Organizational Culture Correlates of Health Systems Responsiveness among Chronic Care Centers: A Cross-Sectional Study in Tier Three Hospitals in Kenya
Keywords:
Health system responsiveness, Socio-demographic characteristics, chronic conditions, Diabetes Mellitus, HypertensionAbstract
Purpose:
This study assessed how organizational culture influences health system responsiveness in diabetic and hypertensive clinics in tier three hospitals in Kenya, focusing on patients’ non-clinical expectations such as dignity, prompt attention, communication, and respect.
Methodology: A cross-sectional survey was conducted among 308 respondents attending chronic care clinics in Kimilili, Uasin Gishu, and Gatundu tier three hospitals. Data were collected using a structured questionnaire measuring organizational culture and responsiveness domains. Responses were rated on five-point Likert scales. Responsiveness scores were summed and dichotomized using the demarcation threshold formula into favourable and unfavourable categories. Data were analyzed using SPSS version 27 at a 95% confidence level using descriptive statistics, one-way ANOVA, and Chi-square tests.
Findings: Overall, 61.7% of respondents reported unfavourable responsiveness. Mean scores for organizational culture indicators ranged from 2.98 to 3.19. Organizational culture did not significantly differ across the three hospitals (p=0.590). However, overall organizational culture (p=0.001), respectful language (p=0.001), cultural sensitivity (p=0.029), adherence to processes (p=0.026), convenience of care steps (p=0.028), and respect for client opinions (p=0.004) were significantly associated with responsiveness, while pay arrangements and client interest focus were not.
Unique Contribution to Theory, Practice and Policy: The study demonstrates that relational aspects of organizational culture significantly influence health system responsiveness in chronic care clinics. Strengthening respectful communication, cultural competence, participatory leadership, and structured patient feedback systems can enhance responsiveness and support patient-centered care in Kenyan tier three hospitals.
DOI: https://doi.org/10.5281/zenodo.18933880
References
Achstetter, K., Köppen, J., Hengel, P., Blümel, M., & Busse, R. (2022). Drivers of patient perceptions of health system responsiveness in Germany. The International Journal of Health Planning and Management, 37(S1), 166–186. https://doi.org/10.1002/hpm.3570
Adhikari, A., Paneru, D. P., & Pokhrel, A. (2024). Responsiveness of services rendered at primary healthcare facilities of Bharatpur, Nepal: A cross-sectional study. BMJ Public Health, 2(1). https://doi.org/https://doi.org/10.1136/bmjph-2023-000546
Almohaisen, N. A., Alsayari, N. M., Abid, M. H., Al Subhi, N. F., Al Masoudi, A., AlGhazali, O. S., & Woodman, A. (2023). Improving patient experience by implementing an organisational culture model. BMJ Open Quality, 12(2). https://doi.org/https://doi.org/10.1136/bmjoq-2022-002076
Amirrudin, M., Nasution, K., & Supahar, S. (2021). Effect of variability on Cronbach alpha reliability in research practice. Jurnal Matematika, Statistika Dan Komputasi, 17(2), 223–230. https://doi.org/https://doi.org/10.20956/jmsk.v17i2.11655
Benavides, J. R. M. (2026). Psychological Determinants of Patient Satisfaction Following Full-Mouth Rehabilitation. European Journal of Prosthodontics and Restorative Dentistry, 34(1), 69–79. https://doi.org/https://orcid.org/0000-0001-7071- 6264
