STRATEGIC MANAGEMENT PRACTICES AND SERVICE DELIVERY IN KENYA’S LEVEL FIVE PUBLIC HOSPITALS: DOES THE INTERNAL ENVIRONMENT MODERATE THE RELATIONSHIP?
Abstract
Background: Kenya’s Level Five public hospitals face critical service delivery challenges due to resource constraints and operational inefficiencies. Grounded in the Resource-Based View, Open Systems Theory, Institutional Theory, Strategic Control Theory, and WHO’s IPCHS framework, this study evaluated the impact of strategic management practices on service delivery and assessed the moderating role of the internal environment.
Methods: An explanatory sequential mixed-methods cross-sectional design was employed across all 16 gazetted Level Five hospitals. Quantitative data were gathered from 110 departmental heads (96.5% response rate) alongside qualitative key informant interviews with 64 senior hospital managers.
Results: Correlation analysis indicated significant positive relationships between the internal environment and service delivery, strategy formulation, implementation and evaluation. Hierarchical regression confirmed a direct positive contribution of the internal environment to service delivery. However, moderated multiple regression revealed that the internal environment does not significantly moderate the relationship between strategic management practices and service delivery.
Conclusion: Strategic management practices directly drive service delivery performance independently of internal environmental variations. Strengthening strategy formulation, execution, and evaluation remains essential, while targeted investments in leadership, governance, and HR capacity should be pursued as complementary drivers of performance.
Keywords: Strategic Management Practices, Service Delivery, Internal Environment, Level Five Public Hospitals, Kenya
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