INFORMATION COMMUNICATION TECHNOLOGY

STRATEGIES AND SERVICE DELIVERY IN PRIVATE

HOSPITALS IN BOMET COUNTY, KENYA

KOECH DANIEL KIBET

D53/NKU/PT/34048/2015

A RESEARCH PROJECT SUBMITTED TO THE SCHOOL OF

BUSINESS IN PARTIAL FULFILMENT OF THE
REQUIREMENTS FOR THE AWARD OF MASTER OF
BUSINESS ADMINISTRATION DEGREE (STRATEGIC
MANAGEMENT OPTION) OF KENYATTA UNIVERSITY

MAY, 2021
 DECLARATION

I declare that this research project is my original work and has not been presented for

a degree or any award in any university. No part of this research project should be

produced or copied without the authority of the author and or Kenyatta University.

Sign: ……………………………………… Date: …………………………

Koech Daniel Kibet

D53/NKU/PT/34048/2015

I confirm that the work reported in this project was carried out by the candidate with

my approval as the university supervisor.

Sign………………………………………. Date……………………………

Dr. Kipkorir Sitienei Chris Simon

Department of Business Administration

School of Business

Kenyatta University

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 DEDICATION

This research proposal is dedicated to my loving Wife, Jackline Kirui and my dear

children, Faith Chepchirchir, Danson Kipyegon and Aron Kipchumba their

tremendous support and encouragement throughout the research process. This

research proposal is also dedicated to the glory and honour of God.

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 ACKNOWLEDGEMENTS

I wish to thank Dr. Kipkorir Sitienei Chris Simon my supervisor, for his academic

mentorship. I would like to acknowledge my family; wife Jackline, my daughter

Faith, and sons Danson and Aron, my father Wesley Lang’at, my mother Sally as well

as my brothers Amos and Ezra for their moral support.

I am grateful to Mr. Cheruiyot, Mr.Otieno, Mr. Bosuben, Mr. Obulemire and Mr.

Moriasi who were my lecturers at Kenyatta University, Department of Business

Administration Kericho Campus for all the academic guidance throughout the course.

I also thank Summary and Milpah for tirelessly typing and editing this proposal.

I am grateful to the management and staff of Tenwek Hospital and Kaplong Mission

Hospital for their friendly reception and support during the research process. I also

thank my colleagues, Peterson, Onyango, Aron, Edna and Jemutai for their

encouragement and their invaluable support and teamwork which motivated me to

successfully carry out this survey.

I thank the Almighty God for His endless mercies, energy and love which provided

natural incentives towards the success of this research project.

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 TABLE OF CONTENTS
DECLARATION......................................................................................................... ii
DEDICATION............................................................................................................ iii
ACKNOWLEDGEMENTS ...................................................................................... iv
LIST OF TABLES ................................................................................................... viii
LIST OF FIGURES ................................................................................................... ix
ABBREVIATIONS AND ACRONYMS ................................................................. xii
ABSTRACT .............................................................................................................. xiv
CHAPTER ONE ..........................................................................................................1
INTRODUCTION........................................................................................................1
1.1 Background to the Study......................................................................................1
1.1.1 Service Delivery............................................................................................2
1.1.2 Information Communication Technology Strategies ....................................6
1.1.3 Private Hospitals in Bomet County, Kenya ................................................11
1.2 Statement of the Problem ...................................................................................12
1.3 Objectives of the study.......................................................................................14
1.3.1 The General objective .................................................................................14
1.3.2 Specific Objectives .....................................................................................14
1.4 Research Hypothesis .....................................................................................15
1.5 Significance of the study ....................................................................................15
1.5.1 The management and staff of private hospitals ..........................................15
1.5.2 Communications Firms and Internet Service Providers .............................16
1.5.3 The Government of Kenya..........................................................................16
1.5.4 The Society .................................................................................................17
1.6 Limitation of the study .......................................................................................17
1.6.1 Accessibility to confidential health information. ........................................17
1.6.2 Unreturned Questionnaires .........................................................................18
1.6.3 Uncooperative respondents .........................................................................18
1.7 Scope of the study ..............................................................................................18
1.8 Organization of the Study ..................................................................................18
CHAPTER TWO .......................................................................................................20
LITERATURE REVIEW .........................................................................................20
2.1 Theoretical Literature Review ...........................................................................20

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 2.1.1 Information Theory .....................................................................................20
2.1.2 Actor-Network-Theory (ANT). ..................................................................21
2.1.3 Unified Theory of Acceptance and Use of Technology. (UTAUT) ...........21
2.1.4 SERVQUAL Model ....................................................................................22
2.2 Empirical Literature Review ..............................................................................23
2.2.1 Electronic Health Records and Service Delivery........................................23
2.2.2 Telemedicine and Service Delivery ............................................................25
2.2.3 Mobile Health and Service Delivery...........................................................27
2.2.4 Wearable Healthcare Technology and Service Delivery ............................30
2.3 Summary of gaps in literature review ................................................................31
2.4 Conceptual Framework ......................................................................................37
CHAPTER THREE ...................................................................................................38
RESEARCH METHODOLOGY .............................................................................38
3.1 Introduction ........................................................................................................38
3.2 Research design .................................................................................................38
3.3 Target Population ...............................................................................................38
3.4 Sampling Design ................................................................................................39
3.5 Data collection procedures .................................................................................40
3.5.1 Validity .......................................................................................................41
3.5.2 Reliability....................................................................................................41
3.6 Data analysis and presentation ...........................................................................42
3.6.1 Regression Analysis ....................................................................................42
3.7 Ethical considerations ........................................................................................44
CHAPTER FOUR......................................................................................................45
DATA ANALYSIS, RESULTS AND INTERPRETATION ..................................45
4.1 Introduction ........................................................................................................45
4.2 Response Rate ....................................................................................................45
4.3 Demographic Information ..................................................................................46
4.4 Descriptive Statistics..........................................................................................52
4.4.1 Information Communication Technology...................................................52
4.4.2 Electronic Health Records ..........................................................................56
4.4.3 Telemedicine and service delivery..............................................................58
4.4.4 Use of Mobile Health during Service Delivery ..........................................60
4.4.5 Use of Wearable Healthcare Technology during Service Delivery ............61

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 4.4.6 Extent to which wearable technologies use affected service delivery in
organization..........................................................................................................62
4.4.7 Level of ICT infrastructure currently implemented in respondent’s
organization..........................................................................................................63
4.6 Inferential Analysis ............................................................................................64
4.7 Healthcare collaboration ....................................................................................68
CHAPTER FIVE .......................................................................................................70
SUMMARY, CONCLUSION AND RECOMMENDATION ................................70
5.1 Introduction ........................................................................................................70
5.2 Summary of Findings.........................................................................................70
5.3 Conclusion .........................................................................................................71
5.4 Recommendations ..............................................................................................72
5.4.1 Recommendation for Further Studies .........................................................73
REFERENCES...........................................................................................................74
APPENDICES ............................................................................................................87
Appendix 1: Introduction Letter ..............................................................................87
Appendix 2: Request for Consent to Conduct Study in Your Institution ................88
Appendix 3: Questionnaire for Hospital Staff .........................................................89
Appendix 4: Research Authorization Letter ............................................................94
Appendix 5: Research Permit ..................................................................................95

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 LIST OF TABLES
Table 2.1: Research Gaps summary.............................................................................34

Table 4.1: Usefulness of ICT innovations in improving service delivery

in respondent’s institution.........................................................................53

Table 4.2: Statements concerning information communication technology use

in respondent’s hospital during service delivery ......................................54

Table 4.3: Electronic Health Records ..........................................................................56

Table 4.4: Telemedicine and service delivery .............................................................58

Table 4.5: Use of Mobile Health during Service Delivery ..........................................60

Table 4.6: Responses regarding use of wearable healthcare technologies

during service delivery. ............................................................................61

Table 4.7: Analysis of Variance on Electronic Health Record and Service

Delivery using SPSS version 25.0.0.0 .....................................................65

Table 4.8: Analysis of Variance on Telemedicine and Service Delivery using

SPSS version 25.0.0.0 ...............................................................................65

Table 4.9: Analysis of Variance on Mobile Health and service delivery using

SPSS version 25.0.0.0 ...............................................................................66

Table 4.10: Analysis of Variance on Wearable Healthcare Technology and service

delivery .....................................................................................................66

Table 4.11: Correlation coefficients using SPSS 25.0.0.0 ...........................................67

Table 4.12: Coefficient of Determination on ICT strategies and service delivery

using SPSS version 25.0.0.0 ....................................................................68

Table 4.13: Healthcare collaboration ...........................................................................68

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 LIST OF FIGURES

Figure 2.1: Conceptual Framework of the Study .........................................................37

Figure 4.1: Response Rate ...........................................................................................45

Figure 4.2: Gender of the respondent ..........................................................................46

Figure 4.3: Age Bracket (Years) ..................................................................................47

Figure 4.4: Marital Status ............................................................................................48

Figure 4.5: Highest Level of Education achieved ........................................................49

Figure 4.6: General working experience ......................................................................50

Figure 4.7: Work experience in the current station......................................................51

Figure 4.8: Position held by respondent ......................................................................52

Figure 4.9: Extent to which wearable technologies use affected service delivery in

organization...................................................................................................62

Figure 4.10: Level of ICT infrastructure currently implemented in respondent’s

organization...................................................................................................64

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 OPERATIONAL DEFINITION OF TERMS

Collaboration Ease of working together for service delivery

Computer Hardware Collection of physical parts of a computer which

comprises of central processing unit, the
Keyboard, monitor, mouse and internal parts

Computer Software These are computer instructions in digital form

which includes operating Systems and computer
applications.

Convenience The ease of performing a task with minimal

effort without hindrances

Diagnosis Refers to judgment about a particular illness

after medical examination.

Efficiency Is the ability to deliver a service in time with

minimal energy so as to meet or surpass
customer expectation.

Electronic Health record Is the use of Information Communication

Systems to keep health records and deliver
health services.

Information Communication

Technology Refers to the use of electronic health records,

Telemedicine, Mobile health as well as wearable
healthcare technologies during service delivery.

M-Health Use of mobile devices to deliver health services

M-Pesa Mobile payment system operated by Safaricom

Telecommunications Company in Kenya

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P2P Payment Is an internet based technology where customers
conveniently transfer Funds from their bank
account to those of other individuals

Policy Is a set of ideas used as a basis for making

decisions.

Reliability The consistency in quality service provision

Responsiveness The ability of an ICT system and equipment to

deliver a quality service

Service Delivery Refers to efficiency, convenience, collaboration,

reliability and responsiveness during service
provision.

Telemedicine Is the use of ICT to provide health services from

a distant geographical place.

Wearable Health Technologies These are health gadgets worn by patients with
the aim of monitoring and aiding their health
status.

ZIP files Is a computer digital files whose contents are

compressed for storage of transmission.

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 ABBREVIATIONS AND ACRONYMS

AIDS Acquired Immunodeficiency Syndrome

ANT Actor Network Theory

BRITAM British American Company

CCK Communications Commission of Kenya

CIA Central Intelligence Agency

CPR Computer Patient Records

DELL A technology solutions company

EHR Electronic Health Records

EPS Electronic Patient System

ERM Electronic Records Management

FBO Faith Based Organization

GSMA Global Systems for Mobile Communications

HIV Human Immunodeficiency Virus

ICDC Industrial and Commercial Development Corporation

ICT Information Communication Technology

MDG Millennium Development Goals

MEDLINE A bibliographic database of life sciences and biomedical information

M-Health Mobile Health

MHF Mission Healthcare Facility

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M-Pesa M stands for ‘mobile’ and ‘Pesa’ is the Kiswahili word for money.
Together it means mobile money

NCD Non communicable Disease

NGO Non-Governmental Organization

SEO Search Engine Optimization

SMS Short Message Service

UTAUT Unified Theory of acceptance and Use of Technology

WHO World Health Organization

ZIP An archived file format that supports the compression of data and
storage

xiii
 ABSTRACT

Due to an ever increasing number of healthcare facilities across Kenya, the quality of
healthcare service being given to patients has become a key factor that has led to huge
performance gap among the existing private healthcare facilities. Healthcare facilities
across the world are now putting service delivery quality as a priority towards
enhancing patients’ satisfaction. This study will boost the existing body of knowledge
by examining the relationship between Information Communication Strategies and
service delivery in private hospitals within Bomet County, Kenya. The specific
objectives of the study were: to evaluate the effect of electronic health records; to
determine the effect of telemedicine; to establish the effect of mobile health as well as
to assess the effect of wearable health technologies on service delivery. The study will
also benefit Information Communication Technology service providers as well as
healthcare service recipients. This study was guided by four theories namely;
Information Theory, Unified Theory of Acceptance and Use of Technology and
Actor-Network-Theory and SERVQUAL model. The respondents were staff of the
selected Hospitals. The study population comprised of two private hospitals namely;
Tenwek and Kaplong mission hospitals with total target population of 720 hospital
staff. Descriptive research design and explanatory approach was used in the study.
Self-administered Questionnaires were used as principal data collection instruments
which were administered to the staff of the selected hospitals by the researcher. Users
of Information Communication Technology in the selected population was stratified
in order to respond to the questionnaires. The analysis of the collected data was done
by use of descriptive and inferential statistics aided by the Statistical Package for
Social Sciences (SPSS 25.0.0.0).To test the extent to which Information
Communication Technology explains any change in service delivery in private
hospitals, coefficient of determination (R2) was calculated and found to be 0.900. A
p-Value of 0.000 was found at 0.05 level of significance indicating that there is
significant positive relationship between Information Communication Technology
strategies. Findings show that the use of electronic health records, telemedicine,
mobile health and wearable health technology strategies in private hospitals improves
service delivery. The study recommends that private hospitals managements should
employ more Information Communication Technology strategies which should
include buying equipment and installing infrastructures that is necessary in treatment
and management of chronic illnesses affecting patients. The study concludes that the
use of electronic health records, telemedicine, mobile health and wearable healthcare
technologies facilitate effective and efficient delivery of healthcare service delivery.
This study recommends that other healthcare Information Communication
Technology innovations not covered by this study should be investigated. Further
comparative studies should target patients in order to make an informed conclusion on
the overall effect of Information Communication Technology strategies on healthcare
service delivery.

xiv
 CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Private hospitals in Kenya have increasingly become first choice destination for

patients seeking better healthcare services. This trend has gradually continued to be

witnessed in greater scale even after government interventions which include

employment of more doctors and provision of special medical equipment to public

healthcare facilities. According to Drury (2005), ICT is the best strategy in healthcare

service delivery. Management and delivery of healthcare services with the aid of ICT

helps in reducing paperwork and decreasing the workload of healthcare workers,

reducing medical errors and increasing efficiency, during service delivery (Wilson&

Anderson, 2000).

