MBA-HCM Theses and Dissertations (2021)

Permanent URI for this collection

http://hdl.handle.net/11071/12645

Browse

Now showing 1 - 20 of 26

Exploring the facilitators and challenges of Emergency Medical Services: a case of Kisii County Government
(Strathmore University, 2021) Manoti, Lyndah Kemunto
Emergency medical services (EMS) are urgent interventions and procedures offered to patients to prevent disability and preserve life after the occurrence of injury or acute illness. The services usually offered in out-of-hospital setups or during transit to a definitive health facility, contribute to the overall health outcomes. Globally, the need for EMS remains critical, as over half of the global mortalities are as a result of emergency medical diseases. This study aimed to explore facilitators and challenges of implementing EMS in Kisii County using the health system building block framework. The research was a cross-sectional qualitative study that utilized interviews for data collection. The target population was 14 the personnel in the EMS department; health managers and EMS frontline workers of the Kisii County. The study findings were subjected to qualitative data analysis and finding presented. The study followed all ethical considerations.The study established that the EMS implementation has improved health services by increasing the scope of services to include referrals, medical evacuation, and health education. The main facilitators for the EMS service delivery were a dedicated, diverse and team spirited work force, good communication and coordination during the dispatch process, availability of infrastructure, medical products, and technologies, and publicly financed system. The study also revealed that the main challenges in the EMS implementation are inadequately trained workforce, staff shortages, some faulty equipment, lack of financial transparency and delays in allocation, lack of a lead agency and national policies on EMS. Based on the findings, the study recommends that EMS implementers ensure that they have well trained and adequate EMS workforce, availability of functional communication, medical and transportation infrastructure. Additionally, develop national EMS policies and publicly financed EMS systems.
Factors influencing voluntary national hospital insurance fund enrolment and retention: a case of Busia County
(Strathmore University, 2021) Akute, Frankie Gweya
Health insurance is an important aspect of health financing. Health insurance is an insurance that covers the whole or a part of the risk of a person incurring medical expenses, spreading the risk over numerous persons. The low uptake of NHIF in Kenya demonstrates the need for measures and strategies that would motivate and spur change at conceptual and theoretical levels in terms of universal healthcare provision. Kenya currently lacks evidence on whether income in the informal sector which contributes to the voluntary contribution members is sustainable and predictable making it able to support the financing of universal health coverage. The study used a cross-sectional survey design to determine factors influencing voluntary National Hospital insurance Fund enrolment and retention, a case of Busia County. Its specific objectives included: to examine the influence of economic status on voluntary enrolment of individuals to the National Hospital Insurance Fund in Busia County; to establish the influence of individual awareness on voluntary enrolment of individuals to the National Hospital Insurance Fund in Busia County; to determine the influence of cultural practices on retention of individuals voluntary enrolled with the NHIF in Busia County; and to explore the influence of quality of service on retention of individuals voluntary enrolled with the NHIF in Busia County. The theoretical foundation featured the conventional health insurance theory and the expected utility theory. The study population was drawn from Busia County and was concentrated in four sub counties; Bunyala, Butula, Teso North and Matayos. The accessible population for the study was 63,458. The sample size for this study was 397 participants. The study used structured questionnaires to collect data. The collected data was analysed quantitatively using SPSS version 20 and Minitab version 20. The results of the age distribution indicated that the majority of the respondents were above the age of 51. As far as the level of education was concerned, the majority of the NHIF members had only primary level of education. An assessment of the results relating to the employment status showed that most of the NHIF members were self-employed. Finally, the vast majority of the members had 4-6 children. Neither economic status factors nor cultural practices have negatively affected individuals’ voluntary enrolment to the NHIF. However, most individuals are neither aware about the enrolment process nor the associated health benefits. The study recommended that the policy makers of the NHIF should do more in coming up with incentives to lure younger individuals to enrol with the scheme. Further, subsidies should be offered to the informal sector so as to boost the voluntary enrolment to the scheme. The NHIF should engage in more awareness campaigns to raise the level of awareness about the method of registration and the associated benefits that accrue to someone upon registration.
