Activity 2.4.1: Case study presentation questions

1. Do you think this case study reflects responsible leadership? 

Yes, responsible leadership is evident in the case study. Dr Tshabalala used a hands-on approach, actively listening to stakeholders and staff before implementing changes to raise staff morale and improve patient care. Despite resource constraints, he demonstrated responsibility and remained solution-focused, demonstrating responsible leadership. 

2. What leadership styles can you identify from this case study?  

This case study demonstrates two distinct leadership styles namely participative leadership and transformational leadership. Dr Tshabalala focused on changing the hospital's culture and operations by giving employees more control over their responsibilities, allowing them to take initiative, and streamlining procedures that directly impacted patients. Transactional leadership traits are also evident in his readiness to interact directly with employees and keep track of their progress and working hours. 

3. Do you think the leadership styles presented in this case study are appropriate?  

The leadership styles are suitable as Dr Tshabalala's transformative and participative leadership styles assisted in bringing the hospital's staff into line with its objectives amidst the significant challenges it encountered. He inspired staff buy-in for the changes that were necessary by allowing them to participate in the planning process. To overcome the hospital's challenges, his strategy addressed both operational efficiency and staff morale. 

4. How would you deal with this case?  

In a similar manner, I would prioritise process improvements and adopt a transformational and participative leadership style, focusing on involving all stakeholders in the process. I would address issues with resources and morale by actively listening to the needs of the staff and patients, including the workforce in problem-solving. Furthermore, I would prioritise data-driven and technological approaches to optimise procedures, ensure ongoing employee training, and push for more government funding or external donors to address structural problems like staff shortages. 

Bulelwa Fihla 

In addressing leadership challenges at Prince Mshiyeni Memorial Hospital (PMMH), Dr Sandile Tshabalala drew upon several leadership theories. His approach was rooted in transformational leadership, where he sought to inspire staff to overcome resource constraints and improve service delivery. He also demonstrated situational leadership, adapting his style to address the varied needs of stakeholders, including hospital employees and patients. Additionally, stakeholder theory was applied as Tshabalala balanced the interests of different internal and external parties, recognising the complexity of managing a large public institution with limited resources and high demands (Zungu, Mathu, & Scheepers, 2018). 

The case study reveals multiple leadership challenges, primarily the difficulty in balancing the interests of different stakeholders. Dr Tshabalala contended with labour unrest from hospital staff, who were frustrated by low wages and poor working conditions, while patients protested against long waiting times and service delivery failures. Additionally, resource constraints, particularly in the pharmacy, posed significant challenges. To address these issues, Tshabalala engaged with unions and government officials to ensure staff concerns were heard, while simultaneously implementing process improvements, such as the cubicle dispensing system (CDS), to enhance service delivery (Zungu et al., 2018; Nxumalo, 2016). 

To combat these leadership challenges, several strategies were used. Stakeholder engagement was crucial, with Tshabalala involving staff in decision-making to gain their buy-in and encourage ownership of new processes. Process optimisation was another key strategy; for example, the introduction of the CDS streamlined pharmacy operations and reduced waiting times for patients. Furthermore, enhancing communication channels with both staff and patients helped to foster transparency and trust, reducing tensions and improving morale (Zungu et al., 2018). These strategies highlight the importance of collaborative leadership in resource-constrained environments. 

The primary stakeholders involved in decision-making at PMMH included internal stakeholders, such as hospital staff, management, and unions, as well as external stakeholders, including patients, community members, and political leaders. Dr Tshabalala demonstrated consideration for stakeholder interests by engaging all parties in the planning and implementation of changes. For instance, he worked closely with unions to address staff concerns and involved patients in the redesign of pharmacy services to ensure their needs were met (KZN Health Department, 2001). These efforts reflect a leadership style that prioritised collaboration and transparency, which ultimately helped to stabilise the hospital and restore its reputation (Zungu et al., 2018). 

Could you identify any secondary stakeholders that might be indirectly affected by the decisions made in the case study? 

