Pragmatic-informed exploration of clinical governance implementation and challenges in South African public hospitals: qualitative insights from allied health managers
1
1 School of Public Health, Walter Sisulu University, Mthatha, South Africa
2
2 Institute for Clinical Governance and Healthcare Administration, Walter Sisulu University, Mthatha, South Africa
3
3 Biostatistics Analytic Training Services Unit,, Walter Sisulu University, Mthatha, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1600
ABSTRACT
BACKGROUND:
Allied health managers play a unique role that connects administrative and clinical roles across multidisciplinary areas, making them vital for service integration and quality improvement initiatives. However, there is a lack of empirical evidence on how allied health managers understand and engage with clinical governance structures, as well as the impact of their involvement, or lack thereof, on hospital performance. This study addresses that gap by investigating the views of allied health managers on the challenges to implementing clinical governance in public hospitals.
METHODS:
A qualitative pragmatic approach was employed to conduct focus group discussions with allied health managers in four public hospitals in the Eastern Cape and Mpumalanga provinces. Utilising convenience non-probability sampling, 20 allied health managers participated in four focus group discussions, with four to six participants per hospital.
RESULTS:
Four main themes emerged: leadership and governance, operational challenges, workforce challenges, and resource constraints. Under leadership and governance, participants noted a consistent underrepresentation of allied health professionals in leadership roles, a lack of commitment from executive management, and non-inclusive decision-making processes. With operational challenges, recurring issues included inadequate complaint management systems, frequent breakdowns in referral processes, and delays caused by bureaucratic procedures. Workforce challenges highlighted concerns about limited opportunities for training and professional development, low staff morale, and ongoing staffing shortages. Resource constraints, including inadequate budget allocation, physical infrastructure deficiencies, and shortages of essential equipment, were identified as barriers to implementing clinical governance.
CONCLUSIONS:
While formal clinical governance frameworks are increasingly established to enhance the quality of care, healthcare facilities operate under severe resource constraints, bureaucratic dysfunction, and a professional hierarchy that excludes allied health professionals from meaningful participation in decision-making processes. These findings highlight the importance of addressing identified gaps in clinical governance practices, ensuring multidisciplinary inclusion to optimise hospital performance in resource-limited settings.
Allied health managers play a unique role that connects administrative and clinical roles across multidisciplinary areas, making them vital for service integration and quality improvement initiatives. However, there is a lack of empirical evidence on how allied health managers understand and engage with clinical governance structures, as well as the impact of their involvement, or lack thereof, on hospital performance. This study addresses that gap by investigating the views of allied health managers on the challenges to implementing clinical governance in public hospitals.
METHODS:
A qualitative pragmatic approach was employed to conduct focus group discussions with allied health managers in four public hospitals in the Eastern Cape and Mpumalanga provinces. Utilising convenience non-probability sampling, 20 allied health managers participated in four focus group discussions, with four to six participants per hospital.
RESULTS:
Four main themes emerged: leadership and governance, operational challenges, workforce challenges, and resource constraints. Under leadership and governance, participants noted a consistent underrepresentation of allied health professionals in leadership roles, a lack of commitment from executive management, and non-inclusive decision-making processes. With operational challenges, recurring issues included inadequate complaint management systems, frequent breakdowns in referral processes, and delays caused by bureaucratic procedures. Workforce challenges highlighted concerns about limited opportunities for training and professional development, low staff morale, and ongoing staffing shortages. Resource constraints, including inadequate budget allocation, physical infrastructure deficiencies, and shortages of essential equipment, were identified as barriers to implementing clinical governance.
CONCLUSIONS:
While formal clinical governance frameworks are increasingly established to enhance the quality of care, healthcare facilities operate under severe resource constraints, bureaucratic dysfunction, and a professional hierarchy that excludes allied health professionals from meaningful participation in decision-making processes. These findings highlight the importance of addressing identified gaps in clinical governance practices, ensuring multidisciplinary inclusion to optimise hospital performance in resource-limited settings.
| eISSN: | 2654-1459 |
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