AN APPRAISAL OF BUSINESS POLICY MODELS IN THE MANAGEMENT OF MISSION HOSPITALS IN THE SOUTH EAST NIGERIA

1 AN APPRAISAL OF BUSINESS POLICY MODELS IN THE MANAGEMENT OF MISSION HOSPITALS IN THE SOUTH EAST NIGERIA IGWE ANTHONY ANIAGBAOSO PG/Ph D/08/47351 A THESIS SUBMITTED TO THE DEPARTMENT OF MANAGEMENT, FACULTY OF BUSINESS ADMINISTRATION, UNIVERSITY OF NIGERIA, ENUGU CAMPUS IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE AWARD OF DOCTOR OF PHILOSOPHY (Ph D) IN MANAGEMENT SUPERVISOR: PROF U J F EWURUM DECEMBER, 2011 APPROVAL This Thesis has been approved for the Department of Management, Faculty of Business Administration, University of Nigeria, Nsukka- Enugu Campus, by: ………………………………………… …………………………………… PROF UJF Ewurum DR C.A Ezigbo Supervisor Head of Department ………………………………………… External Examiner …………………………………… Internal Examiner CERTIFICATION IGWE ANTHONY ANIAGBAOSO a Postgraduate student in the Department of Management with the Registration Number PG/PH D/08/47351 hereby certify that the work embodied in his Thesis is original and has not been submitted in part or full for any other diploma or Degree of this or any other University ………………………………………… Igwe, Anthony Aniagbaoso PG/Ph.D/08/47351 DEDICATION To Blessed Trinity, Our Blessed Mother -Mary mother of God and to my late father Chief Isaac Igwe whose inspiration guided the work ACKNOWLEDGEMENTS I remain forever grateful to the Almighty God for leading me to the successful completion of this work My special appreciation goes to my supervisor, Prof U.J.F Ewurum who painstakingly supervised this work despite his tight schedule as Dean of the Faculty My sincere thanks go to his Lordship Most Rev Dr Calistus Onaga, the Catholic Bishop of Enugu diocese for granting me the permission and support to this programme My unalloyed thanks go to his Lordship Most Rev Dr Anthony Okonkwo Gbuji (Bishop Emeritus of Enugu Diocese) who initially inspired and permitted me to the programme To all the Priests especially Very Rev Msgr Anthony Obiakoizu Iloanusi , Religious of Enugu diocese and my parishioners at our Lady of the Rosary Parish Emene, I thank you all for your love and understanding during this programme To my head of department- Dr C A Ezigbo and the Secretary of the department- Mrs Ngozi Ofodile and all the staff of the management department of the University, I sincerely thank you all for seeing me through in the programme I am indebted to my good friends, Prof Batho Okolo (Vice Chancellor-UNN) Mr C.O Chukwu, Dr Agbaeze, Prof John Eze, Mr Ben.Chukwu, Chief Oliver Igbokidi (Ezeugo), Mr Kingsley Obiekwe and Mr Sunday Okebaram I am also grateful to my family members both the biological family and my parish family (Ebere Udeh , Kenechukwu Ogbodo, Ezinne Stella Mbaeze, Ezinne Eloike, and Onyinye Chukwuma ) who have immensely contributed to the success of this work My special thanks go to the typist ( Amara Ogbu), Toochukwu my nephew, Enyinnaya computer analyst, the UNEC and National Library Librarians, Institute of African Studies UNN and African Institute for Applied Economics, Enugu for helping me with the secondary data for this study IGWE ANTHONY ANIAGBAOSO PG/Ph D/08/47351 ABSTRACT The study on the appraisal of Business policy models in the management of mission hospitals in the South East was motivated by the need to proffer possible strategies and solutions by the use of open system and stakeholders’ business policy models in the management of mission hospitals in the South East Nigeria The study was guided by six key objectives from which appropriate research questions and hypotheses were formulated The study adopted survey design The research instruments were questionnaire and oral interviews The population of the study was 6000 staff of the 27 selected mission hospitals drawn from 57 registered mission hospitals in the five states comprising: Abia, Anambra, Ebonyi, Enugu, and Imo States of South East Nigeria A sample size of 375 was determined from the population using Taro Yamane’s formula while Purposive sampling technique was used in selection of the mission hospitals Cronbach Alpha was used in testing the validity and the reliability of the research instrument The result was 0.98 indicating a high degree of relationship The hypotheses were tested using parametric and non parametric statistical techniques which included: Friedman Chi-square (X 2), ANOVA (one-way) and Z-test Findings reveal that the quality of service to patients in the mission hospitals to a large extent is contingent on having appropriate equipment, competent doctors and availability of drugs as contained in the open business policy model Stakeholders’ business policy model to a large extent also contributed to sustainability of operation in the management