KENYATTA NATIONAL HOSPITAL STRATEGIC PLAN 2013-2018 · The Strategic Plan 2013-2018 was developed...
Transcript of KENYATTA NATIONAL HOSPITAL STRATEGIC PLAN 2013-2018 · The Strategic Plan 2013-2018 was developed...
KENYATTA NATIONAL HOSPITAL
STRATEGIC PLAN 2013-2018
K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
VisionA world class patient-centred specialized care hospital
MissionTo optimize patient experience through innovative, evidence based specialized
healthcare; facilitate training and research; and participate in national health policy formulation
Core ValuesCustomer Focus
Professionalism & Integrity
Equity and Equality
Teamwork and Team Spirit
Safety
MottoWe Listen, We Care
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FOREWORDThe importance of strategic planning cannot be overemphasized. The environment within which Kenyatta National Hospital (KNH) operates is always changing and continues to offer new opportunities and challenges. Acknowledging that Strategic plans are dynamic, the Board of Management undertook to have a mid-term review of the 2013-2018 Strategic Plan to align the Hospital’s operations with the ever changing environment. This reviewed Strategic Plan recognises the need to improve performance in all departments of the Hospital to achieve the desired outcomes. It re-aligns itself with the Health Sector Strategic Plan, the Government’s Manifesto, the Vision 2030 and the Sustainable Development Goals (SDGs) to the financial and human resource management in the delivery of services.
The reviewed Plan aims to deliver in the next two years, sustained outcomes that are desired by the Hospital Stakeholders by improving and combining plans, budgets, human and other resources. This has been lacking in the last three years. It is a roadmap ensuring that short term results are aligned with the long – term Hospital’s goals. To do this, the Hospital continues to embrace and deepen the use of the Balanced Scorecard that will provide periodic assessment of how the Hospital is progressing towards achieving its strategic goals and ultimately its vision. The review has redefined the measures and initiatives taking cognisant of the current situation in the Hospital.
The Board, Management and Staff of the Hospital recognize that the ultimate measure of success is the stakeholder and customer satisfaction rather than profit. To achieve the highest standards of customer and stakeholder satisfaction, employees are treated as partners in the Hospital, and their interests are respected and they have a say on matters that concern them and that their opinions are sought and listened to. Finally, communication and involvement will be emphasised to create a climate of mutually defined expectations and sharing of information on the Hospital’s Vision, values and objectives. In view of the dynamism required for strategy execution, the Board will continue to realign the organizational structure to enable the Hospital achieve the identified strategic objectives effectively.
I wish to emphasize that the Board is committed to the implementation of this Plan in partnership with the Government Ministries, Agencies and other stakeholders in order to realize our Vision “To be a world class patient-centred specialized care Hospital.”
Mr. Mark Bor Chairperson Board of Management
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PREFACEThe reviewed Kenyatta National Hospital’s Strategic Plan 2013- 2018 charts out the direction that the Hospital will take to deliver on her mandate and realise its Vision in the next two years. The Hospital’s mandate as stipulated in the Legal Notice No. 109 of 6th April 1987 is to provide specialized healthcare, facilitate training, research and participate in national health planning.
In reviewing this Strategic Plan, the Hospital adopted an extensive participatory approach. The process entailed consultations and interviews with staff, management, the Board of Directors and external stakeholders. The methodology included administering of questionnaires to all staff, literature review, focussed group discussions, pre and post workshop reviews, strategic planning and validation workshops and stakeholder consultations.
The Hospital re-validated the assessment earlier conducted, the emerging health care facilities taking into account the changed health sector environment after the devolved health functions to the counties and the sustainable Development goals among others. The hospital then re-validated its mission, vision and core values to realign them with the changing environment. These then informed the development of the strategic themes, objectives, measures and initiatives that the hospital will pursue in the next two years.
The review also adapted the Balanced Scorecard approach which is an integrated strategic planning and management system that blends change management and communication that will bring high levels of stakeholder and employee buy-in and a shared vision for the future. Three strategic themes were identified and objectives set under each. Annual targets have also been set and indicative budgets proposed for the activities to be implemented in the entire Plan period. The entire Hospital fraternity adopted “Committed to Care (C2C)” as the Hospital’s one page Balanced Scorecard that will used to communicate to both internal and external stakeholders on the Hospital’s Strategic direction. Collaborations and partnerships with the Ministry of Health, Development Partners and relevant stakeholders will be essential in the realization of this Plan.
I wish to express my deep gratitude and appreciation to staff, the management and the Strategic Plan review steering team. The review has been undertaken solely by the Hospital’s fraternity and this will create more ownership of the processes, initiatives and strategic results. The employees are expected to own the Strategic Plan which in turn will empower them to deliver on the expected results to the benefit of all stakeholders. It is my hope that we will make KNH a world class patient-centred specialized care Hospital.
Lily Koros TareChief Executive Officer
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TABLE OF CONTENTS
FOREWORD ........................................................................................................ iii
PREFACE .............................................................................................................. iv
LIST OF TABLES ................................................................................................ vii
LIST OF FIGURES .............................................................................................viii
EXECUTIVE SUMMARY ................................................................................... ix
LIST OF ACRONYMS AND ABBREVIATIONS ................................................ x
1.1 Background .................................................................................................. 1
1.2 Vision 2030 .................................................................................................. 1
1.3 Rationale for review of the Strategic Plan .................................................. 2
1.4 Process of Reviewing the Plan .................................................................... 2
CHAPTER TWO: SITUATIONAL ANALYSIS ................................................... 3
2.1 Evaluation of Past Performance.................................................................. 3
2.2 SWOT Analysis ............................................................................................ 3
2.3 PESTLE Analysis ......................................................................................... 6
2.4 Stakeholder Analysis ................................................................................... 9
CHAPTER THREE: STRATEGIC FOCUS ....................................................... 12
3.1 Mandate ..................................................................................................... 12
3.2 Vision, Mission, Core Values and Motto ................................................. 12
3.3 Strategy Canvas ......................................................................................... 13
3.4 Customer Value Proposition (CVP) ......................................................... 13
3.5 Strategic Themes and Results ....................................................................14
3.6 Strategic Objectives ....................................................................................14
3.7 Strategy House ........................................................................................... 15
3.8 Corporate Strategy Map .............................................................................16
3.9 Corporate Balanced Scorecard ..................................................................17
CHAPTER FOUR: RESOURCE FLOWS FOR THE STRATEGIC PLAN ........21
4.1 Basic Assumptions ......................................................................................21
4.2 Financial Assumptions ...............................................................................21
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4.3 Internal Capacity Assumptions ................................................................ 22
CHAPTER FIVE: INSTITUTIONAL FRAMEWORK ..................................... 23
5.1 Organisation Structure ............................................................................. 24
CHAPTER SIX: RISKS AND RISK MANAGEMENT ..................................... 25
6.1 Risk Analysis ............................................................................................. 25
CHAPTER SEVEN: MONITORING & EVALUATION ................................... 30
7.1 Introduction ............................................................................................... 30
7.2 Monitoring & Evaluation Framework ...................................................... 30
7.3 Cascading the Plan .................................................................................... 32
7.4 Monitoring and Evaluation Process ......................................................... 34
7.5 Performance Review and Evaluation ....................................................... 35
7.6 Monitoring and Evaluation Unit .............................................................. 35
ANNEXES ........................................................................................................... 36
Annex I: Implementation Matrix and Budget ................................................... 36
Annex II: Committed to Care (C“2”C) ............................................................. 41
Annex III: Objective Commentary .................................................................... 42
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LIST OF TABLESTable 1: Strengths .................................................................................................. 3
Table 2 : Weaknesses ............................................................................................. 3
Table 3: Opportunities .......................................................................................... 4
Table 4 : Threats .................................................................................................... 5
Table 5: Political Factors ....................................................................................... 6
Table 6 : Environmental Factors .......................................................................... 6
Table 7: Social Factors ........................................................................................... 7
Table 8: Technological Factors ............................................................................. 7
Table 9: Legal Factors ........................................................................................... 8
Table 10 : Economic Factors ................................................................................. 8
Table 11: Stakeholder Analysis ............................................................................. 9
Table 12: Core Values ......................................................................................... 12
Table 13: Customer Value Proposition ...............................................................14
Table 14: Strategic Themes and Results ..............................................................14
Table 15: Corporate Balanced Scorecard ...........................................................17
Table 16: Income and Expenditure Forecast 2013 - 2018 .................................21
Table 17: Strategic Risks ..................................................................................... 25
Table 18: Legal Risks ........................................................................................... 26
Table 19 : Financial/Economic Risks ................................................................. 27
Table 20 : Operational risks ............................................................................... 28
Table 21 : Technological Risks ........................................................................... 28
Table 22: Monitoring and Evaluation Responsibilities ......................................31
Table 23: Implementation matrix and Budget ................................................... 36
Table 24: Objective Commentary ...................................................................... 42
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LIST OF FIGURESFigure 1: Strategy Canvas ................................................................................... 13
Figure 2: KNH Strategy House .......................................................................... 15
Figure 3: Strategy Map ........................................................................................16
Figure 4: Organogram ........................................................................................ 24
Figure 5: Cascading approach to be adopted .................................................... 33
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EXECUTIVE SUMMARYThe Strategic Plan 2013-2018 was developed in line with the Kenya Vision 2030, Kenya Health Policy 2012 - 2030 and the Kenya Health Sector Strategic and Investment Plan 2012-2017 among other policy frameworks. It is based on the Balanced Scorecard (BSC) approach. Through this approach strategies are translated into measures that are easily monitored and understood. The BSC framework focuses on making strategy every employee’s job and a continual process. This is in line with best practices worldwide.
After implementing the Strategic Plan for three years, it was felt necessary to review it, given the challenges encountered, the changing health sector environment, and based on the best practise. In reviewing this Strategic Plan, the Hospital adopted an extensive participatory approach. The process entailed consultations and interviews with staff, management, the Board of Directors and external stakeholders. The methodology included administering of questionnaires to all staff, literature review, focussed group discussions, pre and post workshop reviews, strategic planning and validation workshops and stakeholder consultations.
The Hospital re-validated the assessment earlier conducted, the emerging health care facilities taking into account the changed health sector environment after the devolved health functions to the counties and the sustainable Development goals among others. The hospital then re-validated its mission, vision and core values to realign them with the identified changes. These then informed the development of the strategic themes, objectives measures and initiatives that the hospital will pursue in the next two years.
The review also adapted the Balanced Scorecard approach which is an integrated strategic planning and management system that blends change management and communication that will bring high levels of stakeholder and employee buy-in and a shared vision for the future. Three strategic themes were identified and objectives set under each. Annual targets have also been set and indicative budgets proposed for the activities to be implemented in the entire Plan period. The Hospital fraternity adopted “Committed to Care (C2C)” as the Hospital’s one page Balanced Scorecard that will be used to communicate to both internal and external stakeholders on the Hospital’s Strategic direction.
To translate the high level strategy into aligned lower-level objectives, measures and initiatives, the Hospital has adopted a three tier cascading framework comprising of:
i) Corporate Scorecardii) Division/Departmental/Unit Scorecardiii) Individual Employee Scorecard
This framework makes strategy actionable by departments and employees in an effort to make strategy every employee’s concern.
It is estimated that the implementation of the projects and strategic activities in the next two years will require Kshs. 3.0227 billion excluding regular expenditures outside the Strategic Plan.