Dual practice of public hospital medical doctors at county referral hospitals in Nairobi, Kenya
(Strathmore University, 2021) Karugu, Lucy
This study assessed the dual practice of public hospital medical doctors at county referral hospitals in Nairobi, Kenya. The three-county referral hospitals under investigation were Pumwani hospital, Mbagathi hospital, and Mama Lucy hospital. Specifically, the study aimed to 1) establish the prevalence or extent of the dual practice of public hospital medical doctors; 2) determine forms and/or modes of dual practice of public hospital medical doctors; 3) identify factors that drive the dual practice of public hospital medical doctors; 4) find out reasons for commitment to public practice among public hospital medical doctors; and 5) examine consequences or impacts of dual practice of public hospital medical doctors. This study achieved these objectives through mixed methods of data collection and analysis. Moreover, the study adopted a descriptive online questionnaire survey with semi-structured and open-ended questions to collect data from 63 respondents (38 – medical doctors and 25 management teams) across the three hospitals under investigation. The Census sampling technique was adopted. The findings reported that the prevalence or extent of the dual practice of public hospital medical doctors is at 54%. Most public hospital medical doctors who engage in dual practice do so because of the low/negative perception they have on their current public practice income. The findings also indicate that the motivating factor or reason why most public hospital medical doctors engage in dual practice is to enhance their current income. That is to say, private practice income supplements public practice income. Though there exist dual practices among some public hospital medical doctors, the study established that some public hospital medical doctors, however, are committed to public practice. Results indicate that the responsibility to uphold public health for all and building reputation are some of the reasons some public hospital medical doctors are committed to public practice. Also, the study found out that faster promotion, increased salary, and provision of housing benefits are some of the conditions that would make the majority of the public hospital medical doctors who engage in dual practice give up their private practice for public practice. Consequently, the study findings report that consequences of the dual practice of public hospitals medical doctors varies and can either be positive or negative to the health system, patients, and public health institution. This study concludes that healthcare remains a development priority across nations. As the demand for health services increases so will the dual practice of public hospital medical doctors due to the growing disparity in the doctor-patient ratio. The study recommends the need for more policy frameworks on dual practice to work for the benefits of public hospitals. Also, the study recommends further research to focus on all county referral hospitals in Kenya with large sample size.
Examining private sector engagement in provision of public health services towards universal health coverage: a case study of Kisii County
(Strathmore University, 2021) Mounde, Mokaya Isaiah
For Kenya to achieve universal health coverage (UHC) by year 2022, the national and county governments must strengthen engagement with the private sector. Yet there is lack of clarity on private sector engagement across counties. This study sought to describe engagement and impact in Kisii County. Specifically, the study sought to describe the private sector engagement models in Kisii, examine achievements and challenges of engaging the sector in meeting public healthcare goals, and explore management views on the perceived impact of private sector engagement. A multiple methods approach was taken, with data collected from 62 employees of the Kisii county health department and the private sector. The quantitative component entailed collecting survey data from 52 participants (21 public, 31 private). The qualitative component entailed 10 in-depth interviews (five each for public and private). Findings indicated that whereas a myriad of private sector engagement models were employed, the public-private partnership model was most preferred. Engagement achievements included public sector getting human resources from the private sector; technical and capacity building support; and technological and financing support from the private sector. Engagement challenges included difficulty in regulating and holding the private actors accountable under the partnership arrangements; difficulty in engaging the private sector in non-profit initiatives; and county government inability to sustain programmes initiated by the private sector. Overall, private sector engagement was perceived to have had a positive impact on progress towards UHC in Kisii across all six-health system building blocks, namely, governance, health work force, financing, service delivery, healthcare technology and access to medicines. Among others, the study recommends that county governments should have a central role to play in targeting and identifying households for National Hospital Insurance Fund (NHIF) enrolment and that national governments ought to avail financial resources to facilitate increased population coverage through the NHIF in keeping with universal health coverage. The study also recommends that the Kenyan government should increase public financing of the health sector at the county level. By dedicating 15% of the national budget towards healthcare for instance, there will be an uplift in the healthcare system enough to realize the Universal Healthcare Coverage as per the Abuja declaration of 2001 to which Kenya is a signatory.
Organizational levels’ involvement in electronic health system adoption in Nairobi: a case study of Radiant Group of Hospitals
(Strathmore University, 2021) Tchaiwe, Zulu
Kenya has experienced a notable increase in uptake of eHealth interventions since the first initiative documented in 2001. But there is limited knowledge on factors influencing the adoption process of locally produced eHealth systems. EHealth adoption enhances quality of life by improving quality of health service delivery, promoting access and cost containment through modern technology. Despite its benefits eHealth still has high failure rate of more than 40 percent. Studies have shown that a vast amount of eHealth adoption fail during implementation phase. Other studies in Kenya revealed a gap of inadequate involvement between strategic management and system end-users in the adoption of Electronic Health Record (EHR) systems. The purpose of this study was to investigate how the involvement of all organizational levels influence the adoption of EHR system through a two-dimension framework that integrates the adoption process and intra-organizational levels. The main objective of the study was to explore the effectiveness of all organizational levels’ involvement in the adoption of a locally developed EHR system in Kenyan context. The study focused on adoption stages of investment, implementation, and utilization. The study was conducted at Radiant Group of Hospitals by examining processes that occurred during the adoption of a locally produced EHR system. A case study design was used for the study. A qualitative approach was adopted to provide in-depth understanding of circumstances relating to how the different levels in the organization perceived the EHR system adoption process. The sample size of the study was 15 comprising of: four of strategic personnel, five operations personnel and six frontline personnel. The collected data was entered and analysed using Nvivo Pro 11. The results from the study indicated that involvement of all organization level in EHR investment decision can positively influence success of EHR adoption as this promotes end-user’s ownership of the system. Organizations need to take their time in planning adequately and in choosing the right vendor. Successful Implementation relies mainly on adequate training of frontline level plus training of trainers (TOTs), availability of IT supporting infrastructures as well as a supportive IT team and vendors. The system is likely to be used effectively if perceived useful in easing and aiding one’s duties. Individual computer or IT skills and supportive superiors also plays a great role in system usability.
