influence of strategy implementation on the … 31... · karanja, kihara & munga, int. j. bus....

Int Journal of Business Management and Entrepreneurship 3(3): 31- 51, August 2018

© BLACKWELL PUBLISHERS www.blackwellpublisher.com

31

INFLUENCE OF STRATEGY IMPLEMENTATION ON THE PERFORMANCE OF

PUBLIC HEALTH CARE FACILITIES IN NAIROBI COUNTY

KARANJA Irene1, Dr. KIHARA Peter 2, MUNGA Jane3

1,2,3 Kenya Methodist University

Abstract

Effective systems starts with building up a sound and clear vital vision. Vital vision portrays

the coveted future condition of the firm and illuminates the course in which a firm is to take.

The point of this task was to show the after effects of the investigation whether they are

significant differences in the extent to which strategies are implemented in public primary

care facilities that have high level of organization performance versus those that have low

performance level of organization performance in Nairobi County. The particular goal for the

investigation were; to set up whether administration styles impacts the execution of public

small hospitals in Nairobi County, to decide how correspondence can impact the execution of

small public hospitals in Nairobi County, to establish whether availability of resources can

influence the achievements of small public in the County of Nairobi and to determine how

structure of the organization can influence the performance of public primary health care

options in the county of Nairobi. The examination utilized a graphic research plan and

targeted the 80 health facilities in Nairobi County. The research used a sampling formula to

obtain a list of 195 respondents who incorporated of senior, middle and bottom level

managers in the public health facilities in the Nairobi County. The primary data for the study

was sampled through use of self-structured questionnaires that were delivered to the

respondents’ place of work. The information was analysed by use of SPSS and delivered in

tables and graphs. The findings from the study revealed that resource allocation,

communication, leadership style and organizational structure were significantly and

positively associated with the accomplishment of the public health care facilities in Nairobi.

The study concluded that the small public hospitals in Nairobi County had not effectively

implemented resource allocation, communication, leadership style and organization structure

strategies since despite the literature showing that the facilities underperformed, the

respondents agreed that the strategies were important for strategies enhanced the performance

of the facilities. The study recommended that the county health departments should ensure

that they effectively allocate adequate resources and provide effective communication

systems to the public health facilities.

Keywords: Strategy implementation, Organizational performance, Performance, Health care

system

http://www.blackwellpublisher.com/

KARANJA, KIHARA & MUNGA, Int. j. bus. manag & entrep 3(3): 31- 51, August 2018

32

Introduction

Strategy implementation involves the changing of the strategy chosen to meet the firm’s

goals and objectives (Wang, 2000). Strategy implementation of this strategy is also said to be

the way a firm comes up, uses and almagates the firm’s structure, culture and control systems

to enable these follow strategies that improve performance and allow the firm to have a

competitive advantage. For a form to succeed, the implementation of strategies adopted must

exist. Implementation looks at how. Who and where the firm is going to reach the desired

objectives (Hill, 2011). It centres on the whole institution. Execution happens after ecological

outputs, and distinguishing key issues and objectives. Implementation is characterised giving

employees tasks and timelines to complete them to assist the firm reach its objectives. An

implementation plan will have a visionary leader who communicates the behaviours, visions

that is necessary for the success of the implementation process (Kisamwa, 2013).

Organization players should be part of the plan. The process of implementation is made up of

a strategic map that points out the ingredients necessary for effective performance. Such

ingredients include people, finances, work environment, market and people (Bourgeois &

Brodwin, 2004).

An exceptionally regular misstep in execution isn't creating possession all the while.

Additionally, where there is no plan or communication often results in failure of the

implementation process (Ram, Corkindale & Wu, 2013). In most cases the implementation

process of the strategy has too much information but with little meaning or provided and has

no way of ensuring progress. Firms often undertake implementation of strategies on a yearly

basis, which sees the employees and management to be too much involved in day to day

operations and neglecting future objectives (Kaithia, 2014). Another challenge is that that the

process does not have accountability measures where the employees are not even given the

mandate to make changes. To allow for the successful implementation of the strategy, there

must be a few factors to be considered. The staff members who have the needed skills should

be ready to make use of them (Zagotta & Robinson, 2002). There is need for important

resources such as effort and time to be available for the successful implementation of the

strategy. There should be effective and open communication and constant meetings that

update on the progress of the process. The tracking of the implementation will be tracked

with the help of technology and the workplace environment should be conducive to motivate

the employees (Koske, 2003).

On the other hand, the health care framework in Kenya is organized in a way that enables

complex cases to be handed over to a higher authority (Ongalo, 2012). The department of

health in Kenya contains the public framework, with the critical players being the Ministry of

Health and parastatal associations; and the private organization, which incorporates non-

revenue driven, Non-Governmental Organizations (NGO's), and Faith Based Organizations

(FBO) offices. Health solutions are given through a system of more than 4,700 health

institutions countrywide, 51 percent of these institutions are run by the public sector. (Brown,

2015) the performance of the hospitals is greatly influenced by the environmental state

around them (Bryan and Bird, 2017). They interface with the encompassing condition to

anchor the assets required for survival, adjustment and development. Their approaches and


33

exercises are always impacted by outer elements identified within the people they offer

services, recurrence of infections, the demand from the public, changes in the hospital

administrative framework and the framework in healthcare, and the more extensive financial

and political conditions. Development in the health sector in Kenya is sustained by input of

more resources in healthcare in the whole sector (David, 2013). This extended expense inside

the public segment, combined with rising private financial input and more prominent levels

of protection scope by insurance agencies has additionally enhanced the improvement of the

services in the medical sector and pharmaceutical industries. The local public benefits a lot

from these hospitals although not all can be treated due to the high patient demand and the

cheer numbers which takes a lot of time before one actually gets attended to. If a strategy is

executed to the letter, performance key indicators in the health facilities will play a key role

in ensuring medical services offered are in line with international recommendations and also

reflect the need of the local communities (Mintzberg, 2014). In Kenya, strategic

implementation in the healthcare sector is not comprehensive thus in many instances the data

quality is wanting and also poor usage of funds.

