CEO of Frere Hospital in the Eastern Cape, Dr Rolene Wagner, discusses the key to her success as a leader and how she and her team are transforming the previously poor performance of the hospital into a South African healthcare centre of excellence.

Tell us about your background in healthcare and how your experience shaped your leadership style.

I’m a qualified Medical Doctor and have practiced as a Medical Officer at Community Health Centres in both the Eastern Cape (EC) and Western Cape (WC). I’ve held several senior management positions in the public health sector including Chief Director Human Resource Department and acting Deputy Director General (DDG): HR and Corporate Services. When I joined the Frere Hospital management team as CEO, my focus was on delivering an effective and patient-centred healthcare service.

The various positions I’ve held have honed my emotional and social intelligence, qualities which were key in transforming Frere from the hospital that was synonymous with a poor quality service or a place where babies go to die, into a hospital where patients have a positive experience.

My team and I agreed that our higher purpose should be based on patient-centred care and through a range of clinical and operational changes we were able to turn the hospital around.

When you’re leading, there are always moments of conflict and those prepare you practically on how to engage with people and how to find a way forward. I think the public sector is a good training ground for that because our culture in the EC is built around consensus.

Many leaders have acknowledged self-awareness and empathy as key to successfully running a business.  How important are these qualities in a healthcare leader?

I think there are a number of leadership skills or traits that are necessary to be an effective leader. Every leader should know themselves, the people they bring into their management team to lead with them and the people that they lead.

I believe that every leader should have the necessary knowledge and skills for the job they are in; the emotional and social competency to understand and control their own emotions and to understand others and thereby manage their relationships with others. Most importantly, you must understand what values drive you and ensure that your personal values and the values of the organisation that you work for are aligned.

You’ve talked publically about the importance of emotional intelligence (EQ) as a leader. Expand on that for us.

One of the most important qualities a leader can have is EQ. No matter how technically sound a leader is, self-awareness and self-management helps leaders to know their emotions and how to control them for better results.

The reality is that you can have a team of good people who know the industry very well but they still may not have the desired impact because they are not using their EQ adequately. Being empathetic to the plight of our staff and patients are very important EQ aspects that helped me deal with the conflicts that inevitably arise when leading complex organisations.

Cultivating awareness and good relationship management skills is key to getting buy-in from staff of the vision you’re trying to bring to fruition. When I joined the EC DoH in 1999, one of the vital lessons I learnt was to be consultative in my approach. Engaging with your management team, developing a good business plan and developing great people are all critical to success.

What advice would you give healthcare staff about how to overcome bureaucracy in order to make a difference? 

My experience in each senior manager position held and now as CEO has taught me to concentrate on what I have control over and to not get caught up in the bureaucracy. That’s the approach we take at Frere; we concentrated on changing small things that made a difference and that we had control over, and it’s amazing to see how staff use their own initiative to improve service delivery at their level, regardless of what it is.

My can-do attitude has had a ripple effect throughout the hospital. For example, a cleaner can be the best cleaner that they can be by cleaning in a way that they feel good about. It’s about finding out what motivates them internally; it makes my job easier and I can support them in the way that they need to be supported.

Do you employ any methods to streamline processes and improve efficiency? 

We informally use the Lean Management methodology to streamline processes, and as a result we’ve improved efficiency and reduced waste. One of the problems highlighted in the local media and annual patient satisfaction survey was overcrowding and long waiting times of four to six hours in the pharmacy. After applying Lean principles, we reduced waiting times to less than 45 minutes.

Reducing waiting times was part of our goal but it was equally important that we ensured that there was adequate time for effective patient education; that users of the service were satisfied with the service delivery and that employees were engaged and inspired.

To that end, pharmacy management team engaged with the pharmacy staff to identify the root causes of the problems and to develop appropriate counter measures to address those problems. An example of which was strengthening ICT support. We activated a digital medicines dispensing module to print labels and record patient script information. We procured additional computers and printers to eliminate time wasted hand writing medicine labels.

By streamlining the workflow in the pharmacy, we’re able to manage the high demand at the Out Patient Dispensing unit and cut the waste and inefficiency.

We’ve also got a number of financial management strategies in place, including the optimal use of our budget. We make sure that the funding available supports our core business and is prioritised accordingly.

To support that strategy, we have supporting strategies where we look at ways of topping-up the budget so not to have to depend on the government as a singular source of funding. We look for opportunities to partner with other organisations to supplement our income. For example, in 2014 we received R14 million from the Carte Blanche Trust to build two new paediatric theatres. We are currently working on other revenue generation projects.

