Quality health care strategies in the improvement of 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 health care 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 in a patient. The population of this study comprised two national referral hospitals in Kenya, namely Kenyatta National Hospital and Moi Teaching and Referral Hospital which had 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. The study findings showed that different quality improvement programs had varying degree of linear relationships with structural, process and outcome measures. Adoption of Quality Management Systems and Standards (QMS) showed a significant positive correlation with structural measures, application of ICT on hospitals’ operations had a significant positive correlation with process measures, and QMS and Results Based Financing (RBF) had a significant relationship with outcome measures. Specifically, adoption QMS revealed a stronger positive correlation on follow-up systems compared to other quality improvement initiatives. Regarding process measures, adoption of ICT innovations had a significant positive correlation on time taken to discharge patients. Adoption of QMS, and RBF had a significant positive correlation with the level of clients’ satisfaction, and to a greater extent with the average rate of mortality and length of stay of in-patients. Quality audits and quality circles, commitment by staff, sensitization and training of staff were noted as critical drivers for quality improvement initiatives. However, the respondents cited biggest challenges as staff shortage, inadequate facilities, staff attitude, inadequate funds, poor maintenance of facilities, inadequate computerization of services, slow response by support departments, inability of some patients to pay for services and congestion in the wards. The quality of health care services provided to clients translated to better clinical outcomes and client satisfaction which corroborates the effectiveness of quality health care strategies in improving service delivery at the national referral hospitals. The study recommends adoption of integrated approach to Quality Improvement Programs (QIPs) and increased uptake of ICT innovations in the hospitals’ operations to enhance turnaround time. The hospitals’ management should encourage other service delivery innovations at the functional units which are appropriate to their operations and integrate them in the institutional-driven programs. Institutionalization of training programs on attitude change is required for successful implementation of various strategic interventions since staff attitude is one of biggest impediments to implementation of QIPs. The hospitals adopted fragmented quality management systems and it is prudent to adopt an ideal model for implementation of quality health care strategies that is likely to maximize on the intended results at different levels of service delivery systems. The study also recommends incorporation of QIPs in the core-curriculum for Health Care Workers. Further study should be conducted on specific strategic interventions that can be used to maximize clinical outcomes in public hospitals in Kenya.