In healthcare management, ICT links the healthcare service providers with the clients

by facilitating storage, processing and prompt retrieval and exchange of information,

which are key in solving service delivery challenges (Bukachi& Walsh,2007).ICT

integration with the internet has been suggested as a suitable channel for promoting

service delivery in the healthcare sector due to its speed in reaching the masses.

According to Wasonga (2015), ICT had been used widely used large in managing

patients’ records electronically and provision of back up in cases of emergency for

patients’ records, leading to easy tracking of patients’ health progress and effective

healthcare service delivery in both private and public hospitals which a major

challenge in Kenyan healthcare sector.

1
The authorities’ implementation of devolved healthcare services to 47 counties in

Kenya inclusive of subsidies for medical services in public hospitals has currently not

yielded good results for the public healthcare sub sector. The study will focus on

comparative studies on changes introduced through the implementation of ICT use in

the delivery of services in private hospitals in Bomet County in Kenya. The research

is seeking to identify key contributions of numerous ICT techniques including digital

health information, Telemedicine, Mobile health as well as the use of the wearable

health technology on the performance of private hospitals.

1.1.1 Service Delivery

According to World Bank Report published in 2004, it is important to consider both

service providers and the clients when putting in place effective service delivery.

Berman et al. (2011) noted a huge gap in service delivery despite hospitals having

money and technology. The major challenge remains the need for improved delivery

of health services. Swanson & Davis (2003), equates service delivery quality to

customer satisfaction while Boshoff & Gray (2004), talks of service delivery quality

as significantly related to customer loyalty.

Yavas, Babakus & Karatepe (2008), defines service delivery as the effort to retain

customers through quality services. Delivery of quality services also has a key

relationship to organizational growth (Sohail & Shanmugham, 2003). Vito Logrillo

(1989) explains primary healthcare delivery as involving identification, collection,

analysis, interpretation and dissemination of healthcare data.

Thailand healthcare system is characterized by a huge gap between rural and urban

settlements which strains the government attempt resources in its goal of providing

universal healthcare for all. The country also faces lack of long term financial

2
sustainability and shortage of healthcare professionals leading to poor service delivery

(Dean Koh, 2019).

Despite India’s achievement in healthcare products, ICT systems and medical

equipment, many Indians continue to receive low quality primary healthcare (Manoj

Mohanan, Katherine Hay & Nachiket, 2016).Studies on Indian healthcare system

have found evidence of poor service quality due to lack of capacity, poor Medicare

incentives, poor accountability and governance among healthcare providers.

Covid-19 pandemic exposed Italy’s weak healthcare sector. Despite the government’s

huge investment in healthcare sector, the explosion of Covid-19 into a pandemic is

greatly attributed to poor preparation by the government despite the existence of

national and regional pandemic response units. Multilevel governance resulted in

confusion and lack of coordination between the regional and national levels. The

country also has poor public-private collaboration in provision of healthcare services.

This led to inefficiency in procurement of medical supplies hence poor service

delivery (Veronica Vecchi,2020).

With 47 million citizens, Spain has been battling Corona Virus with high casualties

putting the country among the worst hit globally with the highest infection rate and

deaths per million populations. Despite the 24 hour curfew by the government where

essential service providers were permitted to work, the infections continued to rise.

According to Susana de la Sierra (2020), a decentralized and coordinated approach

would have saved the situation in Spain. There is need for new legislation and an

updated approach to deal with epidemics such as Covid-19.

Iran’s healthcare service delivery has been greatly challenged by the Covid-19

Pandemic. According to Atefeh Zandibar & Rahim Badrfam (2020),the Islamic

3
Republic of Iran is doing fairly in the fight against Covid-19.The challenges include

lack of financial resources to make timely procurement medical equipment and

supplies.

According to Tam (2007), quality in healthcare service delivery is promoted by use of

advanced technology, effective medication, qualified and competent human resource

and sufficient doctor-patient ratio, effectiveness, efficiency and affordability of

medical services. Service industries like hospitals can be rated, assessed and ranked

according to patients’ experiences when receiving healthcare services. In Bombali

District, Sierra Leone, primary Healthcare Program (PHCP) which is a joint project

between the Health ministry and Non-Governmental and International organizations

implemented an efficient service delivery system by putting in place management

support systems which includes a drug store, vehicle and parts supply system, forms,

and healthcare ICT systems.

In Nigeria, provision of Primary Healthcare as well as curative services is guided by

the Nigerian constitution enacted in 1999 which stipulates that efficiency in service

delivery is promoted through healthcare service decentralization implementation

through active participation of all stakeholders and mobilization of the required

resources.

Benin being a low income country faces a myriad of healthcare challenges during

service delivery. The major challenge is poor performance of medical equipment and

ICT systems. This is caused by lack of experienced and technologically trained

medical practitioners. The poor healthcare sector management policy by the

government, coupled with political interference in the running of the health sector has

4
led to poor service delivery in public and private healthcare facilities across the

country (Houngbo, Buning, Bunders, Coleman, Medenou, Dakpanon & Horst, 2017).

Healthcare sector in Tanzania is operated under devolved system where local

authorities manage the healthcare services. According to Frumence, Nyamhanga,

Mwangu & Hurtig (2013), Tanzanian local authorities failed to adequately respond to

health challenges as a result of inadequate funding and delays of funds from the

central government, poorly trained local authorities’ healthcare workers and poor

collaboration between healthcare workers and the local communities. Printz ,

Amenyah , Serumaga , & Van (2013),attributes Tanzania’s healthcare problems to

lack of efficient healthcare supply system, poor financing , unreliable healthcare ICT

infrastructure, and poor coordination among healthcare stakeholders.

Kenya is not spared of healthcare service delivery challenges since the devolution of

healthcare sector to the county governments. Frequent healthcare workers unrest has

been attributed to poor remuneration to medical staff, lack of sufficient trained health

workers and lack of appropriate medical equipment and ICT systems. County

governments handle the provision of healthcare services at the county level while the

national government is in charge of policy making and referral hospitals. According

to World Health Organization (2010), 70% of Kenyan population live in rural areas

and are served by community health nurses and local health centres. Challenges

during service delivery include poor transport infrastructure, lack of reliable medical

supply units as well as lack of ICT support systems including electricity and technical

knowhow.

In the current study, service delivery was measured in terms of efficiency which was

the average time taken before a client receives treatment, patient’s progress from one

5
step to another, average length of stay in hospital for admitted patients, and the

average waiting time for special appointments as a result of ICT strategy use.

Convenience was conceptualized in terms of accessibility, availability, affordability

and flexibility. Reliability was measured in terms of consistency in service delivery,

using the rate of ICT systems failure during use, and their life cycle during its

usefulness while collaboration was conceptualized in terms of ease in working

together in knowledge sharing, teamwork and consultations during service delivery.

Responsiveness was conceptualized in terms of flexibility among healthcare workers

in adopting use of ICT strategies in service delivery.

1.1.2 Information Communication Technology Strategies

Information communication Technology can be best examined by considering it as an

extended family of Information Communication equipment comprising hardware and

software that aid in facilitating efficient and effective communication and that which

can be relied on by an organization. ICT family consists of ICT equipment including

radio, Television, mobile phones, hardware and software systems as well as

computers and computer networks. (Rouse, 2005).

Chandler & Redman (2012) argue that ICT is a continuous process that arises from

vigorous research and development endeavors of scholars which culminates in the

production of effective and efficient information systems. These can be run on

computers and mobile ICT enabled devices. The argument brings to light the

inseparable relationship between computers and ICT networks as well as mass media

which includes television sets used to pass information.

According to Mintzberg (1994), a strategy is complete if it has four components as

follows; there must be a guiding plan to guide movement from one point to another.

6
There should also be a pattern made of series of past experiences, a company’s

position to guide the direction of operations and mission and vision to give the

organization a sense of direction and image. ICT strategies in healthcare open up new

avenues in patient treatment and welfare (Arendt,2013) although its deployment in

healthcare facilities comes at a significantly high cost without which it will be

challenging to derive full benefits from its full adoption (Calman, Kitson, &

Hauser,2010).

In order to lower the costs involved in ICT adoption in healthcare management, it is

advisable to utilize the existing infrastructure and equipment which are easily

accessible. These include mobile and broadband ICT readily available in most parts of

Kenya. (Benard, 2017). The use of ICT in healthcare facilities improves treatment

processes and healthcare quality. (Christensson, 2010). This is because the provision

of quality healthcare services relies heavily on exchange of information between

patients and medical staff.

According to Gatero (2010), there is need to develop and integrate hospital ICT

systems in healthcare service delivery so as to avoid costly and risky multi-data entry

points which may cause medical errors and promote accuracy in disease diagnosis,

treatment and general medical care. The ICT strategies that this study will investigate

include Electronic Health Records, Telemedicine, Mobile health as well as wearable

healthcare technology in service delivery in the selected private hospitals in Bomet

County, Kenya.

Electronic Health Records was investigated using availability of electronic medical

records, laboratory reports, procedure reports and discharge summaries. Siika (2005)

defines electronic health record as a digital store of patient data accessible to

7
clinicians, insurance companies, and healthcare staff in used healthcare setting.

According to Kazley and Ozcan (2007), Electronic health records are designed to

store, manage and query patients’ medical information. These are tools that aid in

healthcare management decision making which results in a safer efficient healthcare

system which his effective in the long run. Stratman (2007) attributes poor service

delivery to Poor records management, long documentation process and haphazard

filing systems.

Telemedicine was examined on the level of use of teleconferencing, teleconsultation,

medical imaging and remote patient monitoring. Kamotho and Bukachi, (2020) argues

that telemedicine implemented in rural Africa led to improved blood pressure

monitoring, effective treatment and patients’ management resulting in promotion of

universal healthcare provision. According to Dodoo, Al-Samarraie and Alzahrani

(2021) the wide adoption of telemedicine in health care service delivery across the

Sub-Saharan Africa, is yet to be fully utilized in the fight against Covid-19. Report

from International Telecommunication union of 2005 indicates that telemedicine is a

key tool for improved healthcare service delivery across the world.

Mobile health is the use of mobile devices and global network to deliver health

services and information. Mobile devices most commonly used include cell phones

(feature phones, smart phones and tablets (Adibi, 2015). The successful use of M-

health by medical doctors to improve health outcomes requires the institution to

educate the doctors and other health team members on the benefits of M-health

(Ehrlich, Chester, Kendall & Crompton (2017). The scholars advocate for the

innovative use of mobile technology in healthcare practices. A strong partnership

between the Dutch government, Pfizer Foundation, Care Play, Pharm Access

8
Foundation and Safaricom has led to the introduction of M-Tiba Health wallet into the

Kenyan M-Healthcare sector. Through this system, M-Pesa is used to keep donor

funds and customers’ accounts as well as transfer funds to accredited healthcare

providers to facilitate smooth service delivery.

According to Fedele, Cushing, Fritz, Amaro and Ortega (2017) mobile health among

the youth can lead to improved treatment processes when monitored closely by a

qualified health practitioner as compared to low outcomes when given without

caregiver. Mobile health is however influenced by individuals, family, community,

and health care system domains. Zhao, Ni and Zhou (2018) observe that age affects

use of mobile health services. From their study, middle age and elderly users of

mobile health attach value to the ease of mobile health utility and shy away from

adopting new information technology. This implies that mobile health is easily

embraced by the young generation. Sim (2019) concludes that there is utility shift in

use of mobile health. It is the shift from the earlier monitoring and descriptive tools to

modern digital disease diagnosis, surveillance and treatment. The scholar argues that

it has greatly improved healthcare service delivery despite barriers such as mobile

health regulation policies, mobile health payment challenges as well as difficulty in

identifying appropriate digital biomarkers.Moble health is revolutionalizing

healthcare service delivery through the use of mobile health apps. Due to the

emerging pandemics such as Covid-19, there is need for mobile health systems to

meet the needs of patients. Schizophrenia has been widely managed using mobile

health systems. It has led to research and innovation in mobile mental health (Torous

& Keshavan 2020).

9
Mesut (2015) argues that the most extensive adoption of wearable technologies is in

the health sector Mobile health was measured using the frequency of use of mobile

phones, tablets and personal digital assistants during service delivery. According to

Brady (2006), wearable health devices can be used to diagnose and treat several

diseases so as to improve service delivery. Wearable health technologies were

conceptualized on the level of use of heart rate monitors, hearing aids, blood sugar

monitors and blood pressure monitors. Wearable health devices having been recently

introduced in the market have opened avenues for treatment of chronic illnesses

through close monitoring and treatment. The devices are capable of doing instant

assessment of patients’ conditions and are empowered with several biosensors to

transmit real-time information to be used when prescribing treatments (Dias and

Cunha, 2018).

