Strategic change management practices in Kenyatta National Hospital
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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.