Stakeholder engagement strategies and their influence on healthcare service delivery: a mixed-methods study across multispecialty private hospitals in Nairobi, Kenya

Abstract

Level 5 private hospitals in Nairobi face persistent healthcare service delivery challenges, including patient waiting times 35% above regional benchmarks, care coordination failures in 63% of facilities, and crisis preparedness deficits in 82% of hospitals. While stakeholder engagement is known to improve healthcare outcomes, research has predominantly examined public-sector settings, leaving a critical evidence gap for market-driven private hospitals. This study examined how stakeholder engagement strategies influence healthcare service delivery across Level 5 private hospitals in Nairobi, and whether WHO-style tabletop discussion characteristics moderate these relationships. Anchored in Stakeholder Theory and Complex Adaptive Systems (CAS) Theory, and guided by a pragmatist philosophy, the study employed an explanatory sequential mixed-methods design. A cross-sectional survey of 144 respondents (administrators, medical staff, and patient representatives) across all 11 licensed Level 5 private hospitals in Nairobi constituted the quantitative phase. Hierarchical multiple regression and Hayes’ process macro tested direct and moderating effects. Eight semi-structured key informant interviews, analysed through NVivo 14 content analysis, formed the qualitative phase to explain and contextualise the statistical findings. All three engagement strategies positively and significantly predicted healthcare service delivery. The stakeholder power and influence matrix was the strongest predictor (β = .289, p = .038), followed by engagement mechanisms (β = .261, p = .024) and stakeholder mapping (β = .241, p = .021). Together, the three strategies explained 59.0% of the variance in service delivery outcomes (R² = .590). WHO-style tabletop discussion characteristics significantly moderated all three relationships, adding 6.9% incremental explanatory power (ΔR² = .069, p = .000), with the strongest moderating effect on the power and influence matrix relationship (β = .168, p = .009). Qualitative findings corroborated and contextualised these patterns, revealing that power asymmetries, trust-based communication cultures, and proactive simulation scheduling were key institutional determinants of service delivery quality. Structured stakeholder mapping, power-aware governance, and formalised engagement mechanisms are indispensable determinants of service delivery quality in Nairobi’s private hospitals. WHO-style tabletop discussions function as a significant amplifying mechanism for all engagement strategies. Hospitals should institutionalise stakeholder registries, dynamic power mapping, digital engagement platforms, and scheduled simulation exercises. Regulatory bodies should embed stakeholder engagement standards within hospital accreditation frameworks. Keywords: Stakeholder engagement, healthcare service delivery, tabletop discussions, private hospitals, power and influence matrix, mixed methods, Kenya