Leadership in healthcare quality: strengthening compliance capacity for the regulations relating to standards for emergency medical services

Abstract

In South Africa, Emergency Medical Service (EMS) eligibility and compliance with Office for Health Standards Compliance quality standards for EMS is not well understood. How EMS managers’ knowledge, attitude, and professional practice can be transformed so that EMS organisations may develop capacity to comply with the quality standards for EMS is unknown. The study was conducted on South African public EMS organisations in its provinces. Although the provincial EMS organisations have commonality in terms of structure (e.g., medical qualification, rank, uniform, vehicles), there are significant variations between the provinces (constituting heterogeneity) that necessitated the national study. Through the lens of critical theory, a mixed methods explanatory sequential design was used to describe the knowledge, attitude, and practices of EMS managers in relation to the quality standards for EMS. Phase 1 consisted of a quantitative survey (n=352). Phase 2 included the non-participant observation (N-PO) of national workshops (n=7 provinces) for EMS managers. The survey data were analysed using R Core Teamâ. The survey findings informed the development of a semi-structured interview guide. Interviews (n=11) were conducted with key EMS informants, to thematic saturation. The N-PO and interview data was analysed using ATLAS.ti 23â to develop themes and sub-themes to deepen the understanding of factors that influence quality improvement in EMS. The survey knowledge, attitudes, and practices survey of EMS managers found that few (17%; n = 60) of public EMS managers were trained to manage quality. There were differences between the provinces with scores lower in the rural provinces. Key factors that hinder quality included lack the resources (61%; n = 213) to implement quality improvement projects; most (60%; n = 212) employees not following policies and standards; only 32% (n = 131) of managers said they get strong support from senior management, and few 24% (n = 83) said their staff are motivated to improve quality. What emerged was that there are underlying complex historical influences that have shaped public EMS in South Africa. There are human resource challenges in relation to the manager’s experience, education and training, unfilled vacant posts, and the unprofessional work ethic of employees. The managers felt disempowered with EMS fragmented under the district health system, EMS is marginalised within the health department and the political and labour union influences negatively impact on the EMS quality. The Capacity-Competency-Compass (C3) framework is a novel finding of the study and was found to align to each of the themes that emerged from the findings. A bespoke development of leadership competencies for EMS managers is suggested for EMS to meet the envisaged quality standards. These novel findings are of potential value to EMS and other public service policy makers, managers, clinicians and academics in South Africa and other emerging EMS health systems.