Management Practices in Sub-county Hospitals of Meru County
The third objective of the study was to determine the influence of management practices on
service delivery in sub-county hospitals in Meru County. Table 4.5 presents the results. The
study findings show that on average the respondents agreed that the management practices have
an influence on service delivery in sub-county hospitals in Meru County. The respondents agreed
that management supervises staff adequately mean of 3.86, management has various reward
systems for motivating employees mean score of 3.85, there is sound relationship between staff
and supervisors 3.62, resources are availed for implementing plans mean score of 3.55, and that
the hospital has a motivation policy for staff mean score of 3.54. They however disagreed that
adequate resources are budgeted for implementing plans mean of 3.37, management follows and
adhere to hospital plans mean of 2.76, supervisors lead by examples to staff 3.38, and that the
hospital management follows and adheres to motivation policy 2.79.
Table
Management Practices in Sub-county Hospitals of Meru County
Statements N Mean Std. Dev.
Adequate resources are budgeted for implementing plans 84 3.37 .788
Resources are availed for implementing plans 84 3.55 .827
Management follows and adhere to hospital plans 84 2.76 .652
Management supervises staff adequately 84 3.86 1.121
There is sound relationship between staff and supervisors 84 3.62 .675
Supervisors lead by examples to staff 84 3.38 .805
Hospital has a motivation policy for staff 84 3.54 .884
Hospital management follows and adheres to motivation policy 84 2.79 .678
Management has various reward systems for motivating employees 84 3.85 1.146
Management practice such as “Management supervises staff adequately” was found to be very
key for service delivery to patients. Meaning that when staff are well and adequately supervised,
they are able to deliver services appropriately. This is after the aspect received the highest mean
(Mean=3.86; SD=1.12) compared to other aspects of management practices. This result is in
agreement with the results of (Sato, et al., 2017), healthcare employees raised issues regarding
compensation. For instance, in Uganda, health workers have raised concerns about poor
remuneration relative to other civil servants of equitable professions. Providing opportunities for
career development is considered the basis for promoting employee motivation in healthcare
organizations. This encourages them to give their best towards achieving the changing medical
needs for their communities (Momanyi et al., 2017). Moreover According to Jooste and Hamani
(2017), improved communication, introducing modern hospital facilities, improving working
environments and providing proper water and sanitation systems are vital to ensuring employee
motivation. Health workers’ productivity and quality services can only be achieved in instances
where there are safer and more pleasant working conditions (Fort et al., 2017).
Drugs Procurement Processes in Sub-county Hospitals of Meru County
The fourth objective of the study was to determine the influence of drugs procurement process
on service delivery in sub-county hospitals in Meru County. The results are shown in Table 4.6.
The respondents agreed that procurement pans are flexible drugs mean of 3.77, procurement
policies are adhered to during procurement 3.76, procurement process is flexible scoring and
there are adequate resources for drugs procurement both mean of 3.58. However, they disagreed
that there is minimum lead time during drugs procurement 3.40, staff understand and are familiar
with procurement policy mean of 3.33, there is a hospital policy for drugs procurement mean =
2.74 and that hospitals adhere to procurement plans 2.76.
Table
Drugs Procurement Process in Sub-county Hospitals of Meru County
Statements N Mean Std. Dev.
Adequate resources are budgeted for implementing plans 84 3.37 .788
Resources are availed for implementing plans 84 3.55 .827
Management follows and adhere to hospital plans 84 2.76 .652
Management supervises staff adequately 84 3.86 1.121
There is sound relationship between staff and supervisors 84 3.62 .675
Supervisors lead by examples to staff 84 3.38 .805
Hospital has a motivation policy for staff 84 3.54 .884
Hospital management follows and adheres to motivation policy 84 2.79 .678
Management has various reward systems for motivating employees 84 3.85 1.146
Drug procurement process in sub-county hospitals in Meru County was found to be in place.
