An assessment of the influence of employee participation on service delivery: A case of Kakamega county referral hospital

 Corresponding author: Marleen Isese Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. An assessment of the influence of employee participation on service delivery: A case of Kakamega county referral hospital Marleen Isese *, Geoffrey Kimutai and Pamela Eng’airo Faculty of Business and Economics, The Catholic University of Eastern Africa, Kenya. World Journal of Advanced Research and Reviews, 2025, 27(03), 512–517 Publication history: Received on 29 July 2025; revised on 04 September 2025; accepted on 06 September 2025 Article DOI: https://doi.org/10.30574/wjarr.2025.27.3.2932 Abstract Purpose: This study assessed the influence of employee participation on service delivery at Kakamega County Referral Hospital, addressing the critical gap in employee relations management research within Kenya's public healthcare sector. Scope: A case study design was employed targeting 1,250 employees at Kakamega County Referral Hospital. Using stratified and convenience sampling techniques, 93 health workers were selected based on Mugenda's formula for populations under 10,000. Data collection utilized semi-structured questionnaires with Likert-type scales and interviews with human resource management personnel. Significant Results: Employee participation demonstrated significant positive influence on service delivery across multiple dimensions. Goal setting by employees showed the highest impact (M=4.32, SD=1.048), with 58.7% of respondents strongly agreeing it enhances service delivery. Employee involvement in hospital processes significantly improved service reliability (M=4.26, SD=0.609), with 56.5% agreement. Survey feedback utilization contributed to service improvements (M=3.85, SD=1.016), while employee participation reduced service complaints (M=3.79) and increased customer satisfaction (M=3.75). Major Findings and Conclusions: Employee relations management practices, particularly dispute resolution and employee participation, have statistically significant positive effects on service delivery outcomes. The study concludes that participatory and relational strategies are more effective drivers of service quality than financial incentives alone. Hospital management should prioritize inclusive decision-making, open communication channels, and systematic employee feedback mechanisms to enhance service delivery in public healthcare settings. Keywords: Influence; Employee Participation; Service Delivery; Hospital 1. Introduction Employee relations, also known as employment relations or industrial relations, refers to the systematic efforts undertaken by employers to manage relationships with employees both at the individual and collective levels [1]. This includes addressing employee concerns, ensuring their participation in decision-making, and resolving conflicts in a timely and amicable manner. A well-managed employee relations framework not only enhances employee satisfaction and retention but also contributes to organizational effectiveness, especially in service-oriented sectors such as healthcare. Scholars like [2] argue that smooth and respectful interactions between employers and employees foster operational efficiency and create an environment that supports high levels of performance and customer satisfaction. World Journal of Advanced Research and Reviews, 2025, 27(03), 512–517 513 Globally, employee relations management (ERM) has evolved to encompass broader components beyond traditional dispute resolution and collective bargaining. As [3] point out, ERM today includes issues such as diversity management, equal opportunity practices, work-life balance, policy interpretation, performance management, and grievance handling. When ERM is well-aligned with an organization’s vision, mission, and goals, it becomes a powerful tool for mitigating workplace conflicts and aligning employee efforts with organizational objectives. [4] assert that such alignment minimizes employee turnover and creates a conducive environment for collaboration, innovation, and service excellence. [1] highlights that ethical organizational behavior and a genuine commitment to meeting employees’ professional aspirations form the bedrock of effective employee relations management. Despite the global emphasis on ERM, its application in developing countries remains relatively under-explored and underdeveloped. [5] notes that many organizations in these regions lack structured ERM systems, resulting in unresolved conflicts, high turnover, and poor service delivery. Moreover, globalization and rapid technological change continue to redefine the role of human resources. New challenges such as managing a mobile workforce, retaining skilled talent, and adopting digital technologies are now central to the HR function. [6] further suggests that to maintain employee engagement, HR managers must embrace adaptable tools, inclusive practices, and context-specific strategies that reflect the realities of modern work forces. Within the African context, research