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LIST OF ACRONYMS AND ABBREVIATIONSAD - Assistant DirectorA&E - Accident and Emergency AIDS - Acquired Immunodeficiency SyndromeALOS - Average Length of Stay AMREF - African Medical and Research Foundation BSC - Balanced ScorecardCBA - Collective Bargaining Agreement CEO - Chief Executive OfficerCDC - Centre for Disease ControlCSS - Corporate Support ServicesCVP - Customer Value PropositionDDAID - Deputy Director Affiliation Institutional DevelopmentDDF - Deputy Director FinanceDDFS - Deputy Director Facilities and ServicesDDHR - Deputy Director Human Resource DDI&RA - Deputy Director Internal & Risk AuditDDSPI - Deputy Director Strategy & Planning DDNS - Deputy Director Nursing ServicesDSHI - Diagnostic Services and Health InformationDCS - Director Clinical ServicesDPCC - Director Prime Care CentreGoK - Government of KenyaHACCP - Hazard Analysis and Critical Control PointsHIV/AIDS - Human Immunodeficiency Virus/Acquired Immunodeficiency
SyndromeHMIS - Health Management Information System HOD - Head of DepartmentHOU - Head of UnitHSC - Head of State Commendation HR - Human ResourcesHRM - Human Resource ManagerICT - Information and Communication TechnologyICTM - ICT Manager ISO - International Organization for StandardizationJCI - Joint Commission International KEMRI - Kenya Medical Research InstituteKMTC - Kenya Medical Training CollegeKNH - Kenyatta National HospitalKNHSP III - Kenyatta National Hospital Strategic Plan IIIKPI - Key Performance IndicatorKPCC - Kenyatta Prime Care CentreM&E - Monitoring and EvaluationMEAK - Medical and Educational Aid to Kenya
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MoU - Memorandum of UnderstandingNACC - National AIDS Control CouncilNASCOP - National AIDS/STD Control Programme NBTS - National Blood Transfusion ServicesNPHLS - National Public Health Laboratories ServicesOGW - Order of the Grand WarriorOPI - Organizational Performance IndexQAM - Quality Assurance MangerR&I - Research and InnovationPPPs - Public Private PartnershipsSOPs - Standard Operating Procedures STIs - Sexually Transmitted InfectionsSWOT - Strength, Weaknesses, Opportunities and ThreatsUK - United KingdomUON - University Of NairobiUSA - United States of America VVF - Vesicovaginal FistulaWHO - World Health Organization
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CHAPTER ONE: INTRODUCTION
1.1 Background Kenyatta National Hospital (KNH) was established in 1901 with a capacity of 40 beds. The Hospital operated as a department of the Ministry of Health until 1987 when its status changed to a State Corporation through Legal Notice No. 109 of 6th April 1987. Over the years KNH has grown to its present capacity of 2,000 beds and attends to an annual average of 70,000 inpatients and 500,000 outpatients.
KNH is the public hospital of choice in Kenya and beyond. It offers quality specialised health care to patients from the Great Lakes Region, Southern and Central Africa. These services include open heart surgery, neurosurgery, orthopaedic surgery, reconstructive surgery, burns management, critical care services, new born services, ophthalmology (cornea transplant), oncology, palliative care and renal services (including kidney transplantation), among others.
The Hospital provides training facilities for the University of Nairobi (College of Health Sciences) and the Kenya Medical Training College (KMTC). The institution also works closely with the Kenya Medical Research Institute (KEMRI), Government Chemist, National Radiation Protection Board, National Public Health Laboratories Services (NPHLS), National AIDS and STIs Control Programme (NASCOP), National AIDS Control Council (NACC), National Blood Transfusion Services (NBTS) and African Medical and Research Foundation (AMREF), among others.
The Hospital has established linkages and collaborations with other institutions in providing various clinical services, outreach programs and research. Collaborations have been established with Operation Smile International, Neurosurgical Mission of St. Louis (USA), Plastic Surgical Project of the late Prof. Platt, Open Heart Surgery through Medical and Educational Aid to Kenya (MEAK) of Guys Hospital (UK), Renal Transplant Programme of University of Barcelona/NOVARTIS, Vesico Vagina Fistula (VVF) Project with AMREF and Spinal Surgery with Nuvasive Spine Foundation (USA) among others. Outreach Programmes include Nyeri Neurosurgical Programme and Cancer Treatment Programme in Mombasa and Kisumu. There are various research projects with University of Washington, CDC, University of Nairobi, Grand Challenges Canada, MERCK among others.
1.2 Vision 2030 The overall vision for the health sector is to provide ‘Equitable healthcare at the highest affordable standard to the citizens’. This will be done through a two-pronged approach:
i) Devolution of funds and management of health care to the communities and counties; leaving the Ministry of Health to deal with policy, legislation and research issues; and
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ii) Shifting the bias of the national health bill from curative to preventive care. Specific strategies will involve: provision of a robust health infrastructure network; and improving the quality of health service delivery to the highest standards and promotion of partnerships with the private sector.
KNH recognises the critical role it has to play in the achievement of the Kenya Vision 2030 through provision of patient-centred specialised care, training and research. The Hospital will create centres of excellence for the treatment of cancer, gastroenterology, Renal, diabetes, heart diseases, burns and paediatric emergency care. The Hospital will embrace appropriate technology to deliver this strategy.
1.3 Rationale for review of the Strategic PlanThe third KNH Strategic Plan (KNHSP III) built on the gains made in the previous two Plans and is reinforced by clear systems and processes as well as enabling action plans. After implementing the Plan for the last three years, it was necessary to review in order to re-align it with the changing operating environment and lessons learnt during implementation.
The review enhances the framework for the Hospital’s competitiveness in the ever changing environment through unity of purpose brought about by setting out relevant and specific objectives for the realisation of the overall goal.
1.4 Process of Reviewing the PlanA highly participatory and consultative strategic planning process was initiated to review the current Strategic Plan. This included the formation of a Strategic Plan Review Steering Team tasked with coordinating the activities of the review.
The process entailed consultations and interviews with staff, management and the Board of Management who provided invaluable inputs, guidance and ideas to the process. The methodology included discussions, administering questionnaires to all staff and their inputs were incorporated into the review, focus group pre and post workshop brainstorming sessions, validation workshops and stakeholder consultations.
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CHAPTER TWO: SITUATIONAL ANALYSIS
2.1 Evaluation of Past PerformanceThe Hospital has implemented two (2) strategic plans; Strategic Plan 2005 – 2008 and 2008 – 2012 to various degrees of success. Key achievements were: initiation of various projects and services; acquisition of various essential equipment; ongoing efforts of transformation into a patient-centred hospital; staff motivation; and attainment of ISO 9001:2008 certification.
2.2 SWOT AnalysisThe hospital has identified following factors that may influence its performance
2.2.1 Strengths
Table 1: Strengths
STRENGTH STRATEGIC IMPACTBrand name “Kenyatta National Hospital”
• Largecustomerbase• Variouspartnershipsandcollaborations
GoK support Resource mobilizationHigh volume of patients Potential for high revenue generationStrategic location AccessibilityHighly qualified and skilled staff Quality specialized careVast Land and Infrastructure • Qualityspecializedcare
• RoomforexpansionTraining and research Innovations, policy formulation and quality
healthcare Competitive pricing Stable revenue baseGood leadership and management • Strategicdecisions
• Betterexecutionofstrategies• Attractdeveloppartners
Bulk purchasing Economies of scale
2.2.2 Weaknesses
Table 2 : Weaknesses
WEAKNESSES STRATEGIC IMPACTInadequate asset management • Highmaintenancecosts
• Inefficiency• Frequentreplacementofassets• Haphazardacquisition
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WEAKNESSES STRATEGIC IMPACTUnconducive work environment • Lowstaffmorale
• Lowproductivity• Lowcustomersatisfaction
Shortage of some specialized skills • Poorclinicaloutcomes• Unmetcustomerexpectation
Inadequate dissemination of research findings
• Lackofimprovementsinqualityofcare• Missedopportunitytoinformpolicy
Weak processes and systems • Poorservicedelivery• Lossofrevenue• Highoperationalcosts• Highprojectscosts• Delaysincompletionofprojects• Lowemployeeandpatientsatisfaction
Inefficient Contract Management • Poorservicedelivery• Increasedlitigation• Delayedprojectimplementation
Inadequate succession planning • Lackofcriticalskills• Poorservicedelivery
Low ICT uptake • Inefficiency• Lowcustomersatisfaction
2.2.3 Opportunities
Table 3: Opportunities
OPPORTUNITIES STRATEGIC IMPACTPotential for expansion of services • Increasedrevenue
• Highmarketpresence• Increasedcapacityforqualityspecialized
care• Establishmentofcentresofexcellence• Attractcorporateclientele• Diversifyingrevenuestreams
Potential for research partnerships and funding
• Improvedservicedelivery• Influencehealthpolicies• Capacitybuilding
Existence of professional networks • Knowledgesharingandtransfer• Improvedservicedelivery• Enhancedresourcemobilization
Existence of corporate clientele • IncreasedrevenueSupport by development partners • Increasedfunding
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OPPORTUNITIES STRATEGIC IMPACTCustomer goodwill • Positiveimage
• ImprovedrevenuebaseDemand for specialized training • Increasedrevenue
• Improvedservicedelivery
2.2.4 Threats
Table 4 : Threats
Threats Strategic ImpactUnfavourable government policies • Unpredictablecostofcompliance
• ReducedfundingHigh poverty levels • Increasedindebtedness
• ReducedrevenueIncrease in accidents and disasters • Strainonresources
• ReducedrevenueEmerging and re-emerging diseases • Resourcediversion
• HighMortalityandMorbidityrate• Increasedinterventioncosts• AdditionalCapacitybuildingcosts
Industrial unrests • Disruptionofservices• LossofRevenue• Lossofproperty• Negativepublicimage• Increasedworkload
Power of suppliers • Highcostsofsuppliesduetomonopolistictendencies
• Misrepresentationonpricing• Shortageofsupplies
Increased prevalence of lifestyle diseases • StrainonresourcesandspaceWeak referral system • Congestion
• Highdemandonresources• Negativepublicimage• Poorqualityofservice
Low uptake of medical cover • Strainonresources• Highbaddebts
Litigation • Strainonresources• Poorcorporateimage
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Threats Strategic ImpactCorruption • Highoperationalcosts
• Lossofrevenue• Poorcorporateimage• Poorservicedelivery
Other upcoming referral health facilities • Highturnoverofspecializedpersonnel• Reducedmarketshare• ReducedGoKbudgetaryallocations
2.3 PESTLE Analysis
2.3.1 Political Factors
Table 5: Political Factors
FACTORS STRATEGIC IMPACT Power politics • Breakdownininfrastructureandservices
• Promotionofnegativeculture• Multiplereportinglines• Compromisedleadership
Political unrest (Riots and violence) • Strainonresources• Uncertaintyofdonorfunding• Delaysinprojectimplementation
Political interference • Interferencewithhospitalmandate• Compromisedleadership
Political goodwill • Createsconducivelegalframework• Improvedfundingbothlocaland
internationalTerrorism • Insecurity
• Strainonresources
2.3.2 Environmental Factors
Table 6 : Environmental Factors
FACTOR STRATEGIC IMPACTPoor waste management • Increasedemandforhealthservices
