| dc.description.abstract | The Public Health Institutions have not been spared the environmental changes. Through
the process of strategic change, public health institutions seek to reposition themselves in
order to create new competences and capacities to exploit and deal with new situations.
In the late 1980s Kenyatta National Hospital experienced several challenges including
major resource constraints while the demands for its services were increasing. This
presented a challenge to the hospital management in seeking for best ways possible of
sustaining quality health services within the framework of decreasing revenue from the
central government. As a result the hospital had to adopt strategic change in order to
survive in the Kenyan economy, which has not been doing well in the last ten years. It is
against this background and the struggle by the referral hospital to stay afloat that this
study undertook to analyze the change effort at the referral hospital. The study sought to
establish the strategic change management practices of the referral hospital and the
factors that are influencing the change management practices. The study was conducted
by carrying out in-depth interview with senior heads of departments at the hospital.
The study came up with a number of findings: First the findings on what was the force
behind the need for change are consistent with the literature by Hill and Jones (2001)
who see the primary purpose of strategy as aligning the management of an organization
with changes in the enviroriment. Public _dissatisfaction with declining service quality
exerted pressure on the referra.l hospital to change and respond appropriately, with a view
of rendering it more efficient and effective in the delivery of health services. Second, the
change management process indicates attempts by the referral hospital to apply change
management models proposed by varIOUS change experts. A VISIOn was crafted,
strategies developed, separating from the past by re-designing the hospital symbols of the
Logo and flag to capture new hospital image envisioned by the mission statement, teams
were established and legitimacy and political support was mobilized.
The study revealed that several factors negatively affected the change process. Resistance
(both behavioral and systemic), individual resistance was posed mainly by clinicians who
for example resented the recruitment of an expatriate Mr. Bob Wilcox to manage change
on high salaries without adequate consultation, unsupportive cultural practices,
inappropriate leadership, poor teamwork and low commitment to the change combined to
slow crown the change process. Improved quality at the hospital together with declining
quality of city clinics led to even higher congestion at the hospital. The hospital changes
invested heavily in improved infrastructure and equipment, which contributed to
additional recurrent costs.
Despite the constraints, change at the referral hospital made considerable gams. The
reform effort has enabled the hospital Improve on the quality of care, cleanliness,
efficiency, effectiveness, and quality customer care while improving greatly the staff
morale. It has enabled the hospital retain highly skilled medical specialists within easy
reach at all times and has resulted to improvement of public relations between the referral
hospital and other partners both in the private and public sector. Lastly, hospitals have an
important role in the health care system and need to embrace rapid change in order to
play their correct role in the changing scene of health care. | en |
