A paradigm-shift in mitigating health public-private partnership risk: A systems thinking approach.

Abstract

This study sought to explore whether a paradigm shift is needed to implement a Systems Thinking approach in risk mitigation strategies on Public-Private Partnership (PPP) projects. Underpinned in Principal Agent Theory and Systems Thinking, the study followed a qualitative methodology. Semi-structured face-to-face interviews were conducted over a month. Ten practitioners from the public and private sectors, with relevant South African health sector PPP experience, were purposively selected. Key study findings revealed different perspectives held by public and private parties regarding risk identification, analysis and mitigation, driven by their conflicting mandates. Institutional knowledge loss within the public sector was found to erode the rigour of risk mitigation. Barriers to adopting a Systems Thinking Approach were: entrenched standards validated by existing international practice, culture of silo-ism; lack of leadership support for innovation and bureaucratic processes. The study has business implications since optimal risk allocation influences private sector investment appetite. Private sector collaboration is critical to achieve the infrastructure goals set out by the National Development Plan. Key study insights propose policy amendments, knowledge management and a mind-set change to mitigate health PPP project risk. Areas for future research are delineated.