Abstract

Baptist Teaching and Referral Hospital is a state corporation established to provide advanced and comprehensive health services 50 years ago. It forms the apex of the health care system with a bed capacity of 1,500 beds. It provides complex health care services, research and training and educational facilities for students and health professionals. The management of the hospital included the management board, the director, deputy directors and head of departments. To ensure high quality service provision, the facility through the management provides a favorable climate and culture to deliver such services by professional staff. The facility employs a participatory approach in communication and management of the hospital is thereby engaging a wide range of stakeholders. Despite the challenges facing it as well as the whole health sector like poor funding, shortage of personnel, drugs and medical supplies, dynamic medical technology, delayed discharges and emerging infections, it has managed to maintain and improve quality service provision. These are through patient focus, interprofessional and intersectoral integration and performance management.

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Strategic Management in Healthcare

Baptist hospital was founded five decades ago with a vision to provide advanced, comprehensive and coordinated health care services to all. This is achieved through building capacity for health care providing universal access to high quality health care and treatment, integration and decentralization of health services. It is a state corporation fulfilling the role of the National Teaching and Referral Hospital in the Peoples Republic of Johnson. It has a board of management, which ensures efficient and effective operation of the hospital to deliver quality health care services.

Size of the Facility

Baptist Teaching and Referral Hospital is the second largest hospital in Johnson and covers an area of 35 hectares. Within the hospital complex there is the College of Health Sciences (University of Indiana); the Mary Hill Medical Training College and Soviet Medical Research Institute. The hospital has 35 wards, 15 out-patient clinics, 10 specialized theaters and Accident & Emergency Department. It has 1,500 beds of which 300 beds are for the Private Wing and staff numbering is 3,727 people.

Type of Facilities and Services

Teaching and Referral Hospital is the highest cadre of the health care system and therefore it provides sophisticated diagnostic, therapeutic, and rehabilitative services. The facility acts as a center of excellence, where it provides the health care requiring highly skilled staff and more complicated technology. Being the apex of health care system, it has a higher concentration of facilities in terms of resources and infrastructure and is very expensive to manage. It also provides trainings for health workers at both pre-service and in-service levels. It provides the undermentioned clinical services.

Health Care

Baptist Hospital provides sophisticated curative tertiary care, preventive care and participates in public health promotion programs. They are conducted for the general public to embrace behavior change and promote primary health care system. The hospital receives referrals from the lower levels and provides information on various health problems and diseases. It provides extra-mural treatment alternatives to hospitalization, such as day surgery, home care, home hospitalization and outreach services.

Quality of Care

As a teaching facility, the hospital provides leadership in setting high clinical standards and treatment algorithms thus providing access to the best quality of health care in the country.

Research

Due to the highly developed infrastructure and personnel, it provides solutions to national health problems and policy formulation through research activities. It also provides both basic and post-graduate teaching and training for health professionals.

Payment

Adequate resources are the key to achieving quality and sustainable provision of health services (Muller, Bezuidenhout, & Karien, 2006). Several financing strategies for the health care services provided in Baptist Hospital have been developed and they include taxation, user fees, donor funds and health insurance. They are important avenues of sourcing for funds and should reflect the cost of service provision as well as the affordability by population.

High dependence on budgetary allocation by the state has reduced the provision of an adequate level of services to the public in health sector. This is attributed by the fluctuating tax revenues, inflations and poor growth. The Baptist Hospital therefore has fully embarked on the health insurance fund and development partners. In the health insurance scheme everyone contributes without exception, as the hospital lobbies for funds from donors and development networks. The funds are the key in providing and sustaining drugs and medical supplies.

Management

The hospital is governed by a management board with the sole responsibility of administrative management and development. To improve the efficiency of the services and management of the hospital, the board constitutes a team of 10 members and three committees. The committees include: the Finance committee, which adjudicates all tenders and quotations in the hospital; the development committee, which identifies maintenance needs of the hospital and addresses them, and establishment committee, which deals with personnel policies and guidelines.

Organizational Structure

The Management Board

The hospital is manned by the statutory board, which ensures effective management and sound execution of policies.

The Director

Has the responsibility of daily running of the hospital.

Two Deputy Directors

They are two of which one is in charge of Clinical services while the other one is in charge of Administrative services.