Attribute of drug procurement process such as “procurement plans are flexible” had the highest
mean (Mean=3.77; SD=1.19) compared to others. This implies that flexibility of procurement
plans is very important in the drugs procurement process wish has an implication on service
delivery. This result contradicts with the findings of Oketch et al. (2014) whose report indicated
that though devolution of health-care services was planned to be seamless and designed to be
fool-proof, it was hard to maintain. Even as doctors resigned all over the place citing tribalism
and missed salaries, hospitals ran the risk of going without crucial medical supplies as some
counties turned their backs on state provider KEMSA, which they accused of inflating costs.
This also disagrees with results of Muhingi et al. (2015) who argues that as a result of these
procurement challenges, there have been numerous reports on drug shortages in various counties.
Respondents’ Opinion on Service Delivery
Respondents were asked to respond to the set of questions related to service delivery at Sub-
County Hospitals in Meru County, Kenya. The results in Table 4.7 show that respondents agreed
that managers are allocated the necessary authority to achieve planned objectives and held
accountable for overall performance and results mean score of 3.82, services may be provided in
the home, the community, the workplace, or health facilities as appropriate mean of 3.82,
hospital services are effective in serving patients’ needs mean of 3.61, and services are directly
and permanently accessible with no undue barriers of cost, language, culture, or geography
means score of 3.55.
Table
Respondents’ Opinions on Service Delivery
Statements N Mean Std. Dev.
Hospital services are effective in serving patients’ needs 84 3.61 .932
Services offered in this hospital are safe to the patients 84 3.40 .778
Services offered here are centered on the patient’s needs 84 3.58 .867
Health services are well managed so as to achieve the
core elements described above with a minimum wastage 84 2.80 .636
of resources
Managers are allocated the necessary authority to achieve
planned objectives and held accountable for overall 84 3.82 1.153
performance and results
Health services are delivered in a timely manner to the
patients 84 3.36 .801
Services are directly and permanently accessible with no
undue barriers of cost, language, culture, or geography 84 3.55 .870
Health services are close to the people, with a routine
point of entry to the service network at primary care level 84 2.77 .588
Services may be provided in the home, the community, 84 3.82 1.153
the workplace, or health facilities as appropriate
However, respondents disagreed that health services are well managed so as to achieve the core
elements described above with a minimum wastage of resources means of 2.80, health services
are close to the people with a routine point of entry to the service network at primary care level
2.77, and health services are delivered in a timely manner to the patients means score of 3.36.
From the responses of the respondents it was evident that “Managers are allocated the necessary
authority to achieve planned objectives and held accountable for overall performance and results
and Services may be provided in the home, the community, the workplace, or health facilities as
appropriate” were good indicators of service delivery. This is because these two attributes of
service delivery received the highest mean (Mean= 3.82; SD=1.153 and Mean=3.82; SD=1.153
respectively). This meant that there was proper service delivery in all sub-county Hospitals in
Meru County. These findings concurs with the findings of (Umeano-Enemuoh, et al.,
2015) who examined patients’ satisfaction of service delivery and care in tertiary institution in
Southeast Nigeria. In their contribution, they aim to determine the factors which enhance and
deter patients’ satisfaction in a tertiary institution and service delivery and care. To do this, the
study used a cross sectional survey design in which 360 carefully selected participants completed
self-administered questionnaire to rate their satisfaction level, quality of services provided, as
well as factors of importance where best service was provided. Overall, participants were quite
satisfied (Mean score = 3.75) with the services delivered by the different service providers.
Equally, respondents also noted that the overall quality of care of the health facility was good
(mean score = 3.45). Pharmacy received the highest satisfaction level with a mean rating of 4.1.
Over a third participants (38 %) rated the services provided by the doctors as best despite giving
the highest quality ratings with a mean of 3.9 to pharmacy compared to mean ratings of 3.4 for
the doctors.
Moreover, the findings also agree with the findings of (Ogunfowokan and Mora, 2012) who
focused on the experiences of patients on time, expectation and satisfaction of service delivery.