Statement of the Problem

According to research studies, many companies fail in the strategy implementation stage

despite coming up with a concrete and effective procedure. Vemic (2016) notes that more

than 50 per cent of companies are often unsuccessful in the implementation of the

organization strategy. A study conducted by Oswald and Mascarenhas (2011) established that

82% of the respondent organizations were unable to effectively execute the organization

strategy due to the organization process challenges notwithstanding the challenge of strategy

flexibility. To this effect, we can conclude that executing a strategy is one the leading barrier

facing most companies nowadays. In addition, despite its significance, this problem has not

received the deeper analysis that it deserves. Strategy execution has not received enough

attain from scholars. Vemic (2016) has argued that most researchers tend to focus on actual

framework and it’s immediate existence rather than the implementation stage. Therefore, this

research will close the gap existing in the literature on the topic of strategy implementation.

Public health care facilities in Kenya have had a sluggish performance over the past five

years (RoK, 2014). The-is is attributed to several factors, strategy implementation being one

of them. With the current devolved governments and the devolution of health services to

county level, much focus is now being laid down on development of county public hospital

facilities. Using the foundation of this information this research seeks to find out how

strategy execution affects the performance of medical services institution in Kenya. It is

hoped that if these health facilities are able to strictly follow their strategic plans

implementation to the letter, their performance will significantly improve.

Objective of the study

The study specifically sought:

i. To find out if the leadership styles influences the goal achievement of medical

institutions in the county of Nairobi.


34

ii. To figure out how relaying can affect the achievements of public medical institutions

in the county of Nairobi.

iii. To establish whether availability of resources can influence the performance of of

public medical institutions in the county of Nairobi.

iv. To determine how structure of the organization can influence the performance of

public primary health care facilities in Nairobi County.

Theoretical Framework

The study was based on three main theories that is; the general systems theory, the dynamic

capabilities theory, and Higgins 8-S strategy implementation framework.

The General Systems Theory

According to Chen and Stoup (1993), the General Systems Theory (GST) emerged from the

works of an Austrian biologist Ludwig von Bertalanffy in 1930’s. The theory studies the

structure and properties of a system in terms of relationships and interdependencies among

various components from which the properties of the whole emerge. The system theory also

views the world in terms of relationships and integration and emphasizes the principle of

organization.

Bank, Carson & Nelson (1996) define a system as many objects joined in regular

interdependence or interaction that seek to meet a common goal. This implies that a system is

made up of different components that work together in a regular relationship to accomplish a

common goal. The system components include entities, objects of interest within the system,

attributes, or defining properties of entities, states of the system’s collective descriptive

variables at a given time, activities taking place at a given time, and events that have the

potential to change the state of the system (Bank, 1996)

Modern organizations qualify as open systems and within an organization as a system; there

exist subsystems like human resource, administrative, management information systems,

social-technical, structural and others (Swanson & Holton, 2001; Torraco, 2005) The

common features of a system include the systems boundary, its external environment, and

sensitivity to disturbances both within and outside the system. The GST supports all the

variables in this study. Leadership styles, communication, resources and structure can be

looked at as key components in the organizational system and works harmoniously to achieve

good performance. The leadership component in an organization alone may not succeed in

strategy implementation effort without creating proper structures and ensuring active

participation of other subsystems like resources (human and non-human), social-technical

and information subsystem (communication). Moreover, organizations must also

continuously interact with the dynamic environment to obtain the required resources that

drive implementation of a strategy to success. The systems theory underpins all the variables

in this study.

The Dynamic Capabilities View

Teece was the one who introduced the organisation dynamic capabilities view in early 1990s.

The framework is based on the works of Barney (1991), Rumelt (1984) and Wernerfelt


35

(1984). The theoretical framework of this view is based on the resource-based view of the

organisation which considers the organisation resources as the ones responsible for a higher

performance on the firms part. If resources have the VRIO characteristics, the organization

gets to be at an advantage than its competitors (Barney, 1991; Rothaermel, 2012).

The dynamic capability theory (Eisenhardt & Martin, 2000) purports that firms will always

try to change its resources to evolve with the changes happening in a changing environment.

As explained by Teece, Pisano and Shuen (1997), the approach if dynamic capabilities looks

at the ability of the organisation to build, integrate and reconfigure their internal and external

abilities into new abilities that are able to deal with the changes in a dynamic environment

(Helfat, Finkelstein, Mitchel, Peteraf, Singh, Teece& Winter, 2007). The dynamic capability

theory underpins two independent variables in this study. Leadership is a dynamic capability

and a change in leadership skills is required as the environment of business changes.

Organizational structures keep on changing with changes in strategies necessitated by the

market changes. Structural capabilities and adaptability are required for organizations to

survive in a complex and dynamic environment.

Higgins 8-S Strategy Implementation Framework

Higgins (2005) did a revision of the McKinsey’s 7-S framework and came up with a revised

8-S framework for implementation of organizations strategies. Peters and Waterman (1982)

came up with the widely used and popular 7-S strategy implementation model. In their

research of the “best run” American firms, the two scholars Peters and Waterman came up

with seven components that are intertwined that management need to consider when they

want to implement strategies in the firm.