• IncreasedcostofwastemanagementGlobal warming • Increaseindiseaseburden
• ChangingpatternofdiseaseWater shortage • Poorservicedelivery
• Increaseinhospitalacquiredinfections• Increaseincommunicabledisease
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FACTOR STRATEGIC IMPACTUnplanned development • Publichealthnuisance
• IncreaseindemandforhealthservicesAir and water pollution • Increaseindiseaseburden
• Increaseinhospitalacquiredinfections• Increaseincommunicabledisease
2.3.3 Social Factors
Table 7: Social Factors
FACTORS STRATEGIC IMPACTUnhealthy lifestyle • Increaseinlifestylediseases
• NeedformoreinvestmentsAttitudes, culture and beliefs • Noncompliancetotreatment
• PoorhealthoutcomesHigh illiteracy levels • Poorhealthoutcomes
• HighcostoftreatmentIncrease in substance abuse • IncreaseinmentalhealthdisordersUse of alternative medicine • Poorclinicaloutcomes
• Delayedinterventions• Highcostofmanagingcomplications
Family instability and gender based violence
• Increaseindemandforresourcesandservices
Increased life expectancy • Increaseinold-agerelateddiseases
2.3.4 Technological Factors
Table 8: Technological Factors
FACTORS STRATEGIC IMPACTTechnological changes • Improvedservicedelivery
• Frequentreplacementofequipment• FrequentICTupgrades• Budgetaryconstraints• Needforskilledpersonnel
New energy sources • Costreduction• Environmentalconservation
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2.3.5 Legal Factors
Table 9: Legal Factors
FACTORS STRATEGIC IMPACTChange in Labour laws • Improvedemployeesatisfaction
• Increasedhealthcarecosts• Needforincreasedbudgetallocations• Increasedindustrialaction• Increasedworkmancompensation
Inadequate legal framework for KNH • Constraintsindecisionmakingandpolicyimplementation
• ImpedimenttoresourcemobilizationPoor contract management systems • Poorservicedelivery
• Increasedlitigation• Delayedprojectimplementation
Statutory and Regulatory framework e.g. NEMA, OSHA and Procurement Regulations
• Improvedworkenvironment• Increasedlitigation• Increasedenvironmentalmanagementcosts• Increasedbudgetaryallocations• Improvedservicedelivery
2.3.6 Economic Factors
Table 10 : Economic Factors
FACTORS STRATEGIC IMPACTHigh interest rates and inflation • Delayedandhighcostsofequipment
replacement • Highoperationalcosts• Lowpurchasingpower• Disruptionofprocurementplans
Health Insurance Schemes • IncreasedandguaranteedrevenueInadequate National Health budget allocation
• Poorhealthservicedelivery• Lowinvestmentincapitalacquisition
High poverty levels • Increaseindiseaseburden• Unabletomeetrevenuetargets• Customersinabilitytopayforservices
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2.4 Stakeholder Analysis
2.4.7 Stakeholders Analysis
Table 11: Stakeholder Analysis
Stakeholder What they expect from KNH
Expectations of KNH from them
Impact
Patients • Qualityhealthcare• Compliancewith
service charter• Compassion,courtesy
• Cooperation• Compliancetorules
and regulations, and prescribed treatment
• Paymentofbills
High
College of Health Sciences (UON)
• Goodfacilities• Conducive
environment for teaching
• Researchfacilities
• Complywithrulesandregulations
• ComplywithKNHstandards
• Settlesharedutilitybills• Contolstudentnumbers
High
Kenya Medical Training College (KMTC)
• Goodfacilities• Conducive
environment for teaching
• Researchfacilities
• Complywithrulesandregulations
• ComplywithKNHstandards
• Settlesharedutilitybills• Controlstudentnumbers
High
Students • Conducivelearningenvironment
• Goodfacilities
• Compliancewithrulesand regulations
• Commitmenttoservice
Medium
Hospital Visitors • Compliancewithservice charter
• Qualityhealthcare• Informationand
Health education• Professionalismand
integrity• Maintainhealthand
safety standards
• Compliancewithrulesand regulations
• CorporateSocialResponsibility
• Collaborationtodeliverquality services
Medium
Health Professional Bodies
• Administrativesupport• Complianceto
standards• Complianceto
statutory requirements
• EnforceProfessionalism• Provideupdateon
professional development• Developmentofstandards
in health care• Advisoryrole
High
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Stakeholder What they expect from KNH
Expectations of KNH from them
Impact
Ministry of Health / Government of Kenya
• Implementationofhealth policies and standards
• Prudentresourcemanagement
• Professionalism,ethicsand integrity
• Goodcorporategovernance
• Disastermanagement• Participationinhealth
planning and policy
• Budgetarysupport• Policyguidelines• TimelyresponsetoKNH’s
needs • Maintainprimaryand
secondary healthcare facilities
• Enhancenationalreferralsystem
• Equitabledistributionofresources
• EnactmentofKNHBill• Facilitatebi-lateraland
multi-lateral development partnerships
• Involvementinpolicyformulation
High
Health insurance providers
• Qualityhealthcare• Honourcontracts
• Timelysettlementsofclaims
• Partnership
High
Development partners
• Goodcorporategovernance
• Feedback
• Mutuallybeneficialcollaboration
High
Suppliers • Fairtreatment• Promptpayment• Plannedprocurement• Integrity• Customercare
• Meetcontractualobligations
• Integrity• Customercare• Competitivepricing• Qualitygoodsand
services• Timelydeliveryofgoods
and services
High
Tenants • Wellmaintainedandsecure premises
• Fairrents• Timelypaymentof
rates
• Timelypaymentofrentand utility costs
• Goodneighbourlinessand co-existence
• Keeppropertyingoodcondition
• Maintaincleanenvironment
Medium
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Stakeholder What they expect from KNH
Expectations of KNH from them
Impact
Media • Accesstoaccurateinformation
• Co-operation• Professionalism
• Accuratereporting• Professionalism• Enhanceourvisibility• Respectpatientrights
Medium
Police • Accesstohospital• Efficiency• Co-operation• Professionalopinion
• AdequateSecurity• Professionalism• Paymentforservices• Accurateandtimely
information• Cooperation
Medium
Judiciary • Accurateinformation• Co-operation• Expertopinion
• Professionalism• Justice• Cooperation
Medium
Correctional services
• Professionalism• Cooperation• Efficiency
• Paymentforservices• Professionalism• Cooperation• Securityofinmates
Low
Trade Unions • Fairtreatmentofallemployees
• CompliancewithCBAs• Timelyremittancesof
member contributions
• Clearandtimelycommunication
• Cooperation• Industrialpeace
High
Our Neighbours • Adherencetolocalauthority by-laws
• Safeenvironment
• Safeenvironment• Adherencetolocal
authority by-laws• Harmoniouscoexistence
Low
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CHAPTER THREE: STRATEGIC FOCUS
3.1 MandateThe Hospital was established under Legal Notice No.109 of 6th April 1987 and is mandated to:
i) Receive patients on referral from other hospitals or institutions within or outside Kenya for specialized health care;
ii) Provide facilities for medical education for the University of Nairobi Medical School, and for research either directly or through other co-operating health institutions;
iii) Provide facilities for education and training in nursing and other health and allied professions;
iv) Participate as a national referral hospital in national health planning.
3.2 Vision, Mission Core Values and Motto
3.2.1 Vision A world class patient-centred specialized care hospital
3.2.2 MissionTo optimize patient experience through innovative, evidence based specialized healthcare; facilitate training and research; and participate in national health policy formulation
3.2.3 Core Values
Table 12: Core Values
Core value Description
Customer Focus Empathetic and caring, treating all people with worth and dignity and timely delivery of services
Professionalism and integrity The drive to do the right thing to our clients all the time in an ethical manner
Equity and equality Serving all customers with fairness and impartiality
Teamwork and Team Spirit Willingness to work with others for the common good of our customers and the organization
Safety Offering services in a secure environment free from errors, injuries, accidents, and infections.
3.2.4 MottoWe Listen, We Care
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3.3 Strategy CanvasThe Hospital adopted the strategy canvas to look for ways of creating improved services and delivering them to customers in effective and efficient way. The strategy canvas illustrates the emphasis of critical elements (key differentiators) in positioning the organizations strategy within the service industry in efforts to create cost-effective strategy for delivering services. In bid to optimize customer experience, the Hospital identified in its strategy canvas: Process turnaround time, Ambience, Average Length of Stay (ALOS), process automation, pricing/cost, expertise and modern medical technology. The data from the strategy canvas is used to investigate and identify the options Hospital might use in more cost-effective delivery of its services.
The Strategy canvas was developed to show the differentiating factors that will set aside KNH from other health care providers:
Figure 1: Strategy Canvas
High
Low
Emph
asis
Process turnaround
time
Ambience ALOS Process automation
Current status
To be
Pricing/Cost Expertise Modern medical
technology
3.4 Customer Value Proposition (CVP)The Hospital will endeavour to develop, retain and strengthen its relationship with customers and stakeholders in the provision of services. Based on the customer segmentation and stakeholder analysis in table 11, the following is the customer value proposition:
13 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Table 13: Customer Value Proposition
Attributes Image Relationship• Evidencebased• Expertise• Reliable• Responsive/Receptive• Accountable/
Transparent• Accessible• Affordable• HighQuality• Innovative
• Professional• Caring• Integrity• Efficient&Effective• Consistent• Impartial(Fairness)• Resilience
• Trusting• Empathetic• Compassionate• Valued• Collaborative• Friendliness• Confidentiality
3.5 Strategic Themes and ResultsThe Plan focuses on three thematic areas each with a strategic result whose successful execution will enable the Hospital achieve its mission and vision. These areas are:
Table 14: Strategic Themes and Results
Strategic Theme Strategic result1. Operational excellence Seamless, effective and timely service delivery
and efficient utilization of resources2. Excellence in clinical outcomes Improved quality health care 3. Customer centric Satisfied, informed and happy customer
The above strategic themes were broken down into a set of strategic objectives which are linked to activities, results and/or outcomes. The objectives focus on improvements necessary for the Hospital to create and deliver value to her customers and stakeholders. They are action oriented and give an outline of what the Hospital will be doing to attain competitive advantage and success in discharging her mandate. Key Performance Indicators (KPI’s) identified for each of the objectives provide measures to enable the Hospital monitor the implementation of this Strategic Plan. The objectives have been placed into the four perspectives of the Balanced Scorecard (BSC) framework.
3.6 Strategic Objectives 1. Optimize Customer Experience2. Expand and improve services3. Enhance Cost Management4. Increase Revenue Generation5. Enhance clinical Governance6. Enhance Risk Management
14K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
7. Improve service delivery systems8. Improve knowledge management & innovation9. Maximize Research & Partnership10. Promote Positive Organization Culture11. Improve Equipment & Infrastructure12. Improve Human resource Capacity
3.7 Strategy HouseThe development of this Strategy can be compared to building a custom made house. The Mission, Vision and Customer needs make up the “roof” of the house. The strategic results are like the” roof lintel”, while the Strategic themes make up the “pillars” of the house. The strategic perspectives are the “different layers of blocks” of the house and the “foundation” is anchored on engaged leadership, interactive communication and core values at the Hospital. Figure 2 shows the KNH Strategy House.
