TOWARDS SUPERIOR PERFORMANCE IN PUBLIC HOSPITALS:
AN ASSESSMENT OF STRATEGIC CAPABILITIES - THE CASE OF KOMFO
ANOKYE TEACHING HOSPITAL
BY
GEORGINA YEBOAH
THIS THESIS IS SUBMITTED TO THE UNIVERSITY OF GHANA, LEGON IN 
PARTIAL FULFILLMENT OFTHE REQUIREMENT FOR THE AWARD OF MBA 
DEGREE IN “HEALTH SERVICES ADMINISTRATION”
MAY 2001
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tt 3712£9
Aft17l-Ys
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DEDICATION
This work is dedicated to the glory of God, my loving husband Edward and Children, 
Steve, Stephanie and Ivan
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DECLARATION
I declare that except for references which have been duly acknowledged, this work is 
the result of my own research and have not been presented in whole or part for the 
award of another degree elsewhere.
GEORGINA YEBOAH 
(STUDENT)
DR. K. ANS 
(SUPERVT
OBUOBI 
(SUPERVISOR)
D A T E . a i l . A p v 1,,..0 ^
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ACKNOWLEDGEMENT
I wish to empress my sincere thanks to the Almighty God for his support, guidance and 
wisdom accorded me in the presentation of this work.
Writing this thesis was not an easy task but with the assistance of my supervisors, Dr. 
K.A. Ofei and Mr. A.A.D. Obuobi, I was able to come this far. Their criticisms, 
suggestions, guidance and encouragement have made the work what it is today.
I also appreciate the encouragement and support of my husband Edward, who also 
typed and edited most of my work.
The financial support of my employer, the Ministry of Health, helped this thesis to 
progress. I am grateful for that.
My final thanks to the staff of Komfo Anokye Teaching Hospital for their co-operation.
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ABSTRACT
Improvement in health service delivery has become an issue in recent times all over the 
world with Ghana not being an exception. In Ghana, Public Hospitals have come under 
severe media and public criticism for poor service delivery.
To be able to meet the expectation of the public, these hospitals must possess certain 
resources and competences. Not only should public hospital improve on their 
performance but should also do their best to excel in the health care industry.
This requires that the resources and competencies, which are necessary for health 
services delivery, must be distinct from that of others in the health service industry.
The study therefore sought to find out whether Komfo Anokye Teaching Hospital 
(KATH) possessed any distinct resources and competencies and how they could be 
exploited for superior performance.
The study employed a multi method approach of data collection. Structured 
questionnaires, documents and archives were used to get information on the hospital’s 
past performance and also identify the resources and competences that Komfo Anokye 
Teaching Hospital possessed.
The study showed that Komfo Anokye Teaching Hospital had almost all the resources 
central to health service delivery as well as distinctive resources. KATH, compared 
with its competitors, was found to be endowed with physical resources like facilities for 
special cases. For example, Neonatal unit, Radiotherapy Centre, state-of-the-art X-ray
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and Family planning facilities. However, the facilities at the hospital were over utilized 
and some of its equipment needed to be changed as they were old.
KATH had a strong human resource position as it had staff with vast expertise 
especially in the clinical areas. The hospital’s relationship with the School of Medical 
Sciences of the Kwame Nkrumah contributed greatly to this advantage. The lecturers 
provided services through their teaching.
However, the performance of activities (competencies) was not encouraging. The 
resources had not been fully deployed to create competences in the performance of 
critical activities. From the overall assessment of KATH’s competencies no unique 
competencies were found. In the area of Service Delivery/Operations the performance 
was ordinary. It would have been expected that with the good human resources position 
of the hospital, it would have a unique competence in this area.
As a teaching hospital which has research as part of its mission, KATH’s performance 
in research and development was poor. It even had the personnel to undertake research. 
It could use research to improve on its services.
Managements of Public Hospital should not think that due to the resource constraints 
that they face improving performance or excelling in performance cannot be attained.
They should know their organizations by doing an internal assessment to identify 
strengths, which could be exploited and the weaknesses which ought to be strengthened 
and improved for superior performance.
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TABLE OF CONTENTS
Title page....................................................................................................................i
Dedication................................................................................................................ ii
Declaration............................................................................................................... iii
Acknowledgement..................................................................................................iv
Abstract................................................................................................................... v
Table of Contents..................................................................................................vii
Abbreviations......................................................................................................... xii
List of Tables........................................................................................................ xiii
List o f Figures........................................................................................................ xv
CHAPTER ONE: INTRODUCTION............................................................... 1
1.1 Background.....................................................................................................1
1.2 Problem Statement......................................................................................... 3
1.3 Research Questions........................................................................................ 5
1.4 Hypothesis.......................................................................................................5
1.5 Objectives........................................................................................................5
1.6 Significance o f the Study.............................................................................. 6
1.7 Scope and Limitation of the study................................................................ 7
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1.8 Organization o f Study.................................................................................... 7
1.9 Definition o f important terms used in the study........................................8
CHAPTER TWO: THEORETICAL FRANMEWORK................................ 10
2.1 Introduction.................................................................................................... 10
2.2 Approaches to strategy................................................................................. 10
2.3 Conceptual model for superior performance............................................ 12
2.3.1 Strategic capability.......................................................................................13
2.3.2 Positional Advantage...................................................................................24
2.3.3 Performance outcomes.................................................................................25
2.3.4 Converting sources into superior positions and outcomes....................26
2.3.5 Identifying sources o f advantage.............................................................. 36
2.3.6 Sustaining superiority.................................................................................. 40
2.4 Implication for the study of hospitals.........................................................44
CHAPTER THREE: RESEARCH METHOLODOGY..................................... 46
3.1 Introduction......................................................................................................... 46
3.2 Research strategy............................................................................................... 46
3.3 Research setting..................................................................................................47
3.4 Study population.................................................................................................48
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3.5 Sampling procedure............................................................................................. 50
3.6 Sampling characteristics......................................................................................50
3.7 Data collection methodology..............................................................................51
3.8 Pre-testing o f  Questionnaire............................................................................... 53
3.9 Data collection limitation....................................................................................53
3.10 Data processing and analysis..............................................................................54
CHAPTER 4: RESULTS AND DISCUSSIONS......................................................55
4.1 Introduction............................................................................................................55
4.2 F indings.................................................................................................................. 55
4.2.1. Performance for the past three years...............................................................55
4.2.2. Resource profile o f KATH................................................................................69
4.2.3. Identification o f Competitors............................................................................81
4.2.4. Unique Resources............................................................................................... 82
4.2.5. Competencies profile o f KATH........................................................................ 87
4.2.6. Linkages within the hospital.............................................................................. 95
4.3 Discussion.................................................................................................................96
4.3.1 Past performance of KATH................................................................................96
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4.3.2 Resources................................................................................................................. 98
4.3.3 Competencies..........................................................................................................101
CHAPTER FIVE: SUMMARY OF FINDINGS, RECOMMENDATIONS 
AND CONCLUSION...................................................................................................... 105
5.1 Introduction.............................................................................................................105
5.2 Summary o f findings................................................................................................. 105
5.2.1 Performance for the past 3 years.......................................................................... 106
5.2.2 Critical resources and competences and their uniqueness............................... 107
5.3 Recommendations......................................................................................................112
5.4 Conclusion...................................................................................................................115
References............................................................................................................................. 117
APPENDICES...................................................................................................................... 123
APPENDIX I QUESTIONAIRE................................................................................ 123
APPENDIX II Komfo Anokye Teaching Hospital-Organogram............................138
APPENDIX III Variables, Indicators and Measurements-Details........................... 139
APPENDIX IV Departmental objectives....................................................................... 140
APPENDIX V Physical Resources Profile o f KATH................................................144
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APPENDIX VI Types o f  Specialist/Specialized Staff................................................... 156
APPENDIX VII Competence profile o f KATH...............................................................157
APPENDIX VIII Data Set on KATH................................................................................ 161
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ABBREVIATIONS
A & E: Accident and Emergency
D. AVAIL: Drug Availability
DEN :  Dental
DIR. TON 1: Direction to Records Office
DIR. TION 2: Direction to Clinic/Consulting Room
ENT: Ear, Nose and Throat
EXAMIN: Patient Examined
HOSP AVER: Hospital Average
INSTRUCT: Understood Pharmacy Instructions
KATH: Komfo Anokye teaching Hospital
KNUST: Kwame Nkrumah University of Science and Technology
MED: Medicine
MOH: Ministry o f Health
O&G: Obstetrics and Gynaecology
PAED: Paediatrics
PIMS: Profit Impact of Marketing Strategies
POLY: Polyclinic
RBV: Resource-based View
RET/N. RET: Told to Return or Not
SUB-BMC: Sub-Budget Management Centre
SMS: School of Medical Sciences
SURG: Surgery
U. DELAY: Unnecessary Delay
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LIST OF TABLES
Table 3.1 Departments................................................................................................... 49
Table 3.2 Position in Department/Hospital.................................................................50
Table 3.3 Grade................................................................................................................ 51
Table 3.4 Variables, Indicators and Measurement for the Study.......................... 53
Table 4.1 Objectives for the past three y ea rs .............................................................56
Table 4.2 Objectives achieved..................................................................................... 57
Table 4.3 Present objectives.........................................................................................57
Table 4.4 Out-patient attendance............................................................................  59
Table 4.5 Admissions 1998-2000..............................................................................60
Table 4.6 Out-patient satisfaction..............................................................................63
Table 4.7 Poor out-patient responses..................................................................... 65
Table 4.8 Responsiveness and Reliability............................................................ 66
Table 4.9 Care............................................................................................................ 67
Table 4.10 Physical Environment............................................................................. 68
Table 4.11 Clients’ perception of providers........................................................... 68
Table 4.12 Adaptability o f Staff.............................................................................. 73
Table 4.13 Staff Commitment and Loyalty..........................................................74
Table 4.14 Knowledge about Financial Resources............................................. 75
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Table 4.15 Reliability o f Sources of Funds............................................................76
Table 4.16 Reputation before the Public.............................................................. 78
Table 4.17 Resource Allocation...............................................................................81
Table 4.18 KATH’s potential competitors...........................................................82
Table 4.19 Critical Activities.....................................................................................88
Table 4.20 Inbound Logistics....................................................................................89
Table 4.21 Operations/Service D elivery ................................................................89
Table 4.22 Marketing.................................................................................................90
Table 4.23 Service........................................................................................................91
Table 4.24 Firm Infrastructure...................................................................................91
Table 4.25 Human Resources Management...........................................................92
Table 4.26 Technology Development..................................................................... 93
Table 4.27 Procurement............................................................................................ 93
Table 4.28 Overall Assessment of Competences...................................................94
Table 4.29 Internal Linkages.................................................................................... 95
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LIST OF FIGURES
Figure 2.1 Conceptual model for Superior Performance.......................................... 12
Figure 2.2 The Value Chain...........................................................................................20
Figure 4.1 Pie Chart showing Regional Outpatient Attendance for year 2000.. .59
Figure 4.2 Chart Showing Regional Admissions...................................................... 61
Figure 4.3 KATH Average...........................................................................................62
Figure 4.4 Respondents opinion on types of skills their staff have....................... 73
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CHAPTER ONE 
INTRODUCTION
1.1 BACKGROUND
The performance of an organization determines its success or failure. The improvement of 
performance should therefore be a way of life o f organizations. The starting point is the 
recognition of the need which results from the recognition o f a problem. In pursuit of 
improvement in performance, organizations do not seek to catch up with others but to 
outperform them. According to Porter (1996), a company can outperform rivals only if  it 
can establish a difference that it can preserve. It must either deliver greater value to 
customers or create comparable value at a lower cost or do both.
Leebov (1988) asserts that service (performance) excellence is a process, not a programme. 
A programme has a beginning and an end. However, service excellence is a strategic way of 
doing business. To him, it should be valued in the culture of hospitals. It needs to be firmly 
installed and actively and aggressively maintained forever.
Many approaches to strategy intended towards superior performance have been propounded 
over the years. This was first conceived by Andrews (1971) who defined strategy as the 
match between what a company can do (strengths and weaknesses) within the universe of 
what it might do (environmental opportunities and threats). Though its power recognized, 
managers were not given enough insights about how to assess both sides of the 
organisational environment.
In the 1970s and 1980s, the external environment dominated most developments in strategy 
analysis and internal environment analysis was considered during strategy implementation. 
Tools like the Portfolio Planning, Profit Impact of Market Strategies (PIMS) and Experience 
Curve were also much emphasized.
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In the early 1990s, the pendulum swung dramatically to consider factors inside the 
organization. The sources o f  competitive advantage were attributed to be inside the 
organization, which were the skills and collective learning. This approach laid less emphasis 
on the external environment.
However, since the mid-1990s, an approach which dwells on Andrew’s (1971) framework is 
receiving much attention. It brings together both the external and internal environment of 
organisations. It helps to understand why some firms perform better than others.
The strategy literature talks about two dimensions of performance. They are financial (e.g. 
return on capital, shareholder wealth creation, profit growth) and market place performance 
e.g. market share, utilization, customer satisfaction, customer loyalty (Hunt and Morgan, 
1995; Day and Wensley, 1988.). For profit businesses have superior financial performance 
in the form of profitability as their primary objectives. On the contrary, the most important 
organizational performance outcome for health care delivery is comprehensive and durable 
change in the mental and physical well being o f people. The human centred purpose 
differentiates health care providers from other types o f enterprises and shapes the 
fundamental concept o f quality in health care settings. Hence, the provision o f service 
quality and customer satisfaction appear to be the critical objectives in the strategy 
development process o f health care organization. For this reason service quality and 
customer satisfaction have become important factors in the delivery o f health care. Service 
quality is defined as the consumer’s comparison between service expectations and service 
performance. Woodward (2000) defines quality of health care to include such characteristic 
as accessibility, appropriateness, effectiveness, efficiency and acceptability as well as equity. 
According to Arrington et al., (1995), performance is concerned with the efficiency of, 
effectiveness of customer satisfaction with, and value added by the sum total o f what health 
care organization achieve through their processes, services and products.
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The Ministry of Health (MOH) Ghana has undergone a lot o f reforms since 1988 which are 
meant among other things to improve on its efficiency and enable it to provide better quality 
service. Since 1996, after a study on Quality Assurance confirmed dissatisfaction with 
existing services, the Ministry has devoted a lot o f attention to quality assurance in all its 
curative institutions.
In addition, the Ministry has as part o f its objectives the following. These have to be 
followed by all its health facilities:
(i) To increase geographical and financial access to health service to all people living 
in Ghana.
(ii) To provide better quality of care in all health care facilities and all outreach 
centres.
(iii) To improve efficiency at all levels of the health care system.
From the above, the MOH is more interested in public hospitals giving customer (patient) 
satisfaction a priority even before profitability.
The study therefore considered how service excellence could be achieved in all curative 
health institutions (public hospitals) through their strategic capabilities.
1.2 PROBLEM STATEMENT
People around the world are demanding greater quality in the health care they receive and 
accountability in the health care system. In Ghana, one would always hear listeners who 
phone-in during discussions on health issues on radio/television complaining about the 
quality of service and customer satisfaction. Patients and their relatives have begun taking 
legal actions against public hospitals for what they see as negligence o f duty. In 1997 two 
separate cases at Komfo Anokye Teaching Hospital (KATH) which bordered on negligence
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of duty which resulted in the amputation of the arm o f a boy and the death o f a male patient 
ended up in the courts and KATH was made to pay compensation to the relatives concerned. 
The current restructuring o f MOH (embodied in the GHS and TH Act525) seeks to make the 
teaching hospitals autonomous and to be managed by boards. This is to help improve on their 
efficiency and effectiveness. Despite these challenges for improved performance public 
hospitals are faced with i nadequate funds (i.e. physical constraints) created by worsening 
economic conditions. In their dilemma they cannot increase arbitrarily the cost o f delivery. 
For example Korle-Bu Teaching Hospital (KBTH) in 2000 tried to do so to help improve 
performance but was not allowed by government to implement the new fees.
Public hospitals cannot throw their arms in despair under such circumstances. However, 
strategic management literature provides suggestions for the resolution o f the situation. The 
literature sees organisations as a collection o f capabilities and it is these capabilities which 
determine how efficiently and effectively a company performs its functional activities (Collis 
and Montgomery, 1995, Hunt and Morgan 1996, Day and Wensley, 1988). These 
capabilities which are the heart o f a firms performance are subject to the interplay of 
fundamental market forces which are demand (does it meet customers needs?), scarcity (is it 
imitable or substitutable or durable?) and appropriability (who owns the profit?). It therefore 
follows that public hospitals and for that matter KATH, will be positioned to succeed (i.e. 
meet the quality care standards) if they have the best and most appropriate stocks of 
capabilities for their businesses, objectives, policies and strategies.
Andrews (1980) notes that subjectivity, lack of confidence and unwilling to face reality on 
the part o f mangers make it hard for organizations to know themselves. But for the sake of 
self awareness, he suggests that it is necessary for an organization to identify approximately 
its central strength and crucial vulnerability to help it develop judgments about what it can
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do and what it can do particularly well. Knowing them will also help in their proper 
management and sustaining them for a long-term payback.
The study therefore sought to use the strategic management approach to carry out an internal 
assessment o f KATH to identify the stocks of capabilities which KATH possesses and which 
could be exploited to become a benchmarked-hospital in the Ashanti Region.
1.3 RESEARCH QUESTIONS
Hospitals provide certain services, which require them to possess certain critical resources 
and competences. The research therefore sought to find an answer to the following 
questions:
• What are these critical resources and competences
• Does KATH meet this requirement?
• How can KATH exploit their resources and competences for superior performance?
1.4 RESEARCH HYPOTHESIS
The study was conducted with the hypothesis that there are unique resources and core 
competencies, which KATH possess which could be exploited for superior performance.
1.5 OBJECTIVES
Generally, the research aims at assessing the resources and competencies of KATH, which 
could be exploited to meet the challenges in the environment for superior performance. 
Specifically, the key objectives of the research were to:
i) investigate the performance of KATH for the past three (3) years.
ii) find out the resources and competences critical to health service delivery.
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iii) assess the sources of advantage (in terms of resources and competences) KATH 
possesses
iv) determine how these sources of advantage could be exploited for superior 
performance
1.6 SIGNIFICANCE OF STUDY
The environment in which the public hospitals in Ghana operate has changed significantly. 
Many are the challenges (both opportunities and threats) that face them. Users expect more 
from hospitals than before. Public hospitals cannot continue with their mediocre and in 
some cases poor performance. They must become responsive organizations making every 
effort to satisfy the needs and wants of their markets. It is important for them to determine 
how responsive they want to be and develop appropriate systems for measuring and 
improving satisfaction in their market place. This is because people who come into contact 
with responsive organizations report high levels o f satisfaction.
Moreover, complaints about limited resources have hindered them from actually taking time 
to understand even the little that they have and how they could be exploited for an 
advantage.
The study is expected to make management of these hospitals conscious o f the challenges 
and their implications for them as well as the potential within them which must be harnessed 
for excellent performance.
Specifically, the conclusions are intended to help the management of KATH to begin to 
think of creating a unique market position in the northern sector of Ghana and particularly in 
the Ashanti Region. It is hoped that it will pay attention to those strengths identified and the 
weaknesses that are important for excellent performance.
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1.7 SCOPE AND LIMITATION OF THE STUDY
The study was concerned with improving performance in public hospitals with particular 
interest in a teaching hospital. It did an in-depth strategic analysis o f the hospital and how 
the findings could help achieve excellent performance.
Literature on strategic analysis relevant to the Ghanaian context was not available. Thus the 
study depended heavily on studies done in the field of marketing, journals and textbooks. 
Due to the limited time available to the researcher and the respondents, the competitive 
profiling o f KATH against each of its most relevant competitors could not be done. 
However, respondents were able to make a comparative assessment with the competitors 
they identified.
1.8 ORGANIZATION OF STUDY
This work is organized into five (5) chapters. Chapter one gives a general introduction to the 
work and highlights the research questions as well as the significance o f the study. It ends 
with an explanation of key terminologies used in the work.
Chapter two presents the theoretical framework, which touches on definition, developments 
in strategy and the conceptual model for the study.
In chapter three, the methodology is discussed. The main issues include data sources, 
collection tools and how the data so collected was analysed as well as the research setting. 
The analysis, interpretation and discussion of the findings of data collected with the aid of 
questionnaire and documents and archives were done in chapter four.
The last chapter, chapter five, contains the summary of findings, recommendations and 
conclusion.
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1.9 DEFINITION OF IMPORTANT TERMS USED IN THE STUDY
1. Strength -  It is a resource or skill o f advantage relative to competitors and the needs 
o f the markets a firm serves or expects to serve.
2. Weakness -  A limitation or deficiency in a resource or skill that seriously impeded an 
Organizations performance.
3. Unique Resources -  They are those resources which create competitive advantage 
and are difficult to imitate.
4. Value -  What buyers are willing to pay for what a firm provides them.
5. Customer Value -  The bundle of benefits customers expect from a given product 
or service.
6. Value Activities -  They are the physically and technologically distinct activities a 
firm performs.
7. Satisfaction -  Refers to a state felt by a person who has experienced a performance 
(outcome) that has fulfilled his or her expectations. It is thus a function o f relative 
levels and perceived performance. If the performance exceeds the expectation, the 
person is highly satisfied. If the performance matches expectation, the person is 
satisfied. If it falls short of expectations, the person is dissatisfied.
8. Equity -  services are provided to all people who require them
9. Accessibility -  Ready access to services is provided
10. Acceptability -  care meets the expectations of the people who use the services
11. Appropriateness -required care is provided, and unnecessary or harmful care is 
avoided
12. Comprehensiveness -  care provision covers all aspects o f disease management from 
prevention to remediation, psycho-social aspects of care are considered
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13. Effectiveness- care produces positive change in the health status or quality o f life of 
the patient
14. Efficiency- high quality care is provided at the lowest possible cost
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CHAPTER TWO 
THEORETICAL FRAMEWORK
2.1 INTRODUCTION
This chapter discusses in detail the concept of strategic capability. It begins with the 
approaches to strategy; a conceptual model for superior performance and other literature 
relevant to the research questions.
2.2 APPROACHES TO STRATEGY
The field of strategy has largely been shaped around a framework first conceived by Andrew 
(1971). In his book “The concept o f corporate strategy” he defined strategy as the match 
between what a company can do (organizational strengths and weaknesses) within the 
universe of what it might do (environmental opportunities and threats).
However, managers were given little insight about how to assess either side of the 
environment.
During the 1970s and 1980s, the external environment dominated the themes in strategy 
literature. During this period, most developments in strategy analysis concentrated on the 
industry environment o f the firm and its competitive positioning in relation to rivals.
During the 1980s, tools like Portfolio Planning, the Experience Curve, PIMS and Porter’s 
Five Force brought rigour and legitimacy to strategy at both the business-unit and corporate 
level (Collis and Montgomery, 1995; Grant, 1998). Top executives were judged on their 
ability to restructure, clutter and delayer their corporations (Prahalad and Hamel, 1990). 
Tools like Porter’s Five Force Model showed clearly how to choose the “right industry” and 
within them, the most attractive competitive positions.
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By contrast, strategic analysis o f the firm’s internal environment remained underdeveloped. 
According to Grant (1999), the internal environment analysis, for most part, has been 
concerned with issues o f strategy implementation.
At the business-unit level, the pace of global competition and technological change has left 
managers struggling to keep up. As markets move faster and faster, managers complain that 
strategic planning is too static. As many big companies faced threats from smaller, less 
hierarchical competitors, they either suffered great setbacks or went through dramatic 
change. By the late 1980s, they were struggling to justify their existence.
With the introduction of new approaches to strategy like the 7 -  S framework of Tom Peters 
and Bob Waterman (1989), core competencies and competing on capabilities, there was a re­
direction from outside to inside the firm. These approaches emphasized the importance of 
skills and collective learning embedded in an organization and o f management’s ability to 
marshal them. This view assumed that the roots of competitive advantage were inside the 
organization and that the adoption of strategies was constrained by the current level of the 
company’s resources. However, little attention was given to the external environment. 
However, during the 1990s, there has been a movement forward in the interest in the role a 
firm’s resources and competencies as the principal basis for strategy and the primary 
determination of a firm’s performance. This is what has become known as the resource- 
based view (RBV) of the firm (Collis and Montgomery, 1995; Barney, 1991; Mahoney and 
Pandian, 1992; Peterlaf, 1993).
The RBV brings these approaches together and fulfils the promise o f Andrew’s framework. 
It combines the internal analysis o f phenomena with companies with external analysis o f the 
industry and the competitive environment. It derives its strength from its ability to explain in 
clear m anagerial terms w hy some firms perform better than others. It sees resources and 
competences as the heart o f a company’s competitive position subject to the interplay of
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three fundamental market forces which are demand (does it meet customer needs and is it 
competitively superior?), scarcity (is it imitable or substitutable and is it durable?), and 
appropriability (who owns the profit?).
2.3 CONCEPTUAL MODEL FOR SUPERIOR PERFORMANCE
Fig 2.1
Source: Day and Wensley (1985), Hamel and Prahalad (1994)
From Figure 2.1 a firm’s strategic capabilities are its unique resources and distinctive 
competences which are regarded as its sources o f advantage in the market place. The 
positional and performance superiority is a consequence of relative superiority in the 
resources and competences as business develops. The sustainability o f this superiority is 
contingent on barriers that make the sources difficult to imitate. Because these barriers to
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imitation are continually eroding, the firm must continue to invest in upgrade and leverage to 
sustain or improve the advantage. A detailed discussion of the model follows:
2.3.1 STRATEGIC CAPABILITY
Strategic capability is a related concept that especially applies to the ability of an 
organization to be an effective competitor by levering its resources and core competencies 
speedily and effectively where they are needed. The p ossession or access to distribution 
networks which achieve high quality service levels is an example (Walton, 1999). Andrew, 
(1980) describes strategic capability as an organization’s demonstrated and potential ability 
to accomplish against opposition o f circumstances or competition, whatever it sets out to do. 
It is this that determines the difference in the performance o f different organizations as it 
enables a firm to produce efficiently and/or effectively market offerings that have value for 
some market segments. Johnson and Scholes (1999) relate it to the resources available to an 
organization and the competence with which the activities of the organization are 
undertaken.
Johnson and Scholes (1999) assert that without the possession o f the strategic capability 
necessary to support an organization’s strategies, the success o f the strategies, no matter how 
good they are, will be at stake. Thompson and Strickland (1990) also share the same view. 
They noted that internal weakness (the lack of strategic capability) negatively affected the 
implementation of growth strategies at U.S Sprint as the firm while expanding its business, 
failed to  upgrade its  accounting system and electronic calls routing switches necessary to 
handle the flood of customers. This led to a loss of $3 billion over two years.
Organizations must have a certain level o f strategic capability to perform at the level 
required for success. Thus the first step in validating a tentative choice among several
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opportunities is to determine whether the organization has the capacity to prosecute it 
successfully (Andrew, 1980).
The analysis o f an organizations strategic capability is important in terms of understanding 
whether the resources and competences fit the environment in which the organization is 
operating and the opportunities and threats which exist. Again, new opportunities may exist 
by stretching and exploiting the organization’s unique resources and competences either in 
ways which competitors find difficult to match or both (Johnson and Scholes, 1999). This 
requires innovation in the way organizations develop and exploit their resources and 
competences. To Newman et al., (1988), knowing “where we are” helps in planning for the 
future. A firm can build on its strengths and can circumvent or buttress its weaknesses.
Every organization has actual and potential strength and weaknesses. Since it is prudent in 
formulating strategy to extend or maximize the one and contain or minimize the other, it is 
important to try to determine what they are and to distinguish one from the other. The 
identification, proper management of and investment in strategic capabilities for a long-term 
payback are necessary. If  a company lacks those necessary for crafting a strategy, its 
management should move fast to build them.
Andrew (1980) notes that subjectivity, lack of confidence and unwillingness to face reality 
on the part o f managers make it hard for organizations to know themselves. But for the sake 
of self-awareness, he suggests that it is necessary for an organization to identify 
approximately its central strength and crucial vulnerability to help it develop judgments 
about what it can do and also what it can do particularly well.
Little help is got when after the identification of strategic capabilities a long list is generated. 
There is the need for an evaluation which should be done in the light o f the strategies or 
goals of the organization and the challenges in the environment and those which can help in
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the successful implementation of the strategies and goals exploited. This is because some of 
the capabilities may be more important than others as they count more in determining 
performance, in competing successfully and in forming a powerful strategy.
