Strategic Management Dimensions, Firm-Level Characteristics and Healthcare Service Delivery in National Government Referral Hospitals in Kenya

Abstract

In recent years, strategic management dimensions were increasingly adopted to strengthen healthcare systems and support reforms aimed at improving healthcare service delivery (HSD), which is vital to population well-being. Although the implementation of these strategies had contributed to enhancements in HSD, performance challenges persisted in Kenya, even within established social health mechanisms. This study examined the effects of strategic planning, strategic alignment, Total Quality Management (TQM), and corporate governance on HSD in Kenya’s National Government Referral Hospitals. It also investigated the moderating effect of firm-level characteristics on the relationship between strategic management dimensions and HSD. The study was underpinned by stakeholder theory, with additional support from the resource-based view, contingency theory, and strategic fit theory. A positivist philosophy and descriptive and explanatory research designs were adopted to guide data collection, analysis, and interpretation. The target population included management staff and patients from national referral hospitals, with a sample of 199 hospital management respondents and 100 patients selected through stratified random sampling. Data were collected using structured questionnaires and secondary data sheets. Validity and reliability of instruments were ensured through expert review and Cronbach’s Alpha. Ethical standards were strictly observed. Data analysis involved descriptive statistics, factor analysis, and regression analysis. Diagnostic tests for multicollinearity, normality, and heteroscedasticity were performed. Findings showed that all four strategic management dimensions had a significant positive effect on healthcare service delivery (HSD): strategic planning (β = 0.971, p = 0.000), strategic alignment (β = 0.694, p = 0.000), TQM (β = 0.782, p = 0.000), and corporate governance (β = 0.894, p = 0.000). Firm-level characteristics significantly moderated these relationships (β = 0.156, p = 0.011), highlighting their critical role in shaping service outcomes.The study recommends standardized, adaptable strategic planning aligned with national health goals and mandatory enforcement of TQM across referral hospitals. Corporate governance should be strengthened with inclusive, accountable leadership, supported by adequate resources. Hospitals must develop actionable plans, engage all staff in quality management, and foster positive organizational cultures focused on patient care. Leadership development is essential. Future strategic management theories should integrate these dimensions and recognize leadership and culture as key moderators in healthcare service delivery effectiveness.