Figure 2: KNH Strategy House
Vision“A world class patient-centred
specialized care hospital”
Mission“To optimize patient experience through innovative, evidence
based healthcare; facilitate training and research; and participate in national health policy formulation”
Customer Needs - Enablers & Challenges
Strategic ResultsSeamless, effective and timely service delivery and efficient utilization of resources
| Improved quality health care | Satisfied, informed and happy customer
Operational Excellence
Customer
Financial Stewardship
Internal Process
Organizational Capacity
Engaged Leadership | Interactive Communication | Core Values
Excellence in clinical outcome
Customer centric
15 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
3.8 Corporate Strategy MapThe Strategy Map gives a synopsis of the strategic focus at a glance. It shows a logical connection between the BSC perspectives, themes and strategic objectives in relation to the Vision, Mission and Core Values. The map is a cause and effect diagram that shows how one perspective or objective, leads to the next and ultimately, delivery of the Vision and Mission.
Through the Organizational capacity perspective, KNH will equip staff with requisite skills to re-engineer the internal business processes. Efficient processes will in turn lead to prudent financial management and ultimately better services to customers and stakeholders, which will enhance overall clinical outcomes, patient-centred and customer satisfaction. The Strategy Map is presented in Figure 3.
Figure 3: Corporate Strategy Map
Optimize Customer Experience
Expand and improve services
Increase Revenue Generation
Enhance Cost Management
Enhance clinical governance
Enhance risk management
Improve Equipment & Infrastructure
Improve knowledge management & innovation
Maximize Research & Partnerships
Promote Positive Organization Culture
Improve service delivery systems
Improve Human Resource Capacity
Customer
Financial Stewardship
Internal Process
Organizational Capacity
16K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
3.9
Cor
pora
te B
alan
ced
Scor
ecar
dA
cor
pora
te B
alan
ced
Scor
ecar
d (B
SC)w
as d
evel
oped
and
sho
ws
how
the
stra
tegi
c th
emes
are
map
ped
onto
the
BSC
per
spec
tives
, the
ob
ject
ives
that
will
ope
ratio
naliz
e th
e the
mes
, the
exp
ecte
d K
PI’s
and
activ
ities
that
will
be p
ut in
pla
ce fo
r suc
cess
ful a
chie
vem
ent o
f the
st
rate
gy. Th
e BS
C is
pre
sent
ed in
Tab
le 1
5 be
low
:
Tabl
e 15
: C
orpo
rate
Bal
ance
d Sc
orec
ard
PER
SPEC
TIV
EO
BJEC
TIV
EK
EY P
ERFO
RM
AN
CE
IND
ICAT
OR
TARG
ETIN
ITIA
TIV
ES
CU
STO
MER
Opt
imiz
e cu
stom
er
expe
rien
ce
•Customersa
tisfaction
inde
x•
%re
solutio
ntocustomer
feed
back
70 100
•Develop
afe
edba
ckm
anagem
entsystem
•Carryoutann
ualcustomersa
tisfactionsurveys
and
impl
emen
t the
reco
mm
enda
tions
•
Implem
entp
atient-cen
tred
careg
uide
lines
Expa
nd a
nd
impr
ove
serv
ices
•New
specialistteams
•No.ofc
entresof
exce
llenc
e1 •
No.ofv
alue
add
ed
serv
ices
1 3 2
•Createc
entresofe
xcellenc
e(Can
cer,
Gas
troe
nter
olog
y an
d Re
nal)
•Develop
servicei
mprov
emen
tinitia
tives
(e-P
aym
ent p
latfo
rm, c
linic
boo
king
)
FIN
AN
CIA
L ST
EWA
RD
SHIP
Incr
ease
reve
nue
gene
ratio
n•
%In
creasein
revenu
ege
nera
ted
•%Bed
occup
ancyin
Pr
ime C
are C
entr
e•
Kshs.raised
throug
hRe
sour
ce M
obili
zatio
n•
New
revenu
estreams
5 p.
a.
75 230
Mill
ion
p.a
2
•Im
plem
entatio
nofre
view
eduserfeecha
rges
•Increasecustomerbasef
orPrimeC
areC
entre
•Creditp
re-assessm
ento
fpatientate
ntrypoints
•Introd
uced
aycares
urgeryfo
rPrimeC
are
Cen
tre a
t the
Day
Car
e Cen
tre
•Com
mercializationofpha
rmacyan
don
estop
shop
dia
gnos
tic se
rvic
esEn
hanc
e C
ost
Man
agem
ent
•Bu
dgetcom
plianc
e•
Percen
tagere
ductionin
was
tage
2
100
50•
Develop
and
implem
enta
costsa
ving
strategy
•Stream
lines
upplierp
aymen
tprocess
•Es
tablish
Inventorytracking
system
•Es
tablish
aco
stingun
it1 C
entr
e of
exc
elle
nce
at th
e en
d of
yea
r 5. P
erce
ntag
e co
mpl
etio
n ra
te w
ill b
e as
per
the
wor
k pl
an2 To
be
mea
sure
d in
yea
r 5 (s
econ
d ye
ar o
f im
plem
enta
tion
)
17 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
PER
SPEC
TIV
EO
BJEC
TIV
EK
EY P
ERFO
RM
AN
CE
IND
ICAT
OR
TARG
ETIN
ITIA
TIV
ES
INTE
RN
AL
PRO
CES
SEn
hanc
e cl
inic
al
gove
rnan
ce•
Percen
tagere
ductionin
med
ical
erro
rs 3
•%re
ductioninm
ortality
rate
s•
%re
ductioninav
erage
leng
th o
f sta
y •
%re
ductionofH
ospital
acqu
ired
infe
ctio
ns
10 0.5
p.a.
5 10 p
.a.
•Develop
and
implem
enta
system
of
docu
men
ting
med
ical
erro
rs•
Con
ductclin
icalau
ditsand
implem
ent
reco
mm
enda
tions
•Im
plem
entinfectio
n,preventionan
dco
ntrol
polic
y an
d gu
idel
ines
•
Develop
constitutiona
land
statutoryob
ligations
impl
emen
tatio
n fr
amew
ork
Enha
nce
risk
m
anag
emen
t•
%ofh
ighrisksm
itigated
•Pa
tientsafetyinde
x30
p.a
.TB
D•
Develop
anEn
terpriseRisk
Man
agem
ent(ER
M)
Syst
em (R
isk P
olic
y an
d ri
sk a
ppet
ite st
atem
ent)
•Und
ertake
plann
edriskprofile
•Develop
and
implem
enta
Secur
itypolicy
•Develop
and
implem
entp
atientsa
fetytracking
sy
stem
•
Con
ductbaselinep
atientsa
fetysu
rveyand
im
plem
ent r
ecom
men
datio
ns
Impr
ove
serv
ice
deliv
ery
syst
ems
•No.oftreatm
ent
prot
ocol
s•
%adh
eren
ceto
Stand
ard
Ope
ratin
g Pr
oced
ures
•%adh
eren
ceto
Service
Del
iver
y C
hart
er•
No.ofa
utom
ated
pr
oces
ses4
6 p.
a
100
100
2
•Develop
/ada
ptand
institu
tiona
lizet
reatmen
tpr
otoc
ols
•Und
ertake
processm
apping
(Ortho
paed
ic,
Dia
gnos
tics a
nd O
ncol
ogy)
•Und
ertake
hospitalw
ideI
CTbu
sine
ssprocess
anal
ysis
and
reen
gine
erin
g•
Acq
uireanew
Health
Inform
ation
Man
agem
ent S
yste
m (H
MIS
)
3 To b
e m
easu
red
in y
ear 5
(sec
ond
year
of i
mpl
emen
tati
on4 M
edic
al re
cord
s and
inve
ntor
y m
anag
emen
t
18K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
PER
SPEC
TIV
EO
BJEC
TIV
EK
EY P
ERFO
RM
AN
CE
IND
ICAT
OR
TARG
ETIN
ITIA
TIV
ES
ORG
AN
IZAT
ION
AL
CA
PAC
ITY
Impr
ove
know
ledg
e m
anag
emen
t and
in
nova
tion
•No.ofinn
ovations(n
ew
prod
ucts
or s
ervi
ces)
•
%In
creasein
thev
olum
eof
kno
wle
dge r
epos
itory
•%o
fdisseminated
re
sear
ch
2 p.
a.
10 80
•Im
plem
entK
nowledg
eMan
agem
enta
nd
Inno
vatio
n Po
licy
•Develop
and
implem
enttalen
tman
agem
ent
polic
y
Max
imiz
e
rese
arch
&
Part
ners
hips
•%in
creasein
research
fu
ndin
g•
%in
creasein
research
co
nduc
ted
•No.ofn
ewprojects
•No.ofn
ewM
OUs
10 10 p
.a.
1 p.
a.1
p.a.
•Develop
am
echa
nism
fortrack
ing
impl
emen
tatio
n of
rese
arch
find
ings
.•
Implem
entresearchfin
ding
s.•
Review
and
implem
entR
esearchPo
licy
•Increaseand
mob
ilizefu
ndingforr
esearch
activ
ities
•Develop
and
implem
entresou
rcem
obilizatio
nst
rate
gy
•Stream
linep
rocessflow
forM
OUsa
ndcon
tracts
•Develop
partnershipsw
ithlo
cala
nd
inte
rnat
iona
l ins
titut
ions
Prom
ote
posit
ive
orga
niza
tiona
l cu
lture
•Em
ploy
eesa
tisfaction
inde
x •
%decreasei
ncorrup
tion
perc
eptio
n in
dex
•%decreasei
ndisciplin
ary
case
s
70 10 30
•Initiatec
hang
eman
agem
entp
rogram
•
Carryoutculturecha
ngec
ampa
ign
•Im
plem
entrew
ardsand
sanc
tionpo
licy
•Le
adershipand
talentm
anagem
enttraining
19 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
PER
SPEC
TIV
EO
BJEC
TIV
EK
EY P
ERFO
RM
AN
CE
IND
ICAT
OR
TARG
ETIN
ITIA
TIV
ES
Impr
ove
Hum
an
Reso
urce
Cap
acity
•
Nurseto
patientra
tio•
%ofstafftraine
dasp
er
plan
ned
trai
ning
s•
Replacem
entc
ycletime
•%in
creasein
staff
pe
rfor
man
ce in
dex
1:15
100
3 m
onth
s10
•Re
view
theR
ecru
itmen
tPolicy
•Und
ertake
twoyearstrainingan
dde
velopm
ent
prog
ram
mes
•
Review
and
implem
enta
perform
ance
man
agem
ent s
yste
m
•Im
plem
entjobevalua
tionre
port
Impr
ove
equi
pmen
t &
infr
astr
uctu
re
•%equ
ipmen
tava
ilability
•%im
plem
entatio
nof
reno
vatio
n Pl
an•
Worken
vironm
ent
satis
fact
ion
inde
x•
%im
plem
entatio
nof5
year
cap
ital r
epla
cem
ent
and
inve
stm
ent p
lan5
90 100
62 10
•Develop
aKNHSite
MasterP
lan
•Develop
and
implem
enta
fiveyearc
apita
land
eq
uipm
ent i
nves
tmen
t and
repl
acem
ent p
lan
•Initiatei
mplem
entatio
nofIC
Tmasterp
lan
•Develop
and
implem
enta
reno
vatio
nplan
•Con
ductworken
vironm
entsur
veyan
dim
plem
ent r
ecom
men
datio
ns
5 Impl
emen
tati
on o
f 5 y
ear c
apita
l rep
lace
men
t and
inve
stm
ent p
lan
to s
tart
in th
e ye
ar 5
20K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
CHAPTER FOUR: RESOURCE FLOWS FOR THE STRATEGIC PLAN
This Strategic Plan covers a five year period (2013-2018). However the review has picked what needs to be implemented in the next two years which will require Kshs. 3.0227 billion to implement the prioritised initiatives. The hospital financial forecast for the period is as shown in table 16:
Table 16: Income and Expenditure Forecast 2013 - 2018
Income Budget in Kshs. MillionsYear 1
2013/2014Year 2
2014/2015Year 3
2015/2016Year 4
2016/2017Year 5
2017/2018Cost sharing 4,037 4,766 4,944 7,059 7,059KPCC surplus 62 70 79 104 181GoK Recurrent Grant 7,590 6,699 6,735 6,808 8,703GoK Capital Grants 394 292 479 580 3000Donor funded projects 200 200 270 11 200Total income 12,283 12,027 12,507 14,562 19,143Total Recurrent expenditure
11,889 11,735 12,965 13,982 15,643
Total Capital expenditure 394 292 479 580 3,500Total expenditure 12,283 12,027 13,444 14,462 19,143Overall surplus/(deficit) - - (937) - -
In developing/implementing this Strategic Plan the following assumptions have been made:
4.1 Basic Assumptions1. An enabling political and economic environment shall prevail over the plan
period;2. The hospital is to enter into PPP for resource mobilization and
implementation of its programmes;3. Full Government support for KNH programmes;4. The Government shall facilitate Health flagship projects as identified in
Vision 2030 and the Government Manifesto.