According to Stalk et al (1992) a capability becomes strategic only when it begins and ends 
with the customers. Companies with such a focus are conceived o f as “a giant feedback loop 
that begin with identifying the needs of the customers and ends with satisfying them”. Day 
and Wensley, (1988) who also shared the same opinion point out that the assessment of 
opportunities for competitive advantage must revolve around the analysis o f customer 
benefit in the absence of which an organization’s attempts to leverage its skills and resource 
into positional advantages are likely to prove ineffective. Coyne (1985) also points out that, 
a firm should not only have a skill or resource that its competitor does not have, (i.e. 
capability gap) but also the gap must make difference to customers. Changing conditions in 
an industry can lead to the need for re-evaluation of a firm’s strategic capability in the light 
of newly emerging determinants of success in the industry.
Resources
Companies have very different collections of physical and intangible resources which make 
them different from others (Collis and Montgomery, 1995). These resources help an 
organization in the effective performance of its functional activities. Thus an organization is 
positioned to succeed with the best and most appropriate stocks o f resources for its business 
and strategy. These resources could be owned, leased or rented.
A resource audit helps to identify and classify resources available to an organization both 
from within and outside to support its strategies. According to Johnson and Scholes (1999) 
an audit should not just list the resources but must assess the nature, quantity, quality and 
uniqueness.
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The literature on resources groups it into four categories (Johnson and Scholes, 1999; Grant, 
1999; Andrew, 1980; Kay, 1993). They are:
• Physical resources: These include machines and buildings. When assessing a firm’s 
physical resources, factors such as age, conditions, capability and location should be 
considered.
• Financial resources: These include the sources and uses o f money such as obtaining 
capital, managing cash, the control o f debtors and creditors and the management of 
relationships with suppliers o f money.
• Human resource: It involves the assessment o f the number and types o f different 
organization, adaptability o f human resources and innovative capability o f the people.
• Intangibles: These include corporate image, patent, brand names, good contact, employee 
loyalty and goodwill.
Before choosing a strategy or implementing it the resources on hand and available should be 
appraised. Their actual or potential capacity to take advantage o f perceived market needs or 
cope with attendant risks should be objectively estimated.
Resources add value to organizations by taking inputs from suppliers, finance from the 
capital market, human resource from the labour market and converting them into finished 
goods and services. Effective resource analysis enables an organization to determine the core 
competences it requires in order to be successful (Famham, 1999).
To outperform competitors an organization will need to have unique or superior resources 
(Johnson and Scholes, 1999; Collis and Montgomery, 1995; Day and Wensley, 1988). They 
are more tangible requirements for advantage that enable a firm to exercise its capabilities. 
Superior performance will therefore be based on developing a competitively distinct set of 
resources and developing them in a well-conceived strategy. Every firm has some resources 
which are unique which have the potential for producing a comparative advantage for the
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firm (Hunt and Morgan, 1995).
A comparative advantage exists when a firm’s resources enable it to produce a market 
offering that, relative to that o f competitors, is perceived by some market segments to have a 
superior value and/or can be produced at a lower cost.
A comparative advantage in resources, then, can translate into a position o f competitive 
advantage in the market place and superior performance -  but not necessarily. Having the 
necessary resources is a necessary condition for achieving corporate purpose.
Hamel and Prahalad (1993) argue that organizations should not only fit their resources to the 
opportunities being pursued but should also endeavour to stretch their resources to exploit 
new opportunities in the environment. In their own words “abundant resources alone will not 
keep an industry giant on top when its hungrier rival practices the strategic discipline of 
stretch”.
Competence
Competence is the ability of an organization to undertake a particularly productive activity. 
The literature uses the terms “capability” and “competence” interchangeably. The key 
distinctions are adjectives used to modify the terms. Thus Selzmick (1959) used distinctive 
competence to describe those things that an organization does particularly well relative to 
competitors and Igor Ansoff (1965) used the same term to analyse the basis o f firms’ growth 
strategies. Hamel and Prahalad (1990) coined the term core competences to distinguish those 
capabilities fundamental to a firm’s performance and strategy. The value of the terms 
distinctive and core competences is that they center attention on the issue of competitive 
advantage.
Johnson and Scholes (1999) noted that usually good or poor performance is not found in the 
resource base per se but rather in the way in which resources are deployed to create
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competences in the organizations activities together to sustain superior performance. Every 
organization has competences that enable it to carry out the activities necessary to move its 
products/services through the value chain. Some will be done adequately, others poorly but a 
few must be especially done well if the organization is to excel in performance. The 
literature on strategy call the competences necessary for the successful performance o f an 
organization’s activities threshold competences (Johnson and Scholes (1999) and those 
which underpin its competitive advantage, core distinctive competences or superior skills 
(Johnson and Scholes, 1999; Hamel and Prahalad, 1990; Andrew, 1980; Day and Wensley, 
1988; Selznick, 1957).
Competence when used to describe performance implies that performance cannot be 
satisfactorily defined purely in terms of output but the way in which people approach their 
jobs which impacts on whether they will successfully accomplish goals (BBC Resource 
Book, 1994).
Hamel and Prahalad (1990) define core competence as a group o f skills and technologies that 
enable an organization to provide particular benefit to customers. This implies that core 
competence is about harmonising streams of technology, organization o f  work and delivery 
of value. There is a shared understanding of customer needs and technological possibilities 
among various categories o f workers who work together to meet these needs. Day and 
Wensley (1988) calling them superior skills, describe them as the distinctive capabilities of 
personnel that set them apart from the personnel of other competing firms. Bharadwaj et al., 
(1993) observe that superior skills and resources do not automatically give a business a 
competitive advantage but rather, they provide an opportunity to leverage skills and 
resources to achieve competitive cost and/or differentiation advantages.
Core competences are important in the development of strategy, as they are usually unique to 
the organization and therefore important in delivering sustainable advantage. Thus strategic
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options that do not address core competences are less likely to contribute to strategy than 
those that do (Thompson and Strickland, 1990). They also provide potential access to a wide 
variety o f markets ( Hamel and Prahalad, 1990).
Johnson and Scholes (1999) noted that depending on how an organization is positioned and 
the strategies being pursued, the core competences will differ from organization to 
organization.
As with resources, besides using core competences to fit the environment in which an 
organization is operating, they could also be the basis on which the organization stretches 
into new opportunities (Johnson and Scholes, 1999). In mature markets, core competences 
could be exploited to develop “value-added” services and geographical spread o f markets. 
Core competences should be managed with special care through the focused commitment of 
resources, assignment o f dedicated people and the continued efforts to learn supported by 
dramatic goals for improvement.
Identifying Competence
The literature proposed two main approaches to understanding and analyzing an 
organization’s competences (Grant 1999; Johnson and Scholes 1999). They are:
1. A functional classification which identifies organizational competences in 
relation to each other o f the principal functional areas o f the firm e.g. corporate 
office, management information, research and development, manufacturing,
product design, marketing, sales and distributions
2. The Value Chain Analysis. A detail discussion on the value chain is done in this 
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Value Chain Analysis
Michael Porter (1985) proposed the value chain as a company tool for identifying ways to 
create more value for customers. It describes the activities within and around an organization 
and relates them to an analysis o f the competitive strength o f the organization or its ability to 
provide value for-money products or services.
Every organization is a collection of activities that are performed to design, produce, market 
deliver and support its product/services. Porter is o f the view that it is from the performance 
of these activities that competitive advantage can be derived.
Fig. 2.2 THE VALUE CHAIN
Source: Johnson and Scholes (1999)
The value chain identifies nine (9) strategically relevant activities that create value and cost 
in a specific business. The task o f the organization is to examine its cost and performance in
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each value creating activity and to look for improvements to the extent that it can perform 
certain activities better than competitors. The ability to perform these activities and fit them 
in the overall system can lead to improved performance (Porter, 1996). This indicates that 
value activities are the discrete building blocks of competitive advantage. The value 
activities are grouped into two- primary and support.
• Primary activities- These involve the sequence of bringing materials into the business,
operating on them, sending them out, marketing them and serving them.
The five (5) main activities here are:
• Inbound logistics: activities relating to receiving, storing and disseminating inputs to 
the product/service. For example, materials handling, warehousing, transport, stock 
control.
• Operations: activities concerned with the transformation of inputs into final 
products/services. Example machining, packaging, assembling, testing.
• Outbound logistics: activities concerned with the collection, storage and distribution 
of final products to customers. For services, they may be more concerned with the
arrangements for bringing customers to the service if  it is a fixed location.
• Marketing and sales: activities which provide the means by which consumers/users 
are made aware of the product/service and are able to purchase them. Example 
advertising, selling, promotion, pricing.
• Service: activities which enhance or maintain the value o f the product. Example 
installation, repairs, training, parts supply.
The primary activities most deserving of further analysis depend on the industry. What may 
be vital to a service firm may be different from that of a goods firm. A service firm may be
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more concerned about operations and marketing and sales while a food distributor may be 
seeing inbound and outbound logistics as its critical areas/ processes and another firm may 
see all activities as critical in its performance (Crop, 1988).
• Support activities: help to improve the effectiveness or efficiency o f primary activities.
They are divided into four (4) distinct activities specific to a given industry.
o Procurement: Refers to the purchasing o f inputs used by the firm to the value 
chain
o  Technology development: Every value activity has a technology, even if  it is 
know-how, procedures or technology embodied in process equipment. 
Example Research and Development (R&D), process development, 
o Human resource management: Involves recruiting, hiring, training,
development and rewarding personnel. This area supports both primary and 
secondary activities.
o Firm infrastructure: Include systems of planning, general management, 
finance, legal, information and management, governmental affairs and quality 
management. It supports the entire value chain.
Porter (1996) asserts that competitive strategy is about being different. That is, deliberately 
choosing a set o f activities to deliver a unique mix of value. This implies that for a company 
to outperform competitors it has to establish a difference and also preserve it. This difference 
comes from the performance of the value activities.
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Sources of Advantage
Unique resources and core competences are seen by researchers as the two broad sources of 
core competences. The two put together represent the ability of a business to do more or 
better than its competitors (Day and Wensley, 1988). They enable a firm to perform the 
various value activities at a lower cost or in a different way, thus helping in the attainment of 
lowest cost and/or differentiated position.
To outperform competitors an organization will need to have unique or superior resources 
(Johnson and Scholes, 1999; Collis and Montgomery, 1995; Day and Wensley, 1988). They 
are more tangible requirements for advantage that enable a firm to exercise its capabilities. 
Superior performance will therefore be based on developing a competitively distinct set of 
resources and developing them in a well-conceived strategy. Every firm has some resources 
which are unique which have the potential for producing a comparative advantage for the 
firm (Hunt and Morgan, 1995).
A comparative advantage exists when a firm’s resources enable it to produce a market 
offering that, relative to that o f competitors, is perceived by some market segments to have a 
superior value and/or can be produced at a lower cost.
A comparative advantage in resources, then, can translate into a position o f competitive 
advantage in the market place and superior performance - but not necessarily. Having the 
necessary resources is a necessary condition for achieving corporate purpose.
Hamel and Prahalad (1993) argue that organizations should not only fit their resources to the 
opportunities being pursued but should also endeavour to stretch their resources to exploit 
new opportunities in the environment. In their own words “abundant resources alone will not 
keep an industry giant on top when its hungrier rival practices the strategic discipline of 
stretch.
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2.3.2 POSITIONAL ADVANTAGE
According to Day and Wensley (1988), the positional advantages o f a business are directly 
analogous to competitive mobility barriers that could deter a firm from shifting its strategic 
position. They can be broadly construed as lowest delivered cost positions and differentiated 
positions.
Lowest delivered cost positions: entails performing most activities at a lower cost than 
competitors while offering parity products.
Differentiated positions: entails perceiving a consistent difference in important attributes 
between the firm’s offerings and its competitors or performing value- adding activities in a 
way that leads to perceived superiority along dimensions that are valued by customers. This 
can happen in diverse ways: Provision of superior service, strong brand name, and superior 
product quality.
Porter (1980) asserts tha t seldom, i f  ever, can a firm achieve the two positions since any 
attempt will lead to firms being trapped in a mediocre performance, unable to deliver either 
in a superior way. He calls such a situation as “ being stuck in the middle”.
However, this assertion has received many dissenting views being seen as a fallacy of the 
generic strategy. Baden-Fuller and Stopford (1992) claim that the best firms are striving all 
the time to reconcile the opposite.
A business has a c ompetitive advantage when its customers purchase its services because 
they believe they are a better value. Customers may measure value in terms o f a lower price 
or the benefits to be derived from a characteristic o f a service. With hospital services, the 
competitive advantage may be the result o f a lower price, but may also come from a 
perception that services are a higher quality or have some other characteristics to which 
consumers attach a higher value (Kropf 1988).
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2.3.3 PERFORMANCE OUTCOMES
The strategy literature refers to two dimensions of performance (Stacy, 1993; Bhardwaj et al 
1993; Hunt and Morgan 1996; Day and Wensley 1988):
(i) Financial: e.g. return on investment, shareholder wealth creation.
(ii) Market Place: e.g. customer satisfaction, market share, utilization, customer 
loyalty.
Day and Wensley (1988) criticize accounting conventions which are used to  measure the 
financial performance o f organizations for their
(i) inadequate handling of intangible (for example, goodwill which is a commercial 
asset with future value becomes an arithmetic necessity) and
(ii) improper valuation of sources of competitive advantage with investment in these 
sources treated as overheads without being seen as contributing towards long­
term performance.
The Resource Advantage (R -  A) Theory of Hunt and Morgan (1995) propose that the 
primary objective o f firms is superior financial performance and the indicator used is 
profitability. The most popular performance indicators are market share and profitability. 
Market share is based on the premise that it helps to distinguish winners from losers’ by the 
market share they achieve. Day and Wensley (1988) find this to be simplistic as in reality 
competition is played out over many time periods within evolving markets. Kotler and 
Clarke (1996) also argue that though customers may be dissatisfied but:
(i) Because there are not alternatives or competitors
(ii) Because o f inertia in the market place as the organization might still be strong in 
the system, they may continue to utilize the services or patronize the goods.
Other indicators like customer satisfaction and customer loyalty are little used though they 
afford the considerable benefit o f reflecting customer responses to positional advantages and
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the product being offered. Day and Wensley (1988) believe that they should come before 
market share and profitability outcomes.
Firms seek a level o f  performance which goes beyond some referent which could be the 
firm’s own performance in a previous time period or a set of rivals firms, an industry average 
or a stock of market.
The superior performance enjoyed by firms have been attributed to the possession of 
resources and skills which enable the firms to produce efficiently and/or effectively market 
offerings that give value to some market segment. These resources yield market place 
positions of competitive advantages which in turn brings superior performance. Researchers 
have pointed out the factors that have contributed to the superior efficiency and effectiveness 
of Japanese car companies include corporate cultures, promotion of teamwork, treatment of 
suppliers as partners, just-in-time inventory systems and total quality management (Hunt and 
Morgan 1996).
2.3.4 CONVERTING SOURCES INTO SUPERIOR POSITIONS AND OUTCOMES 
The conversion of sources o f advantage into pay offs has been addressed only in piecemeal. 
The strategy literature generally deals with how unique resources and care competences are 
converted into positional advantages. Porter (1985) talks about cost and differentiation 
drivers. On the other hand, marketers skip the relationship o f the input sources o f advantage 
(for example, relative advertising, sales and promotion expenditure) with the performance 
outcomes of market share or profit.
Both approaches leave a serious gap, as the conversion o f positional advantages to 
performance outcomes is not given any attention. Day and Wensley (1988), however, do 
much to mediate the relationship.
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• Sources To Positions of Advantage
The drivers o f positional advantage are the high leverage skills and resources that do  the 
most to lower cost or create value to customers. Each activity in a firm’s value chain is 
influenced by the combined effect of these drivers (Porter 1985).
• Cost drivers
Are the structural determinants o f costs o f each activity that are largely under a firm’s 
control. They are the factors that determine the cost efficiency o f  a firm. Cost efficiency is a 
measure of the level o f resources needed to create a given level o f value (Johnson and 
Scholes, 1999). The efficiency with which an organization performs its activities contributes 
greatly to the provision o f products/services valued by customers. The management of cost 
is fundamental to long-term profitability for any firm operating in a competitive market. To 
a great extent, the  strength o f  a business rest on  its  ability to deliver products/services at 
costs lower than competitors. The cost of products/services should not be viewed as simple 
accumulation of direct and allocated expenses for its production and sale, but also as an 
indicator of the firm’s ability to manage its resources. The proper handling o f these cost 
drivers can bring about cost reductions which in turn can give an organization an advantage. 
The cost drivers are discussed below:
• Economies o f  Scale
This i s n ormally a ssociated w ith m anufacturing firms d ue t o a h igh c apital c ost o f  p lants 
needed to be recovered over a high volume of output. This source o f cost advantage could 
also be in distribution or marketing in other industries. It arises from the ability to perform 
activities differently and more efficiently at larger volume or from the ability to pay off the 
cost o f intangibles such as the cost of advertising and R&D over a greatest sales volume.
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Service firms can exploit economies o f scale by centralizing their service production while 
decentralizing thier customer contact (Upah 1980) or centralizing critical services and 
decentralizing less critical ones. This is particularly important to equipment intensive 
service firms.
Competitive advantage could be obtained through the ability to secure funding for large- 
scale investments, competence in mass consumer advertising or the ability to develop and 
sustain global networks of partners or distributors. Economies o f scale could also be 
associated with selection and training of employees, purchased goods and services and 
investments in specialised technology and R&D to systematize the service delivery process. 
These activities enable a multi-unit service firm to achieve a cost advantage relative to single 
unit and multi-unit service firms with fewer units.
• Supply Cost
Clearly influences an organizations overall cost position and are particularly important t o 
organizations which act as intermediaries where the value added through their own activities 
is low and the need to identify and manage input cost is critically important to success. The 
management of supply relationships greatly influences an organization’s cost.
• Product/Process Design
Little attention has been paid to the role of product design to overall cost competitiveness of 
a company. Good contacts and relationships through out the value chain will help to get the 
necessary information for the analysis o f the design/cost relationships. Product design can 
affect the cost of after sale service.
When the production process is checked cost can also be reduced. In service firms, the 
process involved in service provision could be reduced or standardised.
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• Experience
Is a key source o f cost advantage, which has been explained through the experience curve. It 
suggests that over time, the efficiency with which an organization performs an activity 
improves. This helps the organization to develop core competences in this activity and gain 
cost advantage. Experience can lower cost overtime through factors like improved 
scheduling, labour efficiency improvement and better tailoring o f  raw materials to the 
process.
Moreover, as an organization’s members work together over a period o f time the 
organization may realize the economies of information interchange through common training 
and experience and repeated interpersonal interactions (Williamson, 1971; 1975). Thus there 
is more efficient flow o f information in the organization and transaction costs are reduced 
and the firm becomes more efficient as experience is gained.
However, according to Winter (1987), experience can be a source o f competitive advantage 
only when the (i) learning is tacit and not observable in use and (ii) underlining knowledge is 
complex. In addition a few people should be privy to the information and employee mobility 
should also be low (Bharadwaj et.al., 1993).
• Drivers o f Differentiation
They represent the underlying reasons why an activity is executed in a unique or superior 
way. They correspond directly to the sources o f advantage that reside in unique resources or 
core competences when mobilized by an effective strategy. The main drivers are:
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• Policy Choices
Effectiveness is a measure o f the level o f value, which can be created from a given level of 
resources. The analysis relates to how well the organization is marching its products/services 
to the needs of the customers, which it has identified, and the competences underpinning this 
effectiveness. Where competition is based on value added, the information for its assessment 
should be based on the customer’s/users point o f view o f the product/service. The sources of 
value added are what Porter (1985) calls differentiation drivers. Principal among them are (1) 
policy choices about what activities to perform and how to perform them. Examples, product 
features and performance, level o f a dvertising spending, quality o f inputs procured fo r an 
activity, skill and experience level of personnel employed in an activity and training 
provided, (2) timing that gains first -mover advantages.
• Timing that gains first-mover advantage
Different combinations of drivers interact to determine the extent to which an activity is 
unique or superior to that of competitors.
• Managing linkages
Another driver which could be managed for both cost or differentiation advantage is linkages 
within and outside the value chain. Porter (1985) defines linkages as the relationship the 
way between one value activity is performed and the performance o f another. Identifying 
linkages is a process o f searching for ways in which each value activity affects or its affected 
by others. Competitive advantage/improved or superior performance and its sustainability 
are derived from the way the activities of an organization fit and reinforce one another 
(Porter, 1985, 1996). In her article about the extraordinary performance o f a group
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companies over the last ten years, Loomis (1984) described their managements as doing 
three things better than their competitors. Among them is the better management o f the 
overall systems relative to competitors. In other words, they push for the better functional 
execution within business system and better management of both inter-relationships within 
the companies and the critical external inter-relationships with suppliers, customers and 
competitors. This makes it more difficult for competitors to imitate than when it is based on 
separate activities.
Two broad types of linkages exist:
• Linkages within the value chain (internal linkage)
• External linkages (vertical linkages and linkages with buyers
Linkages within the value chain
Traditionally, the work o f a company is done by departments. But these departments pose 
some problems as they typically operate to maximize their own objectives and not that o f the 
company. By so doing walls are created between departments leading to lack o f cooperation. 
Such situations add to overall cost and diminish value in the product/service. For superior 
performance, core processes should be identified and capabilities developed to manage these 
processes (Kotler, 1994; Johnson & Scholes, 1999). This will help get competences which 
are compatible, as they will relate to the same view of what value for money means to the 
customer. Linkages can lead to competitive advantage through optimisation and 
coordination. Linkages often reflect trade-offs among activities to achieve the same overall 
results. Checking the performance of a value activity can help reduce the cost o f other 
activities. The coordination of activities will help to ensure quality products/services 
delivery. It helps in cost reduction and enhances differentiation.
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Internal linkages can take the following forms:
• Linkages between primary activities. Paying attention to inspection of purchased inputs 
can enhance the quality o f product/service as well as reduce cost o f production.
• Linkages between primary and support activities. The management o f this linkage may 
be the basis of a core competence. For e xample procurement practices can i mpact on 
inbound logistics as well as the final product/service or good human resource 
management practices like training and development can benefit all the primary activities 
and the quality o f product/service.
• Linkages between different support activities. Top management’s support for innovation 
will enhance technology development.
External linkages - Performance can also be improved through the ability to compliment or 
coordinate the activities of the organization with those of suppliers, channels or buyers.
• Vertical linkages: Reflect interdependencies between a firm’s activities and the 
value chains of suppliers and channels. This implies that the way suppliers and 
channels perform their activities can affect the cost or performance of the firm 
they deal with. Their value chains can be identified by examining how their 
behaviour affects the activities of the organization and its performance. Porter 
(1985) observes that due to the difficulty associated with the identification of their 
value chains they are often overlooked.
Kotler (1994) points out that suppliers should not be seen as cost centres or adversaries but 
as partners in working out profitable strategies.
Linkages with suppliers centre on issues like supplier’s product design characteristics, 
service quality assurance, delivery procedures, order processing etc. It could also be in the 
form of a supplier performing an activity that the firm might otherwise undertake. For cost
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reduction and quality enhancement a firm can specify its requirement for its suppliers as well 
as check their performance.
Linkages with channels could also take the form o f location of channel’s warehouse, material 
handling technology (which can impact on the firm’s outbound logistics and packaging cost), 
or promotional activities. The performance of channels when checked can contribute to cost 
reduction and quality enhancement.
• Linkages with buyers: With the public hospitals services are sold directly to 
user/consumer/buyer and not through channels. What the  consumer is going to 
receive and experience at all points o f contact with a service firm is what 
Normann (1984) terms “ service package”. To gain competitive advantage the 
value c hain o f  t he b uyer s hould b e u nderstood a nd a s ervice package t hat w ill 
give the buyer satisfaction developed (Kropf 1988). Each activity along the value 
chain can be examined to determine the value received by the buyer. The value 
activities of the producing firm can affect the value created fo r the buyer. For 
example the use o f  a film that requires a lower dose o f radiation for a 
mammography can increase the value of the service provided to patients by 
lowering their risk of developing radiation induced cancer.
Day and Wensley (1988) assert that the u sefulness of the notion of drivers is difficult to 
assess. They believe that at best it is a descriptive tool, lacking any theory to clarify how 
drivers work or even how they can be isolated. It is not even clear that they all mean the 
same thing. For instance, some drivers of differentiation correspond directly to sources of 
advantage s uch as 1 ocation, s cale o r 1 evel o f  i ntegration. However, “ policy choices”, t he 
most prominent differentiation driver are discretionary decisions about activities to perform 
and how to perform them. Though such decisions are critical, they are not sources of
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advantage but rather mediating events that determine the degree o f leverage an investment in 
a particular skill on resource has on cost or differentiation.
• Converting Sources Directly to Performance
The conversion o f sources to performance has been based on the fundamental theorem of 
market share determination. The theorem is based on the premise that market shares of 
various competitors are proportional to their shares of total marketing effort (Kotler 1984).
Cook (1983) applies the theorem in the “new paradigm marketing strategies”. In this model, 
when a firm’s capacity to supply products is greater than the market demand for its 
advantage, then that firm has an advantage. The size of this advantage is estimated by 
subtracting a firm’s share o f strategic investments from its share o f units sold. When the 
firm’s share of spending (investments) is equal to market share an equilibrium is reached. 
On t he contrary when i nvestment i s 1 ower t han m arket s hare o f  u nits s old, s hare o f  u nits 
eventually will decline in search o f a new balance in consumer preferences.
Day and Wensley ( 1988) find the structure o f  Cook’s model as making many flaws. To 
them, the fundamental theorem a s applied by C ook has numerous restrictive assumptions 
which when relaxed would render the theorem virtually unmanageable for diagnostic or 
prescriptive purposes. They suggest other issues which should have been incorporated in the 
model. They include:
1) Differences between firms in their ability to spend marketing dollars 
effectively;
2) The likelihood of diminishing returns to additional investments;
3) The carrying over effects of past investments and
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4) Synergistic effects of the marketing mix various.
They also find the basic valuation model proposed by Cook “more damaging”. The 
valuation model presumes that the current level o f investment in terms o f annual cash outlays 
is the proper basis for assessing the level o f market share a firm can sustain. The resulting 
market share has a net present value that relates current outlays to the discounted value of the 
future revenue stream (Cook 1985). They think the model potential value of past and current 
strategic investments.
A complete picture must reflect:
1) The link between today’s investments and opportunities to executive 
tomorrow’s options;
2) The value o f first-mover advantages; and
3) The strategic choice o f when and how the profit potential o f a positional 
advantage will be realized.
• The Payoff from Positional Advantages
A cost or differentiation advantage should eventually lead to superior performance (market 
share and/or profitability). The size and duration will, however, depend on:
o Whether t he v alue p erceived b y t he customer a nd the r esulting p rice p remium are 
greater than the extra cost o f the activities that create differentiation, 
o The objectives business in terms of the trade off between higher immediate profit and 
increased market share gained with a penetration price, 
o The difficulty the competitors will have in matching or leapfrogging the advantage. 
Not all industries afford equal opportunities to sustain an advantage. Those with
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durable, irreversible and market-specific assets and a slow pace of technological 
change are much more likely to promise enduring profitability.
Unique resources and distinctive competences are not automatically converted into positional 
advantages, nor are positional advantages into performance outcomes. The conversions are 
medicated jointly by strategic choices, including objectives and entry timing and the quality 
to tactics and implementation.
2.3.5 IDENTIFYING SOURCES OF ADVANTAGES 
• Key Success Factors
Day and Wensley (1988) are o f the view that the managerial usefulness of any effort to 
assess advantage comes from the accurate identification o f the handful o f skills and 
resources that have the greatest leverage on position and performance. These are the key 
success factors (KSF) that must be managed very well to ensure long-run competitive 
effectiveness. Grant (1999) describes them as the factors that determine a firm’s ability to 
survive and prosper in an industry. He gives two conditions which a firm must meet t o 
survive and prosper in an industry:
o It must provide customers with what they want to buy (i.e. what do out customers 
want?).
o It must survive competition (i.e. what does the firm need to do to survive 
competition?).
Management should understand the primary reason for the existence o f its firms and the 
underlying factor o f its p erformance is customers. It should therefore identify the firm’s 
customers and their needs as well as their reason for their selection o f the firm instead of 
others. This will help the firm to determine the factors which will help it to meet the needs 
of the customers.
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Management should also examine the basis o f competition in the industry, the intensity and 
key dimensions as well as how it can obtain superior position. The point here is that a 
company can be extremely strong in areas which are unrelated to business success, either in 
existing or future/envisaged business areas. Such “strengths” then are not strengths at all, 
and they can in fact constitute a major source of weakness if  a company attempts to use these 
to compete strategically.