Determinants of health seeking behavior among health workers in Kenya: a case of AAR Healthcare Kenya
(Strathmore University, 2021) Njuguna, Eva Wangeci
Whereas several studies have described health seeking behavior within the context of various diseases, and some among different population sub groups, the dominant perspective taken of healthcare workers has been that of service providers and not as consumers. This study sought to identify and assess the factors that influence health seeking behavior of healthcare workers in Kenya hence addressesing this gap. The specific objectives were: to determine the predisposing, the enabling, and the ‘need’ factors that influence health seeking behavior of healthcare workers. To achieve these objectives the study focused on a particular sub-group, that is, health care workers at AAR Health care Kenya - a private for-profit health services provider with a national footprint. The study was anchored on the Andersen health behavior model and adopted a mixed methods research design. The study targeted 200 health workers with a focus on those working at the Nairobi Outpatient Centres. The study employed a stratified random sampling technique whereby a 30% sample was picked from each subgroup, resulting in a sample size of 75 subjects. Primary data was collected through a questionnaire and data obtained analyzed through descriptive and inferential statistics. To this end, the study found that predisposing factors such as age, gender, level of education, marital status, religion and ethnicity determined the health seeking behavior of HCWs. The study also established that quality of health services in the health facility, cost of health service, ability to pay for the health service, availability of drugs, medical health insurance coverage, and waiting time before getting treatment in a health facility influenced health-seeking behavior of HCWs. Need factors such as perceived health status, severity of their illness, the status of their illness, duration they have stayed with a disease/ illness, ability to self-medicate and having poor health perception influenced HCWs health seeking behavior. The regression indicated that there is a positive and statistically significant association between health seeking behavior of HCWs and need factors, enabling factors and while predisposing factors were found to be statistically insignificant with health seeking behavior of HCWs. The study recommends for up-scaling the coverage of the existing health insurance schemes including the National Health Insurance Scheme, for HCWs. There is need to increase the number of health facilities in under-served areas. The quality of care provided at health facilities also requires attention (improve quality of care) and ensure availability of drugs. It is expected that the findings of this study will be of benefit to the healthcare workers in terms of improving the health seeking behavior of HCWs. To policy makers and regulatory institutions, the findings may trigger policy formulation aimed at improving the health seeking behavior by HCW; and to scholars and researchers the study addzknowledge in the field of health seeking behavior of HCWs and also act as a basis forzfurther research.
Examining level of awareness and compliance with the World Health Organization safety checklist among Kenyan anesthesiologists
(Strathmore University, 2021) Ntonjira, Muthoni
Patient safety is a fundamental right and is of great value among patients undergoing medical procedures that involve the administration of anesthesia due to the risks and high potential for complications. Statistics show that the global rate of adverse patient outcomes (mortality and complications) remain high, particularly in low- and middle-income countries. While factors such as low numbers of medical specialists contribute, there is growing evidence linking adverse outcomes to poor compliance to safety checklists and guidelines in surgery, including the World Health Organization Safe Surgery Checklist. This study assessed and explored compliance to safety checklists by medical specialists in order to inform policy and practice on how compliance can be improved for better outcomes. The study employed a mixed method approach to assess factors that influence compliance to the components of WHO surgical safety checklist among anesthesiologists and explore underlying reasons. Both quantitative and qualitative data were collected using questionnaires and interviews. Findings showed an understanding and good knowledge about all the components of the WHO safety checklist among the practitioners. Many agreed that the safety checklist is central to improving the safety in the operating room and in the surgical procedures. In terms of compliance, not all aspects of the checklist were adhered to by the practitioners. Participants only agreed to adhere to some of the aspects of the WHO safety checklist. The level of compliance with the WHO checklist strongly dependent on the level of knowledge among the respondents regarding the presence of these WHO safety checklist (p=0.000, B=0.821); high levels of knowledge correlated to high levels of compliance. There are significant discordances between knowledge and compliance of the WHO surgical safety checklist. Recommendations for improving compliance to the WHO safety checklist have been provided.
Assessing patients’ satisfaction with universal health coverage reforms using servqual model: a case of Matuu Sub County Hospital, Machakos County
(Strathmore University, 2021) Nzomo, Benjamin Masila
Kenya’s quest to be among nations worldwide providing Universal Health Coverage (UHC) to their populations took off in earnest in December 2018 with the roll out of a pilot study in four Counties namely Isiolo, Kisumu, Nyeri and Machakos. Quality health care services offered in a health facility as postulated by patient satisfaction is one of the cornerstones of UHC. Some studies have shown that as financial barrier to access of health care is lifted and service coverage increases, service quality often plummets in terms of safety, timeliness, efficiency, effectiveness and patient-centeredness due to overutilization and deficient governance structures among others. Empirical evidence of this in Sub Saharan Africa is however rather thin especially the shift in patient’s expectations and perceptions of service quality in the early phase (first five years) of UHC implementation. This study addressed this gap by evaluating patient’s satisfaction of services offered at a public sub-national level 4 health facility in Kenya three years after UHC roll out. Using a descriptive cross sectional study design, a sample of 311 patients was randomly selected to fill a SERVQUAL questionnaire to record their pre-service expectations and post service consumption perceptions of the services given since UHC commencement. Perception-expectation (P-E) gap scores were then analyzed using Statistical Package for Social Science (SPSS Version 25) to determine the statistical significance of the mean differences between patients’ expectations and perception of the five dimensions surveyed. The study findings showed a statistically significant overall patients’ satisfaction with UHC reforms in Matuu Sub County hospital. Patients were most satisfied with assurance; followed by empathy, reliability, tangibles and finally responsiveness. However, notable areas of dissatisfaction included the long turn-around time, staff’s inability to effectively communicate on when services will be offered and the uncaring attitude of the healthcare workers.
