EVALUATION OF DETERMINANTS OF STRATEGY IMPLEMENTATION IN GOVERNMENT HOSPITALS IN NAIROBI COUNTY

ABSTRACT 
This study sought to establish the determinants influencing strategy implementation in Government hospitals in Nairobi County. The study sought to examine whether organization structures, culture, leadership, resources and communication influences strategy implementation in government hospitals. A descriptive survey was adopted. The target population was the CEO and Head of department employees from the 18 government hospitals in Nairobi County and given the size of the population, a sample size of 108 employees was selected through stratified random sampling method. The employees were stratified into two strata which was CEO employee and Head of departments employees. Within each stratum, simple random sampling was used to identify individual employee respondents. Data was collected by use of questionnaires. The questionnaire consisted of structured open and closed ended statements. The study adopted a descriptive case study research design. Data was analyzed by the use of descriptive statistics and inferential analysis. Specifically, means, frequencies and percentages were used. Factor Analysis and Correlation analysis was used to extract the relevant factors and their relationship with strategy implementation. The findings were presented in tables, figures and graphs. It can be concluded that there was effective strategy implementation at the government hospitals. It is possible to conclude that organization structures in place in government hospitals in Nairobi distort and dilute the intended strategy. Organization structure at government hospitals was inconsistent with strategy implementation and this may have led to poor strategy implementation. It can be concluded that the implementation of a strategy in Kenyan hospitals often encounters rough going because of deep rooted cultural biases in the organization .Therefore it was possible to conclude that culture at government hospitals was not conducive for strategy implementation and this may have led to poor strategy implementation. It was concluded that leadership at government hospitals was not effective and this may have led to poor strategy implementation. The study concluded that organization resources are key determinants of strategy implementation. The management of organization resources at government hospital is not effective and this had led to poor strategy implementation the study concluded that communication channels for strategy implementation at government hospitals are not conducive and this may have contributed to the poor implementation of strategy. The study recommends for strategy implementation to be successful, government hospitals and other health centre institutions needs effective leadership and to align its culture to strategy. Specifically, hospitals need to address the resistance of employees by improving on communication and training.

CHAPTER ONE 
INTRODUCTION 
Background of the Study 
Strategic management is increasingly becoming extensively used by large and small firms, nonprofit institutions, governmental organizations and multinationals as they seek to adapt to the rapidly changing environment (David, 2003). Public sector organizations according to Sterling (2003 are formed for the purpose of serving the public as opposed to the accumulation of profits for owners or investors benefit and their roles are increasingly taking centre place in the lives of people globally. In the same vein, there has been rising scrutiny and expectation from beneficiaries, governments, partners and donors for them to be run professionally with higher levels of accountability, efficiency, effectiveness, sustainability as well as demonstration of the impact of their work. 

Strategy implementation as a process of transforming strategic intentions into actions for decision making and embracing all those actions that are necessary to put the strategy into practice (Kiruthi, 2001) also entails development of programs, budgets and procedures. Successful implementation is therefore critical and difficult as the strategic choice that requires consideration of the resources to be used which include human resource, structure, systems and other changes. Even though formulating a consistent strategy is a difficult task for any management team, making that strategy work (implementing it) throughout the organization is even more difficult (Hrebiniak, 2006). A myriad of factors can potentially affect the process by which strategic plans are turned into organizational action and unlike strategy formulation, strategy implementation may be seen as something of a craft, rather than a science, and its research history has previously been described as fragmented and eclectic (Noble, 1999b). The strategy implementation process according to Steiner (1997), covers the entire managerial activities and as argued by Higgins (2005) almost all the management functions which include; planning, controlling, organizing, motivating, leading, directing, integrating, communicating, and innovations are in some degree applied in the implementation process. To effectively direct and control the use of the firm's resources, Pierce and Robinson (2003) stress that mechanisms such as organizational structure, information systems, leadership styles, assignment of key managers, budgeting, rewards, and control systems are essential strategy implementation ingredients. Overall, the concept is that implementation activities are closely related to one another and decisions about each other are usually made simultaneously. As such the implementation process includes the various management activities that are necessary to put strategy in motion, institute strategic controls that monitor progress and ultimately achieve organizational goals. There are many (soft, hard and mixed) factors that determine the success of strategy implementation in government hospitals, ranging from the people who communicate or implement the strategy to the systems or mechanisms in place for co-ordination and control resources. 

Since independence in 1963, The Kenyan Government has initiated or adopted several policies and strategies aimed at improving service delivery as well as improving the welfare and economic wellbeing of the citizenry. Among these includes Sessional Paper No. 10 of 1965 which focused on the elimination of poverty, disease and ignorance, adoption of Millennium Development Goals (MDGs) which among advocated among others are health related approaches focusing on the need to scale-up investment up to 2015 in order to achieve the goals. Most recently government came up with National Poverty Eradication Plan (NPEP), the Poverty Reduction Strategy Paper (PRSP), the Economic Recovery Stimulus (ERS) and the Vision 2030. 

Specifically, the Vision 2030 advocates for the restructuring of the health delivery system especially Government hospitals and strengthening of health service delivery will be achieved through decentralization and operationalization of health care management to the facility level, pursuant of which, the major flagship projects will be; de-linking the Ministry of Health from service delivery to focus on regulation and supervision and providing operational autonomy to tiers 4, 5 and 6 (district, provincial and national) hospitals. The re-categorisation of hospitals by the government is a step in the right direction. Under this thrust will be to establish functional referral systems at all levels (hub and spoke model). Under revitalisation of health infrastructure, two specific initiatives will be undertaken: Rehabilitation of Government health facilities, primarily community health centres and dispensaries whose work is to promote preventive health care and to treat diseases at the community level. The implementation of these strategies will prepare Government hospitals to consolidate Kenya’s position as the regional hub for health care services. In addition, in the health sector reforms have therefore been introduced to improve the country’s health care delivery systems. Despite an unprecedented rise in the Government’s financial allocation to the health sector, the need for health services has escalated beyond the financing capacity of the Ministry of Health (Vision, 2030). 

A review of strategic plan (2005/6-2009/10) carried out in 2010 by the Ministry of Public Health and Sanitation (MoPHS) observed that the poor implementation process of the strategies and recommended that strategic planning and implementation be fast tracked The report also identified inefficient support systems especially finance, procurement and commodity logistics, human resource management, referral and regulatory systems negatively affected the implementation of the planned activities and hence delivery of quality health services to Kenyans. Similarly, review of National Health Sector Strategic Plan 2005/2010 number of key challenges including lack of resources, poor working environment and lack of staff involvement leading to poor staff morale which has had negative impact on service delivery in public healthcare institution. In order to improve, reorganization of the district administration was recommended, that is, creation of new districts called for the development of new public health and medical services offices hence increasing the number of planning units to be involved in developing the plan. Also, the review emphasized the need of improvements driven by the level of investments made in the health sector in terms of health inputs such as human resources, infrastructure, commodities and operations. It was further noted that better focused management support would lead to better efficiency in translating the inputs into service improvements.

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Item Type: Kenyan Postgraduate Material  |  Attribute: 65 pages  |  Chapters: 1-5
Format: MS Word  |  Price: KSh900  |  Delivery: Within 30Mins.
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