Worldwide, health care costs are spiralling upwards, forcing health sectors to find alternative organisational structures. Increased global competition and rapid technological and environmental changes are forcing organisations to restructure themselves from rigid bureaucracies towards leaner, more flexible and responsive structures. Aligning traditional health care systems with current transformational needs in South Africa is becoming more and more difficult. This is exacerbated by the growing number of people who live in poverty, the increase in HIV/AIDS cases and their growing dependence on government
funding for service delivery.
This article explores future prospects for more flexible structures that encourage
government “to cope with” and “create change” within the South African health sector. Important drivers in creating the change process are linked to the
strategic and policy objectives of the organisation and is supported by effective
internal staffing decisions that promote the achievement of organisational and
employee goals. This includes performance management techniques, partnerships for service delivery and improved human resource utilisation. A hypothetical
model offers the reader alternatives in creating change through flexible horizontal
structures and relationships. The theoretical underpinnings of this model are based on the formation of partnerships and its interaction with network and process
based structures. By drawing a comparison between the continuum of a classical
hierarchical organisation and the networked organisation, the authors attempt to
provide valuable insight into the contrasts that exists between both structures and
their impact on service outcomes.