Figure 1: McKinsey’s 7-S Framework

(Pearce & Robinson, 1991)

Shared

Values

Strategy

System

s

Staff

Structure

Style Skills


36

Higgins (2005) did a revision of this model by adding an eighth component that was referred

to as strategic performance, which is the outcome when the seven components in the 7-S

model interact with each other. He further made a replacement of skills with Re-Sources as

one of the models S because a firm is nit able to implement its strategies without seeking

more resources such as technology, information, time and money.

Figure 2: Higgin’s 8-S Framework

Higgins, (2005), Journal of Change Management 5 (1)

According to Higgins this revised framework allows management to operate in a more

effective and efficient way when managing the activities that are related to implementation of

the firms strategy. The models observes that managers who agree that the implementation of

the strategy is as important as the implementation of a strategy are able to put more time and

resources to the execution of the strategy which leads to improved performance for the firm.

According to the 8-S model if strategy implementation is to be a success there is need to align

the firms components which are represented by the 8-S with the strategy that the firms wants

to Implement. Nevertheless due to the ever changing environment in which most businesses

exist it is essential that the management to continue realigning their strategies with the

changes that occur frequently. This means that the 8-S components will have to be

continuously aligned to match the changing strategies. This is one of the key problems

managers face when they try to implement strategies. The 8-S components are related, the

managers are tasked with continually changing these components to match the changing

strategies if the strategies are to be successfully implemented and if they intends this

implementation to improve the organisation performance (Higgins, 2005).

Context

Aligned

Strategic

Performance

System and

Processes

Shared

Values

Structure

Style

Staff Re-Sources

Strategy and

Purposes

Performance


37

Conceptual Framework

Independent variables Dependent variable

Figure 3: Conceptual Framework

Leadership styles

The nonexistence of specific leadership among the firm leaders have been pointed out as a

major obstacle to successful strategy implementation. A study by Bourgeois and Brodwin

(2004) pointed out that management need to evaluate the readiness of the organization before

implementing a strategy. Michlitsch (2000) investigated the Role of Strategic Leadership in

Effective Strategy Implementation: Perceptions of strategic leaders, this research sought to

determine if strategic leadership has a positive effect on successful implementation of a

strategy of a firm. Therefore, poor leadership or lack of leadership involvement results to

poor strategy implementation.

Communication

Communicating effectively in any organisation is important as it has the ability to enhance

productivity as it directly affects the way the employees perform the tasks. The managers

should give clear instructions to their employees so as to allow for tasks to be performed

effectively increasing productivity. Communication that is poor often leads to decreased

productivity as the employee might not understand or get the information he or she needs to

perform a task. In case a manager forgets to point out important details, the completion of the

task might be delayed or might be completed but with errors. Managers are advised to

communicate clearly to enhance efficiency and productivity and also strengthen the firms

external and internal operations.

Leadership style

Communication

Resources

Organizational structure

Performance of public

health care in Nairobi

County


38

Resources

Hospitals need to manage their scarce resources effectively. The resources should be used

effectively for the hospitals to provide efficient care to those in need of health care services.

The current research will show how public Health care manages scarce resources and will

also help in identification of methods that can help improve the efficiency and quality of care

in health facilities. Hospitals has different resources including beds, resident physicians,

information on patients and specialist surgeons among others. For h of these resources the

study will demonstrate how effective use of these resources can help enhance performance in

the health facilities.

Organizational Structure

Drazin and Howard (1984) note that, creation of an effective structure for the managers

involves selecting the most effective controls and structure for the firm that will assist in the

implementation of the chosen strategy. Schaap (2006), states that the firm structure and

strategy should be well aligned to ensure strategy implantation is a success. If there are

changes in the environment then the organisation will have to make changes to its structure.

In case the organisation is not quick to make this adjustment, it can be characterised by

decreased performance and be at a disadvantage compared to its competitors. Bryson (2005)

also recommends changing the structure of the firm to match the strategy to implemented for

successful implementation. The various strategies require differing structures. Drazin and

Howard (1984) explain that a goof fit between the firm structure and strategy can positively

affect the performance of the business unit.

Research Methodology

This study adopted descriptive research design. A research design is made up of decisions

that a researcher takes in regard to what, by how much, where and by what means related to

the research inquiry (Cooper and Schindler, 2000). Survey is an excellent tool as it considers

issues such as economy of the design rapid data collection and ability to understand a

population from a part of it. The target population were 400 top managers who were sourced

from 80 public health care facilities in Nairobi County.

Table 1: Target Population

Level of Management Number Percentage

Senior level mangers 40 10

Middle level manager 160 40

Lower level managers 200 60

Total 400 100

This study adopted multi-stage sampling technique where public primary health care facilities

were sampled in the first place since the unit of analysis in this study were the public primary

care health care facilities. These facilities were listed down to form a sampling frame from

which the facilities to participate in this study were drawn. Secondly, for each selected health

care facilities managers who were grouped from the level of seniority were interviewed using


39

a stratified random sampling technique. This study utilised the sample size calculation

formulae from Mugenda and Mugenda (2003) that recommends that for a population with

more than 10,000 participants the formulae to be used should be as given below:

Using this formula, a sample size of 195respondents will be interviewed for the purpose of

this study.

The study used an interview guide to obtain primary data where senior management staffs

were interviewed to enable collection of qualitative data. Data was collected through drop

and pick latter method. The questionnaires were then collected after two days. Senior

managers were interviewed face to face during the first visit. However, in this study, the

questionnaires were used as the main tool for data collection. Secondary data collection was

done thorough scrutiny of the organizations strategic plan, other publications, organizations

websites, and other studies and reports on the organization. Validity of this study was

established using Cronbach Alpha. The value for the alpha value was between 0 and 1.00.

According to Cronbach (1951), the acceptable level of alpha value is 0.7 and above.

