Determinants of successful strategy implementation in medium-sized hospitals in Nairobi, Kenya: a case of Bristol Park Hospital

Abstract

The performance of organizations, including those in the healthcare sector, is determined not only by the quality of strategic plans but also by the effectiveness of their implementation. Despite developing well-crafted strategic plans, many medium-sized hospitals in Kenya face significant challenges in translating plans into action, resulting in implementation gaps that undermine organizational performance. This study sought to assess the determinants of successful strategy implementation in medium-sized private hospitals, with Bristol Park Hospital serving as a case study. Guided by the Dynamic Capability Theory (DCT), Resource-Based View (RBV), and McKinsey 7S Framework, the study pursued three objectives: to examine the impact of organizational alignment on strategy implementation, to investigate the role of internal resources in driving strategic execution, and to assess the influence of organizational structure and decision-making processes on implementation outcomes. A qualitative case study design was adopted, and purposive sampling was used to recruit 20 management personnel out of a total of 69 at Bristol Park Hospital. Data were collected through semi-structured key informant interviews, transcribed verbatim, coded, and analyzed thematically with the aid of NVivo software. Interviews revealed that the majority of respondents felt that successful strategy implementation requires aligning strategic objectives with the organization’s mission, vision, culture, and shared values, supported by effective communication channels. Respondents highlighted that internal resources, particularly human capital, financial allocations, and technological capacity, are critical enablers of execution, with targeted staff training and external partnerships helping to mitigate resource constraints. The hospital’s organizational structure was generally seen as facilitating communication and accountability, although respondents noted a need for greater decentralization in decision-making to enhance responsiveness. Additionally, while the Balanced Scorecard framework was widely used, respondents indicated that it requires customization to better suit the hospital’s operational realities. Overall, the study suggests that strategy implementation success in medium-sized private hospitals depends on a holistic approach that integrates organizational alignment, optimizes internal resource utilization, and adapts strategic frameworks to contextual realities. Respondents recommended strengthening communication systems, conducting regular strategy review meetings, investing in targeted capacity-building programs, and refining strategic frameworks such as the Balanced Scorecard to improve adaptability and comprehensiveness.

Keywords: Strategy Implementation, Organisational Alignment, Internal Resources, Organisational Structure, Balanced Scorecard, McKinsey 7S, Resource-Based View, Dynamic Capability Theory, Medium-Sized Private Hospitals, Kenya