DETERMINANTS OF STRATEGY IMPLEMENTATION IN
THE PUBLIC HEALTH FACILITIES IN MOMBASA
DDBA 8560 - Seminar in Healthcare Managerial Decision Making
Background of the Study
Strategy can be defined as the balance of actions and choices between internal
capabilities and external environment of an organization. Accordingly, strategy can be
seen as a plan, ploy, pattern, position and perspective. According to Bateman and
Zeithman (2003), a strategy is a pattern of actions and resource allocations designed to
achieve the goals of the organization. A strategy involves an evaluation of the likely
impacts of both the external and internal organizational environment, the long-term goals
of the organization. From the perspective of classical strategic management theory,
strategy is considered a deliberate planning process, initiated by top management, based
on an elaborate industry analysis and aimed at designing a cohesive grand strategy for the
corporation (Mintzberg & Lampel, 2009).
The study was anchored on four theories; the resource-based theory, stakeholder theory,
systems theory and institutional theory. The resource based theory looks at the internal
strengths and weakness in organizational resources showing how the resources are
allocated and deployed in order to assist in the implementation of the strategies. On the
other hand, the stakeholder theory informs the study by urging managers to be clear about
how they want to do business, specifically what kinds of relationships they want and need
to create with stakeholders to deliver on their purpose. The systems theory however
views an organization as a real system that is open to and interacts with the environment
and can acquire qualitatively new properties through emergence, resulting in continual
evolution. The institutional theory assumes that organisations are deeply embedded in the
wider institutional context. Thus, organisational practices are either a direct reflection of,
or response to, rules and structures built into their larger environment (Montgomery,
2004; Freeman, 1994 & Kaplan, 2009).
The demands for increased performance and accountability in health care arise from
increasing expectations for improved service and higher standards of care by patients, the
public, government and policy makers. Health care workers must do more than practice
medicine and play increasingly more demanding roles of leading and building teams
effectively allocating resources and ultimately addressing the needs of the people they
serve. The management of hospitals in Kenya, Mombasa included remained in the hands
of medical doctors, who, despite having a lot of technical and professional expertise,
lacked adequate strategic management skills to access and make proper use of the
resources and mitigate against the new devolution challenges. The procurement of goods
and services at county level has been centralized at County headquarters and that has led
to Confusion and procurement challenges which might affect quality of procured
products and service delivery.
According to Bhasin (2009) implementation is the process through which a chosen
strategy is put into action. It involves the design and management of systems to achieve
the best integration of people, structure, processes and resources in achieving
organizational objectives. A strategic plan provides a business with the roadmap it needs
to pursue a specific strategic direction and set of performance goals, deliver customer
value, and be successful. However, this is just a plan, it does not guarantee that the
desired performance is reached any more than having a roadmap guarantees the traveler
arrives at the desired destination.
Although formulating a consistent strategy is a difficult task for any management team,
making that strategy work, that is, implementing it throughout the organization is even
more difficult. A myriad of factors can potentially affect the process by which strategic
plans are turned into organizational action. Unlike strategy formulation, strategy
implementation is often seen as something of a craft, rather than a science, and its
research history has previously been described as fragmented and eclectic. It is thus not
surprising that, after a comprehensive strategy or single strategic decision has been
formulated, significant difficulties usually are during the subsequent implementation
process (Starkey, 2004).
The challenges of strategy implementation are illustrated by the unsatisfying low success
rate (only 10 to 30 percent) of intended strategies. The primary objectives are somehow
dissipated as the strategy moves into implementation and the initial momentum is lost
before the expected benefits are realized. Successful implementation is a challenge that
demands patience, stamina and energy from the involved managers. Henry (2004)
identified four challenges affecting successful strategy implementation. He cited lack of
fit between strategy and structure; inadequate information and communication systems;
and failure to impart new skills. He identified most challenges as concerning connecting
strategy formulation to implementation; resource allocation; match between structure
with strategy; linking performance and pay to strategies; and creating a strategy
The most important thing when implementing a strategy is the top management’s
commitment to the strategic direction itself (Rapa & Kauffman, 2005). The top managers
must demonstrate their willingness to give energy and loyalty to the implementation
process. To successfully improve the overall probability that the strategy is implemented
as intended, senior executives must abandon the notion that lower-level managers have
the same perceptions of the strategy and its implementation, of its underlying rationale,
and its urgency. They must not spare any effort to persuade the employees of their ideas
(Rapa & Kauffman, 2005).
Communication process plays a major role in the strategy implementation process. The
way in which a strategy is presented to employees is of great influence to their
acceptance of it (Rapa & Kauffman, 2005). It is essential both during and after an
organizational change to communicate information about organizational developments to
all levels in a timely fashion (Miniace & Falter, 2006). Aaltonen and Ikåvalko (2002)
stated that organizational culture also influences strategy implementation. Marginson
(2002) contend that strategy implementation evolves either from a process of winning
group commitment through a coalitional form of decision-making, or as a result of
complete coalitional involvement of implementation staff through a strong corporate
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complex problems due to vagueness of the assignment of responsibilities and diffusion of
responsibilities through numerous organizational units. To avoid power struggles
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