Table 2

Management strategies and employee response to challenges in the face of austerity

State of managementTransformativeAdaptiveAbsorptive
 Hospital A
  • History of poor management, communication and mistrust among stakeholders.

  • Break down in management-union relations.

  • New management with autocratic management and leadership style.

  • Pharmacist joined the outreach team when three contract workers contracts were terminated to assess and monitored treatment use and adherence at clinics.

  • Non-governmental partners asked to buy items.

  • Revived Ill Health Committee.

  • Borrowed supplies from other hospitals.

  • Clerks, laundry worker, porters did other work.

  • Nurses used as cleaners, kitchen staff, porters and mortuary attendants.

  • Junior nurses manage wards and administer medication.

  • Borrow food and drugs from other hospitals.

  • Workers donated money to buy food for the patients.

  • Supervisor used their money to buy paper to print documents.

 Hospital B
  • New management had democratic leadership style.

  • Better communication and trust among stakeholders.

  • Teamwork and cohesion among managers.

  • In-service training for management and shop stewards continued.

  • Staff rotation.

  • Team discussion on how to respond to staff shortage.

  • Finance and HR managers established of bilateral forum.

  • Used interns in finance and supply chain.

  • Outsourced all services that required highly skilled artisan.

  • Used funds from Hospital Board to buy small items.

  • Some staff worked extra hours, late and on weekends.

  • Staff paid overtime, sometimes late.

  • Nurses used as cleaners, clerks and porters.

  • Junior nurses administered medication.

 Hospital C
  • Stable management with autocratic management and leadership style.

  • Lack of team work.

  • Managers do not attend meetings; decisions about budget cuts are not communicated.

  • Standard meetings with unions do not happen as they should.

  • Conflict, poor communication and mistrust among stakeholders.

  • Staff rotation in maternity section.

  • Asked 40 workers from Public Works, but was rejected by unions.

  • Revived Ill Health Committee.

  • Borrow food and medication from other hospitals.

  • Nurses used as porters, mortuary attendants, clerks and general assistants.

  • Junior nurses expected to administer treatment and manage wards.

  • Experienced cleaners were used as house keepers, electricians, welders.