Effectiveness of quality health care strategies in improving service delivery at the national referral hospitals in Kenya

Abstract

This study investigated the effectiveness of quality health care strategies in improving service delivery at the national referral hospitals in Kenya. National referral refers to any process in which healthcare providers at lower levels of the health system seek the assistance of providers who are better equipped or specially trained to guide them in managing or to take over responsibility for a particular episode of a clinical condition ina patient. The population of this study comprised two national referral hospitals in Kenya, namely Kenyatta National Hospital and Moi Teaching and Referral Hospital which have a total of 96 departments and units. Due to small sample, a census survey was conducted at the two national referral hospitals. A total of 96 questionnaires were administered and 67 were completed and returned, which represented 69.8 per cent response rate. Qualitative data analysis was done using one-tailed test to establish regression coefficient at 95% confidence interval and qualitative data was subjected to content analysis. The study findings revealed that healthcare strategies have a positive effect on service quality at the national referral hospitals, although the strategies had varying degrees of association with service delivery systems, processes and outcomes. Adoption of ICT applications had a greater impact on follow-up systems compared to other strategic interventions. Strategic Leadership Training, Results Based Financing (RBF), and specific strategic interventions at the departmental level had a high significant effect in improving service quality outcomes such as rate of re-admission, average mortality rate, time taken to serve clients and average waiting time to be served. Quality improvement initiatives by some departments to reduce rates of infection indicated a slightly significant relationship compared to other interventions. Quality healthcare strategies adopted by the hospitals also had a very significant relationship with average length of in-patient stay. The level of client satisfaction showed a greater significant relationship with the adoption of ICT and specific strategic interventions by the departments to improve service quality. The findings also showed that vision, mission, strategic plan, service delivery charter, human resources and physical facilities were critical drivers in the implementation of quality healthcare strategies in the two hospitals. Clearly, this demonstrates that quality improvement strategies at the hospitals require a multifaceted approach and adoption of appropriate model for implementation of the strategies. The study recommends adoption of integrated approach to Quality Improvement Programs (QIPs) and increased uptake of ICT innovations to enhance turnaround time. The hospitals’ management should encourage other service delivery innovations at the functional units which are appropriate to various departments to complement institutional-driven programmes. Institutionalisation of training programmes on attitude change is required for successful implementation of various strategic interventions since staff attitude is one of the biggest impediments to implementation of QIPs. It is prudent to adopt an ideal model for implementation of quality healthcare strategies to optimise service quality and clinical outcomes. The study also recommends incorporation of QIPs in the core-curriculum for healthcare workers. Further study should be conducted on specific strategic interventions that can be used to optimise quality of healthcare services and clinical outcomes in public hospitals in Kenya.