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The current trend of globalization and rapid working environment change has become a challenge for organizational
management of change. The purpose of the study therefore was to investigate the relationships between
organizational culture and change management at Kakamega provincial hospital. The specific objectives of the study
was to establish the relationship between institutional leadership and management of change and to find out the role
of training and development in managing change at the KPGH using organizational culture. The data for this study
was collected from primary and secondary sources. The study adopted Hofstede’s organizational culture theory
framework to understand the relationship between organizational culture and change management. Descriptive
survey design was adopted for the study. The research instruments were questionnaire and documentary analysis.
The study population comprises of senior, middle management staff, general employees, and subordinates staffs. The
sample of one hundred and eighty eight respondents was selected for the study using stratified and simple random
sampling technique. Correlation analysis was used to establish the relationships between organizational culture and
change management in Health sector in Kenya. Results identified element associated with organizational culture in
KPGH. The study further established that there is a positive correlation (r= 0.783, p < 0.05) significant relationship
between institutional leadership and management of change in KPGH. The study revealed a significant positive
correlation (r=0.3.9, P<0.05) between the level of training and development and managing change at the KPGH.
This study is significant since it is hoped that findings and recommendation of the study will benefit Kenya
government, MOH, Employees of Health institutions, scholars of various fields will use the findings to carry out
further research to compliment and supplement the current study.
Key Words: Organizational Culture, change Management, institutional management, training and
development
Introduction
The ever-changing business environment market demands and avoid unnecessary costs
produces vast amounts of information it is important to ask the question if we can, in
concerning trends and events in the some way, predict, understand or influence the
technological, political/legal, social and process of change. The purpose of this study is
economic environment that might have a to determine the role of organizational culture
substantial effect on the organization and its in planning and managing a process of change
strategies, (Martino, 1993). This highlights a in the health sector in Kenya.
need for assessing the role of organizational
culture in management of change as The majority of academic literature has ably
organizations are facing a continuously described culture and dwelled on
changing environment, both locally and measurement and control mechanisms
globally. Far from all, businesses manage to (Hofstede 1991; Schein 1985). However, despite
succeed with their organizational changes. the enthusiasm for organizational culture and
Olson (2008) stressed that if wanting to meet its transformational character displayed by
Africa International Journal of Management Education and Governance (AIJMEG) 2(2):30-45 (ISSN: 2518 -0827)
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theory was used to understand the conceptual institutional leadership, training and
relationship between the elements of development and technology.
organization culture which includes:
Change Management:
Institutional leadership
Management of prescriptions
Management of admissions
Training and
Management of attendance
Development Management of customer care
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learning environment, and to lower staff transition state to a future desired state.
turnover. This may be true of stable Change can also be defined to mean an
organizations which are comfortable with their alteration in the existing field of forces that
current state of affairs. In organizations which tends to affect the status quo. In order for
are undergoing major, fundamental changes, equilibrium to be restored, action has to be
the high levels of consensus and the absence of taken.
conflict referred to by the authors may Armstrong, (2003) is of the view that change
disappear, due to opposition to change and can create instability with disharmony and
even people leaving the organization. In this surprise. The organizations culture can create
way, a strong organizational culture may have solidarity and can inspire commitment and
detrimental effects on the process of change, productivity. The organization's culture can
especially if it is not managed skillfully. actively and forcefully work against an
Organizational culture is commonly organization when change becomes necessary.
conceptualized as dynamic (Frank and If not properly managed, change can decrease
Farhrbach, 1999; Hatch, 1993; Schein, 1996), morale, motivation, commitment and create
multifaceted (Harrison, 2000) and layered conditions of conflict within an organization.
(Detert et al., Hofstede et al., 1990; Schein, Collin (1994), suggested that effectiveness
1992). The conclusions that can be drawn from must include the ability to identify the right
these authors is that while change may be things to do in the future, the right products
opposed by entrenched organizational and services to offer, the appropriate
cultures, an alternative way of making changes technologies to exploit, the best procedures
happen is to begin by changing the culture and structures to introduce, to find, recruit and
itself, after which the changes to the retain people with appropriate skills.
organization will take place smoothly. This is Effectiveness also requires the ability to adopt
confirmed by Martins and Terblanche (2003), in order to achieve these new tasks.
who suggest that structure and culture in Effectiveness, therefore, entails the capacity to
organizations exist in close alignment. adapt to changing circumstances.
