Organisational culture and trust as influences over the implementation of equity-oriented policy in two South African case study hospitals

This paper uses the concepts of organisational culture and organisational trust to explore the implementation of equity-oriented policies – the Uniform Patient Fee Schedule (UPFS) and Patients’ Rights Charter (PRC) - in two South African district hospitals. It contributes to the small literatures on organisational culture and trust in low- and middle-income country health systems, and broader work on health systems’ people-centeredness and “software”. It was concluded that achieving equity in practice requires managers to take account of “unseen” but important factors such as organisational culture and trust, which are key aspects of the organisational context that can profoundly influence policies. In addition to implementation “hardware” such as putting in place necessary staff and resources, it emphasises “software” implementation tasks such as relationship management and the negotiation of values, where equity-oriented policies might be interpreted as challenging health workers’ status and values, and paying careful attention to how policies are practically framed and translated into practice, to ensure key equity aspects are not neglected.

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Erasmus E, Nkosi M, Govender V, Gilson L. Organisational culture and trust in the health system: how different mind-sets, values and relationships influenced the implementation of equity-oriented policy in South African case study hospitals. International Journal for Equity in Health. 2017;16(164). doi: 10.1186/s12939-017-0659-y