Table 2.

Management strategies and employee response to challenges in the face of austerity

	State of management	Transformative	Adaptive	Absorptive
Hospital A	History of poor management, communication and mistrust among stakeholders. Break down in management-union relations. New management with autocratic management and leadership style.	Pharmacist joined the outreach team when three contract workers contracts were terminated to assess and monitored treatment use and adherence at clinics.	Non-governmental partners asked to buy items. Revived Ill Health Committee. Borrowed supplies from other hospitals.	Clerks, laundry worker, porters did other work. Nurses used as cleaners, kitchen staff, porters and mortuary attendants. Junior nurses manage wards and administer medication. Borrow food and drugs from other hospitals. Workers donated money to buy food for the patients. Supervisor used their money to buy paper to print documents.
Hospital B	New management had democratic leadership style. Better communication and trust among stakeholders. Teamwork and cohesion among managers.	In-service training for management and shop stewards continued. Staff rotation. Team discussion on how to respond to staff shortage. Finance and HR managers established of bilateral forum.	Used interns in finance and supply chain. Outsourced all services that required highly skilled artisan. Used funds from Hospital Board to buy small items.	Some staff worked extra hours, late and on weekends. Staff paid overtime, sometimes late. Nurses used as cleaners, clerks and porters. Junior nurses administered medication.
Hospital C	Stable management with autocratic management and leadership style. Lack of team work. Managers do not attend meetings; decisions about budget cuts are not communicated. Standard meetings with unions do not happen as they should. Conflict, poor communication and mistrust among stakeholders.	Staff rotation in maternity section.	Asked 40 workers from Public Works, but was rejected by unions. Revived Ill Health Committee. Borrow food and medication from other hospitals.	Nurses used as porters, mortuary attendants, clerks and general assistants. Junior nurses expected to administer treatment and manage wards. Experienced cleaners were used as house keepers, electricians, welders.