Exploring the roles and experiences of health managers participating in the appointment systems learning initiative in city health facilities in Cape Town
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Background: The appointment system learning initiative (ASLI) was introduced in 2016 as a way of implementing appointment systems in the City of Cape Town, in response to lengthy waiting times at PHC facilities It was intended as a safe space for learning, and piloted facility-generated planning in which knowledge was shared in workshops over 18 months. Variability in how well appointment systems had taken root was noted at the second feedback workshop. Currently, there is little information on the experiences, perceptions and roles of managers with regard to the initiative, or what unforeseen issues may have had an impact. Aim: This study aimed to reach an understanding of how the Appointment Systems Learning Initiative approach and its implementation was experienced by participating facility and PPHC managers at City Health facilities in Cape Town. This includes an exploration of the roles and experiences of health managers, including their perceptions of the benefits and challenges of the process. Methods: A qualitative, exploratory design was used. Individual, semi-structured interviews were conducted with a sample of twelve facility managers and two PPHC managers. Manager’s roles were analysed deductively according to Mintzburg’s 2009 framework, while other data analysis was inductive. Ethical clearance was obtained from UWC BMREC prior to commencement. Informed consent was obtained from participants and confidentiality was preserved at all stages of research. Results: Managers viewed the learning experience positively and felt that facility-generated planning was preferable to hierarchical imposition of programmes. They found it motivating to learn how other facilities had solved problems and designed their systems. Contextual changes to the health system affected ASLI by increasing the pace and prescriptiveness of implementation, and impeded the capacity for PPHC managers to offer support. Facility managers fulfilled critical leadership roles according to Mintzberg’s model, but the way in which they carried out roles such as delegation, team building or communicating may have affected implementation. Challenges included issues with human resources, insufficient time available for managing implementation, lack of preparation beforehand, insufficient support and contextual changes. Benefits included shorter working hours for staff, better organisation in facilities, shorter waiting times and improved satisfaction for end-users.