MBA-HCM Theses and Dissertations (2020)

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The Role of human resource management practices on motivation of health care workers in Machakos County
(Strathmore University, 2020) Mirera, Jaqueline Moraa
Work settings are the focal determining factor for the motivation of workers. As the public health care segment in Kenya suffers from problems of professionalization with human resource, the private healthcare sector is expanding fast with the emphasis on management of human resource lying at the centre of the success of private health facilities. The purpose of the study was to establish the role of human resource management practices on the healthcare workers motivation in Machakos County. The specific objectives of the study were to establish the effect of recruitment on motivation of healthcare workers, determine the effect of training on motivation of healthcare workers, examine the effect of performance management on healthcare workers’ motivation and assess the effect of reward management on motivation of healthcare workers in Machakos County. The study adopted a descriptive research design in which the target population was 1179 healthcare employees in Machakos County. Disproportionate stratified sampling and simple random sampling was used to sample 299 respondents. The questionnaire was the selected tool for data collection. Trained research assistants were utilized to oversee the issuance of questionnaires to the participants of this study. Quantitative data collected was analysed by the use of descriptive statistics. The study also used inferential statistics namely correlation and regression analysis to test the relationship between the dependent and the independent variables. The findings are presented in figures and tables. The findings revealed that recruitment, training, and reward management positively influenced healthcare workers motivation. There was however a negative relationship between performance management and employee motivation. The study recommended that first, healthcare facilities should enhance the use recruitment in order to attract the best talents. Secondly, they should embrace the use of training to enhance employee skills and thirdly, embrace performance management with the goal of enhancing employee motivation. Finally, that the health care organizations should use more of rewards to motivate their employees.
Uptake and implementation of the 5S quality improvement model at the Kenyatta National Hospital’s Prime Care Centre
(Strathmore University, 2020) Okello, Roseline
The 5S quality management approach involves, sorting, setting in order, shining, standardizing and sustaining the improvements. The concept has been adopted by the Kenyan Ministry of Health, through the Kenya Quality Model for Health (KQMH) framework because it provides a solid foundation for achieving operational excellence. While it is a relatively straightforward concept, most facilities find it hard to sustain 5S improvements over time, reverting to poorly organized work places and unsafe practices. This study sought to describe the process of uptake and implementation of the 5S continuous quality improvement model at the Kenyatta National Hospital’s (KNH) Prime Care Centre (KPCC). It also sought to understand the opinions of staff in its implementation and explore factors that promote and impede its implementation. Qualitative in-depth interviews were employed to collect data among staff. The study found that the Hospital has a unit mandated with institutionalizing 5S, with assigned coordinators and trained quality assurance staff. However, there was resistance to changing practice to accommodate 5S, contributing to slow uptake overall. There was deliberate effort to promote uptake through changing corporate culture. There was variation in the extent to which different units were implementing 5S, with study findings suggesting that effective adoption was strongly reliant on a leadership style that encourages effective team work and discipline. The study findings contribute to knowledge on factors that contribute to successful deployment of new quality management systems at busy hospitals, leading to improved quality.
A framework for robotic process automation (RPA) for the first-line resolution of customer queries: a case study of Safaricom
(Strathmore University, 2020) Muriithi, Kelvin Wachira
Customer support is important for every institution, be it profit-making or non-profit making. Better services save money, complains and time. Big companies with millions of customers, strives to provide better customer care support due to the high number of customers. They have always found themselves not achieving the kind of support that their customers want. The biggest challenge that such companies with large customer base face in their customer care department, is having enough workforce to respond to customer queries. Keeping on employing new staff does not solve the problem fully as there is a limit to how many employees the company can be able to sustain beyond which the company running cost will exceed the returns. Therefore, this research proposed to solve this challenge by developing a framework for Robotic Process Automation that would enable the creation of a digital workforce to augment the human workforce available for first-line customer query resolution. The main literature that was supporting this research was previous frameworks on RPA. These frameworks do not address customer query resolution, are specific to a given technology and hence not adaptable to different technology. The existing frameworks are also specific to processes and companies which makes them inapplicable to changes in process or company. This research developed a framework that guides the implementation of RPA for customer care department. The framework is not specific to any technology and hence can be used across the company. Test processes used was customer query response process in Safaricom which is a Telcom company in Kenya. The test results gotten from the test bots was 75% success rate with 100% accuracy rate on the pulled response. There are failures that happened with accounted for 9% due to third-party applications. With this framework and the resultant prototype bot, time taken to given customers their feedback in each shift was reduced from 2 hours to about three minutes. This research enabled streamlining and standardization of the customer care processes as well as automating the reporting part of the customer care process. The results indicated that the value is not only in the bot. This study gives organizations insight on how to successfully implement RPA and what factors to beware of to avoid failure.
