Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district

Background As part of health system strengthening in South Africa (2012–2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the health system rather than only of individuals, the research explored the mechanisms triggered in context to produce outputs, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system. Methods We conducted a realist evaluation, adopting the case study design, over a two-year period (2013–2015) in the district of focus. The initial programme theory was developed from 10 senior manager interviews and a literature review. To understand the processes and mechanisms triggered in the local context and identify outputs, we conducted 15 interviews with managers in the management team and seven with non-state actors. These were supplemented by researcher notes based on time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome configuration alongside theoretical constructs. Results The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom-up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justifications for change and setting the scene (a new agenda, distributed leadership). These micro-practices in themselves, and by managers engaging with them, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new practices within a routine meeting. Conclusion District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant ‘bottom-up’ capacity development in district health systems. By drawing on soft skills and the policy resources (hardware) of the system they can influence motivation and buy-in to improve management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces.

Bottom up innovation for health management capacity development: a qualitative case study in a South African health district

Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing management capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Understanding capacity as a property of the health system not only of individuals , the research explored mechanisms triggered in context, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system to produce outputs.Methods We conducted a realist evaluation complemented by a case study approach over a two-year period (2013-2015) in the district. The initial programme theory development included ten senior manager interviews and a literature review. To understand processes and mechanisms triggered in local context and identify outputs we conducted fifteen interviews with managers in the management team and with seven non-state actors, supplemented by researcher notes and time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome-Actor configuration alongside theoretical constructs. Results The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justification for change and setting the scene (a new agenda, distributed leadership). These micro practices and managers engaging with the new practices, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new meeting practices within a routine meeting. Conclusion District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant ‘bottom-up’ capacity development in district health systems. Doing so by drawing on intangible soft skills and tangible policy resources (hardware) of the system to influence motivation and buy-in for improved management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces.

Bottom Up Innovation for Health Management Capacity Development: a Qualitative Case Study in a South African Health District

Background As part of health system strengthening in South Africa (2012- 2017) a new district health manager, taking a bottom-up approach to developing managerial capacity, developed a suite of innovations to improve the processes and practices of managers and NGO partners in monthly district management team meetings. Using a systems perspective on capacity development, the research explored the initial sensemaking by the district manager, how these homegrown innovations interacted with existing social processes and norms, the mechanisms for change that were triggered and the emergent capacity outputs. Methods We conducted a realist evaluation complemented by a case study approach over a two-year period (2013-2015) in the district. The initial programme theory development included ten senior manager interviews and literature review. To understand processes and mechanisms triggered in local context and identify emergent capacity outputs we conducted fifteen interviews with managers in the management team and with seven non-state actors, supplemented by researcher notes and time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome -Actor configuration alongside theoretical constructs. Results The new district manager drew on complex frames, tacit and experiential knowledge to design bottom up innovations, and collective capacity development was triggered through micro-practices of sensemaking and sense-giving. Sensegiving included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justification for change and setting the scene (a new agenda, distributed leadership). These micro practices, managers engaging with the new practices and social sense-making, influenced the motivation of managers and partners to further participate in new meeting practices, and triggered a generative process of buy-in and emergent capacity in a routine meeting structure. Conclusion District managers are well placed to design local level capacity development innovations and must draw on multiple knowledge forms to enable relevant ‘bottom-up’ capacity development in complex health systems. Managers must draw on their intangible soft skills and the tangible policy resources (hardware) of the system to influence motivation and buy-in for improved management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing in routine spaces, to unleash capacity.

STRATEGI PEMASARAN DALAM MENINGKATKAN VOLUME PENJUALAN SUPLEMEN MAKANAN IMFORCE KAPLET

ABSTRAK Penelitian ini bertujuan untuk menganilis strategi pemasaran Suplemen Makanan Imforce Kaplet pada PT. Mahakam Beta Farma khususnya bauran pemasaran (marketing mix) yang diterapkan perusahaan. Kemudian untuk mengetahui hasil kekuatan (strength), kelemahan (weakness), peluang (opportunities), dan ancaman (threat) serta gambaran strateginya sehingga dapat diaplikasikan untuk peningkatan penjualan produk. Dengan menggunakan teknik penelitian SWOT, Matriks, IFAS, dan EFAS serta diagram cartesius. Penelitian ini menggunakan metode kualitatif, yaitu studi khusus yang menghasilkan data-data deskriptif yang dituangkan dalam kata-kata. Teknik pengumpulan data pada penelitian ini penulis melakukan kunjungan langsung ke kantor PT. Mahakam Beta Farma cabang Lampung untuk melakukan wawancara pribadi dengan Bapak I Wayan Sudana sebagai District Manager dan dilengkapi dengan data-data penjualan beberapa tahun kebelakang. Kesimpulan dari analisis yang dilakukan pada strategi pemasaran PT. Mahakam Beta Farma adalah perusahaan telah menjalankan strategi pemasaran dengan benar dan tepat serta pada perhitungan analisis SWOT yang dituangkan pada diagaram cartesius perusahaan tersebut berada di posisi kuadran I yaitu Gowth. Yang mana perusahaan dapat mengembangkan, mempertahankan, dan meningkatkan kualitas produk agar masyarakat terus percaya pada produk Imforce kaplet yang mengandung banyak vitamin yang sangat baik untuk menjaga dan memelihara daya tahan tubuh. Kata kunci: strategi pemasaran, bauran pemasaran, analisis SWOT, matrika IFAS, matriks EFAS, diagram Cartesius.

Relationships between qualifications of a forest district manager and economic conditions on the one hand and the operating result of a forest district on the other

Relacje między kwalifikacjami nadleśniczego i warunkami gospodarczymi a wynikiem działalności nadleśnictwa