Data analysis was both quantitive and qualitative. Quantitive data was cleaned (edited) to

ensure that the data was complete and did not have inconsistences. Statistical Package for

Social Sciences (SPSS) version 20 software helped in the analysis of the coded data. This

study employed descriptive statistics such as mean scores, standard deviation, percentages,

dispersion to analyse the data obtained. Descriptive in this study was presented in form of

frequency charts, graphs, and pie charts and cross tabulations. Secondly, this study used the

bivariate linear correlation analysis to establish how each of the predictor variable

(independent variable) under investigation in this study relates to the dependent variable

(performance). Regression analysis was used to present the inferential output in this study.

The Beta values in the regression analysis gave weights to the study variables.

The regression analysis took the following model:

Y = β0 + β1X1 + β2X2 + β3X3 + β4X4 + ε

Where: Y represents performance in public primary health care facilities; β0 is the value of

the constant; X1 represents leadership styles; X2 represents organizational communication; X3

represents organizational resources; X4 represents organizational structure

Results and Discussions

The study had a sample of 195 managers. Out of 195 managers, of 190 responded to the

questionnaires well answered giving the study a 96% response rate. Mugenda and Mugenda

(2003) indicates that for generalization a 50% response rate is adequate for analysis and

reporting, a 60% response rate is good, while a response rate of above 70% and over is

excellent.


40

Influence of Resources On Performance Of Public Health Care

The study sought to assess how resources affect the performance of the public health care in

Nairobi County in Kenya.

The findings presented in table 2 show that 75.6% agreed that adequate funds to run

operations influence performance of public health care, 75.6% agreed that payment of

employees on time influences performances of public health care, 64.5% agreed that

adequacy of technology employed, 66.6% agreed that well trained and adequate staff, 67.7%

agreed that adequacy of facilities employed for operation, 75.5% agreed that patients are

satisfied with time offered and 73.3% agreed that adequate supply of drugs and equipment

influences performance of public health care. The findings concur with a study by Oswald

and Mascarenhas (2011) which found that resource allocation is one of the key dimensions

towards enhancing strategy implementation. According to Oswald and Mascarenhas (2011)

allocating adequate resources to the organizational strategies such as human resources,

budgets band support enhances the effective implementation of the strategies.

Table 2: Level of Agreement on Statements on Resource Allocation

Agree Strongly

agree

Neutral Disagree Strongly

disagree

Mean

Adequate funds to

run operations

46.7% 28.9% 8.9% 15.6% 0% 4.11

Employees paid on

time

28.9% 46.7% 24.4% 0% 0% 3.87

Adequacy of

technology

employed

17.8% 46.7% 31.1% 2.2% 2.2% 3.69

Well trained and

adequate staff

33.3% 33.3% 24.4% 0% 8.9% 3.74

Adequacy of

facilities for

operation

26.7% 40.0% 26.7% 0% 6.7% 3.81

Patient satisfied

with time we offer

24.4% 51.1% 13.3% 6.7% 4.4% 4.16

Adequate supply

of drugs and

equipment

42.2% 31.1% 24.4% 2.2% 0% 4.07

Influence of Communication on Performance of Public Health Care

The study sought to determine the influence of communication on performance of public

health centre. From the findings as shown in table 3 below, 80% of the total respondents

agreed that they embraced communication with simple language (31% agree; 49% strongly

agree) with a mean of 3.92, 73.3% of the total respondents agreed that they embraced use of

numeral communication channels in their respective organizations with a mean of 4.05 as

well, 77.8% agreed that feedback availability was enhanced with a mean of 4.04, 75.6%

agreed that regular communication with employees and this had a mean of 4.02, 77.8%

agreed that conveyance of the same message was embraced in their respective organizations


41

and this had a mean of 3.99, 80% agreed that frequent and adequate address to employees

problems was enhanced with a mean of 4.16 and 69.9% of the total respondents agreed that

minimal delays in communication influences performance of public health cares and this had

a mean of 3.88.

The findings from the study imply that effective communication is a key strategy towards

enhancing performance of public health sectors. According to Martha (2010) effective

communication is one of the main determinants of firms’ competitiveness in that it enhances

the firms to either receive or sent the necessary information. Through communication, the

firm is able to realize what happens in its external environment thus making its take and

adopt the necessary strategies to streamline the behaviour of the environment. Similar to the

findings, Kisamwa (2013) argues that good communication has to have feedback whereby the

employees, customers and other organizational stakeholders are offered timely feedback on

their inquiries, promoting regular communication and giving the rightful information and to

the right persons.

Table 3: Level of Agreement with Statements on Communication

Agree Strongly

Agree


disagree

Mean

Communication with

simple language

31.1% 48.9% 15.6% 0% 4.4% 3.92

Use of numeral

Communication

channels

42.2% 31.1% 17.8% 4.4% 4.4% 4.05

Feedback availability 40.0% 37.8% 15.6% 2.2% 4.4% 4.04

Regular

communication with

employee

40.0% 35.6% 17.8% 2.2% 4.4% 4.02

Convey same message

to all employee

37.8% 40.0% 15.6% 4.4% 2.2% 3.99

Issues and problems

Frequently and

adequately addressed

48.9% 31.1% 13.3% 4.4% 2.2% 4.16

Delays in

communication

37.8% 31.1% 28.9% 0% 2.2% 3.88

Influence Of Leadership Style On Performance Of Public Health Care

In addition, the study sought to determine, the influence of leadership style on performance of

public health care. The findings as shown in table 4 below indicate that 64.4% (29% agree

and 36% strongly agree) of the total respondents agreed that their leadership styles made

employees to feel good around them and this had a mean of 3.67, 73.4% of the respondents

said that they agreed that communicating to others in simple words enhanced the

performance of the public health care, 66.7% agreed that making other think of old problems

in a new ways, 71.1% of the respondents said that helping others employees develop


42

themselves enhanced the performance with a mean of 3.78, 62.2% agreed that telling

employees what to do if they want to be rewarded enhanced performance, 75.6% agreed that

employees meeting their target enhanced the performance, 53.3% agreed that letting others to

continue working in the same way, 75.5% agreed that others having complete faith in them,

71.1% of the total respondents agreed that use of tools, stories and models to help other

understand and 64.4% of the total respondents agreed that providing employees with new

ways of looking at complex or difficult issues influences performance of public health care.