• Characteristics of Sources of Advantage
Literature on the subject indicate that for any resource and competence to qualify as the basis 
for effective strategy o r  a source of competitive advantage (superiority) they must meet a 
number of challenging criteria or must pass a number o f external market tests (Barney, 1991; 
Coyne, 1985; Stalk et al., 1992; Bharadwaj et al., 1993; Hamel and Prahalad, 1990; Collis 
and Montgomery, 1995). These are:
• They must provide value to the buyer. In other words, they must contribute to the
production o f something that customers want at a price they are willing to pay.
• They must be inimitable so that they will be rare. This will ensure the sustainability of
competitive advantage and performance. Sources of advantage which can be easily
imitated generate only temporary value. Since inimitability does not last forever, 
managers can check against this and sustain superior performance for some time by 
building their sources around the following:
- Physical uniqueness example location, minerals rights, patent
- Causal ambiguity which arises from tacitness, complexity and specificity 
(Ploanyi, 1962; Barney, 1986b; Nelson and Winter, 1982: Williamson, 
1985). Tacitness is defined as the implicit and non-codified accumulation of
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- skills that result form learning by doing. Complexity results from the 
interrelationships between various skills and assets. The complexity o f firms 
o f ten makes it difficult to identify their critical success factors as they 
cannot be explained by one factor but by linked factors. Thus they cannot be 
explained by one factor but by linked factors. Specificity entails the 
transaction -  specific skills and assets that are utilized in the production 
process and provision of services for particular customers.
• There must not be any strategically equivalent substitutes for these sources of advantage. 
Barney (1991) notes that substitutability are in two forms:
(i) where a competitor substitutes similar resources/skills that 
enables it to formulate and implement identical strategies.
(ii) where very different resources/skills are used as strategic 
substitutes
• They must be durable. The resource/competence should be able to sustain competitive 
advantage over time. Collies and Montgomery (1995) states tha t “the 1 onger 1 asting a 
resource is, the more valuable it will be”. Most industries are so dynamic that the value 
of resources and competences depreciate quickly. Banking on the durability o f most 
unique resources and competences is risky as they have limited life and will earn only 
temporary profits.
• The test o f appropriability. According to Collis and Montgomery (1995) not all profits 
from a resource automatically goes to the company which ‘owns’ it. The value is always 
subject to bargaining among a host o f players including customer, distributors, suppliers 
and employees. When strategy is based on such resources profit can be hard to capture.
• According to Johnson and Scholes (1999), when core competences depends on specific
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individuals the organization becomes vulnerable to the loss o f  this individual. However if 
it is a corporate competence its sustainability is secured.
• The test o f competitive superiority: Resources and competences should be assessed 
relative to competitors. Every company can identify one activity that it does relatively 
better than other activities and claim that as its core competences. In assessing core 
competences managers must look beyond what their organizations perform best 
internally to what they do better than competitors. To Collis and Montgomery (1995), the 
term distinctive competence is more appropriate if  competence is assessed relative to 
competitors. The disaggregation of a firm’s core competence into specifics helps to 
understand the sources of the firm’s core competence into specifics helps to understand 
the sources of the firm’s uniqueness and measure by analyzing the data whether it is 
competitively superior on those dimensions. It also helps in driving actionable 
implications i.e. what to do with it.
According to  Hax and Majuf (1996), a relevant competitor is  one who fulfills one o r 
more of the following conditions. From a market point o f view: 
o It has a high market share; 
o It has experienced a sustained market growth;
o It earns high levels o f profitability with regard to the industry average; 
o It has demonstrated an aggressive attitude against your entire business or 
important segments o f your business; 
o  It has a highly vulnerable position against your own competitive actions.
From a functional point of view:
o It has the lowest cost structure; 
o It has the strongest technical base; 
o It has the strongest marketing;
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o It offers the best product quality; 
o It shows the highest level o f vertical integration; 
o  It exhibits the highest level of capacity utilization.
To him, a sound strategy has to be supported by a thorough understanding of a firm’s most 
relevant competitors, since a business strategy aims at achieving a sustainable advantage 
over them.
2.3.6 SUSTAINING SUPERIORITY
Sustained superior performance occurs only when firm’s comparative advantage in resources 
and competences continue to yield a position o f competitive advantage despite the actions of 
competitors. Since all firms seek superior performance (be it financial/market place), a firm 
having unique resources and core competences will have its competitors doing all that lies 
within their ability to neutralize its advantage. If sources o f advantage could be obtained 
from the market place, they will do so or substitute them or find new ones which can produce 
value which is superior to the advantaged competitor. Hamel and Prahalad (1994) asset that 
market leadership today is not equal to market leadership tomorrow as the market which a 
company dominates today is likely to change substantially. To them there is no such thing as 
“sustaining” leadership; it must be regenerated again and again.
Companies that have unique resources and core competences must therefore be wise to know 
that the value of these resources can be eroded with time and competition (Day and Wensley, 
1988; Bharadwaj et al., 1993; Collis & Montgomery, 1995). To ensure a continuous 
advantage, which will in turn bring sustained performance, they must be nurtured 
continually. If this is not done the sources of advantage may be taken for granted leading to 
erosion of performance. Furthermore, other companies may not be ideally positioned with 
competitively sources of advantage - some of their resources may be good, others may be
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mediocre while others liabilities (Collis & Montgomery, 1995) truly believe that “in most 
companies resources do not pass the  objective application o f  the market tests”. Since the 
environment is not stable there is the need for firms to keep on building for the next round of 
competition or survival. There is therefore the need for continuous investment in upgrading 
and leveraging of resources.
• Investment in resources and competences
All resources and competences require constant monitoring and maintenance expenditures 
(Dierickx & Cool, 1 989). This is  because the barriers to  imitation o f  these resources and 
competences are prone to decay in the absence of proper attention. Firms competing in the 
same industry are likely to continuously strive to bridge resource and competence gaps that 
put them at a disadvantage relative to competitors. In addition, in dynamic environments 
where factors like consumer preferences change, the sources o f advantage underlying a 
firm’s superior performance are prone to depreciate overtime. Under such circumstances, 
ensuring the durability of a firm’s unique resources and competences will require investment 
in these sources. This will help to maintain and build both threshold and distinctive resources 
and competence. As Porter (1985) notes, a firm must offer “ a moving target to its 
competitors, by reinvesting in order to continually improve its position”. Not only should a 
firm invest in current resources and competences but also it should invest in new resources 
and skills for the future. All the processes that contribute to the sources o f advantage should 
also be invested in.
Collis and Montgomery, (1995) point out that the competitive dynamics that determine an 
industry’s attractiveness must be examined when investing in core competences. This will 
help managers to avoid the risk o f making an investment that will yield low returns.
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• Upgrading resources
For companies without any unusually valuable resources and core competences or have them 
limited or substituted by competitors, Collis and Montgomery, (1995), suggest upgrading of 
resources and competences. Companies must continually upgrade the number and quality of 
their resources and associated competitive positions in order to hold off the most inevitable 
decay in their value. They define upgrading as moving beyond what the company is already 
good at, which can be accomplished in a number o f ways. This can be done by adding new 
resources a nd c ompetences a nd/or b y u pgrading t o a ltemative r esources a nd c ompetences 
that are threatening the company’s current capabilities. They noted that the most successful 
example of upgrading has been adding new competences “sequentially, often over extended 
time period”.
• Leveraging resources
Corporate strategies must strive to  1 everage resources into all the  markets in  which those 
resources and core competences contribute to comparative advantage or to compete in new 
markets that improve the corporate resources i.e. extending valuable resources and core 
competences across markets (Collis and Montgomery, 1995). The extent to which resources 
and competences can be extended across markets depends on their specificity. Certain 
specialised valuable resources (e.g. expertise in narrow scientific disciplines and secret 
product formulas) may lose their value quickly when moved away from their original setting 
since they are so specific. However highly fungible resources like cash, many kinds of 
machinery and general management skills can be extended to other markets. They may 
however, rarely constitute the key sources of comparative advantage (Collis and 
Montgomery, 1995). Some of the strategic errors committed in leveraging o f resources are 
overestimating o f the transferability of specific assets and capabilities; overestimation of the
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ability o f organizations to compete in highly profitable industries; and lack o f  regard of the 
competitive dynamics o f that market. However, if  done appropriately, the rewards of 
resource leveraging are high.
Hamel and Prahalad (1993), also argue that the key to competitive advantage is not initial 
resources endowment, but a firm’s ability to leverage its resources and competences. They 
propose five ways of doing this:
o Concentrating resources through the process of: converging resources upon a few 
clearly defined and consistent goals (what they call “strategic intent”); focusing 
the effort o f each group, department and business unit and individual priorities in 
a sequential fashion; and targeting those activities that have the biggest impact on 
customer’s perceived value, 
o Accumulating resources through: extracting lessons from the stockpile of 
experiences, and borrowing from other firms by learning from them or accessing 
their resources and competencies through alliances and outsourcing etc. 
o Complementing resources by blending different types o f resources in ways that 
multiply the value o f e ach, and balancing to ensure that limited resources and 
competences in one area do not hold back the effectiveness of resources and 
competences in another, 
o Conserving resources by utilizing resources and competences through recycling 
them though different products, markets and product generations; and co-opting 
resources through collaborative arrangements with other companies, 
o Recovering resources by increasing the speed with which investments in resource 
generate cash returns to the firm. A key determinant o f resource recovery is new 
product development cycle time.
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2.4 IMPLICATION FOR THE STUDY OF HOSPITALS
One o f the earliest attempts to examine quality (Donalbedian, 1966) led to the development 
of a conceptional framework that divided health care delivery into 3 aspects: Structure, 
process and outcome.
Donalbedian (1966) states that:
“This three-fold approach is possible because there is a fundamental, functional relationship
among the three elements......................................  Structural characteristics of the setting in
which care takes place have a propensity to influence the process of care so that its quality is 
diminished or enhanced. Similarly, changes in the process o f care including variations in its 
quality, will influence the effect o f care on health status, broadly defined”.
Structure encompasses relative stable characteristics of hospitals and other delivery 
institutions. Among these factors are number and mix o f personnel, types and nature of 
equipment and facilities and aspects o f organisation such as committee structure 
Process includes the activities involved in providing and receiving care. In health planning 
language “activities” are a combination o f task or interventions that go to solve a health need 
or demand presented by an individual or group (Montoya-Aguilar, 1987)
One important attribute o f the health care activities that constitutes an  essential aspect o f  
health system performance is their quality. Therefore, the quality o f performance of hospital 
or any health institution may be appreciated on the basis o f level o f quality share by its main 
activities. Relevant indications include such issues as timeliness, continuity and patient 
compliances well as whether diagnostic and compassionate manner and the efficiency in a 
competence with which services are delivered. Process also deals with the interaction 
between the provider and the consumer. The interactive view of the process focuses on how 
well the service employee delivers functional quality (how care is experienced by the
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consumer) as well as technical quality (competence in what is done) (Lanning and O’Connor 
1990).
Outcome o f care involves such aspects of health care on the health status o f the patient. It 
results from the interaction by the structure/process. It may include such factors as quality of 
life, and patient satisfaction. How well the service interaction meets the consumer’s 
expectation is of primary importance as an outcome measure.
This approach is analogous to that o f strategic management.
Health Planning Strategic Management
Structure - Resource
Process - Value Activities (competences)
Outcome - Performance outcomes
Therefore using the strategic management approach to assess the capabilities o f hospitals, 
which could be exploited for superior performance, is on course.
Public hospitals like any other organisation need to have a business approach to their 
management. Though they might not have profit making as the number one priority, due to 
the financial constraints they face (inadequate governmental support) they should not lose 
sight of improving their performance. This will help to also increase their market share and 
get some profit to support their efficient running.
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C H A P T E R  T H R E E  
RESEARCH METHODOLOGY
3.1 INTRODUCTION
The study which was both exploratory and descriptive sought to gather and examine 
information from the Komfo Anokye Teaching Hospital (KATH) for the purpose of 
establishing as accurately as possible the resources and competences which the hospital 
possess and which could be exploited to improve its performance to make it a leader in 
health service delivery in Ashanti Region.
3.2 RESEARCH STRATEGY
The study used the case study approach. Robson (1993) defines case study as a strategy for 
doing research, which involves an empirical investigation o f a particular contemporary 
phenomenon within its real life context using multiple sources o f evidence. Considering the 
issues to be addressed and the objectives of the study using the case study approach will help 
to bring to light the strategic capabilities, which could be exploited to improve performance 
at KATH.
However, case studies are not without limitations. Because of their intense nature, they can 
usually only focus on a small number of cases. This leads to a question about the 
representativeness o f the findings and whether they provide an adequate base for both the 
development and the answering of research questions.
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3.3 RESEARCH SETTING
The study was carried out at the Komfo Anokye Teaching Hospital (KATH) which is the 
second largest hospital in this country with a bed compliment o f  813.
• Geographical Position
The hospital can be found in Kumasi the capital town o f the Ashanti Region. It is located on 
a hill overlooking the city o f Kumasi. It is bordered on the east, south, west and north by the 
main Bantama-Kejetia dual carriageway, the Central Police Barracks and the Bantama 
Township respectively. This is the site where the legendary fetish priest o f Ashanti Okomfo 
Anokye planted a mysterious sword which remains stuck in the soil till this day.
• Mission
The hospital has as its mission “to provide quality health care to the public, teach and 
undertake research”.
• Developments
The hospital was completed in 1954, and initially named the Kumasi Central Hospital. The 
name was later changed to Komfo Anokye Hospital in honour o f the legendary priest 
Okomfo Anokye. In 1975, in pursuance of government policy to establish a second medical 
school in Ghana, the hospital was upgraded to a Teaching Hospital. In addition to patient 
care, it was to provide the necessary teaching facilities for medical students of the Medical 
School of the Kwame Nkrumah University of Science and Technology, Kumasi. The school 
was also required to provide clinical service through teaching.
With the implementation of the Hospital Administration (PNDC) Law 209 the hospital came 
under the management o f the Board appointed by the MOH in 1990. A Chief Administrator 
who sees to the implementation of the policies of the Board was appointed.
’ (See Appendix II for the organizational structure of KATH)
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• Catchment Area
KATH serves as a referral hospital for the Ashanti, Northern, Upper East and West, Brong- 
Ahafo, Western, parts o f Eastern and Central Regions.
• Services
The hospital provides the following services through its various departments:
o Clinical
o Diagnostic
o Support Services
o Pharmaceutical 
o Physiotherapy
Accident and Emergency, Surgery, Child Health, 
Obstetrics and Gynaecology, Dentistry, Ear, Nose 
and Throat (ENT), Ophthalmology (Eye), Medicine, 
Anaesthesia, Polyclinic, Radiotherapy, Psychiatry. 
Radiology, Microbiology, Clinical Biochemistry, 
Haematology, Pathology and Blood Bank.
Laundry, Catering, Engineering and Estate, Stores 
and Supplies, Limb Fitting, Accounts, Internal 
Audit, Security.
Pharmacy.
Physiotherapy.
3.4 STUDY POPULATION
The study was conducted at the KATH using 23 departments (see Table 3.1) most of which 
are directly involved in patient care and a few indirectly involved (i.e. do not deal directly 
with patients). The source o f data collection was the staff o f these departments. The study 
sought to find out from them the resources and competences o f the hospital and how unique 
they considered the resources and competences in the performance of activities of the 
hospital relative to competitors.
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TABLE 3.1 DEPARTMENTS
FREQUENCY PERCENTAGE
Accident/Emergency 2 8.0
Accounts 1 4.0
Administration 1 4.0
Anaesthesia 1 4.0
Blood Bank 1 4.0
Child Health 8.0
Clinical Biochemistry 1 4.0
Clinical Microbiology 1 4.0
Dentistry 1 4.0
ENT 1 4.0
Haemathology 1 4.0
Histopathology 1 4.0
Maintenance 1 4.0
Medical Records 1 4.0
Medicine 1 4.0
Obstetrics & Gynaecology 1 4.0
Pharmacy 1 4.0
Physiotherapy 1 4.0
Polyclinic (Dispensary) 1 4.0
Radiography 8.0
Surgery 1 4.0
Supplies and Stores 1 4.0
TOTAL 25 100.0
From the table (3.1) while some departments had 4.02% of the total respondents, others had 
8.0%. For instance at the A & E department there were 2 units headed by 2 Principal 
Nursing Officers who did not have detail knowledge about the resources and competencies 
of each others unit.
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3.5 SAMPLING PROCEDURE
(i) Convenience sa mpling was u sed t o gather i nformation f  rom 2 7 h ealth w orkers
from the 23 departments. .
In order to get candid responses, top management and heads o f departments were not 
selected. It was in only two departments where the heads were selected as they fell into the 
above-mentioned criteria. These heads were selected because in their departments they were 
the only persons who had detail knowledge of their department and the hospital. This was 
especially evidenced at the Medical Records and Statistics Department where the staff 
contacted referred the researcher to see the head to complete the questionnaire.
3.6 SAMPLING CHARATERISTICS
The sampling method used succeeded in providing respondents who were supervisors, senior 
departmental members and heads of departments. Tables 3.2 and 3.3 show the positions and 
grades of respondents.
From table 3.2, 68% o f respondents were supervisors, 24% were Heads o f departments and 
8.0% were departmental members.
Table 3.3 indicates that respondents cut across clinical, diagnostics, pharmaceutical and 
administration and support areas which are the main services areas o f the hospital.
TABLE 3.2 POSITIONS IN DEPARTMENT/HOSPITAL
POSITION FREQUENCY PERCENTAGE
Supervisor 17 68.0
Head o f Department 6 24.0
Departmental Member 2 8.0
TOTAL 25 100.0
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TABLE 3.3 GRADES
FREQUENCY PERCENTAGE
Principal Health Services Administrator 1 4.0
Principal Nursing Officer 5 20.0
Specialist 4 16.0
T echnologist/T echnician 5 20.0
Supply Officer 1 4.0
Pharmacist 2 8.0
Principal Anesthetist 1 4.0
Accountant 1 4.0
Biochemist 1 4.0
Principal physiotherapist 1 4.0
Senior Biostatistician 1 4.0
Senior Radiographer 1 4.0
Senior Medical Officer 1 4.0
TOTAL 25 100.0
3.7 DATA COLLECTION METHOD
The study was conducted using a combination of data collection methods to obtain primary 
and secondary data. Structured questionnaires which were self-administered were used to 
collect primary data. Respondents answered questions about the direction of the 
organization, the resources and competences of the hospital and their uniqueness. This 
conforms to what the literature on strategy proposes for the identification o f unique resources 
and core competences, and the linkages between their departments and other departments.
In the design of the questionnaire, both closed-ended and open-ended questions were used
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for easier and  quicker responses a nd e xpression o f  opinions respectively. In developing a 
checklist for the assessment of resources and competences the factors proposed in the 
strategy literature (Johnson and Scholes, 1999; Grant 1998) were considered. Also, Porter’s 
Value Chain Model and the checklist used by Hax and Majuf (1996), in his competitive 
profiling o f Procter and Gamble (P & G) against Unilever, were partly utilized. The critical 
activities of KATH were classified into 8 different activities. Porter’s ‘Outbound logistics’ 
was not seen as a critical activity due to the fact that the production and consumption of 
services are simultaneous/inseparable.
The use of documents and archives like annual reports, statistics, minutes, circulars and 
financial reports were sources o f secondary data. Information on the p erformance o f the 
hospital for the past 3 years was obtained from these sources as well as information about 
developments in the hospital. Addy (2000) suggests that marketing-related assessment 
should be customer-based using consumer research to assess customer perception about 
some of the activities o f organizations. Thus extracts from customer satisfaction study 
conducted by KATH was used for this purpose.
The rationale for adopting a multi-method approach was to attempt to achieve convergence. 
In this way, it would be possible to compensate partly for the limitations and biases inherent 
in any one method. This was done with regard to suggestion by Weick (1979) and Webb and 
Weick (1979) that organizational behaviour is best captured and examined through multiple 
methods.
Table 3.4 below shows the variables, indicators and measurements for the study. See 
appendix (III) for details o f indicators and measurements.
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TABLE 3.4 VARIABLES, INDICATORS AND MEASUREMENTS FOR THE STUDY
VARIABLES INDICATORS MEASUREMENT
Performance Performance for the past 3 
years
Utilization, customer satisfaction, 
objectives, major policies, mortality 
rates.
Resources Physical, Human, Financial 
and Intangible Resources
Quality, Quantity and Ownership of 
Resources.
Competences Value activities How particularly well they are 
performed relative to competitors.
Linkages Linkages within the hospital Inter-departmental collaboration 
coordination o f departments.
Source: Researcher’s own construct
3.8 PRE-TESTING OF QUESTIONNAIRE
The questionnaire was pre-tested in some of the departments o f KATH. Medical doctors, 
nurses and paramedics were used. Twenty staff were used in the pre-testing. From the pre­
testing, a few changes were made to the questionnaires. A few open-ended questions were 
changed into closed-ended questions.
3.9 DATA COLLECTION LIMITATIONS
1) Some of the respondents could not tell exactly what pertained in the competing 
hospital especially with regard to the competence with which activities were 
performed. Thus causing them to rate based on personal observations from within the 
hospital.
2) With those who indicated that there were no competitors of KATH, their rating of the 
competences were done as perceived internally. In both cases, however, respondents 
tried to give their fair ratings about the indicators.
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3) Though not all the departments o f the hospital were selected for responding to the 
questionnaire yet with t he 2 2 t he s tudy w as a ble t o g et t he i nformation n eeded to 
achieve its aims.
4) Out o f  the 23 departments, no information was obtained from one o f the departments 
(Eye Department) thus; it not been represented in the data analysis. Full information 
about the Polyclinic was not obtained as the respondent went on leave and the next 
person who could have offered the necessary information was not available whenever 
the researcher went to her office.
3.10 DATA PROCESSING AND ANALYSIS
Responses from the questionnaires were coded on receipt and entered into the computer and 
processed using the Statistical Package for the Social Sciences (SPSS). Some o f the 
packages used were frequencies and cross tabulations. Some o f the data were presented 
graphically and in tables. Data on physical resources were manually processed. Data from 
documents on past performance were processed by hand (manually).
Furthermore, the means o f the responses of the activities were found and the ratings done. 
This was to help determine how strong the strengths and how weak the weaknesses were. 
The ratings were done as follows:
High weakness (HW) -  1 Mild Weakness (MW) -2 Even (E) - 3 
Mild Strength (MS) -  4 High Strength (HS) -5
The distinctiveness of the strengths was also tested against three prominent characteristics of 
distinctive competences which are inimitability, substitutability and customer benefit (or 
valued by customers). A similar testing was performed in determining the unique resources. 
The distinctive strengths were finally compared with the key success factors (or critical 
activities) o f KATH identified to determine necessary strengths and weaknesses.
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C H A P T E R  F O U R  
R E SU L T S AND D ISC U SSIO N S
4.1 INTRODUCTION
This chapter discussed the findings o f the study in accordance with the study’s objectives 
which were:
> To investigate the performance o f KATH for the past three (3) years.
> To find out the resources and competences critical to health service delivery.
> To assess the sources o f advantages (in terms of resources and competences) KATH 
possesses.
> To determine how these sources of advantage could be exploited for superior 
performance.
It starts with a presentation of the performance o f KATH for the past 3 years, r esources 
available to KATH, the competences with which activities are performed and ends with the 
linkages within the hospital.
4.2 FINDINGS
4.2.1 PERFORMANCE FOR THE PAST THREE YEARS
The study sought to look at what the hospital had been able to do in terms o f improvement in 
quality of life and patient satisfaction as well as efforts made by the hospital towards the 
achievement o f  t hese. Measurements u sed w ere h ospital d irection, hospital u tilization b y 
patients and patients’ satisfaction.
Organizational Direction
One cannot consider the performance of an organization without finding out what its
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objectives were during the period under study. Therefore where the hospital hoped to be 
during the last three (3) years was considered.
• Objectives
The objectives that were set for the hospital for the past 3 years were used in this study as 
one of the measures of its performance.
TABLE 4.1 OBJECTIVES FOR THE PAST THREE YEARS
OBJECTIVES FREQUENCY PERCENTAGE
To provide quality health care 11 44.0
To improve the quality of 
management 1 4.0
Don’t know 13 52.0
Total 25 100.0
From Table 4.1, 48% o f respondents were able to tell what they thought the objectives of the 
hospital were for the past three years. The other 52% did not have any knowledge about 
them.
Concerning the achievements o f the objectives as indicated in Table 4.2, respondents 
differed in their opinions. While some thought the objectives were achieved as there was 
improvement in the health service delivery (16%), others indicated that they could not be a 
achieved due to inadequate logistics, lack of cooperation and communication among 
departments and new structures to improve the quality of management not fully established 
(24%). 60% could however, not tell whether or not the objectives were achieved. The 
hospital’s mortality rates indicated a drop from 32.7% in 1 998 to  8.2% in  1 999 and rose 
again to almost 10% in 2000. The rates over the years were high implying that quality of 
health life had not been fully achieved.
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TABLE 4.2 OBJECTIVES ACHIEVED
ACHIEVED FREQUENCY PERCENT
YES 4 16.0
NO 6 24.0
DON’T KNOW 15 60.0
TOTAL 25 100.0
Attempts at crosschecking the responses from annual reports proved futile, as there were no 
annual reports for the period 1997 -  2000. The reason for this was given as the non- 
submission of departmental reports. However, from the files there was an indication of the 
introduction of a new management system in the hospital -  The Budget Management 
Concept (BMC) with its sub-budget management centres -  since the year 1998. Also in line 
with the MOH objectives for the period 2000 - 2  002 (as indicated in Chapter One under 
Background), KATH has also had as its objective to provide quality health care to its users 
since the year 2000. Measurable targets for the two objectives could, however, not be 
obtained.
TABLE 4.3 PRESENT OBJECTIVES
YES NO DON’T KNOW
OBJECTIVES 28.0 - 72.0
COMMUNICATION OF 
OBJECTIVES TO:
EMPLOYEES 24.0 12.0 64.0
CUSTOMERS 8.0 28.0 64.0
SHAREHOLDERS 8.0 8.0 84.0
From Table 4.3 28% indicated their knowledge of the present objectives of the hospital and 
gave it as
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"To improve on the quality o f  health care”.
72% could, however, not tell what the objectives o f the hospital were.The critical events 
which gave rise to the present objectives were given as:
• Competition
• Globalisation
• Technology
• Changes in customer tastes and preferences
• Government regulations
• Medico-legal developments.
On the average, 13.3% indicated that the present objectives of KATH had been 
communicated and articulated to employees, customers and shareholders; 16% indicated that 
they had not and 70.7% could not tell. Can this be a contributory factor to the lack of
knowledge of the past and present objectives on the part o f employees?
Regarding the objectives o f their departments, all the respondents were able to indicate them, 
though they were also in general terms and not measurable terms. They were also found to 
be convergent with that o f the hospital as they all moved towards the achievement of quality 
health care (See Appendix IV).
However, considering the generalization and observations by the researcher during the data 
collection, it could be said that most departments were guided by the mission of the hospital 
(indicated in Chapter Three under Research Setting) in coming up with their objectives
which reflect more on their functions than targets for a period (see Appendix III).
• Corporate Plan
This is a document indicating the medium or long-term direction of an organization. It 
contains the goals, objectives and strategies that an organization is pursuing. This was non­
existent at the hospital. However, an administrator indicated that there were plans of
58
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preparing one for the year 2002.
• Hospital utilization by patients 
TABLE 4.4 OUTPATIENT ATTENDANCE
1998 1999 2000
357,407 358,623 328,566
Source: KATH Medical Records and Statistics Department
The outpatient attendance for the years 1998 -  2000 is presented in Table 4.4 above. While 
in 1999 the attendance increased by 0.34%, it fell by 8.4% in 2000. Though there was no 
indication of a specific target by the hospital, it could be said that normally, a rise rather than 
a fall in attendance would be expected.
FIGURE 4.1 PIE CHART SHOWING REGIONAL OUTPATIENT ATTENDANCE
FOR YEAR 2000.
58%
21%
□  KATH H Kumasi District 11 Rest of the Region
Source: Researcher’s construct
From Figure 4.1, in the year 2000, outpatient attendance at KATH formed 20.6% of the total 
of the Ashanti Region, with the health facilities in the Kumasi District having 21% and the 
rest of the region having 58.4%. This is about a fifth of the region’s total outpatient 
attendance (1,592,979*) which is quite substantial.
