MBA-HCM Theses and Dissertations (2019)

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    An Assessment of the purchasing arrangements of an employer in-house managed scheme: a case study of AAR Healthcare
    (Strathmore University, 2019) Mwaura, Njeri Lilian
    Kenya has made a commitment to achieve Universal Health Coverage (UHC) by 2022. The country is undertaking health financing reforms that will set it on the path to achieving this goal. While health financing reforms have typically focused on the resource generation and pooling function of the health system, there is increasing recognition of the importance of the purchasing function of the health financing system. Purchasing refers to the transfer of pooled funds to healthcare providers in exchange for healthcare services provided to citizens. Purchasing could either be passive, which means merely paying bills, or strategic, which means structured to enhance the health system goals of equity, efficiency, and quality. Healthcare purchasing in Kenya is carried out by 5 main entities namely 1) the national hospital insurance fund (NHIF), 2) the county health systems 3) private health insurance 4) community-based health insurance schemes, and 5) employer in-house medical schemes. Previous studies done in Kenya has assessed the purchasing arrangements of the first 4. There is however not study that has examined the purchasing arrangements of employer in-house medical schemes. To fill this knowledge gap, this proposed study examined the purchasing arrangements of employer in house schemes in Kenya. Specifically, the study used a qualitative case study approach to examine the extent to which the purchasing arrangements of the AAR in-house medical scheme are strategic. This study employed the conceptual framework developed by the Resilient and Responsive Health Systems (RESYST) consortium to examine the purchasing actions of the AAR medical scheme across the three purchasing relationships, namely purchaser-government, purchasing-providers, and purchasing-citizens. Data was collected through a combination of in depth interviews and document reviews Respondents for the in-depth interviews were selected purposively to get individuals with in-depth knowledge of scheme. Relevant documents that contain information on the scheme were also obtained and analysed. Qualitative data was audio recorded, transcribed, importeded to NVIVO software, and analysed using a thematic approach. It was evidenced, by the findings put forward in this section that the purchasing mechanism in AAR Healthcare is passive as characterized by arbitrary fun allocation to the in-house scheme and nominal sourcing of providers. There was no evidence of strategic purchasing with regard to the acquisition or distribution of financing in the service provision process. The process was however deemed effective by all users. With regard to the second objective, it was evident that AAR Healthcare did not feature a specific purchasing entity as the purchasing functions were distributed between the HR, Procurement and Finance department. This therefore rendered the relationship between the purchaser and the other entities- citizens (employees), government and providers- as fragmented and uncharacterized; the system was essentially run as in-house health benefit scheme with the exception of contracted services given that the organization provided health services, such services were mainly sought in-house as opposed to through contracts with other providers. The main recommendation forthcoming from this study is that AAR Healthcare should consider a switch to strategic purchasing in effecting its healthcare provision function to employees. In achieving these, it will be necessary to first and foremost institute a designated purchaser for the fund; one that would be charged with orchestrating all functions involved with other actors in the purchasing function. Findings from this study can also be used to prescribe possible purchasing arrangements for employer managed schemes.
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    Using lean operations to reduce wastes in the medication administration process at the Gertrude’s Children’s Hospital, Nairobi, Kenya
    (Strathmore University, 2019) Nyarangi, Wambugu Naomi
    Lean operations can help to reduce waste and improve workflow, resulting in fewer medical errors, cost savings, reduced medication turnaround times, and reduced product verification and delivery time in the healthcare industry. This study sought to describe the current medication processes at Gertrude's Children’s Hospital, to identify wastes in the medication administration processes, and, to develop and validate a novel medication process that minimizes identified wastes and improves safety and quality throughout the process. The study employed a descriptive cross-sectional design. The study employed a census approach in the recruitment of study respondents. Both quantitative and qualitative data. Data were obtained using a self-administered structured questionnaire from the frontline staff involved medication administration process and via in-depth interviews. Value Stream Mapping tool was used to analyze the medication administration process and process mapping was done to display the process flow. Data were analyzed using descriptive and inferential statistics. Regression analysis was done to identify factors contributing to waste in the medication process. Statistical Package for Social Sciences (SPSS) was used to analyze quantitative data. Qualitative data from the in-depth interviews were analyzed thematically and a framework approach was used in the analysis. Overall, the targeted population was all employees involved in the frontline of the medication administration process (n=60). The study excluded two staff on leave schedule and together with a non-response rate of 10.3% (6) a total of 52 staff (18 pharmacists, 18 nurses, and 16 doctors) were enrolled in the study. Among the respondents 63.5% (n=33) were females and 36.5% (n=l9) were males. The results of the study established that there was a positive relationship between organizational, people (staff and patients), technological, environmental, and task-related factors with timely medication administration but the relationship was insignificant. Thematic analysis revealed that process engineering on the technology system by putting process alerts will help in reducing medication turnaround times. In conclusion, the factors leading to medication delays were poor communication, lack of teamwork, and inadequate staffing. The study, therefore, recommended there is a need for the hospital management to look into outpatient staffing ratios to have adequate staff, to enhance a culture of teamwork among staff, and put in place in the technology system, some process alerts in the system to give prompts for action on the computerized order system
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    Influence of pharmaceutical logistics management information systems as an enabler of Universal Health Coverage implementation in Nyamira County
    (Strathmore University, 2019) Wando, Stephen Odhiambo