The findings imply that majority of the respondents viewed leadership strategy as a key

aspect in enhancing performance of the public health sector. The findings concur with those

by Sterling (2013) who established that leadership style was a key strategy that enhanced

organizational performance through promotion of a collaborative and supportive work

environment. Leadership that is customer oriented enhances the quality of services offered to

the customers as well as promoting the relationship among the employees thus making the

workforce united for a common goal (Sterling, 2013).

Table 4: Level of Agreement with Statements on Leadership Style

Agree Strongly

agree


disagree

Mean

Makes employees

feels good around

me

28.8% 35.6% 28.9% 0% 6.7% 3.67

I tell others in a few

simple words what

need to be done

37.8% 35.6% 17.8% 6.7% 2.2% 3.93

I make others think

about old problems

in new ways

31.1% 35.6% 22.2% 2.2% 8.9% 3.72

Help other

employees to

develop themselves

37.8% 33.3% 20.0% 8.9% 0% 3.78

Tell employees what

to do if they want to

be rewarded

24.4% 37.8% 31.1% 4.4% 2.3% 3.65

Am i satisfied when

employees meet the

agreed target

40.0% 35.6% 20.0% 2.2% 2.2% 4.02

I am contented to let

others to continue

working in the same

way

31.1% 22.2% 33.3% 8.9% 4.4% 3.59

Other people have

complete faith in me

31.1% 44.4% 24.5% 0% 0% 3.83

I use tools, images

and models to help

others understand

40.0% 31.1% 20.2% 6.4% 4.4% 4.01

I provide new ways

of looking at

31.1% 33.3% 28.9% 2.3 4.4% 3.71


43

complex issues

Influence of organization structure on performance of public health centre

The study sought to establish the influence of organisation structures on performance of

public health care facilities in Nairobi County. From the findings as shown in table 5 below,

68.9% of the total respondents agreed (40% agree and 28.9% strongly agree) that revising

and creating appropriate structures to match changes in strategy influences the performance

of public health care services and this had a mean of 4.05. The findings further had it that

82.2% of the total respondents agreed (42.2% agree; 40% strongly agree; mean 4.17) that

adequate information before new strategy is implemented, 73.3% of the respondents agreed

(42.2% agree; 31.1% strongly agree; mean 4.03) that clear system of governance influences

performance of the public health care.

The findings further revealed that 73.3% of the total respondents agreed that having central

command centre influenced health care performance in the public sector with a mean of 3.97,

53.3% of the total respondents agreed that having well-coordinated work activities enhanced

the public health care performance with a mean of 3.62, 71.1% agreed (28.9% agree; 42.2%

strongly agree; mean 3.84) that structures that allows quick decision and feedbacks influences

the performance of the public health care services, 78.8% of the total respondents agreed that

well-designed reporting authority enhanced the performance of the public health care systems

and this had a mean of 3.88. The findings also had it that 57.8% of the total respondents

agreed (31.1% agree; 26.7% strongly agree; mean 3.60) that central decision structure

enhances performance of the health care in the public domain, 71.1% of the respondents in

the study agreed that flexible structures that allow changes enhance performance of the public

health care, 66.7% of the respondents with a mean of 3.85 agreed that making sure that

employees have adequate knowledge and skills enhanced the performance of the public

health care.

The findings further showed that 70.0% of the total respondents in the study agreed that

encouraging division of work and specialization with a mean of 3.61, 68.9% of the

respondents said that they agreed that adequate level of supervision influences public health

care performance, 71.1% agreed (40% agree; 31.1% strongly agree; mean 4.04) that

encouraging team work influences the performance of the public health care, 71.1% of the

total respondents agreed that well-structured job enhance the performance of the public health

care with a mean of 3.96 and 75.5% of the respondents agreed (42.2% agree; 33.3% strongly

agree; mean 4.05) that encouraging reference to the past experience influences performance

of public health care.

The findings from the study imply that organizational structure is a key aspect in promoting

the performance of public health care services in Kenya. The study findings concur with the

study by Koske (2003) and Higgins and Vince (2012) who established that organizational

structure through well designed authorities and well structure information flow channels

enhances the performance of the organization through integration of the capabilities of the

firm and promoting an effective workforce that knows who to report to and receive orders

from. According to Johnson et al. (2014) organizational structure is a key organizational


44

strategy that serves to promote a collateral working system which has both parties in the

organization effectively performing with their roles clearly defined. A good organizational

structure encourages division of labor and working as a team so as to achieve a common goal

through combined effort.

