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

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tim

ely

serv

ice d

eliv

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and

effici

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reso

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prov

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ualit

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plem

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nofre

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entsatisfactioninde

x•

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plem

entatio

nof5yea

rcap

italrep

lacemen

tand

inve

stmen

tplan

90 100

70 10

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elop

aK

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and

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fiveyea

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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

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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 ]