Nel, Karen2024-09-182024-09-182022Nel, Karen. (2022). Combining complexity leadership with operational systems and structures for adaptability in South African private hospitals [PhD thesis, University of the Witwatersrand, Johannesburg]. WireDSpace.https://hdl.handle.net/10539/40902https://hdl.handle.net/10539/40902A research report submitted to the Faculty of Commerce, Law and Management, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Doctor in Philosophy in the field of Leadership, Johannesburg 2022The global healthcare landscape is complex. The South African Government and various other researchers have highlighted the unequal nature of the healthcare system in South Africa. The system is unsustainable and urgently needs substantial transformation in its current form. As set out by the South African Government, introducing universal healthcare coverage for the whole population is a solution. This will, however, significantly impact and change all role- players relatively quickly, especially for private hospitals. The purpose of this study was to critically examine whether private hospitals in South Africa were positioned for adaptability, considering complexity leadership (with concepts: entrepreneurial leadership, operational leadership and enabling leadership) and operational systems and structures (with concepts: agile, lean and leagile), as an approach to deal with the potential changes. A mixed methods study with an explanatory sequential design was utilised where the quantitative results and sample informed the population and questions of the qualitative study. Additionally, the quantitative results' drivers were identified in the qualitative study, namely causal factors, leadership and operational consequences, and aggravating factors. This study confirmed that the leadership displayed in private hospitals and the operational systems and structures implemented in private hospitals were not aligned with complexity leadership and operational systems and structures as defined in the conceptual model of this study. A unique finding was that operational systems and structures in private hospitals had a significantly higher impact on the hospitals' daily management than the leadership displayed in these hospitals. This was especially evident between managers and non-managers and between clinical and non-clinical employees, with non-clinical employees viewing the impact of the operational systems and structures implemented in hospitals as significantly more impactful than the leadership displayed in these hospitals. Furthermore, it was identified that operational leadership and lean systems and structures were the preferred approaches in private hospitals and negatively impacted the display of entrepreneurial leadership and agile systems and structures in these hospitals. Moreover, it was found that exploitative leadership, which is the leadership approach when dealing with old certainties, labelled as operational leadership in the current complexity leadership framework, should be relabelled a administrative-operational leadership in South African private hospitals, as a result of the hierarchical, autocratic culture. Assessing the impact of the COVID-19 pandemic on the leadership displayed and the operational systems and structures that were implemented in these hospitals, it was identified that employees can either experience disruption in a positive light through an adaptive response supported flexibility, or be traumatised by it when management implemented an order response with increased controls. It was conclusively confirmed that private hospitals in South Africa do not regularly display complexity leadership nor implement operational systems and structures as defined in this study's conceptual model. Four recommendations were made that can assist the private hospital industry in becoming more adaptable. The first recommendation is for the industry to implement CL and OSS as defined by the study's conceptual model. This implementation will naturally develop into an adaptive space. The second recommendation is to overcome the disconnect between industry players, head offices and hospitals, and to increase collaboration. Although the adaptive space will impact this recommendation positively, it has to be driven and supported by senior leadership. The third recommendation is to develop a formal industry framework for adaptability in private hospitals. The fourth recommendation is for the implementation of integrated and applied development programmes for leaders and staff at all levels. The programmes will assist everyone to better understand the relationship between CL, OSS, business acumen, and business successen© 2022 University of the Witwatersrand, Johannesburg. All rights reserved. The copyright in this work vests in the University of the Witwatersrand, Johannesburg. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of University of the Witwatersrand, Johannesburg.administrative leadershipHealthcarePrivate hospitalsAdaptive spaceAdaptabilityComplexity leadershipEntrepreneurial leadershipOperational leadershipEnabling leadershipCollaborationUCTDLeagileLeanAgileOperational systems and structuresSDG-3: Good health and well-beingThesisUniversity of the Witwatersrand, Johannesburg