Influence of strategic leadership on performance of public referral healthcare institutions in Nairobi City County, Kenya

Abstract

Performance of public healthcare institutions in developed and developing countries has attracted concern from both healthcare providers and users of the health facilities. Lack of leadership has been cited as one of the key causes of poor performance in public healthcare institutions. The purpose of this study was to examine the influence of strategic leadership practices on organisational performance of public referral healthcare institutions in Nairobi City County, Kenya. The study was guided by four specific objectives: to examine the influence of strategic vision on performance of public referral healthcare institutions; assess the influence of core value initiatives on performance of public referral healthcare institutions; determine the influence of management innovation on performance of public referral healthcare institutions; and establish the influence of human capital development on performance of public referral healthcare institutions in Nairobi City County. The research was anchored on Transformational Leadership Theory, Upper Echelons Theory and Stewardship Theory. The study adopted a cross-sectional survey design. Primary data was collected using structured questionnaires. The study targeted 135 senior and middle level managers and 4 health facility in-charges of public referral hospitals in three (3) sub counties of Nairobi City County hosting Kenyatta National Hospital, Pumwani Maternity Hospital, Mbagathi District Hospital and Mama Lucy Kibaki Hospital. All the managers and health facility in-charges were sampled. Stratified sampling procedure was used to divide respondents into the three sub-counties. Respondents from each stratum were selected using purposive sampling method. Pilot study was conducted to help test validity of the instrument and reliability (using Cronbach’s Coefficient Alpha). Descriptive statistics were used to summarise data into meaningful form. For variable relationships, inferential statistics were utilised. Analysed descriptive and inferential data was displayed using graphs and tables. The study found out that strategic vision significantly influences performance of public referral hospitals, β = .430, t = 4.975, p = .000. Further, core value initiatives significantly influence performance of public referral hospitals, β = .769, t = 12.569, p = .000. Similarly, management innovation significantly influences performance of public referral hospitals, β = .832, t = 15.675, p = .000. Lastly, human capital development significantly influences performance of public referral hospitals, β = .634, t = 8.568, p = .000. The study concluded that although strategic vision, core value initiatives, management innovation and human capital development practices existed, some respondents were uncertain whether the practices were yet to be implemented. The study recommends that top management adopts strategies to gain trust from the facility users and the general public. This can be done by fostering honesty and support initiatives, consistent service delivery, and building accountability. In addition, introduction of new functional structures would enhance efficiency in operations in the health facilities. The study also recommends that employees be encouraged to advance their skills. This can be done through virtual training and learning, mentoring and job rotation exercises. Top leadership of the health facilities should ensure there exists equitable human resource development at all functional levels. The study further recommends that comparative studies be conducted on the same subject matter using views of lower cadre employees.