| dc.description.abstract | 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. | en_US |