Heads of Departments

They manage various clinical and non-clinical services in the hospital. For example, the clinical departments include medicine, surgery, dentistry, radiology, quality assurance and dermatology. Professional support department includes medical records, public health, laundry, nutrition, catering and occupational therapy. Administrative departments include personnel, finance, administration, supplies and procurement.

Culture and Climate of the Organization

To be one of the top-performing hospitals in the nation providing advanced and comprehensive health care, there are specific external pressures and internal factors impelling quality. Through the profound leadership, the hospital has developed overarching key elements and systems that powerfully support high quality care and successful quality improvement. The strategies include developing the right culture for quality to flourish, employing the right people to advocate for quality, devising and updating right processes for quality improvement and providing the right tools to perform duties. These are critical in ensuring the right culture and climate in the hospital promoting high quality service provision.

The Right Culture

This is essential in creating a good working climate that leads to good outcomes and effective quality management (Meyer J., Silow-Caroll S., Todd K., Larry S., and Rybowski L., 2004). The Baptist Hospital has performed the following actions to instill a culture of quality: it is developing clear quality related mission and vision, has strong leadership system, works together within the organization, provides supportive organizational structures and institutions and creates clear communication channels.

The Right Personnel

To promote quality in service delivery, the recruiting and retaining of top-level staff must be emphasized. This includes all the levels of management from top managers to the bottom social workers. It is achievable through selective hiring of physicians and nurses, employing a manageable number of high quality clinicians and establishing a multidisciplinary team to coordinate patient care and quality improvement.

The Right Processes

The hospital is engaged in quality improvement through constant measuring, problem solving techniques and accountability assurance. It has been achieved by selection of measurable indicators, hiring a dedicated and qualified staff in data management, adequate reporting both up and down in the administrative levels.

The Right Tools

To create a climate conducive to support and sustain high quality service delivery, the hospital provides its staff with necessary tools for specific jobs performed. These include investing in information technology; personalizing information system to meet specific organizational needs and providing immediate feedback to patients by devising IT systems.

Organizational Leaders and Stakeholders

The Baptist Hospital has the following stakeholders whose interests are considered and who work together to achieve the mission and goals of the facility.

Patient and Local Community

The ultimate goal of the hospital is to serve and satisfy the needs of the patients and the community through provision of advanced and comprehensive health care services.

Hospital Staff

Hospital Staff includes employees and credentialed professional staff, which comprise of the physicians, health workers, dentists and management boards. They work together to ensure quality improvement and continuous service delivery.

Ministry of Health

Physician Leadership Resource (2013) indicates that the ministry performs funding functions of all public hospitals in the nation and also has the authority and legislative power on health facilities and health care systems. It is also involved in the government of the public hospitals through monitoring and evaluation of performances.

Academic Partners

Being a teaching hospital, Baptist Hospital is formerly affiliated with universities that offer medical and clinical programs. It provides a setting for training and research by undergraduate and postgraduate students undertaking medical and clinical courses.

Donors

These are the key stakeholders in funding the ongoing operations of the hospital, which include a donation for equipment and special projects. They are governed by an independent board of directors, which relates to the hospital through directors. The partnership acts in the best interest of the organization and ensures accountability and transparency.

Communication Channels

Communication among staff and with patients is a key aspect of quality service delivery and achieving patient satisfactions (Stolt, 2009). The hospital employs both bottom-up and top-down communication channels to meet health professional obligations, increase access to the treatment, improve quality care and proper reporting, monitoring and evaluation. However, communication challenges are inevitable and can easily lead to reduced quality, health disparities and adverse health outcomes. Both internal and external communication channels influence quality service provision as effective internal communication is a requisite for the organizations activities and quality integration. On the other hand, external communication channels provide better service delivery to the customers and partners.

Location of the Facility and Population Size

Baptist Hospital is located along the Hospital Road in Ruwe, the capital city of Ondiek, 4 kilometers from General Post Office. It faces International Conference Centre on the south side near Mbagathimu roundabout. To the north of the hospital compound, there is the Nairobi-Kisumu railway line. It has a bed capacity of 1,500 beds with a staff of 3,727. The average annual outpatient and inpatient attendance is 600,000 visits and 89,000 patients, respectively.

Demographics of the Areas Population

The hospital is located in Ruwe County, the capital city of the republic of Ondiek. It covers a geographical area of 694 square kilometers and has population of 3,138,369 inhabitants. The population density is 4,515 per square kilometer and poverty rate is 22%. 50% of population has attained primary education while 18% has secondary education. The country has improved infrastructure and 80% of the population have access to improved water and sanitation.

