The impact of job redesign on employee job outcomes : the case of the implementation of a private-public partnership model at a hospital

It has been widely reported that despite high health expenditure and a myriad of policies in place, South Africa’s health outcomes are worse than those in many lower income countries. The adverse health outcomes are even more pronounced in a rural province such as the Eastern Cape Province. Consequently, the Eastern Cape Department of Health (ECDOH) had turned to Private Public Partnerships (PPP) with the hope of mitigating some of the challenges beleaguering the health system in the province. This study evaluated the impact of the implementation of one of the PPP models at an Eastern Cape Hospital on key employee job outcomes. This is crucial as there had not yet, been this type of scientific assessment of the impact of the PPP model since the inception of the PPP about half a decade ago. Theoretical guidance of the study was provided by the Job Characteristics Theory (JCT) of Oldham and Hackman (1975), which predicted that changes in five core characteristics of a job will affect three critical psychological states which will in turn impact on key employee job outcomes. Uniquely, this study veered away from the traditional quantitative approach to the application of the JCT but rather adopted a qualitative case study approach. There is historical evidence that cross cultural validation of a theory in a new setting (a South African PPP hospital in this instance) benefits from an initial qualitative study. Data collection and analysis were guided by the JCT. Primary data collection was by semi-structured, face to face, one on one interviews. The analyses of the data specifically employed pattern matching and explanation building techniques, all underpinned by the JCT. Validity of interview data was strongly contributed to by available relevant case study documents. This study found that indeed, the implementation of this PPP model brought about changes in all five (JCT) core job characteristics of clinical staff, but to varying degrees in the three unique shared service areas. Interestingly, the three psychological states were found to have been impacted upon by changes in the JCT core job characteristics but also by factors related to the context of the job, such as quality of supervision and co-worker relationship. In contrast to the predictions of the JCT, this study also found that the key job outcomes were impacted directly by such contextual factors as the recent availability of specialists and staff shortages, among others. It also emerged that the PPP implementation has directly evoked a perception of inequity and breach of psychological contract among clinical staff working at the shared service areas. Among the three shared areas, the accident and emergency unit was discovered to have had the worst overall impact. Due to the importance of contextual factors at this PPP setting, key recommendations were directed towards improved management of the jobs. It is also recommended that a follow-up quantitative study be commissioned to further explore the main themes that emerged from this study. This research report is presented in three sections. Section 1 is the evaluative report itself, structured as an academic paper. Section 2 expands on the literature that was briefly reviewed in Section 1 while Section 3 outlines, in greater details, the research methods followed during the conduct of the research and the justifications thereof