Registration Number W80/85341/2012
Background: Management is as old as human civilization and sprung out of necessity to satisfy both individual and communities with basic requirements such as food, cloth, shelter, and security. It is a critical administrative role in ensuring progress in any organization. It is a decision making role aimed at providing strategic leadership for an organization (Black, et. al., 2009) towards the achievement of a set of goals. Like any other organization, hospitals also require proper management coupled with good management practices to ensure high performance with regards to quality and volume (quantity) of healthcare delivery. However, in Kenya after many successive government policies implemented such as free healthcare access, devolution of hospital management etc, all targeting at improving public healthcare delivery over the years, health sector performance especially within the public sector still remains below expectation (MoH, 2014). There still exists high level of inequality in healthcare access both geographically and economically, public health sector workers working part-time in private hospitals (Moonlighting), inadequate human resources, lack of qualified health workers, low morale, poor staff attitude, weak supervision, inefficient use of resources etc. The core of this situation always appears to be management yet many of the policies implemented to improve the health system were directed towards management, thus making it proficient to reassess the role of management in healthcare delivery in Kenya. Against this backdrop, coupled with inadequate literature specific to Kenya, the study purposed to address the question of whether management matters in healthcare delivery, specifically with respect to hospitals. It purposed to address this question through the following specific objectives; to identify key hospital management practices in government owned hospitals in Kenya; to investigate the nexus between hospital management practices and the quantity and quality of healthcare delivery and to analyze the effect of hospital management on the efficiency and health outputs of hospitals in Kenya.
Methods: The study employed cross sectional research design where both qualitative and quantitative data were collected from all the 25 hospitals in central Kenya. The study collected data from samples of hospital managers and patients. The patients sample sizes were computed using Fisher’s method and random sampling method was used in selection of patients where the data was entered into the computer using research electronic data capture (Red Cap) device. In addition, qualitative data about performance of hospitals were collected using key informant and focus group. The data was collected through the administration of questionnaires, interviews, DEA efficiency estimating method coupled with OLS and Tobit estimation techniques were used to analyze the data which was also presented in form of tables and charts.
Results: The study found out that the most popular management practice in the study area was regular supervision, practiced by 99% of the managers, followed by effective communication, practiced by 88%; good relation with others, practiced by 81%; and consultation and consensus building, practiced by 70%. The findings also revealed that 17 (68%) of the hospitals had good management, whereas 13 (52%) were technically efficient and hospitals with good management practice is 2.4 times extra likely to be technically efficient compared to hospitals with poor management practice. Most of the management practices had a statistically significant direct effect on the quantity or volume of hospital service. Moreover, strong associations between quality indicators and management practices were evident from the data. In particular, work plan, work plan implementation, effective communication and overall management index were positively associated with the reduction in emergency waiting time for the Caesarian section.
Conclusions: The study concludes that good management when applied to hospitals results in improved hospital outputs and outcomes. The study concludes that management practices in Kenyan public hospitals are strongly and positively associated with hospital performance (quality and quantity of the services offered), and with the health outcomes of communities. It has also been shown that hospital efficiency levels are generally high, with 19(76%) out of 25 hospitals ranging from 73.2% to 100%.
Recommendations: The study recommends that government (MoH) should make policies that ensure that the three top hospital managers; the medical superintendent, nursing officer and the administrator ) resides within the hospital compound, increase competition among hospitals of a similar category, hospital managers and prospective managers be sensitized and trained in various management practices, continuous monitoring and evaluation on management standards and hospital performance and entrenchment of management practices such as daily supervision, staff empowerment, the delegation of duties and motivation. Finally, it recommends that further study ought to be carried out to investigate how managers’ residence affects hospital performance.