Voices from the Field: Performance Improvement Workshop Enhances Supervision of Health Workers in Lesotho and Swaziland

Influenced by a workshop on strengthening supervisory skills, Nurse Sister Sibongile Khoza now sits down with her subordinates to find the root cause when a difficulty arises: “In one instance, I discovered that burnout was causing a nurse’s negative attitude towards work. Sitting down with her and thrashing out the problem worked.”

Khoza, from Swaziland’s Mbabane Government Hospital, participated in the performance improvement workshop through the IntraHealth-led Southern African Human Capacity Development (SAHCD) Coalition. Matron Meddy Shongwe from the Manzini Regional Health Office—who supervises five nurse sisters—also participated: “The workshop taught me about team work, leadership skills and how to motivate people. I have used it in everyday planning, problem solving, and conflict resolution as well as supportive supervision.”

Strengthening supervision is one strategy to better support Swaziland’s health workers as they deal with the country’s very high rate of HIV infection as well as other urgent health needs amidst a chronic shortage of doctors and nurses.

Another participant who has modified her supervisory approach as a result of the workshop’s lessons is Nurse Matron Mabuza, who works at Pigg’s Peak Government Hospital: “I have used what I learnt from the performance improvement course in my work not to impose on the staff that I supervise.” The course persuaded Mabuza to better listen to her subordinates and include and empower them in the decision-making process, and Mabuza learned to give them space to work out their problems.

After attending the workshop, Mabuza sat with her staff—five nurse sisters, 35 staff nurses, and 23 nurse assistants, auxiliaries and orderlies—and shared her lessons with them. She encouraged them to work well among themselves and listen to one another’s ideas.

To create clearer expectations for her staff, Mabuza has been involved in formulating policies and guidelines for a quality improvement program. “We are putting the policies in writing so that everyone in the department is aware of what they are supposed to do,” she comments.

Initially, working on the policies was challenging for the hospital staff. “At first we felt it was impossible to formulate a policy, until we realized that it is exactly what we are doing everyday,” adds Dr. Ngorima, a physician at Pigg’s Peak hospital.

As interventions like policies are shared with the staff, “the challenge is bringing the staff to the same understanding as everyone who attended the [SAHCD workshop] so that they own the intervention as an improvement to our facility and to our patients,” says Mabuza.

Pigg’s Peak Hospital has benefitted from other improvements because of the SAHCD intervention despite the facility having a shortage of resources. Sister Siphiwe Mahlalela, who is supervised by Matron Mabuza, expressed how the performance improvement workshop, like SAHCD’s other workshops on leadership development and quality assurance, has enhanced teamwork among staff members. “We felt empowered that you can take advantage of the available resources. For example, we had a problem in the kitchen when the contracted company left without notice, and the support staff team helped with the cooking until a replacement was found.”

Staff members have been credited with:

  • Allocating a room in the outpatient department that is set aside for emergencies. A doctor is now assigned to this room to attend to emergency patients, allowing both emergency and non-emergency patients more privacy.
  • Moving the location of the x-rays closer to the outpatient department, where they are needed most often
  • Creating signs that provide directions to the different departments and services offered
  • Fostering enhanced team spirit among employees
  • Cleaning up the yard and removing machines that were lying around
  • Developing hand washing procedures
  • Fixing the incinerator.

Funded by USAID, the SAHCD Coalition is comprised of five organizations besides IntraHealth: Council for Health Service Accreditation of Southern Africa; Management Sciences for Health; East, Central and Southern African Health Community; Foundation for Professional Development; and Training Resources Group Inc.

The Coalition aims to establish a strong coordinated regional response to the HIV/AIDS epidemic in Southern Africa and to improve the capacity of the public and private sectors to deliver HIV/AIDS services. An associate award of the IntraHealth-led global Capacity Project, the Coalition:

  • Provides technical assistance in human resources for health planning, policy and advocacy
  • Contributes to the development of training programs, curricula, standards and policies
  • Strengthens human resources information and management systems
  • Builds local capacity in policy development and implementation
  • Enhances knowledge management and best practices programming.