Introduction

NALEDI was commissioned by DPSA in early November 2005 to research the
functioning of public hospitals in South Africa, building on our experience in the Chris
Hani Baragwanath Hospital (CHB) transformation project. Given that the research report
had to be completed by the end of the first week in December, it was agreed that
NALEDI would limit its investigation to eight tertiary (level 3) and regional (level 2)
hospitals in three provinces.

We conducted on average four interviews in each institution (with the CEO, a senior
clinician, nursing middle manager/s, and trade union shop stewards). While this provides
a somewhat limited assessment of hospital functioning, it does nonetheless provide broad
indicators. We used the intensive and in-depth analysis developed in our four-year-long
research and participation in the CHB transformation project to guide our interviewing
strategy and interpret the results.

The research methodology we have employed is essentially a qualitative methodology,
which facilitates a more complex analysis of the relationship between cause and effect
than quantitative methodologies and permits the ‘experience from below’ to be captured
and explored. The research conducted at CHB consisted of a series of intensive
interviews and focus groups with representatives of all occupational categories and
management groupings within Chris Hani Baragwanath in order to identify problems and
develop strategic proposals for transformation. These were conducted in 2002 and 2004.
In addition, our research has consisted of a process of participant observation over the
period of four years that NALEDI has been present at the institution as a transformation
adviser