Internal and External Threats to the Integrity of the Organization

Poor Management of Health Institutions

The health system entails provision of complex services, which include proper funding and delivery of public health promotion and prevention programs. Furthermore, it provides direct services like immunization, treatment of injuries, control of outbreaks and emerging diseases, natal care and treatment for communicable and non-communicable diseases. The services are provided by a range of stakeholders, including hospitals, communities, donors, government and health workers. This complexity in the health system requires good management and organization, which is inadequate in most of the hospital facilities indicated by fragmentaion of the health services. The facilities need to be managed effectively through the establishment and implementation of sound policies. According to Muller et al., (2006) improved hospital management should be to minimize waste, enhance incentives, create and sustain a high-performing workforce.

Acute Shortage of Drugs in Hospitals

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Because of fewer funding sources, public hospitals face acute insufficiency in supplies of medicines and other essential supplies. This is contributed by hoarding of drugs by medical personnel who secretly supply them to their private pharmacies (Kenneth W., Muiruri B., & Ayodo E. 2012) Moreover, it leads to many patients unable to afford drugs from such pharmacies due to inflated prices, lowering health care access and quality in the public sector. As a teaching and referral hospital providing highly sophisticated services and serving a large number of client, it makes its operation costs. Funds from treasury are not sufficient to meet such needs thereby leading to stoppage of medicines and some supplies delivery.

Insufficient and Mismanagement of Funds and Resources

Effective management of health system is a challenge, where the facility lacks enough resources and funds. Circulation of money within the system through collection and distribution are critical factors for essential and quality service delivery (Palliative Care Services, 2012). Hence, ensuring financial management and protection is central to improving equity and access to health care. Kenneth et al. (2012) state that Public Hospitals often face bureaucratic and complex budgeting processes leading to the limited incentives thus inefficiency in service delivery. Information regarding the cost of care is deficient in most public hospitals leading to lack of financial accountability. Sufficient management of health resource remains a major challenge in the public sector thus calling for sustained external assistance.

Medical Technology

Technology in the health sector is dynamic and this constant changing affects the sector in many ways. Technological advancement is valuable in the medical sector because it has led diseases and health problems that were untreatable to become curable and manageable through health service intervention (Palliative Care Services, 2012). It lowers lifetime disability and increases life expectancy. However, technological change has accounted for the increase of the cost of medical care, making it unaffordable to the poor. The situation is worse in the Sub Saharan Africa nations, where public hospital faces financial constraint thus unable to acquire such technological changes.

Delayed Discharges

Delayed discharges in Baptist Hospital are mostly attributed by scheduling of tests and surgery; longer time to provide test results; consultation processes; poor discharge planning and higher demands of teaching and research. These situations are dynamic and vary between hospitals and time from short-stay patients to the longstay ones. Delayed discharges trickle down to longer waiting times by patients. It adversely affects public image of the organization and therefore the health facility should re-align its staffing arrangements.

Shortage of Health Workers

To ensure provision of quality health care services, the adequate number of health workers needs to be in line with the population size (Kenya Health Rights Advocacy Network, 2007). Lower numbers of health workers is not only a general public hospitals challenge but also the Baptist Hospital. This is in respect to the cadres such as pharmacists and doctors. The hospital handles a large number of patients with few doctors attributing to vacancy rates of 25%. It is imperative that recruitment of key health workers should be enhanced and issues of poor worker retention be addressed. Health staff shortage undermines quality service provision due to the overworking of the few staff available, longer waiting times by patients tarnishing the public image of the facility.

HIV/AIDS

HIV/AIDS advent has brought many challenges in both developing and developed countries in the health systems (World Health Organization, 2004). The HIV/AIDS epidemic has raised demands on existing limited facilities at Baptist Hospital. It contributes to the double burden by creating the need to provide adequate health care to both HIV infected patients and those suffering from other chronic ailments. The number of inpatients and outpatients has increased with people living with HIV/AIDS occupying 60% of bed capacities in the hospital. The high cost of maintenance of HIV patients has implicated the health budget significantly. This is due to the increased expenditure on drugs, reagents, treatment of opportunistic infections and sick staff. The few available health staff is further overwhelmed by the increase admission of AIDS patients contributing to heavy workloads. These and longer incubation periods of patients in the hospital adversely affect productivity of the workforce hence the low quality of service provision.