Effectiveness of leadership and governance in public healthcare provision in Meru County Referral Hospital
(Strathmore University, 2020) Hassan, Ibrahim
The achievement of sustainable development goal number three SDG3 requires strengthening of all the six pillars for health system which includes leadership and governance; health financing; health information; health service delivery; human resource for health; medicines and technology. Leadership and governance is considered the most important pillar in realizing the successful implementation of the universal health coverage (UHC) and quality healthcare services delivery in public facilities. Kenya is in the process of implementing UHC as part of the “Big 4” agenda. Since devolution of health to the county governments in 2013, successful implementation of UHC will depend on effective health governance at the county level. For the health board to be effective in its leadership and governance mandate, its adherence to the “Mwongozo” code of conduct guidelines is not only of necessity but ultimately vital. “Mwongozo” addresses the matters of effectiveness of Boards, transparency and disclosure, accountability, risk management, internal controls, ethical leadership and good corporate citizenship. This study sought to investigate effectiveness of leadership and governance as an enabler of public healthcare provision at the only county hospital with a management board, that is, Meru Teaching and Referral Hospital, in Meru County. Purposive sampling technique was employed with target population being all 13 board and 11 committee members of Meru Teaching and Referral Hospital, out of which 11 board members and 10 committee members responded to the interview. Data was collected through structured in-depth interview guides, transcribed, organized and analyzed thematically in respect to study objectives. Findings showed no mention of “Mwongozo” code of governance as a guiding by board and committee members which means they are not well acquainted with the values of board members. The study findings revealed some board members had no idea of the important needs of residents of Meru County which is likely due to misrepresentation of residents in the board and could render the board ineffective. There was lack of clear framework for induction programme and no benchmarking activities for the board and committee which greatly undermines the efficacy of the board. The women in the board are less than 33%; there is low youth representation and no representation of people with disability. Study revealed among the challenges to be addressed to strengthen leadership and governance in Meru County: fund the health sector adequately, minimize political interference, increase communication between policy makers and implementers, facilitate good feedback mechanisms, and allocation of enough resources for the training and recruitment of healthcare workers.
Assessing employee retention strategies at AAR Healthcare Limited Kenya
(Strathmore University, 2020) Khalibwa, Irene
Organizations are facing the hurdles of retaining their most valued employees with the current cutting competition among companies to have team of high performing workers. Studies have shown that the healthcare industry has very high staff turn-over with doctors who are key drivers of the healthcare industry having an average of 3 years’ length of stay in one particular employer. Some health facilities such as AAR however buck this trend. AAR Healthcare is one of the Tier 1 leading private healthcare services provider in Kenya with comparably high employee retention rate. This study assesses various employee retention strategies applied by AAR Healthcare Kenya. The study specifically investigates how work environment, training and development, recognition and compensation and leadership and management of employee strategies have been applied at AAR Healthcare Kenya and their effectiveness. The research applied a quantitative cross-sectional design approach. A multi-stage convenient sampling technique was adopted to select research respondents from the 21 branches and the headquarters with a total population of 343 employees. The findings of study showed that there was a relationship between employee retention and work environment safety, organization culture, leadership management style and reward recognition, all at 10% significance level. Conversely, the number of trainings did not have a statistically significant relationship with employee retention. Additionally, the study found that the employees were happy with the strategies employed to provide a good working environment and also with the organization culture. However, when it came to the reward and recognition and the leadership and management styles, there was room for improvement based on the responses. The study recommends that healthcare practitioners look into their strategies on these key areas the study focused on and especially, in reward and recognition and leadership and management style as this will further increase their chances of retaining their work force. Additionally, this study serves as a benchmark for policy makers on what can be done to help formulate strategies based on retention and offer guidance on what to do to increase employee retention for organizations .
