A framework to foster intrapreneurship amongst unit managers working at three public hospitals in Mangaung, Free State

Abstract

English: Introduction and background: Dynamic environmental challenges compel different organizations such as the health sector to focus on innovative changes to address difficult health care challenges. The aim of the study was to develop a framework to support the fostering of intrapreneurship within unit/operational nurse managers working in three public hospitals situated in Mangaung, Free State.The objectives of the study were to analyse the concept of intrapreneurship using Walker and Avant’s framework for concept analysis; to explore the conduciveness towards intrapreneurship of unit/operational managers within the hospital working environment, to explore the intrapreneurial characteristics of unit/operational nurse managers as well as their understanding and view of intrapreneurship within the hospital working environment. Methodology: A convergent parallel mixed method design that included a concept analysis, exploratory qualitative research methodology in the form of focus groups and the application of a quantitative-type descriptive survey using Hill’s Intrapreneurial Index questionnaire III (2003) were used. Reliability was determined through the use of a pilot case study, split-half and test-retest reliability. An exploratory pilot study lead to the adaptation of a number of concepts in the survey to suit the population better. Purposive sampling was used to select participants for the qualitative data collection process that included five focus groups managed by an expert facilitator. In the quantitative data collection process, all members of the population (N=104) had a chance to participate. Ethical clearance was obtained from the Faculty of Health Sciences, University of the Free State. The ethical principles of beneficence, respect for human dignity, and justice were considered. Participation in the study was voluntary, participants were informed of the risks and benefits of the study and homogeneity of the group was maintained at all times. Findings: The concept analysis process underlined the complexity of the multifaceted concept of intrapreneurship and highlighted critical attributes such as innovation, creativity and risk-taking. The majority of the antecedents were located within the organization whilst the consequences highlighted innovative ventures, the identification of opportunities and improved performance. A total of 42 participants attended the focus group sessions with 8 to 9 participants per group. The participants were mostly women (89.7%) and between 50-59 years (55.3%). The focus group discussions yielded a number of interesting results. Participants considered the concept to relate to a business venture, innovation, involvement and of being valued. Factors that were considered conducive to intrapreneurship included for example training and development, planning, quality improvement initiatives and a business focus in the organization. They considered the infrastructure, limited resources, poor security, communication, limited respect for rights and lack of incentives as detriemental to intrapreneurship. Within the quantitative data collection process the response rate was 40% (n=42). Findings from the survey indicated a primarily low intrapreneurial intensity index. Five of the six intrapreneurial indexes as postulated by Hill scored low (leadership, policies, culture, structure and task) whilst only the employee index scored relatively high, indicating participants’ self-valuing of own innovative vision, and courage to embrace change. Conclusion: The analysis and triangulation of data provided the conceptual data to develop a framework to support intrapreneurship in this context. The framework hinges on the external and internal environment – highlighting the positive and negative influences that come to play. The positive external environmental factors included environmental dynamicity and uncertainty as compared to negative factors such as limited organizational ownership and legislative obstacles. The internal environment outlines the importance of organizational wellbeing, organizational leadership, support and communication. Attributes within the intra-environment include innate, personal attributes of unit/operational managers, demographic and situational attributes. Recommendations from the study focussed on the enhanced teaching and learning of intrapreneurship principles and practices in the public hospital environment, the utilization of the intrapreneurship framework in nursing management programmes (formal and nonformal), the support of intrapreneurial activities at national and provincial level and the inculcation of a paradigm shift to embrace the intrapreneurial approach within health care services. The use of transformational leadership style and the capacity building of nursing teams seem to be pivotal in this process. Limitations: The small sample size in the quantitiatvie survey was a cause of concern, whilst the participants’ limited knowledge and understanding of the concept of intrapreneurship may have influenced the meaningful identification of factors that hinder or foster intrapreneurship in the public hospital work environment – this might have lead to a focus on challenges they face from day-to-day. The current health care services context was seen to create uncertainty and fear of cutting positions. This may have resulted in insecurity amongst unit/operational nurse managers and their willingness to freely disclose matters of concern.