According to Dinh-Le, Chuang, Chokshi, and Mann (2019) wearable health

technology is instrumental in enhancing transparency between patients and chronic

condition management in healthcare facilities. Wearable health gadgets facilitate

movement of data from patients to doctors (Greiwe and Nyenhuis 2020). The author

argues that they help in tracking patients’ health progress thus empowering them to be

managers of their own health. The scholar claims that wearable health devices are

capable of transmitting crude responses signaling users to either halt their operations

or proceed. Therefore it helps in preventing unforeseen health risks associated with

lack of monitoring and control. Majority of wearable health devices generate accurate

personal wellness reports which aid in health coaching and guidance towards set

health goals (Greiwe & Nyenhuis, 2020).

10
1.1.3 Private Hospitals in Bomet County, Kenya

In Kenya, the health system is made up of the Ministry of Health, parastatals and the

private sector. The Kenya’s new constitution adopted in August 2010 created a

pathway to devolved healthcare system to improve efficiency, stimulate innovation

and improved access to healthcare services through equitable distribution of

healthcare facilities in all the 47 counties. Formal devolution of health services in

Kenya was done on August 2013 with a complimentary budget of Kenya Shillings

210 billion (Barker, Mulaki, Mwai, & Dutta, 2014).

The private hospitals in Kenya fall into two categories; the non-commercial private

sector and private for- profit sector. The non -commercial private sector comprises of

healthcare facilities established by Faith Based Organizations (FBOs), Non-

Governmental Organizations (NGOs) which include mission hospitals, mission clinics

and dispensaries. Kenya has a total of 9696 health facilities spread across the country.

According to Kenya Master Facility List of 2016, 4616 of these facilities are operated

by the public sector while 3696 are run by the for-profit private sector. Out of the

3696 private facilities, 1384 centers are operated by Faith Based Organizations

(FBOs), Non-Governmental Organizations or Community Based Organizations

(CBOs).Tenwek and Kaplong mission hospitals fall under the private hospitals run by

Faith Based Organizations.

The size of private healthcare market is estimated at Kenya Shillings 20.7 billion (260

million US Dollars). Private hospitals take 67% of all the money spend by Kenyans in

the private sector. The private health sector in Kenya is the largest employer of

healthcare professionals because the private healthcare sector owns 67% of all the

country’s healthcare facilities (World Bank Group, 2010)

11
Private Hospitals meeting level 5 and 6 standards do not exist unlike public healthcare

sector which has a few. Electronic health record, telemedicine, mobile health as well

as wearable healthcare technology have been uniquely integrated in Tenwek and

Kaplong mission hospitals’ private healthcare management. This has been done

despite the high costs involved in acquisition and implementation and the common

notion that private hospitals are efficient in nature and are driven by high profit

margin goals. Private hospitals in Bomet County especially Tenwek and Kaplong

mission hospitals have integrated Healthcare ICT in service delivery and have not

compromised the affordability and quality of healthcare services (Mulaki & Muchiri,

2017).

1.2 Statement of the Problem

Due to the rising population in Kenya and the increase in complexity of ailments

affecting human beings, service delivery in healthcare facilities has been recording

challenges ranging from inefficiency in treatment and poor patient progression from

one point to the next, loss and misplacement of patient files, Poor diagnosis leading to

worsening of illnesses among patients and lack of an efficient payment and revenue

collection system as well as obsolete ICT equipment and systems. Service delivery

has therefore been poor, inefficient and ineffective. According to Health Sector

Analysis Report (2013-2014), the citizens of Bomet County have been complaining of

inefficiency in service delivery in the available healthcare facilities where relative

efficiency level is 43.1% which is below average.

Achievement of Millennium Development Goals on healthcare which involves

delivery of interventions to reduce mortality levels among children, mothers and

adults in the society (WHO, 2010).Tanahashi (1978) acknowledges the use of

12
different terms such as utilization, coverage, availability and access to determine

whether people are receiving healthcare services they need or not. Access to

healthcare services is guided by their availability, affordability and acceptability by

clients to use the services (WHO, 2010).

Peters, Garg, Bloom,Walker, Brieger, and Hafizur (2008), developed a balanced

scorecard used to survey healthcare facilities in order to fully develop healthcare

services. The scorecard generates data through interviews with healthcare sector

workers, facility surveys, client provider and exit interviews aimed at determining the

level of customer satisfaction and perceptions on service quality. The major

components of the scorecard are indicators of service quality which include;

availability and access, service safety, efficiency, quality and service equity (WHO,

2010).

Berenson & Cassel (2009) observes that Poor service delivery in healthcare

management as characterized by inefficiency and inconsistency was driven by supply

chains which locked out clients from participating in decision making towards

improving delivery services. The Vision 2030 developed by the government of Kenya

considers health as a pillar in enabling the country to provide efficient, high quality

and affordable healthcare services to all citizens with emphasis on a devolved

healthcare system to offer preventive and curative care at the community level

(Omondi, 2016).

According to Zineldin (2006), the current patients’ dissatisfaction being witnessed in

health care facilities results from poor service quality and high medical costs in

developing countries. This has become the driving force for the struggle to improve

healthcare service quality. Parasuraman, Zeithaml, and Berry (1985), defines service

13
quality as the gap between a patient’s expectation and perception of services delivered

along the quality dimensions.

Todays’ consumers of healthcare services are increasingly sophisticated,

knowledgeable, and confident on healthcare issues and this motivates service

organizations to constantly strive for quality service provision. According to Kotler et

al. (2011), the advancement in quality of healthcare products and services is driven by

consumers who actively update service providers on their experiences through active

research and communication so as to maximize healthcare benefits.

1.3 Objectives of the study

This section consists of general and specific objectives.

1.3.1 The General objective

This study investigated the effect of Information Communication Technology

strategies on service delivery in private hospitals in Bomet County, Kenya.

1.3.2 Specific Objectives

The specific objectives of the study were to:

i. Assess the effect of electronic health records on service delivery in private

hospitals in Bomet County, Kenya.

ii. Determine the effect of telemedicine on service delivery in private hospitals in

Bomet County, Kenya.

iii. Establish the effect of mobile health on service delivery in the private

hospitals in Bomet County, Kenya.

iv. Establish the effect of wearable health technologies on service delivery in

private hospitals in Bomet County, Kenya.

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1.4 Research Hypothesis
i. Electronic health records have no significant effect on service delivery in

private hospitals in Bomet County, Kenya.

ii. Telemedicine has no significant effect on service delivery in private hospitals

in Bomet County, Kenya.

iii. Mobile health has no significant effect on delivery of services in private

hospitals in Bomet County, Kenya.

iv. Wearable health technologies have no significant effect on service delivery in

private hospitals in Bomet County, Kenya.

1.5 Significance of the study

The findings and recommendations of the current study are beneficial to the

following:

1.5.1 The management and staff of private hospitals

The managers and staff of private hospitals can use the findings and recommendations

of this study to gauge their progress towards achieving their goals and objectives by

investing in healthcare ICT. This involves investing in ICT systems, internet, mobile

technology and digital diagnostic and treatment machines to deliver healthcare

services to its clients and boost service delivery. With an ICT added value, employees

would be able to operate effectively and efficiently in delivering optimal treatment

and care to the patients. Hospital staff can use the findings to improve on their

commitment to the use of ICT in improving healthcare services. The management

benefits from the findings in regard to improvement on their organizational roles.

This study found out that ICT networks and computers have a key role in aiding the

delivery of effective and efficient healthcare services. The management and staff of

15
healthcare institutions should therefore implement ICT innovations use in their

institutions. The management should procure modern ICT systems and equipment to

pave way for efficiency in service delivery. The management of healthcare

institutions should also invest in training staff on technology innovations and their use

in boosting responsiveness, effectiveness and efficiency in service delivery.

1.5.2 Communications Firms and Internet Service Providers

The communications industry in Kenya is undergoing rapid developmental changes.

To benefit from the ready market in the remote geographical places, the firms should

ensure that they put adequate investment in reaching out to underserved regions.

Healthcare sector offers a high opportunity for ICT investments. The private sector is

notably the best consumer of ICT services. Findings in the current study indicate that

internet networks and computers play a key role in facilitating use of electronic health

records, use of telemedicine, mobile health and wearable healthcare technologies.

Communications and internet service providers should invest in modern effective

equipment and systems which can facilitate efficient use of their services by the

healthcare providers. Communication firms should engage in research and

development towards development of advanced healthcare ICT systems and

equipment together with the best ICT infrastructure for healthcare service provision.

1.5.3 The Government of Kenya

The private healthcare sector is one of the contributors towards achievement of

government‘s goal and objective of providing affordable quality healthcare to all

citizens. The study is important to the government in formulating policies to establish

public private partnerships in Healthcare ICT so as to realize the global millennium

development goal of quality healthcare provision to all. The government can also use

16
the research to identify best approaches towards involving the private healthcare

providers as government’s agents of quality healthcare service provision.

The findings from the current study calls for government’s intervention in subsidizing

the high cost of procuring modern healthcare ICT systems and equipment for use in

hospitals across the country. The government should also strengthen public-private

partnership in ICT healthcare provision.

1.5.4 The Society

Healthcare services are established to serve the human community. Through efficient

and effective quality healthcare services, the members of the society will live healthy

lives. The study recommends that members of the society being healthcare

beneficiaries should be sensitized on the importance of embracing use of technology

in accessing healthcare services in hospitals.

1.6 Limitation of the study

The following factors influenced the process of the research:

1.6.1 Accessibility to confidential health information.

Healthcare employees were shy to give any information concerning their clients’

health progress as a result of technology use since the medical staffs are always

governed by professional oath of keeping clients health information as a secret. To

mitigate against the uncooperative respondents who were concerned with their job

security, reassurance letter was written to them by the researcher to enhance trust and

show commitment.

17
1.6.2 Unreturned Questionnaires

Respondents filling the questionnaires and failing to return was safeguarded by

simple, clear and brief questions which eliminated perceived high time consumption

required to fill the questionnaires often seen as a waste of time in the work place.

1.6.3 Uncooperative respondents

In order to boost management and medical staff rapport for the study, their

confidentiality was guaranteed through the use of anonymous questionnaires, and the

principle of voluntary participation in the research.

1.7 Scope of the study

The study took place within Bomet County at Tenwek and Kaplong hospitals, where

medical staff and management team were the respondents. The study also involved

the use of questionnaires at the selected hospitals to get data from employees. This

study was carried out in the year 2020 on effect of healthcare ICT strategies on

service delivery.

1.8 Organization of the Study

This study comprises three chapters. The first chapter examines background of the

study, Statement of the problem, Objectives of the study, research questions, and the

significance of the study. This chapter further discusses limitations and scope

including how the study was organized. Chapter two of the study presents a

theoretical review, the empirical review, research gaps and the chapter ends with a

conceptual framework. Chapter three comprises research methodology, research

design, target population and techniques used during data collection and procedures of

data collection. The chapter also discusses validity and reliability and data analysis

18
together with presentation. The chapter gives regression analysis and ends with ethical

considerations. Chapter four comprises data analysis, results and interpretation.

Chapter five discusses summary of findings, conclusion and recommendations.

19
 CHAPTER TWO

LITERATURE REVIEW

2.1 Theoretical Literature Review

A theoretical review critically examines the evolution of state of knowledge and

scholarly works already published (Taveggia, 1974). Basing research studies on

existing theories facilitates scientific inferences in guiding the research works hence

giving validity to newly discovered knowledge (Cooper, 1982).

2.1.1 Information Theory

In 1948, Claude Shannon in his mathematical theory of communication

comprehensively describes how much information can be exchanged between

different members of a system. According to Stone (2015), the ability to precisely

separate signals from noise as indicated by Shannon (1948), was a green light to

modern success in ICT industry. The Information theory discusses the benefits of

information that have been systematically organized and stored for easier retrieval and

reference as electronic records. The applicability of this theory arises from the need to

perform healthcare raw data analysis and transmission, data encryption and

compression as well as access and retrieval of information. The theory is used to

explore compressed digital data and its storage. Examples of application of the

Information Theory are the Zipping of healthcare data using computers as electronic

records and healthcare consultations by use of Telemedicine. This theory guided the

study on the effect of electronic health records, telemedicine, and mobile health and

wearable health technologies and service delivery in private hospitals.

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2.1.2 Actor-Network-Theory (ANT).

ANT was founded by a French anthropologist, Bruno Latour with a British sociologist

Steve Woolgar in 1970’s after engaging in a comprehensive field research at the Salt

Lake Institute in California. Latuor (1993) explains that people should think of

humans and non-humans as inseparable actors co-existing in a social environment.

ANT explores how relations between objects, people and concepts are formed and is

not interested in why they are formed. The three components of ANT include;

Heterogeneous networks, network consolidation and network ordering. This theory

postulates that ICT is both a technological and social phenomenon. This theory

explains why people and technology coexist as observed in ICT use in the healthcare

sector. ANT as both a theory and method helps in seeking the relationship between

healthcare, society and technology. Lee (2001) strongly advices researchers

examining the field of technology to ensure that their works give the relationship

between phenomena. According to the author, technology does not function in

isolation but rather coexist in a mutual environment which is characterized by social

interactions where users interact with technology. There is a network between

electronic health recording and telemedicine. The hospitals are trying to consolidate

these networks. In the current study ANT theory is linked to the first and the second

specific objectives of the current study.

2.1.3 Unified Theory of Acceptance and Use of Technology. (UTAUT)

Venkatesh, Morris, Davis and Davis having thoroughly studied previous theories

developed UTAUT in 2003 out of; Theory of Reasoned Action(TRA) from Fishbein

and AJzen (1975), Technology Acceptance Model (TAM) from Davis (1989),

Venkatesh and Davis (2000); Motivation Model (MM) from Davis, Fred , Richard

21
and Paul. (2006); Theory of Planned Behavior (TBP) from Taylor and Todd (1995);

Model of PC Utilization (MPCU) (Thomson et al., 1991).