Impact of demographics, technology and health systems characteristics on healthcare costs among private health insurers in Kenya
(Strathmore University, 2021) Mnyapara, Jebidah Mkabili
Introduction: There is a global concern on the rising health care expenditure. Several literatures have attributed this to Gross Domestic Product (GDP) growth, disease prevalence such as the upsurge of both communicable and non-communicable diseases, population growth, an aging population, increasing life expectancy, medical progress and technology advancement, sustained increase in medical insurance coverage, waste, public health expansion initiatives, provider payment mechanisms such as fee for service and rising cost of prescription drugs among others. The rising healthcare cost is ultimately borne by the payers of the healthcare system and more specifically to this study, private health insurers in Kenya. This study therefore sought to establish the impact of demographics, technology and health systems characteristics on healthcare costs among private health insurers in the Kenya in order to recommend strategies to address these costs. The conceptual framework adopted for this study sought to establish if there was a relation between the dependent variable; private health insurance costs and the independent variables- demographics, technology and health systems characteristics. Methodology: This was a quantitative mixed study employing both investigative and descriptive statistics; a census based-cross sectional study of the thirty-two (32) private medical insurers in Kenya; twenty-seven (27) medical insurance and five (5) re-insurance companies. Data was obtained from primary sources through a structured questionnaire and secondary data from insurance industry reports and other publications on the topic. Descriptive analysis was conducted using SPSS and data analyzed using mean, frequencies, and standard deviation to enumerate the number of health insurers by variables under study. Correlation analysis was conducted to establish a relation between the dependent variable; private health insurance costs and the independent variables- demographics, technology and the health systems characteristics. Results of the study presented using tables and charts. Conclusion: The study concluded that health systems characteristics factors have a higher impact on healthcare costs among the private health insurers in Kenya than demographics and technology. However, there are some individual variables within the factors that have a higher impact on healthcare costs such as emerging health risks factors (smoking, tobacco consumption and sedentary lifestyles), increasing prescription drug costs, fraud and abuse, low utilization of primary care gatekeeper and advancing medical technologies. Correlation analysis showed that technology and health systems characteristics were positively and significantly correlated which means if the two factors were addressed, the healthcare costs of private medical insurers in Kenya would decrease. The same nature of relationship was observed with demographics but the relationship was insignificant.
Quality improvement initiatives in county hospitals: a multiple case study of four hospitals in Uasin Gishu County
(Strathmore University, 2021) Kiprop, Jedidah
There is growing evidence showing that expanded access to healthcare services is in itself insufficient, and that quality and patient safety are vital components for achievement of good outcomes. Like other counties, Uasin Gishu County has made effort to encourage healthcare facilities to take up continuous quality improvement (QI) initiatives. While hospitals report implementing QI, no assessments have been done to inform the county policymakers. This study sought to fill that gap. Using four facilities as cases (Huruma, Turbo, Pioneer, and Uasin Gishu), the study employed a mixed-methods approach, including a questionnaire survey covering 180 participants (various roles and levels) and qualitative in depth interviews with facility in charges, heads of department or QI focal persons (champions). The study found that the Plan-Do-Study-Act (PDSA) model was the primary approach used across the County, building mainly from the vertical HIV care program. Most QI initiatives were externally driven under vertical programs such as reproductive health, tuberculosis and infection prevention programs. Barriers to QI implementation included staff and organizational-level challenges. Staff-related factors such as laxity, high turnover and low morale were elicited. Organization barriers included hierarchical culture, poor communication practices and inadequate QI leadership support from the County. Factors that facilitated QI implementation included relevance of the initiatives to the staffs, training in QI, monitoring of projects and rewarding staffs. While a narrow range of clinical outcomes were monitored objectively, most outcomes were estimated subjectively, making it difficult to gauge the effectiveness of the QI activities. The initiatives were also not sustained beyond the initial scope. The study recommends improving the QI approach by focusing strongly on internal gaps, improving the integration with existing structures, instituting on job training and addressing human resource challenges.