of mission hospitals The study also indicated that open system business policy model to a large extent promoted competitiveness in the management of mission hospitals There was a significant relationship between open business policy model and human resource management in the mission hospitals Environmental turbulence and uncertainties such as ‘government policies on taxations and importation’ constituted the greatest challenges to the adoption of business policy models in mission hospitals Stakeholders’ business policy model also impacted positively on the supply chain management through drug availability, quality drugs and good treatment in mission hospitals Based on the results of the study, the following recommendations were made: hospitals Organizations should work toward greater relationship management institutionalize sustainability factors that can boost the confidence of staff, restructure the rules of management by adopting new strategies that encourages interactions and interdependence between the hospital and its environments Hospital management should undertake continuous service innovation of activities and put in place in all the hospitals, boundary spanners who are expected to keep management informed about the environmental changes which could affect business policy adoption Private public partnership in the healthcare institutions should be fostered in the mission hospitals The study concludes that adopting open system and stakeholders’ business policy models are vital and important for high performance management of the mission hospitals With appropriate implementation of business policy as was identified in this work the following outcomes will be inevitable: service quality will be assured, sustainability of operation will be improved, competitive advantage will be maximized, human resource management will be stable, effective and efficient, supply chain management will be optimized and environmental challenges will be predicted, adapted to and managed TABLE OF CONTENTS Title Page - i Approval Page - ii Certification Page - iii Dedication iv Acknowledgements v Abstract vi List of Tables -xi List of Figures xii CHAPTER ONE: INTRODUCTION 1.1 Background of the Study 1.2 Statement of the Problem 1.3 Objectives of the Study 1.4 Research Questions 1.5 Research Hypotheses 1.6 Significance of the Study 1.7 Scope of the Study 1.8 Limitations of the Study 1.9 Profile of the Selected Mission Hospitals 10 1.10 Definition of Terms 24 References 27 CHAPTER TWO REVIEW OF THE RELATED LITERATURE 2.1 Theoretical Frame work 31 2.2 Conceptual Framework 39 2.3 Service Quality and Open Business Policy in Hospitals 44 2.4 Stakeholders Business Policy in Sustainability of Operations 50 2.5 Competitiveness in management of Mission Hospitals 61 2.6 The Human Capital Elements in Mission Hospital Management 70 2.7 Environmental Analysis and Challenges of Adopting Business Policy Models in Mission Hospitals 2.8 Influence of Stakeholder Business Policy Model in Supply Chain Management 2.9 Summary of the Related Literature Review References 86 106 109 112 CHAPTER THREE RESEARCH METHODOLOGY 3.1 Research Design 134 3.2 Sources of Data 134 3.3 Population of the Study 135 3.4 Sample Size Determination 137 3.5 Description of Research Instrument 140 3.6 Validity of the Instrument 140 3.7 Reliability of the Instrument 140 3.8 Methods of Data Analysis 141 References 142 CHAPTER FOUR: DATA PRESENTATION, ANALYSIS AND INTERPRETATION 4.1 4:2 4:3 Questionnaire Distribution and Response Rate Hypotheses Testing Discussion of Results References 143 160 170 180 CHAPTER FIVE: SUMMARY OF FINDINGS, CONCLUSION AND RECOMMENDATIONS 5.1 Summary of Findings 183 5.2 Conclusion 184 5.3 Recommendations 184 5.4 Contribution to Knowledge 186 5.5 Areas for Further Research 188 Bibliography Questionnaire 189 216 Appendix 223 Appendix 11 Appendix 1II Appendix IV Appendix V 229 230 231 232 LIST OF TABLES Table 2.1 Dimensions of Quality - - - - - - 47 Table 2.2 Components of Successful Teamwork - - - - 73 Table 2.3 Common Barriers Of Inter Professional Communication And Collaboration - - Table 3.1 Population and Staff Strength Table 3.2 Sample Size Allocation - - - - - - - - - 135 - - - - 139 - 74 Table Questionnaire Distribution and Response - - - - 143 Table 4.2 Distribution of Respondents by Gender - - - - 144 Table 4.3 Distribution of Respondents by Age - - - - - 144 Table 4.4 Educational Qualification of Respondents - - Table Marital Status of Respondents - - - - Table 4.6 Work Experience of the Respondents - - - Table 4.7 Table 4.8 Oral Interview Responses - - - - - 145 146 - - 147 148 Objective One: The Extent to Which the Quality of Service To Patients In Mission Hospitals Is Contingent on Having Appropriate Open System