According to a study conducted by Wanjau Muiruri and Ayodo in 2012

According to a study conducted by Wanjau, Muiruri and Ayodo in 2012 on the factors which affect provision of service quality in the public health sector Kenyatta National Hospital, they identified general low employee’s capacitating, low adoption of technology, poor communication channels and inadequate fund as the main factors that affect delivery of quality health services to patients attending public health facilities and thus having an impact on perception of health service quality, satisfaction and loyalty of patients.Like in most developed countries, managing public health in USA is characterized by emphasis on performance and improving quality of healthcare. In order to attain these critical indicators, public health management is fully equipped with the necessary resources and management skills (Nembhard, Alexander, Hoff & Ramanujam 2009). The hospitals personnel are more equipped with the management skills that enable them to efficiently manage resources and provide evidentiary basis for determining patient, clinician, and organizational outcomes (Nembhard et al., 2009). In other words, the health professionals are well capacitated to enable them improve the patient services health outcomes.• Management Style on Service Delivery Management of Health care system has previously been to some extent inefficient, incoherent and mostly driven by supply, thereby keeping patients on the outside of the design, development and also delivery process (Berenson and Cassel, 2009). With history, health care organizations, mainly public viewed customer service as an independent, non-critical function which was best left to professional judgment of physicians where necessary. But today there is a shift to a model which is organizational in which the patients have influence on every function (Glickman,Baggett, Krubert, Peterson &Schulman 2007). Organizations operating in Public Health, which continuously take up the challenge of huge restructuring have encountered and are still experiencing difficulties in full and proper implementation of these services (Glickman et al., 2007).Effective management is cited as a vital enabler of quality from the providers’ perspective, managers, policy-makers and equally the payers. Management affects everything within the hospital environment (Mosadeghrad, 2014). Good ideas remain useless if people have them for quality improvement, where the management is not good. Most studies have cited lack of professional managers in public healthcare organizations. Most managers are not qualified professional managers, rather are hospital physicians, nurses, doctors or are healthcare professionals (Mosadeghrad, 2014). In fact, in most Public Hospitals, the managers have no experience and knowledge in management. According to Buong’, Adhiambo, Kaseje, Mumbo, Odera and Ayugi, in their study done in 2013 the authors determined that majority of public health managers were trying to resolve problems as short term measures. Besides, there were no criteria and objectives which were in place used to appoint and select managers in healthcare facilities. National policies were considered prescriptive and did not allow for sufficient flexibility which was needed to adapt to local circumstances. Mostly, public healthcare managers were demanding more power in order to identify and recruiting the most appropriate personnel needed to provide quality services to patients (Buong’ et al, 2014).• Patient CooperationPatient involvement and cooperation is needed and affects the quality of medical services. “If doctors do their job well, but the patient does not follow medical orders, the objectives would not be achieved.” Clinical outcomes depend on the ability of patients to provide information and cooperate with clinicians.• Physician Motivation and SatisfactionPhysicians’ job satisfaction is very important in delivering high quality medical services to patients. Medical doctors identified nine organizational factors that they believed influence their motivation and consequently their job satisfaction. These were pay, working environment, managerial leadership, organizational policies, co-workers, recognition, job security, job identity, and chances for promotion.• Resources and facilitiesAvailability of resources affects the quality of medical services. The demand for medical services is beyond the capacity of healthcare organizations: “Healthcare resources are limited but people expectations are very high”. Participants provided concrete examples of low quality medical services because of resource shortage: Insufficient infrastructures, resources, and equipment inhibit delivery of quality medical services. For instance, a good patient information system is necessary for effective patient diagnosis and treatment.• Collaboration and Partnership DevelopmentIt is important for practitioners to have good support services. A nurse should administer medicines on time and should not administer wrong medicines to patients; nurses should be more responsible and should be reserved for sets there. Practitioners should show ability to effectively communicate with other health professionals or institutions to consider to the delivery of high quality medical services for example, the hospital does not have a CT- Scan. The patient relative has to get an appointment from other hospital and then take the patient there for CT-Scan. All these can be sorted out easily through collaboration between two hospitals.• Financial ResourcesThe fixed budget is widely used in hospitals, often based on historical spending levels, with a (frequently inadequate) provision for price changes (Peters, Elmendorf, Kandolaand Chellaraj, 2000). Such a system clearly can secure good expenditure control and is administratively undemanding (Smee, 2002). However, it can often perpetuate historical inequities and fail to respond to new demands and priorities (Peters et al, 2000). Moreover, fixed budgets offer few incentives to maximize the effectiveness, quality, or quantity of care offered by hospitals (Smee, 2002). Indeed, many budget systems continue to finance hospitals through line-item budgets directly from the ministry of health. Such mechanisms allow central bureaucracies to exert the maximum level of control over peripheral spending with little or no capacity at peripheral levels for flexible use of funds in response to local needs (Arhin-Tenkorang, 2000). Thus, centralized budget systems can contribute to technical inefficiency by preventing local managers from optimizing the deployment of inputs thereby perpetuating poor quality of service (Peters et al, 2000).Financial management, in service organizations, has been a constraint and an obstacle to other functions that contribute to service delivery (Adams and Colebourne, 1989). They suggest an ‘enlightened’ approach to finance in service organizations. This consists of more participative and positive approach where far from being an obstacle, it contributes to strategic planning, costing systems, personnel motivation, quality control, continued solvency, and keeping outsiders’ confidence in management (Arhin-Tenkorang, 2000). In particular, there is a need to distinguish ‘good costs’ that improves organizational capabilities and quality service delivery from ‘bad costs’ that increase bureaucracy hence becoming obstacles to service delivery (Sun and Shibo, 2005). Allocated resources for health flow through various layers of national and local government’s institutions on their way to the health facilities (Blas and Limbambala, 2001). Financial accountability using monitoring, auditing and accounting mechanisms defined by the country legal and institutional framework is a prerequisite to ensure that allocated funds are used for the intended purposes (Oliveira- Cruz, Hanson, and Mills. 2001). In many developing countries, governments do not have the financial and technical capacity to effectively exercise such oversight and control functions, track and report on allocation, disbursement and use of financial resources (Smee, 2002).

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