Strengthening pharmaceutical distribution chain in Kenya: a case study of the Kenya Medical Supplies Authority and Dagoretti Sub-County Hospital
(Strathmore University, 2021) Lelei, Delyth
The increasing demand for medical products continues to put pressure on pharmaceutical supply chains, jeopardising the health system's goal of universal access to safe, effective, quality, and affordable commodities. Evidence-based supply chain management interventions could help address the majority of the challenges. Using the case of Kenya Medical Supplies Authority (KEMSA) and Dagoretti Sub-County Hospital (DSCH), this research aimed to identify factors that affect the performance of Kenya’s public health sector pharmaceutical distribution chain and identify areas for improvement. Specifically, the study aimed to (i) characterize the pharmaceutical distribution value chain linking the central medical store (KEMSA) and use point (DSCH), (ii) identify all non-value-add steps/processes and activities throughout the value chain, and (iii) propose an alternative distribution chain that could perform a similar function with higher effectiveness. A cross-sectional qualitative study design was used to collect data using key informant interviews. Qualitative data was managed in NVIVO and analysed following a thematic approach. Findings highlight four key activities that characterise the pharmaceutical distribution chain in the public sector: 1) demand for pharmaceutical products, 2) procurement, 3) warehousing, and 4) distribution. Besides, the study identified the adoption of technology, training of staff, collaboration between KEMSA and DSCH/counties among the most important value-adding factors. However, having fewer KEMSA distribution facilities and the use of manual procurement activities were identified as the primary non-value-add process reducing the performance of the pharmaceutical distribution chain in the public sector in Kenya. The study, therefore, recommends a shift from a manual procurement process to an online system to improve efficiency by reducing delays in the tendering process. Besides, KEMSA should consider expanding the network of distribution facilities across the country to enhance ease of access to pharmaceutical commodities, enhancing efficiency in service delivery whilst reducing the logistical costs and delays in transporting commodities.
The Effect of psychological safety on quality of healthcare services by health workers in Kitale County Referral Hospital
(Strathmore University, 2021) Ouma, Edward Ochieng
Healthcare organizations operate in a dynamic, complex industry full of high demands and accountability with an aim to deliver services to the patient and the stakeholders at large. It hence needs a collaborative approach in carrying out its mandate, meaning individual, team dynamics and its organizational climate comes into play. When quality is critical and effective safe patient care is warranted, then performance comes to play. As a result, health organizations that tend to enhance an environment that facilitates faster learning, creativity, and innovation tend to have a better chance of success. Where an individual can air their opinion without fear of repercussion, take interpersonal risk without fear of retribution as long as it intends to meet or even further the organizational goals. These, as a result, lead to increased patient safety due to no fear of reporting medical errors, enhanced team cohesion, innovative solutions to emerging challenges. However, information concerning, the role of psychological safety on quality of health in Kenya is scanty. The objective of the study was to determine the effects of psychological safety of healthcare workers on the provision of quality healthcare in Kitale County referral hospital. The research was underpinned by the theories of conservation of resources, trait activation, and social exchange. The study applied quota and convenience sampling techniques as well as a cross-sectional descriptive design. Primary data was collected through structured questionnaires. Data collected was analyzed by both correlation analysis and multiple regression via SPSS. Results showed that team psychological safety had non-significant relationship with quality of healthcare(p-value>0.05) while both the individual (p-value=0.044) and organization (p-value<0.001) psychological safety have significant relationship with quality of healthcare. These results conclude that individual and organizational psychological safety contributes to improvement in healthcare quality in Kitale county referral hospital. The study recommends that county governments and management of public hospitals should improve individual, team and organizational psychological safety as a way of driving creativity and innovation in enhancing healthcare quality.
Implication of the construction of clinical hybrid roles on service delivery in Kenyan Private Hospitals
(Strathmore University, 2021) Nguu, Michelle
There is an increasing trend of clinicians and other healthcare workers taking on management roles in addition to their clinical roles; consequently, leading to the growth of hybrid clinical managers. This has been influenced by the change of policy around service delivery, increased need for accountability in terms of the quality of health services offered and patient outcomes. Evidence from several studies shows that the inclusion of doctors in strategic, financial and policy reforms agendas leads to better performance. Over the last decade there has been a growing interest in investigating how hybrids transition, navigate and manage the duality of their roles. This study used Identity theory to understand how clinical hybrids make sense of their identity as both clinicians and managers and how they navigate both roles whilst prioritizing better service delivery. Identity theory focuses on the construction processes of personal identity and social identity through the processes of forming, repairing, maintaining, strengthening, or revising the constructions. Identity theory was useful in explaining the identity work doctors in this study undertook to manage tensions between their personal, social professional identities. The clinical hybrids in this study did not want to lose their identity as doctors and want to remain within their professional groups to maintain their legitimacy with their peers. To assess how doctors navigate their dual role, how they deal with their peers and what accountability mechanisms they put in place as managers to protect their clinical autonomy, this study used ethnography of private hospitals in Nairobi County. A total of ten doctor managers were conveniently sampled across different gender, specialties, and years of working experience. Data was collected using in depth interviews with the aid of an in-depth interview guide that made use of open-ended questions for in-depth inquiry. The interviews lasted 45- 60mins and were audio recorded and later transcribed and thematically analyzed alongside hand-written notes taken during the interviews to complement the audio recording. The study results revealed that to manage the uncertainty of their dual roles, clinical hybrids relied on evidence-based practices to ensure positive clinical outcomes. The study revealed that organizational support was key in helping hybrid clinicians manage their dual roles. When hybrid managers lacked organizational support and were left out of key strategy making decision, this usually led to negative impact on service delivery because they would be forced to meet the objectives of the organizations at the expense of offering quality care. However, the hybrids showed innovative top and downward strategies that helped them navigate their role and organizational conflicts by drawing on administrative l skills acquired as a prerequisite to the current roles. The hybrids recommended that organizations employing hybrid clinical managers institute well illustrated job descriptions and allocate percentage time to be spent on clinical and managerial roles to avoid dual role conflict. The study findings will be useful in informing context specific training that not only builds clinicians’ management and leadership skills but also supports them through the transition period through e.g. mentorship activities, reflective sessions etc. that can support hybrids to support their daily work. Additionally, the results can be used to inform the ministry of health and professional associations in development of clear job titles and positions for clinicians who are also managing organizations and in provision of the required recognition for such positions.
Examining the effect of result based financing on health worker motivation in Makueni County, Kenya
(Strathmore University, 2021) Makau, Leonard Cedric
Calls for universal health coverage (UHC) have triggered renewed focus on strengthening primary health care (PHC) and improving health worker performance. In Kenya, health service delivery is impeded by the poor quality of service, inefficient use of resources and low health worker motivation among other factors. Result-based financing (RBF) has the potential to strengthen service delivery by improving motivation, quality and resource use. The RBF concept typically entails deploying some form of financial reward towards staff who achieve a certain level of performance or outcomes. Studies on RBF in low and middle-income countries have given mixed results. This study looked at the effect of RBF on the motivation of PHC staff in Makueni County. Specifically, it sought to determine the effect of RBF, operational funds and service improvement funds on staff motivation. The study was conducted in the six sub-counties in Makueni County using a descriptive research design. Data was collected using a questionnaire, and descriptive and inferential statistical analyses were done. The study found a strong positive correlation between performance-based incentives and healthcare workers’ motivation. Also, the study revealed that performance-based payments and motivation of healthcare workers had a strong positive relationship. The study found that operational funds and motivation of healthcare workers have a strong positive relationship. The study established that service improvements funds had a strong positive correlation with the motivation of healthcare workers. The study recommended that health facility management consider performance-linked incentives for staff, and that effort is made to ensure availability of operations and service improvement funds for smooth running of the facilities. This would contribute to the UHC goal of ensuring access to safe and high-quality healthcare services.
Availability and affordability of essential medicines for Non-Communicable Diseases across six Kenyan Counties
(Strathmore University, 2021) Mohamud, Ahmed Mire
The burden of Non-Communicable diseases (NCDs) is increasing in Kenya and other low-and middle-income countries. Evidence suggests that poorer groups are more affected as they have to incur lifelong costs of treatment associated with NCDs. Typically, out of pocket payment for NCD medicines consumes the largest share of treatment costs for NCDs, exposing households to the risk of catastrophic health spending. This study sought to assess the availability and affordability of three medicines used for management of diabetes, dyslipidemias (problems of poor cholesterol control) and hypertension in pregnancy at public and private hospitals in Kenya, and assess the risk of incurring catastrophic health expenditure due to out of pocket purchase of the medicines. This study used a quantitative approach, analyzing data using the WHO/HAI methodology to determine availability and affordability of Atovarstatin 20mg, Metformin 500mg, Methyldopa 250mg. The study found out that atorvastatin’s availability was 32% and 70% in public and private facilities respectively; Metformin (94% and 84% in public and private respectively) and Methyldopa 75 and 82% for public and private facilities respectively. The lowest paid government worker would require a day’s wages to purchase a monthly dose of Atorvastatin in public facilities, and three days’ wages to purchase at a private facility. However, price differences were minimal for the other two medicines. The medicine price ratio (MPR) for Atorvastatin was nearly four times that of the international reference price list, the ratio was higher in private facilities as compared to public facilities (4.75 vs 1.19). The MPR for Methyldopa was 1.18 times the international reference price for both public and private facilities. The MPR for Metformin was three times the international reference price with the ratio being higher in private facilities. Finally, the study found that the risk of incurring catastrophic health expenditure due to out of pocket purchase of medicines for households was 1.5%, 6.8%, 15.1% and 28.8% for Metformin, Atorvastatin, a combination of two medicines (Atovarstatin and Metformin) and Methyldopa respectively. The study concluded that NCD medicines had low availability, were unaffordable and had a considerable risk of catastrophic health expenditure, especially among the poor.