Structure is one of the determinants of culture,
and conversely, culture has an influence on the
organizational structure and operational Institutional Leadership and Management
Change
systems in an organization.
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reason, managers attempting cultural change in relevance from a cultural perspective. Training,
order to change an organization should identify creativity and teamwork are as a consequence
the negative aspects of the organizational of cultural aspects that require attention.
culture and seek to change them, rather than The characteristics of trained personnel are
condemning the whole culture. very much in line with a person/task culture.
They tend to stand in contrast to the
role/power cultures, which constrain
Role of Training and Technology on employee empowerment and the effective
Management Change
utilization of the inherent intellectual capital
Training and development can be defined as
that resides within the enterprise. Senge (1995)
the process of providing employees with
is of the opinion that the core of the culture
specific skills or helping those correct
transformation is the concept of organizational
deficiencies in their performance (Poh, 2001).
learning. In learning organizations cultural
Previous empirical studies have provided
norms defy business tradition (Senge 1995).
extensive evidence that training and
Technological and process changes are
development facilitate the updating of skills,
instrumental in upsetting peoples well-
and lead to increased commitment, well-being,
established comfort zones and as a result
and sense of belonging, thus directly
people tend to experience emotional stress,
strengthening the organization’s
(Porter 2001). Behaviour is influenced by
competitiveness (Acton and Golden, 2002;
powerful negative emotions that emanate from
Karia and Ahmad, 2000; Karia, 1999). Bartlett
stress related conditions and stress has
(2001) found that perceived access to training,
therefore become a workplace issue that needs
social impact of training, motivation to learn,
to be addressed by leaders in managing people
and perceived benefits of training are positively
through change (Rees and Redfern 2000).
related to organizational commitment and
consequently to organizational change.
According to Cherrinton (1995), a successful 3. RESEARCH METHODOLOGY
training and education program creates more Research design
favourable employee attitudes and loyalty and To execute this research, the descriptive
helps employees in their personal development method was adopted as research design. This
and advancement. Moreover, Deming (1986) type of research attempted to describe such
stresses the importance of education and things as possible behaviour, attitudes, values
training for continual updating and and characteristics (Mugenda and Mugenda,
improvement, identifying one source of human 1999).
motivation at work as intrinsic motivation: the Study area
desire to grow; learn and to develop oneself. The study was carried out at the Kakamega
Appropriate training at an early stage of the Provincial General Hospital which is one of the
organizational change process can be used to Provincial General Hospitals in Kenya.
forestall the mutterings of discontent that Kakamega is the provincial headquarter of
would otherwise arise from those who are Western province and is bordered by Lugari
resistant to change. district to the North East, Vihiga to the South
Zwell (2000) states that a successful culture East, Mumias district to the West and Bungoma
fosters employee development and encourages district to the North West (Development Plan,
employees to become actively engaged in the 1994). The hospital is situated along the
activities of the organization. The underlying Kakamega-Kisumu highway, two kilometres
rationale is that an enterprise’s response in from Kakamega town centre. The hospital
serving its clients cannot be greater than the serves a catchment population of
collective efforts of its employees. Therefore, approximately five million people who resides
staff development and motivation assumes in the province and acts as a referral hospital to
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Africa International Journal of Management Education and Governance (AIJMEG) 2(2):30-45 (ISSN: 2518 -0827)
29 health centres, dispensaries and districts subject on which the measurement is being
hospital. taken. The target population of this study
Target population comprised of 24 senior management staff, 24
Target population is the population marked for middle management staff, 226 general
the study. It refers to all the units of whatever employees, 112 subordinates’ staff and 78 casual
nature that a researcher intends to study (Leedy, staffs.
2005). A population element is therefore, the
In each stratum the proportion of male to female was considered, the researcher used 188 (40%) sample
from each of the stratum that represents the total population. The study adopted 40% of the study
population taking into consideration of missing value analysis. Missing value analysis was designed to
highlight missing values as well as to replace them in the data set. Also high level of statistical
significance is required (dalen, 1979). This is shown in table 3.2 below.