4.2 Financial Assumptions1. Cost sharing fees will be reviewed during implementation of this Strategic
Planresultingin10%increaseinrevenueperannum.
21 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
2. New revenue streams will be introduced.3. Staffcostwillincreaseby10%annually4. Resource mobilization office to raise Kshs.230 million per year starting in
year two5. Donor funded projects will raise Kshs.200 Million annually
4.3 Internal Capacity AssumptionsThe Hospital will:
1. Create centres of excellence2. Develop its Human Resource capacity in a competitive manner.3. Improve on internal processes4. Provide an enabling environment and adequate equipment for effective and
efficient service delivery5. Implement Hospital Management Information Systems (HIMS)6. Maintain and improve its Information and Communication Technology
(ICT).
22K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
CHAPTER FIVE: INSTITUTIONAL FRAMEWORK
5.1 Organisation Structure
5.1.1 The Board of ManagementThe Board of Management consists of ten members and the Chief Executive Officer (CEO) who is the Board Secretary. The Board is responsible for overseeing the management of the Hospital and provides guidance and direction in order to attain corporate objectives. To achieve these objectives the Board has constituted four committees, namely: Clinical Research and Standards; Human Capital, Finance and Administration; Risk and Audit; and Corporate Strategy and Enterprise.
5.1.2 ManagementThe Hospital is headed by the CEO who is responsible to the Board of Management for the day-to-day running of the Hospital. The CEO is assisted by three Directors (Clinical, Prime Care Centre and Corporate Services) and thirteen Deputy Directors. The hospital has adopted a devolved governance structure for effective service delivery, accountability and ease of communication. The Directors and Deputy Directors form the Executive Management Committee that assists the CEO to implement the Strategic Plan and policies approved by the Board.
23 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Fig
ure
4: O
rgan
ogra
m
Dir
ecto
r
Dep
uty
Dir
ecto
r
Hea
d of
D
epar
tmen
t
Hea
d of
Se
ctio
n/U
nit
Key
:
24K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
CHAPTER SIX: RISKS AND RISK MANAGEMENT
6.1 Risk AnalysisThe preparation of the Strategic Plan took cognizance of the risks that are likely to affect the implementation of the Plan. The risks are grouped as strategic, legal, organizational, operational, financial and technological.
Measures to ensure identification of risks and mitigation include development of enterprise risk management policy, recruitment and training of staff, regular consultations with relevant agencies, acquisition of requisite facilities, and periodic monitoring of the implementation process. Tables 17 to 21 show the Risk Analysis Matrices for the various risk categories.
6.1.1 Strategic Risks
Table 17: Strategic Risks
Risk Factors Likelihood (Negligible, Marginal, Certain)
Impact (High, Medium, Low)
Mitigating Actions
Inadequate legal framework (Operating under legal notice)
Negligible High • FinalizedraftBill• Lobbyforenactment
Change in disease patterns
Certain High • Developnewstrategies• Resourcemobilization• Training
Establishment of other referral institutions and health facilities.
Certain Medium • DevelopstrategiestomakeKNHthepreferred facility.
• Investinmarketingandbusinessintelligence
• Improveoperationalefficiency.• Developcompetitivepricing
strategies.• Establishspecializedsatelliteclinics
Establishment of centres of excellence in the country and the region
Certain High • DevelopstrategiestomakeKNHthepreferred facility.
• Investinmarketingandbusinessintelligence.
• Benchmarking• Improveoperationalefficiency.
25 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Risk Factors Likelihood (Negligible, Marginal, Certain)
Impact (High, Medium, Low)
Mitigating Actions
Medical Training institutions establishing their own health facilities.
Certain High • Investinmarketingandbusinessintelligence.
• Improveoperationalefficiency.
6.1.2 Legal Risks
Table 18: Legal Risks
Risk Factors Likelihood (Negligible, Marginal, Certain)
Impact (High, Medium, Low)
Mitigating Actions
Increased public expectations in line with constitutional requirements• BillofRights• Accessibility• Costs• Quality
Certain High • LobbyforNationalSocialHealthInsurance Scheme
• PublicPrivatePartnership• LobbyforGovernmentexemptions/
reimbursements• Devolution Certain Medium • Establishcentresofexcellence• MedicoLegal
CasesCertain Medium • Capacitybuildingandappropriate
standards• ProfessionalIndemnitycover• Staffsensitization• DisseminateCodeofConductand
Ethics
26K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
6.1.3 Financial/Economic Risks
Table 19 : Financial/Economic Risks
Risk Factors Likelihood (Negligible, Marginal, Certain)
Impact (High, Medium, Low)
Mitigating Actions
Revenue loss Marginal High • Automation• Staffsensitizationandculture
change• Sanctions• Improveinternalcontrols• Improvedsecurity
Inadequate financial resources
Certain High • PublicPrivatePartnerships• Supportgroups/development
partners• Budgetprioritization• LobbyforincreasedGOKfunds• Resourcemobilization• Investinmarketing/public
awareness • Diversifyrevenuestreams
Inflation Certain Medium • Betterplanning• Marketintelligence
Unpaid debts/ credit
Certain High • Streamlineadmissionprocess• Improvecreditcontrol• Automatebillingsystem• Encourageclientstoregisterwith
health insurance schemes• Lobbyforsponsorships• Lobbyforreimbursementsfrom
GOKCorruption Marginal High • Automation
• AdherencetoSOPs• Implementanti-corruptionplans• AdherencetoCodeofConductand
Ethics• Standardizespecificationsforgoods
and services• Improvecommunicationwiththe
public
27 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
6.1.4 Operational Risks
Table 20 : Operational risks
Risk Factors Likelihood (Negligible, Marginal, Certain)
Impact (High, Medium, Low)
Mitigating Actions
Brain Drain Marginal Medium • Knowledgemanagement• Mentorship• Developsuccessionmanagement
plan• Competitiveremuneration
Skill Gaps Certain High • Successionstrategyandplanning• Timelyrecruitment• SkillsbasedTraining• Mentorship
Disasters Certain High • ImplementDisasterManagementPolicy.
• SeekforadequatefundingIndustrial Unrest Certain High • HonourCollectiveBargaining
Agreements. [CBA]• Effectivecommunicationwiththe
Trade Unions• AdheretoLabourLawsand
regulations.
6.1.5 Technological Risks
Table 21 : Technological Risks
Risk Factors Likelihood (Negligible, Marginal, Certain)
Impact (High, Medium, Low)
Mitigating Actions
Slow pace of Automation
Marginal High • ImplementICTMasterplan• Sourceforfunds(Development
partners, GoK)• PublicPartnershipPartnerships
Low uptake of technology
Certain High • Plannedcapacitybuilding• Sourceforfunds(development
partners, GoK)
28K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Risk Factors Likelihood (Negligible, Marginal, Certain)
Impact (High, Medium, Low)
Mitigating Actions
Rapid changes in equipment design and technology
Certain High • Leasingofappropriateequipment• Upgrade/replaceequipment• Trainingandsensitizationofstaff• Trade-infornewerequipment
Cyber security Certain High • Riskprofiling• DevelopandimplementRisk
Management PlanIncreased Power cost/outage
Marginal Low • Procureequipmentwithenergysaving devices
• Powerbackup/surgeprotectors• Powerfactorcorrectionequipment
Critical data systems failure
Marginal High • Databackups• Disasterrecoverysites• DevelopandimplementRisk
Management Policy Disposal of E-Waste
Marginal Medium • DevelopandimplementaE-wastepolicy
• LeasingofEquipmentTerrorism Certain High • Threatassessment
• Enhancesecurity,surveillanceandtraining
29 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
CHAPTER SEVEN: MONITORING & EVALUATION
7.1 Introduction The Monitoring and Evaluation (M&E) framework for the Plan will enable the Hospital to identify and manage the gaps in the implementation of the Plan. The framework will bring together all Hospital stakeholders to ensure timely implementation and the desired impact. A monitoring and evaluation system will be put in place to ensure performance is reviewed and analyzed on a regular basis. This will take into account the internal and external factors that may affect the implementation of the Plan.
This Monitoring and Evaluation framework aims at:
• FocusingattentionofstakeholdersanddirecteffortstowardstheultimateVision of the Hospital
• Informingpolicymakersaboutprogresstowardsachievingtargetsassetinthe strategic plan.
• Providestrategicinformationtodecision-makerstomakeevidence-baseddecisions.
In addition to the above considerations the M&E framework has been developed to address some of the challenges identified during the Mid-term review of the Plan.
7.2 Monitoring & Evaluation FrameworkThe Balanced Scorecard and strategy maps will be used as the strategy execution tool in order to effectively communicate and monitor the achievement of the stated Strategic Objectives.
7.2.1 Scope of M & EThe M&E will carry out three types of monitoring which address different stages in the results chain, namely;
i) Physical implementation monitoring: Will address whether activities and initiatives have taken place in line with timelines and target set achieved;
ii) Financial implementation monitoring: Will addresses whether or not budgets have been released and spent in line with allocations; and
iii) Outputs, outcomes and impact monitoring: To trace whether or not results are occurring amongst the target population.
30K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
7.2.2 Objectives of the M&E Framework The specific objectives of the M&E Framework are to:
i) Provide a Hospital wide-wide framework for tracking progress and demonstrating results.
ii) Build capacity to regularly and systematically track progress of implementation of the KNH SP 2013/18.
iii) Facilitate KNH and other stakeholders assess the Hospital s̀ performance in accordance with the agreed objectives and performance indicators to support management for results (evidence based decision making).
iv) Improve compliance with Government policies (accountability), and constructive engagement with stakeholders (policy dialogue).
v) Facilitate continuous learning (document and share the challenges and lessons learnt)
7.2.3 Responsibilities for Implementation, Monitoring and Evaluation The following monitoring & evaluation framework will be used in order to ensure successful implementation of the Plan:
i) An M&E team comprising of the Senior Directors and the Heads of Divisions and Departments shall be established to champion implementation of the Strategic Plan. The Head of Planning Department will be responsible for the overall monitoring, evaluation and reporting.
ii) Quarterly M&E meetings chaired by the CEO to review the status of the Strategic Plan implementation.
iii) The CEO will provide quarterly reports on implementation status to the Board.
iv) Annual review of the Strategic Plan. v) Management dashboard will be developed to monitor the implementation of
Key Performance Indicators.