They determined the time spent by patients at the service points in the general Outpatient
Departments (OPD) at the National Hospital Abuja (NHA), to establish the perception of patients
regarding the patient–clinic encounter time, and to describe their level of satisfaction with the
services received. A cross-sectional study was conducted at the general OPD of the NHA.
Information which relate to the time spent at the various service points amongst others were
obtained from 320 randomly selected patients, using a patient administered validated
questionnaire. Eighty four per cent (84%) of the patients who responded adequately were
identified and analysed. There was a significant relationship between a short waiting time as
perceived by patients, clinic visit encounters where patients’ expectations were met or surpassed,
and overall patients’ satisfaction with the clinic visit encounters. Based on the outcome of their
results, they concluded that reduction in patient–clinic encounter time and meeting patients’ pre-
visit expectations may significantly improve patient satisfaction after clinic visit encounter at the
general OPD of NHA.
Correlation Analysis: Relationship between Independent and Dependent Variables The
researcher further did a Karl Pearson correlation analysis to determine the relationship
between the independent variables and dependent variable. This inferential statistics was since it
can analyze the degree of relationship between two variables. The computation of a correlation
coefficient yields a statistic that ranges from Negative 1 to Positive 1. This statistic is called a
correlation coefficient(r) which indicates the relationship between the two variables and the
bigger the correlation the stronger the coefficient between the two variables being compared. The
results are shown in Table.
Table
Relationship between independent and Dependent Variables
Service delivery
Service delivery Pearson Correlation 1
Sig. (2-tailed)
N84
Staff Pearson Correlation .892**
Sig. (2-tailed) .000
N84
Facilities Pearson Correlation .969**
Sig. (2-tailed) .000
N84
Management practices Pearson Correlation .891**
Sig. (2-tailed) .000
N84
Drugs procurement process Pearson Correlation .930**
Sig. (2-tailed) .000
N84
Looking at the outcome the results shows that there is a strong and positive association between
independent variable (staff, facilities, Management practices and drugs procurement process) and
dependent variable (service delivery). From the analysis, the results show that the coefficient of
correlation of staff showed (r=0.893, p=0.001), facilities showed (r=0.969, p=0.001),
management practices showed (r=0.891, p=0.001) while drugs procurement process model
showed (r=0.930, p=0.001). This shows that there was a strong and positive association between
independent variables (staff, facilities, Management practices and drugs procurement process)
and service delivery at Sub-County Hospitals in Meru County, Kenya.
Regression analysis
The study used the entered method by the name multiple regressions analysis to analyze the
collected data to measure and determine factors influencing service delivery at Sub-County
Hospitals in Meru County, Kenya. The use of this inferential statistics was informed by the fact
that multiple regression attempts to determine whether a group of variables together predict a
given dependent variable
Model summary
This research sought further to establish the extent to which independent variables (staff,
facilities, management practices and drugs procurement process) influence the service delivery.
The summary mode results in Table 4.9 shows that the overall p-value is less that 0.05 (5%).
This shows that the overall regression model is significant at the calculated 95% level of
significant. It further inferred that the studied independent variables (staff, facilities, management
practices and drugs) model have significant influence on the service delivery at Sub-County
Hospitals in Meru County, Kenya. The regression model specifies coefficient of determination
R² as 0.956, this means that at 95.6% of the relationship has been explained by the studied four
independent variables (staff, facilities, management practices and drugs) model. The rest 4.4%
are yet to be explained by other further researchers.
Table
Model summary
Model R R² AdjustedR² Std. Error of the Estimate
1.978a.956 .954 .23713
Analysis of Variance (ANOVA)
The study used ANOVA to establish the significant of the regression model. The model is
considered significant if the p-value is less than 0.05. Table 4.10 shows that p-value is 0.001
implying that the regression model used was statistical significant and is good for predicting the
influence of (staff, facilities, management practices and drugs procurement process) on the
service delivery. Basing the confidence level at 95%, the analysis indicates the highly reliability
of results obtained. The overall ANOVA results indicate that the model was significant at
F=427.648 meaning that the overall model was significant and that (staff, facilities, management
practices and drugs procurement process) have influence on the service delivery at Sub-County
Hospitals in Meru County, Kenya.