Bhati, D., Deogade, M. S., & Kanyal, D. (2023). Improving patient outcomes through effective hospital administration: A comprehensive review. Cureus, 15(10), e47731. https://doi.org/DOI:%2010.7759/cureus.47731
Bragge, P., Delafosse, V., Kellner, P., Cong-Lem, N., Tsering, D., Giummarra, M. J., Lannin, N. A., Andrew, N., & Reeder, S. (2025). Relationship between staff experience and patient outcomes in hospital settings: An overview of reviews. BMJ Open, 15(1), e091942. https://doi.org/http://creativecommons.org/licenses/by-nc/4.0/
Coleman, P. (2022). Validity and reliability within qualitative research for the caring sciences. International Journal of Caring Sciences, 14(3), 2041–2045. https://doi.org/https://oro.open.ac.uk/81588/
Fetene, M. B., Bayable, S. D., Wendimu, E. S., Belehu, K. D., Almaw, A. A., Dula, P. K., & Bejiga, B. Z. (2022). Perioperative patient satisfaction and its predictors following surgery and anesthesia services in North Shewa, Ethiopia. A multicenter prospective cross-sectional study. Annals of Medicine and Surgery, 76, 103478. https://doi.org/https://doi.org/10.1016/j.amsu.2022.103478
Geldsetzer, P., Haakenstad, A., James, E. K., & Atun, R. (2018). Non-technical health care quality and health system responsiveness in middle-income countries: A cross-sectional study in China, Ghana, India, Mexico, Russia, and South Africa. Journal of Global Health, 8(2), 020417. https://doi.org/https://doi.org/doi: 10.7189/jogh.08.020417
González-Carvajal, J., González Nahuelquin, C., Solano Ruiz, C., & Andina Díaz, E. (2026). Intercultural Health: Healthcare Strategies in Hospitals—A Qualitative Meta‐Synthesis. Nursing Forum, 2026(1), 3876846. https://doi.org/10.1155/nuf/3876846
Guan, T., Chen, X., Li, J., & Zhang, Y. (2024). Factors influencing patient experience in hospital wards: A systematic review. BMC Nursing, 23(1), 527. https://doi.org/10.1186/s12912-024-02054-0
Hong, Z., Lu, J., Chen, G., Tang, Q., Sun, H., Wei, T., Zhao, S., & Lu, J. (2025). Health system responsiveness: Comparison of different levels of medical institutions in Kunshan City, China. Annals of Medicine, 57(1), 2446693. https://doi.org/10.1080/07853890.2024.2446693
Kamau, B., Büsche, C., Kroeger, A., & Mac, P. A. (2025). Needs assessment and contextual analysis of public emergency medical services in Nakuru County, Kenya. Discover Health Systems, 4(1), 143. https://doi.org/10.1007/s44250-025-00324-5
Khan, G., Kagwanja, N., Whyle, E., Gilson, L., Molyneux, S., Schaay, N., Tsofa, B., Barasa, E., & Olivier, J. (2021). Health system responsiveness: Systematic evidence mapping review of the global literature. International Journal for Equity in Health, 20(1), 112. https://doi.org/10.1186/s12939-021-01447-w
Kinyenje, E., Degeh, M. M., Nassoro, O. A., Bahegwa, R. P., Hokororo, J. C., Yahya, T. A., German, C. J., Mohamed, M. A., Ngowi, R. R., & Msigwa, Y. S. (2023). Patient-Provider interaction in primary healthcare facilities in tanzania: Findings from star rating assessment. J Service Sci Manage, 16(5), 642. https://doi.org/10.4236/jssm.2023.165034
Kumar, A., Gangwar, R., Ahmad Zargar, A., Kumar, R., & Sharma, A. (2024). Prevalence of Diabetes in India: A Review of IDF Diabetes Atlas 10thEdition. Current Diabetes Reviews, 20(1), e130423215752. https://doi.org/10.2174/1573399819666230413094200
Lawton, R., O’Hara, J. K., Sheard, L., Reynolds, C., Cocks, K., Armitage, G., & Wright, J. (2015). Can staff and patient perspectives on hospital safety predict harm-free care? An analysis of staff and patient survey data and routinely collected outcomes. BMJ Quality & Safety, 24(6), 369–376.