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respective employees. The researcher before questionnaires were returned out of the 188
collecting data from the participant informed that were given out generating a response rate
the various Heads of departments in advance of 80%. A total of 150 questionnaires were
about the study. It is the responsibility of the therefore used in the data analysis.
researcher to establish rapport with the Missing value analysis was performed to check
respondents. for patterns of missing data and the sizes of the
Reliability and Validity of Research missing values. Missing value analysis was
Instrument designed to highlight patterns of missing
Reliability values as well as to replace them in the data set.
The questionnaire was tested for reliability by The missing value analysis results showed that
using Cronbach Coefficient Alpha to determine the percentage of missing values was less than
the internal consistency of the items. This is a 20%. This was consistent with most studies
method of estimating reliability of test scores with large sample sizes given that almost any
by the use of a single administration of a test procedure for handling missing values was
(Mugenda and Mugenda, 1999). For the expected to yield similar results (Saunders et al.
purpose of this study, the items were 2007).
considered reliable when they yielded a
reliability coefficient of 0.70 and above. The
value of Cronbach Coefficient Alpha is Assessment for Normality
generally required to be over 0.70. The Generally, the assumptions include
reliability of the elements associated with independence of error, homogeneity of variable
organizational culture, institutional leadership, and normality. Normality in particular can
training and development, technology and often be addressed prior to hypothesis testing
institutional challenges. The items on elements through data screening procedures. Normality
associated with organizational culture was is a test that each variable and all linear
0.960, items on “institutional leadership” was combinations of the variable are normally
0.944, items on “training and development” distributed (Kline, 1998). Normality of the
was 0.869, items on “technology” was 0.950 and variables in the data set was examined using
items on “t institutional challenges” was 0.847. Skewness and Kurtosis. Previous research has
Validity of the Instrument suggested that appropriate Skewness values
To test the validity of the research instrument, are those that range from -2 to +2, while
the questionnaire was prepared and submitted Kurtosis values for appropriate “Peakedness”
to the supervisor and other research experts for are those that range from -6 to +6 (Bryne, 1998).
cross checking and also to assess the relevance The score of Skewness and Kurtosis on each
of the content. The questionnaires were pre- item was therefore analyzed and reported.
tested, modified and free from ambiguity. Pilot
study was carried out three weeks prior to the
main study in Kisumu Provincial General
Hospital in order to establish the construct
validity of the schedules.
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Table 4.7: The relationship between institutional leadership and Management of change (significant
at the 0.05 level)
Independent variable Dependent variable Correlation coefficient Significance(P)
Institutional Leadership Management of change 0.783 P< 0.05
Source: Survey data.
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The results indicate a significant positive The role of training and development in
correlation between leadership, knowledge management of change.
and skills and management of change (r= 0.783, An examination of the association between the
p < 0.05). level of training and development and
These results imply that the culture of management of change revealed the
leadership relates positively with management information presented in table 4.9 below.
of change. Therefore, good leadership, armed
with the right knowledge and skills is likely to
ease the management of change and vice versa.
Table 4.8 The relationship between the level of training and development and management of
change (Significance at the 0.05 level)
Independent variable Dependent variable Correlation coefficient Significance (P)
Level of training and development Management of change 0.309 P< 0.05
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knowledge workforce and studying social and belonging, thus directly strengthening the
demographic trends, few would dispute that organizations competitiveness (Acton and
the primary task of management today is the Golden, 2002; Karia and Ahmad, 2000; Karia,
leadership of organizational change.” 1999). Zwell (2000) also observed that a
As observed by Konzes and Posner (1995), successful culture fosters employees’
leaders need therefore to among others: development and encourages employees to
investigate change, inspire a shared vision, become actively engaged in the activities of the
thereby initiating a new culture, reducing the organization. The study established that the
power distance by delegating and encouraging level of training and development among the
diversity of opinion, leading by example and Kakamega Provincial General Hospital
using a more nurturing and mentoring employees provided an avenue for the staff to
approach. By so doing, the staff is likely to maximize their talents in the hospital besides
receive change positively and consequently enhancing their intellectual capital.
easily manage the change. These views were
well captured by Nauns (1992) who concurred
that, “There is a more powerful engine driving Summary of findings
an organization towards excellence and long
The study, through the sample of hospital staff
range success than an attractive, worthwhile,
established that teamwork culture,
and achievable vision of the future, widely
organizational communication, leadership
shared”. Consequently, the crux of the matter
culture, capacity building and to a smaller
for any leader who intends to overcome the
extent the culture of commitment was being
resistance of organizational culture to change,
practiced at the Kakamega Provincial General
is to first come up with a comprehensive vision
Hospital. These finding of the study showed
and then to explain it in terms that are
that the culture of leadership, knowledge and
intelligible to the whole of the organization.
