CEO of Bertha Gxowa Hospital in Germiston, Johannesburg, Dr Nokwethemba Mtshali-Hadebe, is the youngest hospital CEO in SA, leading a team of 767 staff members. In this interview Dr Hadebe talks about turning the hospital into a Centre of Excellence through effective leadership and a marked culture change.
Tell us about your background in healthcare and why you joined the public health sector.
I graduated in Medicine from the University of KwaZulu-Natal and did my internship at the Helen Joseph Hospital. After completing my community service, I went back to Helen Joseph where I worked in the Emergency Medicine department. Shortly after that, I joined Sakhiwo Health Solutions, a Health Planning and Infrastructure company as their Marketing and Stakeholder Manager.
Before joining the Bertha Gxowa Hospital, I worked for Metropolitan Life as a Medical Advisor and left to take the position of Clinical Manager at the Far East Rand Hospital. In between that, I studied a management advancement programme and obtained an MBA degree at the Wits Business School.
Intuitively I knew that I didn’t want to specialise in any clinical disciple, so focussing more on the administrative management side of healthcare was a natural path for me to follow. When the opportunity came for me to work in the public sector, I took it without looking back.
I gained a lot of experience working in the private sector but my passion lies in the public sector and that’s where I feel that I can make the biggest impact. I’ve learnt a lot about processes and management principles, which has played a role in effecting change at the hospital, and I’m dedicated to bringing efficiency to the public sector because of what I learned in the private sector.
How has your experience and medical background prepared you for your current position as a CEO?
My experience as a doctor gave me an in-depth understanding into some of the issues my staff face on a daily basis. I understand the intricacies of the industry and I know how the system works and that stands me in good stead to improve the work experience of doctors and nurses, but it has also helped me do my job as CEO. For example, because I understand clinical processes I can ask relevant questions when we’re looking at clinical case reviews to get to the root of the problem.
My strategy is to always put my team’s well-being first in order to deliver the best quality care to patients. We find a way to work together to make sure that we address concerns and find ways that satisfy all the stakeholders involved.
Would you say hospitals are better run by doctors?
I think it’s possible for a good manager to be effective even though they might not have a healthcare background. Someone from a different industry may never fully understand the intricacies of healthcare but if they are good managers and apply themselves, they can successfully manage a hospital. Effective managers get the best out of the people they lead. If you as a leader can translate your vision of where you want to take the organisation and get buy in from the people you lead, you can succeed.
How would you describe your leadership style and how it has impacted on the organisation?
My approach to management is to get people to understand why something needs to be done and create urgency around it; provide adequate support but allow people to carry on with the process. The hospital must be able to run efficiently in my absence and for that to happen, my management team, regardless of the department they lead, must know what goes on in the hospital and the elements which make the serves function – you cannot just only focus on your area.
I’ve delegated my duties to the Supply Chain Manager and on another occasion to the HR Manager. I did that in order for the management team to understand how each department contributes to the functioning of the hospital, especially those which aren’t patient-facing. If the Supply Chain Manager doesn’t order certain consumables, it could disrupt the service. If you understand the impact and the urgency, you can make a contingency plan beforehand.
It was a positive experience because the team appreciated the experience and I have confidence that it doesn’t matter who from my team I leave in charge, the hospital will continue to function and not collapse.
What were some of the challenges that the hospital faced before you took your role as acting CEO and now as CEO?
The hospital has had a few challenges, some related to clinical processes and some related to staff attitudes. We’ve made considerable progress on some of the issues but we need to strengthen our clinical processes further. We’ve identified target disciplines that fall in line with the Sustainable Developmental Goals (SDGs) for health, for example maternal and child health. We’ve succeeded in reducing child and infant mortality to national standards.
In addition to improving clinical processes, I wanted to introduce a culture shift, and changing the perception that people have about working in the public sector. For instance, staff arriving late for work and leaving early on Fridays. There is a perception in the public sector that no one takes responsibility when things go wrong and people aren’t accountable for their actions. But I’m building a culture of doing the right thing at the right time. Healthcare workers are service providers and we need to take that seriously to provide quality care – good customer service is a big part of it.
Staff attitude affects how patients, who ultimately are the customers, experience public health. We can’t be making excuses because we are serving large volumes of people, with the majority being unable to afford private care. We have a huge responsibility to serve those patients and to do it well.
Can you tell us about the monthly merit awards that you give to staff that go above and beyond the call of duty?
One of the issues which came up during organisational culture sessions was that staff members felt demotivated because good work wasn’t acknowledged and management only noticed them when things had gone wrong. The sessions also revealed a breakdown in communication, which created barriers between management and staff.
So we used the year-end function as a way to breakdown some of those barriers. Traditionally the year-end function is a very formal and hierarchal event; we wanted to change that and get everyone in the organisation involved and build a culture of team work.
We had a property caretaker and someone from Allied Workers Union hosting and presenting the awards and we created a platform for our staff members to showcase their talents. This had a powerful impact on the staff and we wanted to continue with it, so we started monthly merit awards as a way to continuously recognise good work.
We ask managers and the supervisors and the different departments to nominate the individuals they want to recognise and then there’s a committee that sits and looks at the motivation and selects the winning person to award the merit to. We are also planning to profile the individuals in our newsletter in an effort to acknowledge the people who make this service happen.
What other initiatives have you implemented?
We’ve partnered with the Centre for Public Service Innovation (CPIS) to find innovative ways to further improve processes and the overall service. Pharmacy was one of the first departments we identified. We implemented lean management to streamline processes in the pharmacy department and have managed to reduce waiting times by 55% in a short period of time.
At first there was a bit of scepticism but once people saw the results it was easy to get their buy-in. We’ve since handed the project back to the pharmacy team who have taken ownership of the project and they provide weekly progress report. As a manager, you want to see projects progressing without you being the only driving force.
People often think innovation means coming up with grand ideas but innovation means changing the way that we are working today or what can we do better with the resources that we have. It’s really about changing mind-sets and I encourage my team to take the lead and find ways to do things differently where traditional methods don’t provide the required results.
Do you think that technology has a significant role to play in healthcare?
The era of digitalisation is upon us and there’s talk of moving from paper-based systems to electronic records. But until that’s put into policy, we need to explore how we can leverage technology and social media platforms to our benefit to strengthen the messages we put out to patients and the public.
There’s so much information available online that every person with a smartphone can now access it. If patients are turning to Google to learn more about their health, then maybe we need to put information on Google to make sure that when patients do a Google search they get the right information and that information is coming from us and not a random site on Google.
Technology is already a big part of our lives, so we need to harness it from a health point of view to improve patient care.