White Paper: Improving Patient Safety in Public Hospitals in South Africa with Minimal Resources


This white paper examines whether training healthcare leaders to coach workers at the front line to identify and solve problems results in fewer prenatal deaths in a resource constrained health setting in South Africa. The training was delivered virtually by U.S. coaches using standard materials and monthly phone calls.  We chose hospitals in the public hospital system in the Gauteng province (greater Johannesburg) South Africa to test the hypothesis that Organizational Excellence can work in developing economies. We found that patient outcomes improve when leaders learn to coach frontline workers. 

What’s inside?

  • Frontline staff's role is to identify and solve problems
  • Management's role is to assure that people are trained in problem solving
  • The cultural environment needs to make it safe for people to speak up about problems

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Evolving Leadership

South Africa currently spends 8.7 % of GDP on healthcare, but only 4.2 % on public healthcare. The public system covers some 50 million uninsured South Africans while the other 4.3 % of GDP is spent on private health care. The majority of the 8 million white South Africans have access to private insurance, private practice physicians and private for-profit hospitals. Public hospitals in South Africa are overcrowded and have difficulty serving the needs of the poor and mostly uninsured population. The results are long waiting times to see physicians and receive medicine, as well as very high hospital infection rates leading to death. Infant mortality hovers around 28/1000 vs. 5.8/1000 in the U.S.

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