Business Policy Model 148 Table 4.9 Objective Two: The Extent to Which Stakeholder Business Policy Model Can Improve the Sustainability of Operations in The Management Of Mission Hospitals Table 4.10 150 Objective Three: The Extent to Which Open System Business Policy Models Can Promote Competitive Advantage in the Management of Mission Hospitals 152 Table 4.11 Objective Four: The Role of Open System Business Policy Models Towards the Management Of Human Resources In The Mission Hospitals 154 10 Table 4.12 Objective Five: The Challenges of Adopting Business Policy Models in Mission Hospital 156 Table 4.13 Objective Six: The Influence of Stakeholder Business Policy Models In the Supply Chain Management of Mission Hospitals 158 Table 4.14 Friedman Test Rank 161 Table 4.15 Friedman Test Rank 163 Table 4.16 Friedman Test Rank 165 Table 4.17 ANOVA 166 Table 4.18 One- Sample Kolmogorov- Smirnov test 167 Table 4.19 Sample Kolmogorov- Smirnov test 168 industrial relations and managing organizational conflicts Ensuring of quality of work lives Consistency in manpower compensation and recognition Periodic employee performance appraisal Employee training and development planning, Question 5: what is the greatest challenge of adopting business Policy Models’ adoption in Mission Hospitals? S/N SA Environmental Uncertainty such as government policies on taxation and importation Environmental Turbulence generated by the increasing rate of changes in technology Environmental complexity generated by many diverse external elements such as technologies, cultural and value changes, governmental regulating and granting agencies that interact with the hospital organization Incompetence in the use of technology and poor innovation Unhealthy work environment and policies Inflexibility and insensitivity to change Competitive pressure from other health care facilities A UD D SD Question 6: How does stakeholder business policy model influence the supply chain management of mission hospitals? S/N SA Administration and availability of drugs taking into cognizance of the needs /requests of patients Timely decision on purchasing and supply of drugs Dominant influence on inventory management, decision and cost Ability to handle unexpected challenges on drug administration and procurement Dominant control of information sharing in the process of demand and supply of the hospital Establishment of trust and loyalty between the suppliers, patients and the hospital A UD D SD APPENDIX I HYPOTHESIS ONE NPar Tests Descriptive Statistics N Efficacy of the procedure, or treatment in 335 relation to patient’s condition Efficiency with which services are provided 335 Respect and caring in with which services are 335 provided Timeliness with which a needed test, 335 procedure, treatments or service is provided to the patient at the most beneficial time or necessary time Safety of the patients (and others) to whom 335 the services are provided Availability of a needed test, procedures, 335 treatments or service to the patients who needs it Mean Std Deviation Minimum Maximum 2.2149 1.28851 1.00 5.00 1.6478 1.7642 87280 82326 1.00 1.00 4.00 5.00 2.2478 1.16901 1.00 5.00 1.6179 63125 1.00 3.00 2.1373 89189 1.00 4.00 Friedman Test Ranks Mean Rank Efficacy of the procedure, or treatment in relation to patients condition Efficiency with which services are provided Respect and caring in relation with which services are provided Timeliness with which a needed test, procedure, treatments or service are provided to the most beneficial time or necessary time Safety of the patients (and others) to whom the services are provided Availability of a needed test, procedures, treatments or services to the patients who need it 4.05 2.78 3.17 4.14 2.79 4.07 Test Statistics N 335 Chi-Square 506.631 Df Asymp Sig .000 a Friedman Test From the above table, the calculated Chi-Square value is 506.631 This is greater than the critical chi-square value (df = 5, α = 0.05) of 11.07050 Also, the asymptotic significance of 0.000 < 0.05 Therefore, the null hypothesis should be rejected Hence, the quality of service to patients in the mission hospitals is significantly contingent on having appropriate open business policy HYPOTHESIS TWO NPar Tests Descriptive Statistics N Remuneration and motivation of 335 employees Evaluation and restructuring of 335 stakeholders task to include new ideas and opportunities Readjusting the stakeholders' mindset 335 with sustainability-based thinking perspective and behavior Involvement and participation of all 335 stakeholders in decision making process Enhancing the negotiation and dialogue 335 abilities of the stakeholders and management Aligning the information flow of the 335 stakeholders and management with the goals, vision