The improvement of organisational performance and healthcare service delivery through knowledge management practices in the Gauteng Department of Health
Badimo, Kgabo Hendrik
This research was instigated by testimony of the failure and the subsequent crisis in the South African public healthcare system. Official investigations had brought to light alarming operational deficiencies in institutions under the aegis of the Gauteng Department of Health. The South African public sector and government departments, in general, are currently challenged by a complex transformation process which has a prime objective to ameliorate public accountability, service delivery and budgetary control. They are likewise faced with the equally labyrinthine and demanding task of establishing a public-sector organisation with meaningful and effective operational processes that are, in addition, expected to synchronise with the modern economy. The researcher is unequivocal: the success of the GDH in responding to the challenges of improving organisational performance and healthcare service delivery depends essentially on their knowledge management strategy.
Knowledge, across public-sector organisations, is increasingly being acknowledged, not only as a strategic resource but also as a valuable organisational asset. In the context of this research, knowledge is defined as the experience that resides in the minds of people; termed tacit knowledge (as opposed to formal, codified or explicit knowledge). In an analogous manner, research studies abound with evidence that has identified knowledge management as having an influence on operational performance for healthcare service delivery. Yet, a brief inquest indicated that our overall understanding of the existence of the relationship between knowledge management and operational performance for healthcare service delivery in the South African public sector is, at best, exiguous.
With these appraisals in mind, the researcher developed a theoretical model that revealed factors that could influence organisational performance and healthcare service delivery. The model focused on knowledge management capabilities and organisational performance. The prime objective was to operationalise the theoretically derived knowledge management capabilities constructs, identify statistically the enhancing or impeding factors that impact on organisational performance and develop a structural equation model to verify this theoretical paradigm. The ambition of this study was similarly to investigate the use of knowledge management by the Gauteng Department of Health for its transformation to achieve improved organisational performance and healthcare service delivery. This study in essence addressed four research questions: Firstly, what was the level of understanding of knowledge management in the Gauteng Department of Health and related healthcare facilities? Secondly, how were knowledge management strategies and practices aligned with the Gauteng Department of Health strategies and operational objectives? Thirdly, how was knowledge management used by the employees in the Gauteng Department of Health? and fourthly, how could the results of the literature review and the empirical data be used to create a knowledge-management culture and a collaborative working environment for the Gauteng Department of Health? The elemental, hypothesised pursuit governing the study was to determine the existence of a relationship between the use of knowledge management and an improvement in organisational performance and healthcare service delivery. Collaterally, what enabling environment would be instituted by the gatekeepers of the institutional praxes to capacitate other staff members specifically so as to include the succession planning conundrum?
To accomplish this and after reviewing the literature, the effective factors in knowledge management were identified, namely, knowledge infrastructure proficiencies and knowledge process capabilities. The research followed the parallel mixed-methods approach in gathering and analysing research data. Data was collected using questionnaires with 496 respondents and interviews with 35 interviewees. The sample used in this study comprised employees of the Gauteng Department of Health and its regional healthcare centres. The survey respondents and interview participants were the general staff and executive/senior managers of the Gauteng Department of Health. These individuals were considered to possess the most comprehensive knowledge about their organisation’s characteristics and strategy, which included knowledge management adoption.
In order to identify the relationships between the model elements, appropriate tests were initiated using the Statistical Package for Social Sciences. Exploratory and confirmatory factor analyses and structural equation modelling were utilised and the proposed model was then extracted and content analysis was applied in evaluating the resulting qualitative data.
The findings of this study furthermore indicated that knowledge management concepts were not universally understood in the Gauteng Department of Health. A structural equation model development strategy, postulated in the factor analysis, also produced a new best-fitting knowledge management capability model based on the new constructs. The structural equation model suggested that significant factors influencing the improvement of the organisational performance and healthcare service delivery are those of knowledge management capability. The regression analysis showed that most of the inter-correlations were significant, thus confirming the theory that knowledge management capabilities have a direct influence on organisational performance and healthcare service delivery.
The research contributed theoretically to a comprehensive understanding of the relationship between knowledge management principles and factors that influence organisational performance and healthcare service delivery. Practically, the research contributed to confirming the use of knowledge management by the Gauteng Department of Health could to the improvement of its overall organisational performance and healthcare service delivery. The study further demonstrated the impact of knowledge management activities as a driving force for organisational change and the effect of knowledge management on the improvement of workforce productivity and organisational effectiveness. The new knowledge management capability model could additionally assist the Gauteng Department of Health determining the extent to which knowledge management is used and where to focus in developing and implementing knowledge management strategy. The study encourages practitioners to take cognisance of the fact that organisations are unique and that the factors which enhance or impede knowledge management are to be thoroughly examined.
This case study was endorsed for its significant contribution to regional healthcare system, as well as the broader national healthcare structure.
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