on employee relations remains relatively sparse and fragmented. [7] emphasizes that Western HRM theories may not always translate effectively to the realities of African workplaces due to differences in organizational structures, governance, and socioeconomic dynamics. For example, bureaucratic public institutions may lag in adopting participatory ERM practices compared to private enterprises that are more agile and innovation-driven. According to [8] the effectiveness of ERM in African countries often depends on localized practices, leadership style, and institutional capacity. Cases such as Tanzania Breweries and PricewaterhouseCoopers demonstrate that sophisticated HRM approaches—if properly adapted—can drive organizational success even in developing economies. Furthermore, in developing economies like Kenya, implementing HRM policies and practices faces several systemic barriers. [9] identifies key HRM implementation challenges in Kenya including limited training resources, resistance from trade unions, weak recognition of HR’s strategic role, and widespread issues of retrenchment, poor work ethics, and under investment in HR research. These challenges are further compounded in the public sector, where centralized decision-making and bureaucratic inertia can hinder responsive human resource practices. [10] pointedly observed that all resources in an organization are rendered static without human resource input—highlighting the irreplaceable role of employees in driving change and delivering services. Nowhere is this more evident than in the public healthcare sector, where the role of human capital is not only critical to service delivery but also central to public trust and social welfare. In Kenya, the devolution of healthcare services to county governments was meant to increase responsiveness, efficiency, and equity in service provision. However, these reforms have brought with them new tensions in employee relations. [11] similarly note that poor industrial democracy, lack of participatory management, and unaddressed grievances among health workers have contributed to recurrent strikes, subpar care, and low morale within healthcare facilities. Healthcare is a labor-intensive industry that relies heavily on the commitment, motivation, and collaboration of its workforce. Yet, studies such as that by [12] reveal that healthcare workers across the globe increasingly experience work-related stress, burnout, and disengagement—often due to unresolved conflicts, lack of recognition, or poor working conditions. To mitigate these challenges, [13] advocate for strengthened industrial peace mechanisms through employee-focused relations strategies. These include fair compensation, inclusive leadership, regular communication, and recognition of employee contributions—factors that research by [14] shows can enhance retention and reduce turnover. In Kenya’s public healthcare sector, employee relations are further strained by perceived inequities in human resource deployment, poor working conditions, and inefficiencies in salary administration. These factors contribute to high levels of dissatisfaction among healthcare staff, ultimately affecting service delivery. According to [5], changes in hospital autonomy under devolution have limited the ability of county facilities to independently respond to employee concerns or institute proactive workforce strategies. Consequently, employees often feel unheard and undervalued, which manifests in low morale and diminished service quality. World Journal of Advanced Research and Reviews, 2025, 27(03), 512–517 514 Moreover, labor unions have emerged as powerful actors in mediating the employer-employee relationship, especially in healthcare. While trade unions advocate for improved pay and working conditions, the confrontational nature of some engagements has at times led to service disruptions. [15] caution that while collective bargaining is important, unions and governments must strike a balance between pushing for better terms and sustaining critical public services. This calls for the institutionalization of fair and participatory employee relations systems that provide structured platforms for dialogue, negotiation, and dispute resolution. According to the Labour Commissioners Annual Report [16] there were 82 strikes in 2010, 23 strikes in 2011, and 17 strikes in 2012, with the bulk of the strikes occurring in the public healthcare sector. Employee-employer disputes, inadequate or non-existent infrastructure, and poor remuneration methods and delayed salary payments are all sources of aggravation in Kenya's public healthcare industry [17]. Patients, communities and governments across the area and abroad are concerned about the public healthcare sector's incapacity to reverse worsening healthcare situation [18]. To this end, there is a great concern on the need for research to fill the gap in the health care sector on employee relations management and service delivery given the unending wave of health worker strikes. This study was conducted to assess the influence of employee relations management practices on service delivery at the Kakamega County Referral Hospital. 