The perceptions of the working environment of anaesthesiologists migrating from the public to the private sector in a developing country: an exploratory, qualitative study

Abstract

Background: There is a significant disparity in the distribution of medical practitioners within the public and private healthcare sectors of South Africa (SA). This study explores anaesthesiologists’ perceptions of their working environment in the public sector following their migration to private practice. Their reasons for leaving are largely unknown.

Methods: Rich pictures were applied in an exploratory, qualitative research design using Checkland’s Soft Systems Methodology. Anaesthesiologists who left the Department of Anaesthesiology at the University of the Witwatersrand between 2014 and 2017 and worked in the Johannesburg metropole private sector were invited to a workshop. Participants were asked to draw a rich picture to illustrate their perceptions of the working environment in the department and to draw a picture depicting the ideal anaesthesiology working environment in the department. Explanations of their pictures were audio recorded, and deductive thematic analysis was used to analyse the data, guided by Herzberg’s Motivation-Hygiene Theory.

Results: The rich data from this study foregrounded job dissatisfaction and a lack of satisfaction in the department due to Herzberg’s poor hygiene and motivator factors, such as a high workload, a lack of resources, working relationship conflicts (within the department and between disciplines), inflexibility with work-life balance, and a lack of accountability regarding clinical conduct in the operating theatre and departmental administrative or managerial tasks. These factors are some of the important reasons for anaesthesiologists’ migration from public to private practice.

Conclusion: This study demonstrates the complexity of interactions between individuals working together in systems that are often tense and sensitive to multiple dynamic influences. These systems are context-specific but must recognise the motivator and hygiene factors that may ultimately impact quality health service delivery and education.