MBA-HCM Theses and Dissertations (2015)

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    Exploring the perceptions of pediatric health care workers on audit and performance feedback in Kenyan County Hospitals
    (Strathmore University, 2015) Waiganjo, Peter
    Poor service delivery in the Kenyan public healthcare institutions can be attributed to non-compliance to evidence based practises and clinical guidelines by the health providers. This has resulted to drug dose errors, poor compliance with evidence‐based standards and high mortality rates from avoidable and treatable illnesses in children. It is through audit that intervention approaches and processes are developed and implemented in a healthcare system to improve service delivery. Health systems must be improved if continued and sustained gains in health outcomes are to be made particularly in low and middle income countries. Through an exploratory qualitative research design using semi-structured interviews and focus group discussions, the perceptions of the healthcare workers on audit and feedback were explored. A total of 53 paediatric healthcare workers from were purposively sampled through 10 focus group discussions and 10 semi structured interviews. Data were transcribed, themes explored, and revised in two rounds of coding and analysis in Microsoft Excel, subjected to a layered analysis, and reviewed. Eight major themes of the perceptions and behaviour of the healthcare workers to A&F were identified: commitment to improve care; opportunity to reflect on quality of care delivered; understand hospital morbidity and mortality; reinforced standards on care; used data for planning; enhanced teamwork, A&F as an incentive; and enhanced supportive supervision. The reporting and the data within the hospitals were accurate and reliable and used for decision making. The audit and performance feedback reports positively influenced the behavioural attributes and the leaderships and management skills of the health workers. The hospitals appreciated the feedback reports which elicited reactions they were never aware about their performance. There was general perception in the improvement of paediatric care and reduction in variation in practice and documentation process in the hospitals.
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    Factors that influence the uptake of corporate governance practices in mission Hospitals in Nairobi County - Kenya
    (Strathmore University, 2024) Owuor, C. A.
    This study assessed factors influencing the uptake of Corporate Governance Practices (CGP) in Mission Hospitals in Nairobi County, Kenya, examining the CGP, challenges encountered, and best practices implemented. Grounded in Stakeholder Theory and Agency Theory, the research targeted Mission Hospitals sponsored by the Kenya Conference of Catholic Bishops (KCCB) with a 100-bed capacity or more within Nairobi County. A mixed-method research design was adopted and a census approach employed due to the small nature of the target population. Data was collected from 72 respondents, comprising board members, trustees, owners, directors, top managers using structured questionnaires and Key Informant Interviews (KII). Out of 60 distributed questionnaires, 48 were fully completed and returned (80% response rate) while 12 were poorly completed or not returned at all. All 12 key informants participated in the interviews (100% response rate), ensuring high representativeness and generalization of study findings. The study revealed a robust adoption of CGP in mission hospitals, supported by a high cumulative mean score of 3.542 and a standard deviation of 0.920. Qualitative interview insights reaffirmed the hospitals' commitment to CGP adoption, emphasizing clear governance structures and formalized decision-making processes. Significant relationships were identified between independent variables (Vision, Empowerment, Engagement, Accountability, Stewardship) and Dependent variables (CGP uptake), with stakeholder engagement emerging as a potent enabler in the uptake of CGP. Challenges in implementing CGP included resistance to change, limited resources, regulatory complexities, and cultural considerations, requiring leadership commitment and organizational alignment for effective mitigation. Best practices for enhancing CGP uptake included having a shared strategic direction, empowerment of the Board, robust stakeholder engagement and enhancing Board accountability. Regression analysis supported stakeholder engagement's significance, rejecting the null hypothesis (p-value=0.032). Recommendations included active stakeholder involvement in governance processes, investment in board training and development, and engaging stakeholders in the vision-setting process. Future research should explore corporate governance practices' contribution to Hospital management across private and government sectors.