Mannion, R., & Davies, H. (2018). Understanding organisational culture for healthcare quality improvement. Bmj, 363. https://doi.org/doi:%20https://doi.org/10.1136/bmj.k4907
Mazur, B. (2023). Organizational culture in enterprises applying the humanistic and economic paradigm of management. In Organizational Culture-Cultural Change and Technology. IntechOpen. https://doi.org/DOI:%2010.5772/intechopen.113155
Mirzoev, T., & Kane, S. (2017). What is health systems responsiveness? Review of existing knowledge and proposed conceptual framework. BMJ Global Health, 2(4), e000486. https://doi.org/https://doi.org/10.1136/bmjgh-2017-000486
Mogaka, J. N., Sharma, M., Temu, T., Masyuko, S., Kinuthia, J., Osoti, A., Zifodya, J., Nakanjako, D., Njoroge, A., & Otedo, A. (2022). Prevalence and factors associated with hypertension among adults with and without HIV in Western Kenya. Plos One, 17(1), e0262400. https://doi.org/https://doi.org/10.1371/journal.pone.0262400
Mohamed, S. F., Mwangi, M., Mutua, M. K., Kibachio, J., Hussein, A., Ndegwa, Z., Owondo, S., Asiki, G., & Kyobutungi, C. (2018). Prevalence and factors associated with pre-diabetes and diabetes mellitus in Kenya: Results from a national survey. BMC Public Health, 18(S3), 1215. https://doi.org/10.1186/s12889-018-6053-x
Okafor, C. H., Ugwu, A. C., & Okon, I. E. (2018). Effects of Patient Safety Culture on Patient Satisfaction with Radiological Services in Nigerian Radiodiagnostic Practice. Journal of Patient Experience, 5(4), 267–271. https://doi.org/10.1177/2374373518755500
Otieno, F. C., Mikhail, T., Acharya, K., Muga, J., Ngugi, N., & Njenga, E. (2021). Suboptimal glycemic control and prevalence of diabetes-related complications in Kenyan population with diabetes: Cohort analysis of the seventh wave of the International Diabetes Management Practices Study (IDMPS). Endocrine and Metabolic Science, 3, 100093. https://doi.org/https://doi.org/10.1016/j.endmts.2021.100093
Pengpid, S., & Peltzer, K. (2020). Prevalence, awareness, treatment and control of hypertension among adults in Kenya: Cross-sectional national population-based survey. Eastern Mediterranean Health Journal, 26(8), 923–932. https://doi.org/https://doi.org/10.26719/emhj.20.063
Qin, X., Wang, R., Huang, Y.-N., Zhao, J., Chiu, H.-C., Tung, T.-H., Harrison, J., & Wang, B.-L. (2023). Organisational culture research in healthcare: A big data bibliometric study. Healthcare, 11(2), 169. https://doi.org/https://doi.org/10.3390/healthcare11020169
Röttger, J., Blümel, M., Fuchs, S., & Busse, R. (2014). Assessing the responsiveness of chronic disease care-is the World Health Organization’s concept of health system responsiveness applicable? Social Science & Medicine, 113, 87–94. https://doi.org/https://doi.org/10.1016/j.socscimed.2014.05.009
Semyonov-Tal, K. (2024). Responsiveness of Inpatient Care and Provision of Dignity: Insights from a Patient Experience Survey in Israel. Health Policy, 105043. https://doi.org/https://doi.org/10.1016/j.healthpol.2024.105043 Get rights and content
Sileyew, K. J. (2019). Research design and methodology. Cyberspace, 1–12. https://doi.org/DOI:%2010.5772/intechopen.85731
Taherdoost, H. (2017). Determining sample size; how to calculate survey sample size. International Journal of Economics and Management Systems, 2. https://doi.org/http://www.hamta.org
Topp, S. M., & Chipukuma, J. M. (2016). A qualitative study of the role of workplace and interpersonal trust in shaping service quality and responsiveness in Zambian primary health centres. Health Policy and Planning, 31(2), 192–204. https://doi.org/https://doi.org/10.1093/heapol/czv041
Triguero-Sánchez, R., Peña-Vinces, J., & Ferreira, J. J. M. (2022). The effect of collectivism-based organisational culture on employee commitment in public organisations. Socio-Economic Planning Sciences, 83, 101335.
Willie, M. M. (2024). Cultural Change Strategies and Challenges in Healthcare and Technology Sectors. Journal of Public Administration, 59(3), 558–572. https://doi.org/10.53973/jopa.2024.59.3.a14
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