1.1. Research Question How does employee participation influence service delivery in Kakamega Referral Hospital? 2. Materials and Methods The researcher employed a case study research design was adopted. A case study design is particularly suitable for the study “Employee Relations Management Practices and Service Delivery in Kakamega County Referral Hospital” because it allows for an in-depth, contextual exploration of complex organizational dynamics within a real-life setting. This design is ideal for capturing rich qualitative data through interviews, observations, and document reviews, making it possible to uncover patterns, relationships, and causal pathways that might be missed by purely quantitative methods. Kakamega County Referral Hospital serves as a critical case because it is a major public health facility in the region and is subject to both county and national labor policies, making its employee relations practices both relevant and instructive. A total of 1250 employees were targeted. The workers of Kakamega County Referral Hospital, who formed the study's target were sampled using stratified sampling, while convenience sampling was employed to gather sample units for each. Because there are fewer than 10,000 people in the hospital, [19] fomula was used to sample 93 health workers from the Kakamega County referral hospital. The researcher also included the Human Resource Management personnel through purposive sampling. A semi-structured questionnaire, specifically with the use of a Likert type scale on the research tools was used to collect data. Qualitative data was also collected form the human resources manager on the similar variables through use of an interview schedule. The researcher received authorization from The Catholic University of Eastern Africa Postgraduate School of Business and Economics which issued the introductory letter. After obtaining the letter from the research the investigator achieved NACOSTI permission. A request was directed to Kakamega County Referral Hospital medical superintendent through the delivery of a permit from NACOSTI. 3. Results The research question in this research sought to establish the influence of employee participation in the hospital on service delivery. The researcher through a likert scale questionnaire of of 5 strongly agree, 4 agree, 3uncertain, 2 disagree and 1 strongly disagree provided a number of items related to employee participation that the respondents were to rate either agreeing or disagreeing with the statements. The results are as presented in Table 1. The findings in Table 1 show that setting of goals by employees enhances service delivery was the most rated item (M=4.32, SD=1.048) with majority 54(58.7%) of the respondents strongly agreeing while 25(27.2%) agreed with the statement. Quite a number were however of the opinion that goal setting does not enhance service delivery as depicted by 6(6.5%) who disagreed and 3(3.3%) strongly disagreed. At least 4(4.3%) of the respondents were not sure whether goal setting helped in enhancing delivery of services by the employees. Hospital personnel participation results in better service reliability according to staff measurements (M=4.26, SD=.609). A large portion of respondents acknowledged that employee involvement enhances service reliability at the kakamega county hospital with agreement from 52 people representing 56.5% of the participating subjects. Of the respondents, 32(34.8%) strongly supported this statement and 8(8.7%) were undecided regarding the matter. World Journal of Advanced Research and Reviews, 2025, 27(03), 512–517 515 Table 1 Influence of employee participation on service delivery Statement [n=92] 5 4 3 2 1 Min. Max Mean SD Setting of goals by employees enhances service delivery 54 (58.7%) 25 (27.2%) 4 (4.3%) 6 (6.5%) 3 (3.3%) 1 5 4.32 1.048 Utilization of survey feedback by personnel has enhanced the delivery of services at the hospital 22 (23.9%) 50 (54.3%) 7 (7.6%) 10 (10.9%) 3 (3.3%) 1 5 3.85 1.016 Increased employee involvement leads to reduction in service complaints 29 (31.5%) 42 (45.7%) 4 (4.3%) 7 (7.6%) 10 (10.9%) 1 5 3.79 1.271 Involving personnel at the hospital has enhanced service reliability 32 (34.8%) 52 (56.5%) 8 (8.7%) 0 (%) 0 (0%) 1 5 4.26 .609 Employee participation has fostered customer satisfaction within the hospital 35 (38.0%) 28 (30.4%) 10 (10.9%) 9 (9.8%) 10 (10.9%) 1 5 3.75 1.348 Key: nSample Size, MinMinimum, MaxMaximum, SD-Standard deviation Survey feedback utilization by personnel directly contributes to service delivery improvement in the hospital according to respondents (M=3.85, SD=1.016). Respondents who agreed with the statement represented more than half of the participants at 50(54.3%) while those who strongly agreed accounted for 22(23.9%). The majority of 10(10.9%) of respondents commented against the belief that employee feedback utilization boosts service delivery in the hospital facility while 3(3.3%) strongly challenged this perspective. The study participants