and strategies of the organization Mean Std Deviation Minimum Maximum 3.2119 1.24048 1.00 5.00 1.7284 1.00341 1.00 5.00 1.4925 50069 1.00 2.00 1.5940 72753 1.00 4.00 2.0418 1.17026 1.00 5.00 1.4090 49238 1.00 2.00 Friedman Test Ranks Mean Rank Remuneration and motivation of employees 5.73 evaluation and restructuring of stakeholders task to include 3.10 new ideas and opportunities Readjusting the stakeholders' mindset with sustainability- 2.84 based thinking perspective and behavior Involvement and participation of all stakeholders in decision 2.94 making process Enhancing the negotiation and dialogue abilities of the 3.75 stakeholders and management Aligning the information flow of the stakeholders and 2.63 management with the goals, vision and strategies of the organization Test Statisticsa N 335 Chi-Square 1215.464 Df Asymp Sig .000 a Friedman Test From the above table, the calculated Chi-Square value is 1215.464 This is greater than the critical chi-square value (df = 5, α = 0.05) of 11.07050 Also, the asymptotic significance of 0.000 < 0.05 Therefore, the null hypothesis should be rejected Hence, stakeholder business policy model can significantly improve the sustainability of operations in the management of mission hospitals HYPOTHESIS THREE NPar Tests Descriptive Statistics Service quality Cost control Innovation capacity Quality of human resources Flexibility towards customer demand Security of human and information Friedman Test Ranks N Mean Std Deviation 335 335 335 335 335 335 2.3881 2.2985 2.5403 1.9761 1.8896 2.1194 1.16274 87574 1.08225 1.25947 1.07908 1.12833 Minimum Maximum 1.00 1.00 1.00 1.00 1.00 1.00 5.00 5.00 5.00 5.00 5.00 5.00 Mean Rank Service quality 3.78 Cost control 3.62 Innovation capacity 4.21 Quality of human resources 2.78 Flexibility towards customer 3.14 demand Security of human and information 3.48 Test Statisticsa N 335 Chi-Square 215.201 Df Asymp Sig .000 a Friedman Test From the above table, the calculated Chi-Square value is 215.201 This is greater than the critical chi-square value (df = 5, α = 0.05) of 11.07050 Also, the asymptotic significance of 0.000 < 0.05 Therefore, the null hypothesis should be rejected Hence, open system business policy model significantly promotes competitiveness in the management of mission hospitals HYPOTHESIS FOUR ANOVA Sum Squares Between People of 1079.739 Within People Between Items 109.788 df Mean Square F 334 3.233 21.958 Residual 1012.046 1670 606 Total 1121.833 1675 670 2201.573 2009 1.096 Total Sig 36.233 000 Grand Mean = 2.1080 With a calculated F-value of 36.233 > critical F-value of 2.2141 with a significance value of 0.000 < 0.05, this result is significant Therefore, the null hypothesis is rejected Hence, there is a significant relationship between open business policy model and human resource management in the mission hospitals HYPOTHESIS FIVE NPar Z Tests Descriptive Statistics N Mean Responses on challenges in adopting BPM 2345 1.7838 in Mission Hospitals Std Deviation Minimum Maximum 80775 1.00 5.00 One-Sample Kolmogorov-Smirnov Test Responses on challenges in adopting BPM in Mission Hospitals N Normal Parameters Mean Std Deviation Most Extreme Absolute Differences Positive Negative KolmogorovSmirnov Z a,,b Asymp tailed) Sig 2345 1.7838 80775 287 287 -.218 13.878 (2- 000 a Test distribution is Normal b Calculated from data Testing the responses of the respondents with the Z-statistics, the Kolmogorov-Smirnov Z values in the table above were obtained The Z-value of 13.878 (which is greater than Z-critical value (95% level of significance) of 1.96) indicated that the respondents’ responses to the question is normally distributed Hence, the null hypothesis should be rejected Therefore, environmental turbulence and uncertainties significantly constitute the greatest challenge to the adoption of business policy models in mission hospitals HYPOTHESIS SIX NPar Z Tests Descriptive Statistics N Response on influence of stakeholder 2345 BPM in the chain supply management of mission hospitals Mean Std Deviation Minimum Maximum 1.9373 92781 1.00 5.00 One-Sample Kolmogorov-Smirnov Test Response on influence of stakeholder BPM in the chain supply management of mission hospitals N Normal Parameters Mean Std Deviation Most Extreme Absolute Differences Positive Negative KolmogorovSmirnov Z 2345 1.9373 92781 353 353 -.222 17.106 a,,b Asymp tailed) Sig (2- 000 a Test distribution is Normal b Calculated from data Testing the responses of the respondents with the Z-statistics, the Kolmogorov-Smirnov Z values in the table above were obtained The Z-values of 17.106 (which is greater than Z-critical value (95% level of significance) of 1.96) indicated that the respondents’ responses to the question is normally distributed