| dc.description.abstract | This study investigated the effectiveness of quality health care strategies in improving
service delivery at the national referral hospitals in Kenya. National referral refers to any
process in which healthcare providers at lower levels of the health system seek the
assistance of providers who are better equipped or specially trained to guide them in
managing or to take over responsibility for a particular episode of a clinical condition ina
patient. The population of this study comprised two national referral hospitals in Kenya,
namely Kenyatta National Hospital and Moi Teaching and Referral Hospital which have
a total of 96 departments and units. Due to small sample, a census survey was conducted
at the two national referral hospitals. A total of 96 questionnaires were administered and
67 were completed and returned, which represented 69.8 per cent response rate.
Qualitative data analysis was done using one-tailed test to establish regression coefficient
at 95% confidence interval and qualitative data was subjected to content
analysis. The study findings revealed that healthcare strategies have a positive effect on
service quality at the national referral hospitals, although the strategies had varying
degrees of association with service delivery systems, processes and outcomes. Adoption
of ICT applications had a greater impact on follow-up systems compared to other
strategic interventions. Strategic Leadership Training, Results Based Financing (RBF),
and specific strategic interventions at the departmental level had a high significant effect
in improving service quality outcomes such as rate of re-admission, average mortality
rate, time taken to serve clients and average waiting time to be served. Quality
improvement initiatives by some departments to reduce rates of infection indicated a
slightly significant relationship compared to other interventions. Quality healthcare
strategies adopted by the hospitals also had a very significant relationship with average
length of in-patient stay. The level of client satisfaction showed a greater significant
relationship with the adoption of ICT and specific strategic interventions by the
departments to improve service quality. The findings also showed that vision, mission,
strategic plan, service delivery charter, human resources and physical facilities were
critical drivers in the implementation of quality healthcare strategies in the two hospitals.
Clearly, this demonstrates that quality improvement strategies at the hospitals require a
multifaceted approach and adoption of appropriate model for implementation of the
strategies. The study recommends adoption of integrated approach to Quality
Improvement Programs (QIPs) and increased uptake of ICT innovations to enhance
turnaround time. The hospitals’ management should encourage other service delivery
innovations at the functional units which are appropriate to various departments to
complement institutional-driven programmes. Institutionalisation of training programmes
on attitude change is required for successful implementation of various strategic
interventions since staff attitude is one of the biggest impediments to implementation of
QIPs. It is prudent to adopt an ideal model for implementation of quality healthcare
strategies to optimise service quality and clinical outcomes. The study also recommends
incorporation of QIPs in the core-curriculum for healthcare workers. Further study should
be conducted on specific strategic interventions that can be used to optimise quality of
healthcare services and clinical outcomes in public hospitals in Kenya. | en_US |
