A health care management control model for effective performance of the South African public healthcare system

Ph.D. (Business Management)Ever since Anthony (1965) in a seminal paper titled: “Planning and Control Systems” initiated the debate on the nexus between management control systems and the improvement on the organisational performance, the contentious issue in the debates which have been raging in the 21st century has not been centred on whether management control influences the organisational performance, but on the key constructs that determine the effectiveness of a management control model. In effect, different theorists and organisational practitioners have interpreted the predictors of effective management control differently. It is not questionable that these different debates and interpretations have resulted in a plethora of different and competing management control theories which have so far proved effective for measuring and improving the performance of most of the modern organisations. However, the fundamental argument in this thesis is that considering the pace of the evolution that the modern organisations are undergoing and the specific management control related challenges that continue to mar the effective performance of the modern South African public healthcare system, an analysis of the existing management control theories reveals a nemesis anchored on a total lack of appropriate coherent management control model which can be adopted for improving activities’ control in the South African public healthcare system. In a bid to develop an alternative management control theory which can be used for remedying such practical and conceptual limitations, the study posits in its overriding research hypothesis that the effective application of the a priori multidimensional healthcare management control model in Figure 1.1 would significantly influence the successful monitoring and evaluation of the activities in the South African public healthcare system. It is also part of the proposition in the overriding research hypothesis that the effectiveness of the a priori multidimensional healthcare management control model in Figure 1.1 is predicted by the four constructs that include; considering the essential healthcare management control prerequisites, setting the appropriate healthcare performance standards, the use of a balanced combination of healthcare management control techniques, and the application of the appropriate healthcare corrective and improvement measures. Despite the fact that the evaluation of discrete management control theories and literatures confirmed that it is ubiquitous in the modern organisational practices that the effectiveness of a management control model is influenced by these four constructs, the study also applied confirmatory factor analysis as a quantitative research technique to determine the overall fitness of the a priori multidimensional healthcare management control model in Figure 1.1. A general interpretation of the results of confirmatory factor analysis indicated that the a priority multidimensional healthcare management control model in Figure 1.1 perfectly reproduces the observed 416 sample data. This sample data comprised of public healthcare managers and officials who were drawn through multistage sampling from a target population of 4 776 public healthcare managers and primary healthcare facility coordinators in South Africa. In addition to confirmatory factor analysis, the thesis also used structured interviews as the main qualitative research technique to enhance the detailed evaluation of how management controls are accomplished in the South African public healthcare system and the additional constructs and variables that could be used in the modification of the model in Figure 1.1. The thematic analysis of the qualitative data collected from 50 interviewed public healthcare officials and managers in the Gauteng and Mpumalanga Provinces indicated certain constructs and variables which were per se distinct from the four constructs in the healthcare management control model in Figure 1.1. However, the interpretation and comparison of the results of confirmatory factor analysis with the key interview findings yielded conclusions which are at tandem with the ratiocination in the overriding hypothesis that the effectiveness of a healthcare management control model is measured by the four constructs in Figure 1.1. While drawing from these final findings, it was recommended that the South African public healthcare system must adopt the postulated healthcare management control model in Figure 1.1 as the measure for improving the monitoring and evaluation of its activities so as to not only achieve the desired level of performance, but also the outlined strategic public healthcare objectives and goals. In other words, it is argued that the use of the postulated healthcare management control model in Figure 1.1 would provide a turn around strategy for the reason that the resulting significant improvement in the monitoring and evaluation of the activities’ accomplishment would significantly influence the general improvement in the performance of the South African public healthcare system, and subsequently the enhanced ability to achieve the outlined strategic public healthcare goals and objectives. The thesis concludes with the suggestion that, other than in the healthcare sector, further research can explore how the postulated management control model in Figure 1.1 can be used to improve process efficiency, resources’ optimisation and competitiveness across different organisations