acknowledged that better employee engagement creates less service complaints and employee participation improves customer satisfaction in the hospital (M=3.79, SD=1.271, M=3.75, SD=1.348). Respondents expressed agreement regarding survey feedback utilization in service delivery at the hospital by 42(45.7%) while 29(31.5%) strongly concurred with the statements and 10(10.9%) disapproved and 4(4.3%) remained neutral about its effectiveness. The respondents evinced strong agreement through this survey that hospital customer satisfaction has seen improvement because of participating employees. Only 9(9.8%) disagreed. The HR manager acknowledged that employee participation promotes a culture where workers feel valued and can openly share their insights. These sentiments corroborate with what is established through the questionnaire by the employees. The HR manager had this to say: Here at the hospital we have several ways through which employees get involved and by this our personnel department is able to collect information from them with regard to their opinions, needs and grievances. We obtain these feedback by way of dialogues with the employees in capacity building forums.(Personal Communication, June 2024, HR Manager) 4. Discussions The research question aimed to assess how employee participation influences service delivery at Kakamega County Referral Hospital. The findings from Table 4.3 indicate that employee involvement, particularly in goal setting, plays a significant role in enhancing service delivery. With the highest mean score (M=4.32, SD=1.048), the majority of respondents strongly agreed that when employees are involved in setting their own goals, their commitment to work improves, which in turn boosts service outcomes. These results align with [20] who emphasized that goal-oriented employees tend to exhibit positive attitudes and higher motivation, resulting in improved job performance. The active involvement of employees in defining their objectives likely fosters a sense of ownership and accountability, critical drivers of quality service in healthcare settings. Further findings showed strong support for the idea that employee involvement enhances service reliability (M=4.26, SD=0.609). Most respondents acknowledged that their participation in hospital processes positively affects the consistency and dependability of the services offered. This is in line with the work of [21] who argue that employee engagement, particularly in decision-making processes, significantly improves service delivery across organizations. World Journal of Advanced Research and Reviews, 2025, 27(03), 512–517 516 The utilization of survey feedback also emerged as an important participation strategy (M=3.85, SD=1.016), with the majority of respondents agreeing that feedback collected from staff has led to improvements in service delivery. Additionally, employee participation was found to contribute to a reduction in service complaints (M=3.79) and increased customer satisfaction (M=3.75), indicating that engaging staff in operational decisions and feedback mechanisms strengthens client-focused outcomes. These quantitative insights were supported by qualitative data from the HR manager, who highlighted that participation mechanisms such as dialogues and feedback forums are in place and are actively used to understand and respond to employee concerns. This shows that employee participation is not only valued but also systematically implemented as a strategy to improve service quality at the hospital 5. Conclusion The study concludes that employee relations management practices play a vital role in shaping service delivery outcomes at Kakamega County Referral Hospital. Strong and positive employee relationships contribute to a conducive work environment, enhance staff motivation, and ultimately improve the quality of services provided. Specifically, the findings revealed that dispute resolution practices and employee participation have a statistically significant and positive influence on service delivery, highlighting the importance of open communication and inclusive decisionmaking. While trade union recognition was found to have a positive correlation with service delivery, its influence was not statistically significant. On the other hand, employee compensation, despite being recognized for boosting individual performance, did not demonstrate a meaningful impact on overall service delivery. These findings underscore the need for hospital management to prioritize relational and participatory strategies as key drivers of effective service delivery, beyond financial incentives alone. Compliance with ethical standards Acknowledgments I wish to acknowledge the support I received from Dr. Geoffrey Kimutai and Dr. Pamela Eng’airo in regard to analysis and editing my work. Disclosure of conflict of interest There was no competing conflict of interest. Statement of ethical approval Research permit was sought from National Commission Science Technology and Innovation (NACOSTI) to carry out the research. 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