    One of the key determinants of the success of the UHC program in Kenya is likely to be the timely availability of pharmaceutical products at the facilities. However, there are currently no plans to assess the challenges faced by counties regarding the logistics of supplying pharmaceutical products. This prompted the researcher to conduct a study with the general objective being to establish the influence of pharmaceutical logistics management information systems as an enabler of universal health coverage implementation. The study utilized both qualitative and quantitative approaches in analysing the data. The population of the study was drawn from Nyamira County with 120 health facilities and the sample size was 74 respondents. The researcher adopted the use of the questionnaire in gathering information, the findings clearly indicate that there was no proper selection support system that ensures the high-quality product selection, appropriate quantity of the product to be selected, and the need satisfaction of the product also the County drug policy document are not being used irrespective of being a very important document, the procurement support system was discussed to check whether it accommodates the element of planning in terms of budget and supply planning though the one in place is not that effective in the County, forecast, and development a system using 9ispensed user data in the procurement support system in universal health coverage is not effective. Medical practitioners are even not aware of distribution data in the issue of the procurement support system and are not even aware of the forecast being done using distribution data, on the distribution support system, there are no written provisions for the redistribution of overstocked supplies, and a program accommodating policy of storing & issuing stock according to first to expire that should be addressed by the system and Utility support system that is in place to manage the use of inventory and ensure waste reduction is not efficient, the study recommends that for logistic management information system to be implemented in the UHC facilities the system must have the selection, distribution procurement, and utility system which is effective and the study further suggests that more studies be conducted on the influence of pharmaceutical logistics management information systems on the performance of the public hospital in Kenya. This will help give a holistic idea of the causes of logistic management process delays that could be due to the use of substandard systems used in record keeping, material handling, and Distribution or could be due to the use of poorly trained medical professionals.
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    Factors affecting the adoption of the Health Management Information System at St. Catherine's Hospital, Uganda
    (Strathmore University, 2019) Saku, Hudhaifa
    Health management information systems are essential in improving the performance of medical service delivery in health organizations. While changes have been made to improve the healthcare sector across the continent, much information is still needed to explain how HMIS works across hospital departments. This study sought to establish factors affecting the adoption of Clinic Master/HMIS across different departments at St. Catherine's Hospital. The specific objectives were; to establish how organizational factors, human factors, and technological factors affect the adoption of Clinic Master/HMIS across different departments at St. Catherine's Hospital. The study was based on the diffusion of innovation theory and the technology acceptance model theory. The research design was a cross-sectional survey of 109 respondents drawn from various departments in the hospital. The study findings revealed that technological factors had a statistically significant relationship with the adoption of HMIS/Clinic Master. Overall, the results of the study established that there was a positive relationship between human factors, organizational factors, and technological adoption of Clinic Master/HMIS in the hospital. However, human factors and organizational factors had an insignificant positive relationship with the adoption of the system. Future studies should try to determine whether other factors are affecting the adoption of HMIS in the hospital. The study also recommends that research should be carried out on the behavioral aspect of the doctors who do not use the system but rely on billers and cashiers to enter their reports and requests. The study recommends the need for standardization of HMIS implementation by policymakers in order to enhance adoption. This study looked at all the users of the system; whether clinical, non-clinical, or even para-clinical, unlike other studies which focused on mainly the clinical staff. This made it difficult to make hospital-level comparisons since different hospitals are in different adoption stages hence the focus on one hospital.
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    Challenges facing the implementation of managed healthcare in private hospitals in Kenya: a case of Avenue healthcare
    (Strathmore University, 2019) Mbugua, Margaret
    MHC has confirmed the capability of eliminating surplus medical expenditures and improving the effectiveness as well as the quality of medical care delivery specifically in the USA. However, despite the existence of MHC for a number of years, the concept is yet to fully take root in developing countries in Asia and Africa, where out of pocket payments make the greatest percentage of healthcare financing. In Kenya, health insurance represents less than 20% of the total insurance premiums and statistics indicate less than 10% of all healthcare finances are subjected to risk pooling through health insurance. This study examined the challenges encountered in the implementation of MHC in private hospitals in Kenya. The study was carried out at Avenue Healthcare in Nairobi County and involved the medical workers at the facility. The study was anchored on the Kutzin descriptive framework and the traditional indemnity model, and employed a cross-sectional descriptive design. The population was made of the 9 Avenue Healthcare Centres in Nairobi County and the unit of analysis was the 104 medical workers in these centres. This research used primary data, collected using a self-administered questionnaire developed based on the constructs of the literature review. The collected data were then analysed using descriptive and inferential statistics. The findings established that health workers' attitude affects implementation of MHC in private hospitals within Kenya and that there must be profound commitment and support by health workers for smooth implementation of MHC. The study also found that there is poor health workers' knowledge of the concept. The results show that the major costs drivers for MHC (MHC) programs are: administrative; operational, set-up, marketing and training. The regression results revealed a positive and statistically significant relationship between health workers' knowledge and attitude, costs of and implementation of MHC. The study concluded that implementation of MHC in private hospitals in Kenya is significantly influenced by health workers' knowledge and attitude and costs. The study recommends that the management of private hospitals in Kenya should involve medical workers in planning and implementation of MHC programs, develop training and development programs and ensure training is carried out frequently on MHC programs prior to implementing the programs.