Case Study: Who are the Stakeholders and how should you Consider and Involve them in the Decision-Making from a Responsible Leadership Perspective?

In the case study "Addressing Operational Constraints through Contextual Leadership at a KZN Public Hospital," Dr. Sandile Tshabalala, CEO of Prince Mshiyeni Memorial Hospital (PMMH), faced a complex environment of diverse stakeholders. From a responsible leadership perspective, effectively identifying and engaging these stakeholders was essential in navigating the hospital's operational challenges.

Stakeholders at PMMH

The stakeholders at PMMH can be broadly categorised into two groups: internal and external stakeholders.

Internal stakeholders consist of hospital management, healthcare professionals (including doctors, nurses, and pharmacists), administrative staff (clerks and porters), and the government, which owns and funds the hospital. These individuals and entities are directly involved in the day-to-day operations and decision-making processes within the hospital.

External stakeholders include patients, labour unions, the local community, political figures, media representatives, and civil society organisations such as HIV/AIDS and civil rights activists. These groups are affected by the hospital's services and have an interest in its performance and impact on public health.

Involving Stakeholders in Decision-Making

Dr. Tshabalala adopted a responsible leadership approach by recognising the importance of involving all these stakeholders in the hospital's decision-making processes. His strategies demonstrated a clear understanding of the complexities within the healthcare environment, focusing on collaborative solutions that addressed the specific concerns of different stakeholder groups.

For internal stakeholders, Tshabalala prioritised engagement with unions, which had a history of labour unrest at PMMH. He recognised that stabilising the workforce was crucial for maintaining consistent service delivery. By arranging a meeting with the Member of the Executive Council (MEC) for Health, he facilitated an open dialogue, allowing employees to voice their concerns and receive direct responses about the government's commitment to addressing their issues. This approach aimed to build trust and reduce the likelihood of further disruptions.

When addressing the concerns of doctors, who were struggling with heavy workloads and inefficiencies, Tshabalala introduced a patient batch treatment system. This system streamlined patient consultations, reducing wait times and idle periods, and ultimately allowed doctors to manage their time more effectively. This intervention demonstrated his commitment to improving the working conditions of medical staff, directly impacting their ability to deliver care efficiently.

In response to challenges faced by pharmacy and admissions staff, Tshabalala took a hands-on approach by observing their workflows and identifying key bottlenecks. He actively involved these staff members in planning changes, which included implementing the Cubicle Dispensing System (CDS) and doubling the number of dispensing windows. By doing so, he empowered the staff, fostering a sense of ownership and responsibility, which in turn improved morale and overall productivity.

For external stakeholders, particularly patients, Dr. Tshabalala's focus was on enhancing the quality of service delivery. He implemented measures to reduce wait times at the pharmacy, such as increasing the number of dispensing windows and reorganising medicine dispensing processes based on patient categories. These actions aimed to directly address patient dissatisfaction, a major concern given the high demand for services at the hospital.

Engaging the local community was another crucial element of Tshabalala’s strategy. He recognised the value of community-based solutions, especially for chronic patients who needed ongoing access to medication. By arranging for the distribution of chronic medicines at local community centres, such as churches, he made healthcare more accessible and reduced the burden on the hospital’s facilities.

In addition, Tshabalala understood the importance of maintaining a constructive relationship with politicians, who play a role in representing the concerns of the community and influencing public perceptions. By keeping them informed about ongoing improvements and addressing issues raised in the KZN legislature, he mitigated potential negative media coverage and ensured continued political support.

Lastly, collaboration with civil society organisations, such as the Treatment Action Campaign (TAC), was integral to Tshabalala’s approach. Recognising the TAC’s expertise and network of community health workers, he partnered with them to enhance follow-up care for patients with chronic diseases like HIV/AIDS and TB. This collaboration not only improved patient outcomes but also strengthened the hospital’s ties with key external partners.

Principles of Responsible Leadership

Through these actions, Dr. Tshabalala exemplified core principles of responsible leadership. His approach to stakeholder engagement involved actively seeking input from a wide range of groups, appreciating their unique perspectives and contributions. His focus on transparency and communication ensured that stakeholders were kept informed about changes and the reasoning behind them, fostering trust and reducing resistance.

By involving staff in the decision-making process, Tshabalala emphasised empowerment, allowing employees to take ownership of their roles and contribute to problem-solving. This participatory approach enhanced morale and increased the likelihood of successful implementation of new strategies. Finally, his commitment to collaboration with external organisations demonstrated a willingness to leverage available resources and expertise, broadening the hospital’s capacity to address complex healthcare challenges.