Table 5: Level of Agreement with Statements on Organizational Structure

Agree Strongly

agree


disagree

Mean

Revise and creates

structures to match the

changes

40.0% 28.9% 20.0% 6.7% 4.4% 4.05

Adequate information

before new strategy is

implemented

42.2% 40.0% 15.6% 2.2% 0% 4.17

Governed by clear systems 42.2% 31.1% 26.7% 0% 0% 4.03

We have a central

command center

33.3% 40.0% 20.0% 4.4% 0% 3.97

Strategic work activities are

well coordinated

22.2% 31.1% 37.8% 4.4% 2.2% 3.62

Structures allows quick

decisions and feedback

28.9% 42.2% 26.7% 0% 2.2% 3.84

Well-designed reporting

authority

35.6% 42.2% 15.6% 4.4% 2.2% 3.88

Centralized decision

structure that allows quick

decisions

31.1% 26.7% 37.8% 2.2% 2.2% 3.60

Structures are flexible to

allow changes

22.2% 48.9% 17.8% 8.9% 2.2% 3.85

Employees have

knowledge, experience and

skills

40.0% 26.7% 31.1% 2.2% 0% 4.03

Encourages division of

work and specialization

26.7% 33.3% 24.4% 6.7% 8.9% 3.61

Adequate level of

supervision in every

section, department

28.9% 40.0% 24.4% 6.7% 0% 3.79

Our managers encourage

teamwork

40.0% 31.1% 22.2% 4.4% 2.2% 4.04

Jobs are well structured

with no overlaps, conflicts

or ambiguity

26.7% 44.4% 24.4% 2.2% 2.2% 3.96

Encourages to refer to the

past experience

42.2% 33.3% 17.8% 0% 2.2% 4.05

Coefficient of Correlation

Stigler (2002) notes that the Pearson product-moment correlation coefficient quantifies linear

correlation (dependence) between two variables X and Y. the results provides a value that is

between +1 and −1 inclusive, with 1 representing a positive correlation, while 0 represents no


45

correlation, and −1 shows a negative correlation. He also notes that a p-value that is less than

0.05 is often considered as significant.

As presented in Table 4.9, the study performed Pearson correlations for the relationships

between performance of health care facilities and strategy implementation variables.

Table 6: Pearson Correlation Matrix

*Correlation is significant at the 0.05 level (2-tailed)

Source: Survey data, 2017

As shown above, at 5% significance level, there was a positive correlation between strategic

implementation and performance of primary public health care facilities in Nairobi County.

This is based on the Pearson correlation co-efficient obtained of 0.693, 0.711, 0.7318 and

0.723 respectively. These person correlation coefficients imply that there is a strong positive

relation between performance of primary public health care facilities in Nairobi County as the

correlation coefficients exceeded 0.5.Ochieng (2009) supports the relationship between

strategic implementation and performance of firm, which is in line with the study findings.

Regression Analysis

The combined effect of strategy implementation variables on performance of public health

facilities was examined using multiple linear regression analysis where the model summary

(Table 7), regression coefficients (Table 8), and ANOVA (Table 9) results were obtained.

Model Summary

Table 7: Coefficient of Determination (R2)

Model R R Adjusted Std. Change Statistics

Performance

of health

care

facilities

Resources Communicatio

n

Leadership

style

Organizatio

n structure

Performance of

health care

facilities

1

Resources 0.693 1

(0.002)

Communication 0.711 0.547 1

(0.0011) (.000)

Leadership

style

0.7318 0.682 0.629 1

(0.007) (0.003) (0.061)

Organization

structure

0.723 0.684 0.539 0.7318 1

(0.011) (.003) (.032) (0.027)


46

Square R

Square

Error of

the

Estimate

R

Square

Change

F

Change

df1 df2 Sig. F

Change

1 .980a .960 .959 .15441 .960 643.336 4 187 .000

a. Predictors: (Constant),Resources, communication, leadership style and organization

structure

Source: Research Data, 2017

Coefficient of determination try’s to determine the extent to which any change or variation in

the dependent variable can be explained by the existing change in the independent variables

or the percentage of variation in the dependent variable (performance of public health

facilities and the independent variables (Resources, Communication, leadership style and

organization structure). The four independent variables that were studied explained 96% of

the relationship between the independent variables and performance of public health facilities

(dependent variable) as shown by the R2. This shows that that the study’s four independent

variable make up 96% to health facilities performance, the remaining 6% represents other

variables not in this study that affect the performance of health facilities. There is need for

more research to be done to determine the other variables affecting the dependent variable of

the study.

Analysis of Variance

Table 8: Analysis of Variance ANOVAa

Model Sum of Squares Df Mean Square F Sig.

1

Regression 76.691 4 19.173 1,127.824 .001b

Residual 3.195 187 .0.017

Total 79.886 191

a. Dependent Variable: performance of public health facilities

b. Predictors: (Constant), resources, communication, leadership style and organization

structure.

The results in Table 8 are for the analysis of variance. The ANOVA results show that the

regression model level was significant at P 0.001%. This shows that the data collected was

adequate to make inferences in regard to the parameters of the population. The value of p was

lower than 0.05 showing that the model was significant at 95% confidence interval.

Regression Coefficients

The regression coefficients associated with the dimensions/ approaches of strategy

implementation and performance of public health facilities are presented in Table 9.


47

Table 9: Regression Coefficients

Model Unstandardized

Coefficients

Standardized

Coefficients

t Sig. 95.0% Confidence

Interval for B

B Std.

Error

Beta Lower

Bound

Upper

Bound

1

(Constant) 4.833 .049 99.344 .002 4.737 4.929

Resources .146 .014 .249 10.553 .004 .173 .198

Communication .227 .011 .418 21.462 .002 .206 .248

Leadership style .553 .016 1.064 34.191 .001 .521 .585

Organization

structure .301 .015 .594 19.914 .001 .331 .571

a. Dependent Variable: Performance or public health facilities

Source: Research Data, 2017

According to the findings, Resource (B=0.146, P=0.004), Communication (B=0.227,

p=0.002), Leadership Style (B=0.553, p=0.001) and Organization Structure (B=0.301,

p=0.001) were all significant in predicting the performance of primary public healthcare

facilities in Nairobi county as all the p values were less than 0.05. The resulting regression

equation was:

Y=4.833+0.146x1+0.227x2+0.553x3+0.307x4+e

Where Y= Performance of primary healthcare facilities, β0 = Constant, β1, β2, β3 and β4 =

Coefficients of determination of the independent variables, X1= Resource, X2=

Communication, X3= Leadership Style, X4= Organization Structure. This implied that all

independent variables positively affected the performance of primary public healthcare

facilities in Nairobi.