Determinants of the performance of satellite clinics: a case study of Mater Misericordiae Hospital in Nairobi, Kenya
(Strathmore University, 2020) Mutia, Rhoda
Increased competition in the healthcare industry has forced hospitals to adopt innovative expansion strategies. One such strategy is establishment of satellite clinics. This study sought to examine the performance of the satellite clinic model for the Mater Hospital in Nairobi. The study specifically sought to establish the effect of medical infrastructure, medical staff responsiveness, and medical service quality on the performance of satellite hospitals in Kenya. The study adopted a quantitative research methodology relying on a descriptive research design. The unit of analysis was the satellite hospitals under Mater Hospital with the unit of observation being drawn from the patients served within the satellite hospitals. The satellite hospitals served a total of 126,986 patients in 2018. The study utilized the Krejcie and Morgan table to draw a representative sample that research data was collected from. The study utilized a structured questionnaire with Google forms being utilized in the data collection. The collected study data were analyzed using both descriptive and inferential statistics. The study was able to obtain an 83% response rate with the findings. The results show that over 59% of respondents were female and that 80% have attained more than o-level education. 58% of respondents were repeat clients having received services from the hospital for over three years. The study concludes that R2= .493 variations in the hospital performance of satellite clinics are determined by the level of medical service quality, medical service responsiveness and medical infrastructure at the satellite clinics. The study recommends that the hospital should foster provision of quality medical care, professionalism and responsiveness of the workforce to enhance performance. The study also recommends that the hospital ensures adequate facilities and accessibility of the satellite clinics to enhance performance. The study further recommends that the hospital should rely on the findings of the study in making future decisions in the expansion of satellite clinics and should leverage modern technologies in enhancing patient care.
Effect of staff motivation on retention of nurses in Kenyatta National Hospital
(Strathmore University, 2020) Kironji, Margaret
The provision of quality and affordable healthcare remains a challenge for many countries and has been shown to be constrained by many factors including economic, social and political factors. This then results in an imbalance between the supply and demand for health services. Shortage of skilled health workers then provides further strain on improving access to quality health services. Therefore, there is a need to establish how to make the most of this rare resource, including how to work on the retention of the health care workers. The study was anchored on Herzberg Two Factor Theory that argues that individuals are interested at two different areas of motivation. First level includes psychological needs such as advancement, personal growth, the nature of work, responsibility, and achievement (motivators). Second group of factors the “hygiene/extrinsic are work related like salaries, work conditions, policies and administration. This study aim was to investigate the effect of staff’ motivation on the retention of nurses at Kenyatta National Hospital (KNH). The specific objectives were to determine the effect of financial incentives, career development, working conditions and personal factors affecting retention of nurses in Kenyatta National Hospital- Kenya. Using a mixed methods cross sectional study design, both quantitative and qualitative data was collected from nurses working at Kenyatta National Hospital (KNH). A sample of 228 nurses were randomly selected for self-administered questionnaires for the study. To complement the quantitative data, qualitative data was collected through purposive in-depth interviews with 10 departmental heads in the nursing cadre to understand factors that influenced nurse’s motivation at work. The quantitative data was analyzed using Statistical Package for Social Scientist (SPSS). Descriptive statistics such as frequencies and percentages were used to summarize data while logistic regression was used to estimate adjusted odds ratios. Qualitative data was analysed manually using thematic analysis of issues emerging from the data and informed by findings from the questionnaires. Results showed that nurse’s intention to leave KNH was 60 percent and that age, education, availability of career development initiatives, desire for better working conditions and need for a better pay significantly influenced nurses’ intention to leave KNH. The recommendations from this study include ensuring revision of any CBA agreed on that will look into nurses being paid for overtime hours worked, access car loans and mortgages, ensure nurses are provided with basic career development opportunities such as career talks and scholarship opportunities. Additionally, nurses ought to be provided with good social welfare facilities. The other incentive is provision of clean and safe work environment for nurses. And importantly to review workload at the facility to allow fair distribution and motivate their nurses.