Automated Clinical Decision Support in HIV management: a comparative study of Point-of-Care and Retrospective Data Entry outcomes
(Strathmore University, 2021) Masibo, Wundundi Sammy
Kenyan healthcare facilities are increasingly adopting electronic medical records (EMRs) and electronic health management information systems (HMIS). Many public hospitals have automated HIV/AIDS care services in pursuit of efficiency and better patient outcomes. This has triggered interest in clinical decision support (CDS) systems. The CDS systems are designed to provide patient-specific information that is intelligently filtered to healthcare providers at appropriate times to enhance clinical decision-making. Studies have shown that automating CDS has certain advantages over manual systems. What remains unclear is whether the way the automated CDS is deployed has an impact. Point-of-care deployment refers to the use of CDS systems at the actual time of service delivery (data collection and system delivery are concurrent). Data is entered in real-time. Retrospective data entry (RDE) refers to deployment of systems to be used after the actual service delivery. Data is captured in primary manual tools and later transferred to the electronic database after the fact. This study sought to establish whether deploying a CDS system at point-of-care (POC) is more beneficial than deploying it retrospectively given the incidental capital outlays for POC systems. The study entailed a cross-sectional analysis of data collected through the KenyaEMR system; an electronic medical records system developed to manage HIV/AIDS services in Kenya. The study found that deploying CDS systems at point-of-care results in a lower patient missed appointment rate (21.34%, SD 8.24) compared to CDS applied retrospectively (31.58%, SD 15.47). CDS systems deployed at POC also result in better viral load testing rates (42.06%, SD 10.49) compared to retrospective CDS (37.56%, SD 10.03). There was no significant variation in the viral load suppression rates between POC and RDE modes (81.88%, SD 7.47 and 79.67%, SD 7.63 respectively). The study also enumerated challenges faced by system end-users when KenyaEMR is deployed retrospectively. These included duplication of work (84%) and lack of quality and timely data (74%). The potential barriers that constrain facility transition from retrospective data entry to point-of-care deployment were also established and included inconsistent power supply (95%) and negative staff attitude (74%).
Exploring factors influencing the implementation of clinical risk management programs by nurses in public hospitals: a case study of the Mbagathi Hospital in Nairobi Kenya
(Strathmore University, 2021) Ogolla, Christine
As patient safety becomes a priority issue in health systems, clinical risk management (CRM) continues to gain prominence. CRM refers to strategies aimed at identifying, analyzing, and managing potential risks in healthcare organizations. Evidence shows that implementing CRM among nurses can be difficult in low-resource settings. This study explored the perspectives and experiences of nurses in implementing CRM in the context of a Kenyan public hospital, the Mbagathi Hospital in Nairobi Kenya. The study specifically explored how organizational culture and leadership, and resource availability affect the ability of nurses to implement clinical risk management activities at the Hospital. A qualitative approach was taken. This entailed interviewing up to 20 purposively selected nurses, ensuring that their experiences were captured at different levels of the hospital system. Data was collected using an open-ended interview guide, developed building on the objectives of the study. Data were transcribed and transferred into NVIVO for thematic analysis. The study findings revealed that the main resource factors that affect the implementation of CRM programs were the limitations of human, financial, and physical, and IT resources. This study also identified leadership factors like poor safety culture, poor leadership support and commitment, and poor collaboration and communication to affect CRM programs. This study concluded that although nurses are expected provide high quality and safe care, these challenges have created an unconducive environment to effectively integrate CRM programs into their professional practice. This study suggests that hospitals should provide a favorable working environment, foster leadership commitment, and support, and avail the necessary resources for the successful implementation of CRM programs. The findings of this study were disseminated by giving written feedback to study participants and the hospital management in form of emails. Dissemination will also be done by publishing the study in a peer-review journal to inform management of other public hospitals on strengthening the implementation of clinical risk management activities, and also to inform research on related topics.
An Assessment of activity completion time in a health care delivery program: a five year study of the kidney transplantation program at Kenyatta National Hospital, Nairobi-Kenya
(Strathmore University, 2021) Ngigi, John
The health and economic burdens due to non-communicable diseases (NCD‘s) in Kenya is on the rise and requires multi-sectorial engagements and collaborations to contain. Chronic kidney disease (CKD) is one of the NCD‘s with significant morbidity and mortality affecting about 10% of the Kenyan population. The healthcare system should be able to provide quality healthcare to the citizens in line with the sustainable development goals (SDG) where universal health coverage (UHC) is one of the deliverables. The Interlife kidney transplantation program at the Kenyatta National Hospital (KNH) is one of the initiatives set up within the healthcare system with the aim to provide specialized healthcare within the CKD care continuum. This study focused on the Interlife program as a case model on timeliness of healthcare delivery. This was a retrospective review of medical records of patients who were evaluated for suitability for kidney transplantation and eventually underwent kidney transplantation surgeries at KNH between 2010 and 2014. The study investigated the timeliness of various key processes involved in the pre-transplant and immediate post-transplant periods. The primary objective was to determine the throughput time within the transplant evaluation process. Specific objectives were:- To determine the turnaround time for some key routine diagnostic blood tests required for safety in kidney transplantation; (Human immunodeficiency virus (HIV), Hepatitis B virus surface antigen (HBsAg), hepatitis C virus antibodies (HCV) and cytomegalovirus antibodies (CMV)), to establish the timeliness of access to consultations with two key specialties (cardiology and anesthesiology) within the kidney transplant program, to determine adherence to the kidney transplant pathway for two key processes (kidney ultrasound and blood assay for calcineurin inhibitor (CNI) in blood), to determine average hospital length of stay among kidney transplanted patients and to establish the frequency and reasons for cancellations of planned kidney transplant surgeries. The deviations of the timings from the transplant protocol which ultimately contributed to the overall delay in the program were noted. Categorical data had counts and percentages calculated. For normally distributed continuous data, means and standard deviations were calculated. For skewed data, the median and interquartile ranges were calculated. Inferential statistics were reported at 95% confidence with the p value ˂ 0.05 considered statistically significant. Analysis was performed using the Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Ninety nine individual patients‘ medical records were traceable. Males were the majority at 73(73.7%). Twenty patients had their elective kidney transplant surgeries cancelled at least once for reasons which were medical, social, financial or logistical. In conclusion, the pre-transplant evaluations and the peri transplant processes in the program are not timely and it is recommended that measures be undertaken to address the preventable causes of delays and cancellations of elective transplant surgeries as part of the program quality improvement initiatives.