Afrikaans: Inleiding en agtergrond: Dinamiese omgewingsuitdagings noop verskillende instellings soos die gesondheidsektor om te fokus op innoverende veranderinge wat moeilike gesondheidsorg uitdagings aanspreek. Die doel van die studie was om ʼn raamwerk te ontwikkel vir ondersteuning van bevordering van ondernemingskap intrapreneurskap by eenheids/operasionele verpleegbestuurders wat werksaam is in drie staatshospitale in Mangaung, Vrystaat. Die doelwitte van die studie was om die konsep ”intrapreneurskap te ontleed deur gebruik te maak van Walker en Avant se raamwerk vir konsepanalise; om die intrapreneurskap-eienskappe van eenheids/operasionele verpleegbestuurders te verken; insluitend hul begrip en siening van intrapreneurskap binne die hospitaal se werksomgewing. Metodologie: ʼn Gelyktydige parallel gemengde metode ontwerp is gevolg wat ʼn konsepanalise, verkennende kwalitatiewe navorsingmetodologie in die vorm van fokusgroepe en die toepassing van ʼn kwantitatiewe beskrywende opname wat Hill se Ondernemer Indeks Vraelys lll (2003) insluit. Hill het die betroubaarheid van die instrument bevestig deur gebruik te maak van ʼn loods gevallestudie, gedeelde half en toets-hertoets betroubaarheid. ʼn Verkennende loodsstudie het tot die aanpassing van sekere konsepte gelei wat beter by die navorsingspopulasie pas. ‘n Doelgerigte steekproef seleksie is gedoen om deelnemers vir die kwalitatiewe data versamelingsproses te verkry. Vyf fokusgroepe, gelei deur ʼn kundige fasiliteerder is gehou. In die kwantitatiewe data insamelingsproses het al die lede van die navorsingspopulasie (N=104) die geleentheid gehad om deel te neem. Etiese goedkeuring om die navorsing uit te voer is vanaf die Fakulteit Gesondheidswetenskappe, Universiteit van die Vrystaat verkry. Die etiese beginsels van om aan ander goed te doen, respek vir menswaardigheid en regverdigheid. Is gehandhaaf. Deelname aan die studie was vrywillig en die deelnemers was ingelig oor die risiko’s en voordele van die studie. Die homogeniteit van die groep was deurgaans behou. Bevindinge: Die konsepanalise proses het die kompleksiteit van die multi gefasetteerde konsep van intrapreneurskap onderskryf en kritiese eienskappe soos innovasie, kreatiwiteit en neem van risiko’s beklemtoon. Die meerderheid van die voorafgaande was gelokaliseerd binne die organisasie terwyl die gevolge van intrapreneurskap innovasie, risiko’s, die identifikasie van geleenthede en verbeterde werkverrigting beklemtoon het. Twee-en-veertig deelnemers het die fokusgroepsessies bygewoon met 8 tot 9 deelnemers per groep. Die deelnemers was hoofsaaklik vroue (89.7%) tussen die ouderdom van 50-59 jaar (55.3%). Die fokusgroepbesprekings het ʼn aantal interessante resultate gelewer. Deelnemers het die konsep as verwant aan ʼn besigheidsonderneming, innovasie, betrokkenheid en van waarde beskou. Faktore wat intrapreneurskap bevorder, het opleiding en ontwikkeling, beplanning, gehalte-verbetering inisiatiewe en ʼn besigheidsgerigtheid in die organisasie, ingesluit. Deelnemers het infrastrukture, beperkte bronne, swak sekuriteit, kommunikasie, min respek vir regte en die gebrek aan aansporing as nadelig vir intrapreneurskap beskou. In die kwantitatiewe data-insamelingproses was die responssyfer 40% (n=42). Bevindinge van die opname het hoofsaaklik ‘n lae intrapreneursintensiteit-indeks aangedui. Vyf van die ses intrrapreneusindekse soos deur Hill voorgestel, het lae waardes behaal (leierskap, beleide, kultuur, struktuur en taak), terwyl slegs die werknemersindeks ‘n relatief hoë waarde behaal het. Die resultaat was aanduidend van die deelnemers se eie waarde rakende hul eie innoverende visie en moed om verandering aan te gryp.Gevolgtrekking: Die analise en triangulasie van die data het die konseptuele data voorsien om ʼn raamwerk te ontwikkel om intrrapreneurskap in hierdie konteks te ondersteun. Die raamwerk sluit die eksterne en interne omgewing in met ‘n beklemtoning van positiewe en negatiewe invloede wat ʼn rol speel. Die positiewe eksterne omgewingsfaktore het omgewingsdinamiek en onsekerheid ingesluit, in teenstelling met negatiewe faktore soos beperkte organisatoriese eienaarskap en wetlike struikelblokke. Die interne omgewing dui die belang van organisatoriese welstand, organisatoriese leierskap, ondersteuning en kommunikasie aan. Eienskappe binne die intra-omgewing sluit ingebore, persoonlike eienskappe van eenheid/operasionele bestuurders, demografiese asook situasionele eienskappe in. Die aanbevelings van die studie het gefokus op die bevordering van onderrig en leer van intrapreneurskapsbeginsels, verbeterde praktyke in die publiekehospitaalomgewing, die benutting van dieintrapreneurskapraamwerk in verpleegbestuursprogramme (formeel en in-formeel), die ondersteuning van intrapreneurskapaktiwiteite op nasionale- en provinsiale vlak en die teweeg bring van ʼn paradigmaskuif wat die ointrapreneurskapbenadering binne gesondheidsorgdienste insluit. Die gebruik van transformasie leierskapstyle en die ontwikkeling van kapasiteit in verpleegspanne blyk deurslaggewend in hierdie proses te wees. Beperkinge: Die klein steekproef in die kwantitatiewe opname was ʼn bron van kommer, terwyl die deelnemers se beperkte kennis en begrip van die konsep van intrapreneurskap die betekenisvolle identifikasie van faktore wat intrapreneurskap in die werksomgewing van publiekehospitale beperk of bevorder, mag beïnvloed het. Hierdie tendens mag gelei het tot ʼn beperkte fokus op die uitdagings wat hulle van dag tot dag die hoof moes bied. Deelnemers was ook deel van die onsekerheid binne die huidige gesondheidsorgdienste met ʼn moontlike vrees vir die vermindering van poste. Dit mag gelei het tot onsekerheid by eeheids/operasionele verpleegbestuurders en gepaardgaande vrymoedigheid om vrylik apekte van ongemak of kommer te opper.