Influence of organizational climate on employee performance at public hospitals in Makueni County, Kenya
(Strathmore University, 2020) Khalid, Shyreen
Human resource for health is considered essential to the production, delivery and provision of quality health care services. However, Kenya, like other countries in Africa, faces a challenge with its healthcare human resource as most of its trained employees are moving to developed countries. The general objective of this study was to establish the influence of organizational climate on employee performance at public hospitals in Makueni County, Kenya. Specifically, the study sought to assess effects of working conditions, interpersonal relationships and incentives on performance of employees. Accordingly, a descriptive survey research design was adopted. The target population was the 837 employees at public hospitals in Makueni County. The study selected a sample of 270 respondents using stratified random sampling method. Data collection was via a semi-structured questionnaire. Descriptive statistics were used to analyze quantitative data and the findings presented in tables and figures. Qualitative data analsysis was by use of content analysis. The study also determined the direction and strength of the relationship between independent and dependent variables through correlation and regression analysis. The study found that working conditions, interpersonal relationships, and incentives had a positive and statistically critical impact on employee performance. The study also found that changes in working conditions, interpersonal relations and incentives affects middle level management more, followed by members of staff and lastly top-level management. Additionally, hierarchical level was established to have a positive moderating influence on the relationship between organizational climate and employee performance at public hospitals. Based on the above findings, our recommendations are that the administration of public hospitals should ensure that they provide employees with conducive working environment. This includes ensuring that they have enough working space and amenities. Hospitals may also consider regularizing activities that can help improve interpersonal relations such as team building. This study had several limitations: the study focused on a single county; the study focused on only three aspects of organizational climate; not all factors affecting performance were explored. Further studies that address these limitations are therefore recommended.
Health worker perceptions towards safe-care accreditation and quality of care: a case of the Ruaraka Uhai Neema Hospital, Nairobi, Kenya
(Strathmore University, 2020-06) Kamau, Paul Ndungu
Hospital accreditation is a process where hospitals meet the highest peer-agreed standards. Staff buy-in is a key factor for the success of the accreditation. This study aimed to explore perceptions of healthcare workers towards SafeCare accreditation and quality of care and to propose a model for effective inclusion of healthcare workers in the accreditation process.
Knowledge, Attitude and Practices regarding task shifting of eye care services in Kenya
(Strathmore University, 2020-12) Ollando, Ernest Agola
Task shifting is a practice whereby tasks are delegated, where possible, to staff with shorter trainings and fewer qualifications, often to address human resource shortages. Kenya, like many Sub Sahara African countries, has a shortage of Ophthalmologists, with only about 132 serving a population of almost 48 million. The main objective of this study was to establish the knowledge, attitude and practices of Ophthalmologists and Non-physician Cataract Surgeons (NPCS) in Kenya, regarding task shifting of eye care services. Four subsidiary objectives that guided this study were: to determine the knowledge of Ophthalmologists and NPCS in Kenya regarding task shifting of eye care services, to determine the attitude of Ophthalmologists and NPCS in Kenya regarding task shifting of eye care services, to determine the practices of Ophthalmologists and NPCS in Kenya regarding task shifting of eye care services and to determine the role of task shifting, its merits, demerits, critical success factors as well as duration over which task shifting should be utilized in Kenya. The Theoretical framework used in this study was Principal-Agent Theory. For this study a mixed-methods approach was employed, involving a survey and key informant interviews. A pre-tested, structured online questionnaire was sent to 267 prospective participants via email or whatsApp. A response rate of 60.3% was achieved, with 161 out of 267 prospective participants returning the questionnaire. A total of 32 key informant interviews were conducted via telephone with purposively selected participants from both groups. Quantitative data was analyzed using SPSS version 23 to generate proportions, frequencies, and percentages. Results were presented in form of graphs, pie-charts and tables. For the qualitative study, interview recordings were transcribed into a text program following which the qualitative data was analyzed using Nvivo version 11. The findings of the quantitative and qualitative methods were integrated during the interpretation/ discussion phase of the study, following a sequential explanatory model. Majority of the participants understood what task shifting is; deemed it as necessary and affirmed that they delegated some tasks to other cadres in the course of their day to day Ophthalmic practice. Medical task shifting was acceptable to majority of the respondents, as was surgical task shifting. There was concern about Optical task shifting owing mainly to erroneous prescription of spectacles by some NPCS. Majority of the workplaces did not have Policies and Guidelines to inform task shifting practices. Almost all the key informants agreed that task shifting had a role in Ophthalmology in Kenya. A number of benefits were cited by participants, including cost savings, improved access to care, equitable distribution of eye health workers, improved quality of care amongst others. Several challenges were also mentioned by participants, including: unregulated task shifting environment, unclear scope of practice, lack of a legal framework for task shifting amongst others. Participants in this study knew about task shifting, deemed it as necessary and thought it should be practiced for as long as there’s a shortage of Ophthalmologists in the country. Several benefits were brought forth by the participants, but there were also several significant challenges that ought to be addressed by the decision makers, going forward. Attention should be paid to training and deploying enough Ophthalmologists to cover the whole republic in the long term.

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