Implication of the construction of clinical hybrid roles on service delivery in Kenyan Private Hospitals

Nguu, Michelle
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Strathmore University
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.
A Dissertation submitted in partial fulfillment of the requirements for the award of the Degree of Master of Business Administration in Healthcare Management at Strathmore University
Clinical hybrid roles, Service delivery, Kenyan Private Hospitals