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TABLE 4.5 ADMISSIONS 1998 -  2000
HOSPITAL BED ADMISSIONS
COMPLIMENT 1998 1999 2000
KATH 750 36987 34750 40601
(45.7%) (48.5%) (40.3%) (41.3%)
St. Patrick’s 142 3872 4107 5062
(Offinso) (8.7%) (5.1) (4.8%) (5.2%)
KNUST 85 4076 4076 4759
(5.2%) (5.4%) (4.7%) (4.8%)
St. Michael’s 82 40309 5698 5775
(Pramso) (5%) (5.7%) (6.6%) (5.9%)
Regional Total 1.640* 76202 86248 98280
KATH’S ADMISSIONS ARE COMPARED WITH SOME OF THE POTENTIAL COMPETITORS AND 
THE REST OF THE REGION.
Admissions at KATH fell from 48.5% in 1998 to 40.3% in 1999 but rose a little to 41.3% in 
2000. That o f St. Patrick’s and KNUST hospitals (two of its potential competitors) also fell 
in 1999 and rose slightly in 2000.
The average in-patient utilization for the period (1998 -  2000) was 43.4% for KATH and 
16.1% for the potential competitors. This shows that the average in-patient utilization of 
KATH was greater than its competitors by a factor o f 27. Also it is clear that KATH’s 
admissions were almost half of that of the entire Ashanti Region (see Figure 4.2).
* The regional total excludes the attendance and admissions at private hospitals.
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FIGURE 4.2 CHART SHOWING REGIONAL ADMISSIONS
40%
□ KATH O Relevant Competitors □ Rest of Region
• Customer satisfaction 
There was no information on customer satisfaction for the period 1998 -  2000. However, a 
patient satisfaction survey conducted early this year (2001) was used (see Table 4.6).
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CHAPTER FOUR 
R E SU L T S AND D ISC U SSIO N S
4.1 INTRODUCTION
This chapter discussed the findings o f the study in accordance with the study’s objectives 
which were:
>  To investigate the performance of KATH for the past three (3) years.
>  To find out the resources and competences critical to health service delivery.
>  To assess the sources of advantages (in terms o f resources and competences) KATH 
possesses.
>  To determine how these sources o f advantage could be exploited for superior 
performance.
It starts with a presentation o f the performance o f KATH for the past 3 years, r esources 
available to KATH, the competences with which activities are performed and ends with the 
linkages within the hospital.
4.2 FINDINGS
4.2.1 PERFORMANCE FOR THE PAST THREE YEARS
The study sought to look at what the hospital had been able to do in terms o f improvement in 
quality of life and patient satisfaction as well as efforts made by the hospital towards the 
achievement o f t  hese. Measurements u sed w ere h ospital d irection, hospital u tilization b y 
patients and patients’ satisfaction.
Organizational Direction
One cannot consider the performance of an organization without finding out what its
55
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objectives were during the period under study. Therefore where the hospital hoped to be 
during the last three (3) years was considered.
• Objectives
The objectives that were set for the hospital for the past 3 years were used in this study as 
one of the measures o f its performance.
TABLE 4.1 OBJECTIVES FOR THE PAST THREE YEARS
OBJECTIVES FREQUENCY PERCENTAGE
To provide quality health care 11 44.0
To improve the quality of 
management 1 4.0
Don’t know 13 52.0
Total 25 100.0
From Table 4.1, 48% of respondents were able to tell what they thought the objectives of the 
hospital were for the past three years. The other 52% did not have any knowledge about 
them.
Concerning the achievements of the objectives as indicated in Table 4.2, respondents 
differed in their opinions. While some thought the objectives were achieved as there was 
improvement in the health service delivery (16%), others indicated that they could not be a 
achieved due to inadequate logistics, lack of cooperation and communication among 
departments and new structures to improve the quality o f management not fully established 
(24%). 60% could however, not tell whether or not the objectives were achieved. The 
hospital’s mortality rates indicated a drop from 32.7% in 1 998 to  8.2% in  1 999 and rose 
again to almost 10% in 2000. The rates over the years were high implying that quality of 
health life had not been fully achieved.
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TABLE 4.2 OBJECTIVES ACHIEVED
ACHIEVED FREQUENCY PERCENT
YES 4 16.0
NO 6 24.0
DON’T KNOW 15 60.0
TOTAL 25 100.0
Attempts at crosschecking the responses from annual reports proved futile, as there were no 
annual reports for the period 1997 -  2000. The reason for this was given as the non­
submission of departmental reports. However, from the files there was an indication of the 
introduction of a new management system in the hospital -  The Budget Management 
Concept (BMC) with its sub-budget management centres -  since the year 1998. Also in line 
with the MOH objectives for the period 2000 -2 0 0 2  (as indicated in Chapter One under 
Background), KATH has also had as its objective to provide quality health care to its users 
since the year 2000. Measurable targets for the two objectives could, however, not be 
obtained.
TABLE 4.3 PRESENT OBJECTIVES
YES NO DON’T KNOW
OBJECTIVES 28.0 - 72.0
COMMUNICATION OF 
OBJECTIVES TO:
EMPLOYEES 24.0 12.0 64.0
CUSTOMERS 8.0 28.0 64.0
SHAREHOLDERS 8.0 8.0 84.0
From Table 4.3 28% indicated their knowledge of the present objectives of the hospital and 
gave it as
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“To improve on the quality o f  health care 
72% could, however, not tell what the objectives of the hospital were.The critical events 
which gave rise to the present objectives were given as:
• Competition
• Globalisation
• Technology
• Changes in customer tastes and preferences
• Government regulations
• Medico-legal developments.
On the average, 13.3% indicated that the present objectives of KATH had been 
communicated and articulated to employees, customers and shareholders; 16% indicated that 
they had not and 70.7% could not tell. Can this be a contributory factor to the lack of 
knowledge of the past and present objectives on the part o f employees?
Regarding the objectives o f their departments, all the respondents were able to indicate them, 
though they were also in general terms and not measurable terms. They were also found to 
be convergent with that o f the hospital as they all moved towards the achievement of quality 
health care (See Appendix IV).
However, considering the generalization and observations by the researcher dining the data 
collection, it could be said that most departments were guided by the mission of the hospital 
(indicated in Chapter Three under Research Setting) in coming up with their objectives 
which reflect more on their functions than targets for a period (see Appendix III).
• Corporate Plan
This is a document indicating the medium or long-term direction of an organization. It 
contains the goals, objectives and strategies that an organization is pursuing. This was non­
existent at the hospital. However, an administrator indicated that there were plans of
58
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preparing one for the year 2002.
• Hospital utilization by patients 
TABLE 4.4 OUTPATIENT ATTENDANCE
1998 1999 2000
357,407 358,623 328,566
Source: KATH Medical Records and Statistics Department
The outpatient attendance for the years 1998 -  2000 is presented in Table 4.4 above. While 
in 1999 the attendance increased by 0.34%, it fell by 8.4% in 2000. Though there was no 
indication of a specific target by the hospital, it could be said that normally, a rise rather than 
a fall in attendance would be expected.
FIGURE 4.1 PIE CHART SHOWING REGIONAL OUTPATIENT ATTENDANCE
FOR YEAR 2000.
□  KATH 13 Kumasi District ■  Rest of the Region
Source: Researcher’s construct
From Figure 4.1, in the year 2000, outpatient attendance at KATH formed 20.6% of the total 
of the Ashanti Region, with the health facilities in the Kumasi District having 21% and the 
rest of the region having 58.4%. This is about a fifth of the region’s total outpatient 
attendance (1,592,979*) which is quite substantial.
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TABLE 4.5 ADMISSIONS 1998 -  2000
HOSPITAL BED ADMISSIONS
COMPLIMENT 1998 1999 2000
KATH 750 36987 34750 40601
(45.7%) (48.5%) (40.3%) (41.3%)
St. Patrick’s 142 3872 4107 5062
(Offinso) (8.7%) (5.1) (4.8%) (5.2%)
KNUST 85 4076 4076 4759
(5.2%) (5.4%) (4.7%) (4.8%)
St. Michael’s 82 40309 5698 5775
(Pramso) (5%) (5.7%) (6.6%) (5.9%)
Regional Total 1.640* 76202 86248 98280
KATH’S ADMISSIONS ARE COMPARED WITH SOME OF THE POTENTIAL COMPETITORS AND 
THE REST OF THE REGION.
Admissions at KATH fell from 48.5% in 1998 to 40.3% in 1999 but rose a little to 41.3% in 
2000. That o f St. Patrick’s and KNUST hospitals (two o f its potential competitors) also fell 
in 1999 and rose slightly in 2000.
The average in-patient utilization for the period (1998 -  2000) was 43.4% for KATH and 
16.1% for the potential c ompetitors. This shows that the average in-patient utilization of 
KATH was greater than its competitors by a factor o f 27. Also it is clear that KATH’s 
admissions were almost half o f that o f the entire Ashanti Region (see Figure 4.2).
* The regional total excludes the attendance and admissions at private hospitals.
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FIGURE 4.2 CHART SHOWING REGIONAL ADMISSIONS
40%
□ KATH 13 Relevant Competitors El Rest of Region
44%
• Customer satisfaction 
There was no information on customer satisfaction for the period 1998 -  2000. However, a 
patient satisfaction survey conducted early this year (2001) was used (see Table 4.6).
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'FtGvrRt zf.Z, S o - j - i U .  l C^iSTowACvC SYMvsf-^Cl f'Or-a WCc-k~Y  ?c
Q > « O o )
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KATH AVERAGE
I M N i r  ia _ ~ r
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4-- G cDvi~ ^  \ ' c m  '
FINDINGS AND CONCLUSIONS
12*
Based on the com putations, the re su lts  obtained  are  as dep ic ted  in Iho foIJo-.vinp, tables. 
land ings o f  Patient Sa tis fa c t io n  S u rv ey
.S/BMC D1K.TION DIK.TION WAIT. TIM U. DELA Y rXAMIN. TOLD DIA INSTRUCT KET./N.Rf PRIVACY D. AVAIL. PHA. INsT STAFF At )hCS!’. CL hMEKG. EMKRG. 2 OVERALL No. Resp
1
A&E i 92 r '87 98 14 79 69 58 92 ICS 45 102 42| 28 - . 10 ,7 41 111
■ %  i 82.88 78.3S 83.29 12.61 71.17 62.16 52 25 82.88 97.30 40.54 91.89 37.841 25.23 9.01 70 36.94
DEN 98 •108 90 I] 103 84 85 72 ICS 34 41 37 30 y 3 35 111
88.29 97.30 81.081 2 70 92.79 75.68 76 58 64.86 97.30 30.63 36.94 33.33 27.03 8.11 33.33 31.53
| | _
;POLY 141 139 66 30 1-281 73 45 83 146 18 71 70 41 21 15 67 147
j_ 95.92 S4.56 44.90 20.41 87.07 V 49.66 30.61 56.46 99.32 1224 48.30 47.62 27.89 14.29 10.20 45.58
-
|en t 111.0 108 85 11 113 86 69 93 114 4 1o 17 12 9 .... ...8 29 117
1 75.51 73.47 72.65 9.40 96.5S1 73.50 . 58.97 79.49 97.44 3.42 13.68 14.53 10 26 7.69 88.89 24.79
i '
|eyh 103 65 28 31 107 as 70 109 20 30 5 11 8 -] j 111
I 92.79 5S.56 25.23 27.93 96.40 79.28 61.26 63.06 98.20 18.02 27.03 4.50 270 9.91 72.73 9.91
1 - _
MED/S .96 % 54 14 58 64 95 100 42 88 43 41 12 44 104
92.31 92.31 51.92 13.46 71.15 55.77 61.54 91.35 96.15 40.38 84.62 41.35 11.54 58.33 42.31
SUR/S 106 95 44 19 89 99 97 101 107 26 34 13 G 17 14 12 120
85.83 80 36.67 15.83 74,17 82.5 80.83 84.17 89.167 21.67 28.3 10.83 7.5 14.2 82.35 10
TOTAL 821
AVER 87.65 82.08 57.25 14.62 84.19 68.36 60.29 74.61 96.41 23.84 47.25 27.14 20.00 10.67 59.411 28.72 _ . . ..
v \v c ls ka  r ^ w v o ^ -  u - o h  f '- i f v M t  ''f
University of Ghana          http://ugspace.ug.edu.gh
The hospital average on the whole was low in waiting time (57.25), cleanliness (20.0), staff 
attitude (27.14), drug availability (23.85) and pharmacy instructions (74.25).
Users who went to the pharmacy were used with the drug availability indicator. It was 
observed that all the essential drugs were available at the pharmacy during the survey. It was 
therefore concluded that the drugs which were not available were possibly those outside the 
essential drug list.
The percentage of clients who were very satisfied with the hospital’s services was very low 
(23.7%). Its Eye Clinic recorded the lowest for its overall customer satisfaction (9.9%). 
Also 4.5% and 2.7% found the clinic’s staff attitude to be good and the clinic clean 
respectively. In addition, its waiting time was also high as patients (74%) had to spend over 
2-4 hours before being seen.
Areas o f high hospital average included privacy (96.41%), no unnecessary delays (85.38%), 
direction to Records Office not difficult (87.65%) and directions to Clinic/Consulting Room 
(82.08%) as well as patients examined 984.19%).
Poor responses from patients were not overlooked (see Table 4.7). They were in respect of 
important indicators like drug availability (those who did not go to the pharmacy at all), staff 
attitude (poor staff attitude), hospital cleanliness (dirty environment) and overall satisfaction 
(unsatisfactory).
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TABLE 4.7  POOR OUTPATIENT RESPONSES
S/BMC D. AVAIL STAFF ATT. HOSP. CL.
OVERALL
SATIS.
A & E (No.) 4.00 11.00 12.00 12.00
% 3.60 9.91 10.81 10.81
DEN (No.) 63.00 3.00 3.00 10.00
% 56.76 2.70 2.70 9.01
POLY (No.) 48.00 16.00 10.00 8.00
% 32.65 10.88 6.80 5.44
ENT (No.) 31.00 2.00 2.00 4.00
% 26.50 1.71 1.71 3.42
EYE (No.) 31.00 4.00 6.00 7.00
% 27.93 3.60 5.41 6.31
MED/S (No.) 21.00 6.00 6.00 9.00
% 20.19 5.77 5.77 8.65
SUR/S (No.) 56.00 8.00 4.00 3.00
% 46.67 6.67 3.33 2.50
Source: KATH Patient Satisfaction Survey Report (2000)
The hospital’s average on patients who found the hospital’s services unsatisfactory was 
6.59% which is on the high side. The highest overall unsatisfactory service was recorded by 
the Accident and Emergency Unit (10.8%). The Polyclinic recorded the highest in poor staff 
attitude of 10.88%.
This implies that for every 100 patients who attend the hospital about 7 are not satisfied with 
the hospitals services which is a very big number and should be a matter o f concern.
• In-patient survey
The areas looked at were:
• Responsiveness and Reliability -  response time (prompt response to clients’ needs, 
organization and efficiency of care and communication).
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• Care -  relates to empathy and assurance (knowledgeable and courteous, polite,
reassuring and sympathetic, inspiring, trust and confidence).
• Environmental Impact -  refers to the directly observable characteristics of the
health care environment (clean, tidy environment, comfort o f surroundings).
TABLE 4.8 RESPONSIVENESS AND RELIABILITY
OBGY SURG PAED MED HOSP.
AVER
Number of people interviewed Total: 265 51 81 45 88
Average length of sta^/ in hospital (Days) 9.00 29.60 8.18 13.70
INFORMATION
Clients were informed 
of:
% % % % %
Their illness 80.39 72.84 55.56 70.45 69.81
Tests to be done 52.94 79.01 77.78 89.77 74.88
Examinations to be done 72.55 85.19 97.78 87.50 85.75
Results o f Tests and Examinations explained to them. 47.06 53.09 37.78 47.73 46.41
Prescribed Medication explained to them. 98.04 77.78 91.11 96.59 90.88
Clients were given sufficient information concerning:
Ward/hospital rules/routine 82.35 62.96 73.33 77.27 73.98
Where to direct their inquires 56.86 46.91 55.56 51.14 52.62
The Physician responsible for their care 90.20 66.67 64.44 82.95 76.07
ACCESSIBILITY
Clients had no difficulty:
Contacting physician 82.35 66.67 80.00 82.95 77.99
Contacting nurses 94.12 75.31 91.11 90.91 87.86
Locating places in the hospital 94.12 74.07 91.11 97.73 89.26
Clients:
Were treated satisfactorily within reasonable time 94.12 79.01 88.89 95.45 89.37
Were visited by doctor/doctors at lease once a day 66.67 70.37 88.89 73.86 74.95
Could discuss problems with doctor(s) 94.12 74.07 91.11 95.45 88.69
Source: KATH Patient Satisfaction Survey Report (2000)
The information flow, which is supposed to be an important factor in the interaction process, 
has some pitfalls. Less than 50% of clients received an explanation of their test results and 
only 52.6% knew where to direct their concerns. This state can lengthen response time and 
lead to adverse occurrences. It is however, noteworthy that over 80% were treated
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satisfactorily within reasonable time. Access to physician was not very satisfactory. The 
hospital’s overall average on responsiveness and reliability (77.04%) was quite good.
TABLE 4.9 CARE
OBGY SURG PAED MED HOSP.
AVER
Number of people interviewed Total: 265 51 81 45 88
Average length of stay in hospital (Days) 9.00 29.60 8.18 13.70
Staff: % % % % %
Introduced themselves to clients 25.49 18.52 13.33 14.77 18.03
Responded to needs of clients 88.24 77.78 88.89 89.77 86.17
Were courteous to clients 82.35 64.20 80.00 88.64 78.80
Clients:
Received all prescribed medication from hospital 
pharmacy
76.47 27.16 62.22 48.86 53.68
Had confidence in staff competence and skill 100.00 82.72 88.89 94.32 91.48
Relatives stayed by them 21057 60.49 91.11 42.05 53.80
Nurses 94.12 66.67 40.00 84.09 71.22
Source: KATH Patient Satisfaction Survey Report (2000)
Confidence of clients in staff competence was as high as 91.5% and on the average the staff 
were quite courteous to the clients (78%). Response to clients’ needs was also quite 
encouraging at 86%. However, drug availability and staff introducing themselves to clients 
were not encouraging. It could be said that the staff o f the hospital were quite empathetic 
and assuring.
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TABLE 4.10 PHYSICAL ENVIRONMENT
OBGY SURG PAED MED HOSP.
AVER
Number of people interviewed Total: 265 51 81 45 88
Average length of stay in hospital (Days) 9.00 29.60 8.18 13.70
Staff: % % % % %
Considered the ward temperature satisfactory 88.24 59.26 11.11 84.09 60.67
Complained of odor in ward 27.45 39.51 33.33 21.59 30.47
Found bathroom very clean 27.45 1.23 2.22 21.59 13.12
Found toilet very clean 25.49 1.23 0.00 18.18 11.23
Considered meals supplied very satisfactory 5.88 0.00 0.00 12050 4.60
Considered the ward to be very clean 15.69 9.88 0.00 21.59 11.76
Were not disturbed by mosquitoes at night 72.55 59.26 71.11 64.77 66.92
Were not disturbed by flies during the day 60.78 74.04 84.44 65.91 71.30
Were not disturbed by visitors during the day 76.47 75.31 66.67 81.82 75.07
Were not disturbed by staff during the day. 90.20 88.89 95.56 78.41 88.26
Source: KATH Patient Satisfaction Survey Report (2000)
Like the outpatient survey, the hospital average for the physical environment was 43.3% 
which is not satisfactory. Meals supplied to patients were not found very satisfactory (4.6%). 
The cleanliness o f ward facilities like toilets, bathrooms and wards all fell below 15%.
TABLE 4.11 CLIENTS’ PERCEPTION OF PROVIDERS
OBGY SURG PAED MED HOSP.
AVER
Number of people interviewed Total: 265 51 81 45 88
Average length of stay in hospital (Days) 9.00 29.60 8.18 13.70
Clients perceived Staff: % % % % %
To work under stress 7.84 38.27 17.78 6.82 17.6
To find their work stimulating 98.04 82.72 88.89 95.45 91.2
Workload to be heavy 47.06 32.10 37.78 42.05 39.2
As having a positive attitude towards their work 96.08 80.25 91.11 89.77 89.8
Had a common objective -  good care for patients 98.04 77.78 93.33 93.18 90.5
Overall assessment of service to be very 
Satisfactory
21.57 1.23 0.00 19.32 10.5
Source: KATH Patient Satisfaction Survey Report (2000)
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Health care workers usually complain of heavy workload and the stress associated with the 
work. Interestingly, the clients did not see it as such. They saw them as having a positive 
attitude towards their work.
The overall assessment o f the hospital’s service by in-patients was not encouraging as only 
10.5% found it to be very satisfactory. With the department o f Paediatrics none o f the 
respondents found its services very satisfactory.
4.2.2 RESOURCE PROFILE OF KATH
A resource profiling/auditing identifies and classifies the resources that an organisation owns 
or can access to support its strategies. It attempts to assess the quality o f resources available, 
nature of those resources, and the extent to which the resources are unique. The study 
assessed the types o f resources w hich KATH possessed and which were categorized into 
physical, human, financial and intangible. . "  qN.
Physical resources
For the detail analysis o f the physical resources, their quantities, quality and ownership see 
Appendix V . T he major equipment, facilities, beds and  cots o f  the  various service areas 
were assessed.
Clinical -  Equipment and facilities in the Department of Medicine were in good condition. 
Its diagnostic equipment were big in size, but considering the utilization most o f the facilities 
were found to be over utilized. At the Obstetrics and Gynaecology department (O & G) with 
the exception of the cardiothocograph, most equipment were not in very good state. Some 
like the diathermy machines and the resuscitaire were old. Facilities like the theatres, labour 
ward, in-patient wards and ultra sound services were over-utilised.
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Accident and Emergency (A & E) operating theatre equipment and facilities were in good 
condition, have normal capacity except the theatre recovery ward which was small. At the 
casualty unit, the conditions o f the facilities at the recovery wards were poor. Except its 
P.O.P room, the capacities o f all other facilities were small.
Furthermore, anaesthetic machines were in a good shape and so were those at the department 
of Child Health (Paediatrics). However, the facilities o f the latter were over-utilised and its 
wards needed attention. Moreover, the equipment and facilities at the surgery and oral health 
(dentistry) departments were in a good state and enjoyed normal utilization.
In addition, at the ENT department, equipment and facilities were over-utilised with its 
mastoidectomy set being outmoded. The locations of all facilities were easily accessible to 
users.
Finally, most o f the beds and cots were in poor conditions.
Diagnostic -  The quality of almost all the equipment in the laboratories was good. Even 
those above ten (10) years were still in good conditions. The issue o f adequacy of equipment 
did not arise. Respondents, however found their laboratories to be small and welcomed 
bigger facilities. One o f the respondents complained about the sterility o f  the Microbiology 
laboratory. This was due to the absence of air-conditioners which had led to the leaving of 
all doors ajar. Conditions in all the laboratories were rated as either poor or satisfactory. 
Since the Histopathology laboratory was a little separated from the other laboratories and the 
main hospital, locating it became difficult for some patients. With the exception of the 
parasitology laboratory, the other two laboratories under the Microbiology department were 
not easily located by users.
Physiotherapy -  The equipment and facilities were all in a good state. However, considering 
their utilization, most equipment were being over-utilised and all facilities were small in
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capacity/size. Accessibility to the department was difficult, especially for cardio-vascular 
accident (stroke) patients, as they had to climb some stairs before getting to the department. 
A modem and spacious physiotherapy was being put up at the time o f the study.
Pharmaceutical -  The equipment of the department were outmoded with some being beyond 
repairs. There were a lot of drugs which the hospital could prepare itself to reduce the cost 
of drugs but was limited by the equipment at its manufacturing unit. The various 
dispensaries -  outpatient and in-patient were located at the patient service areas and were 
easily accessible to patients.
Administration and Support Services -  There were facilities which provide support services 
for those directly involved in health service delivery. The Maintenance Department had 
well-equipped workshops and ensured the maintenance and repairs of hospital equipment 
and o ther facilities. T he s tand-by generators d id n ot s upply p ower t o the  entire hospital, 
when there were black outs, but to only very sensitive service areas. The Administration and 
Accounts Department could be said to have the necessary tools/equipment for their work. 
However, the photocopiers in both departments were not in a very satisfactory state. This 
impeded the smooth movement o f work.
The Medical Records and Statistics Department was in the process of being computerized. 
Its patient cards issuing points were all located near the various consulting rooms. The 
Supply and Stores Management Department did not have quality equipment and facilities as 
well as air-conditioners and computers. Almost all its equipment and facilities were more 
than 15 years, in poor state and small in capacity.
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All the equipment and facilities were owned by the hospital except the ultra-sound at the O 
& G department and some of the equipment in the Clinical Biochemistry Department which 
were owned by the School of Medical Sciences. With the ultra sound service the proceeds 
went to the Medical School.
Human resources
Human resources are the productive services that human beings offer to a firm in terms of 
the skills, knowledge, reasoning and decision making abilities. Their assessment involves the 
number and types o f different organisational members, their adaptability and innovative 
capabilities (Grant 1998).
Skills
Staff of KATH were highly endowed with the necessary skills for the performance o f their 
duties and also had the necessary knowledge about their jobs (i.e. understood what their jobs 
entailed). 96% of respondents attested to this fact.
From Fig. 4.4 100 % o f respondents indicated that staff of their departments had technical 
skills. 60 %, 48 %, 40 % and 92 % said that their staff had managerial, computer, clerical 
and innovative skills respectively. 88 % also indicated that some o f their staff were unskilled 
It was noted that the hospital had started a computerization programme and was therefore 
providing training for those who would be utilizing/operating the computers. Departments 
without clerical skills depended on the General Administration for such services.
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FIGURE 4.4 RESPONDENTS OPINION ON TYPES OF SKILLS THEIR 
STAFF HAVE
Technical Managerial Computer Clerical Innovative Unskilled
Skills
TABLE 4.12 ADAPTABILITY OF STAFF
RESPONSE FREQUENCY PERCENTAGE
Very Adaptable 10 40.8
Adaptable 12 48.0
Not very Adaptable 3 12.0
Not Adaptable 0 0.0
Total 25 100
From Table 4.12, the adaptability of the staff of KATH was encouraging as they were able to 
move in line with the new developments in the health sector. 40.8% and 48% thought that 
their staff were very adaptable and adaptable respectively
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TABLE 4.13 STAFF COMMITMENT AND LOYALTY
RESPONSE FREQUENCY PERCENTAGE
Very Devoted 5 20.0
Devoted 10 40.0
Fairly Devoted 10 40.0
Not Devoted 0 0.0
Total 25 100.0
While 20% of respondents thought staff were very devoted, 40% and 40% also thought staff 
were devoted and fairly devoted respectively. Current records o f labour disputes available at 
the hospital indicate that there had been agitations which led to strike actions in some cases 
by doctors and nurses against either management or the government. Some of the reasons 
were about working conditions, payment of allowances and accommodation. To the 
workers, reasons for these agitations and even strike actions had all been genuine. However, 
all avenues for the resolutions o f the grievances were never exhausted before the strike 
actions were embarked upon.
Key S taff
All the key staff in the organization were under management’s direct control except most of 
the medical consultants/specialists and the scientists who were employees o f the Kwame 
Nkrumah University of Science and Technology (KNUST). They doubled as lecturers of the 
University and health service providers of the Hospital.
Some of these key staff also served as heads of the clinical and diagnostic departments. The 
problem management had with them was proper supervision. As lecturers and heads of 
departments at the School o f Medical Sciences of the University, very little time was 
available to them to do proper supervision at the hospital. The time factor also affected the
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health service provision. For instance, some respondents indicated that because they were 
not always available when needed, the hospital management did not proceed smoothly. 
Again, the hospital management did not have the power to discipline these staff when they 
failed to respond to duty.
Financial resources
In assessing the financial resources o f KATH the study considered the following:
• Major sources o f  funds and their reliability
• Uses o f funds
• Financial policy
• Financial plan(s)
TABLE 4.14 KNOWLEDGE ABOUT FINANCIAL RESOURCES
LEVEL OF 
KNOWLEDGE FREQUENCY PERCENTAGE
Knowledgeable 4 16.0
Not very knowledgeable 7 28.0
Don’t know 14 56.0
Total 25 100.0
An interesting thing that came out of the assessment of the financial resources was 
respondents’ knowledge about them. It came out that while 16% knew a lot about the 
financial management o f the hospital, 28% had some knowledge and 56% did not have any 
knowledge (see Table 4.14). Though it was not an issue being looked for but its occurrence 
was noteworthy. This is so because as organizational members whose e fforts lead to the 
generation of funds for the organization and who depend on the hospital for inputs they
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should know about other sources and their reliability and the uses o f funds. The knowledge 
helps to prevent speculations and also leads to commitment on the part o f staff.
