ArticlePLOS global public health2026
Measuring organisational readiness for health system change in South Africa using the European Foundation for Quality Management Excellence Model (EFQM).
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Successful health system transformation depends on organisational readiness, yet few African studies have applied structured excellence frameworks to assess change capacity. This study evaluated the readiness of two district health systems in South Africa's North West Province using the European Foundation for Quality Management Excellence Model (EFQM). A descriptive cross-sectional survey was conducted using a standardised, EFQM-based, self-administered questionnaire. The questionnaire was distributed to 200 senior and middle-level health managers, chief executive officers, and clinical leaders across the Bojanala Platinum and Ngaka Modiri Molema districts. Quantitative EFQM domain scores were calculated and compared across districts. A total of 193 responses were received (96.5%), including complete European Foundation for Quality Management Excellence Model process data from 112 participants. The combined sample achieved a mean EFQM -PER score of 75.45 (SD = 16.61) and a median of 76.00 (IQR: 66.50-87.25). Bojanala recorded higher EFQM-PER performance (mean = 77.74, SD = 14.88; median = 80.45, IQR: 72.00-89.00) than Ngaka Modiri Molema (mean = 74.06, SD = 17.54; median = 74.80, IQR: 64.00-86.50). Leadership (76.94%) and Policy and Strategy (72.79%) were the strongest-performing EFQM Excellence Model domains, falling within the strengthening range (greater than 70%). People (51.81%) and Partnerships and Resources (45.5%) scored below the readiness threshold, identifying critical vulnerabilities in human resource engagement and resource coordination. No significant associations were observed between readiness scores and socio-demographic characteristics. Health system readiness in the North West province is supported by strong leadership and policy alignment; however, weaknesses in workforce empowerment and partnership management pose substantial risks to sustainable reform. Targeted strengthening of these underperforming domains is essential to translate strategic intent into resilient, people-centred health system change.
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