ArticleSocial science & medicine (1982)2017
Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya.
Article in Social science & medicine (1982), 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 46 papers, 2 of them syntheses that pooled it.
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Who cites it
46 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Measuring hospital care resilience: a systematic literature review.The European journal of health economics : HEPAC : health economics in prevention and care · 2026Pooled it
- Health disparities across the counties of Kenya and implications for policy makers, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.The Lancet. Global health · 2019Pooled it
- Understanding the role of 'software' in health system capacity for non-communicable disease response: hypertension care in rural Coastal Kenya.Health policy and planning · 2026Article
- Understanding the relational culture of healthcare workplaces: a framework to guide improvement interventions, derived from a realist evaluation of neonatal care in Kenya.BMC health services research · 2025Article
- Strengthening hospital infrastructure in a war context: the case of the Mopti regional hospital.Globalization and health · 2025Article
- Learning analysis of health system resilience.Health policy and planning · 2025Article
- Developing a pricing model for general medical consultation services among private consulting rooms in Harare, Zimbabwe.PloS one · 2025Article
- "Learn from Errors": Post-traumatic growth among second victims.BMC public health · 2024Article
- Hospital governance accountability structure: a scoping review.BMC health services research · 2024Article
- How does Public Financial Management (PFM) influence health system efficiency: A scoping review.Wellcome open research · 2024Article
- Influences of community engagement and health system strengthening for cholera control in cholera reporting countries.BMJ global health · 2023Article
- Observational
- Minimal resilience and insurgent conflict: qualitative analysis of the resilience process in six primary health centres in central Mali.BMJ global health · 2023Article
- Application of complexity theory in health and social care research: a scoping review.BMJ open · 2023Article
- Provision and utilization of maternal health services during the COVID-19 pandemic in 16 hospitals in sub-Saharan Africa.Frontiers in global women's health · 2023Article
- Identification of Key Components in Health System Using System Thinking Approach: A Scoping Review.Medical journal of the Islamic Republic of Iran · 2023Article
- Chameleon Leadership and Innovative Behavior in the Health Sector: The Mediation Role of Job Security.Employee responsibilities and rights journal · 2023Article
- 'Real-world' priority setting for service improvement in English primary care: a decentred approach.Public management review · 2023Article
- Methodological reflections on health system-oriented assessment of maternity care in 16 hospitals in sub-Saharan Africa: an embedded case study.Health policy and planning · 2022Article
- The sociology of rationing: Towards increased interdisciplinary dialogue - A critical interpretive literature review.Sociology of health & illness · 2022Review
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system 'hardware' (resource scarcity) and 'software' (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence.
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