Other parent theories are; Innovation Diffusion Theory (IDT) from Moore and

Benbasat (1991); and Social Cognitive Theory (SCT) from Compeau and Higgins

(1995) and Compeau, Higgins and Huff (1999).This study will use UTAUT’s four

predictive determinants to examine the behavioral intention governing the use of ICT

strategies in healthcare service delivery within the research population. These

determinants are; performance expectancy among the ICT users, Social Influence,

effort expectancy as well as facilitating conditions within the private healthcare

system. The four key moderators that were identified by Venkatesh, Morris, Davis,

and Davis (2003) as affecting the relationship between determinants and intention

include; voluntariness and experience gender and age.

According to Venkatesh et al. (2003), attitude is that affective reaction that attracts

individuals into using a system. Faith-based hospitals have a rich history of attaining

the Christian mission of assisting the suffering. This virtue is driven by a positive

attitude towards that which will enable the management to attain their mission. This

theory is linked to the use of electronic health records and mobile health in service

delivery in private hospitals in Bomet county Kenya.

2.1.4 SERVQUAL Model

In 1985, Parasuraman, Zeithaml& Berry developed SERVQUAL model from the

following ten dimensions of service quality; tangibility, reliability, responsiveness,

competence, access, courtesy, communication, credibility, security as well as

understanding. Parasuraman, Parsu, Zeithaml, Valarie ,Berry and Leonard (1988),

conducted further research on service quality and among ten elements of service

22
quality, only tangibility, reliability and responsiveness remained constant while the

remaining seven determinants were synthesized into assurance and empathy. This

resulted in the modified version of SERVQUAL model which has five service quality

dimensions namely; tangibility, employees’ appearance and available facilities,

reliability of carrying out service delivery consistently and accurately, responsiveness

of employees to customer demands, assurance that can translate to customer

confidence on services, as well as empathy on how the organization provide care and

attention to customers. Buttle (1996) recommends SERVQUAL use in measuring

customers’ perceptions towards service delivery. The SERVQUAL model addresses

study variables of reliability and responsiveness.

2.2 Empirical Literature Review

This section examines and reviews existing literature within the objectives of the

study. This includes key studies on ICT and service delivery in private hospitals in

Kenya.

2.2.1 Electronic Health Records and Service Delivery

The origin of Electronic Health Records can be traced bank to paper-based data

records of patients in Healthcare facilities. Berenson and Cassel (2009) in their study

of consumer –driven healthcare observes that consumer awareness in healthcare

sector enables them to shop for quality services and prompting the healthcare service

providers to be more responsive to quality service provision. Poor service delivery in

healthcare management characterized by inefficiency, poor response to medical

emergencies and poor medical coverage of remotes places are attributed healthcare

providers locking out clients from participating in decision making towards improving

23
delivery services. The study however is broad and lacks to examine service delivery

strategies in private hospitals.

Zineldin (2006) in their study on patients’ satisfaction noted that the current patients’

dissatisfaction being witnessed in health care facilities results from poor service

quality and high medical costs in developing countries. This according to him

influences a patient’s recommendation of best healthcare facilities to others facing

similar health challenges. This has become the driving force for the struggle to

improve healthcare service quality. Parasurman et al. (1985) studied service quality in

terms of a gap between a patients’ pre-set standards and need for services delivered

along the quality dimensions. Both studies examine patients’ satisfaction during

service delivery but fail to examine the specific tools that facilitate improvement of

service delivery which this study focuses on.

A study done by Smaltz, Detlev and Eta (2007) concludes that EHR help hospital

staff in delivering efficient and effective medical services. Electronic Health Records

help hospital staff fast-track patient registration and store accurate patient information

which translates to efficiency during service delivery. EHR role in service delivery

include; tracking patients’ registration, managing and delivery appropriate data as

well as storage of real-time comprehensive healthcare information. Gerber et al.,

(2010) observes that electronic health records is one of the wide range of healthcare

ICT systems whose other components include telemedicine, healthcare information

systems, use of mobile devices-learning and decision support systems.

According to Blair (2007), Electronic health records act as a reliable backup tool for

retrieval of patient’s information during emergency healthcare need since it facilitate

quick retrieval of patients’ information for timely treatment. Miller and West 2007 in

24
their study on the value of electronic health records in community health facilities,

highlights the benefits of Electronic health records as leading to improved quality of

healthcare provision, access to medical record, reduced costs of keeping paper

records, reduced human errors associated paper based filing. EHR also leads to

saving of time during treatment of patients.

The current study examined Electronic Health Records in terms of patients’ Medical

records, laboratory records, procedure reports as well as discharge summaries.

2.2.2 Telemedicine and Service Delivery

In their study on technology acceptance model using physician acceptance of

telemedicine, P.J. –H., Ma, P.-C., & Chau, P.Y. (1999) concludes that telemedicine is

an IT based innovation that helps physicians enhance patient care which in turn

enables healthcare organizations to uplift their competitive advantage.. Although the

initial cost of implementation of telemedicine is high, it becomes cost effective in the

long run as it aids in capacity building in healthcare systems in developing countries

(Campenella et al., 2004).

Telemedicine in Latin America involves the use of distance education to encourage

mothers to breastfeed their babies (De Orneset al., 2002). Telemedicine improves

maternal health in rural areas (Martinez, 2005) while in urban areas, it helps in mental

health promotion. In Africa, AMREF is expanding its clinical coverage in rural areas

with the help of Telemedicine. Telemedicine provides a professional platform to

medical staff in hospitals supported by AMREF with a target of expanding across

about 80 rural hospitals across east Africa. Kangethe, (2018) concludes in her study

that telemedicine enables patients to carry out self-monitoring, disease management

and improvement in adherence to medication.

25
In their study on Telemedicine, Eysenbach, (2001), Turner (2003) Whitten, Sypher

and Patterson (2000) observes that telemedicine system comprises of computerized

equipment which facilitates medical professionals to deliver healthcare services away

from the point of service delivery. Their findings show a significant contribution of

Teleconsultation to improved service delivery in healthcare management.

Verhoeven, Dijkstra,Nijland, Eysenbach and Pijnen (2010) concludes that the use of

Telecommunication for information monitoring and exchange via emails, mobile

phones and automated messaging services has led to significant improvement in

healthcare service delivery. Video conferencing acts as a link between healthcare

providers with their clients simultaneously through healthcare education. The

equipment used in teleconferencing includes television, digital camera, webcam and

videophone among others.

Telemedicine has been widely accepted in healthcare disease management from a

study done by Bloom, 1996 and Turner, 2003. This is attributed to the decrease in

waiting time, travel time and poor service from use of telephone systems to make

medical calls and appointments. The ministry of health report of 2016 in Kenya,

observes that telemedicine was established jointly by the Government and German

Merck which aimed at enabling the rural areas access quality healthcare services

through the use of Teleconferencing. This program invested 100,000 Euros for the

initial phase which linked the medical experts at Kenyatta National Hospital with

Machakos level four hospital. This technology aimed at boosting research and

development and provided a strong foundation for pharmacovigilance, community

awareness and healthcare education.

26
From a study done by Wasonga (2015), telemedicine can be put in two categories;

real-time and pre-recorded diagnosis, treatment and prevention of ailments from a

distance. In a study by Wooton, Craig and Patterson (2006),real-time telemedicine

consists of teleconsultation, tele-pathology and tele-dermatology. Mea (2006)

postulates that pre-recorded telemedicine include tele-electrography, tele-obstetrics as

well as tele-radiology.

Chetley, Davies, Trude, McConnell, and Ramirez, (2006) observes that telemedicine

can be the best reliable and cost effective way that the developed nations can use to

reach out and aid the healthcare systems of poor countries across the world. This fact

is attributed to the high cost acquisition and implementation sophisticated

telemedicine remote systems which require high bandwidth. Wasonga (2015)

recommends use of telemedicine in service delivery because it facilitates exchange of

information between patients and healthcare providers.

2.2.3 Mobile Health and Service Delivery

Free, Philiphs, Watson, Galli, Felix and Edwards (2013) in their study on mobile

health found out that mobile health is an emerging ICT strategy being adopted

globally by several healthcare facilities in care and treatment of patients . Mobile

health involves the use of mobile devices such as cell phones, smart phones and

tablets, under a global network to deliver health services and information. Marufu and

Maboe (2017) in their study on utilization of mobile health by doctors recommends

that mobile health technology education should be given to the medical staff so as to

improve service delivery. Studies indicate that M-health facilitates easy

communication among healthcare staff and their clients thereby leading to improved

customer satisfaction (Lewis&Kershaw, 2010).

27
Lemens (2013) observes that Use of short message services (SMS) phenomenally

improved the rate of early infant diagnosis (EID) amongst those pregnant mothers

infected with HIV and are enlisted in prevention of mother–to-child transmission

(PMTC) program in Kenya hence improving customer satisfaction. M-Health being

adopted rapidly in Kenya because of the high mobile phone penetration among the

Kenyan population. The M-Health in Kenyan healthcare facilities currently focuses

on use of mobile devices in data collection, storage and data exchange as investigated

by Kenyan Healthcare Sector Market Study Report of 2016.

Clansan et al., (2013) in their study noted that mobile health involves the use of

mobile devices and global network to deliver health services and information. Mobile

devices most commonly used include cell phones, feature phones, smart phones and

tablets.

Chester et al., (2017) concludes that the successful use of M-health by medical

doctors to improve health outcomes will require the institution to educate the doctors

and other health team members on the benefits of M-health as well as advocating for

the innovative use of mobile technology in healthcare practices.

In their study on text messaging tools in healthcare service delivery, Cole-Lewis and

Kershaw(2010) observes that M-health field is accruing evidence that technology

integration within the health sector has great potential to promote better health

communication to influence positive healthy lifestyle, improve decision making by

health professionals and clients, and enhance healthcare quality by improving access

to health information and communication where this was previously not possible.

There is ample evidence in the scholarly literature that demonstrates the usefulness of

ICT tools such as M-health interventions(Telemedicine, web-based strategies, email,

28
mobile phones, mobile applications, text messaging and monitoring sensors) for

reducing adverse effects of diabetes and hypertension in developed countries

discovered by De Jonghet al.,(2012)

In her study, Carol Leach-Lemens, 2013, noted that HIV positive women over 18

years of age enrolled in a PMTC program were randomized to receive either SMS text

messages (195) or the usual care (193).Use of text messaging significantly improved

the rate of early infant diagnosis(EID) among HIV-positive pregnant women enrolled

in prevention of mother -to- child transmission(PMTC) program in Kenya according

to researchers of the seventh international AIDS society conference on HIV

pathogenesis, treatment and prevention (Carole Leac-Lemens,2013). Messages were

developed according to the constructs of the health belief model as follows; Perceived

susceptibility- an individual’s assessment of the risk of medical consequences of not

attending clinic and infant not being tested, Perceived severity-individual’s

assessment of seriousness of this and consequences, Perceived barriers-an individual’s

assessment of the influences that facilitate or discourage adoption of the promoted

behavior as well as Perceived benefits –an individual’s assessment of the positive

consequences of adopting the behavior.

Depending on the gestational age, those in the SMS group received up to eight text

messages before delivery and after. In total, there were outcome data for 38(98.2%)

women with a median age of 27 years. At baseline, medium gestational age was 34

weeks. In total, close to 20 %( 38/194) of those in the SMS group attended a post-

partum clinic compared to 11 %( 22/187) in the control. Those in the control had over

one and a half times the increased risk of not attending clinic after giving birth, 95%

of the 1012 HIV positive pregnant women interviewed, 490(47%) were ineligible;

29
either the did not own a cell phone (35%) or they were illiterate (21%).Of the 468

births (90%), only 315 were followed up until 8 weeks (Carol Leach-Lemens, 2013)

Non-communicable diseases (NCDs) are a global occurrence affecting increasing

number of individuals. NCDs contributed to 63% of the 57 million deaths worldwide

(Alwan, 2010). A strong partnership between the Dutch government, Pfizer

Foundation, Care Play, Pharm Access Foundation and Safaricom has led to the

introduction of M-Tiba Health wallet into the Kenyan M-Healthcare sector. Through

this system, M-Pesa is used to keep donor funds and customers’ accounts as well as

transfer funds to accredited healthcare providers to facilitate smooth service delivery.

2.2.4 Wearable Healthcare Technology and Service Delivery

In a study on affective wearable, Picard & Healey (1997) explains that a wearable is

anything worn by the user. Collier & Radolph (2015) discovered that there is a merger

between fitness and wearable health devices. The wearable medical devices market

report of the year 2016, explains that the current focus among healthcare providers is

driven by technological advancements in development of medical devices and launch

of several smart phones based healthcare apps compatible with wearable devices. ABI

research indicates that the wearable technology market is projected to reach 170

million devices by 2017, while the revenue from the sale of wearable technologies is

estimated to reach 19 billion US dollars by 2018 (Kurwa, Mohammed & Liu, 2008).

Rutherford (2010) in a study on wearable technology health solutions observes that

wearable healthcare technologies are spearheading a great paradigm shift in the health

sector. The greatest contribution of wearable technologies delivery of healthcare

services is its ability to monitor a patient’s health status and gather useful information

30
in service delivery as indicated in a study done by Chan, Esteve, Fourniols, Escriba

and Campo (2012)

Bonata (2010) in a study on advances in wearable technology found out that the

technology helps doctors monitor the heart rate, the patient’s blood sugar level, the

blood pressure, fever and other health indicators. Anand et al. (2016) in their study on

wearable health technology, conclude that wearable healthcare gadgets offers much

promise to improve healthcare service delivery for both patients and healthcare

service providers these devices facilitate constant monitoring and data collection

which are used in developing a pattern of patient behavior useful in healthcare service

delivery. Leonard, Silverman, Sherpa,Naegle, Kim, Coffman and Ferdschneider

(2017), found out that wearable health interventions blended well with mobile health

in management and treatment of ailments. Wearable sensor bands aided in tracking

heightened emotions among users. Management of thoughts and feelings triggered by

the immediate environment can be monitored consistently using wearable mobile

health technologies.

