Journal article
A qualitative study of the dissemination and diffusion of innovations: bottom up experiences of senior managers in three health districts in South Africa.
- Orgill M Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Province, South Africa. ms.orgill@uct.ac.za.
- Gilson L Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Province, South Africa.
- Chitha W Health Systems Enablement & Innovation Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Michel J Health Systems and Policy Department, Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
- Erasmus E Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, Western Province, South Africa.
- Marchal B Institute of Tropical Medicine, Antwerp, Belgium.
- Harris B Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa.
- 2019-03-31
Published in:
- International journal for equity in health. - 2019
Bottom up
Communication
Diffusion
Dissemination
District manager
Health system
Innovation
Policy analysis
Delivery of Health Care
Diffusion of Innovation
Humans
Qualitative Research
South Africa
English
BACKGROUND
In 2012 the South African National Department of Health (SA NDoH) set out, using a top down process, to implement several innovations in eleven health districts in order to test reforms to strengthen the district health system. The process of disseminating innovations began in 2012 and senior health managers in districts were expected to drive implementation. The research explored, from a bottom up perspective, how efforts by the National government to disseminate and diffuse innovations were experienced by district level senior managers and why some dissemination efforts were more enabling than others.
METHODS
A multiple case study design comprising three cases was conducted. Data collection in 2012 - early 2014 included 38 interviews with provincial and district level managers as well as non- participant observation of meetings. The Greenhalgh et al. (Milbank Q 82(4):581-629, 2004) diffusion of innovations model was used to interpret dissemination and diffusion in the districts.
RESULTS
Managers valued the national Minister of Health's role as a champion in disseminating innovations via a road show and his personal participation in an induction programme for new hospital managers. The identification of a site coordinator in each pilot site was valued as this coordinator served as a central point of connection between networks up the hierarchy and horizontally in the district. Managers leveraged their own existing social networks in the districts and created synergies between new ideas and existing working practices to enable adoption by their staff. Managers also wanted to be part of processes that decide what should be strengthened in their districts and want clarity on: (1) the benefits of new innovations (2) total funding they will receive (3) their specific role in implementation and (4) the range of stakeholders involved.
CONCLUSION
Those driving reform processes from 'the top' must remember to develop well planned dissemination strategies that give lower-level managers relevant information and, as part of those strategies, provide ongoing opportunities for bottom up input into key decisions and processes. Managers in districts must be recognised as leaders of change, not only as implementers who are at the receiving end of dissemination strategies from those at the top. They are integral intermediaries between those at the at the coal face and national policies, managing long chains of dissemination and natural (often unpredictable) diffusion.
In 2012 the South African National Department of Health (SA NDoH) set out, using a top down process, to implement several innovations in eleven health districts in order to test reforms to strengthen the district health system. The process of disseminating innovations began in 2012 and senior health managers in districts were expected to drive implementation. The research explored, from a bottom up perspective, how efforts by the National government to disseminate and diffuse innovations were experienced by district level senior managers and why some dissemination efforts were more enabling than others.
METHODS
A multiple case study design comprising three cases was conducted. Data collection in 2012 - early 2014 included 38 interviews with provincial and district level managers as well as non- participant observation of meetings. The Greenhalgh et al. (Milbank Q 82(4):581-629, 2004) diffusion of innovations model was used to interpret dissemination and diffusion in the districts.
RESULTS
Managers valued the national Minister of Health's role as a champion in disseminating innovations via a road show and his personal participation in an induction programme for new hospital managers. The identification of a site coordinator in each pilot site was valued as this coordinator served as a central point of connection between networks up the hierarchy and horizontally in the district. Managers leveraged their own existing social networks in the districts and created synergies between new ideas and existing working practices to enable adoption by their staff. Managers also wanted to be part of processes that decide what should be strengthened in their districts and want clarity on: (1) the benefits of new innovations (2) total funding they will receive (3) their specific role in implementation and (4) the range of stakeholders involved.
CONCLUSION
Those driving reform processes from 'the top' must remember to develop well planned dissemination strategies that give lower-level managers relevant information and, as part of those strategies, provide ongoing opportunities for bottom up input into key decisions and processes. Managers in districts must be recognised as leaders of change, not only as implementers who are at the receiving end of dissemination strategies from those at the top. They are integral intermediaries between those at the at the coal face and national policies, managing long chains of dissemination and natural (often unpredictable) diffusion.
- Language
-
- English
- Open access status
- gold
- Identifiers
-
- DOI 10.1186/s12939-019-0952-z
- PMID 30925878
- Persistent URL
- https://sonar.ch/global/documents/160045
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