Table
Analysis of Variance (ANOVA)
Model Sum of Squares df Mean Square F Sig.
Regressio
n
96.186 4 24.047 427.648 .000b
Residual 4.442 79 .056
Total 100.628 83
Multiple Regression
The researcher further conducted multiple regression analysis as shown in Table 4.11 to
determine the extent of the (staff, facilities, management practices and drugs) have influence on
the service delivery at Sub-County Hospitals in Meru County, Kenya. The beta coefficients in
the regression model show that all of the tested independent variables had significant and
positive relationship between independent variable and dependent variables. All variables
showed a p-value less than 0.05 (5%).
1 1 2 2 3 3 4
4
1=¿ 0.295 , P =
0.02
¿
2=¿0.967 , P =
0.001
¿
Table
Multiple Regression Analysis
Standardized
Unstandardized Coefficient Coefficient
Model B Std
Error
Beta t Sig.
1 (Constant) .035 .095 .366 .716
Staff .295 .125 .261 2.365 .020
Facilities .967 .100 .973 9.707 .000
Management practices .709 .144 .686 4.937 .000
Drugs .431 .107 .421 4.036 .000
As shown in Table 4.11 is the estimation of regression model equation:
Y=B0+¿ B X +B X + B X + B X ¿+𝘦
Y=0.035+0.295 X1 +0.967 X 2+0.709 X 3+ 0.431 X 4 +¿𝘦
This equation was relevant since all the
four independent variables studied (staffX1, facilities X2, management practices X3 and drugs X 4
) were found to influence the service delivery at Sub-County Hospitals in Meru County, Kenya
because all p-values came to values less 0.05. From the finding, Y-Intercept (B0=¿¿0.035) depicts
that holding all independent variables (staff, facilities, management practices and drugs) model
constant, the service delivery at Sub-County Hospitals in Meru County, Kenya is performing at
3.5%.
Further, from the findings staff (X1=¿ B¿) it mplies that a unit change of X1(staff) =0.295,
will improve the service delivery by 29.5%, and the improvement is statistically significant. In
addition from the findings, facilities, (X2=¿ B¿) it mplies that a unit change of X2
(facilities) =0.967, will improve the service delivery by 96.7%, and the improvement is
3=¿ 0.709 , P =
0.001
¿
4=¿ 0.431, P=
0.001
¿
statistically significant. Further, from the findings, management practices model, (X3=¿ B¿ ) it
mplies that a unit change of X3(management practices model) =0.709, will improve the service
delivery by 70.9%, and the improvement is statistically significant. Finally, from the findings,
drugs model, (X 4=¿ B¿) it mplies that a unit change of X 4(drugs model) =0.431, will improve
the service delivery by 43.1%, and the improvement is statistically significant.
From these findings it is evident that state of service delivery in sub-county Hospitals in
Meru County is influenced by staff, facilities, drugs procurement process and management
practices. This implies that if hospital staffs are increased in terms of their aspects (such as
advancement of skills, financial support to further education, enough time for training,
rotation as well as competitive compensation packages) service delivery will be improved.
Additionally when Hospital facilities are increased by a unit (functional laboratories, state
of the art laboratories, accessibility by roads, affordable use of ambulances etc) service
delivery to patients will also increase in Meru County. Moreover when management
practices (adequate budgeting of resources, resource allocation, adequate supervision of
staff, managers leading by example, adherence to motivation policy) increase by a unit in all
sub-county Hospitals in Meru County subsequently service delivery also increases.
Consequently, when drugs procurement process increases by a unit (flexible procurement
process, minimum lead time in drugs procurement, adequate resources for drugs
procurement, adherence to procurement plans etc) service delivery in all sub-county
Hospitals in Meru County increases.
