Total quality management on performance of electronic claims systems in medical insurance firms in Kenya: a case of National Health Insurance Fund, Kenya

Abstract

The long-term success of organizations in a rapidly changing global economy is dependent on organizational systems that are pegged at improving quality services which in turn translate to customer satisfaction, continuous improvement and competitive advantage. Total quality management impacts the creation of systems in an organization to help in learning and improving business performance and productivity. TQM as a management principle ensures that quality practices are inculcated in all areas of a business through inclusion of all levels of staff to achieve customer satisfaction. To improve efficiency, NHIF is implementing TQM which include leadership practices, training interventions and teamwork activities that play an important role in the improvement of the electronic claims system. NHIF adopted the electronic claims systems to increase efficiencies in payments of claims to HCPs and approval of LOUs for its members. However, some challenges are being experienced in the day-to-day workings of the system hampering quality service to customers. The main objective of the study was to establish the effect of TQM on performance of E-Claims Systems in medical insurance firms in Kenya; a case of NHIF, Kenya. The specific objectives were to establish the effect of leadership on performance of E-Claims systems in medical insurance firms in Kenya; to assess the effect of training on performance of E-Claims system in medical insurance firms in Kenya and to examine the effect of teamwork on performance of E-Claims Systems in medical insurance in Kenya. The specific objectives of the study were guided by three variables: leadership practices, training interventions and teamwork activities. The study was guided by Public Value Theory and Stakeholders Theory which will inform the study variables. The study adopted descriptive research design because the study was intended to gather quantitative and qualitative data, which described the effect of TQM and performance of E-Claims System in medical insurance firms in Kenya. The target population consisted of 300 employees drawn from NHIF. The study sample size relied on primary data collection. Data was analyzed using quantitative technique, descriptive statistics (mean and standard deviation), inferential statistics (Pearson correlation and regression analysis) as well as statistical package of social sciences (SPSS version 21.0) to develop regression model for the study. The study findings established that there is a significant positive relationship between leadership practices, training interventions, teamwork activities and performance of E-Claims Systems. The study recommended that government should help in formulating policies and laws that govern public sector organizations whose main mandate is service delivery to ensure quality of service to customers. The study further indicated that further studies should be undertaken to determine the extent of how other total quality management practices can influence performance of the e claims systems in medical insurance. Further studies should also be done in the private insurance firms for comparative analysis.