According to the findings, a constant of 0.4833 was obtained, implying that if all the factors

under study are held constant, performance of primary public healthcare facilities would be

0.4833 units. When all the factors are held constant, a unit change in Strategy implementation

would change performance by 0.4833 units. When all the factors are held constant, a unit

increase in Leadership style would increases performance of primary public healthcare

facilities by 0.553 units

Conclusion

The study aimed at finding out the role of strategy implementation on the performance of

public health care facilities in Nairobi County. From the findings as reviewed in the previous

chapter, the study concluded that resources are key measures to ensure performance of public

health care facilities in Nairobi County. The study concluded that most of the health care

facilities in Nairobi did not receive adequate resource allocation in terms of funds to support

the operations, enough drugs, adequate trained staff and technological systems to support the

operations of the facilities. This is due to the continued underperformance as revealed in the

literature despite the respondents’ agreement that resources enhance performance.


48

The study concluded that performance of public health care facilities in Nairobi County was

enhanced by communication. Effective communication entails frequent communication,

proper communication channels and giving of feedback to any concerns of any stakeholder.

The factors enhance the effective information sharing and flow of orders and decisions within

the organization thus making the relationships within the organization reliable. The study

further concluded that there was no effective communication among the public health

facilities in Nairobi County. This is based on the deteriorating performance in the facilities

despite the respondents’ endorsement that effective communication enhances performance of

the health care facilities.

On the leadership style and performance of public health facilities, the study concluded that

effective leadership style influences the performance of public health care facilities

positively. The study concluded that using new ways and innovative means to handle issues,

using tools and criteria that enhance the understanding of issues as well as helping other

employees to handle issues are among leadership style approaches that enhance the

performance of public health facilities. However, the study concluded that leadership style

was not effectively implemented based on the fact that the literature revealed a recurring

underperformance of the public health care facilities despite the agreement by the

respondents that the strategy enhances performance of the facilities.

On the influence of organizational structure on the performance of public health facilities in

Nairobi, the study concluded that organizational structure was a key aspect in enhancing the

performance of public health care facilities in Nairobi County. The study concluded that

revising structures to match changes, adopting flexible structures and sharing information

clearly before any changes are made influenced the performance of the public health

facilities. Based on the literature, it is evidence that public health care facilities despite the

study findings revealing the organizational structure enhances the performance. This

therefore makes the study to conclude that the facilities have not fully and effectively

embraced reliable and proper organizational structures thus making them to continue

underperforming.

Recommendations of the Study

Public health care facilities are very crucial in not only the economic development but also on

the social and political progress of any country. It is on this merit that the study recommends

that the managers of the health care facilities should ensure that they embrace resource

allocation as a strategy to enhance their performance. The study recommends that the county

government and other relevant stakeholders should ensure that they allocate adequate budget

to the health care facilities as well as recruiting well trained employees and providing

technological mechanisms to the facilities so as to enhance their performance.

The study recommends that the management of the public health care facilities should

embrace proper communication and information sharing as a way of enhancing flow of

information thus enhancing the relationships among the employees which essential for

commitment and performance as well. The management should ensure that they give


49

feedback to both the employees and the customers who are the key stakeholder in such

facilities.

The study further recommends that the management of the health care facilities should ensure

that they embrace effective and favourable leadership styles such as employee involvement,

rewarding and allowing them to be heard so as to promote their satisfaction and commitment

with influences their resourcefulness within the facilities. The study recommends that the

management of the public health facilities should act as examples to the employees such that

they practice acceptable leadership styles which the employees learn from.

Finally, the study recommends that the management of the public health facilities should

ensure that the organizational structures adopted are flexible such that they can accommodate

changes at any time and still remain relevant to the organization. The management should

ensure that all the stakeholders are well explained of any planned changes to the structure of

the organization so as to avoid rejection and promote unity.

Recommendations for further studies

The study focused on the influence of strategy implementation on performance of primary

public health care facilities thus, there is need for a similar study to focus on other factors that

influence the performance of the health care facilities, a sector that has over the recent past

deteriorated drastically in the performance.

The study was limited to public health care facilities in Nairobi County. This therefore means

that there is need for a similar study to focus on the Primary public health care facilities in

other areas especially the marginalized areas whose performance is even low as compared to

those in Nairobi.

The study adopted a descriptive research design which incorporated of both qualitative and

quantitative data. There is therefore a urge for a similar study to adopt a different research

design so as to establish whether there can be a U-turn in the findings based on the research

design used.

References

Banks, J., & Carson, I.I.J.S. & Nelson, B.L. 1996. Discrete-Event System Simulation.

Barney, J., Wright, M., & Ketchen Jr, D. J. (2001). The resource-based view of the firm: Ten

years after 1991. Journal of management, 27(6), 625-641.

Bourgeois, L.J. & Brodwin, D.R. (2004): Strategic Implementation: Five Approaches

to an Elusive Phenomenon. Strategic Management Journal,5 (3), 241- 264

Brodwin, D.R. (2004). Strategic implementation: Five approaches to an elusive

phenomenon. Strategic Management Journal, 5(3), 241-264.