Table 22: Monitoring and Evaluation Responsibilities
No Tasks Responsibility1. Resource mobilization, collaboration and partnerships,
receiving M&E reports, providing feedback and taking action CEO and Board of Management
2. Design M&E tools, supervise data collection, analyse data and generate M&E reports
Head of Planning Department
3. Departments and Divisions to meet monthly to assess the implementation of the Strategic Plan
ALL Directors, HODs and HOUs
4. Divisional Heads to present their progress reports on Key Performance Indicators during the CEO’s monthly meetings
Directors
31 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
No Tasks Responsibility5. Implement Strategic Plan, collect and analyse data, submit
to Planning Department , receive feedback, and implement decisions
ALL Directors, HODs and HOUs
6 Make BSC and Strategy Reporting part of Management Meetings agenda
DCoS
7.2.4 ReportingThe M&E framework will generate the following report:
i) Monthly Progress Reports on ImplementationAll the departments will be required to submit monthly progress reports on the indicators and initiatives to Planning department by 5th of the succeeding month.
ii) Quarterly Performance Review ReportsAt all levels a performance review reports will be produced outlining the performance against the Strategic Objectives outlined in this Strategic Plan. The reports will be discussed by the Hospital s̀ Executive management Committee (EMC) as well as all the stakeholders at the quarterly performance review meetings. The discussion will focus on a review of the findings and the agreed action points. The finalized report will be submitted to the Board of Management.
iii) Annual Strategic Plan Performance ReportAn annual Strategic Plan performance report will be developed. The report will be validated by stakeholders to:-
• Obtainstakeholderinsightontheinformationgenerated;• Mitigatebiasthroughdiscussionoftheinformationgeneratedwithkey
M&E actors and Objective owners;• Generateconsensusonthefindingsandgaps• StrengthenownershipandcommitmenttoM&Eactivities
7.2.5 M&E toolsThe Planning Department will develop tools for monitoring and evaluation and sensitize all the stakeholders within one month of the Launch of this Revised Strategic Plan.
7.3 Cascading the PlanIn a bid to translate high level strategy into aligned lower-level objectives and measures, the Hospital will adopt a three tier cascading framework comprising of:
i) Corporate Scorecardii) Divisional/Departmental/Unit Scorecard
32K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
iii) Employee ScorecardIn this regard the Hospital will align the Vision to make strategy actionable by departments and down to employees while linking rewards, recognition and incentives to results.
Figure 5: Cascading approach to be adopted
Division/Department/Unit scorecard
Tier 2
Corporate scorecard
Tier 1
Employee Balanced Scorecard
Tier 3
Strategic Direction
Strategy
Strategy
Performance
Performance
Corporate
Division/D
epartment/
Unit
Employee
Tactical Execution
33 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
7.4
Mon
itori
ng a
nd E
valu
atio
n Pr
oces
sIMPLEMENTATION
Mon
itori
ng a
nd R
epor
ting
Syst
em
A
ctio
ns
Out
puts
Sh
ort-t
erm
ou
tcom
es
Long
-term
ou
tcom
es
Impa
ct
MONITORING AND REPORTING
Examples of Actions, Outputs and Outcomes
Esta
blish
M&
E un
itD
evel
op M
&E
tool
sH
old
quar
terly
SP
revi
ew m
eetin
gs
A fu
nctio
nal i
nteg
rate
d, th
e M
&E
syst
emEff
ectiv
e an
d tim
ely
feed
back
to
stak
ehol
ders
Perf
orm
ance
repo
rts
Perf
orm
ance
dat
a on
reso
urce
s, ou
tput
s and
tren
ds.
Regu
lar u
pdat
es o
n co
re
perf
orm
ance
indi
cato
rs.
Out
put I
ndic
ator
s
Tim
ely
repo
rtin
g on
im
plem
enta
tion
stat
us o
f the
Pla
n;Ti
mel
y m
eetin
g of
repo
rtin
g ob
ligat
ions
O
bjec
tive
deci
sion
mak
ing
for
perf
orm
ance
impr
ovem
ent;
plan
ning
and
reso
urce
allo
catio
nIm
prov
ed a
ccou
ntab
ility
to
gove
rnm
ent,
DPs
and
citiz
ens;
Polic
y di
alog
ue w
ith st
akeh
olde
rs.
Evid
ence
-bas
ed p
olic
y de
velo
pmen
t an
d ad
voca
cy.
Out
com
e In
dica
tors
Real
izat
ion
of
stra
tegi
c res
ults
Ach
ieve
men
t of a
ll se
t tar
gets
Impa
ct In
dica
tors
EVALUATION
2014
2015
2016
20
1720
18
34K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
7.5 Performance Review and EvaluationThe performance review process will be one of the learning mechanisms in the Hospital for follow up and learning:
• Allperformancereviewsandevaluationswillcontainspecific,targetedandactionable recommendations,
• Alldepartments/Unitswillprovidearesponsetotherecommendation(s)within a stipulated timeframe, and outlining agreement or disagreement with said recommendation(s), proposed action(s) to address said recommendation(s) and time frame for implementation of said recommendation(s).
• TheplanningDepartmentisrequiredtomaintainarecommendationimplementation tracking Plan which will keep track of review and evaluation recommendations as well as agreed follow-up
• TheimplementationoftheagreedactionswillbemonitoredbytheM&Eunitat all levels.
7.6 Monitoring and Evaluation UnitFor effective monitoring and evaluation of the Strategic Plan, an M&E unit within the Planning Department with an additional six staff needs to be established.
35 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
ANNEXES
Annex I: Implementation Matrix and Budget
Table 23: Implementation matrix and Budget
Objective Activities Timeframe Budget (Kshs in Millions)
Responsi-bility
Y4 Y5 Y4 Y5 TotalCustomer PerspectiveOptimize customer experience
Develop a feedback management system
- - - CACM
Carry out annual customer satisfaction surveys
2 2 4 CACM
Implement the recommendations annual customer satisfaction surveys
2.5 2.5 5 CACM
Implement patient-centred care guidelines
3.5 1 4.5 HOD PSQHC
Expand and improve services
Create centres of excellence (cancer-diagnostics and management; Gastroenterology and Renal)
200 1000 1200 DCS
Develop service improvement initiatives (e-Payments, automate clinic booking)
20 20 40 DCoS
Financial Stewardship Perceptive 0Increase revenue generation
Implementation of reviewed user fees
2 - 2 DDF
Increase customer base for prime care (engage the insurance companies )
5 5 10 DPCC
Credit pre-assessment at entry point (A&E)
- - - DCS
Introduce day care surgery for Prime Care Centre at the Day Care Centre
2 - 2 DPCC
36K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Objective Activities Timeframe Budget (Kshs in Millions)
Responsi-bility
Y4 Y5 Y4 Y5 TotalCommercialization of pharmacy and one stop shop diagnostic services
2 2 4 DPCC
Enhance Cost Management
Develop a cost saving strategy
1.5 - 1.5 DDF
Implement a cost saving strategy
- - -
Streamline supplier payment process
- - - DCoS
Establish Inventory tracking system
3.2 1 4.2 DDSCM
Establish a costing unit 4 4 8 DDF Internal Process PerspectiveEnhance clinical governance
Develop and implement a system of documenting medical errors
• Developtoolforcritical incidence reporting and root cause analysis
• Traintheprocessowners
• Sensitizestaffonculture of safety
• Implementationofthesystem
• M&E
7 2 9 DCS
Conduct clinical audit 1.8 1.8 3.6 HOD R&IImplement clinical audit recommendations
1.2 1.2 2.4 DCS
Review infection, prevention and control policy and guidelines in line with National Policy
1 1 2 DCS
Develop constitutional and statutory obligations implementation framework
- - - DDCS
37 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Objective Activities Timeframe Budget (Kshs in Millions)
Responsi-bility
Y4 Y5 Y4 Y5 TotalEnhance risk management
Develop Enterprise Risk Management Policy (Risky Policy and risk appetite statement)
8 - 8 DDI&RA
Implement the Enterprise Risk Management Policy (Risky Policy and risk appetite statement)
- 9 9
Undertake planned risk profile
- - -
Develop a security policy - - - SSMImplement a security policy
- - -
Develop patient safety tracking system
2 - 2 DDNS
Implement patient safety tracking system
- 1.5 1.5
Conduct baseline Patient safety survey
2 - 2 HOD PSQHC
Implement Patient safety survey recommendations
1.5 1.5 3
Improve service delivery systems
Develop treatment protocols (Cancer, Diabetes, hypertension Paediatrics, Reproductive health and Surgery )
6 6 12 DCS
Undertake process mapping (Orthopaedic, diagnostics and oncology )
2 2 4 DCS
Undertake Hospital wide ICT business process analysis and engineering
10 - 10 ICTM
Acquire a new HMIS (Refer ICT Master Plan)
- - - ICTM
Organizational Capacity Perspective Improve knowledge management and innovation
Implement Knowledge Management and Innovation Policy
15 12 27 HOD R&I
38K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Objective Activities Timeframe Budget (Kshs in Millions)
Responsi-bility
Y4 Y5 Y4 Y5 TotalDevelop talent management policy
- - - DDHR
Implement talent management policy
1.5 1.5 3
Maximize research & Partnerships
Develop mechanism for tracking research findings implementation
- - - HOD R&I
Implementation of research findings
- - - DCS
Review Research Policy 1 - 1 HOD R&IImplement Research Policy
- - -
Develop resource mobilization strategy
2 - 2 DDAID
Implement resource mobilization strategy
- - -
Increase and mobilize funding for research activities
1.5 2.5 4 HOD R&I
Streamline process flow for MOUs and contracts
- - - DDCS
Develop collaborations and partnership with local and international Institutions
1 1 2 DCS
Promote positive organizational culture
Initiate change management program
1 2 3 DDHR
Carry out culture change campaign
3 2 5
Implement rewards and sanction policy
5 5 10
