title: Management of district hospitals--exploring success.
abstract: BACKGROUND
  
  
  
  OBJECTIVE
  The aim of the study was to explore and document what assists a rural district hospital to function well. The lessons learned may be applicable to similar hospitals all over the world.
  
  
  METHODS
  A cross-sectional exploratory study was carried out using in-depth interviews with 21 managers of well-functioning district hospitals in two districts in South Africa.
  
  
  RESULTS
  Thirteen themes were identified, integrated into three clusters, namely 'Teams working together for a purpose', 'Foundational framework and values' and 'Health Service and the community'. Teamwork and teams was a dominant theme. Teams working together are held together by the cement of good relationships and are enhanced by purposeful meetings. Unity is grown through solving difficult problems together and commitment to serving the community guides commitment towards each other, and towards patients and staff. Open communication and sharing lots of information between people and teams is the way in which these things happen. The structure and systems that have developed over years form the basis for teamwork. The different management structures and processes are developed with a view to supporting service and teamwork. A long history of committed people who hand over the baton when they leave creates a stable context. The health service and community theme cluster describes how integration in the community and community services is important for these managers. There is also a focus on involving community representatives in the hospital development and governance. Capacity building for staff is seen in the same spirit of serving people and thus serving staff, all aimed at reaching out to people in need in the community. The three clusters and thirteen themes and the relationships between them are described in detail through diagrams and narrative in the article.
  
  
  CONCLUSIONS
  Much can be learned from the experience of these managers. The key issue is the development of a team in the hospital, a team with a unified vision of giving patients priority, respecting each other as well as patients, and working in and with the community to achieve optimal health care in the district hospital.
authors.affiliation: Department of Family Medicine, University of the Witwatersrand, Parktown, South Africa. couperid@medicine.wits.ac.za
authors.forename: Ian D
authors.initials: ID
authors.lastname: Couper
authors.forename: Jannie F M
authors.initials: JF
authors.lastname: Hugo
mesh_terms: D001291:Attitude of Health Personnel; D003142:Communication; D003256:Community Participation; D003430:Cross-Sectional Studies; D003625:Data Collection; D006767:Hospitals, District / Q000458:organization & administration* / Q000592:standards; D006780:Hospitals, Rural / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D007857:Leadership; D010564:Personnel, Hospital; D011340:Problem Solving; D013019:South Africa; D000078329:Workforce