Major sources o f  funds and reliability 
The hospital’s major sources of funds were:
• Government o f Ghana (GOG)
• Internally-Generated Funds (IGF)
• Donor Pool Fund (DPF)
Though respondents differed on the percentages o f the various sources of funds, the financial 
statements over the years indicated that GOG had always been more than half o f the total 
revenue of the hospital, followed by IGF and then DPF.
TABLE 4.15 RELIABILITY OF SOURCES OF FUNDS
Sources
Very
Reliable
(% )
Reliable
(% )
Not Very 
Reliable
(% )
Not
Reliable
(% )
Don’t
Know
(% )
Row
Total
(% )
GOG 12.5 75 12.5 0.0 0.0 100
IGF 50 25 0.0 0.0 25.5 100
DPF 12.5 25 0.0 0.0 12.5 100
None of the sources was found to be “not reliable”. They all had some level of reliability. 
75% of the respondents viewed GOG as reliable and 12.5% and another 12.5% as very 
reliable and not very reliable respectively. The reason given for its being “very reliable” was 
the fact that it was government’s responsibility to provide funds for the running of the 
hospital and therefore did that all the time. The timing of the release o f funds was given as 
the reasons for its not being very reliable as there were always delays especially during the
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first and last quarters o f the financial years. Those who viewed it as “reliable” based it on 
the two reasons above.
With IGF, 50% o f respondents saw it as very reliable and 25% as reliable. Data available 
indicated that whenever, there was a prolonged strike action, there were losses in IGF. In 
1998 the strike action by Junior Doctors in Ghana in December resulted in revenue loss of 
^120 million to the hospital. It was observed that the IGF had been the source that the 
hospital depended on when there were delays in the release o f the GOG.
An Accountant intimated that the availability o f the DPF depended on the Ministry of 
Health’s Donor partners honouring their pledges. Thus making it not very reliable.
Uses o f  Funds
The hospital funds were used to incur the following broad expenditure items:
• Personal Emoluments
• Traveling and Transport
• General Expenditure
• Maintenance, Repairs and Renewals
• Stores and Supplies
• Capital Expenditure
• Drugs
• Other Expenditure
Financial Policy and Plan
The hospital did not have a financial policy. However, it had had short-term (yearly) 
financial plans for the years 1999, 1998, 1997. From their financial report and accounts for 
1998 it was indicated that the hospital was able to achieve the plan for the year.There were
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no financial plan for 2000 and 2002.
Management o f  Creditors
Since 1998, KATH had been able to streamline the handling o f its creditors. It first 
streamlined its procurement practices by introducing the tender system and buying as and 
when necessary. It was able to reduce its payment period from 180 days before 1998 to 45 -  
60 days in 1998. This had given it a good reputation before its creditors.
Intangible resources
These include corporate image, product image (brand names), patents employee loyalty, 
networks (relationships) and goodwill. The study considered the hospitals reputation before 
the public, relationships and access to low cost supplies.
TABLE 4.16 REPUTATION BEFORE THE PUBLIC
RESPONSE FREQUENCY PERCENTAGE
EXCELLENT 2 8.0
GOOD 10 40.0
SATISFACTORY 11 44.0
NOT GOOD 2 8.0
TOTAL 25 100.0
From Table 4.16 the highest responses fell between good (40%) and satisfactory (44%). 
From a radio programme recently (i.e. in 2000) undertaken by the hospital to ascertain the 
perception of the public about the hospital, it came out that there was confidence in the 
ability of the providers to offer good quality care. However, the public did not find the 
providers responsive (i.e. willing to help customers and provide prompt service), empathetic
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and courteous. It was this negative perception of the providers that had given the hospital 
not very good reputation before the public.
Relationships
Customers
The hospital had two main customers -  the general public and the Ashanti Goldfields 
Company Ltd. ( AGC). The relationship between the hospital and the general public was 
“basic” (Rust et al. 19960. In other words, there was no lasting relationship established as 
after the  transaction, both  parties w ent their way. H owever, w ith  the A.G.C. Ltd. i t  was 
more “reactive” in nature as the hospital had offered to respond to the AGC’s needs when it 
had any problem.
Other Hospitals/Institutions
The hospital had  links w ith  the  Kwame Nkrumah University o f  Science and Technology. 
Whilst its School o f Medical Sciences used the hospital’s facilities for the training o f medical 
students, it also rendered services in the form of patient care and others to the hospital. The 
hospital benefited from the services of some of these lecturers who were mostly 
consultants/specialists. Certain departments at the hospital also had links with hospitals and 
University in Europe and the U.S.A. with whom joint researches and training programmes 
were done. The Haematology Department had link with the St. George’s Hospital Medical 
School (U.K) in the areas of staff training, joint research and assistance in research. The 
Biochemistry Department had established a network with Emory University (U.S) in the area 
of sharing o f medical problems and achievements. Finally, the Surgery and Accident and 
Emergency Departments had networks with the Utah University Hospital (U.S), Harvest 
Africa (U.S) and the University of Holm (Germany) in the areas o f staff training and the
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performance o f  major special surgeries which the hospital did not have the capacity (in 
respect o f skill or resources or both) to perform.
Suppliers
The hospital saw its suppliers of goods and services as partners as they both worked together 
for their mutual benefit. The hospital undertook registration o f suppliers every year, 
monitored their performance and offered financial assistance to its suppliers o f services like 
those undertaking maintenance or constructional works (for later refund) and regular 
meetings held with them as well as proved itself creditworthy. In other words, its had proved 
to be a reliable and supportive partner. The suppliers on their part offered favourable credit 
facilities and assistance in cases of emergencies when the hospital fell on them (i.e. suppliers 
of goods). However, meetings are not held with suppliers of goods.
Low Cost o f  Supplies
Since it is a big institution which makes major purchases quarterly, it was able to enjoy low 
cost of suppliers from bulk purchase discounts and its tender system. It also had access to 
the Ministry of Health’s Central Medical stores where the prices o f some o f the items were 
relatively cheaper.
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Resource Allocation
TABLE 4.17 RESOURCE ALLOCATION
RESPONSE FREQUENCY PERCENTAGE
Even 5 20.0
Unbalanced 12 48.0
Don’t know 8 32.0
Total 25 100.0
To the majority o f respondents, the allocation of resources (physical, financial, human) in the 
organization was unbalanced (48%). Some of these people could not tell the basis of 
resource allocation but others thought it depended on who could “shout louder” to influence 
management. To those who perceived the allocation as even (20%) they gave the basis as 
volume of work, size and needs o f department/unit.
4.2.3 IDENTIFICATION OF COMPETITORS
Any sound strategy has to be supported by a thorough understanding of the firms’ most 
relevant competitors, since a business strategy aims at achieving sustainable advantage over 
them (Hax and Majuf, 1996). Thus an external assessment o f KATH’s capabilities relative to 
its relevant competitors was done to determine their distinctiveness. Respondents were asked 
to identify who they thought were the relevant competitors of KATH using the criteria 
below:
A relevant competitor was one who fulfills or has the potential o f fulfilling one or more of 
the following conditions:
(i) Had a high market share or enjoyed high patronage of its services.
(ii) Had a strong technical/managerial base.
(iii) Offered quality services.
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(iv) Had demonstrated an aggressive competitive attitude against your entire or 
important segments o f your business.
Some respondents viewed KATH as a giant in the health service industry in the Ashanti 
Region without any relevant competitor(s) (24%). The major ones identified were in both 
private and public sectors.
TABLE 4.18 KATH’S (POTENTIAL) COMPETITORS
PUBLIC HOSPITALS PRIVATE HOSPITALS
1. KNUST Hospital (Kumasi)*
2. St. Michael’s Hospital (Pramso)
3. Manhyia Polyclinic (Kumasi)
4. St. Patrick’s Hospital (Offinso)
1. Bomso Specialist Clinic (Kumasi)
2. Aninwa Medical Centre (Kumasi)
3. AGC Hospital (Obuasi)
*Under Ministry o f Education (i.e. KNUST)
4.2.4 UNIQUE RESOURCES
From the strategy literature , for a resource to qualify as a basis for an effective strategy or
superior performance it must pass a number of external market test of its value (Collins and
Montgomery, 1995; Grant, 1996; Bharadwaj et al., 1993). Four o f the tests/characteristics
were used to determine the uniqueness of the resources of KATH possess. They were:
Imitability
Substitutability
Ownership/ appropriability
Customer value
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Their relevance to the hospital/health service delivery was also considered i.e. their linkage 
to critical success factors.
Physical Resources
As far as physical resource were concerned KATH could be said to be highly endowed. Its 
facilities were well equipped with state-of-the-art equipment, some o f which were time and 
cost saving for both hospital and users and were not available at the competitors’ facilities. 
These included X-ray machines which exposed users to lower doses o f radiation, foetal 
monitoring machines (Cardiotocographs), autoanlysers and oxygen and sterilisation plants, 
diathermy machines (used in surgeries) as well as anaesthetic equipment.
It also had an advantage in terms o f the facilities operated under its various service areas. 
Some of the facilities were not found anywhere in the region or had a comparative advantage 
over those in existence in the region or even the competitors facilities. These include:
Clinical
Specialist Clinics
Diagnostic
Neo-natal Unit, Anaesthesia, Accident and Emergency 
(24 hour service), Sickle Cell, Asthma, Hypertension,
Diabetic, Renal, Cerebral Palsy Clinics 
ENT (Hearing Assessment Centre) -  none in the region 
Oral Health -  none of the competitors operate this facility, 
Modem Family Planning Centre, High Dependency Unit, 
Radiotherapy -  none in the region, Dialysis Centre -  none 
in the region.
Mycology and Bacteriology Services, Blood Bank, Endoscopy, 
Radiology, Histopathology with a big Mortuary and a 
Laboratory -  the only one in the region.
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Pharmaceutical
Physiotherapy
Support Services
A manufacturing unit with an A-Septic Laboratory (for sterile 
preparations)
None in the region except at AGC hospital but not 
comparable to that o f KATH. A Non-Governmental 
Organization was putting up a state- o f -the- art physiotherapy 
facility (with equipment) for the hospital 
Central Sterilisation Unit which offers services to other 
hospitals as well as maintenance Unit.
Human Resources
KATH had an advantage in human resources. It had a relatively high number of human 
resources with varied educational, technical and professional qualifications commensurate 
with its status as a teaching hospital. These staff were experts who worked in the various 
service areas of the hospital (i.e. clinical, diagnostic, pharmaceutical, physiotherapy and 
administrative and support services).
Clinical
Diagnostic
Pharmaceutical
Physiotherapy
Medical Consultants/Specialists, Resident Doctors, 
Specialized Nurses, Dental Technologist/Assistants (see 
Appendix VI for the details o f the specialists).
Scientist, Technologist, Radiologist, Radiographers, 
Technicians, Pathologists.
Clinical Pharmacists and experienced Pharmacists. 
Physiotherapists, Physiotherapy Assistants.
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Administrative and Support - Experienced Administrators, Biomedical Engineers and
Technologists, Estate Officers, Biostatistician, 
Prosthetist, Accountants.
Financial Resource
KATH enjoyed a strong financial position. Its capacity to generate funds internally was high. 
With the GOG and DPF, the other public hospitals except the KNUST hospital, also 
benefited from it, however, because of its size and utilization rate, KATH enjoyed a higher 
percentage. The others in the private sector, on the other hand, do not have access to these 
sources. They m ay resort to debt financing the interest o f which c ould add to their cost. 
AGC hospital, however, is financed by the AGC Ltd. These sources of funds provided value 
to the customers as they were used in the provision o f items/services which benefit 
customers directly or indirectly like the improvement of facilities and the provision of 
supplies for service delivery.
Intangible Resources
The uniqueness of these resources was in the areas of low-cost o f supplies, supplier relations 
and networks/links with other hospitals/institutions.
The low-cost o f supplies from the Central Medical Stores can also be obtained by the other 
public hospitals. The hospital can exploit the low cost of supplies to lower its cost of service 
delivery.
Its r eputation before s uppliers a s a r eliable and s upportive 1 ong t erm p artner i s due t o i ts 
good creditor management.
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Links with the institutions/hospitals outside the country were enjoyed through the effort of 
the Medical School and the programmes associated with them are yearly and it brings a lot of 
benefits to both the hospital and users. For instance when the medical doctors from the 
University o f Utah Hospital in the United States o f America came on their yearly visits, they 
brought special equipment which enabled them to perform surgical operations which the 
hospital was limited in doing. They also trained the hospital's staff in the use o f those 
equipment and the performance of such operations.
4.2.5 WEAKNESSES 
Physical Resources
The hospital itself did not have any ultra-sound machine for use by its patients who utilize its 
Obstetrics and Gynaecology Department . The doctors who used the one for the SMS did 
only a few cases and not even every day. Thus most patients went outside the hospital for the 
service. This impacts on the comprehensiveness o f the health care which is a characteristic of 
quality (Woodward, 2000).
Most of the hospital beds were very old and in bad conditions. They have been in the 
hospital since its establishment in 1954.
Many facilities were found to be small in size or capacity. The wards were small as they 
were overutilised. Floor cases on some of the wards was not abnormal any more.
• The laboratories complained of their sizes being small and they had not been a s
sterile as they should be.
• The supplies and stores management unit is small and not in good condition which 
impacted on the storage of materials and equipment. Its handling and sewing
equipment were also old and in a poor state. The manufacturing unit of the
pharmacy department had very old equipment most o f which were unserviceable.
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Human Resource
• The sense of commitment and loyalty of employees and staff of the University was 
not strong. The majority o f responses were between devoted and fairly devoted.
• There was the lack o f management’s direct control over key staff who were 
employees o f the KNUST. Since the hospital management did not have the power 
to sanction the university staff it is health care quality that will suffer in the end.
Financial Resources
• The hospital had never had a financial policy and had since the year 2000 not had a 
financial plan.
Intangible Resources
• There was no proper/good customer relationship. In other words, there was still a 
focus on transaction marketing instead of relationship marketing. No deliberate 
efforts to retain customers were made.
• The hospital did not have a very good image before the public
4.2.5 COMPETENCES PROFILE OF KATH
Competences refer to a firm’s capacity for undertaking a particular productive activity. The 
difference in performance o f different organizations in the same industry is rarely fully 
sxplained by differences in their resource base per say but also on how resources are 
deployed to create competences in the activities of the firm.
The profiling o f the competences was to give an understanding o f the necessary competences
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Critical activities
Critical activities are those activities that have the greatest leverage on position and 
performance. They determine the survival and prosperity o f a firm in an industry. In other 
words they are the activities in which public hospitals have to excel to achieve superior 
performance
that KATH had to develop to truly achieve sustainable advantage.
Table 4.19 CRITICAL ACTIVITIES
ACTIVITIES FREQUENCY PERCENTAGE
All activities 18 72.0
All but marketing 2 8.0
All but service 2 8.0
All but marketing and service 1 4.0
All but technological development 1 4.0
All but service, firm infrastructure and procurement 1 4.0
Total 25 100
From Table 4.16 while 72 % of respondent saw all activity as central to health service 
delivery, 8 % viewed all activity as critical except marketing and 4.0 % viewed all except 
service, firm infrastructure and procurement.
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Competences
The detail weighting of the activities can be found in Appendix VII
TABLE 4. 20  INBOUND LOGISTICS
ACTIVITIES Rating o f  Activities
HW MW E MS HS
Receipt and Inspection X
Stock Control System X
Storage of Inputs/Supplies X
Timeless of Supplies X
Distribution of Supplies to user departments X
AVERAGE X
KATH’s strengths in receipt and inspection o f  goods and storage o f inputs/supplies were 
equally matched by competitors. On the other hand, KATH could be said to be performing 
ordinarily in these activities. Its performance was poor in stock control systems, timeliness 
of supplies and distribution of suppliers to user units/departments or KATH was not 
performing well in these areas.
TABLE 4. 21 OPERATIONS/SERVICE DELIVERY
ACTIVITIES Rating of Activities
HW MW E MS HS
Effectiveness o f care X
Staff Responsiveness to Customers/Users X
Process of Service Delivery X
Maintenance of Facilities X
Timeliness of Service Delivery X
Availability of Supplies/Drugs X
AVERAGE X
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The competitive position o f KATH against its competitors was quite similar. The only 
source o f advantage was in the effectiveness of health care. This respondents’ believed was 
made possible through the expertise of its staff and the provision of 24-hour service. KATH 
performance in timeliness o f service delivery was poor. On the other hand, it could be said 
that KATH did a little better in quality of service; ordinarily in staff responsiveness to 
customers/users, process o f service delivery, maintenance o f facilities and availability of 
supplies/drugs; and not well in timeliness o f service delivery. Staff attitude (staff 
responsiveness to customers), waiting time (timeliness of service delivery), process of 
service delivery and drug availability were all found unsatisfactory in the hospital’s customer 
satisfactory survey. About the distinctiveness of the strength in effectiveness of care, 
respondents differed in their opinions. 73% saw it as distinctive and 27% did not see it as 
such.
TABLE 4.22 MARKETING
ACTIVITIES Rating of Activities
HW MW E MS HS
Pricing Strategy X
Promotion Strategy X
Market Research X
Physical Environment X
AVERAGE X
KATH’s position in marketing was poor. Market research was very poor and the physical 
environment was nothing to be happy with. Patients also found the physical environment not 
very satisfactory (Refer to Patient satisfaction survey).
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TABLE 4.23 SERVICE
ACTIVITIES Rating of Activities
HW MW E MS HS
Client Education/Counseling X
AVERAGE X
From Table 4.23, KATH’s performance in Education/counseling was ordinary. Relatively it 
was on a par with its competitors.
TABLE 4.24 FIRM INFRASTRUCTURE
ACTIVITIES Rating o f  Activities
HW MW E MS HS
Top Management Support X
Planning Systems X
Control Systems X
Organizational Structure X
Corporate Culture X
Leadership Capabilities X
Communication and Information Systems X
Accounting Systems X
Financial Management/Control X
Leadership Styles X
Control of Board of Directors X
AVERAGE X
KATH had a slight ease due to the better leadership capabilities. On the contrary, in the 
performance of the other activities its strengths were matched by its competitors. While 
55.6% of respondents saw their leadership capabilities as difficult to surpass, 44% did not 
share such a view. The researcher’s investigations, however revealed that A.G.C. and 
KNUST hospitals matched these leadership capabilities as their managements also had
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educational and professional qualifications.
TABLE 4.25 HUMAN RESOURCE MANAGEMENT
ACTIVITIES Rating of Activities
HW MW E MS HS
Selection and Recruitment X
Health and Safety Measures X
Training and Development X
Employee Empowerment X
Reward Systems X
Promotion Systems X
Appraisal Systems X
Labour/Management Relationship X
Manpower Planning X
AVERAGE X
KATH did not enjoy any advantage as far as human resource management was concerned. It 
was exactly even with the other hospitals in the areas o f training and development employee 
empowerment, promotion systems, labour/management relationships and manpower 
planning. Conversely, it did worse in selection and recruitment, health and safety measures, 
reward and appraisal systems. Respondents commented that the selection and recruitment of 
permanent staff, reward systems, promotions and manpower planning (implementation) were 
all controlled by the MOH. The hospital however, recruited casual staff and they were of the 
view this was not properly done as many of the casuals did not have any skills and/or were 
semi-literates.
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TABLE 4.26 TECHNOLOGICAL DEVELOPMENT
ACTIVITIES Rating o f  Activities
HW MW E MS HS
Level of Automation X
Research and Development X
Technology System X
Research and Development Funding X
Research and Development Facilities X
Human Resources for Research and 
Development
X
AVERAGE X
The position of KATH in the level of automation and technology system was quite similar to 
that o f the others. KATH, unlike the others, has research as part o f its mission. With this in 
mind, it could be said that KATH was not performing well in this area. From the hospital’s 
annual financial reports, no budgetary allocation for Research and Development or 
expenditure on it was found.
TABLE 4.27 PROCUREMENT
ACTIVITIES Rating o f  Activities
HW MW E MS HS
Selection and Evaluation o f Suppliers X
Quality Management of Purchased 
Goods/Services
X
Methods of Procurement X
Timeliness of Procurement X
Procurement Lead Time X
AVERAGE X
Either the competing hospitals had maintained a slight advantage over KATH as a result of
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better methods of procurement, timeliness of procurement and procurement lead-time or 
KATH was performing slightly badly in these areas. However, there was similar 
performance in the areas o f the selection and evaluation of suppliers and quality management 
of purchased goods/services.
TABLE 4.28 OVERALL ASSESSMENT OF COMPETENCES
CRITICAL ACTIVITIES RATING
INBOUND LOGISTICS -
OPERATIONS E
MARKETING -
SERVICE E
FIRM INFRASTRUCTURE E
HUMAN RESOURCE MANAGEMENT E
TECHNOLOGICAL DEVELOPMENT E
PROCUREMENT -
Key:
-: KATH was weaker than competitors/KATH’s performance was poor.
E: KATH was even with the competitors/KATH’s performance was ordinary.
Table 4.26 presents the overall (competitive) assessment o f KATH which identifies its 
strengths and weaknesses in each of the critical activities (critical success factors) categories. 
KATH was even w ith the  competitors/KATH’s performance w as ordinary in  the areas o f  
operation/service delivery, service, firm infrastructure, human resource management and 
technological development. On the other hand, in the area o f inbound logistics, marketing 
and procurement its position was slightly weaker than its competitors/KATH’s performance 
was poor.
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4.2.6 LINKAGES WITHIN THE HOSPITAL
The study considered the departmental relationships within the hospital and how 
management was coordinating them.
TABLE 4.29 INTERNAL LINKAGES
LINKAGES PERCENTAGE
Presence o f Linkages 100
Co-operation Among Departments 88
Teamwork in the Hospital 80
Co-ordination of Activities 32
From Table 4.29, all the respondents indicated that there were interrelationships 
(interdependence) within the hospital. In other words, they perceived that the performance of 
the activities of their departments impacted on some departments and so did theirs.
The linkages took the following forms:
Clinical Clinical
Clinical Diagnostic
Clinical Administrative and Support
Clinical Pharmaceutical
Clinical Physiotherapy
Diagnostic Diagnostic
Diagnostic Pharmaceutical
Diagnostic Administrative and Support
Physiotherapy Administrative and Support
Pharmaceutical Administrative and Support
Administrative and Support- Administrative and Support
There were linkages between those involved in direct service delivery for example Clinical -
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Clinical; Clinical -  Diagnostic; Clinical -Pharmaceutical; Diagnostic -  Diagnostic.
The Clinical departments depended on the diagnostic investigations to determine the 
treatment that should be given to a patient. If investigations are poorly done, it can affect the 
effectiveness of the care given.
88% believed that there was co-operation between their departments and the others which 
were affected by their activities. 80% believed that there was teamwork in the performance 
of the activities of the hospital as a whole. However, only 32% observed that there was co­
ordination of the activities o f the entire hospital. For those who did not observe any  co­
ordination of the activities (68%), they said that there was no forum/meeting o f all heads of 
departments where the hospital’s performance was discussed.
4.3 DISCUSSION
4.3.1. PAST PERFORMANCE OF KATH 
• The hospital’s direction
Considering the calibre o f respondents, reasons for the lack o f knowledge o f the objectives 
could be attributed to the lack of communication either from management to heads of 
departments and employees; or from heads of departments to departmental members; or the 
lack o f  involvement o f organizational members in  setting objectives fo r the  hospital. The 
lack of interest or effort on the part o f organizational members to find out what the direction 
of the organization could also be a factor. This was evident during the data collection. Most 
respondents’ commented that the questions about the direction of the hospital should have 
been directed to the administrators s ince they were the people who should determine the 
hospital’s direction.
The researcher’s attempts at finding out from the files evidence o f the communication of the 
objectives did not yield any results. Circulars, minutes of committee meetings and staff
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durbars did not have any such indications.
• Hospital Utilization by Patients
The high utilization could be attributed to the fact that KATH is a referral centre. Data on 
referrals could, however, not be obtained as the Medical Records and Statistics Department 
did not have such records. Also, users have access to some o f its general and specialist 
clinics like the Polyclinic, Accident and Emergency, Eye, Ear, Nose and Throat (ENT), 
Dental and Ante-natal Clinics, without being referred from any health facility (see Appendix 
X for Top Ten diseases of Out-patients and Top Ten Causes o f Admissions which shows 
diseases like malaria which could be treated at health centers and district hospitals).
• Patient satisfaction
According to Day and Wensley (1988) the insights performance indicators like customer 
satisfaction and customer loyalty provide cannot be inferred from historical evidence of 
market share, utilization or profitability. An increase in the latter indicators may be taken to 
mean that the organization is doing well while on the other hand customers may be 
dissatisfied or not fully satisfied with the offerings.
One reason for the long waiting time was found to be the lack o f adequate human resources 
especially doctors and nurses. This had led to heavy workload on staff which might have 
accounted for the not encouraging staff attitude. In  the course o f the data collection, the 
researcher happened to be at an emergency ward with eight beds (which were fully occupied 
at that time) but with only one nurse on duty attending to the patients some o f whom had to 
be prepared for the theatre. In such a situation, it would be difficult for this nurse working 
under pressure to be as nice as patients might expect. The nurse/patient ratio was at time of 
the study 1:7 instead o f 1:3 which was the norm.
An observation made by the researcher was the presence o f visitors at ward entrance wanting 
to see their patients outside the hospital’s visiting hours (4 pm -5 pm). Many of them gave
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their reasons as sending drugs to their patients. Such a situation stemming from the drug 
situation at the in-patient pharmacies is a cause for worry.
The issue o f  poor cleanliness augurs ill for a hospital which aims at improving the health of 
its clients as the situation exposes clients to infections. The issue o f congestion on some of 
the wards, especially those departments with lowest in cleanliness (i.e.Surgery and 
Paediatrics), was found to be a contributing factor. On such wards cleanliness will definitely 
be a p roblem a s t here would b e o ver utilization o f  w ard f  acilities. T hese were the s ame 
places with high responses o f odour on the wards.
The most worrying aspect was the fact that in two departments none o f the respondents 
found the food very satisfactory. No wonder many relatives visiting outside the visiting 
hours came with food for their patients.
The patient satisfaction survey has gone to prove the assertion o f  Day and Wensley (1988) 
right. Though a lot o f patients utilized the hospital, they were not very satisfied with its 
offerings. This also goes to prove that the hospital’s objective o f improving the quality of 
health care was not completely achieved, as the users’ expectations were not fully met.
4.3.2 RESOURCES 
• Physical
With regards to its pharmaceutical service (manufacturing unit) KATH could greatly reduce 
the expenditure on drugs by manufacturing some o f its commonly used drugs as it already 
has the expertise instead o f the practice of buying all drugs from outside and putting mark 
ups on them. By so doing efficiency of care could be assured a\s the cost of drugs could go 
down.
In service marketing the physical resources which are part of the physical evidence play a 
major role in influencing patients' impression about the hospital as they are used as indicators
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of quality. All the physical resources of advantage were owned by KATH. According to 
Collins and Montgomery (1995), not all profits from a resource automatically flow to the 
company who has it. Such returns normally accrue to the owner of the resource. However, 
since the resources of advantage were owned by KATH it follows that the returns from them 
would accrue to it. Thus basing a strategy on such resources can make returns easy to 
capture.
The poor state o f its materials handling and storage equipment and facilities can affect the 
quantity o f materials that could be procured at any given time. Moreover, the storage of 
some supplies can also be done within a relatively short period which will necessitate 
purchases at short intervals which could add to the cost of service delivery.
• Human
The presence o f the vast expertise of staff gives patients the confidence in the ability o f staff 
to provide the service. The continuous use o f these skills lead to their improvement which 
can also lead to increased efficiency of individual workers or work groups (Bharadwaj et al., 
1993) which can in the end improve the quality of health service. Grant (1998) indicates that 
the adaptability of employees determine key aspects o f strategic flexibility to the firm. Thus 
the adaptability of the hospital's staff can help the hospital to be more responsive to changes 
in market (patient) requirements.
With the exception of the Bomso Specialists Clinic which had a few full-time medical 
specialists in the fields o f Obstetrics and Gynaecology, Paediatrics (Child Health), Surgery 
and Medicine, the other hospitals did not. They depended on part-time specialists -  most of 
whom were from the KATH -  whose services respondents found not very reliable.
According to Grant (1996) the commitment and loyalty o f employees determine the capacity 
of the firm to attain and maintain competitive advantage. The employee turnover rate was 
very high among the nurses. On the average, 10 nurses left the hospital and the service of the
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Ministry o f Health every month. With the doctors those who complete their residency 
programme and become "Specialist" resign from the Ministry o f  Health to join the Kwame 
Nkrumah University o f Science and Technology (KNUST) as lectures of the School of 
Medical Sciences. This implies that the capacity o f KATH to attain and maintain superiority 
in the health industry in the Ashanti Region is limited.
