healthcare experience, is intimately familiar with the human resources, equipment and administrative challenges of rural primary healthcare.

“We know from experience that stable, robust rural healthcare teams are built on a long-serving, dedicated and committed leadership core. We want to impart the skills and values-driven practices that help make sustainable leadership possible,” he says.

Balancing patient care with self-care

He cites an example of the Beaufort West District Hospital losing its medical manager a few years ago. “Suddenly, the junior doctor team was without leadership. It impacted hugely on their social worker, nurses and allied health professionals. Eventually, a medical officer became the clinical manager and then the medical manager and has now been there for more than five years. Today, it’s one of the most robust hospitals in our area,” he says.

Asked to outline an ethical dilemma from everyday practice, Prof Jenkins cites a medical doctor working in eye clinics where 60 to 70 patients are booked daily. The doctor often works until 20:00 on clinic days. Healthcare workers need to develop the ability to unpack and voice the dilemmas of caring for patients while also maintaining a sustainable lifestyle.

“The ethics of balancing good patient care with wholesome self-care is explored in these workshops. Understanding what values drive us and developing better self-management are just some ways to keep colleagues healthy and retain them in the rural areas,” he adds.

Assumptions are destructive

Often there are assumed values around respect and trust, which illustrate a power gradient. “For example: when a community service doctor at a district facility calls a more senior regional hospital doctor who snappily asks why they cannot do the procedure themselves. It’s very easy for regional staff to be presumptuous, not realising what their district or primary healthcare clinic colleagues are up against,” he adds.

Building trust involves taking time to ask after one another’s wellbeing. “We want to recognise the common humanity among staff and our patients,” he says.

“If somebody refuses to do something, going the disciplinary route can be destructive. Instead, ask them what’s going on. They might be having financial problems or be a single, divorced mother. Asking in an unguarded moment can build, heal and restore meaning for this person at work. If somebody’s lost their joy and is bordering on burnout, that helps. It’s about awareness, listening unconditionally and compassionate caring. That’s what brings us together,” he stresses.

Asked how one builds resilience to avoid burnout, Prof Jenkins says experience has taught him that it’s not just about hard output such as the number of patients you attend to, operations, outreaches or cost efficiencies.

A Western Cape survey conducted in 2016 on behaviour change, organisational behaviour and performance in the provincial healthcare system highlighted some concerns. “Staff reported that they experienced the workplace as hierarchical, and that they weren’t appreciated or being heard. Since then, there’s been an active process of culture change to improve things at all levels – and our work is aligned with this,” he says.

Ethical leadership development

The programme focusses on ethical dilemmas with systemic consequences. The goal is to build relationships and enable communication and collaboration to resolve healthcare-system issues. Prof Jenkins says once the COVID-19 epidemic settles down, they will have three multidisciplinary workshops and one train-the-trainer workshop over four years.

“The various district hospitals and sub-district primary healthcare clinics nominate people. We’re keeping the workshops down to about 15 people to make sure it is interactive and allows people to discuss real ethical dilemmas.”

As part of this work, a graphic designer has developed a high-quality practical workbook to bolster the training and to help develop more trainers for the rollout of the values-driven Leadership in Action programme.

Prof Jenkins observes that South Africa has gone through a period of ‘very questionable’ ethics in many sectors recently. “But there’s been a turn and we recognise that to practise ethical medicine, ethical leadership is critical. We want to be part of new hope in South Africa,” he adds.

More about Prof Louis Jenkins

Prof Jenkins is the Head of Family and Emergency Medicine at the Stellenbosch University-linked George Hospital and is in charge of the training complex. Married to a former school teacher who volunteers as a counsellor for women with crisis pregnancies, Prof Jenkins runs three times a week and loves gardening and planting trees on his smallholding near Wilderness.

The images on this page were taken leading up to the 2019 Discovery Foundation Awards before COVID-19 reached South Africa. Stay healthy. Stay home.