2.3 Summary of gaps in literature review

The Information theory helped in linking efficiency and reliability of electronic health

records to organization, storage retrieval and exchange of healthcare information

during service delivery through use of computers and healthcare ICT systems. During

this study, the theory failed to address the challenge of keeping patients’ information

confidential without compromising the process of healthcare service delivery. When

ICT equipment breaks down or slowdown in functioning, efficiency and reliability is

compromised. The information Theory does not address these emerging issues during

ICT use in service delivery.

31
During this study Actor-Network theory supports the fact that society and technology

are inseparable and coexist because Electronic Health Records and mobile health

boost efficiency and convenience while telemedicine facilitates collaboration during

service delivery. The theory does not explain responsiveness by healthcare

management towards adoption and use of ICT during service delivery. The theory

also failed to highlight the link between ICT strategies use and reliability during

service delivery.

Unified Theory of Acceptance and Use of Technology by Venkatesh et al.,(2003)

supports the results of this study as seen in the adoption of healthcare ICT in private

hospitals because of the anticipated performance expectancy by the healthcare staff.

The study also found out that there is a positive attitude among healthcare staff

towards technology. The theory, however failed to show whether religious mission of

the healthcare facilities under study contributed to the positive attitude towards

healthcare ICT by healthcare staff.

The SERVQUAL model established that healthcare ICT adoption improved service

delivery through promotion of responsiveness and reliability. The theory failed to

address the issue of efficiency, convenience and collaboration which are part of the

variables in this study.

A study done by Wesso (2014) on the perceived quality of healthcare services and

patients’ satisfaction relied on the generic theory, the Nordic perspective and the Gap

theory to carry out investigation in South African public hospitals. The current study

uses Information theory, ANT, SERVQUAL and UTAUT to study the influence of

ICT strategies on service delivery in private hospitals. Kanyua (2015) employed

Innovations-Diffusion theory and contingency theory to investigate the factors

32
influencing adoption of ICT in public hospitals in Kenya. This study failed to utilize

the theoretical frameworks guiding this research.

Wanjau, Muiruri, Ayodo & Eunice (2012) studied employee competence, adoption of

technology, type of ICT channel used, financial resources and technological

advancements as dependent variables of quality of healthcare service. This however,

did not look at ICT strategies employed in the current study. Mwonjoria

(2014),focused his study on factors influencing utilization of health services where he

concluded that medical prescription’s ,product efficiency, healthcare infrastructure,

staff attitude, professionalism, compassion; ,communication and courtesy greatly

influenced service delivery. The current study focuses on electronic health records,

telemedicine, mobile health and wearable health technologies in service delivery.

Nderitu (2016) investigated service delivery quality based on tangibility,

responsiveness, emphathy, healthcare infrastructure and staff professionalism leaving

gaps on efficiency, convenience, collaboration and reliability which the current study

addresses. Mwangi (2017) investigated the role of financial resources, Information

technology departments, security and privacy as factors influencing ICT strategy

adoption in public hospitals in Kenya leaving a gap for study in private hospitals.

Namusonge & Muturi(2014) investigated the role of financial resources on ICT

performance unlike the current study which examines the quality of healthcare service

delivery as a result of ICT strategies adoption in private hospitals.

Oyegoge (2013) used interviews and surveys to study the adoption and utilization of

ICT in Nigerian hospitals. The current study uses descriptive research design. Wood

(2014) employed cluster sampling technique to investigate decision making in

healthcare management in relation to ICT adoption which provides a gap for stratified

33
 sampling technique use as employed in the current study. Nisakorn & Thanakorn

(2013) concentrated on factors affecting the adoption of healthcare Information

Technology by randomly sampling hospital departments unlike the current study

which used stratified sampling.

Table 2.1: Research Gaps summary

Researcher Theme/Topic/ Research Findings Gaps of Aim of study

Objective Research
Omondi (2016) Factors Influencing He found out that The study This study
delivery of service in Management was focused on
government has to delegate carried private
hospitals in Kenya responsibilities so as to out in hospitals in
improve daily operations Public Kenya
It was also discovered that hospitals
rare use of ICT systems and in Kenya
equipment during service
delivery caused inefficiency
in public hospitals.
Wesso (2014) The perceived The investigation was done The This study
quality of Healthcare in South Africa investigati was carried
services and Investigation targeted on was out in Kenya.
patients’ satisfaction perceived Quality done in
in South African The study uses Generic South
Public Hospitals theory and The Nordic Africa
perspective and the Gap
Perspective as theories
guiding the study.

Factors Influencing The study found out that The study This study
Akacho(2014) provision of insufficient financial used used
healthcare service resources, human resources census descriptive
delivery in Kenya and poor communication and research
channels negatively affected survey design
service delivery method of
study

34
Wanjau et Factors Affecting They found out that Research This research
al.(2012) Provision of service employee incompetence, was covered
Quality in the public adoption of Technology, carried private
Health Sector type of communication out in the healthcare
channel used as well as public sector
technological advancements healthcare
affected service delivery sector
Also discovered that lack of
financial resources
negatively affected service
delivery

Mwonjoria Factors Influencing The study found out that The study This study
(2014) utilization of Health correct diagnosis, medical focused focused on
services in Private prescriptions, product on factors ICT strategies
Health facilities efficiency, reliability and the influencin on service
physical attributes of g delivery
healthcare infrastructure utilization
Affected service delivery. of health
Another finding shows that services
staff attitudes,
professionalism
,communication
,compassion and courtesy
greatly influenced service
delivery
Nderitu(2016) Service Quality and The researcher found out The study This study
Performance of that an increase in focused focused on
Private Hospitals In tangibility, responsiveness on service Service
Nairobi County and empathy in service quality Delivery
delivery led to a
corresponding increase in
performance of Private
Hospitals
The study also found the
private hospital’s easy-to-
use Infrastructure,
professional friendly staff
and customer friendly
payment method.

Mwangi(2017) Factors Influencing Availability of financial The focus This study

adoption of ICT resources, IT department, was on focused on
Strategy in The Patient exposure, Patients’ public private
Kenyan Public medical history as well as Hospitals Hospitals
Health Sector privacy and security
influenced strategy adoption
in Kenyan public Hospitals

35
Abdalla & Effects of ICT The research found out that Research This research
Wanjiru Adoption on organizations value data was on dwelt on ICT
(2015) Procurement Process transfers, placement and ICT in the in Healthcare
in Kenya’s Oil tacking of orders as well as oil sector sector
Industry general procurement policies
Nyaggah Factors Influencing Availability of Funds, The study This study
(2015) Adoption of ICT training, ICT Infrastructure, used used
Public Hospitals in staff attitude influences the Innovatio Information
Kenya Implementation of ICT in ns- Theory,
Public Hospitals in Kenya Diffusion ANT&SERV
Theory QUAL model.
&Conting
ency
Theory

Namosonge & Financial Resources The study discovered that The study This study
Muturi(2014) on ICT Performance organizations seeking to be deals with focused of
In Inventory at par with modern Inventory service
Management by technological advancements Managem delivery
Freight Forwarders have to invest heavily in ent
ICT.
Oyegoge(2013) Adaptation and It was discovered that ICT Research Descriptive
Utilization of ICT In adds value ,reduces costs of Method research
Nigerian Hospitals operation, manages risks and involved design was
is instrumental in creating use of used
new reality innovations Interview
s and
surveys
Otieno (2013) To Explore Factors Work performance is The study This study
Influencing the affected by the Adoption of is focused on
Adoption and Use of ICT in areas including; restricted delivery stage
ICT in Healthcare, working speed, enhanced to the of services
Kenya. communication and Increase Adoption
in productivity stage of
ICT
Wood(2014) Tales from Tenwek: Decision making in Used This study
Case Studies From Healthcare management is cluster used stratified
Bomet, Kenya determined by the available sampling sampling
healthcare professionals, technique technique.
Finances,
And access to Technology

Phichitchaisop Factors Affecting the The study discovered that Target The study
a & Naenna Adoption of the quality and Performance populatio used tratified
(2013) Healthcare of ICT helps hospital n studied samples.
Information employees deliver better randomly
Technology services

Source: Researcher (2020)

36
2.4 Conceptual Framework

Figure 2.1 illustrates conceptual framework on the relationship between variables.

ICT Strategies
Independent Variables Dependent Variables
Electronic health records
 Medical records H01
 Laboratory records
Service Delivery
 Procedure reports
 Discharge summaries

Telemedicine
 Efficiency
 Teleconferencing H02
 Teleconsultation
 Medical Imaging  Convenience
 Remote Patient Monitoring

 Collaboration
Mobile health H03
 Cell Phones
 Tablets  Reliability
 PDAs

Wearable health technologies  Responsivenes

 Hearing aids H04
 Blood pressure monitors
s
 Blood sugar monitors
 Heart rate monitors

Figure 2.1: Conceptual Framework of the Study

This framework summarizes the relationship between electronic health records,

Telemedicine, mobile health, and wearable health technologies with efficiency,

convenience, collaboration, reliability and responsiveness.

37
 CHAPTER THREE

RESEARCH METHODOLOGY

3.1 Introduction

This chapter discusses research design, target population, sampling design and

explains the data collection procedures. Validity and reliability are also discussed

including data analysis, empirical model used and the ethical considerations of the

study.

3.2 Research design

Creswell (2014) explains research design as falling under strategies within qualitative,

quantitative and mixed methods useful in guiding research process. A research design

outlines appropriate steps an investigator will follow from formulation of research

questions, operationalization of the study variables as well as data analysis. This is

because research design is developed to build and portray confidence in research

outcome because it ensures that high levels of reliability and validity of research

instruments is achieved (Cooper & Schindler, 2008).

The use of descriptive research design in this study provided a clear picture of the

situation as it naturally happens as recommended by Burns & Grove (2003). This

involves defining, explaining and describing, comparing and contrasting and in

addition, tabulation of quantified information collected from the field.

3.3 Target Population

This study targeted 720 respondents who are the medical staff of the selected private

hospitals in Bomet County. Each category is shown in the following Table.

38
Table 3.1: Distribution of the Study population

Population Category Study population

Doctors 18
Clinical officers 157
Nurses 280
Pharmacists 14
Lab technicians 21
Ophthalmologists 40
Interns 190
TOTAL 720
Source: Tenwek and Kaplong Hospitals HR records of 2020

3.4 Sampling Design

This study employed stratified random sampling. A census of the target population

was stratified so as to respond to the research questionnaires. These were doctors,

clinical officers, nurses, pharmacists, laboratory technicians, ophthalmologists and

interns 30% of the targeted population was considered as recommended by Mugenda

& Mugenda (2003). In this study the sample size was 215 respondents. The sampling

table is presented in the following table:

Table 3.2: Target population distribution and sample size

Population category Population Sample size(30% of

population)
Doctors 18 5
Clinical officers 157 47
Nurses 280 84
Pharmacists 14 4
Laboratory Technicians 21 6
Ophthalmologists 40 12
Interns 190 57
Total 720 215
Source: Tenwek and Kaplong Hospitals HR records of 2020

39
3.5 Data collection procedures

This study used pre-formulated questionnaires which consist of both closed and open-

ended questions which promote comprehension accuracy and uniformity in questions.

The questionnaires will be issued and collected within three days.

After the selection of research tools, this study commenced with written request for

permission to carry out research in the selected hospitals in Bomet County, Kenya.

The written request for permission was delivered by hand to the selected hospitals.

During the presentation of the request, details of the topics under investigation

including relevance of the study findings were shared with heads of the hospitals

including the interested stakeholders.

After the approval of the request and a green light from the heads of the hospitals to

kick start the field study, the investigator established a friendly rapport with the staff.

In order to elicit best responses from the study, the investigator explained in clear

terms and any ambiguity in research questions clarified. Respondents were

encouraged to be frank, fair, honest and sincere through prior awareness that the

responses are meant for research purpose only and were handled with utmost

confidentiality. This means that no right or wrong response would lead to

victimization of the respondent.

Questionnaires were administered to individual respondents with sufficient time being

given between the questionnaire intervals. After every questionnaire session, the

respondents were appreciated orally. The final procedure involved manual collection

of the responses, arranging them according to their assigned numbers and analyzing

them according to their responses.

40
3.5.1 Validity

The validity of a research instrument is determined by its reliability to generate the

desired outcome. Validity is about the accuracy and meaningfulness of measurements

derived from research outcome (Bryman & Cramer, 2005). Shenton (2004)

recommends a combination of strategies be employed in ensuring trustworthiness in

research projects. This study therefore considered two types of validity: content

validity and construct validity.

To ensure content validity, this study subjected the questionnaire to double checking

and verification and use of pilot study. According to Mugenda & Mugenda, (2003), a

pilot test is an initial test used in verifying the validity of instrument before actual

research. The pretest sample that was used in this study is 3%. Pilot test during

research promotes clarity of research instruments which helps to highlight similar

interpretation of research questions among the respondents.

The variables in the study were operationalized to ensure construct validity hence

optimize theoretical assumptions guiding the study. Calculation of the correlation

coefficient was done for the two halves using SPSS version 25.0.0.0, where 0.803 was

obtained implying that the research instrument was reliable.

3.5.2 Reliability

Hair, Black, Tatham & Anderson (2006) explains that the main purpose of reliability

testing is to ascertain the credibility and trustworthiness of research data. Reliability is

the uniformity of true results produced by the set of variables being measured during

research. Hair et al. (2006) identifies two diagnostic measures that should be

employed in determining internal consistency. These are; Inter-Item correlation

(Correlation ˃ 0.3), which measures the correlation among research items and

41
Cronbach’s alpha (˃0.7) to measure the consistency of the whole scale. According to

Hair et al.,(2006), reliability testing is determined by the level to which a set of

measures represent a concept of interest with discriminate reliability examining the

level to which two concepts which are similar are conceptually are distinct.

To compute the coefficient of reliability the study used Split-Half method which is

done by scoring two odd and even items of a test separately. One test was

administered and the reliability index calculated using the Cronbach’s Alpha since the

study used Likert scale.

3.6 Data analysis and presentation

Primary data was collected from respondents in the field. This was followed by

editing and coding into specific categories. In analyzing the collected data

comprehensively, both quantitative and qualitative data were used with the help

SPSS. During the interpretation of quantitative data, descriptive statistics were used

while qualitative data was processed using thematic analysis. Analyzed data was

presented by use of tables, pie-charts and bar graphs. In the determination of the

relationship between the use of ICT strategies and service delivery in the selected

private hospitals, correlation and regression analysis was used.

3.6.1 Regression Analysis

During the estimation of the relationship between the dependent variable(Y) and the

independent variable(X) using a best fit line (regression line) on a scatter plot,

multiple regression models was used.

This model was defined by the equation;

y=a+bx1+bx2+bx3+bx4+Ɛ

Where a is the y-intercept of the line and b is its slope.

42
 a = the intercept

b = the slope of the line

y = service delivery

X1 = electronic health record

X2 = telemedicine

X3 = mobile health

X4 = wearable healthcare technology

Ɛ = Error

Table 3.3: Table on Operationalization and variables measurement

Variable Type of Indicators Quantification of Measurement of the
Variable Variables Variables
Information Independent  Medical Records  Level of 5 Point Likert type
Communication  Laboratory Reports usefulness Scale
Technology  Discharge  Frequency
strategies summaries of use
Electronic  Procedure Reports
Health Record s
Telemedicine Independent  Teleconfenecning  Level of 5 Point Likert type
 Teleconsulations usefulness Scale
 Remote monitoring
 Medical imaging
Mobile Health Independent  Use of cell  Level of 5 Point Likert type
phones usefulness Scale
 Use of tablets
 PDAs
 Mobile
computers
Wearable Independent  Hearing aids  Frequency 5 Point Likert type
Health  Blood pressure of use Scale
technologies monitors
 Blood sugar
monitors
 Heart rate
monitors
Service Delivery Dependent  Efficiency
 Convenience  Level of 5 Point Likert
 Collaboration usefulness type Scale
 Reliability
 responsiveness

Source: Researcher (2020)

43
3.7 Ethical considerations

Research data was only collected from voluntary respondents. A consent form for

participation was part of the questionnaire to ensure voluntary participation in the

study. Emergency assistance contact numbers were provided on the questionnaire for

any clarification that may be required by the respondent. Unconditional anonymity

and privacy of the respondents and organizations used in the study were guaranteed

with utmost care not to leak their feedback to the public domain. Only general

findings and summary of the entire the data were published to reflect the academic

mission of the study and will never be used in any form of disciplinary or legal

investigations against the respondents or the organizations’ management. These

guiding principles were clearly outlined on the questionnaire. Raw data collected from

the research questionnaires was scanned, saved and stored in a password- protected

personal computer for at least five years to await further analysis and reference

purpose.

44
 CHAPTER FOUR

DATA ANALYSIS, RESULTS AND INTERPRETATION

4.1 Introduction

This chapter is a presentation of processed information from the data collected from

the field during the study on Information Communication Technology strategies and

service delivery at Private hospitals in Bomet County, Kenya.

4.2 Response Rate

This study targeted 215 respondents drawn from different departments in medical

profession. Those who completed filling in the questionnaires were 169 representing a

response rate of 78.6 percent as presented in Figure 4.1. Gall et al. (2007) asserts that,

a response rate of over 60% of the target is adequate for a study. Therefore, the

response rate of 78.6% being an acceptable limit was considered adequate to

generalise findings of this study.

No-Responses
21%

Responses
79%

Figure 4.1: Response Rate

Source: Research (2020)

45
4.3 Demographic Information

Demographic information was based on the gender of the respondent, their age

bracket (years), marital status, highest level of education achieved, and general

working experience as well as work experience in the current station. The section also

provides the position held by respondent hold in the organization.

Female
46%

Male
54%

Figure 4.2: Gender of the respondent

Source: Research data (2020)

As shown in Figure 4.2, majority of respondents were male (54.4%) with the

remaining 45.6% being female. This generally implies that male healthcare facility

professionals in different departments within the selected private hospitals have

marginal domination over their female counterparts.

46
 40.0

35.0
34.3
30.0
30.2
25.0
Percent

20.0 22.5

15.0

10.0 13.0

5.0

-
18 - 25 26 - 35 36 - 50 Over 50
Age Bracket (Years)

Figure 4.3: Age Bracket (Years)

Source: Research data (2020)

Figure 4.3 indicates a relatively evenly distributed age brackets of respondents as

follows: 18 - 25 years (22.5%), 26 - 35 years (30.2%), 36 - 50 years (34.3%), and

Over 50 years (13.0%). This can be analyzed further to indicate a majority of

healthcare facility professionals range from 26 years to 50 years of age. This may be

considered as the most productive age and also able to adapt to ICT usage in hospital.

47
 60.0

56.2
50.0

40.0
Percent

30.0

20.0
21.3
10.0
10.7 11.8

-
Single Married Separated Widowed

Figure 4.4: Marital Status

Source: Research data (2020)

Marital status of respondents showed a majority of them being married (56.2%) while

the single, separated or widowed were represented by 21.3%, 10.7% and 11.8%

respectively as shown in Figure 4.5.

48
 University
40%

College
60%

Figure 4.5: Highest Level of Education achieved

Source: Research data (2020)

Figure 4.5 illustrates the highest level of education achieved by the respondents. It

was discovered that, majority (60.4%) of healthcare facility professionals in private

hospitals have attained college certificate with the remaining 39.6% being university

degree holders. The level of education is important for this study since it corresponds

with the level of comprehension of the study concept by the respondent and thus

effectively and articulately handles the research question. Therefore, higher level of

education would indicate more knowledge on key issues being addressed by the

researcher. Holders of college and university certificate would therefore be considered

as adequately knowledgeable to address questions relating to ICT strategies and

service delivery in hospitals.

49
 Over 5 years
29% 0 - 2 years
24%

3 – 5 years
47%

Figure 4.6: General working experience

Source: Research data (2020)

As presented in Figure 4.6, 46.7% of respondents have a general experience of 3-5

years in medical profession with 24.3% having 0 - 2 years. Others (29.0%) have over

5 years’ experience. This disclosure adds to the researcher a confidence that besides

respondents’ possession of adequate knowledge to address the research questions for

this study; they also have the necessary experience.

50
 Over 5 years
20%
0 - 2 years
31%

3 – 5 years
49%

Figure 4.7: Work experience in the current station

Source: Research data (2020)

Figure 4.7 indicate that 48.5% of the respondents have 3 – 5 years’ experience in their

current station with 31.4% having 0 - 2 years while 20.1% have over 5 years. This is

an indication that majority of respondents had at least 3 years in their current stations

and thus understand them well to answer questions regarding their current

organization.

51
 45.0

40.0 42.0

35.0

30.0
29.0
Percent

25.0

20.0
19.5
15.0

10.0

5.0
1.2 1.2 2.4 4.7
-
Doctors Nurses Laboratory Technicians Interns

Position Held

Figure 4.8: Position held by respondent

Source: Research data (2020)

The researcher was also interested in knowing the position held by respondent hold in

the organization. As shown in Figure 4.8, the distribution of respondents was as

follows: doctors (1.2%), clinical officers (19.5%) nurses (42.0%), pharmacists (1.2%),

laboratory technicians (2.4%), ophthalmologists (4.7%), and interns (29.0%). This

indicates a fair representation of different departments and thus dispel any fear of

biased information since each category give their own opinion on the influence of ICT

strategies on delivery of services in private hospitals.

4.4 Descriptive Statistics

4.4.1 Information Communication Technology

This section presents findings on use of ICT in private healthcare facilities.

Statements were analyzed and results were presented in a 5-point Likert-scale table

with mean and standard deviation used for interpretation of results.

52
Table 4.1: Usefulness of ICT innovations in improving service delivery in
respondent’s institution

Standard Deviation
Extremely useful

Very useful

Not useful

Not sure
Useful

Mean
a) Electronic Health Records 71.6 21.3 4.7 0.6 1.8 4.6 0.8

b) Telemedicine 53.8 26.6 11.8 4.1 3.6 4.2 1.0

c) Mobile Health 35.5 47.9 5.3 5.3 5.9 4.0 1.1

d) Wearable health technologies 30.8 51.5 - 11.2 6.5 3.9 1.2

Average 47.9 36.8 5.5 5.3 4.4 4.2 1.0

Source: Research data (2020)

Findings indicated that ICT innovations are very useful in maintaining electronic

health records (mean of 4.6), but it causes a low variation in maintaining records

(standard deviation of 0.8) as well as telemedicine (mean of 4.2, ICT caused slight

variation (standard deviation of 1.0). Information communication technology

innovations were also found to be very useful in mobile health (mean of 4.0) causing

a slight variation (standard deviation of1.1). Information communication technology

had a moderate usefulness on wearable health technologies (mean of 3.9) and led to

somewhat variation (standard deviation of 1.2). Just as argued by Chandler &

Redman(2012) ICT innovations are a continuous process that arise from vigorous

research and development endeavors of scholars which in turn culminates in the

production of effective and efficient information systems aimed at enhancing service

delivery in healthcare facilities across the world. These can be run on computers and

mobile ICT enabled devices. This argument brings to light the inseparable

53
relationship between computers and ICT networks as well as mass media which

includes television sets to pass information.

Table 4.2: Statements concerning information communication technology use in

respondent’s hospital during service delivery
Table 4.2 indicates the usefulness of information communication technology in the

hospitals during service delivery in various aspects

Standard Deviation
Strongly Disagree
Strongly agree

Disagree
Neutral
Agree

Mean
Statement

a) Using Electronic Health Records to

keep medical records saves time in
making references in service 59. 36.
delivery 2 1 1.2 1.2 2.4 4.5 0.8

b) Laboratory records of patients are

easy to retrieve when stored in 46. 53.
computers 7 3 - - - 4.5 0.5

c) Computerized procedure reports 48. 39. 10.

saves time 5 1 1 1.2 1.2 4.3 0.8

d) Patient discharge summaries saves

time as they are easily generated by 16. 71. 11.
computers 0 0 8 - 1.2 4.0 0.6

e) Computerized record management

eliminates time wastage in service 78. 13.
delivery 7 6 5.9 1.8 - 4.7 0.7

f) ICT strategy adoption enhances 65. 24.

service delivery 7 3 9.5 0.6 - 4.6 0.7

72. 23.
g) ICT use is reliable in service delivery 2 1 4.7 - - 4.7 0.6
58. 33.
Average 1 0 8.0 0.6 0.3 4.5 0.7

Source: Research data (2020)

54
Table 4.2 indicates that using Electronic Health Records to keep medical records

saves time in making references in service delivery (mean of 4.5) but causes little

variations (standard deviation of 0.8). Laboratory records of patients are easier to

retrieve when stored in computers (mean of 4.5), however computers usage lead to

low variations in retrieval (standard deviation of 0.5). Computerized procedure reports

saves time (mean of 4.3) but variations in time was low (standard deviation of 0.8).

Patient discharge summaries enable patients to be discharged on time as they are

easily generated by computers (mean of4.0), the variations in times saved was low

(standard deviation of 0.6). Computerized record management strongly eliminates

time wastage in service delivery (mean of 4.7) but leads to low deviation in service

delivery (standard deviation of 0.7). ICT significantly enhances service delivery

(mean of4.6), but leads to low deviation (standard deviation of 0.7).ICT is greatly

reliable in service delivery (mean of 4.7) which in turn varies slightly (standard

deviation of 0.6).

The findings are coherent with Benard (2017) who argues that in order to lower the

costs involved in ICT adoption in healthcare management, it is advisable to utilize the

existing infrastructure and equipment which are easily accessible. These include

mobile and broadband ICT readily available in most parts of Kenya. The use of ICT

strategies in healthcare facilities improves treatment processes and healthcare quality

(Christensson, 2010). This helps in improving service delivery in hospitals which

translates to saving lives. This is because the provision of quality healthcare services

relies heavily on exchange of information between patients and medical staff.

According to Gatero (2010), there is need to develop and integrate hospital ICT

systems in healthcare service delivery so as to avoid costly and risky multi-data entry

points which may cause medical errors and promote accuracy in disease diagnosis,

55
treatment and general medical care. Additionally, according to Tam (2007), quality in

health service delivery is promoted by use of advanced technology, effective

medication, qualified and competent human resource and sufficient doctor-patient

ratio, effectiveness, efficiency and affordability of medical services. Service industries

like hospitals can be rated, assessed and ranked according to patients’ experiences

when receiving healthcare services.

4.4.2 Electronic Health Records

This section presents findings on ICT specific tools including electronic health

records, telemedicine and service delivery, use of mobile health during service

delivery, use of Wearable Healthcare Technology during service delivery, and

hospital information communication Technology. Results were presented in a 5-point

Likert-type table with mean and standard deviation used for results interpretation.

Table 4.3: Electronic Health Records

Standard Deviation
Occasionally
Very Often

Not sure
Rarely
Often

Mean

Statement

a) Medical records 36.1 47.9 14.8 1.2 - 4.2 0.7

b) Laboratory records 26.0 62.1 11.8 - - 4.1 0.6

c) Procedure Reports 35.5 22.5 29.0 6.5 6.5 3.7 1.2

d) Patient discharge summaries 11.2 52.7 24.9 7.7 3.6 3.6 0.9
Average 27.2 46.3 20.1 3.8 2.5 3.9 0.9

Source: Research data (2020)

56
In Table 4.3 ICT was found to be oftenly used in managing medical records (mean of

4.2) whose deviation was low (standard deviation = 0.7) followed by laboratory

records (mean of 4.1) and standard deviation of 0.6. ICT was found to have moderate

effect on procedure reports (mean of 3.7) which in turn varied slightly (standard

deviation of 1.2). Patient discharge summaries was found to be useful with a mean of

3.6 with a low variation (Standard deviation = 0.9). This implies that ICT has

significant effect in maintaining laboratory records, procedure reports, and patient

discharge summaries, hence greater effect on medical records.

As argued by Smaltz, Detlev & Eta (2007), electronic health records help hospital

staff in delivering efficient and effective medical services. The records help hospital

staff fast-track patient registration and store accurate patient information which

translates into efficiency during service delivery. Electronic health records role in

service delivery include; tracking patients’ registration, managing and delivery

appropriate data as well as storage of real-time comprehensive healthcare information.

This eliminates the rampant loss of patients’ information, poor response to medical

emergencies and time wastage evident in many healthcare facilities. The study

examined electronic health records in terms of patients Medical records, laboratory

records, procedure reports as well as discharge summaries.

57
4.4.3 Telemedicine and service delivery

Table 4.4: Telemedicine and service delivery

This section indicates the level of agreement by respondents on telemedicine.

Strongly Agree

Deviation
Standard
Disagree

Disagree
Strongly
Neutral
Agree

Mean
Statement

a) Teleconferencing has
enhanced collaboration with
international experts and
stakeholders for improved
service delivery 27.2 68.0 1.8 3.0 - 4.2 0.6

b) Teleconsultations use has

promoted convenience during
service delivery 45.6 46.7 7.7 - - 4.4 0.6

c) Remote patient monitoring is

key towards improved
responsiveness to patients’
medical needs. 63.9 32.5 1.2 2.4 - 4.6 0.6

d) Medical imaging using

Telemedicine is reliable 17.8 52.7 25.4 3.0 1.2 3.8 0.8
Average 38.6 50.0 9.0 2.1 0.3 4.3 0.7

Source: Research data (2020)

Table 4.4 shows that collaboration with international experts and stakeholders led to

significant improved service delivery as a result of teleconferencing (mean of 4.2)

whose effect caused little variation( standard deviation of 0.6). Teleconsultation use

has promoted significant convenience during service delivery (mean = 4.4) whose

variation was low (standard deviation of 0.6). Remote patient monitoring is key

towards improved responsiveness to patients’ medical needs (mean of 4.6) but the

variation in responsiveness was low (standard of deviation 0.6) Medical imaging

58
using telemedicine is reliable (mean of 3.8) with insignificant variation (standard

deviation of 0.8).

The findings are consistent with existing literature that there is a significant

contribution of telemedicine leading to improved service delivery in healthcare

management. Video conferencing acts as a link between healthcare providers with

their clients simultaneously through healthcare education. As argued by Bloom (1996)

& Turner(2003), telemedicine has contributed to the decrease in patients’ waiting

time, travel time and has enhanced service delivery as a result of use of telephone

systems to make medical consultations and in booking healthcare appointments. The

results are also in line with Information Theory advanced by Claude Shannon (1948),

which utilizes the electronic zipping of healthcare data using computers and

consultations by use of telemedicine. It implies that the use of Telecommunication for

information monitoring and exchange via emails, mobile phones and automated

messaging services has led to significant improvement in healthcare service delivery.

59
4.4.4 Use of Mobile Health during Service Delivery

Table 4.5: Use of Mobile Health during Service Delivery

Responses regarding the extent to which mobile health is used in the hospital during

patient treatment.

Standard Deviation
Very large extent

Moderate extent
Large extent

Small extent

Not sure

Mean
Statement

a) Use of cell phones to

communicate with patients is
convenient 32.5 33.1 33.7 0.6 - 4.0 0.8

b) There is improved efficiency in

use of tablets to communicate
healthcare information with
patients 27.2 39.6 33.1 - - 3.9 0.8

c) Personal digital assistants

facilitates teamwork among
hospital staff 42.0 43.2 10.7 3.6 0.6 4.2 0.8

d) Mobile computers are efficient

to use for service delivery 52.1 46.2 1.2 0.6 - 4.5 0.6

e) Mobile health improves service

delivery in this hospital 46.7 50.3 2.4 - 0.6 4.4 0.6
Average 40.1 42.5 16.2 0.9 0.2 4.2 0.7

Source: Research data (2020)

Findings revealed that use of cell phones to communicate with patients is convenient

(mean of 4.0) but leads to low variation in communication. (Standard deviation of

0.8). ). There is moderate efficiency in tablets use for communicating healthcare

information to patients (mean of 3.9) which had low variation in communication.

(Standard deviation of 0.8). Personal digital assistants largely facilitate teamwork

60
among hospital staff (mean of 4.2) but cause little variation on teamwork. (Standard

deviation of 0.8). Mobile computers are efficient to use for service delivery (mean of

4.5) with a small variation (standard deviation of 0.6). Mobile health to a large extent

improves service delivery in hospitals (mean of 4.4) whose variation was low.

(Standard deviation of 0.6).

These results reject the hypothesis that mobile health has no significant effect in care

and treatment of patients. According to Free, Philiphs, Watson, Galli, Felix&Edwards

(2013), Mobile health involves the use of mobile devices such as cell phones, smart

phones and tablets, under a global network to deliver health services and information.

4.4.5 Use of Wearable Healthcare Technology during Service Delivery

Table 4.6: Responses regarding use of wearable healthcare technologies during

service delivery.

Standard Deviation
Occasionally
Very Often

Not sure
Rarely
Often

Mean
Statement

a) Hearing aids 66.3 9.5 14.2 8.3 1.8 4.3 1.1

b) Blood pressure monitors 68.6 20.1 11.2 - - 4.6 0.7

c) Blood sugar monitors 50.9 47.3 0.6 0.6 0.6 4.5 0.6

d) Heart rate monitors 53.3 29.6 17.2 - - 4.4 0.8

Average 59.8 26.6 10.8 2.2 0.6 4.5 0.8

Source: Research data (2020)

Findings in the table 4.6 show that hearing aids oftenly enhance hearing (mean of 4.3)

causing slight variation. (Standard deviation of 1.1). Wearable technologies are very

useful in blood pressure monitoring (mean of 4.6) whose variation was low (Standard

61
deviation of 0.7).The technologies are oftenly useful in monitoring of blood sugar

(mean of4.5) with a low variation (standard deviation of 0.6). Pacers are oftenly

useful in regulating heart beats (mean of 4.4) with a low variance (standard deviation

of 0.8).

The findings are in line with Mesut’s (2015) assertion that the most extensive

adoption of wearable technologies is in the health sector. According to Rutherford

2010, wearable healthcare technologies are spearheading a great paradigm shift in the

health sector. The greatest contribution of wearable technologies delivery of

healthcare services is its ability to monitor a patient’s health status and gather useful

information in service delivery (Chan et al., 2012)

4.4.6 Extent to which wearable technologies use affected service delivery in

organization

Assessment of the extent to which wearable technologies use affect service delivery in

hospital.

80.0
70.0
71.0
60.0
50.0
Percent

40.0
30.0
20.0
10.0 16.0
9.5 3.0 0.6
-
Very High High Degree Moderate degree Low degree Very low degree
Degree
Response

Figure 4.9: Extent to which wearable technologies use affected service delivery in
organization

62
Figure 4.9 indicates that use of wearable technologies affects service delivery to a

very high degree (71.0%). Other respondents stated that the effect is high (16.0%),

moderate (9.5%) and low degree (3.0%). Only 0.6% of respondents stated that use of

wearable technologies affects service delivery in their respective organization to a

very low degree.

These findings indicate that wearable technologies are extremely fundamental in

monitoring blood pressure, blood sugar, heart rate as well as hearing ability. This can

further be confirmed by Bonato’s (2005) argument that wearable health technologies

help doctors monitor the heart rate, the patient’s blood sugar level, the blood pressure,

fever and other health indicators. These devices can be used to diagnose several

diseases hence medical treatment and subsequently improve service delivery (Brady

et al., 2006). Wearable healthcare gadgets according to Akshay et al., (2016), offers

much promise to improve healthcare service delivery for both patients and healthcare

service providers. The devices facilitate constant monitoring and data collection

which are used in developing a pattern of patient behavior useful in healthcare service

delivery.

4.4.7 Level of ICT infrastructure currently implemented in respondent’s

organization

The figure presents the level of ICT infrastructure currently implemented in

respondent’s respective organization.

63
 45.0

40.0
40.8
35.0

30.0
29.0
Percent

25.0 26.6
20.0

15.0

10.0

5.0
2.4 1.2
-
Very Advanced Advanced Normal Obsolete Very Obsolete
Response

Figure 4.10: Level of ICT infrastructure currently implemented in

respondent’s
Findings organization.
indicated that 26.6% of respondent’s hospital in Bomet County have very
Source: Survey data 2020
advanced ICT infrastructure with advanced ICT infrastructure.40.8% rated that they

have advanced ICT. Other respondents indicated that ICT infrastructure implemented

in their respective organizations were normal (29.0%), obsolete (2.4%), and very

obsolete (1.2%). This implies that ICT infrastructure implemented in most private

hospitals are advanced.

4.6 Inferential Analysis

Inferential analysis was based on correlation coefficients, coefficient of

determination, analysis of variance and coefficients matrix.

64
Table 4.7: Analysis of Variance on Electronic Health Record and Service
Delivery using SPSS version 25.0.0.0

Model
Sum of Squares Df Mean Square F p-Value

1 Regression 76.226 1 76.226 639.535 .000a

Residual 19.905 167 .119

Total 96.130 168

A Predictors: (Constant), Electronic health records
B Dependent Variable: Service delivery

Source: Research data (2020)

Analysis of variance tested whether there was significant effect of electronic health

records on service delivery. A p-Value of 0.000 was found at 0.05 level of

significance indicating that there was significant positive effect of electronic health

records on service delivery.

Table 4.8: Analysis of Variance on Telemedicine and Service Delivery using

SPSS version 25.0.0.0

Model
Sum of Squares Df Mean Square F p-Value

1 Regression 46.455 1 46.455 156.176 .000a

Residual 49.675 167 .297

Total 96.130 168

A Predictors: (Constant), Telemedicine
B Dependent Variable: Service delivery
Source: Research data (2020)

Analysis of variance determined whether there was significant effect of telemedicine

on service delivery in private hospitals. A p-Value of 0.000 was found at 0.05 level of

significance showing significance of telemedicine on service delivery.

65
Table 4.9: Analysis of Variance on Mobile Health and service delivery using
SPSS version 25.0.0.0
Model
Sum of Squares Df Mean Square F p-Value

1 Regression 78.329 1 78.329 734.833 .000a

Residual 17.801 167 .107

Total 96.130 168

A Predictors: (Constant), Mobile health
B Dependent Variable: Service delivery

Source: Research data (2020)

Analysis of variance was used to indicate whether there was significant effect of

mobile health on service delivery. A p-Value of 0.000 was found at 0.05 level of

significance indicating that there was significant positive effect ofmobile health on

service delivery.

Table 4.10: Analysis of Variance on Wearable Healthcare Technology and

service delivery
Model
Sum of Squares Df Mean Square F p-Value

1 Regression 71.448 1 71.448 483.408 .000a

Residual 24.683 167 .148

Total 96.130 168

A Predictors: (Constant), Wearable healthcare technology
B Dependent Variable: Service delivery

Analysis of variance was used to indicate whether there was significant effect of

wearable healthcare technology on service delivery. A p- Value of 0.000 was found at

0.05 level of significance indicating that there was significant positive effect of

wearable healthcare technologies on service delivery.

66
Table 4.11: Correlation coefficients using SPSS 25.0.0.0
Unstandardized Standardized p-
Model Coefficients Coefficients T Value
Std.
B Error Beta

1 (Constant) -0.552 0.137 -4.018 0.000

Electronic health 0.472 0.077 0.416 6.109 0.000

record

Telemedicine 0.176 0.075 0.066 2.347 0.012

Mobile health 0.185 0.069 0.122 2.681 0.043

Wearable healthcare 0.426 0.082 0.376 5.172 0.000

technology
a Dependent Variable: Service delivery

Source: Research data (2020)

Table 4.11 shows analysis of coefficients for variables. Given model as

y=a+bX1+bX2+bX3+bX4 then the coefficients can define the following relationship:

y = -0.552 + 0.472X1 + 0.176X2 + 0.185X3 + 0.426X4

This indicates that, a positive change in electronic health record, telemedicine, mobile

health and wearable healthcare technology by a unit leads to a positive change in

service delivery by 0.416, 0.066, 0.122, and 0.376 respectively. On electronic health

records on service delivery, p-Value = 0.000 ˂ 0.05 level of significance. Therefore,

the hypothesis “Electronic health records have no significant effect on service

delivery” was rejected. For telemedicine p-Value = 0.012˂ 0.05 level of significance.

The hypothesis “telemedicine has no significant effect on service delivery” was

rejected. For mobile health, A p-Value = 0.043˂ 0.05 level of significance hence a

rejection of the hypothesis “mobile health has no significant effect on service

delivery”. A p- Value =0.000 ˂ 0.05 level of significance for wearable healthcare

technologies rejects the hypothesis, “wearable healthcare technologies have no

significant effect on service delivery”.