skills relate positively with management of
Thus, a management must indeed act in
change. As shown from the study finding, there
accordance with the vision so as to impart
is a significant positive correlation between the
meaning to staff, as to how to interpret events
culture of internal communication and
that are being played out during periods of
management of change. The study established
change.
that the level of training and development
among the Kakamega Provincial General
The role of training and development in Hospital staff is positive correlation between
managing change at the Kakamega the level of training and development and
Provincial General Hospital. management of change. This provided an
Regarding training and development, the avenue for the staff to maximize their talents in
current study established that the levels of the hospital besides enhancing their intellectual
training in the staff was high with a majority of capital.
the staff and 112 (74.7%) reporting that they Conclusion
were of diploma level and above. The study From the findings of the study, it can be
further established that there is a positive concluded that this study provided an
correlation between training and managing opportunity to understand the organizational
change at the Kakamega Provincial General characteristics and relationship between
Hospital. organizational culture and change
This finding is consistent with other empirical management in the Kenyan health sector.
study findings which provided evidence to the Within the non-profit sector, especially in
effect that training and development facilitate health sector and social services, change is a
the updating of skills, and lead to increased constant factor.
commitment, well-being and sense of
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Africa International Journal of Management Education and Governance (AIJMEG) 2(2):30-45 (ISSN: 2518 -0827)
From the findings of the study, it can be employees will be more likely to perform better
concluded that there is a significant and to feel a higher level of commitment
relationship between institutional leadership towards the organizations.
and management of change in Kakamega
Provincial General Hospital. The findings Because the future is unknowable, and because
indicated that at Kakamega Provincial General surprises are certain, one’s chances of
Hospital, the culture of leadership impact developing the “right” policy are not good.
directly on management of change. Therefore, Survival and growth in these turbulent times
the importance of institutional leadership in the depend partly on what you do (management of
change process is paramount for survival of change) and largely on how you do it
organization. (implementation). The ability to change
direction fast, realign resources and move
Findings of the study, it is concluded that the forward aggressively, is vital. Now, as never
level of training and development among the before, deep introspection, hard trade-offs and
personnel of Kakamega Provincial General creative thinking which is key to creating an
Hospital provided an avenue for the staff to organization that is at once disciplined and
maximise their talents and updating their skills, flexible, single-minded and open-minded,
hence, positive outcome for management of patient and aggressive, cautious and bold.
change. The correlation test of analysis further
indicate that there is a significant relationship
between the level of training, development and Further Research
managing change at the Kakamega Provincial
The present study was carried out in a hospital
General Hospital.
environment where nurses tend to spend
Recommendations
relatively long periods in one ward. In
The research focused on the relationship
organizations where employees are more
between organizational culture and change
mobile within the organization, there may not
management in Health sector in Kenya. The
be time to form a well-defined subculture that
research has been restricted to Kakamega
can have significant impact on management of
Provincial General Hospital. The
change. Furthermore, it was assumed that a
recommendations presented relate to the
ward would constitute a subculture;
specific findings of the study and to a broader
subsequent research might want to empirically
policy perspective. Based on the foregoing
determine that rather than assume it. The
discussion of the findings and conclusion, this
literature also suggests that subcultures can
study recommends the following:
form around a number of possible dimensions;
It is critical for these types of organizations to
future research might look at other types of
develop strategic means to manage and
subcultures formed around, for example,
efficiently respond to the continuous changes.
professions or occupations.
Ultimately a strong positive culture and
effective management of change can strengthen
This study employed a descriptive survey
an organization in their strategic environment
design. In any model in which causal
while leading to improved financial health,
relationship is suggested, longitudinal studies
vitality, and in the end serving clients more
provide for stronger inferences. Thus, the
effectively.
research design developed and tested in this
study could benefit from being tested in a
In addition, the findings prescribe potential
longitudinal design. For this reason,
implications for top management to review
longitudinal studies of organizational culture
their organizational culture dimensions,
dimensions are strongly recommended and
consistent with the training needs of the
long overdue.
employees within the organizations. Hence,
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