Factors affecting compliance to infection prevention and control measures among frontline health workers: a case study of the Kitale County Referral Hospital
(Strathmore University, 2021) Kisaka, Yvette Nafula
The quality of services provided at a healthcare facility is greatly influenced by compliance to infection prevention and control (IPC) standards. Low adherence increases the risk of transmitting pathogens like Covid-19 and exposure to occupational hazards. This study sought to assess factors that affect compliance to the IPC standards by frontline healthcare workers at the Kitale County Referral Hospital in Trans-Nzoia County. For purpose of the study, frontline healthcare workers include nurses and doctors only. The study objectives were to (i) examine the implementation of infection prevention and control (IPC) measures relating to hand hygiene, personal protective equipment (PPE) usage, and safe injection practices at the Kitale County Referral Hospital (ii) describe the patterns of association between selected health worker socio-demographic characteristics and compliance to the IPC standards and (iii) examine health facility factors that affect compliance to the IPC standards. A mixed-methods study design was employed. Actual data was collected from healthcare workers, who were stratified into two groups: nurses and doctors. For quantitative data, participants were selected using the stratified random sampling method, and data collected using a semi-structured questionnaire, followed by analysis using the Statistical Package for Social Sciences (SPSS). For the qualitative component, purposive sampling was employed to select participants, data collected through in-depth interviews guided by a topic guide and analyzed using the by NVivo Pro software. A total of 111 participants were involved in the survey, with eight being included in the in-depth interviews. Of the 111, 81% were nurses, and 65% female. Nearly two-thirds said they had had IPC training. The survey found the level of full compliance to be 53.2% for hand hygiene, 52.3% for PPE use, and 59.5% for injection safety which was lower than expected considering the global efforts towards improving IPC practices in the covid-19 era. Additionally, it showed a significant correlation between health worker cadre and compliance to hand hygiene. Existence of an IPC committee, provision of adequate PPE and injection safety boxes, management support, availability of policies and guidelines, and their ease of accessibility were also linked to level of compliance to hand hygiene, PPE use and injection safety. The findings add to ongoing research aimed at understanding how IPC policy and practice can be improved to eliminate transmission of nosocomial infections, especially in the Covid-19 pandemic.
Patient satisfaction with service quality in Kenyan University Dental Hospitals
(Strathmore University, 2021) Kabubei, Edward Mungure
Patients seek oral health services to alleviate pain, treat diseases affecting the teeth and face, improve aesthetics as well as to prevent and promote oral health. Patient satisfaction has many dimensions which include expectations, values, and actual experiences. It is a key indicator of measuring quality of healthcare. It affects patients’ behavior on how quickly they seek and recommend healthcare services. This in turn influences how effective healthcare will be in terms of their compliance and it shapes how they utilize healthcare services in the future. The main objective of this study therefore was to determine patient satisfaction with service quality in University Dental Hospitals in Kenya. The research was based on the Donabedian theory of patient satisfaction (structure, process, and outcome) and the disconfirmation theory of consumer behavior applied using a SERVQUAL model. The study employed convenience sampling and a cross-sectional study design. Primary data were collected using a guided SERVQUAL questionnaire administered to 388 patients attending Moi University and The University of Nairobi dental hospitals before and after receiving services. The data collected was presented by use of descriptive statistics (mean and standard deviation) and inferential (multiple regression) using SPSS. The results showed that overall patient satisfaction was high with a mean satisfaction score of 93.9%; further, service quality influences patient satisfaction. Improving service quality increases patient satisfaction, revisit intention and recommendation. From the multiple linear regression model the five service quality dimensions positively and significantly influenced patient satisfaction. In addition, the service quality dimensions included in the model accounted for 62.7% change in patients’ satisfaction. The model revealed responsiveness of healthcare givers as the most influential in boosting the patients’ satisfaction, followed by assurance, reliability, empathy, and tangibles dimensions. The study further unraveled that overall service quality increase patient satisfaction and positively impact revisit intention and future utilization of services in University Dental Hospitals. This study therefore recommends to the management of healthcare facilities to invest more resources in making sure that the responsiveness, assurance, reliability, empathy, and tangibles dimensions of service quality are incorporated in their day-to-day service delivery programs as it bolsters their satisfaction and builds loyalty of their patients. The study limitation is that the population under study was confined to public university dental hospitals in Nairobi and Eldoret, Kenya. The findings may not be generalizable to other healthcare services or institutions. Future research can extend this to other sectors of the healthcare system and incorporate a qualitative component to better understand patient and provider behaviour.

Browse

Browsing MBA-HCM Theses and Dissertations (2021) by Issue Date

Results Per Page

Sort Options