Value-Based Healthcare Strategies, Situational Leadership Styles and Performance of County Referral Hospitals in the Lake Region Economic Bloc, Kenya

Abstract

Population health is a core contributor to economic growth of countries, hence the need for countries to develop healthcare systems that yield better healthcare outcomes at affordable costs. The adoption of the value-based healthcare strategies in hospital management is meant to achieve high health outcomes at low costs. The resultant effects are increasing value to the patients as well as attaining universal health coverage. The general objective of the study was to determine the influence of value-based healthcare strategies on county referral hospital performance, with a focus on situational leadership style. Specific objectives were to: determine the influence of integrated practice units on county referral hospital performance, establish the influence of cost per patient measurement on county referral hospital performance, assess the influence of bundled payments for care cycles on county referral hospital performance, determine the influence of integrated information technology on county referral hospital performance and establish the moderating effect of situational leadership styles on the relationship between value-based healthcare strategies and county referral hospital performance. The following theories served as the foundation for the study: value-based theory, resource-based view and upper echelons theory. The research philosophy of positivism served as the foundation for this study. The study adopted a descriptive research design. The study area was the Lake Region Economic Bloc (LREB) counties in Kenya. The study population was 1400 employees of fourteen (14) county referral hospitals in the Lake Region Economic Bloc. The study adopted the stratified random sampling method, in which the management employees were stratified, then the respondents were selected randomly within each stratum. The strata consisted of; hospital management board, departmental (top level) management and sub-departmental (middle level) management. The study sample size was four hundred and fourty five (445) respondents determined using Yamane formula yielding three hundred and twelve (312) respondents plus a 30% (133) increase to cater for non-response. Self-constructed questionnaires that were dropped and picked after two weeks were used to gather primary data. To confirm the content validity, the content validity index (CVI) was computed for every item. The reliability of the data was evaluated using the Cronbach alpha coefficient test, and a score of 0.748 suggested that the questionnaire was reliable. The data was analyzed using descriptive statistics like mean, standard deviation, variance, frequency distribution, and percentages. The study employed simple, multivariate, and hierarchical regression for inferential statistics in order to identify causal relationships. Pearson correlation was used to assess how strongly the independent and dependent variables were related. Tables, graphs, pie charts, frequencies, and percentages were used to display the data. The findings indicated that there was a significant positive relationship between value-based healthcare strategies and the hospitals performance, where value-based healthcare strategies alone are able to explain 49.4% of the variance in the hospital’s performance. Equally, a very strong relationship between value-based healthcare strategies, situational leadership styles and county referral hospitals performance was established, explaining 56.3% of the changes in the hospital’s performance. Hence, situational leadership styles contributed of 6.9% (56.3-49.4) to hospital performance. The study resolved conflicts in theory, policy, and practice, bolstering the argument that county referral hospitals should institutionalise value-based healthcare strategies moderated by situational leadership styles, guaranteeing high-quality healthcare services at affordable costs.