Local businesses and suppliers: They depend on the hospital’s effective functioning for contracts and services. Disruptions or operational challenges could reduce the hospital’s ability to engage with them. Alternatively, improvements to the hospital's reputation and service delivery could indirectly benefit local businesses by improving the overall health and well-being of the community. Furthermore, changes in medication dispensing processes and increased patient throughput could affect the demand for medications and the logistics of supply. 

Advocacy groups: Organisations such as the HIV/AIDS activists and the Treatment Action Campaign are involved in patient welfare. Negative experiences at the hospital may affect their operations and cause them to intervene. 

Politicians and policymakers: As decision-makers, poor service delivery could trigger public outcry and political backlash, impacting their roles. 

-Mbali

Based on the case study, what ethical considerations should responsible leaders keep in mind when considering the stakeholders in decision-making? 

Patient safety and well-being: Leaders must prioritise the health and safety of patients. Issues such as long wait times, incorrect medication dispensation and respecting patients’ rights must be addressed with urgency. 

Employee Welfare: Ethical leaders must ensure fair labour practices, adequate working conditions, and wage equity. Labor unrest and dissatisfaction affect service delivery, and managers must work towards resolving these concerns through open dialouge with employees. 

Transparency and Accountability: Engaging all stakeholders through open communication channels, such as the suggestion boxes and regular forums, helps to build trust. Leaders must be transparent in their decision-making and accountable for outcomes. The impact of decisions on employees’ working conditions, morale, and safety should also be considered. Fair wages, reasonable workloads, and opportunities for professional development are crucial for maintaining a motivated and effective workforce. 

What lessons can be learned from the case study about the importance of considering stakeholders for ethical decision-making? 

1. Involving Stakeholders: A key lesson is the importance of identifying and involving stakeholders early in decision-making processes. Tshabalala’s approach of engaging both internal (e.g., staff) and external (e.g., patients, advocacy groups) stakeholders helped address systemic challenges at the hospital. 

   
   

2. Collaboration Improves Outcomes: The active involvement of staff in planning changes, such as the restructuring of shifts and processes, led to more efficient hospital operations. Empowering employees created a sense of ownership and improved morale. 

   
   

3. Responsiveness to Feedback: The introduction of opinion boxes and proactive consultations allowed management to identify and address problems. Ethical leadership involves not just listening to feedback but responding effectively. 

   
   

4. The Need for Contextual Leadership: Tshabalala's emphasis on understanding the local context, including the community’s socio-economic challenges, crime rates, and the burden of diseases like HIV/AIDS, highlights the importance of adapting leadership strategies to the specific needs of stakeholders. 

What does the literature say around the importance of stakeholder engagement and how you should include this dimension in your decision-making? 

The literature around the importance of stakeholder engagement recognises that stakeholders have become a broader group of agents that leaders interact with, have responsibility for, and try to mobilize. Moreover, it acknowledges the complex relational nature of leadership and that leadership responsibilities extend beyond the dyadic relationship of leader and follower – and that as a consequence leadership motives and values may be contested. This refers back to leadership existing in complex adaptive systems and often deal with wicked problems. 

References 

KZN Health Department (2001). History of Prince Mshiyeni Memorial Hospital. KZN Department of Health. Available at: https://www.kznhealth.gov.za/prince/history.htm 

Nxumalo, M. (2016). Durban hospital workers go on strike. IOL News, 15 June. Available at: https://www.iol.co.za/news/south-africa/kwazulu-natal/durban-hospital-workers-go-on-strike-2035260 

Zungu, S., Mathu, K.M., & Scheepers, C. (2018). Addressing operational constraints through contextual leadership at a KZN public hospital. Emerald Emerging Markets Case Studies, 8(1), 1-18. Available at: https://www.kznhealth.gov.za/princemshiyenihospital.htm 

Zungu, S., Mathu, K.M., & Scheepers, C. (2017). The South African Health Reforms 2009-2014. Emerald Publishing Limited. Available at: https://emeraldinsight.com/