The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study
| dc.contributor.author | Barasa, Edwine W | |
| dc.contributor.author | Cleary, Susan | |
| dc.contributor.author | English, Mike | |
| dc.contributor.author | Molyneux, Sassy | |
| dc.date.accessioned | 2016-10-27T11:56:35Z | |
| dc.date.available | 2016-10-27T11:56:35Z | |
| dc.date.issued | 2016-09-30 | |
| dc.date.updated | 2016-09-30T18:07:54Z | |
| dc.description.abstract | Background: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. Methods: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long’s actor interface analysis and VeneKlasen and Miller’s expressions of power framework to examine and interpret our findings Results: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Conclusions: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes | en_ZA |
| dc.identifier.apacitation | Barasa, E. W., Cleary, S., English, M., & Molyneux, S. (2016). The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/22325 | en_ZA |
| dc.identifier.chicagocitation | Barasa, Edwine W, Susan Cleary, Mike English, and Sassy Molyneux "The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study." <i>BMC Health Services Research</i> (2016) http://hdl.handle.net/11427/22325 | en_ZA |
| dc.identifier.citation | Barasa, E. W., Cleary, S., English, M., & Molyneux, S. (2016). The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study. BMC Health Services Research, 16(1), 536. | en_ZA |
| dc.identifier.issn | 1472-6963 | en_ZA |
| dc.identifier.ris | TY - Journal Article AU - Barasa, Edwine W AU - Cleary, Susan AU - English, Mike AU - Molyneux, Sassy AB - Background: Priority setting and resource allocation in healthcare organizations often involves the balancing of competing interests and values in the context of hierarchical and politically complex settings with multiple interacting actor relationships. Despite this, few studies have examined the influence of actor and power dynamics on priority setting practices in healthcare organizations. This paper examines the influence of power relations among different actors on the implementation of priority setting and resource allocation processes in public hospitals in Kenya. Methods: We used a qualitative case study approach to examine priority setting and resource allocation practices in two public hospitals in coastal Kenya. We collected data by a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations in case study hospitals over a period of 7 months. We applied a combination of two frameworks, Norman Long’s actor interface analysis and VeneKlasen and Miller’s expressions of power framework to examine and interpret our findings Results: The interactions of actors in the case study hospitals resulted in socially constructed interfaces between: 1) senior managers and middle level managers 2) non-clinical managers and clinicians, and 3) hospital managers and the community. Power imbalances resulted in the exclusion of middle level managers (in one of the hospitals) and clinicians and the community (in both hospitals) from decision making processes. This resulted in, amongst others, perceptions of unfairness, and reduced motivation in hospital staff. It also puts to question the legitimacy of priority setting processes in these hospitals. Conclusions: Designing hospital decision making structures to strengthen participation and inclusion of relevant stakeholders could improve priority setting practices. This should however, be accompanied by measures to empower stakeholders to contribute to decision making. Strengthening soft leadership skills of hospital managers could also contribute to managing the power dynamics among actors in hospital priority setting processes DA - 2016-09-30 DB - OpenUCT DO - 10.1186/s12913-016-1796-5 DP - University of Cape Town J1 - BMC Health Services Research KW - Priority setting KW - Power practices KW - Actor interfaces KW - Hospitals KW - Kenya LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 SM - 1472-6963 T1 - The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study TI - The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study UR - http://hdl.handle.net/11427/22325 ER - | en_ZA |
| dc.identifier.uri | http://dx.doi.org/10.1186/s12913-016-1796-5 | |
| dc.identifier.uri | http://hdl.handle.net/11427/22325 | |
| dc.identifier.vancouvercitation | Barasa EW, Cleary S, English M, Molyneux S. The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study. BMC Health Services Research. 2016; http://hdl.handle.net/11427/22325. | en_ZA |
| dc.language | eng | en_ZA |
| dc.language.rfc3066 | en | |
| dc.publisher | BioMed Central | en_ZA |
| dc.publisher.department | Health Economics Unit | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights | Creative Commons Attribution 4.0 International (CC BY 4.0) | * |
| dc.rights.holder | The Author(s). | |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_ZA |
| dc.source | BMC Health Services Research | en_ZA |
| dc.source.uri | http://bmchealthservres.biomedcentral.com/ | |
| dc.subject | Priority setting | |
| dc.subject | Power practices | |
| dc.subject | Actor interfaces | |
| dc.subject | Hospitals | |
| dc.subject | Kenya | |
| dc.subject.other | Priority setting | |
| dc.subject.other | Power practices | |
| dc.subject.other | Actor interfaces | |
| dc.subject.other | Hospitals | |
| dc.subject.other | Kenya | |
| dc.title | The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study | en_ZA |
| dc.type | Journal Article | en_ZA |
| uct.type.filetype | ||
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |