Effect of employee involvement strategies in decision-making on employee performance in level four and three public health facilities in Vihiga County, Kenya

Abstract

Although the government has invested heavily in the health sector, public health institutions continue to operate below the expected standards, as highlighted in the 2023 report by the Kenya Medical Practitioners. Similarly, the World Health Organization observed that the quality of healthcare services provided in Kenya’s public health system falls short of the essential principles of quality care, which emphasize privacy, dignity, choice, safety, autonomy, and fulfillment. This study examined the effect of employee involvement strategies in decision-making on employee performance in level four and three public health facilities in Vihiga County. The study was guided by unitary theory. The study adopted a mixed research approach comprising a descriptive and causal research design. The study targeted a population of 765, that is, 499 from level four and 266 staff from level three. These were the healthcare workers comprising 318 nurses, 70 clinical officers, 31 medical officers, 47 laboratory technicians, 18 pharmacists, 11 nutritionists, 21 public health officers, 107 administrative officers, and 142 support staff. The study's total sample size was 263, using the Yamane formula. The study applied stratified, proportionate, and simple random sampling techniques. Structured questionnaires aided in data collection. A pilot study was done at Malava Sub-County Hospital in Kakamega County using 26 respondents as 10% of the sample population. Reliability was tested using Cronbach's Alpha, while validity was tested using content validity. The study analyzed data using both descriptive and inferential statistics, where descriptive statistics included frequency, mean, standard deviation, and percentages. Inferential statistics entailed Pearson correlation and regression analysis. Data was presented using tables and graphs. A positive effect was significant (β = 0.694, p < 0.05), where employee participation was responsible, as employees felt more motivated and more responsible when they were engaged in decision-making. The discussion has determined that strategic industrial relations are key drivers of employee performance in healthcare institutions. Employee involvement brings about ownership and motivation. County health administrators are advised to institutionalize participatory decision-making. The research suggests that public health institutions must institutionalize effective collective bargaining mechanisms that ensure equity and transparency in employment relations. There should be increased participation of employees through providing inclusive platforms where the staff can have a say in major decisions. The conflict resolution systems should be formal, transparent, and regular to reduce workplace conflicts in order to ensure peace. The communication systems need to be improved through encouraging open and timely, as well as feedback-based, channels that increase trust and accountability.