Governance Mechanisms and Service Delivery: A Comparative Assessment of the Attributes, Dynamics and Roles in Selected Health Institutions in Ghana

Abstract

The issue of hospital governance and its influence on quality of service delivery remains a conundrum that scholars have been attempting to unravel. Specifically, identifying effective governance mechanisms that are holistic and embody De Regge and Eecklo’s (2020) typology of hospital governance comprising attributes, dynamics and roles of governance systems was the focus of this inquiry. A qualitative approach underpinned by an interpretivist research paradigm was adopted in this study. The exploratory and descriptive research designs were used in this study. Face-to-face interviews with selected management, employees and clients of the aforementioned category of healthcare institutions were conducted. A sample of sixty-four (64) respondents were purposively sampled, comprising of sixteen (16) respondents made up of management, staff and clients from each of the four categories of healthcare institutions. The thematic analysis was used in the analysis of data, leading to some important findings. Firstly, this study found that there were variations in the nature and composition of governance mechanisms among the selected public, private, quasi and mission-based healthcare institutions. This study found that the commonality among the governance mechanisms of these four institutions was the encapsulation of the attributes, dynamics and roles which further influenced the decision-making and quality-of-service delivery of the four institutions. This study also found that accreditation was an essential component in the legitimacy of all healthcare institutions, and formed part of the regulatory requirements needed to facilitate hospital governance. Furthermore, the study found that attributes, dynamics and roles influenced quality-of-service delivery by providing quality standards, employee behavioural controls and ethics, as well as customer service training to ensure that patients receive quality care at all times. The study also found that the four healthcare institutions mostly had challenges pertaining to financial challenges, decision-making challenges, logistics challenges, and employee migration/turnover challenges. This study recommends that training be organised for administrators and management of healthcare institutions in Ghana on the role of attributes, dynamics and roles in facilitating quality healthcare service delivery. This will help provide clarity especially in relation to the dynamics and role elements of hospital governance. The study also recommends that management of healthcare institutions explore creative methods of financing to overcome the challenge of cash flow problems largely resulting from delays in insurance settlements. In conclusion, this study has provided new insights on the nature and composition of governance mechanisms in Ghana’s healthcare sector, whilst highlighting major challenges confronting public, private, quasi and mission-based healthcare institutions. The study’s findings provide useful recommendations for policy, practice and future research.