Hence, the null hypothesis should be rejected Therefore, stakeholders’ business policy models impact positively on the supply chain management of mission hospitals APPENDIX 11 Reliability Analysis/Test Case Processing Summary Cases N % Valid 20 100.0 Excludeda 0 Total 20 100.0 a Listwise deletion based on all variables in the procedure Reliability Statistics Cronbach's Alpha Cronbach's Alpha Based on Standardized Items N of Items 980 993 32 APPENDIX 1II INTERVIEW SCHEDULE What you think open system business policy model means? What you mean by stakeholders’ business policy model? Can you give some examples of hospital stakeholders? Do you believe that quality of service to patients in the mission hospitals is contingent on having appropriate open system business policy model? Can you say that stakeholder business policy model enhances the sustainability of operations in the management of mission hospitals? Does it follow that open system business policy model promotes competitiveness in the management of mission hospitals? Does open system business policy model correlate with the role of human resources management in mission hospitals? What you think are the greatest challenge of adopting business policy models in mission hospitals? In what ways does stakeholder business policy model influence the supply chain management of mission hospitals? 10 Will it be correct to say that open system and stakeholders’ business policy model can increase high performance management? APPENDIX IV ORAL INTERVIEW DATA Hospitals Annunciation Mother of Christ St Theresa’s Ntasi Obi Bishop Shanahan Immaculate Doctors 2 Nurses 6 Others 3 2 Heart Fatima Catholic Holy Rosary St Theresa’s 3 Abatete Immaculate 3 3 60 (45.8%) 3 51(38.9%) Heart Maternity St Martins Regina Ceali St Joseph St Ann St Mary’s Total 20 (15.3%) Grand total 131 Source: Field work (2011) APPENDIX V Questions What you think ORAL INTERVIEW ANALYSIS DATA Responses Frequency open system business Is a process of interaction 90 between an organization and policy model means? 20 external environment Percentage 68.70 15.38 Is a design that is open No idea 21 What you mean by Is a process of interaction of those groups who are vital stakeholders’ business for the survival of the policy model? organization 101 Is the act whereby the parties in the organizations interact to achieve their 25 goals No idea Can you give some Doctors, staff, patients, 100 suppliers, and government, examples of hospital general public stakeholders? Doctors, nurses, lab 30 Scientist No idea 16.0 77.09 19.08 3.8 76.33 22.90 0.76 Do you believe that Yes, because it measures 105 the efficiency, efficacy and patients in the mission satisfaction a patient drives from the hospital hospitals is contingent 21 Anyway, it is contingent on having appropriate but other factors support it 3.Nil open system business quality of service to policy model? Can you say stakeholder 1.Yes to a very large extent 2.No model 3.Nil enhances management 3.8 120 91.60 11 8.4 the sustainability operations 16.03 that business policy 80.15 of in the of mission hospitals? Does it follow that Yes of course, to a very 131 large extent open system business 2.Nil 100 policy model 3.Nil 0 80 61.06 51 38.93 0 80 61.06 40 30.53 11 8.4 60 45.8 50 38.17 21 16.03 131 100 0 0 promotes competitiveness in the management of mission hospitals? Does open system 1.Yes 2.Of course to a large extent business policy model 3.Nil correlate with the role of human resources management in mission hospitals? What you think are 1.Turbulence, complexity and technology the greatest challenges 2.Culture, political and of adopting business insensitivity to change 3.Rigidity and poor work policy models in environment mission hospitals? In what ways does 1.Inventory, time stakeholder business management and cost policy model The degree of demand and supply, information flow influence the supply Trust, challenge handling chain management of and harmony mission hospitals? Will it be correct to 1.Yes Nil say that open system Nil and stakeholders’ business policy model can increase high performance management? Total Source: Field work (2011) ... an appraisal of business policy models in the management of mission hospitals in the South East Nigeria 1.3 OBJECTIVES OF THE STUDY The study has the main thrust of critically evaluating business. .. system business policy model and the management of human resources in the mission hospitals To determine the greatest challenge of adopting business policy models in mission hospitals To examine the. .. open business policy models and human resource management in the mission hospitals H1: There is significant relationship between open business policy models and human resource management in the mission