Strategic Management Practices and Organizational Performance of Level Four Hospitals in Migori County, Kenya
Abstract
Public hospitals operate under pressure to provide safe, accessible and responsive healthcare while managing constrained budgets, staffing needs, supplies and rising patient expectations. Strategic management practices are increasingly recognized as vital mechanisms for enhancing quality of patient care, patient satisfaction and efficient service delivery. This study examined the relationship between strategic formulation, implementation, monitoring and evaluation, and resource allocation and organizational performance, while also assessing the moderating role of government health policies. The study was guided by the Resource-Based View, Goal-Setting Theory and General Systems Theory. A correlational research design was adopted. The target population comprised 388 personnel from public Level Four hospitals: eight hospital administrators, 80 departmental heads and 300 nursing/medical staff. Using Yamane’s formula, a size of 252 participants was derived, comprising all eight administrators, 67 departmental heads and 177 nurses/medical staff, yielding 202 valid responses. Structured questionnaires were used, and the data were coded and analysed using descriptive statistics, Pearson correlation, multiple linear regression and moderation analysis. The instrument demonstrated overall internal consistency of Cronbach’s alpha = 0.869. A total of 202 respondents contributed data to the reported analysis. Respondents rated strategic formulation positively (M = 4.19, SD = 0.70), implementation (M = 4.08, SD = 0.76), monitoring and evaluation (M = 4.24, SD = 0.67), resource allocation (M = 4.00, SD = 0.76), government health policies (M = 4.12, SD = 0.77), and organizational performance (M = 4.06, SD = 0.73). In the reported regression discussion, implementation had the largest standardized coefficient (β = 0.248, p < 0.001), followed by formulation (β = 0.215, p < 0.001), resource allocation (β = 0.192, p < 0.001) and monitoring and evaluation (β = 0.185, p < 0.001). Government health policies were reported to moderate the relationship (β = 0.142, p < 0.001; change in R² = 0.075). The findings revealed that strategy formulation, implementation, monitoring and evaluation, and resource allocation each exerted a positive, statistically significant direct effect on hospital performance. Furthermore, government health policies significantly moderated this relationship, accounting for an additional variance in institutional performance. This study concludes that holistic strategic execution paired with supportive policy frameworks is essential for optimizing healthcare delivery in devolved units.
Keywords: strategic management practices, organizational performance, strategic formulation, strategic implementation, strategic monitoring and evaluation, resource allocation, government health policies; Migori County
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