What’s your view on Public Private Partnerships (PPPs)? 

PPPs are a good idea as long as they don’t become overly bureaucratic. There are definitely areas where the strengths of the respective sectors can be leveraged for better health outcomes of the people we serve. I think the private sector realises that there are good things in the public sector too and we are all keen to work together.

With regards to bureaucracy, it’s vital that the parties who want to engage know how to do so within the framework that we must follow. If you know the rules of the game, you’ll be able to play the game. We secured the funding from the Carte Blanche Fund by following the regulations set out by the Public Finance Management Amendment Act (PFMA) around donations. We understand what the PFMA allows us to do or not do and that’s what we’re leveraging.

Can you tell us about some of the revenue projects that you’ve implemented? 

The revenue generation projects are still in an incubation phase. We haven’t yet drawn up any agreements with the medical schemes but we’ve identified aspects of our service platform and specific service units, such as our oncology and the arthroplasty unit, which deliver excellent patient outcomes. However, in order to engage with medical aids to provide some of these services contractually our extra theatres must be fully commissioned. But those are the examples of service units we will be leveraging to generate extra revenue for our hospital. Overall, patients have a very positive experience at the hospital and our services are good value for money. Medical aid patients are also increasingly choosing Frere and some medical schemes have already contracted with us to provide chronic medication services to their members.

Talk to us about universal health coverage.

Unfortunately healthcare costs have risen phenomenally with drugs and equipment costs escalating way above the rate of inflation. When that happens in the private sector, the cost of services is increased and transferred to the patients. In the public sector, we have to find innovative ways to provide healthcare services without transferring the costs to patients.

We know that access to universal healthcare is both a national and a global policy. National Health Insurance (NHI) is coming and we don’t have to wait to be part of a pilot; we need to prepare ourselves now.

When I came to Frere in December 2012, we strategized on what we needed to do to be competitive. Firstly, we needed to make sure that our services were of a standard that patients would be satisfied with in terms of quality and outcome. Secondly, we had to be efficient with the money allocated to us. Patients will choose where they want to go and how they spend their money but quality services have to be affordable.

We’re excited about the direction we’re headed in and as part of our strategy to be competitive, we’re embracing the ePatient trend, launching our website and Facebook page – the first public hospital to do so. It’s not typical for a public hospital to open themselves up in that way but we understand that we have to embrace platforms such as social media in order to grow our client base and engage with them.

You’ve been very open in talking about your personal experience with the healthcare industry because one of your twin daughters was born with a congenital neural tube defect.  How has having a child with special needs impacted your work and motivation to improve healthcare? 

Part of my path in life has been to have a daughter born with a disability. She prepared me to be able to deal with one thing at a time and to cope with adversity with a positive outlook. I’ve had numerous setbacks in life, including a divorce, but these have all served to build aspects of my EQ. None of us start out with strengths in all aspects in emotional intelligence; it’s a skills set you develop when you have to deal with a situation that life throws at you and it is developed by lessons learnt from those experiences.

I’m grateful for the lessons the challenges have taught me. They were essential; even on my first day as CEO of Frere when I was confronted with labour instability. Employees were striking over unpaid salaries and benefits owed to them. It was very clear that employee relations and morale had deteriorated to have reached that stage and I knew that I needed to live out my belief that more time needs to be spent on engaging and inspiring employees.

Together with my management team we started a process of consulting with the strikers and trade union leaders. During our engagement with staff we were mindful of their emotions and most importantly we listened to their suggestions about what needed to be done or how things could be done better. This experience alone has influenced my personality and my character. It taught me how to work with people of different abilities so that together, we could turn Frere Hospital around.

What are your plans for Frere? 

I want to take Frere to the next level. I want to see Frere having a global impact on healthcare. We see ourselves as being the best we can possibly be and a leader in how we provide services to patients. And that premise underpins our strategy of creating value so that more patients will come to Frere. The details of how we get to our goal include value talks around excellent outcomes, positive experiences of the service, good value for money and a team of dedicated people who work together in order to deliver the best service possible. We’ve looked at how we define what those core value outcomes are and all our projects and priorities are focused on finding those things that add value for our patients.

I’ve done a lot of soul searching because it’s important to do so and I can confirm that the public sector is where I’m meant to be. This is the space where I can make a difference. In my current role as a public servant, I have the opportunity to make a difference by just doing my job. And I say that to our staff as well. When you’re kind to someone, you make a difference to that person’s life. More so, when you heal them and take their pain away. We’re in a very fortunate position to work in the public sector.

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