Leadership and talent management training
5 5 10
Improve Human Resource Capacity
Review the Recruitment policy
3 - 3 DDHR
Undertake two training and development programmes (to include CPD, TNAs , trainings E.T.C)
2 - 2
39 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Objective Activities Timeframe Budget (Kshs in Millions)
Responsi-bility
Y4 Y5 Y4 Y5 TotalReview a performance management system
3 3 6 DDHR
Implement a performance management system
2 2 4
Implement the job evaluation report
- - - DCS
Improve equipment & infrastructure
Develop a KNH Site Master Plan
16 34 50 DDFS
Develop a five year capital and equipment investment and replacement plan
4 - 4
Implement a five year capital and equipment investment and replacement plan
580 650 1230
Initiate implementation of ICT Master Plan
- 300 300
Develop a renovation plan 2 - 2Implement renovation plan
- - -
Conduct a work environment survey
2 2 4 DDHR
Implement a work environment survey recommendations
1.5 1.5 3
Total 941.7 2087 3028.7
40K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Ann
ex II
: Com
mitt
ed to
Car
e (C
“2”C
) V
isio
n: A
wor
ld c
lass
pat
ient
-cen
tred
spec
ializ
ed c
are h
ospi
tal
Mis
sion
: To
opti
miz
e pat
ient
exp
erie
nce t
hrou
gh in
nova
tive e
vide
nce b
ased
hea
lthca
re; f
acili
tate
trai
ning
and
rese
arch
; and
par
ticip
ate i
n na
tiona
l hea
lth p
olic
y fo
rmul
atio
n
Cor
e va
lues
: Cus
tom
er F
ocus
; Pro
fess
iona
lism
and
inte
grity
; Equ
ity a
nd E
qual
ity; T
eam
wor
k an
d Te
am S
piri
t; Sa
fety
Mot
to: W
e lis
ten,
We C
are
Stra
tegi
c Them
e: O
pera
tiona
l exc
elle
nce:
Ex
celle
nce i
n cl
inic
al o
utco
mes
Cus
tom
er C
entr
ic
Stra
tegi
c Res
ult:
Seam
less
, effe
ctiv
e and
tim
ely
serv
ice d
eliv
ery
and
effici
ent u
tiliz
atio
n of
reso
urce
sIm
prov
ed q
ualit
y of
hea
lth c
are
Satis
fied,
info
rmed
and
hap
py c
usto
mer
STR
AT
EGY
MA
PSt
rate
gic O
bjec
tive
Mea
sure
men
tTa
rget
Initi
ativ
es
Opt
imiz
e Cus
tom
er
Expe
rien
ce
Expa
nd a
nd im
prov
e se
rvic
es
Incr
ease
Rev
enue
G
ener
atio
nEn
hanc
e Cos
t M
anag
emen
t
Enha
nce c
linic
al
gove
rnan
ceEn
hanc
e ris
k m
anag
emen
t
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ove E
quip
men
t &
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astr
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now
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e man
agem
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in
nova
tion
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imiz
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sear
ch &
Pa
rtne
rshi
ps
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ote P
ositi
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Org
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n C
ultu
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eliv
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syst
ems
Impr
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ourc
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apac
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tom
er
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tom
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xper
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tomersa
tisfactioninde
x•
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edba
ck70 10
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anag
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rvices
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utom
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ipsw
ithlo
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lins
titutions
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izat
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l cu
lture
•Em
ploy
eesa
tisfactioninde
x•
%decreasei
nco
rrup
tionpe
rcep
tioninde
x•
%decreasei
ndisciplin
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ses
70 10 30
•In
itiatec
hang
eman
agem
entp
rogram
•
Carryoutculturecha
ngec
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ign
•Im
plem
entrew
ards
and
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Impr
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uman
reso
urce
cap
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•Nur
seto
patientra
tio•
%ofstafftraine
dasp
erplann
edtr
aining
s•
Replacem
entc
ycletime
•%in
crea
sein
staff
perform
ancein
dex
1:15
100
3 m
onth
s10
•Re
view
theR
ecru
itmen
tpolicy
•Und
ertake
twoye
arst
rainingan
dde
velopm
entp
rogram
mes
•Re
view
and
implem
enta
perform
ancem
anag
emen
tsystem
•Im
plem
entjobev
alua
tionre
port
Impr
ove e
quip
men
t &
infr
astr
uctu
re•
%equ
ipmen
tava
ilability
•%im
plem
entatio
nofre
nova
tionPlan
•W
orken
vironm
entsatisfactioninde
x•
%im
plem
entatio
nof5yea
rcap
italrep
lacemen
tand
inve
stmen
tplan
90 100
70 10
•Dev
elop
aK
NHSite
MasterP
lan
•Dev
elop
and
implem
enta
fiveyea
rcap
itala
ndequ
ipmen
tinv
estm
enta
ndre
placem
entp
lan
•In
itiatei
mplem
entatio
nofIC
Tmasterp
lan
•Dev
elop
and
implem
enta
reno
vatio
nplan
•Con
ductw
orken
vironm
entsur
veyan
dim
plem
entrecom
men
datio
ns
41 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Ann
ex II
I: O
bjec
tive
Com
men
tary
Tabl
e 24
: Obj
ectiv
e C
omm
enta
ry
Perc
eptiv
e/O
bjec
tive
Obj
ectiv
e D
escr
iptio
nIn
tend
ed R
esul
tsM
easu
res
Mea
sure
s Des
crip
tion
Initi
ativ
eO
bjec
tive
Ow
ner
CU
STO
MER
O
ptim
ize
cust
omer
ex
peri
ence
Prov
idin
g pr
oduc
ts
and
serv
ices
that
co
nsis
tent
ly m
eet
and
exce
ed c
usto
mer
ex
pect
atio
ns
Del
ight
ed a
nd
satis
fied
cust
omer
Cus
tom
er
satis
fact
ion
Cus
tom
er sa
tisfa
ctio
n in
dex
•Develop
afe
edba
ck
man
agem
ent s
yste
m
•Carryoutann
ualcus
tomer
satis
fact
ion
surv
eys
and
impl
emen
t the
re
com
men
datio
ns
•Im
plem
entp
atient-cen
tred
ca
re g
uide
lines
DD
PS
Cus
tom
er
com
plai
nts/
co
mpl
imen
ts
Cus
tom
er c
ompl
aint
s re
solu
tion
rate
%re
ductionof
com
plai
nts
Expa
nd a
nd
impr
ove
serv
ices
Incr
ease
the r
ange
of
serv
ices
and
va
lue a
dditi
on to
the
exis
ting
serv
ices
•Satis
fied
cust
omer
•Cus
tomerneeds
are m
et•
Wider
ange
serv
ices
offe
red
New
spec
ialis
t te
ams
The n
umbe
r of s
peci
alis
t te
ams f
orm
ed in
the
peri
od.
•Createcentreso
fexcellenc
e(
Can
cer)
•Develop
service
impr
ovem
ent i
nitia
tives
(e
-pay
men
ts p
latfo
rms,
clin
ical
boo
king
)
DD
AID
No.
of c
entr
es o
f ex
celle
nce
The H
ospi
tal w
ill
deve
lop
canc
er c
entr
e of
ex
celle
nce
Valu
e add
ed
serv
ices
The n
umbe
r ser
vice
s ex
pand
ed o
r im
prov
ed
with
in th
e per
iod
FIN
AN
CIA
L ST
EWA
RD
SHIP
Incr
ease
reve
nue
gene
ratio
nIn
crea
se in
tern
ally
ge
nera
ted
fund
s•
Fina
ncial
sust
aina
bilit
y•
Improv
ed
reve
nue b
ase
Incr
ease
d re
venu
e ge
nera
ted
%in
creasein
revenu
e•
Electron
icpay
men
tproject
•Im
plem
entatio
nofre
view
us
er fe
e cha
rges
•Increasecus
tomerbasefor
Prim
e Car
e C
entr
e•
Creditp
re-assessm
ento
fpa
tient
at e
ntry
poi
nts
%Bed
occup
ancy
in P
rim
e Car
e C
entr
e
Prop
ortio
n of
ava
ilabl
e be
ds o
ccup
ied
in K
PCC
42K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Perc
eptiv
e/O
bjec
tive
Obj
ectiv
e D
escr
iptio
nIn
tend
ed R
esul
tsM
easu
res
Mea
sure
s Des
crip
tion
Initi
ativ
eO
bjec
tive
Ow
ner
Enha
nce
Cos
t M
anag
emen
tO
pera
tiona
l cos
ts a
nd
was
tage
are
redu
ced
•Fina
ncial
sust
aina
bilit
y•
Redu
ced
adm
inis
trat
ive
cost
s•
Minim
ized
w
asta
ges
Budg
et
com
plia
nce
Budg
et to
act
ual
expe
nditu
re v
aria
nce
anal
ysis
•Develop
and
implem
enta
co
st sa
ving
stra
tegy
•Stream
linesupp
lierp
aymen
tpr
oces
s•
EstablishInventorytracking
sy
stem
•Es
tablishaco
stingun
it
DD
F
Perc
enta
ge
redu
ctio
n in
w
asta
ge
The v
alue
of e
xpir
ed
med
icin
es o
r sup
plie
s
Was
tage
inde
x It
is a
com
posit
e ind
ex
calc
ulat
ed a
s the
val
ue
of e
xpir
ed su
pplie
s in
rela
tion
to th
e tot
al
expe
nditu
re li
ne o
f the
ite
m.
INTE
RN
AL
PRO
CES
SEn
hanc
e cl
inic
al
gove
rnan
ceIm
prov
ing
clin
ical
ac
coun
tabi
lity
and
adhe
renc
e to
ethi
cs in
pa
tient
man
agem
ent
Evid
ence
bas
ed a
nd
safe
med
ical
car
eD
ocum
ente
d m
edic
al e
rror
sM
onth
ly m
orta
lity
audi
ts; p
eer r
evie
w ;
bi-a
nnua
l clin
ical
aud
its
to e
valu
ate m
edic
al
erro
rs
•Develop
and
implem
ent
a sy
stem
of d
ocum
entin
g m
edic
al e
rror
s•
Con
ductclin
ical
audi
ts a
nd im
plem
ent
reco
mm
enda
tions
.•
Implem
entinfectio
n,
prev
entio
n an
d co
ntro
l pol
icy
and
guid
elin
es
•Es
tablishHospitalM
edical
Revi
ew B
oard
•Develop
con
stitu
tiona
land
st
atut
ory
impl
emen
tatio
n fr
amew
ork.
DC
S
%red
uctio
nin
mor
talit
y ra
tes
Prop
ortio
n of
dea
ths
amon
g th
e inp
atie
nts
%re
ductionin
aver
age l
engt
h of
st
ay
Aver
age n
umbe
r of
inpa
tient
day
s by
diag
nosi
s%re
ductionof
Hos
pita
l acq
uire
d in
fect
ions
Prop
ortio
n of
pat
ient
s w
ho d
evel
op in
fect
ions
w
hile
rece
ivin
g tr
eatm
ent
43 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Perc
eptiv
e/O
bjec
tive
Obj
ectiv
e D
escr
iptio
nIn
tend
ed R
esul
tsM
easu
res
Mea
sure
s Des
crip
tion
Initi
ativ
eO
bjec
tive
Ow
ner
Enha
nce
risk
m
anag
emen
tId
entifi
catio
n of
sy
stem
ic ri
sks t
hat
hind
ers K
NH
from
at
tain
ing
its g
oals.
H
elps
in re
duci
ng
surp
rise
s, ad
ds v
alue
to
stak
ehol
ders
. En
sure
s pat
ient
sa
fety
, effi
cien
cy
and
effec
tiven
ess
of o
pera
tions
. A
dher
ence
to st
rate
gic
goal
s and
stat
utor
y re
quir
emen
ts
•Re
duced
litig
atio
n•
Patie
ntand
staff
ar
e saf
e •
Efficien
tre
sour
ce
utili
zatio
n •
Improv
ed
corp
orat
e go
vern
ance
%ofh
ighrisks
miti
gate
dN
umbe
r of r
isks
ave
rted
fr
om th
e ide
ntifi
ed h
igh
risk
s (K
shs.