Brown, P. (2015). A qualitative study of patient (dis) trust in public and private hospitals: the

importance of choice and pragmatic acceptance for trust considerations in South

Australia. BMC health services research, 15(1), 297.. (2015). A qualitative study of

patient (dis) trust in public and private hospitals: the importance of choice and


50

pragmatic acceptance for trust considerations in South Australia. BMC health services

research, 15(1), 297.

Bryan, V. & Bird, J. (2017).Healthcare community synergism between patients, practitioners,

and researchers. Hershey PA: Medical Information Science Reference.

Bryson, J. M. (2005). Strategic Planning for Non-Profit organizations, Revised Edition.

Burns, T., & Stalker, G.M. (1981). The Management of Innovation, Tavistock, London,

1961. BurnsThe Management of Innovation1961.

Chen, D., & Stroup, W. (1993). General system theory: Toward a conceptual framework for

science and technology education for all. Journal of Science Education and

Technology, 2(3), 447-459.

Cooper, D.R., & Schindler, P.S. (2000). Business Research Methods. Singapore: McGraw-

Hill Higher Education.

Cronbach, L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika,

22(3) 297-334.

Drazin, R. & Howard, P. (1984). Strategy implementation: a technique for organizational

design, Journal of Management Studies, Vol. 34 No.3, pp.465-85.

Drazin, R. and Howard. V. (2009) ‘‘An Examination of Alternative Forms of Fit in

Contingency Theory’’, Administrative Science Quarterly 30: 514–539.

Eisenhardt, K.M., & Martin, J.A. (2000). Dynamic capabilities: what are they?. Strategic

management journal, 21(10‐11), 1105-1121.

Helfat, C.E., Finkelstein, S., Mitchell, W., Peteraf, M., Singh, H., Teece, D., & Winter, S. G.

(2009). Dynamic capabilities: Understanding strategic change in organizations. John

Wiley & Sons.

Higgins, K. & Vince R. (2012).Constructing a definition for intangibles using the Resource

Based View of the firm. Management Decision.

Hill, C., & Jones, G. (2011). Essentials of strategic management. Nelson Education.

Johnson, G. & Scholes, (2002).Exploring Corporate Strategy. 6th New Jersey: Prentice Hall,

USA.

Kaithia D.A. (2014) An Investigation into the Factors Influencing the

Implementation of Strategic Plans in Public Secondary Schools in Igembe

South District, International Journal of Social Sciences and Entrepreneurship,

Kisamwa, C., (2013) Impact of Turnaround Strategies on the Growth of Microfinance

Institution in Kenya. A project for Masters of Business Administration, University of

Nairobi

Koske, F. K. (2003). Challenges of strategy implementation and its challenges in public

corporations: The case study of Telkom Kenya Ltd. Nairobi: University of

Nairobi, MBA Thesis, Unpublished

Michlitsch, J.F. (2000). High-performing, loyal employees: The real way to implement

strategy. Strategy & Leadership, 28(6), 28-33.

Mintzberg, H. (2014). Administrando governos, governando administrações. Revista do

Serviço público, 49(4), 148-163.

Mugenda, O., &Mugenda, A. (2003).Research Methods – Quantitative and Qualitative

Approaches. Nairobi: ACT Press.


51

Muturi, S. (2015). Evidencing Enablers of Innovation Capabilities and their Effects on

Organizational Performance. Strategic Journal of Business & Change

Management, 2(2)

Ochieng,M.A. (2009). Strategic planning problems and coping strategies .University of

Nairobi.

Ongalo, S. (2012), Influence of computerized health management information system on

service delivery: a case of health institutions within Nairobi, Kenya, Unpublished

MBA Project University of Nairobi.

Oswald A.J. (2011).Business Transformation Strategies: The Strategic Leader as

Innovation Manager: Sage. New Delhi

Priem, R. L., & Butler, J. E. (2001). Is the resource-based “view” a useful perspective for

strategic management research?. Academy of management review, 26(1), 22-40.

Ram, J., Corkindale, D., & Wu, M. L. (2013). Implementation critical success factors (CSFs)

for ERP: Do they contribute to implementation success and post-implementation

performance?. International Journal of Production Economics, 144(1), 157-174.

Rothaermel, F.T. (2012). Strategic management. McGraw-Hill Education.

Sterling, J. (2013), Translating strategy into effective implementation: dispelling the myths

and highlighting what works. Strategy and Leadership.

Swanson, R.A., Holton, E., & Holton, E.F. (2001). Foundations of human resource

development. Berrett-Koehler Publishers.

Teece, D.J. (2014). The foundations of enterprise performance: Dynamic and ordinary

capabilities in an (economic) theory of firms. Academy of management

perspectives, 28(4), 328-352.

Teece, D.J., Pisano, G., & Shuen, A. (1997). Dynamic capabilities and strategic

management. Strategic management journal, 18(7), 509-533.

Torraco, R. J. (2005). Writing integrative literature reviews: Guidelines and

examples. Human resource development review, 4(3), 356-367.

Vemic. (2017). Optimal Management Strategies in Small and Medium Enterprises. Place of

publication not identified: IGI Global Business Science Reference.

Vince, R. (2012). Integrating emotions into the analysis of institutional work. Academy of

Management Review, 37(1), 58-81.

Wang, Y. (2000). Strategy Implementation TU: Seminar Study in Strategy and International

Business, Helsinki University of Technology, Institute of Strategy and International

Business, Unpublished Report.

Zagotta, R. & Robinson D. (2002). Keys to Successful Strategy Execution, Journal of

Business Strategy 30-34

Zollo, M., & Winter, S.G. (2002). Deliberate learning and the evolution of dynamic

capabilities. Organization science, 13(3), 339-351.

influence of strategy implementation on the … 31... · karanja, kihara & munga, int. j. bus....

Documents