• Financial
Grant (1988) is o f the view that a firm's borrowing capacity and its internal funds generation 
determine its capacity for investment expenditure and its ability to weather fluctuations in 
demand and profits over time. It should be noted that Public Hospitals (in Ghana) are not 
permitted to borrow money. It is the government who provides funds for their running 
besides their Internally Generated Funds (IGF). The hospital’s capacity to generate funds 
internally was a major strength. The high utilization o f its services could be a major factor. 
Also, it had well-trained revenue collectors and an accountant in charge o f its internal 
revenue unit. The cooperation of organizational members in ensuring that bills o f patients 
were fully settled was another factor.
Though not a profit orientated hospital there is the need for financial policy and plans which 
contains financial goals, objectives and strategies which the hospital is or will be pursuing 
within a particular period of time. They will enable the hospital to measure or a ssess its 
financial performance and also guide its spending. The lack o f it might lead to a tendency of 
utilizing funds for unplanned programmes or even programmes outside the goals of the 
hospital.
• Intangibles
The lack of proper relationships can have a negative impact on the hospital’s performance. 
Relationship marketing firms can enhance their performance by cultivating new customers
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and/or retaining their existing customers and selling more to them. However, cultivating new 
customers is generally more expensive than retaining existing ones. Riechheld and S asser 
(1990)found5 % reduction in  customer defections to  b e associated with p rofit i ncreases 
ranging from 25 to 85 % in the industries they studied. This suggests that service firms 
(hospitals inclusive) doing business with their customers from a long term relationship 
perspective have a greater potential o f achieving cost advantage. From the study o f  Afari 
(2000), it was established that patient satisfaction is greatly enhanced by relationship 
marketing orientations.
KATH cannot be proud or satisfied with reputation which lied between “good and 
satisfactory” considering its relatively high physical, financial and human resource base. 
The public expects more in accordance with the saying that “to whom much is given, much 
shall be required”. The willingness of patients to return and also sell the hospital to other 
people depends on their impressions about the hospital. Thus the "not very good" 
impressions that the public had about the hospital implied that they did not get the full 
satisfaction that they require.
4.3.3 COMPETENCES
• Service delivery
Effectiveness o f care was attributed to its staff expertise. However, considering its advantage 
in resources KATH would have been expected to exploit them to excel in the performance of 
service delivery. Moreover, timeliness of service delivery is another characteristic o f quality 
care. Thus its weakness does not allow quality o f service to be complete.
• Firm infrastructure-
This is the activity that directs and coordinates all the other activities. The Chief 
Administrator of the hospital was a contract serving officer who had been in an acting
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position for eight (8) years and respondents saw him as inefficient. The Board o f Directors 
had also been there since 1990 (their term of office had expired) and the respondent thought 
that they were not performing as expected.
In addition corporate culture is another important element which could help to improve 
performance. Most literature on organization culture and performance of firms suggests that 
culture can have a significant positive economic value for firms (Barney 1986a; Ouchi, 1981; 
Deal and Kennedy, 1982). The strong culture hypothesis suggests that firms that have strong 
distinctive traits, values and shared belief patterns will outperform organizations that are 
weak on these dimensions (Dennison, 1984). Health services being primarily delivered by 
employees, the “people” component o f service delivery as perceived by customers plays an 
important role in service differentiation.
• Human Resources Management
According to Zeithaml and Bitner (1996) service employees are th e  service because they 
provide the service; the organization in the eyes o f customers as they represent the firm to 
the clients; and marketers as they can influence customer satisfaction. Therefore delivering 
service as promised or to meet customers’ expectations often totally, lies within the control 
of employees (especially those in the frontline). Unless employees are satisfied or happy in 
their job, patient satisfaction will be difficult to achieve.
• Procurement
The selection o f reliable suppliers will help in the supply o f quality products/services and 
also ensure the timeliness o f supplies delivery. In addition poor methods o f  procurement can 
affect the cost o f product/services especially if  it is not competitive. Again, poor 
procurement lead-time can impact on timeliness of supplies and availability o f supplies for 
service delivery.
• Linkages within the hospital (activities)
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According to Kolter (1994) the success of a firm depends not only on how well each 
department performs its work but also on how well the departmental activities are 
coordinated. Too often, company departments are to minimize their departments’ interest 
rather than the company or customer’s interest. This can lead to a slow down in the delivery 
of quality customer service. It therefore follows that the perceived lack o f  coordination could 
affect the quality o f health care and patient satisfaction.
The various service areas in the hospital perform all the value activities. It is the ability to 
link these activities which determines the success or failure o f the hospitals, goals or 
strategies and could be a source of real superior performance. The management of the 
internal linkage can help to achieve efficiency (delivering health care at lowest cost) or 
lowest delivered cost position and enhance quality health care and patient satisfaction. For 
instance by paying attention to its inbound logistics activities performed by its Supplies 
Management Department and partly by the Internal Audit (example Inspection o f inputs 
purchased), KATH can enhance the quality o f its service (Clinical and Diagnostic) as well as 
reduce cost of service delivery. On the other hand the hospital’s, procurement practices can 
also impact on its inbound logistics and final service. From the competences analyses (Table 
4.27) its procurement activities performed by Administration and Support Services were not 
strong. For instance procurement was not timely (Mild Weakness) which could impact on 
timeliness of supplies, which was a Mild Weakness (See Table 4.18) which could in turn 
affect the availability o f Supplies/Drugs for Service delivery which was Even (ordinary) (See 
Table 4.19). These could in the end affect acceptability o f the service to patients.
The nature o f many service jobs suggests that customers’ satisfaction will be enhanced when 
employees work as teams and hospitals are no exceptions. Employees who feel supported 
and that they have a team backing them up will be better able to maintain their enthusiasm 
and provide quality service. By promoting teamwork, hospitals can enhance employees’
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ability to deliver health service excellence while at the same time the intimacy and support 
enhance their indication to be excellent service providers.
From the study, the strengths/advantages of KATH were more in its resources than in its 
competences (activities). The performance o f activities central to the hospitals survival and 
prosperity was not encouraging. Moreover, not much is being done in managing the linkages 
within the organization to improve performance. This confirms the assertion that abundant 
resources alone will not keep an industry giant on top (Hamel and Prahalad, 1993) and also 
that good or poor performance is not fully explained by differences in resource base per se, 
but is determined by the way in which they are deployed to create competences in the 
activities of an organization and the management of the linkages among activities (Johnson 
and Scholes, 1999). It could therefore be said that KATH has not fully deployed these 
resources of advantage to create competences in its activities. This could be one o f the main 
reasons why its past performance was not very satisfactory. Relating the hospital’s 
performance during the past 3 years to the strategic capabilities/analysis it could be said that 
the necessary structures will have to be put in place to ensure improved performance.
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CHAPTER FIVE 
SUMMARY OF FINDINGS, RECOMMENDATIONS AND CONCLUSION  
5.1 INTRODUCTION
In this chapter the summary o f the findings, recommendation and conclusion o f the study are 
presented.
5.2 RESEARCH QUESTIONS
Hospitals provide certain services which require them to possess certain resources and 
competences.
a) What are these critical resources and competences?
b) Does KATH meet this requirement?
c) How could KATH exploit these for superior performance?
The research therefore sought to find answers to these questions
5.3 SUMMARY OF FINDINGS
A key objective of this study was to determine the strategic capabilities (unique resources 
and care competences) o f  KATH which could be exploited for excellent performance. 
Answers to this and others were expected to help determine the strengths o f KATH which 
could be exploited and the weaknesses which need to be developed to meet the challenges in 
the environment.
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5.3.1 PERFORMANCE FOR THE PAST 3 YEARS
It needs to be noted that one cannot move towards excellent performance without 
considering what the past performance was. The study therefore, among other objectives 
sought to find out KATH’s performance for the past 3 years.
Generally, the hospital’s objectives for the past 3 years as indicated by staff were:
b. to provide quality health care
c. to improve the quality of management with the introduction of Budget 
Management Concept (BMC).
However, the specific objectives for the period could not be obtained from any o f the data 
sources. There were no annual reports for that period. Though the lack o f adequate 
logistics/structures was seen as the reasons for the hospital not achieving its objectives, it 
could also be said that the lack of knowledge of staff about the objectives was also a 
contributing factor. This is as a result o f the lack o f involvement o f staff in the setting of 
objectives and the lack of articulation and communication of the objectives to staff. Their 
involvement and knowledge could increase their commitment to the objectives and help in 
achieving them.
The hospital’s major policy reform, the Budget Management Concept could not achieve its 
aim due to the lack of management’s commitment to the policy and the lack of 
empowerment of the manager of the sub-BMCs.
Furthermore, though the hospital enjoyed a high patronage o f its services in the region, most 
of its clients were not very satisfied with the way service was delivered. Some o f the areas of 
poor quality were staff attitudes, cleanliness and drug availability.
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5.3.2 CRITICAL RESOURCES AND COMPETENCES AND THEIR UNIQUENESS 
Knowing what activities and resources are critical to health care delivery will help hospitals 
to avoid spending money, time and other resources on things that do not count or benefit 
patients.
From the findings o f the study the resources critical to the survival and prosperity o f  public 
hospitals are physical, human, financial and intangible.
• Physical Resources 
The types and capacity would depend on the level of health care (i.e. primary, secondary or 
tertiary) particular hospital is established to provide and the number o f patients that a 
hospital facility attends to. Thus for a teaching hospital like KATH which provides tertiary 
care, it would be expected to have sophisticated equipment which could enable it to provide 
the needed services. Thus for KATH to lack its own ultrasonography facilities which would 
even be expected at a secondary health facility is a setback. It did not have a CT scanner and 
therefore, had to refer patients to Korle-Bu for health care. However, KATH had almost all 
the necessary medical equipment and facilities for its service delivery.
For hospitals which provide observation or in-patient care, beds and cots become very 
important physical resources. For KATH, besides ordinary hospital beds, it is expected to 
have for example, orthopaedic and other special beds for the management o f complex cases. 
The findings indicated that the hospital did not have enough orthopaedic beds though it 
handled lot o f orthopaedic cases. Its cardiac beds were however, found to be adequate. The 
conditions of the hospital beds were found to be poor. Most beds had not been changed or 
maintained since the establishment of the hospital in 1954.
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• Human Resources
Human resource is central to health care delivery as it is their skills and knowledge which 
helps to achieve hospitals mission and goals.
Like the physical resources, the calibre of health care providers needed at the various health 
care levels also varies. While at the primary level medical assistant or medical officers can 
deliver the service, at the tertiary level specialists are needed to deliver service and also 
supervise medical officers to deliver service. Human resources -  loyalty and commitment of 
employees is another crucial factor in the health care industry. This will reflect in the 
attitude o f staff to patients, from the patient satisfaction, many staff attitude was found to be 
poor through the responses from the competences profile placed it between poor and good. 
Linking this to the responses from the Human Resources Management activities, it could be 
said that the lack of employee satisfaction due to either poor or good Human Resources 
policies could be a contributing factor. Managerial styles should encourage the feelings of 
loyalty and commitment. They should be made to know that they are the most important 
assets that the hospital has and that the achievement o f the hospital’s vision, mission, goals 
and strategies depended greatly on the skills and knowledge.
KATH has the expertise critical to the delivery o f  its services. Though not adequate, the 
issue was not only new to KATH but a national one. The adaptability and innovativeness of 
the human resources are also crucial due to the continuing changes (developments) in the 
health care field. This would help in their professional development and assist them in 
improving the care that they provide.
• Financial Resources
Money plays an important role in providing health services as it enables the procurement of 
inputs to be made and other monetary incentives, besides salaries paid by central
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government, can also be provided, KATH has a strong financial position. However, the lack 
of a guide in the use o f  the funds can lead to the tendency o f management utilising the fund 
for planned items or even programmes which have not bearing with the goals and objectives 
of the hospital. It had been able to even use part o f its internally generated funds to carry out 
major rehabilitation works on its facilities and also to procure inputs to keep work going.
• Intangible Resources
It has been made clear that in public hospitals relationship marketing orientation enhances 
patient satisfaction (Afari 2000) KATH’s relationship marketing orientation or customer 
relations was poor. No planned efforts had been made to retain patients. Access to low cost 
but quality supplies is very important to health services delivery in public hospitals because 
their first objective is to ensure financial (and geographical) access to all who need their 
services. Thus access o f low cost supplies can help reduce the cost o f services to patients. 
KATH’s reputation before the public was one of satisfactory and good. This as has already 
been presented was as a result o f the public’s perception o f its staff as not being responsive, 
empathetic and courteous. A good reputation can stimulate positive ward o f mouth by 
current users.
Activities which public hospitals have to excel in to obtain superior performance were 
identified as follows:
• Inbound logistics
The way the inputs procured or brought into the hospital are handled in terms of receipts, 
storage and dissemination impacts on the quality of service delivered. KATH performs this 
activity but the competence with which it is done is weak. From the resource profiling it was 
clear that the equipment and the facilities at the supply and stores Management Department
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which played a major role in the performance of these activities were in poor state, and small 
in capacity. It did not even have computers to assist in its store keeping.
• Service Delivery/ Operations
This is where inputs are transformed into final services, which in health care delivery 
involves attending to patients that is the puipose for which hospitals are set up. The 
competence with which this activity was performed was generally not exceptional. 
However, i t d id w ell i n p roviding a n e ffective h ealth c are t o i ts c ustomers. R espondents 
attributed this to the calibre of experts that the hospital had. There is the need for something 
to be done about the timeliness o f service delivery. Patients waited for a long time before 
being attended to. This does not give KATH a good impression before its clients. 
Inadequate staffing was seen as reason for this long waiting time.
• Service
Patients have a part to play in ensuring the effectiveness o f health care. They can effectively 
play this role upon the instructions/education given to them by providers. KATH’s 
performance o f this activity was not encouraging probably due to heavy workload.
• Technological Development
This activity might not be crucial to hospitals offering primary and secondary care but for a 
teaching/tertiary hospital like KATH, which has research (medical) as part o f its mission, it 
becomes crucial. KATH’s general performance o f this critical activity showed that it had not 
placed much importance on it. For instance Research and Development facilities and 
findings were poor. Its expenditure over the period 1998-2000 did not indicate any spending 
on medical research.
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• Procurement
Hospitals depend on material and service inputs for service delivery. The quality o f inputs 
used can also affect the effectiveness of health care and the availability of inputs also 
facilitates work o f providers and enhances quality. On the whole, KATH’s performance of 
this important activity was poor. Not much importance had been placed on it though a 
greater part of funds is spent on it
• Firm infrastructure
It however, takes quality managerial/firm infrastructure to give direction to hospital and also 
coordinate all the other activities performed by the various departments/units towards 
achievement o f goals. From the study, except leadership capabilities in which KATH 
excelled all the other activities were ordinarily performed. Firms that have strong corporate 
culture excel in performance. This strong culture on the part o f KATH was not evident from 
the findings.
• Human Resource Management
In addition, health service like many other services requires interactions between 
patients/users and the employees (providers) and these interactions strongly influence the 
users perception of service quality. Management therefore faces a tremendous challenge in 
selecting, training and motivating employees to care about doing their jobs and provide good 
service to users. The study showed poor selection and recruitment systems, Health and 
Safety Measures and Reward and Appraisal Systems.
• Marketing
Finally, rising expectations and changing needs of the public makes marketing another 
important activity that should not be overlooked. It takes responsive organisations to meet 
such markets. KATH’s marketing orientation was found to be poor.
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From the findings o f the study, KATH had more advantages in resources than in the 
competences with which its value activities were performed. However, it takes advantages 
in both and the deployment o f the resources in the performance o f the activities as well as the 
management o f the linkages within the hospital to achieve superior performance.
5.3 RECOMMEDATIONS
From the findings of the study the following recommendations are made:
1 EMPLOYEE INVOLVEMENT/COMMUNICATION
From the study it was clear from the organisational direction and financial resource profiling 
that not much had been done by KATH management to let employees know about what was 
going on in the hospital.
It is recommended that
(i) key employees should be involved in the goals and objectives setting o f the 
hospital.
(ii) Management should organize staff durbars regularly to explain its goals, policies, 
achievements and problems to employees.
(iii) Heads o f departments should also communicate developments in the hospital to 
their staff
(iv) Employees should also take interest in the management of the hospital
2 IMPROVING ON COMPETENCIES
Though KATH was highly endowed with resources, its competencies were generally weak. 
This could be improved through quality management. For instance, management needs to put
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in p lace good 1 ogistics management p ractices and e nsure. T his w ill h elp i n t he s upply o f 
quality p roducts, availability/timeliness o f  supplies. The appointment o f  a substantive and 
visionary Chief Administrator is also a necessity. In addition, management must become 
committed to Research and Development which is part o f its mission. Through this new and 
improved service which will add to quality service can be developed.
3 PRESSURE OF WORK ON HEALTH STAFF 
Seeing the burden o f work on KATH hospitals:
(i) the public should be encouraged to utilize the other lower levels o f health care
(ii) the teaching hospitals should also render specialist outreach services at the lower 
levels o f health care.
4 HUMAN RESOURCE MANAGEMENT
Human resource policies and practices are considered to be o f particular strategic importance 
in delivering high quality service. Public Hospitals must therefore address issues like job 
redesign, reward systems, employee empowerment and recognizing outstanding 
achievement. With the operationalistion of Act 525, the teaching hospitals and the Ghana 
Health Service will become autonomous and their Boards will have the power to do their 
own recruitments and selection. They should therefore take advantage o f that opportunity 
and put in place the right Human Resources Policies to make their employees feel good in 
their jobs.
In addition, to improve staff attitudes, norms, rules and procedures should be laid down to 
ensure consistent behaviour.
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5 CO-ORDINATION OF ACTIVITIES
There is the need for KATH management to organise yearly performance review 
meetings for heads o f departments and key organizational members to discuss the 
performance o f the departments and that of the hospital as a whole. At such meetings the 
performance o f departments should be linked. In other words in considering the 
good/poor performance o f a department, the other departments whose activities impact 
on it should not be left out. Management of KATH and other Public hospitals must be 
conscious of the linkages within the hospitals and take steps to coordinate them for 
superior performance
6 BUILDING GOOD PUBLIC IMAGE
As a major Referral Centre and the only Teaching hospital serving the northern sector of the 
country, a good public image would help build the public’s confidence in KATH. 
Management should do its best to build a very good public image for the hospital. In this 
direction area like staff attitudes, waiting time, cleanliness and availability of drugs/supplies 
should be given serious attention.
7 SUSTAINING PERFORMANCE
Investment in the resources of advantage is very important in checking against the erosion of 
the advantage through depreciation, imitation or substitution by competitors. KATH should 
make efforts at maintaining its resources of advantage and ensuring that they are always 
unique to help them achieve the needed superior performance. New resources and 
competences which are necessary should also be acquired to meet customers’ needs.
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8 FURTHER RESEARCH
i) There will be the need for further research in the area o f comparative internal analysis of 
teaching /tertiary hospitals. This is so because the critical success factors specific to teaching 
hospitals might be a little different from that o f lower levels o f health care.
ii) Benchmarking could also be done using best performing hospitals
5.4. CONCLUSION
A hospitals resources and competences constitute potential sources o f advantage only if  they 
are central to its survival and prosperity. In other words, they should be able to contribute to 
the production of what would benefit customers. As Day and Wensley (1988) point out, 
assessment o f opportunities for competitive advantage must revolve around the analysis of 
customer benefits. In the absence o f such analysis of customer benefits, a firm’s attempts to 
leverage its resources and competences into positional advantages are likely to prove 
ineffective.
Again, for these sources o f advantage to be a basis for an effective strategy, goal or 
objective, they must not be easy to obtain or copy or substituted by competitors and must be 
owned by the hospital. The superior performance from such resources can be long -term. 
With those owned by the hospitals, any returns accrued from them could be easily captured 
by the hospitals. Results from the study have proved that KATH possesses the critical 
resources that are needed for the health services delivery. However, its performance of 
crucial activities is poor in areas like marketing, inbound logistics, and procurement while 
areas like service delivery, patient education and counseling are not exceptionally done. This 
has gone to prove that hospitals need not only resources but should be able to utilize these
115
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resources to perform critical activities to meet customer expectation.
Findings from the study leads one to conclude that when management’s vision or 
organizational goal or objectives are not well communicated to employees, they might not be 
committed to them which can make achievement difficult. Public hospitals must see their 
employees as the greatest assets which transform their vision to realities. Moreover, the 
management o f these important assets is very important in that it is when they are happy in 
their jobs that they can also ensure patient/client satisfaction.
Finally, it could be said that Public hospitals should be able to identify their strengths and 
weaknesses, develop the weaknesses into strengths and exploit them to achieve quality 
health care. They should also pay attention to the linkages within them and do their best to 
coordinate them so that total quality o f care and customer satisfaction could be achieved.
116
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REFERENCES
Addy, E. (2000), Marketing Management Lecture notes (School of Administration)
Andrew, K.R. (1971), The Concept of Coiporate Strategy. Richard Irvin Inc.
Andrew, K.R. (1980), The Concept of Corporate Strategy, Revised Edition. Richard 
D Irvin Inc.
Annual Financial Report and Accounts 1997, 1998 - KATH 
Arrington, B et al., (1995) Improving Governance, Hospital and Health Services 
Administration, Special CQI Issue 40, No. 1/Spring pp 5-109 
Afari, A. A. (2000), A study o f  Relationship Marketing of Public and Private Hospitals 
in Ghana 
Ansoff, I. 1965
Bharadwaj, S.G, Varadarajan, P.R and Fahy, J. (1993), “Sustainable Competitive
Advantage in service Industries: A conceptual Model and Research Propositions. 
Journal o f Marketing Vol. 57 (October) pp 83-99.
Barney, J. (1986a), Organization Culture: Can it be a source o f sustained competitive 
advantage? Academy of Management Review (July) 656-65.
Barney, J. (1986b). Strategic Factor markets: Expectations, Luck and Business 
Strateg,. Management Science 32 (October) 1231-41 
Barney, J. (1991). Types o f Competition and the Therapy o f Strategy toward an Integrative 
Framework, Academy o f Management Review Vol. 11 (April) pp 791-800.
Baden, F.C and Stopford, J.M. (1992), Rejuvenating the Mature Business: The 
Competitive Challenge, London: Routledge.
Collis, D.J and Cynthia, M.A (1995), Competing on Resources: Strategy in the 1990s 
“Harvard Business Review (July-August) pp 118-28 Vol. 73 No. 4
117
University of Ghana          http://ugspace.ug.edu.gh
Cook, V.J. Jr. (1985), The Net Present Value of Market Share. Journal o f  Marketing,
49 (Summer) 49-63.
Coyne, K.P. (1985,. Sustainable Competitive Advantage: What it is, What it isn’t.
Business Horizons: 29 (January-February), 59-61.
Customer Satisfaction Survey Report (2000) - Komfo Anokye Teaching Hospital, 
Unpublished
Deal, T and Kennedy, A. E (1982, Corporate Culture, Reading, M.A Addison 
Wesley
Dierickx, I and Cook, K (1989), Asset Stock Accumulation and Sustainability of 
Competitive Advantage, Management Science, 35 (November) pp 1504-11
Day, G.S and Wensley, R. (1985), Assessing Advantage: A framework for
Diagnosing Competitive Superiority, Journal of Marketing Vol.52 (April) pp 1-20.
Dennison, D.R. (1984), Bringing Corporate Culture to the Bottomline, Organizational 
Dynamics, 13 (Autumn), 4-22.
Donabedian, A. (1966), Evaluating the Quality o f medical care. Milbank Quarterly, 
44:166-203
Donabedian, A. (1980), Explorations in Quality Assessment and Monitoring. Vol. 1:
The Definition o f Quality and Approaches to its Assessment, Ann Arbor, MI: health 
Administration Press.
Financial Statements (1999) - KATH
Financial Statements (2000) - KATH
Grant, R.G. (1998). Contemporary Strategy Analysis: Concepts, Techniques,
Applications, 3rd edition, Blackwell Publishers Inc.
Glueck, W.F. (1976). Business Policy: Strategy Formation and Management Action 
2nd edition McGraw- Hill Book Company
118
University of Ghana          http://ugspace.ug.edu.gh
Hax, A.C and Majuf, N.S. (1996), The Strategy Concept and Process, Prentice Hall,
London
Hunt, S.D and Morgan, R.M (1975), The Comparative Advantage Theory of 
Competitions, Journal o f Marketing (April) Vol.59 No.2 pp 1-15
Hunt, S.D and Morgan, R.M (1995), The Resource-Advantage Theory of
Competition: Dynamics, Path Dependencies, and Evolutionary Dimensions. Journal 
of Marketing Vol. 60 (October) pp 107-114.
Hamel, G and Prahalad, C.K. (1994), Competing for the Future, Harvard Business 
Review (July-August) pp 122-128
Johnson, G and Scholes, K (1999), Exploring Corporate Strategy, 5th edition, Prentice 
Hall, Europe.
Kay, J. (1993), Foundations of Corporate Success, Oxford. Oxford University Press.
Kotler, P (1994), Marketing Management: Analysis, Planning and Control, 7th edition 
Englewood Cliffs: N.J. Prentice -Hall, Inc.
Kotler, P and Clarke, R.N. (1996), Marketing for Health Care Organizations.
Kropf, R and Szafran, A.J. (1988), Developing a Competitive Advantage in the
Market for Radiology Services, Hospital and Health Services Administration Vol. 33 
No. 2 (summer) pp 213-220.
Lanning, J. A. and O ’Connor S. J. (1990), The Health Care quality Quagmire:
Some Signposts, Hospitals and Health Services Administration Vol. 35 No. 1 
(Spring) pp 39 -  54.
Leebov, W (1988). Service Excellence, The Customer Relations Strategy for Health 
Care, American Hospital Publishing Inc.
Loomis, C.I (1984), The Recovery Skips Middle Managers, Fortune, February ppl 12.
Mahoney, J.T. and Panadian, R. (1992), The Resource-Based View the Conversion of
119
University of Ghana          http://ugspace.ug.edu.gh
Strategic Management. Strategic Management Journal, 13 (June) pp 363-80.
Ministry o f Health Programme o f Work (2000). Draft for Discussion 
Montoya-Aguilar, C. (1987), Appropriate Provision and Management o f Services, In:
Measurement in Health Promotion and Protection, Copenhagen, World Health 
Organization, (WHO European Series No. 22).
Montoya-Aguilar,C. (1994), Measuring performance o f Hospitals and Health Centres. 
WHO/SHS/DHS/94.2
Nelson, R and Winters. (1982), An Evolutionary Theory o f Economic change. Cambridge, 
MA: Harvard University press 
Newman, W et al., (1985), Strategy, policy and Central Management, 9th edition.
South Western Publishing Co.
Newman, R (1984), Service Management: Strategy and Leadership in Service 
Business. Chicester, England, John Wiley.
Quchi, W.G. (1981), Theory 2. Reading . MA Addison Wesley.
Polanyi, M, (1962), personal knowledge: Towards a Post Critical Philosophy, London: 
Ronteledge
Porter, M (1980), Competitive Strategy, New York: free press 
Porter, M (1985), Competitive Advantage: Creating and Sustaining Superior 
Performance, New York: Free Press 
Porter, M (1996), What is Strategy, Harvard Business Review (November-December) 
Prahalad, C.K. and Hamel, G. (1990), The Core Competence o f the Corporation,
Harvard Business Review 68 (May-June) pp 79-87.
Peter Laf, M.A (1993), The Cornerstones of competitive Advantage: Resource -  
Based View, Strategic Management Manual Journal 14 (1993): 179-192.
Robson, C.R. (1993), Real World Research: A Resource for Social Scientists and
120
University of Ghana          http://ugspace.ug.edu.gh
Practioner-Researchers, Blackwell Publishers.
Rust, R.T et al., (1996), Service Marketing, Harper Collins College Publishers.
Reichheld, F.F and Sasser, W.E. (1990), Zero Defections: Quality Comes to Service 
Harvard Business Review, 68 (September-October) 301-7 
Stalk, G et al., (1992), Competing on Capabilities: The New Rule of Corporate 
Strategy, Harvard Business Review Vol. 70 No.2 pp 57-69.
Stacey, R.D. (1993), Strategic Management and Organizational Dynamics, London:
Pitman
Selznick, P (1957), Leadership in Administration, New York: Harper and Row 
Publishers. Inc.
Thompson, A. A. Jnr and Strickland, A.J. (1990), The Concepts and Techniques of 
Strategic Management, 5th edition, Richard D. Irwin Inc.