1M a
nd
abov
e)
•Develop
and
implem
enta
risk
polic
y•
Develop
riskapp
etite
st
atem
ent
•Und
ertake
plann
edrisk
profi
le
•Develop
and
implem
ent
patie
nt sa
fety
trac
king
syst
em
•Con
ductbaselinepa
tient
safe
ty su
rvey
and
impl
emen
t re
com
men
datio
ns
DD
I&R
A
Patie
nt sa
fety
in
dex
This
is a
com
posit
e sco
re
that
incl
ude m
edic
al
erro
rs, p
atie
nt fa
lls
Impr
ove
serv
ice
deliv
ery
syst
ems
Enha
nce S
tand
ard
Ope
ratin
g Pr
oced
ures
, “
wor
k” fl
ow
proc
esse
s and
tr
eatm
ent P
roto
cols
Effici
ent s
ervi
ces
No.
of
trea
tmen
t pr
otoc
ols
Stan
dard
ized
trea
tmen
t gu
idel
ines
in d
iffer
ent
spec
ialti
es
•Develop
and
institu
tiona
lize
trea
tmen
t pro
toco
ls•
Und
ertake
process
impr
ovem
ent
•Und
ertake
hospitalw
ideIC
Tbu
sine
ss p
roce
ss a
naly
sis a
nd
reen
gine
erin
g•
Acq
uireanew
Health
In
form
atio
n M
anag
emen
t Sy
stem
QA
M
%adh
eren
ce
to S
tand
ard
Ope
ratin
g Pr
oced
ures
Con
duct
ing
Inte
rnal
Q
ualit
y au
dits
to
find
num
ber o
f non
-co
nfor
min
g se
rvic
es%adh
eren
ceto
Se
rvic
e Del
iver
y C
hart
er
Aud
it of
dep
artm
enta
l Se
rvic
e Del
iver
y C
hart
er
on ti
mel
ines
s in
deliv
ery
of se
rvic
esN
o. o
f aut
omat
ed
proc
esse
sTh
e lev
el o
f aut
omat
ed
proc
esse
s
44K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Perc
eptiv
e/O
bjec
tive
Obj
ectiv
e D
escr
iptio
nIn
tend
ed R
esul
tsM
easu
res
Mea
sure
s Des
crip
tion
Initi
ativ
eO
bjec
tive
Ow
ner
ORG
AN
IZA
TIO
NA
L C
APA
CIT
YIm
prov
e kn
owle
dge
man
agem
ent a
nd
inno
vatio
n
Cre
atin
g, c
aptu
ring
, st
orin
g, re
trie
ving
and
sh
arin
g kn
owle
dge.
N
ew w
ays o
f doi
ng
thin
gs b
ette
r
•Kno
wledg
ere
posit
ory
•Ea
syaccess
and
retr
ieva
l of
info
rmat
ion
•Kno
wledg
eable
staff
•Im
prov
ed
prod
uct o
r se
rvic
e
No.
of n
ew
prod
ucts
or
serv
ices
New
impl
emen
ted
way
s of
del
iver
ing
serv
ice
or
prod
ucts
•Im
plem
entK
nowledg
eM
anag
emen
t and
Inno
vatio
n Po
licy
•Develop
and
implem
ent
tale
nt m
anag
emen
t pol
icy
HO
D R
&I
%In
creasein
th
e vol
ume
of k
now
ledg
e re
posit
ory
Add
ition
al o
r upd
ated
do
cum
ents
that
incl
udes
m
anua
ls, p
roce
dure
s, re
sear
ch p
aper
s, po
licie
s an
d st
rate
gies
%o
fdi
ssem
inat
ed
rese
arch
Con
fere
nces
, sym
posia
, bu
lletin
s, w
orks
hop
Max
imiz
e
rese
arch
&
Part
ners
hips
Gen
erat
e and
di
ssem
inat
e new
kn
owle
dge,
coo
rdin
ate
rese
arch
act
iviti
es,
iden
tifica
tion
of
prio
rity
rese
arch
ar
eas,
sour
cing
and
m
anag
ing
rese
arch
fu
nds.
Ensu
ring
im
plem
enta
tion
of
rese
arch
find
ings
. In
crea
se n
umbe
r of
col
labo
ratin
g or
gani
zatio
ns.
•New
kno
wledg
ege
nera
ted
•Increased
rese
arch
gra
nts
•Increased
proj
ects
•More
colla
bora
ting
inst
itutio
ns
%in
creasein
re
sear
ch fu
ndin
gRe
sear
ch fu
ndin
g re
aliz
ed in
com
pari
son
to th
e bas
e yea
r
•Develop
mecha
nism
for
trac
king
impl
emen
tatio
n of
re
sear
ch fi
ndin
gs.
•Im
plem
entatio
nofre
search
fin
ding
s.•
Review
and
implem
ent
Rese
arch
Pol
icy
•Increaseand
mob
ilize
fund
ing
for r
esea
rch
activ
ities
•Develop
and
implem
ent
reso
urce
mob
iliza
tion
polic
y •
Stream
lineproc
essfl
owfo
rM
OU
s and
con
trac
ts•
Develop
partnersh
ipsw
ith
loca
l and
inte
rnat
iona
l in
stitu
tions
HO
D R
&I
%in
crease
in re
sear
ch
cond
ucte
d
Num
ber o
f res
earc
h co
nduc
ted
in c
ompa
riso
n to
bas
e yea
rN
o. o
f new
pr
ojec
tsN
ew p
roje
cts i
nitia
ted
in th
e per
iod
(pro
ject
co
ntra
ct si
gned
)N
o. o
f new
MO
Us
New
MO
Us i
nitia
ted
in
the p
erio
d (s
igne
d)
45 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Perc
eptiv
e/O
bjec
tive
Obj
ectiv
e D
escr
iptio
nIn
tend
ed R
esul
tsM
easu
res
Mea
sure
s Des
crip
tion
Initi
ativ
eO
bjec
tive
Ow
ner
Prom
ote
posi
tive
orga
niza
tiona
l cu
lture
Empl
oyee
s are
en
gage
d an
d pe
rfor
min
g op
timal
ly,
and
take
per
sona
l ac
coun
tabi
lity
for
outc
omes
/res
ults
.
•Owne
rship
•Sens
eof
belo
ngin
g •
Motivated
staff
•Pr
ofessio
nalis
m
and
inte
grity
•Staff
loya
lty
Rate
of
abse
ntee
ism
Mon
thly
mon
itori
ng a
nd
anal
ysis
of a
ttend
ance
re
gist
er t
o es
tabl
ish
the
leve
l of a
ttend
ance
•Initiatech
angem
anagem
ent
prog
ram
•
Carryoutculturecha
nge
cam
paig
n•
Implem
entrew
ardsand
sa
nctio
n po
licy
DD
HR
Empl
oyee
sa
tisfa
ctio
n in
dex
Ann
ual e
mpl
oyee
sa
tisfa
ctio
n su
rvey
fo
cusi
ng o
n w
ork
envi
ronm
ent,
supe
rvis
ion
leve
l, re
cogn
ition
,eng
agem
ent
,car
eer p
rogr
essio
n
and
the p
roba
bilit
y of
co
ntin
ued
empl
oym
ent
et a
l.,%decrease
in c
orru
ptio
n pe
rcep
tion
inde
x
Exte
nt to
whi
ch
corr
uptio
n is
bel
ieve
d to
ex
ist
%decreasei
ndi
scip
linar
y ca
ses
Num
ber o
f dis
cipl
inar
y ca
ses r
epor
ted
Impr
ove
Hum
an
Reso
urce
C
apac
ity
Att
ract
and
reta
in
com
pete
nt st
aff,
Impr
ove c
andi
date
as
sess
men
t, sc
reen
ing
and
sele
ctio
n pr
oces
s. Re
duce
recr
uitm
ent
cycl
e tim
e. P
rovi
de
cond
uciv
e wor
king
en
viro
nmen
t, C
ontin
uous
pr
ofes
siona
l de
velo
pmen
t,
•Match
skillsto
task
s•
Empo
wered
staff
•Com
petentstaff
•Re
ducedstaff
tu
rnov
er•
Motivated
staff
•Optim
alstaffi
ng
leve
ls
Nur
se to
pat
ient
ra
tioRa
tio o
f nur
ses t
o pa
tient
s exc
ludi
ng C
CU
•
Review
theRe
cruitm
ent
polic
y•
Und
ertake
threeyears
trai
ning
and
dev
elop
men
t pr
ogra
mm
es
•Re
view
and
implem
enta
pe
rfor
man
ce m
anag
emen
t sy
stem
•
Implem
entjobev
alua
tion
repo
rt
DD
HR
%ofstafftraine
d
as p
er p
lann
ed
trai
ning
s
Prop
ortio
n of
staff
tr
aine
d as
per
the a
nnua
l ap
prov
ed tr
aini
ng p
lan
Repl
acem
ent c
ycle
tim
eTh
e tim
e it t
akes
to
recr
uit s
taff
(3 m
onth
s aft
er e
xit)
%in
creasein
st
aff p
erfo
rman
ce
inde
x
Aver
age s
core
s of s
taff
perf
orm
ance
as p
er th
e PA
S
46K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
Perc
eptiv
e/O
bjec
tive
Obj
ectiv
e D
escr
iptio
nIn
tend
ed R
esul
tsM
easu
res
Mea
sure
s Des
crip
tion
Initi
ativ
eO
bjec
tive
Ow
ner
Impr
ove
equi
pmen
t &
infr
astr
uctu
re
Repl
ace o
ld a
nd
obso
lete
equ
ipm
ent
and
Plan
ts. A
cqui
re
mod
ern
equi
pmen
t an
d Pl
ants
that
ar
e of c
urre
nt
tech
nolo
gy. E
nsur
e Pl
anne
d Pr
even
tive
Mai
nten
ance
for a
ll eq
uipm
ent a
nd P
lant
s. U
nder
take
tim
ely
repa
irs f
or b
uild
ings
, Pl
ant a
nd e
quip
men
t. Im
prov
e IC
T.
Reha
bilit
ate/
refu
rbis
h ol
d bu
ildin
gs a
nd
cons
truc
t new
mod
ern
build
ings
Redu
ce e
quip
men
t do
wnt
ime a
nd
impr
ove a
vaila
bilit
y of
in
fras
truc
ture
to m
eet
the r
isin
g ne
eds
•Re
duced
equi
pmen
t do
wnt
ime
•Increased
equi
pmen
t av
aila
bilit
y •
Redu
cedrepa
ir
cost
s•
Func
tiona
lin
fras
truc
ture
•Autom
ated
pr
oces
s
%equ
ipmen
tav
aila
bilit
yTh
e per
cent
age o
f fu
nctio
ning
iden
tified
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47 K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]
KNHSP III STRATEGIC PLAN MID TERM REVIEW COMMITTEE
Name Position1. Dr. Elizabeth Odera Chairman2. Mr. Job Makanga Co- Chair3. Dr. Evanson Kamuri Member4. Eng. Richard Binga Member5. Mr. Michael Kihuga Member6. Dr. John Ongech Member7. Mr. Eric Omondi Member8. Dr. John Kinuthia Member9. Mr. Douglas Owino Member10. Dr. Anne Waweru Member11. Mr. Simon Ithae Member12. Mrs. Joyce Ong’ayo Member13. Dr. Irene Weru Member14. Mrs. Alice Atamba Member15. Mr. Samuel Wainaina Member16. Mr. Abdalla Ofula Member17. Mr. Mundia Muriuki Member18. Dr. Andrew Owuor Member19. Mr. Twitty Wasonga Member20. Mr. Kibet Mengich Member
Secretariat 21. Mr. Felix Kilumbi22. Ms. Quilent Odera23. Mr. Leonard Cheserem24. Ms. Bernadette Nzomo
48K N H S P I I I [ 2 0 1 3 - 2 0 1 8 ]