Strategic clinical leader attributes and health system factors associated with patient loyalty to HIV care in Ampath-Moi Teaching And Referral Hospital, Eldoret Kenya

Abstract

Patient loyalty is a strategic component that ensures the sustainability of hospitals and gaining a competitive advantage in attracting more patients, however, patient loyalty to Human Immunodeficiency Virus (HIV) care is elusive in Sub-Saharan Africa and the determinants are less documented. The purpose of this study was to determine strategic clinical leader attributes and health system factors associated with patient loyalty to HIV care. The objectives were to determine the proportions of patients with patient loyalty, determine the health system factors associated with patient loyalty, explore the perceptions of healthcare providers on the strategic clinical leader attributes; examine the provider's perceptions of the relationship between strategic leader attributes and patient loyalty, establish the health system factors associated with patient loyalty to HIV care among patients receiving care at AMPATH-MTRH, Eldoret Kenya, and assess the mediating effects of patient satisfaction and health system capacity. This study was guided by the Theory of Planned Behavior and Complexity Theory. The study employed explanatory and exploratory research designs that were done in the Academic Model Providing Access to Healthcare in Moi Teaching and Referral Hospital. The target population included adult HIV-infected patients and healthcare providers who were sampled using stratified, systematic and purposive sampling procedures between December 2019-May 2020. The total sample for the surveys was 438 while for in-depth interviews was 22. Bivariate and multivariate analyses examined associations between variables and predictors of patient loyalty. Structural equation modeling tested mediating effects and thematic analysis extracted qualitative data. Overall perceived patient loyalty was (68%) for patients and (64%) for providers. Patients perceived statistically significant differences in patient loyalty in all clinics while providers perceived none. Results of multiple logistic regression analysis showed that patients and providers who perceived low health system capacity (OR: 0.09, 95% CI: 0.01, 0.7) perceived lower patient loyalty. Lower patient trust (OR: 0.09, 95% CI: 0.03, 0.26), and lower patient satisfaction (OR 0.37, 95% CI: 0.15, 0.87), predicted lower patient loyalty. Providers who perceived low leader adaptive capacity (OR: 0.09, 95% CI: 0.01, 0.67), perceived lower patient loyalty. Results of path analysis showed that patient satisfaction mediated the relationship between patient trust (β=.073, p=.001) and patient-provider communication (β=.16, p=.001) with patient loyalty. Health system capacity negatively mediated the relationship between leader adaptive capacity (β= -.16, p=.001) and patient loyalty while positively mediated clinical leader attributes (β= .33, p=.001) and patient loyalty. Qualitative results identified strategic leader attributes for clinical leaders as having clinical competence, being an effective communicator, being honest, having integrity, having problem-solving skills, being approachable, and being a team leader. The study concludes that a higher proportion of patients are loyal to HIV care and strategic leader attributes are necessary for clinical leaders. Also, health system factors and strategic clinical leader attributes influence patient loyalty to HIV care. The study recommends the need for innovative approaches to maintain loyal patients and address existing gaps in HIV care using robust methodologies, build the capacity of clinical leaders in strategic leadership, cascade strategic leadership at all levels of the facility management, and develop policies and guidelines to address patient and health system dynamics and enhance patient loyalty to HIV care.