Strategic Management Plan

Provide Comprehensive Services across the Continuum of Care

The long-term strategic plan of Baptist Hospital is to develop infrastructures and institutions that will provide all health care services under one roof. This is achieved through scaling up the scope of clinical and health services performed currently. The hospital through the management board will ensure provision of services along the continuum of health right from the primary, secondary and tertiary care. It is achieved by providing and conducting of behavior change programs, curative services and rehabilitative measures to ensure patient satisfaction and their prolonged lifespan.

Through this intervention, HIV/AIDS patient care and management will be fully integrated in the system as the facility provides treatment for both communicable and non-communicable diseases. Health promotion and behavior change programs will reduce the burden of workload due to the reduced admission of HIV/AIDS and lifestyle diseases as a result of public empowerment.

Inter-Professional Teams

The delay discharge will be addressed in the short run by hiring interprofessionals to boost the continuity of the process of care. This ensures standardized care delivery as a result of employment of professionals from different disciplines and through advocacy of autonomy and equality among them. It ensures division of responsibilities and roles between all team members promoting smooth transition of patients from one care to the other. The appropriate tools are provided to create culture and climate for quality service delivery. To achieve rapport between teams and address barriers to the team collaboration, such as mistrust and conflicting views, diverse communication channels are employed. This is to ensure smooth transfer of information between professional boundaries through frequent staff meetings and use of modern information systems.

Intersectoral Integration and Governance Structure

The management board of Baptist Hospital will ensure collaborative actions by all relevant sectors being that health determinants range of social, economic and environmental influences and therefore interrelated. The management will therefore bring together efforts of other stakeholders, institutions and organizations in place to help the hospital achieve its vision. For example, partnerships and networks are formed with other government ministries like Ministry of education to facilitate behavior change among pupils and students, community and donors to facilitate funding. This strategy ensures full utilization of skills of stakeholders and resources of the country thus becoming a long-term cost-effective approach to the quality service provision.

The recognized interrelationship between different sectors ensures collective actions in the sector promoting equality and equity in access and utilization of health services (Esther S., Oelke N., Adair C., and Gail A., 2009). The wider support base promotes funding increasing the budgetary allocation in the hospital. This addresses the staff, medicine and general supply shortages as more will be hired and modern technology holistically incorporated in the health system. Community involvement ensures general public participation, which improves access and full utilization of health services, reducing cases of disease acquisition and transmission. Therefore employing intersectoral collaboration is essential in branding the hospital image by promoting quality management through competent staff, infrastructure and acquisition tools.

Performance Management

According to Esther et al., (2009) success in the health system is achieved through a well coordinated performance monitoring and evaluation systems. The system involves the development of input, process and output indicators, which act as benchmarks for counterchecking and showing the measure of achievements at different levels. This is an ongoing process and will be applied in the hospital through constant reporting to give information for service improvement. The performance management system puts the health facility on par with its development goals and objectives by promptly identifying gaps and addressing them before they are out of hand. The solutions include redesigning processes and procedures, and reinforcing achievements leading to cost-effective high-quality health care. It is therefore applicable in the monitoring of clients satisfaction levels, identifying their needs and concerns calling for informed decision making in the management of the facility.

Patient Focus

The aim of the Baptist Hospital is to meet the clients needs rather than the providers placing the patients at the center of management and planning strategies. It calls for continuous community-based needs assessment to identify, inform, plan and implement policies that address their needs to improve their satisfaction and outcome. Every health worker should understand the culture of clients and setting of the facilities in order to identify health gaps within the population. Patient participation in different levels of development strategies ensures the solutions and policies developed are relevant to the population. It also helps the hospital to deal with emerging diseases and epidemics like HIV/AIDS by focusing on the infected and affected patients solving their problems. Doing so improves the quality of health services provided positively building the hospital image due to the rendering of satisfactory care services.

In summary, Baptist Hospital, a teaching and referral hospital owned by the state, was founded to deliver advanced and comprehensive health services. It is highly specialized to provide sophisticated health services that are unavailable in the lower level facilities. A bed capacity of the hospital is 1,500 beds. Through its board of management it provides a good climate and culture for quality management and service delivery. However, it faces various integrity and developmental challenges like shortage of medicines and staff, insufficient funding, skyrocketing of HIV/AIDS cases and delayed discharges. Addressing these challenges requires strategic management plan development, such as provision of all levels of care services, intersectoral and inter-professional integration, performance management and patient focus. These thereby contribute to high quality service delivery.

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