Exploring The Perceptions of Loyal External Stakeholders During Crises: A Case Study of Kenyatta National Hospital (KNH) Nairobi, Kenya

Abstract

This study examined how loyal patients of Kenyatta National Hospital (KNH) perceive their loyalty to the institution despite the recurring crises that have challenged its reputation. Anchored in Attribution Theory, the research explored how patients cognitively assign causes to both positive and negative experiences within the hospital, and how these attributions shape perception, loyalty, and advocacy. Specifically, the study pursued three objectives: to investigate how patients who are loyal to patronizing Kenyatta National Hospital perceive its services given the series of crises experienced by the hospital in the past; to explore the continual loyalty of patients to KNH in the face of its series of crises in the past; to find out if patients who still patronize KNH’s services would recommend other people to patronize the hospital. Semi-structured interviews were used to collect data from KNH’s outpatients who have visited the hospital for the past seven years, and the qualitative responses were thematically analyzed to reveal deeper insights into patients’ experiences, perceptions, and emotional reasoning behind loyalty. The findings revealed that loyal patients exhibit a strong attributional bias that protects their positive view of KNH. They attributed the hospital's successes (effective diagnosis, expert medical care, and clinical professionalism) to internal, stable, and controllable factors while externalizing crises to broader systemic issues (government underfunding, staff shortages, and limitations of Kenya’s national healthcare system). This separation allows patients to maintain confidence in KNH’s core competencies despite ongoing operational challenges. The study further established that loyalty to KNH is conditional and pragmatic, rather than absolute. Many patients remained committed due to trusted relationships with specific doctors, affordable services, or the lack of viable alternatives. KNH’s enduring “willingness to treat” everyone, regardless of social or financial status, emerged as a critical pillar sustaining this loyalty. However, this loyalty remains fragile - highly dependent on personal experiences and economic capacity. In exploring patients’ willingness to recommend KNH, the study discovered that advocacy is a pragmatic endorsement grounded in lived experience and perceived clinical value rather than a denial of institutional shortcomings. Patients recommended KNH for its specialist expertise, life-saving interventions, and accessibility, often separating these strengths from the external systemic failures surrounding public healthcare. Based on these findings, the study recommended that KNH management adopt a strategic crisis communication model informed by Attribution Theory - one that reinforces the hospital’s internal strengths while transparently addressing external challenges. Further, KNH should institutionalize compassionate communication, celebrate its clinical achievements, and systematically collect patient testimonials to strengthen stakeholder trust. Ultimately, the study concluded that for a national referral hospital like KNH, sustaining loyalty and legitimacy depends less on image management and more on consistently delivering equitable, competent care that communicates credibility through action rather than words.