The influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study

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dc.contributor.authorBarasa, Edwine W
dc.contributor.authorCleary, Susan
dc.contributor.authorEnglish, Mike
dc.contributor.authorMolyneux, Sassy
dc.date.accessioned2021-10-08T06:20:24Z
dc.date.available2021-10-08T06:20:24Z
dc.date.issued2016
dc.description.abstractAbstract 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.
dc.identifier.apacitationBarasa, 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>, 16(1), 174 - 177. http://hdl.handle.net/11427/34269en_ZA
dc.identifier.chicagocitationBarasa, 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> 16, 1. (2016): 174 - 177. http://hdl.handle.net/11427/34269en_ZA
dc.identifier.citationBarasa, 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> 16(1):174 - 177. http://hdl.handle.net/11427/34269en_ZA
dc.identifier.issn1472-6963
dc.identifier.ris TY - Journal Article AU - Barasa, Edwine W AU - Cleary, Susan AU - English, Mike AU - Molyneux, Sassy AB - 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. DA - 2016 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Health Services Research LK - https://open.uct.ac.za 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/11427/34269 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34269
dc.identifier.vancouvercitationBarasa 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;16(1):174 - 177. http://hdl.handle.net/11427/34269.en_ZA
dc.language.isoeng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceBMC Health Services Research
dc.source.journalissue1
dc.source.journalvolume16
dc.source.pagination174 - 177
dc.source.urihttps://dx.doi.org/10.1186/s12913-016-1796-5
dc.subject.otherActor interfaces
dc.subject.otherHospitals
dc.subject.otherKenya
dc.subject.otherPower practices
dc.subject.otherPriority setting
dc.subject.otherAdministrative Personnel
dc.subject.otherBudgets
dc.subject.otherDecision Making, Organizational
dc.subject.otherFemale
dc.subject.otherHealth Priorities
dc.subject.otherHospitals, Public
dc.subject.otherHumans
dc.subject.otherInterinstitutional Relations
dc.subject.otherInterprofessional Relations
dc.subject.otherKenya
dc.subject.otherLeadership
dc.subject.otherMale
dc.subject.otherPractice Management
dc.subject.otherQualitative Research
dc.subject.otherResource Allocation
dc.titleThe influence of power and actor relations on priority setting and resource allocation practices at the hospital level in Kenya: a case study
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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