67
Table 4.12: Coefficient of Determination on ICT strategies and service delivery
using SPSS version 25.0.0.0

Adjusted R Std. Error of

R R Square Square the Estimate

.890a .793 .792 .345

Predictors: (Constant) ICT strategies

To test the extent to which ICT strategiesexplains any change in service delivery in

private hospitals, coefficient of determination (R2) was generated and found to be

0.792. This implies a 79.2% change in service delivery. This confirms that ICT

strategiesplay positive significant role on service delivery in private hospitals.

4.7 Healthcare collaboration

Table 4.13: Healthcare collaboration
Table 4.13 shows the respondents’ opinion in their capacity as professional staff in

healthcare facility on the usefulness of the following ICT innovations in improving

service delivery in their respective institutions

Standard
Disagree

Disagree
Strongly

Strongly

Deviatio
Neutral
Agree

Mean
agree

Statement

n
a) Telemedicine has bridged distance 34. 36. 17. 11. - 3.9 1.0
gap between this hospital and rural 9 1 8 2
communities through home-based
healthcare

b) Telemedicine saves lives 79. 18. - 0.6 0.6 4.8 0.5

9 9

c) Telemedicine is expensive to use 50. 47. 0.6 0.6 0.6 4.5 0.6
9 3

d) Telemedicine helps in management 31. 39. 23. 5.9 - 4.0 0.9

of chronic illnesses 4 1 7
49. 35. 10.
Average 3 4 5 4.6 0.3 4.3 0.8
Source: Research data (2020)

68
Results in Table 4.13 indicates that to a moderate extent the technology has bridged

distance gap between this hospital and rural communities through home-based

healthcare (mean of 3.9), leading to a slight increase in home based

healthcare.(standard deviation of 1.0).Telemedicine is strongly useful in saving lives

(mean of4.8) but variance in lives saved is low (standard deviation of 0.5) It is an

expensive technology to use (mean of 4.5) but the cost did not affect its use(standard

deviation of 0.6). Telemedicine helps in management of chronic illnesses (mean of

4.0) and variation in chronic illness is low, (standard deviation of 0.9).

69
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATION

5.1 Introduction

This chapter presents the summary of findings, the conclusion of the study outcome as

well as recommendations of the study.

5.2 Summary of Findings

This study has found that, ICT strategies have significant positive effects on service

delivery in private healthcare facilities. Technological innovations were found to be

significantly useful in telemedicine, mobile health and wearable health technologies.

Computerized record management eliminates time wastage in service delivery, with

ICT use being reliable in enhancing healthcare service delivery.

In addition, ICT was found to be most useful in managing medical records followed

by laboratory records. ICT was also found to be moderately useful on procedure

reports as well as patient discharge summaries. Remote patient monitoring is key

towards improved responsiveness to patients’ medical needs. This is closely followed

by the fact that, Teleconsultation use has promoted convenience during service

delivery as well as enhancing collaboration with international experts and

stakeholders for improved service delivery.

Findings revealed that mobile computers are efficient to use during service delivery .It

also significantly improves service delivery in hospitals with personal digital

assistants facilitating teamwork among hospital staff. Healthcare ICT is extremely

useful in blood pressure monitoring as well as monitoring of blood sugar. In addition,

healthcare ICT is very useful in monitoring heart rate and as hearing aids.

70
Wearable technologies use affects service delivery to a very high degree. Other

respondents stated that the effect is high, moderate and low degree .An insignificant

percentage of respondents indicated that wearable technologies use affects service

delivery in their respective organization to a very low degree. Telemedicine is

extremely useful in saving lives even though it is an expensive technology to use.

Besides, telemedicine helps in management of chronic illnesses and to a large extent

the technology has bridged distance gap between this hospital and rural communities

through home-based healthcare.

Correlation coefficients as presented in Table 4.8 indicate positive relationship

between each variable against every other. Service delivery correlated at 0.890, 0.695,

0.862, and 0.903 against electronic health record, telemedicine, mobile health, and

wearable healthcare technology respectively. To test the extent to which ICT explains

any change in service delivery in private hospitals, coefficient of determination (R2)

was found to be 0.900. A p-Value of 0.000 was found at 0.05 significant levels

indicating that there is significant positive relationship between ICT strategies.

5.3 Conclusion

The study has found healthcare information communication technology strategies as

key in service delivery in private healthcare facilities. Each of the technological tools

including electronic health records, telemedicine, use of mobile health during service

delivery, as well as use of wearable healthcare technology during service delivery is

important to ensure quality in health service delivery which is promoted by use of

advanced technology, effective medication, qualified and competent human resource

and sufficient doctor-patient ratio, effectiveness, efficiency and affordability of

medical services. Service industries like hospitals can be rated, assessed and ranked

71
according to patients’ experiences when receiving healthcare services. The most

important areas in healthcare facilities that should employ technological innovations

include maintenance of medical records, laboratory records, procedure reports, and

patient discharge summaries.

5.4 Recommendations
The study recommends that private hospitals management should employ more ICT

strategies which should include buying equipment and installing infrastructures that

are necessary in treatment of more complicated illness like carcinogenic diseases.

Government through the relevant authorities should formulate and implement policies

that will encourage and make it conceivable for private hospitals to invest in ICT and

related innovations. There should also be a pattern made of series of past experiences

where healthcare institutions guide the direction of operations towards achieving its

mission through investments in healthcare ICT infrastructure.

The ministry of health should create a collaborative healthcare ICT system which

links the Public healthcare with the private healthcare sector so as to facilitate

improved research and development in healthcare service delivery as well as

collaboration in diagnosis and treatment of chronic illnesses.

Owing to the expensive cost of sourcing and implementing healthcare ICT systems

and infrastructure, the government should consider waiving or subsidizing taxes on

ICT systems and equipment so that both private and public healthcare institutions can

acquire and use them in improving healthcare service delivery.

72
5.4.1 Recommendation for Further Studies

Given limitations and scope of this study, the researcher recommends further that

investigation on the effect of ICT innovations should be extended to public healthcare

facilities in Bomet County for comparison purpose. Additionally, given the study

methodologies are more scientific; a similar study should be extended to other

counties that are considered heterogeneous in population

When conducting other studies, researchers should also incorporate other ICT

strategies and assess whether the effect will deviate from the results found in this

study. The fast paced change in ICT provides room for further studies.

The study population was confined to medical practitioners. There is a huge need to

investigate the effects of healthcare ICT use among the patients. This will provide

researchers with an opportunity to draw a more informed conclusion on the role of

healthcare ICT on service delivery.

For a comprehensive study of the private healthcare sector, there is a huge gap calling

for a comparative investigation on the performance of faith-based healthcare

institutions and Non-governmental organizations’ operated healthcare institutions as a

result of Healthcare ICT use.

73
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 APPENDICES

Appendix 1: Introduction Letter

Kenyatta University-Kericho Campus

P o Box 1423-20200,
Kericho.
Tel:+254-20-2171313/+254-052-2031004
Email: [email protected]
24 January 2020.
Dear Participant,
RE: LETTER OF INTRODUCTION

I am Daniel Kibet Koech, a student of Kenyatta University, Kericho Campus. I am

pursuing a Master’s Degree in Business Administration. I am currently conducting a
research on Information Technology on Service delivery in Private Hospitals in
Bomet County, Kenya.
I am inviting you to freely participate in this research as a respondent and would
highly appreciate your participation in filling the enclosed questionnaires which will
aid in collection of research information on the research topic.
Your participation in this research is completely voluntary and your responses will be
handled with utmost confidentiality. If you agree to participate in this study, please
answer the questions to the best of your ability.
If you have any questions or need for clarification about this research, kindly feel free
to contact me using the following information;
Daniel Kibet Koech
P o Box 395-20400,
Bomet.
Email address: [email protected]
Mobile phone No: 0728748348
Thank you for your cooperation

Sincerely yours
Daniel Koech
INVESTIGATOR

87
 Appendix 2: Request for Consent to Conduct Study in Your Institution

Kenyatta University-Kericho Campus

P o Box 1423-20200,
Kericho.
Tel:+254-20-2171313/+254-052-2031004
Email: [email protected]
24Th January 2020

The Hospital Administrator,

Dear Sir/Madam,

RE: REQUEST FOR CONSENT TO CONDUCT STUDY IN YOUR

INSTITUTION.

I am Daniel Kibet Koech, an MBA student at Kenyatta University, Kericho Campus.

I would like to ask for your permission to allow me conduct a research in your
organization. My respondents will be your staff. I am conducting a research on
Influence of Information technology Strategies on service delivery at Private hospitals
in Bomet County, Kenya.

The survey will last about 1 hour and would be carried out at a time convenient to
your staff. The participation in the study is voluntary and free from any risk. The
responses will be treated with total confidentiality. The names of respondents remain
anonymous and only the data will be used in the study.

After the analysis of the data, your organization will receive a copy of the results
summary.

Sincerely yours,

Daniel Kibet Koech

Master of Business Administration (Strategic Management)

88
 Appendix 3: Questionnaire for Hospital Staff

Please fill in the spaces provided and tick where applicable. Responses will be

handled with utmost privacy and confidentiality. Do not write your name on the

Questionnaire. Your cooperation is highly appreciated.

SECTION A: PERSONAL INFORMATION

1. Gender

Male [ ]
Female [ ]
2. Age Bracket (Years)

18-25 [ ]
26-35 [ ]
35-50 [ ]
50 and above
3. Marital Status

Single [ ]
Married []
Separated [ ]
Widowed [ ]
4. Highest Level of Education achieved.

Primary [ ]
Secondary [ ]
College [ ]
University [ ]
Others specify [ ]
5. General working experience

0 - 2 years [ ]
3 – 5 years [ ]
Over 5 years [ ]

89
 6. Work experience in the current station

0-2 years [ ]3-5 years [ ] Over 5 years [ ]

7. What position do you hold in the organization?

…………………………………………………………………………………

SECTION B: INFORMATION COMMUNICATION TECHNOLOGY

(i) As a professional staff in healthcare facility, what is your opinion concerning the
usefulness of the following ICT innovations in improving service delivery in your
institution?

Extremely Very Useful Not Not

useful[5] useful[4] [3] useful[2] sure[1]
Electronic Health
Records
Telemedicine
Mobile Health
Wearable health
technologies

(ii) To what extent do you agree with the following statements concerning
information communication technology use in this hospital during service delivery?
(Please tick appropriately)

No. Statement Strongly Disagree Neutral Agree Strongly

disagree[1] [2] [3] [4] agree[5]
a. Using Electronic
Health Records to
keep medical
records saves time
in making
references in
service delivery
b. Laboratory records
of patients are easy
to retrieve when
stored in
computers
c. Computerized
procedure reports
saves time

90
d. Patient discharge
summaries saves
time as they are
easily generated by
computers
e. Computerized
record
management
eliminates time
wastage in service
delivery

f. ICT strategy
adoption enhances
service delivery
g. ICT use is reliable
in service delivery

SECTION C: ICT SPECIFIC TOOLS

a) Electronic Health Records
How often do you use the following Electronic Health Records during service
delivery?

Very Often Often Occasionally Rarely Not sure

[5] [4] [3] [2] [1]
Medical records
Laboratory records
Procedure Reports
Patient discharge
summaries
(b) Telemedicine and service delivery
To what level do you agree with the following statements concerning Telemedicine
use in your institution?
Strongly Agree Neutral Disagree Strongly
Agree[5] [4] [3] [2] disagree[1]
Teleconferencing has
enhanced collaboration
with international
experts and stakeholders
for improved service
delivery
Teleconsultations use
has promoted
convenience during
service delivery
Remote patient
monitoring is key
towards improved
responsiveness to
patients’ medical needs.
Medical imaging using
Telemedicine is reliable

91
(c) Use of Mobile Health during service delivery
(i) To what extent are the following statements true concerning mobile health use in
the hospital during patient treatment?
Very Large Large Moderate Small Not
extent[5] extent[4] extent[3] extent[2] sure[1]
Use of cell phones to
communicate with
patients is convenient

There is improved
efficiency in use of
tablets to communicate
healthcare information
with patients

Personal Digital
Assistants facilitates
teamwork among
hospital staff

Mobile computers are

efficient to use for
service delivery
Mobile health improves
service delivery in this
hospital

(d) Use of Wearable Healthcare Technology during service delivery

(i) How often are the following wearable healthcare technologies used in your
organization?
Very often[5] Often[4] Occasionally[3] Rarely[2] Not sure[1]
Hearing aids

Blood pressure
monitors
Blood sugar
monitors
Heart rate
monitors

(ii)To what degree has wearable technologies use affected service delivery in
organization?
Very high degree [ ]5
High degree [ ]4
Moderate degree [ ]3
Low degree []2

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Very low degree [ ]1
(e)Hospital Information Communication Technology

a. Kindly commend on the level of ICT infrastructure currently implemented in your

organization

Very Advanced [ ]5

Advanced [ ]4

Normal [ ]3

Obsolete [ ]2

Very Obsolete [ ]1

SECTION D: HEALTHCARE COLLABORATION

No. Statement Strongly agree[4] Neutral[3] Disagree[2] Strongly

agree[5] disagree[1]
a. Telemedicine has
bridged distance gap
between this hospital
and rural
communities
through home-based
healthcare
b. Telemedicine saves
lives
c. Telemedicine is
expensive to use

d. Telemedicine helps
in management of
chronic illnesses

What measures do you recommend so as to improve digitized diagnosis in private

hospitals?

…………………………………………………………………………………………
…………………………………………………………………………………………

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Appendix 4: Research Authorization Letter

94
Appendix 5: Research Permit

95