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Positive Practice Environment for Healthcare Professionals



The link between working environment and quality of care provided to patients cannot be overemphasized. The state of the working environment whether positive or negative has a direct effect on the quality of care provided to patients and this is well-documented in health and development literature. Satisfied health workers lead to improved patient outcomes and a number of studies have shown this whilst unhealthy working conditions lead to disastrous patient outcomes. Unhealthy working conditions are a cause for concern particularly for the developing countries that are faced with the challenge of attrition of healthcare professionals in which they migrate from home countries to developed countries in search of better working conditions. This has led to a challenge of severe health human resources shortages in developing countries and South Africa is no exception in this regard.

The negative incidents particularly in the public health facilities reported in the media call for an effective intervention by all stakeholders involved in the health system to address these and yield a positive practice environment conducive for quality healthcare provision.

Definition of key words

Positive Practice Environment: Positive Practice Environments are defined as “settings that support excellence and decent work. In particular, they strive to ensure the health, safety and personal well-being of staff, support quality patient care and improve the motivation, productivity and performance of individuals and organisations” Registered Nurses Association of Ontario (2006)

AttritionAttrition is defined as“a reduction in the number of employees or participants that occurs when people leave because they resign, retire, etc., and are not replaced” www.merriam-webster.com/dictionary/attrition


  • The negative incidents reported on by the media taking place in various public health facilities which are a cause for concern
  • The unhealthy working conditions that healthcare workers work under which affects the quality of care they provide
  • The rift in some communities between healthcare workers and the communities they serve exacerbated by the negative reports in the media
  •  The measures by the government in an attempt to address the challenges in health such as the National office of Standards
  • The legislative frameworks by the government supporting positive practice environment such as the Public Service Charter

DENOSA believes that:

  • Positive practice environment is key to quality healthcare provision
  • Positive practice environment not only benefits healthcare professionals but also benefits healthcare consumers and leads to positive health indicators for governments
  • Unless working conditions through positive practice environment are improved, South Africa will continue enduring the effects of migration and attrition of health human resources
  • The effects of positive practice environment would have a positive impact on the health developmental goals of the country and would yield positive health indicators
  • Unhealthy working conditions lead to disastrous patient outcomes and demotivates healthcare professionals

DENOSA position on positive practice environment

  • The state of the working environment directly affects the quality of care provided to patients and a positive practice environment is a key determinant of quality healthcare provision
  • A healthy practice setting maximizes the health and well-being of health professionals and enables them to work to their optimum abilities in providing health services
  • The improvement of the working conditions for health professionals that would yield a positive working environment is dependent on all the stakeholders involved in the health system, however, the government as the employer of public health professionals should take the lead.
  • The legislative frameworks such as the Occupational Health and Safety Act and the Public Service Charter the prescripts of which hold both the government as the employer and healthcare professionals as employees liable for quality healthcare provision should be adhered to by both government and healthcare professionals
  • Unless the 8 components of the positive practice environment namely: equipment, workplace- safety, supplies, payment, resources, education, support and respect are addressed quality healthcare provision is subject to compromise.


The government as the employer of public healthcare professionals has leading and primary role of ensuring that the environment that healthcare professionals work under is the one conducive for quality healthcare provision. Looking at the aforementioned 8 components, it is clear that healthcare professionals themselves also have role to play in ensuring a positive practice environment that would yield quality healthcare provision. It is therefore the responsibility of all stakeholders involved in the health system to each play their part in building an environment that would enable healthcare professionals to deliver healthcare services to their optimum ability so as to curb poor healthcare services.


International Council of Nurses. 2007. Positive Practice Environment:
Quality Workplaces= Quality Patient Care: Information and Action Tool Kit developed by Andrea Baumann for ICN
. Geneva. Switzerland

International Council of Nurses, International Hospital Federation, International Pharmaceutical Federation, World Confederation for Physical Therapy, World Dental Federation & World Medical Association. 2008. Positive Practice Environments for Healthcare Professionals. Geneva. Switzerland

Registered Nurses Association of Ontario. 2006. Healthy work environments best practice guidelines (BPGs) overall project background. Toronto, Canada: RNAO.

www.merriam-webster.com/dictionary/attrition (24/03/2014)