AJ Orenstein Lecture 2012

"Towards the clinician-led management team: a strategy for fixing hospitals?"
29 October 2012

Chris Hani Baragwanath Hospital is iconic. It may be the biggest hospital in the world, extraordinarily complex and frequently a source of conflicts. It serves the largest concentration of lower and middle class workers in the mainspring of the South African economy and it is arguably attempting to perform an impossible task.

How does one make such a monolith work? It is several decades since Professor Thomas McEwan argued authoritatively that a hospital with more than 600 beds would prove to be unmanageable. The Chris Hani Baragwanath Hospital is five times this size.

Professor Von Holdt and a team put together by NALEDI have for many years looked at how to make ‘Bara’ work and he has uncovered extraordinary information. Professor Von Holdt has an in depth understanding of the public health landscape. He has done some ground-breaking research in the area and has used his insights to make significant contributions to the National Planning Commission of South Africa to which he was appointed by the President.

Professor Von Holdt will be talking about his and others’ experiences in transforming the functioning of Professor Martin Smith’s Surgical Unit at Chris Hani Baragwanath Hospital over a period of about 10 years. The project focused on replacing the fragmented and highly centralised silo system of management, dominated by administrators, with the delegation of considerable management powers to an integrated team led by clinicians. This produced systemic changes in the way the division functioned, with positive impact on clinical processes and patient care. The transformation strategy rested on a combination of clinical, managerial and sociological expertise.

The Minister of Health, Dr Aaron Motsoaledi, has talked openly about re-engineering the health system. This lecture is designed to be not only erudite but topical. At a time that the Wits Faculty of Health Sciences is struggling to deal with a rapidly imploding health system, his insights will be very valuable and ought not to be missed! 

Biographical information: Professor Karl von Holdt is the Director of the Society, Work and Development Institute (SWOP) at the University of the Witwatersrand, Johannesburg, where he has been a senior researcher since 2007. Prior to that he was at the Congress of South African Trade Unions (COSATU)-linked policy Institute, NALEDI (National Labour, Economic and Development Institute), and before that Editor of the South African Labour Bulletin. He has published Transition from below: forging trade unionism and workplace change in South Africa (2003), Beyond the apartheid workplace: studies in transition (2005) co-edited with Eddie Webster, and co-authored with Michael Burawoy Conversations with Bourdieu: the Johannesburg moment (2012). His current research interests include the functioning of state institutions, health system functioning, collective violence and associational life, citizenship and civil society.  He was recently appointed to the first National Planning Commission of South Africa and is a member of the National Education Health and Allied Workers Union (NEHAWU) National Health Subcommittee.

Professor von Holdt started his working life teaching literacy to trade union members in the hostels and informal settlements of Cape Town in the early 1980s.  He has also served as coordinator of COSATU's September Commission on the Future of Trade Unions (1996-97), and as a Director on the Board of the South African Post Office (1997-2003).