Institute of Healthcare Management, Strathmore University Business School, Strathmore University, Nairobi, Kenya.
BMC Health Serv Res. 2020 Feb 26;20(1):144. doi: 10.1186/s12913-020-4949-5.
Kenya's new constitution passed in 2010 recognizes the right of quality care resulting in the devolution of health service delivery to the sub-national units called counties in 2013. However, the health system performance continues to be poor. The main identified challenge is poor health systems leadership. Evidence shows that addressing health system leadership challenges using different leadership intervention models has the potential to improve health outcomes. The purpose of this study is to report findings on the effect of project-based experiential learning on the health service delivery indicators addressed by 15 health management teams from 13 counties in Kenya, as compared to the non-trained managers.
A quasi-experimental design without a random sample was used to evaluate the effectiveness of the leadership program. The health managers from the 13 Counties and 15 health facilities had previously undergone a 9-month leadership training, complimented with facility-based team coaching based on 15 priority institutional service improvement projects at the Strathmore University Business School. Pre-test and post-test data were collected in three-point periods (beginning, end of the training, and 24-to-60 months post-training). The control group comprised 14 other health institutions within the same counties.
Leadership training and coaching built around priority institutional health service improvement projects in the intervention institutions showed: a) skilled birth attendance increased, on average, by 71%; b) full immunization of children, increased by 52%; c) utilization of in and out-patient services, which on average, increased by 90%; d) out-patient turn-around time reduced on average by 65% and; e) quality and customer satisfaction increased by 38.8% (in all the intervention facilities). These improvements were sustained for 60 months after the leadership training. In contrast, there were minimal improvements in service delivery indicators in the comparison institution over the same period of time. Ninety-three percent of the respondents attributed team-coaching built around priority institutional health service improvement projects as a key enabler to their success.
The study provides support that an intervention underpinned by challenge driven learning and team coaching can improve a range of health service delivery outcome variables.
2010 年，肯尼亚新宪法通过，承认享有优质护理的权利，由此导致卫生服务提供于 2013 年下放到邦县。然而，肯尼亚的卫生系统绩效仍较差。主要的挑战是卫生系统领导力不足。有证据表明，采用不同的领导力干预模式解决卫生系统领导力挑战，有可能改善卫生结果。本研究旨在报告以经验为基础的项目学习对 13 个邦县的 15 个卫生管理团队所负责的卫生服务提供指标的影响，这些团队接受了培训，而对照组的管理人员未接受培训。
本研究采用准实验设计（无随机样本），评估领导力项目的效果。来自 13 个邦县的 15 个卫生机构的卫生管理人员参加了为期 9 个月的领导力培训，该培训辅以基于斯特雷瑟姆大学商学院的 15 个重点机构服务改进项目的机构内团队辅导。在三个时间段（开始、培训结束时和培训后 24-60 个月）收集预测试和后测试数据。对照组由同一邦县的其他 14 个卫生机构组成。
以重点机构卫生服务改进项目为基础的领导力培训和辅导在干预机构中显示出：a）熟练接生率平均提高了 71%；b）儿童完全免疫率提高了 52%；c）门诊和住院服务利用率平均提高了 90%；d）门诊周转时间平均减少了 65%；e）质量和客户满意度提高了 38.8%（所有干预机构）。这些改进在领导力培训后持续了 60 个月。相比之下，在同一时期，对照组的服务提供指标仅有微小改善。93%的受访者将以重点机构卫生服务改进项目为基础的团队辅导归因于他们取得成功的关键因素。
本研究支持了一种干预措施，即基于挑战驱动的学习和团队辅导可以改善一系列卫生服务提供结果变量。