Upah, G. D. (1980), Mass Marketing in Service Retailing: A Review and Synthesis of 
Major Methods, Journal o f Retail, 56 (Fall) pp 59-76.
Williamson, O. E. (1971), The Vertical Integration of Production: Market Failure 
Considerations, American Economic Review 61 (May) pp 112-23.
Williamson, O. E. (1975), Markets and Hierarchies: analysis and Anti-trust 
Implications, New York: The free Press 
Winter, S.G. (1987,. Knowledge and Competence as Strategic Assets in the
Competitive Challenge, David J. Teece, New York: Harper and Row, pp 159-84 
Walton, J. (1999), Strategic Human Resource Development. Prentice Hall 
Woodward, C.A. (2000), Improving Provider Skills- Strategies for assisting health
workers to modify and improve skills: Developing quality health- a process of 
changes, WHO/EIP/050/00.1 
Weick, K. (1979), The social Psychology of Organizing Research, M.A Addison-
121
University of Ghana          http://ugspace.ug.edu.gh
Wesley pp 188-193.
Webb, E and Weick, K. (1979), Unobstrusive Measures in Organization Theory: A 
Reminder, Administrative Science Quarterly, 24, pp 650-59 
Zeithaml, V and Britner, M. J. (1966), Services Marketing, McGraw-Hill Companies Inc.
122
University of Ghana          http://ugspace.ug.edu.gh
REFERENCES
Addy, E. (2000), Marketing Management Lecture notes (School of Administration)
Andrew, K.R. (1971), The Concept of Corporate Strategy. Richard Irvin Inc.
Andrew, K.R. (1980), The Concept of Corporate Strategy, Revised Edition. Richard 
D Irvin Inc.
Annual Financial Report and Accounts 1997, 1998 - KATH 
Arrington, B et al., (1995) Improving Governance, Hospital and Health Services 
Administration, Special CQI Issue 40, No. 1/Spring pp 5-109 
Afari, A. A. (2000), A study o f Relationship Marketing o f Public and Private Hospitals 
in Ghana 
Ansoff, I. 1965
Bharadwaj, S.G, Varadarajan, P.R and Fahy, J. (1993), “Sustainable Competitive
Advantage in service Industries: A conceptual Model and Research Propositions. 
Journal of Marketing Vol. 57 (October) pp 83-99.
Barney, J. (1986a), Organization Culture: Can it be a source o f sustained competitive 
advantage? Academy of Management Review (July) 656-65.
Barney, J. (1986b). Strategic Factor markets: Expectations, Luck and Business 
Strateg,. Management Science 32 (October) 1231-41 
Barney, J. (1991). Types o f Competition and the Therapy of Strategy toward an Integrative 
Framework, Academy o f Management Review Vol. 11 (April) pp 791-800.
Baden, F.C and Stopford, J.M. (1992), Rejuvenating the Mature Business: The 
Competitive Challenge, London: Routledge.
Collis, D.J and Cynthia, M.A (1995), Competing on Resources: Strategy in the 1990s 
“Harvard Business Review (July-August) pp 118-28 Vol. 73 No. 4
117
University of Ghana          http://ugspace.ug.edu.gh
Cook, V.J. Jr. (1985), The Net Present Value of Market Share. Journal o f Marketing,
49 (Summer) 49-63.
Coyne, K.P. (1985,. Sustainable Competitive Advantage: What it is, What it isn’t.
Business Horizons: 29 (January-February), 59-61.
Customer Satisfaction Survey Report (2000) - Komfo Anokye Teaching Hospital, 
Unpublished
Deal, T and Kennedy, A. E (1982, Corporate Culture, Reading, M.A Addison 
Wesley
Dierickx, I and Cook, K (1989), Asset Stock Accumulation and Sustainability of 
Competitive Advantage, Management Science, 35 (November) pp 1504-11
Day, G.S and Wensley, R. (1985), Assessing Advantage: A framework for
Diagnosing Competitive Superiority, Journal of Marketing Vol.52 (April) pp 1-20.
Dennison, D.R. (1984), Bringing Corporate Culture to the Bottomline, Organizational 
Dynamics, 13 (Autumn), 4-22.
Donabedian, A. (1966), Evaluating the Quality o f medical care. Milbank Quarterly, 
44:166-203
Donabedian, A. (1980), Explorations in Quality Assessment and Monitoring. Vol. 1:
The Definition o f Quality and Approaches to its Assessment, Ann Arbor, MI: health 
Administration Press.
Financial Statements (1999) - KATH
Financial Statements (2000) - KATH
Grant, R.G. (1998). Contemporary Strategy Analysis: Concepts, Techniques,
Applications, 3rd edition, Blackwell Publishers Inc.
Glueck, W.F. (1976). Business Policy: Strategy Formation and Management Action 
2nd edition McGraw- Hill Book Company
118
University of Ghana          http://ugspace.ug.edu.gh
Hax, A.C and Majuf, N.S. (1996), The Strategy Concept and Process, Prentice Hall,
London
Hunt, S.D and Morgan, R.M (1975), The Comparative Advantage Theory of 
Competitions, Journal o f Marketing (April) Vol.59 No.2 pp 1-15
Hunt, S.D and Morgan, R.M (1995), The Resource-Advantage Theory o f
Competition: Dynamics, Path Dependencies, and Evolutionary Dimensions. Journal 
o f Marketing Vol.60 (October) pp 107-114.
Hamel, G and Prahalad, C.K. (1994), Competing for the Future, Harvard Business 
Review (July-August) pp 122-128
Johnson, G and Scholes, K (1999), Exploring Corporate Strategy, 5th edition, Prentice 
Hall, Europe.
Kay, J. (1993), Foundations of Corporate Success, Oxford. Oxford University Press.
Kotler, P (1994), Marketing Management: Analysis, Planning and Control, 7th edition 
Englewood Cliffs: N.J. Prentice -Hall, Inc.
Kotler, P and Clarke, R.N. (1996), Marketing for Health Care Organizations.
Kropf, R and Szafran, A.J. (1988), Developing a Competitive Advantage in the
Market for Radiology Services, Hospital and Health Services Administration Vol. 33 
No. 2 (summer) pp 213-220.
Lanning, J. A. and O ’Connor S. J. (1990), The Health Care quality Quagmire:
Some Signposts, Hospitals and Health Services Administration Vol. 35 No. 1 
(Spring) pp 39 -  54.
Leebov, W (1988). Service Excellence, The Customer Relations Strategy for Health 
Care, American Hospital Publishing Inc.
Loomis, C.I (1984), The Recovery Skips Middle Managers, Fortune, February ppl 12.
Mahoney, J.T. and Panadian, R. (1992), The Resource-Based View the Conversion of
119
University of Ghana          http://ugspace.ug.edu.gh
Strategic Management. Strategic Management Journal, 13 (June) pp 363-80.
Ministry o f Health Programme of Work (2000). Draft for Discussion 
Montoya-Aguilar, C. (1987), Appropriate Provision and Management o f Services, In:
Measurement in Health Promotion and Protection, Copenhagen, World Health 
Organization, (WHO European Series No. 22).
Montoya-Aguilar,C. (1994), Measuring performance of Hospitals and Health Centres. 
WHO/SHS/DHS/94.2
Nelson, R and Winters. (1982), An Evolutionary Theory of Economic change. Cambridge, 
MA: Harvard University press 
Newman, W et al., (1985), Strategy, policy and Central Management, 9th edition.
South Western Publishing Co.
Newman, R (1984), Service Management: Strategy and Leadership in Service 
Business. Chicester, England, John Wiley.
Quchi, W.G. (1981), Theory 2. Reading . MA Addison Wesley.
Polanyi, M, (1962), personal knowledge: Towards a Post Critical Philosophy, London: 
Ronteledge
Porter, M (1980), Competitive Strategy, New York: free press 
Porter, M (1985), Competitive Advantage: Creating and Sustaining Superior 
Performance, New York: Free Press 
Porter, M (1996), What is Strategy, Harvard Business Review (November-December) 
Prahalad, C.K. and Hamel, G. (1990), The Core Competence o f the Corporation,
Harvard Business Review 68 (May-June) pp 79-87.
Peter Laf, M.A (1993), The Cornerstones of competitive Advantage: Resource -  
Based View, Strategic Management Manual Journal 14 (1993): 179-192.
Robson, C.R. (1993), Real World Research: A Resource for Social Scientists and
120
University of Ghana          http://ugspace.ug.edu.gh
Practioner-Researchers, Blackwell Publishers.
Rust, R.T et al., (1996), Service Marketing, Harper Collins College Publishers.
Reichheld, F.F and Sasser, W.E. (1990), Zero Defections: Quality Comes to Service 
Harvard Business Review, 68 (September-October) 301-7 
Stalk, G et al., (1992), Competing on Capabilities: The New Rule o f Corporate 
Strategy, Harvard Business Review Vol. 70 No.2 pp 57-69.
Stacey, R.D. (1993), Strategic Management and Organizational Dynamics, London:
Pitman
Selznick, P (1957), Leadership in Administration, New York: Harper and Row 
Publishers. Inc.
Thompson, A. A. Jnr and Strickland, A.J. (1990), The Concepts and Techniques of 
Strategic Management, 5th edition, Richard D. Irwin Inc.
Upah, G. D. (1980), Mass Marketing in Service Retailing: A Review and Synthesis of 
Major Methods, Journal o f Retail, 56 (Fall) pp 59-76.
Williamson, O. E. (1971), The Vertical Integration of Production: Market Failure 
Considerations, American Economic Review 61 (May) pp 112-23.
Williamson, O. E. (1975), Markets and Hierarchies: analysis and Anti-trust 
Implications, New York: The free Press 
Winter, S.G. (1987,. Knowledge and Competence as Strategic Assets in the
Competitive Challenge, David J. Teece, New York: Harper and Row, pp 159-84 
Walton, J. (1999), Strategic Human Resource Development. Prentice Hall 
Woodward, C.A. (2000), Improving Provider Skills- Strategies for assisting health
workers to modify and improve skills: Developing quality health- a process of 
changes, WHO/EIP/050/00.1 
Weick, K. (1979), The social Psychology of Organizing Research, M.A Addison-
121
University of Ghana          http://ugspace.ug.edu.gh
Wesley pp 188-193.
Webb, E and Weick, K. (1979), Unobstrusive Measures in Organization Theory: A 
Reminder, Administrative Science Quarterly, 24, pp 650-59 
Zeithaml, V and Britner, M. J. (1966), Services Marketing, McGraw-Hill Companies Inc.
122
University of Ghana          http://ugspace.ug.edu.gh
APPENDIX I QUESTIONNAIRE
I am a student o f the University of Ghana doing my research on Creating and Sustaining 
Improved Performance in Public Hospitals, the case o f KATH. The questionnaire will help 
me to understand the strengths and weaknesses of KATH and identify improvement 
opportunities. The purpose of the study is purely academic. However, your candid response 
is very important.
GENERAL INFORMATION 
a) Department/Unit
b) Position.......................................................................................................................
c) G r a d e .......................................................................................................................................
DIRECTION
1. What has been KATH’s major objective for the past three year?
2. Have they been achieved ? Yes / No 
Reasons:.............................................
3. What are the present objectives of KATH?
4.Have they been  well articulated and communicated to
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a) Employees Yes [ ] No [ ]
b)Customers Yes [ ] No [ ]
c) Shareholders Yes [ ] No [ ]
5. What critical events have given rise to the present objectives, e.g. competition, 
globalization, inflation, technology, governmental regulations, changes in customer 
tastes and preferences.
6. What are the objectives of your department?
7. Does KATH have a corporate plan? Yes [ ] No f ]
b) If Yes, when was it introduced ?
d) If No, have you thought of preparing one and when do you hope to introduce
i t? .............................................................................................................................
RESOURCES
From the following questions I would like to know the resources available to KATH 
both form within and outside.
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ITEMS QUANITITY AGE (RANGE) CONDITION CAPACITY/SIZE OWNER
a) Equipment
(list major ones) ......................................  .........................................  ................
b) Facilities
c) Beds
(indicate types)
d) Cots
e) others
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8 p h y s ic a l  r e s o u r c e s
f) Does the location of facilities have any impact on their patronage? Yes[ ] No [ ]
Reasons ...........................................................................................................................
9. HUMAN RESOURCES
a) What is your staff strength?
b) Do your staff have the necessary skills for the Performance of their 
duties? Yes [ ] No [ ]
c) Indicate the types of skills your staff have 
Technical [ ]
Managerial [ ]
Computer [ ]
Clerical [ ]
Unskilled [ ]
Others [ ]
d) Do they have the necessary knowledge about their jobs? Yes[ ] No[ ]
e) How do'you rate the adaptability of your staff to changes ?
Very Adaptable [ ]
Adaptable [ ]
Not very adaptable [ ]
Not adaptable [ ]
f) Do they have innovative capabilities ? Yes [ ] No[ ]
g) Are there any key workers ? Yes [ [ No [ ]
If Yes, answer (h) and (i)
h) Who are
they?..................................................................................................
1 2 6
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i) Are they all under the direct control of management Yes[ ] No [ ]
If No, answer (j) and (k) 
j) List those who are not under management’s direct control and why?
k) What are the problems that management faces with these staff ?
10. FINANCIAL RESOURCES
a) Specify the sources of funds of the hospital and their reliability. Use 
1,2,3,4,5,6, to rate according to their percentage of total funds and 4-very 
Reliable, 3-Reliable, 2-Not very Reliable 1-Not Reliable
Sources Reliable
Government [ ] [ ]
Financial Institution [ ] [ ]
Shareholders [ ] [ ]
Internally -  Generated [ ] [ ]
Donations [ ] [ ]
Others (state) [ ] [ ]
b) Please, list the uses of 
funds.............................
c) Does the hospital have a financial policy ? Yes [ ] No [ ]
d) Does it have a financial plan ? Yes [ ] No [ ]
127
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Indicate whether it is a long or short -  term.
11 in t a n g ir i  e  r e s o u r c e s
a) How do you rate staff attitude to work ?
Very devoted [ ]
Devoted [ ]
Fairly devoted [ ]
Not devoted f ]
b) What reputation does the hospital have before the public ? 
Excellent [ ]
Good [ ]
Satisfactory [ ]
Not good [ ]
c) Who are the customers / users of the hospital?
d) Has the hospital developed relationships with any of these customers ? Yes[ 
] No [ ]
e) If yes, what is the nature of the relationship ? .....................................................
f) Does the hospital have any network / links with other hospitals? Yes / No
g) If Yes, list them and the nature of the relationship.........................................
h) Do you have access to low cost of supplies? Yes[ ] No [ ]
i) Is there any relationship with suppliers ? Yes [ ] No [ ]
j) If Yes, what is the nature of the relationship?.........................
1 2 8
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12.How do you see the allocation of resources in the hospital? 
Balanced [ ]
Unbalance [ ]
Even [ ]
Don't know [ ]
13.What is the basis for resource allocation in the hospital?....
STRENGTH AND WEAKNESSES
From the following questions, I would like to know the strengths and weaknesses of 
KATH. Strengths are resources of advantage or activities that KATH does 
particularly well relative to competitors. Weaknesses are the opposite.
A relevant competitor is one who fulfils or has the potential of fulfilling one or more of 
the following conditions:
i) Has a high market share or enjoys high patronage of its services
ii) Has a strong technical / managerial base
iii) Offers quality services
iv) Has demonstrated an aggressive competitive attitude against your entire 
business or important segments of your business.
14.Using the conditions above which hospital(s) in the Ashanti Region do you think 
is/are the main competitor(s) of KATH?
15.Which of the resources identified above (ie.Questions 8-11)
a) could be said to be strengths of KATH and
b) which of these strengths cannot be easily or gradually obtained and or 
/ substituted by competitors and provide benefits to customers
129
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Strengths
a) Physical
Resources --------------
Difficult to obtain Not substitutable Benefit
customers
b). Human 
resources
c) Financial 
resources
130
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d) Intangible 
resources
COMPETENCES
Please, rate the performance of the following activities as seen at KATH, Tick ( ) 
what is appropriate High Weakness (HW) -  1 Mild Weakness (MW) -  2 Even (E)
Mild Strength (MS) -  4 High Strength (HS) -  5
1 2 3 4 5
HW WiW E MS HS
16. INBOUND LOGISTICS
a) Receipt and Inspection of supplies [ ] [ ] [ ] [ ] [ ]
b) S tock C ontro l System  [ ] [ ] [ ] f ] [ ]
c) Storage of inputs/supplies [ ] [ ] [ ] [ ] [ ]
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d) Distribution of supplies to user depts. [ ] [ ] [ ] [ ] [
e) Timeliness of supplies [ ] [ ] [ ] [ ] [
17. OPERA TIONS/ SERVICE DELIVERY
a) effectiveness of care [ ] [ ] [ ] [ ] [
b) Responsiveness to customers/users [ ] [ ] [ ] [ ] [
c) Process of service delivery [ ] [ ] [ ] [ ] [
d) Maintenance of facilities [ ] [ ] [ ] [ ] [
e) Timeliness of service delivery [ ] [ ] [ ] [ ] [
f) Availability of supplies/drugs [ ] [ ] [ ] [ ] [
18. MARKETING
a) Pricing strategy [ ] [ ] [ ] [ ] [ :
b) Promotion strategy(Public Relations) [ ] [ ] [ ] [ ] [ :
c) Market Research [ ] [ ] [ ] [ ] [ :
d) Physical environment [ ] [ ] [ ] [ ] [ :
19.SERVICE
a) Customer education/counseling [ ] [ ] [ ] [ ] [ ]
20. FIRM INFRASTRUCTURE
a) Top management support [ ] [ ] [ ] [ ] [ ]
b) Planning system t ] [ ] [ ] [ ] [ ]
(e.g. goal setting, strategies development) 
c) Control systems [ ] [ ] [ ] [ ] [ ]
1 2 3 4 5
HW MW E MS HS
d) Organizational structure [ ] [ ] [ ] [ ] [ ]
e) Corporate culture [ ] [ ] [ ] [ ] [ ]
f) Leadership capabilities(Skills) [ ] [ ] [ ] [ ] [ ]
g) Communication and information systems [ ] [ ] [ ] [ ] [ ]
h) Accounting systems [ I [ ] [ ] [ ] [ ]
i) Financial management/control [ ] [ ] [ ] [ ] [ ]
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j) Leadership styles [ ] [ ]
(e.g. autocratic, bureaucratic,democratic,combination) 
k) Control/influence of board of directors [ ] [ ] [ ]
[ ] U  [ ]
[ ] [ ]
21. HUMAN RESOURCE MANAGEMENT
a) Selection / Recruitment [ ]
b) Health and safety measures [ ]
c) Training and Development [ ]
d) Employee empowerment [ ]
e) Reward systems [ ]
f) Promotion system [ ]
g) Appraisal system [ ]
h) Labour/management relationships [ ]
i) Manpower Planning [ ]
22. TECHNOLOGICAL DEVELOPMENT
a) Level of automation [ ]
b) Research and Development [ ]
c) Technology system [ ]
(e.g. computing network, operating system)
d) Research and development funding [ ]
e) Research and development facilities [ ]
f) Human resources for R & D [ ]
23. PROCUREMENT
a) Selection and evaluation of suppiiers [ ]
b) Quality management of purchased [ ]
goods / services
c) Methods of procurement [ ]
d) Timeliness of procurement [ ]
e)Procurement lead time [ ]
[ ] t i [ i
[ ] [ t [ ]
[ ] [ t [ i
[ ] [ [ t ]
t ] [ t [ ]
[ ] [ 
r i r
[
r
[ i
r iL J L 
[ ] [
L .
[
I J 
[ ]
[ ] i [ [ ]
11  t [ [ ]
[ ] t [ [ ]
[ i [ t [ ]
i ] [ 
11  [
[
[
[ ] 
[ ]
i j f [ r 1n J
t ] t t [ ]
[ ] [ t [ ]
t ] [ t [ ]
t ] t t [ ]
t ] [ [ [ ]
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24. Tick [ ] what is appropriate from the activities provided below
(a) the activities which are critical in health service delivery (CA)
(b) Which of the strengths identified in questions 16-23 (i) cannot be easily or 
gradually copied (NEC) (ii) cannot be substituted by competitors (NS) (iii) provide 
benefits to customers (BC)
ACTIVITY 
INBOUND LOGISTICS
a) Receipt and Inspection of supplies
b) Stock Control System
c) Storage of inputs / supplies
d) Distribution of supplies to user depts.
e) Timeliness of supplies
OPERA TIO NS/ SER  VICE PRODUCTION
a) Quality of service
b) Responsiveness to customers/users
c) Process o f service delivery
d) Maintenance of facilities
e) Timeliness of service delivery
f) Availability o f supplies 
M ARKETING
a) Pricing strategy
b) Promotion strategy(Public Relations)
c) Market Research
d) Physical environment
CA NEC NS BC
[ ] 
[ ] 
[ ] 
[ ] 
[ ]
[ J 
[ ] 
[ ] 
[ ] 
[ ] 
[ ]
[ ] 
[ ] 
[ ] 
[ ]
[ ] 
[ ] 
[ ] 
[ ]
SERVICE
a)Customer education/training [ ] L ] [ ] [ ]
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A C TIV ITY CA NEC NS BC
FIRM INFRASTRUCTURE
a) Top management support
b) Planning system
c) Control systems
d) Organizational structure
e) Corporate culture
f) Leadership capabilities(Skills)
g) Communication and information systems
h) Accounting systems
i) Financial management/control 
j) Leadership styles
k) Control/influence o f board of directors 
HUMAN RESOURCE MAN A GEMENT
a) Selection / Recruitment
b) Health and safety measures
c)Training and Development
d) Employee empowerment
e) Reward systems
f) Promotion system
g) Appraisal system
h) Labour /management relationships
i) Manpower Planning 
TECHNOLOGICALDEVELOPMENT
a) Level of automation
b) Research and Development
c) Technology system
d) Research and development funding
e) Research and development facilities
f) Human resources for R & D 
PROCUREM ENT
[ ] 
[ ]
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a) Selection and evaluation of suppliers [ ] [ J [ ] [ ]
b)Quality management of purchased
goods /  services [ ] [ ] [ ] [ ]
c) Methods of procurement [ ] [ ] [ ] [ ]
d)Timeliness of procurement [ ] [ ] [ ] [ ]
e)Procurement lead time [ ] [ ] [ ] [ ]
25. Does the performance of the activities o f other departments impact on your department? 
Yes [ ] No [ ]
26. If Yes, list those departments and indicate those activities 
DEPARTMENT ACTIVITIES
27. Does the performance of your department’s activities impact on the activities o f other departments? 
Yes [ ] No [ ]
28. If Yes, list the departments and indicate how your department’s activities affect theirs.
29. What is the relationship between your department and those you have indicated in 26 and
28?.............................................................................................................................................................
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30. Is there team work in the performance o f the activities o f the hospital as a whole 
Yes [ ] No [ ]
31. Is there a forum > meeting where departments are brought together to discuss 
the performance of the hospital? Yes [ ] No [ ]
137
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APPENDIX II
KOMFO ANOKYE TEACHING HOSPITAL -ORGANOGRAM
HOSPITAL BOARD
INTERNAL AUDIT
CHIEF ADMINISTRATOR
DIRECTOR OF ADMINISTRATION
SUPPORT SERVICES
H
DIRECTOR OF FINANCE j
ACCOUNTS & REVENUE
DIRECTOR OF NURSING
r.
DIRECTOR OF PHARMACY DIRECTOR OF MEDICINE
NURSING SERVICES PHARMACEUTICAL SERVICES CLINICAL, DIAGNOSTICS
& PHYSIOTHERAPY
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VARIABLES, INDICATORS AND MEASUREMENTS -Details
APPENDIX III
RESOURCES
Physical- Age, Condition, Capacity/ Size, Accessibility, Ownership and Uniqueness. 
Human -  Skills, Adaptability, Innovativeness and Knowledge of staff, Ownership. 
Financial -M ajor Sources, Reliability, Financial Policy and Plans 
Intangible -  Loyalty and Commitment of Staff, Reputation, Relationships
COMPETENCES
In-bound Logistics 
Service Delivery 
Marketing 
Service
Firm Infrastructure 
Human Resources Management 
Technological Development 
Procurement
UNIQUENESS OF CAPABILITIES
Inimitability
Non-substitutability
Customer Value
Ownership
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^ A A  ,VNf
p r o s s t a b s  '
f ■
Department * What Is the firs t objective of,your department
I
punt 1 ’
Crosste
' I)
iDUiation
what Is the tlrst objective ol youtdcp altlmenl
ncrease
Si * " to hospital
cordlnate Training of revenue
( various ' staff to and $
departme Improve to provide reduce
ntal quality quality pubIc e xpenditur
I; . " : activities delivery service education e
Department Accident/Emergency ■ 1 1 * j v
Accounts j>Si ' ' ! 1
Administration , . 1 . I j
Anesthesia 1 1
Blood Bank _- --— r i
Child Health — "" 1 2 | i
Clinical Biochemistry ' • 1
I •
Clinical Microbiology 1
.
■ ■ Dentistry 1 •
ENT 1
i
Haematology 1
nislopalhology 1
MmJIcnl Gloclionlc
Medical Recoids 1
Medicine ft. 1 ' RL ■ . .
Ob and G *  • 1
Pharmacy
‘ 1
V 1
Physlotherappy . 1
Polyclinic Dispensary 1
W
Radiography 2 ■ fe
Sugery 1 \
supply and stores ■i
■
management 1
Total ■. , .1 1 20 1 1
i
|
1
. ,
■ |
■ j
]
1
■ ‘ 1 • 1
i
• ■
I
1
!
9
1 I U . r ) ' 1
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'
Department * what Is the firs t objective o f yo
lount
—'» » ----------------------- --------- -------------- what Is
• Installation
ond
malnlenac •V.
e of
hospital
equipment
s Total
Department Accident/EmergenCy 2
Accounts
Adrhlnlstratlon
■ Anesthesia 1
1 Blood Bank
Child Health . ■'
L Clinical Biochemistry
1 .Clinical Microbiology
Dentistry 1L ■ ENT 1
I  Haematology
* Hlstopathology
, Medical Electronic 1 1
1 Medical Records 4. 1
f  Modldno 1
Ob and G 1
I Pharmacy
P Ph'ysintherappy -— : . . . .
Polyclinic Dispensary 1 1
* • Radiography .
P Si/gery
1 , supply and stores A
1 management
lotal 1 25
Crosstabulation
bsstabs
I
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Department * what Is the second objective of your departme
Coun t
i t  Crosstabulatlon
what Is the second objective o f
Training ol 
staff lo 
Improve 
qtlallty 
delivery
to provide 
quality 
service
Increase 
hospital 
revenue 
and 
reduce ' 
expendltur 
e
'our department
I
R ggoo iic Ii/I
cachlhg
sludejifs
ana
residents
doctors
Installation 
and 
mjilnlenac 
e of 
Hospital 
feqjlpment. 
* .$v*li,Vv IS
Department
Total
Accident/Emergency 
Accounts ■ „
Admlnltratlon 
Anesthesia 
Blood Bank 
Child Health 
Clinical Biochemistry 
Clinical Microbiology 
Dentistry 
EN J
Haematology
Hlstopathology
Medical Electronic^ .
Medical Records
Modlclno
Ob and O
Pharmacy
Physlotherappy
Polyclinic DIspensaTy
Radiography
Sugery
supply and stores 
management
1 1
1
! 1
1
■ ,1
%
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'
■ Department * what Is the second objective o f y
l i  ' ' '
•
j •• .
wlml Ib IIio
1 ! ‘
not.
! .. applicable Total
efiartment Accident/Emergency Vi 2
I Accounts
| Admlnitratlon 1
Anesthesia r 1
b Blood B^nk
1 1- Child Health 2
Clinical'Biochemistry
I Clinical Microbiology
Dentistry 1
1 EMT _ 1
Haematology 1
Hlstopathology ■ -)
Medical Electronic 1
Modlcnl Honoidn . 1 1
Medicine 1
’ Ob and G 1
Pharmacy , A
Physlotherappy 1 \  1
Polyclinic Dispensary ‘ 1
Radiography
Sugery _-1
supply and s t o r e s __ ------*
management 1
jtal : 10 25
1
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APPENDIX V PHYSICAL RESOURCES PROFILE OF KATH
• CLINICAL
MEDICINE
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
E.C.G. Machine 4 7 yrs 2 -  Good 
2 - Faulty
Small KATH
Hot Air Sterilizer 1 7 yrs Good Small KATH
Sphygmomanometers 1 3 yrs Good Small KATH
Refrigerators 4 5 yrs Good Big KATH
Endoscopy Machine 1 7 yrs Good Big KATH
Dialysis Machine 1 ly r Good Big KATH
Colonoscopy Machine 3 7 yrs Good Big KATH
Heart Tables 66 4 yrs Fairly good Big KATH
b) Facilities
Specialist Clinics 7 Good Small KATH
E.C.G Services 1 Good Small KATH
Endoscopy Services 1 Good Small KATH
Dialysis Services 1 Good Normal KATH
Colonscopy Services 1 Good Small KATH
In-patient (wards) Good Normal KATH
c) Beds (type)
Normal Beds 130 Satisfactory Normal KATH
Cardiac Beds 11 Good Normal KATH
Bedside Lockers 98 Fairly good Small KATH
O BSTETR IC S AND G YN AEC O LO G Y
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Resuscitaire 3 15 yrs Old KATH
Cardiotocograph 6 4 yrs Good Normal KATH
Ultra-sound Machine 1 10 yrs Satisfactory Over utilized SMS
Diathermy 1 15 yrs Old Normal KATH
Suction Machine 6 5 yrs Satisfactory Normal KATH
Laparoscope 8 yrs Satisfactory Normal KATH
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b) Facilities
Theatres Good Small KATH
Labour Ward Good Small KATH
Ultra Sound Services Good Over utilized SMS
Antenatal Good Normal KATH
Emergency Services Good Normal KATH
Family Planning Good Normal KATH
In-patient Over utilized KATH
High Dependency Poor Small KATH
POL YCLINIC  D ISPENSAR Y  (GENERAL OUTPA T IE N T  PHARM A CY)
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Refrigerator 1 Good Normal KATH
Furniture Not enough KATH
b) Facilities
Dispensary Good Normal KATH
ANESTHESIA
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Anesthetic Machines 9 5 -  15 yrs Good Normal KATH
Suction Machines 9 5 -  15 yrs Good Normal KATH
ACCIDENT & EMERGENCY/OPERATING THEATRE
Items
a) Equipment (Major) Quantity
Age
(range) Condition Capacity Owner
X’ray Viewers 2 Normal KATH
Autoclave 2 3 yrs In good condition Normal KATH
Diathermy Machine 2 In good condition Normal KATH
Suction Machine 2 Normal KATH
Intensifier 1 Faulty Normal KATH
Hand Drill 1 In good condition Normal KATH
Hot Air Oven 1 In good condition Normal KATH
b) Facilities
Operating Room 2 In good condition KATH
Scrub Room 2 In good condition KATH
Instrument Washing 
Room 1 In good condition
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Sluice 1 In good condition
Store Rooms 2 In good condition
Pre-Anaesthesia Room 1 In good condition
Recovery Ward 1 In good condition Small
c) Beds (type)
Adjustable the Side 
Rails 4 Satisfactory
Normal 2 Satisfactory
Orthopaedic 2 Satisfactory
C o ts 2 Satisfactory KATH
D EN TISTRY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Dental Units with 
Chair 5 1 -  3 yrs Perfect Normal KATH
Dental Lab. Equipment 
for Removable 
Prosthodontics
Enough for 
2 Labs. 2 -  10 yrs Satisfactory Normal KATH
b) Facilities KATH
Surgeries 5 1 -  3 yrs Perfect Normal KATH
Laboratory 2 2 - 1 0  yrs Satisfactory Normal KATH
Ward 1 KATH
EAR, NO SE AND  THROAT (E.N.T)
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Audiometers
4
Since
establishment of 
centre
Good Over utilized KATH
Tonsilectomy Set 4 3 yrs Good Small KATH
Trachesotomy Tubes 10 3 yrs Good Small KATH
Mastoidectomy Set 1 - Outmoded KATH
Aural Syringe 4 3 yrs Poor Over utilized KATH
Mouth Gags 2 3 -  25 yrs Satisfactory Over utilized KATH
Nasal Specula 20 - Satisfactory Over utilized KATH
Tongue Depressors 20 - Good Over utilized KATH
Tonsil Dissectors 3 - Good Over utilized KATH
b) Facilities
Out-patient Unit
\  o\-
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In-patient Unit
Audiological
Assessment
Speech Training
Surgical Services
c) Beds (type)
Beds Shared with Dental and Eye Depts.
ACCIDENT AND EMERGENCY/CASUALTY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Dressing Trolleys 6 6 -  12 yrs Good KATH
Pats Trolley 6 5 yrs Good KATH
Wheel Chairs 6 5 yrs Satisfactory KATH
Elec. Suction Machine 1 15 yrs Satisfactory KATH
Theatre Table - - - KATH
P/S Exam Couldi 3 3 yrs Satisfactory KATH
Sutaring Lusts ly r Satisfactory KATH
Trays & Gallipots 10 5 yrs Satisfactory KATH
Screens & Covers 6 10 yrs Satisfactory KATH
Elec. Sterilizer 3 1 yr Good KATH
Paedics Weighing 
Scale 1 3 yrs Good Not enough KATH
b) Facilities
O.P.D 1 Good Small KATH
Suturing Room 1 Good Small KATH
Plaster Room 1 Good Good KATH
Adm. Team 1 Small
Casualty Recover 
Wards 2 Poor Small KATH
In-patient 2 Satisfactory Over Capacity KATH
c) Beds KATH
Normal 85 Old Poor Normal KATH
Adjustable 6 Good KATH
Orthopaedic 2 Old Normal KATH
KATH
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CHILD HEALTH
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Cupboard Good KATH
Suction Machine Good KATH
Drip Stands Good KATH
Instruments Good KATH
Boiler Good KATH
Sterilizing Drum Good KATH
Bed Elevator Good KATH
Diagnostic Set Good KATH
Weighing Scale Good KATH
Oxygen Cylinder Good KATH
Incubators 10 2 -  20 yrs Good Over utilized KATH
Radiant Heater 2 2 yrs Good Over utilized KATH
Phototherapy 2 2 yrs Good Over utilized KATH
b) Facilities
Septic Nurs 1 2 yrs Good Small KATH
Sp. Care Unit 2 Good Small KATH
Wards 3 Poor Small KATH
O.P.D. Gen. 2 Fair Fair KATH
O.P.D. Specialist 1 Good Small KATH
M.C.H. 1 Fair Fair KATH
c) Beds
Ordinary Hospital Beds 40 2 -  40 yrs Fair Fair KATH
d) Cots 112 2 -  40 yrs Good Over utilized KATH
SURGERY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Image Intensifier 3 1 -  new 
2 -o ld
1 -  good 
1 - satisfactory KATH
Arthroscope 1 New Good KATH
Cystoscope 1 New Good KATH
Ultrasound 1 4 yrs Good KATH
Endoscope 3 Good KATH
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Diathermy Machines 4 Good KATH
Sterile Water Plant 1 Good KATH
Pneuma Drill 1 Good KATH
Bedside Lockers 60 KATH
Bedside Tables - KATH
b) Facilities
Well-equipped
Theatres 3 2 -  10 yrs Good Normal KATH
Image Intensifier 2 2 yrs Good Normal
Cystoscopy 1 2 yrs Good Normal
Endoscopy 3 5 yrs Good Adult size -  1 
Paediatric -  2 KATH
Ultrasonography 1 4 yrs Good Normal KATH
Wards 4 50 yrs Satisfactory Normal KATH
c) Beds (types)
Normal 70
A few new, 
most very old
Not very 
good Normal KATH
Orthopaedic
Adjustable 12 Normal KATH
c) Cots 30 > 20 yrs Poor Normal KATH
•  DIAGNOSTIC
HAEMATOLOGY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Microscope 6 5 yrs Good Binocular KATH
Water Bath 1 6 yrs Good Medium KATH
Electrophoresis Tank 2 9-10 yrs Very Good Small KATH
Counter 1 Very Good 8 parameter KATH
Centrifuge 2 Good Medium KATH
Hot Air Oven 1 Large KATH
b) Facilities
HS
Diff. WBC
Platelet Count
G-6 PO
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Reticulocyte
Film Comment
CLINICAL MYCROBIOLOGY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Incubator 3 2 -o ld  
1 -  new
Good 2 -  big size 
1 -  small size
KATH
Autoclme 1 Old Good Large size KATH
Microscope 3 2 -o ld  
1 -  new
Good KATH
Oven 2 Old Good Small size KATH
Computer 1 New Good KATH
Water-Bath 1 Old Good Big size KATH
Auto Analyzer 1 Yet to be use Good Normal KATH
b) Facilities
Bacteriology 1 Since Satisfactory Normal KATH
Parasitory 1 establishment Good Normal KATH
Mycology 1 of hospital Satisfactory Normal KATH
CLINICAL BIOCHEMISTY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Spectrophotometers 4 5 yrs 1 -  good 
3 - unstable
1 -  KATH
3 -SM S
Auto Analyzers
4
2 -  new 
1 -  2nd hand 
1 > 5 yrs
2 -  new 
2 -  broken 
down
1 -  SMS 
3 -KATH
Blood Gas Analyzer 1 3 yrs Broken down SMS
Flame Photometer 1 5 yrs Good SMS
Water Baths 2 5 yrs Good 1 -  medium 
1- large
1 -  SMS 
1 -  KATH
Distilling (H2O) Plants
2
1 -  new 
1 > 10 yrs Good KATH
Adjustable Pipettes
6
3 > 5 yrs 
3 < 2 yrs
3 -SM S  
3 -KATH
b) Facilities
Airconditioners 2 1 < 3 yrs 
1 > 4 yrs Good
1 -  split air 
1 -  window 
type
KATH
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BLOOD BANK
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Radiber Fridge 1 5 yrs Good 250 units KATH
GHT Fridge 2 3 mths Good 150 units each KATH
Radiber Freezer 2 5 yrs Good 100 units KATH
Meditronic Centrifuge 2 5 yrs Good Big KATH
Diamed Centrifuge 2 ly r Good 24 samples KATH
Diamed Incubator 1 ly r Good 100 units KATH
Imufuge (centrifuge) 2 > 10 yrs Good 12 samples KATH
Shaker 2 4 yrs Good Big KATH
b) Facilities
Donor Clinic 1 Poor Too small KATH
Bank- Laboratory 1 Poor Too small KATH
Offices 2 Good Adequate KATH
RADIOLOGY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Conventional Radio­
graphy Machine 2 4 yrs Very good Normal KATH
Dental Machines 2 1 - 1 0  yrs 
1 - 2  yrs Good Normal
KATH
Automatic Processor 2 4 yrs Good Normal KATH
Fluoroscopy Machine 1 Not yet in use New - KATH
Mammography 1 4 yrs Very good Under utilized KATH
Mobile X ’rays 1 4 yrs Very good Normal KATH
C-arm Machine 1 4 yrs Very good Normal KATH
b) Facilities
Accident & Emergency 
Services Over utilized KATH
Mobile Services for In­
patients Normal KATH
Special Examinations KATH
Mammography Under utilized KATH
Theatre Services Normal KATH
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• PHYSIOTHERAPY 
PH YSIO TH E R A P Y
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Shortwave Diathemy 4 5 -  20 yrs Good Over utilized KATH
Infra-red 4 15 yrs Good Over utilized KATH
Ultrasound 3 3 -  5 yrs Good Normal KATH
Diadyne 3 2 -  20 yrs Good Normal KATH
Wax Bath 1 < 30 yrs Good Over utilized KATH
Threadmill 1 2 yrs Good Over utilized KATH
Ergometer 1 15 yrs Good Over utilized KATH
Wheel Chairs 4 2 mths Good Normal KATH
b) Facilities
Electrotherapy 1 Good Small in number KATH
Adult Gymnasium 1 Good Small in number KATH
Children’s Gymnasium 1 Good Small in number KATH
In-patient Good Small in number KATH
c) Beds (types)
Couches 7 15 -  20 yrs Good Small in number KATH
• PHARMACEUTICAL
PHARMACY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Autoclave 1 Old Big KATH
Filtering Unit 1 Unserviceable Small KATH
Distilling Plant 1 Unserviceable Big
b) Facilities
Stores 1 Fairly good Normal KATH
Dispensaries 5 Fairly good Normal KATH
Aseptic Laboratory 1 Fairly good Normal KATH
Manufacturing Unit 1 Fairly good Normal KATH
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• ADMINISTRATIVE AND SUPPORT SERVICE
ADM INISTRATION/BOARD  ROOM
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Electric Generator
2
1 -  4 yrs 
1 - 1 8  yrs Good KATH
Boiler Plant 2 6 yrs Good KATH
Laundry Machines 4 6 yrs Good KATH
Water Pumps 4 5 yrs Good KATH
Computers 30 6 mths Good KATH
Oxygen Plant 1 2 mths Good KATH
Sterilization Plant 1 6 yrs Good KATH
Gas Room Equipment 2 sets 6 yrs Good KATH
Incubators 6 4 yrs Good KATH
b) Facilities
Block of Wards 4 48 yrs Good KATH
ACCOUNTS
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Money Counting 
Machines 3 1 -  7 yrs Good Normal KATH
Adding Machines 2 3 yrs Good Normal KATH
Computers 6 1 -  6 yrs Good Normal KATH
b) Facilities
Revenue
Salaries
Main Accounts
Costing and Monitoring
MEDICAL RECORDS AND STATISTICS
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Computers 26 3 mths Very new Records Dept.
Shelves 32 1 yr Very new Records Dept.
Air Conditioners 2 3 mths Very new Records Dept.
Incubators 10
b) Facilities
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OPD Poly Clinic Satisfactory Normal Records & Stats.
A & E Good Small Records & Stats.
Specialist Consulting Bad Small Records & Stats.
Main Records Offices Satisfactory Normal Records & Stats.
c) Beds (type)
Adult Beds 813
d) C o ts 74
MEDICAL ELECTRONICS UNIT/MAINTENANCE
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Hot Air Sterilizers 6 10 yrs Working KATH
Steam Sterilizers 4 2 yrs Working KATH
E.C.G 4 6 yrs 2 - faulty KATH
X’ray Mobile 2 2 yrs Working KATH
X ’ray Units 2 3 yrs Not working KATH
Surgical Diathery 4 4 yrs 3 -  working KATH
Laundry Machines 6 units 2 yrs Working KATH
Gas Plant 1 ly r Working KATH
Stand by Generator 1 ly r Working KATH
b) Facilities
Electronics KATH
Electricals KATH
Anaesthetic KATH
Estates KATH
SU P P L Y  AN D  ST O R E S  M ANAG EM ENT
Items
a) Equipment 
(Major)
Quantity Age (range) Condition Capacity Owner
Hand Trolleys 2 18 -  20 yrs Poor Small KATH
Wooden Shelves 47 35 -  40 yrs Fair KATH
Sewing Machines 4 30 -  40 yrs Poor Small KATH
Tailoring Machines 1 4 -  5 yrs Good KATH
Refrigerators 2 2 yrs Good Small KATH
b) Facilities
Main Stores Demarcated 35 -  40 yrs Poor Small KATH
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Maintenance Stores 35 - 4 0  yrs Poor Small KATH
Limb Fitting 40 -  45 yrs Poor Small KATH
Laboratory Stores 1 40 -  45 yrs Poor Small KATH
HISTOPATHOLOGY
Items
a) Equipment (Major) Quantity Age (range) Condition Capacity Owner
Tissue Processor 1 2 yrs Good 80 pieces KATH
Microscopes 5 4 yrs Good Binocular KATH
Oven 1 10 yrs Good Medium KATH
Water Bath 2 2 yrs Good Medium KATH
Microtome 3 15 yrs Partially Large KATH
b) Facilities
Mortuary 2 KATH
Laboratory 2 KATH
155
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APPENDIX VI
TYPES OF SPECIALIST/ SPECIALIZED CLINICAL STAFF -KATH
Urologist 
Plastic Surgeons 
Paediatricians 
Neo-natal Specialist 
Obstetrics/ Gynaecologists 
Ophthalmologist 
E.N.T. Specialist 
Orthopaedic Surgeons 
Anaesthesiologist
Scientists
Immunologist
Parasitologist
Microbiologist
Biologist
Biochemist
Consultants/ Specialists Nurses
Physician Specialist 
Cardiologist 
Ultrasonographer 
Nephrologist 
Dermatologist 
Maxillo Facial Surgeons 
Dental Surgeons 
Paediatric Surgeons 
General Surgeons
Critical care 
Peri-Operative 
Diabetic 
Paediatric 
Burns
Ophthalmic
Anaesthetist
Midwives
Renal
156
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ajJT  r
STRATEGIC CAPABILITY PROFILE OF KATH (COM PETENCES) ,— A ’W '  
INBOUND LOGISTICS
ACTIV ITIES W eigfin Z o f Activities
l i w  . M W 2 E3 M S4 HS5
. Receipt and Inspection 2.5
Stock Control System 2.2
Storage o f InpUts/Supplies 2.6
Timeless o f Supplies 2.3
■Distribution o f Supplies t6 user departments '2.1 ■
AVERAGE 2.3
OPERATIONS/SERVICE PRODUCTION
ACTIVITIES Weiglfin 2 o f Activi ties
HW7 M W 2 E3 M S4 HS5
Quality o f Service 3.6
Staff Responsiveness to Customers/Users 3.2
Process o f  Service Delivery 2.9
Maintenance o f Facilities 2.7
Timeliness o f Service Delivery 2.4
Availability o f Supplies/Drugs 2.7
AVERAGE 2.9
MARKETING
ACTIVITIES Weiglfm 2, of Activi ties
HW M W 2 E3 M S4 HS5
Pricing Strategy 2.5
Promotion Strategy 1.8
Market Research 1.1
Physical Environment 2.5
AVERAGE 2.0
I SI
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SERVICE
ACTIVITIES Weighm 5 of Activ ties
HW M W 2 ' EJ MS4 HS5
Customer Education/Training 3.3
AVERAGE 3.3
FIRM INFRASTRUCTURE
ACTIVITIES W eighin 1 of Activi ties
HW M W 2 E3 M S4 HS5
.Top Management SqppCrt 2.8
Planning Systems 2.9
Control Systems 2.7
Organizational Structure 3.4
Corporate Culture 2.9
Leadership Capabilities' 3.8
Communication and Information Systems 2.6
Accounting Systems 2.6
; Financial Management/Control 2.7
Leadership Styles . • 2.9'
Control o f Board o f Directors•i • . . 2.7
AVERAGE ■ : . 2.9
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HUMAN RESOURCE MANAGEMENT
ACTIVITIES Weigtffn ? o f Activi ties
HW7 M W 2 E3 MS4 HS5
Selection and Recruitm ent' 1.9
Health and Safety Measures 2.4
Training and Development ■ 3.4
Employee Empowerment • 2.9
Reward Systems ■ 1.9
Promotion Systems 2.8
Appraisal Systems 2.4
Labour/Management Relationship 2.7
Manpower Planning 2.8
AVERAGE 2.6
TECHNOLOGICAL DEVELOPM ENT
ACTIVITIES Weiglftn S of Activi ties
h w t M W 2 E3 MS4 HS5
Level o f Automation 2.3
Research and Development • 2.6
Technology System 2.6
Research and Development Funding 2.0
Research and Development Facilities 2.3
Human Resources for Research and 
Development
3.2
AVERAGE 2.7
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PROCUREMENT
ACTIV ITIES Weigmn g o f Activi ties
HW ' MW 2 . E J MS HS5
Selection and Evaluation o f Suppliers 2.6
Quality Management o f  Purchased 
Goods/Services .
2.8
'Methods o f  Procurement. 2:3
' Timeliness o f  Procurement 2.1
Procurement Lead Time 1.9
AVERAGE 2.3
J 60
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0 & J  b i  v ' W
MINISTRY OF HEALTH 
DATA. SET ON KOMPO ANOKYE TEACHING HOSPITAL, KUMASI
TOR THE YEAR 1990 -  THE TEN (10 ) TOP DISEASES OP THE
OUT-PATIENTS ■1MT
NO c~j
. ... i
'DISEASE ’• j NO. OP OASES % OP .TOTAL 
»
1
1* Mala r ia  ii 7B772
t ■ ■ ■ ■
22 ,04
2» Acute Eye I n f e c t i o n s  j
i
15935 4 .46
3.
........................... ■' " ................ i
D isease  ,of Oral  Cavi ty 14074 3 .9 4
4. A c c id e n ts  . ]r- : ' " - __  - - " .... - .. - - - ----- . 1 - , - ■ 12257 3 .43
5 . D ia r rh o e a l  D is e a s e s  ! 8175 2 .2 9
6»
i ............ ..... - _ -............ ................... - -  | -
I Upper Re s p i r a t o r y  T ra c t  I n f e c t i o n ) 6787 —X VO o
7 . j Ear I n f e c t i o n  j 5945 | 1 .66
0. i! Skin  D i s ea se s  ,
\ ............................  i
2622 ' 0 .7 3
9. j Hype r t en s ion  !i . ........  | 2511
0 .7 0
10. ! P regnancy  R e la te d  C om p lic a tio n s  I 2384 0 .6 7
TOTAL ATTENDANCES = 357407 »
^998 ten (10) TOP CAUSES FOR ADMISSION
HO. DISEASE | NO. OP CASES'
I o£-tO
V P regnancy  Re l a t e d  Complica t ions I ■ 12636I I 34 .30
.2. i Accidents  . j 12071 : - 5 ,60
3. '
T
j Malar ia . 1371 ■ 3 ,71  
.  ... ' ....... .
' 4 .? .
I •- '■ “ 1 'J '■ 1 1 r, r" r*‘ ir
S Lobar Pnoumonia
i 1163
3 .1 4
5. I Ce reb rova scu la r  Accident  (CVA) ' 444 1 .20
6»
j .................. .................
j Mening i t i s 431 1 .1 7
7.  > j Anaemia
CVlOJ 1 .14
i .......................
8, JGynaoco log ic a l \D i so rd e r s 376 ■ 1 .0 2
9.- 1 Aoquired Inunune D e f f i c i en cy  Syndrome(AIDS) 356 0 .9 6
.10, ; i Hypertensive D i s e a s e s
I 335 0 .91
TOTAL.ADMISSIONS » 36907
- ( BIOSTATISTitflAN )
E. K. APPAII
r. 8 /2 /9 9
4
( 6 i
%
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MINISTRY OP HEALTH
il TOK 1'He Y E A i r iW - T H E  J E N " T w W T T SSaSSS 'CP
I tfiffi o 't r i '- w r a r s
1 ;T0 . ] DISEASE: ' j NO. OF CASES i % OF TOTAL: 
j  .
| t .  I M a l a r i a  j
3 !
7 1 2 4 2 \ 1 9 . 8 7 %I
:| ", | Acute Eye I n f e o t i o n  i
•1 1 —[ „ ,.....  . . . - . . .............,.................. .
1 6 6 . 2 5 | 4 . 6 4 %
5 ~ ,
;! 3, | Disea se  Of O ra l  C av i t y  I 1 2 8 9 1 [  3 . 5 9 %
j. __. . .....   - . - ...... . . .. __ . . ....... , -.............. ..... , j. . * .
1 4. I Acc iden t  ' i 
4 : ................... . . ...........  i 1 2 8 9 1 j  3 . 5 9 %, ” l ........ i
J 5. 1 Upper R e s p i r a t o r y  T r a c t  I n f e c t i o n
? 1 .................  .
7 3 6 2 j  • 2 . 0 5 %
i! -----  ------------- -------------------  ---
:i v. i D i a r r h o e a l  D i s e a se s
. | ....................... ........................  . . . . . . 6 7 5 7
COco
1
■j| t ■ -----  ” ...... ...■j 7. j Ear  I n f e c t i o n 5 8 8 7 I 1 . 6 4 %
!? I Pregnancy and R e l a t e d  Compl i ca t ions
a  i
2 2 1 8 ! 0 . 6 2 %  s> — -----—  — r
1' i Hype r t en s ion
|  I ....... . . . . . . .  1
2 0 7 9 | 0 . 5 8 %
•3 I i ,jr 10. i D i s ea se s  of  Sk in  and U lc e r•il '■ A - r i +  p -p >  c  ■ 1 1 6 3 5  0  I Q h M , 0 . 4 6 %  V r l  ■* C V  °>
3 Note:  T o t a l  O u t - P a t i e n t  A t t endance s  1 9 9 9  D 3 5 8 6 2 3
l --------- f - f -
T o o  y 0
s j ' i  _ . . .  1 9 9 9  TEN ( 1 0 )  TOP CAUSES FOR ADMISSION
jj|
)
1 _______________ i ________ __
j l?OF;:0.' DISEASE! !no. OF CASES' TOTAL
Pregnancy R e la ted  Complications 6597 1 8 , . 9 8 %
Accidents 2 0 1 8
3. i A p la s t ic  and- Other- Anaemias 1 6 2 5
5.81%
4.68%
Malaria 1 5 4 8 4.45%
] I n f l u e n z a  and Pneumonia
! C e r e b r o v a s c u l a r  D i s e a s e s
ii-h-II
-J—
9 4 0 2 . 7 1 %
4 8 2 1 . 3 9 %
7. | Gynaecological D iso rders 3 9 2 i 1 . 1 3%
Acqu ir ed  Immune D e f i c i e n c y  Syndrome(AIDS) j 3 7 3 1 .  . 0 7 %
-i—Malignant Neoplasms ... i 326 _0.-94%
Hyp e r t e n s i v e  D isea ses  
   —
Note: Total Admissions 1999 “ 34750
2 4 0 0 ,6  5%
loo
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> '  ’ )A IA 31.1 ON Koiviro ANOKYI- IHACI UNO IIOSITI AL, KUMA8ir.QR111E.XBAEL» i \ 
j  III; ! KN (jo ) ! QI’ .UISCASE o r  11 IE O UT-PATfcfrlTS .
A
NO DISEASES NO o r  CASES % OE 'TOTAL
! M ALARIA 39102 11.93%
2 ACU r'L- EYE IN I'E C I ION 1G20I »4r9G%
n DISEASES OE O K A ! 'C A '-'I i Y
a c c il5f. n i :s “ ............. ’ ..........” ”  .. .......... ~  ••
13079 i 3.95%
4 1U4G9 3.19%
5 l-AK  INI EC HON 4917 1.50%
6 UPPER RESPIR ATO R Y 1 RACT INTN 3715 : 1013%  W
7 H YPERTENSIO N 2353 0.72%
a D IAR R H O EA DISEASES 2025 0.62%
9 URINARY. TR AC T IN E E O 1 ION 1451 0.44%
10 DISEASES O i: SKIN & ULCERS 1212 0.37%
TO TA L ATTE N D A N C E  O.P.D = 3205GG
D 2000 TEN TOP C AUSES TOR ADM ISSIO N
NO DISEASES NO OF CASES, % OF TO TAL
1 PR EG N ANC Y R ELATED C O M PLIC ATIO N S 0937 22.01%
2 ANAEM IA 2050 5.05%
3 AC CIDEN TS 2007 ■ 4.94%
4 M ALARIA 1504 3.70%
5 C EREBR O VA SCU LAR  AC C ID EN T (STR O KE) 462 1.14%
6 G YN AEC O LO G IC AL D ISORDERS 414 1.02%
7 LOBAR' PNEUM O NIA 379 0.93%
8 DIABETES M ELLITUS 361 0 89%
9 M ENINGITIS 336 0.83%
10 M ALIG N AN T NEOPLASM S 335 0.63%
TO TAL A D M ISSIO N S = 40601
C. TOP T E N  (10) C A U S E S  OF D E A TH -2000
NO. DISEASES ADM ISSIO NS DEATHS % DEATH
1 AN AEM IA 2050 214 6.19
2 AC CIDEN TS 2007 178 5.15
3 H IV /A ID S 332 137 3.96
4 M ALIGNANT NEOPLASM S 335 110 , 3.41
5 D IABETES M ELLITUS 361 . 98 2.84
6 M ALARIA 1504 76 2.20
■ 7 SEPTICAEM IA . 167 75 2.17
.3 C EREBR O VA SCU LAR  A C C ID E N T (STR O KE) 462 74 2.14
9 M ENINGITIS 336 146 4.22
10 LOBAR P N EUM O NIA 379 59 ' 1.71
TOAL DEATHS =3456
D A D M IS S IO N  BY S P E C IA L IT Y  -2000
N O . S P E C IA L IT Y  / D E P A R T M E N T A D M IS S IO N S
1 O BSTETRIC 1427
' 2 G YN AEC O LO G Y 3966
3 CHILD HEALTH /P A E D IA T R IC S 7202
4 PAEDIATRIC  SURG ICAL 1136
5 G ENERAL SURG ICAL 2437
C O R TH O PAED IC 1295
7 G ENERAL MEDICINE 6176
8 CHEST CLINIC 166
9 MBU 2094
10 SEPTIC UNIT 963
11 PSYCHIATRY 2
TO TAL = 40G01
B IO  S TAT IST IC  I AN.
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