Factors affecting employee performance of health care workers: a case study of registrars (doctors) in Kenyatta National Hospital

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Factors affecting employee performance of health care workers: a case study of registrars (doctors) in Kenyatta National Hospital

Literature Review

Theoretical Background of the Study

Theory of Needs

People, with specificity to employees, have an innate desire to excel and be successful with motivational factors of avoiding risky situations. The theory of needs as invented by David McClelland proposes that individual needs are acquired intermittently and over a period of time. In most cases, the requirements are shaped by experiences in one’s life including career (Khurana & Joshi, 2017). As such, McClelland determined that three factors are paramount towards individualistic success. According to Miner (2015), they are achievement, affiliation, and power. Achievement is defined as the need to surpass reasonable expectations by avoiding low-risk and high-risk assumptions. However, the type of risk an individual is involved can determine the reward. The assumption is that low-risk yields low rewards and high-risks bring on high-rewards (Miner, 2015). The second factor is affiliation which is the need to associate with other people within a setting or an environment. Humans tend to conform to the norms of an organization based on their culture. The premise is that the higher the affiliation, the better the performance outcome. The third aspect is power, and power is associated with personal and institutional affiliation (Miner, 2015). Personal power is directive and encompasses the need to be perceived by others on certain levels such as being authoritative or associative. Also, power can be institutionally provoking a social effort to improve the adequate performance of an organization.

Herzberg’s Motivation Theory

The psychologist Herzberg, Fredrick improved on the theory of needs based on a two-factor structure. The study was based on a motivational study conducted on 200 accountants as well as engineers who were employed by firms in Pennsylvania. The conclusions of the study determined that job satisfaction is a two-pronged system. According to Sanjeev and Surya (2016), job satisfaction entails hygiene and motivation. Hygiene encompasses the institutional policies and administrative concepts that include supervision, interpersonal relations as well as wages and salary structures. For motivators, it provides recognition, achievement, and responsibility as well as advancement and growth (Sanjeev & Surya, 2016). The impact that motivators have employee performance is direct and have a causal relationship that determines whether an overall company performance is positive or negative.

Factors Influencing Employee Performance

An organization’s capability to perform based on its pre-determined goals and objectives is evidential through its employee performance on the level of productivity. Comprehension of the factors that influence employee performance is crucial to understand the short-term and long-term outcomes.

  1. Job Stress

Job stress is produced when an individual is not able to properly coordinate the available resources with their roles and responsibilities. In most cases, job stress is directly linked to personal abilities. According to a review by Ahmmad et al. (2016), studies have determined that companies may demand high achievements from their employees from which the employees are unable to cope with the standards. Contrary to this, Aguenza and Som (2018) elucidate that job stress is a social problem and not an institutional one. The study suggests that social issues based on psychological and physical aspects are to responsible for job stress.

  1. Motivation

Motivation is the willingness and the ability of an employee to satisfy the needs of the institution as well as their own. The consensus is that motivated employees perform the best whereas, non-motivated employees do not (Awadl, Gichinga & Ahmed, 2015). The former is propelled by aspects of self-satisfaction, self-fulfilment, and commitment. Kuule (2017) concurs that motivated employees always seek to be involved in their job tasks, improve overall expectations and seek to achieve organizational targets.

  1. Communication

Communication refers to the ability to coordinate information between staff and teams. Absence of proper communication structures can lead to chaos and the inability of an organization to function (Kiruja & Kabare, 2018). The direct result is that delivery of expectations are limited and can lead to a frustrating job environment for the workers.

  1. Empowerment

Empowerment refers to the ability to achieve, accomplish and attain an objective successfully. To achieve the prospects, employees have to be individually motivated as well as institutionally to attain organizational success (Siengthai & Pila-Ngarm, 2016). Therefore, employee performance can directly provide evidence on whether the workers are empowered or not.

Conceptual Framework

A conceptual framework presents the relationship between the dependent and independent variables within a study. The figure below represents the expected outcomes from the interaction of variables and expected results.



Figure 1: A Conceptual Framework






















The employee performance within an organization is directly dependable on the factors on communication, job stress, empowerment, and motivation. Employee performance is a factor that is pivotal to how an organization can achieve its objectives and goals in the long-run. As such, it is necessary to understand how the conceptual framework defines the relationship between the dependent and the independent variable.

Research Gaps/Knowledge Gaps

A full spectrum of studies has researched employee performance over the past three decades. The consensus is that organizational performance and employee performance are correlational with an impact that is directly related to the aspects of the corporate culture. In Kenya, studies conducted have linked organizational factors to employee achievement on performance. Expressly, studies on government institutions have provided a general understanding of why employees performance stagnates and has not improved. The general premise is that the work environment, resource allocation, and management practices are the leading causes of reduced or no employee performance. The limitation of the studies is that the research focuses on aspects of institutional performance and tenets concerning employees. There is a lack of evidence to support that employees affect employee performance directly. The reason is that performance is the process of creating a work environment or setting where employees can perform to the best of their abilities (Korir, & Kipkebut, 2016). The lack of information regarding how employee factor affects employee performance may be the missing link to understanding why government employees, especially in Kenyatta Hospital, is poor or underrated. Additionally, empirical evidence is scanty on how employees factor into employee performance and provide a correlation to organizational performance based on employee performance. Therefore, it is only right to conduct research about employee performance at a government institution such as Kenyatta National Hospital to determine the employee performance factors and how they affect employee performance.







Miner, J. B. (2015). Achievement Motivation Theory: David McClelland. In Organizational Behavior 1 (pp. 62-76). Routledge.

Sanjeev, M. A., & Surya, A. V. (2016). The two-factor theory of motivation and satisfaction: an empirical verification. Annals of Data Science3(2), 155-173.

Ahammad, M. F., Tarba, S. Y., Liu, Y., & Glaister, K. W. (2016). Knowledge transfer and cross-border acquisition performance: The impact of cultural distance and employee retention. International business review25(1), 66-75.

Aguenza, B. B., & Som, A. P. M. (2018). Motivational factors of employee retention and engagement in organizations. IJAME.

Siengthai, S., & Pila-Ngarm, P. (2016, August). The interaction effect of job redesign and job satisfaction on employee performance. In Evidence-based HRM: a Global Forum for Empirical Scholarship (Vol. 4, No. 2, pp. 162-180). Emerald Group Publishing Limited.

Kiruja, E. K., & Kabare, K. (2018). Linking work environment with employee performance in public middle-level TIVET institutions in Kenya. IJAME.

Awadh, I. M., Gichinga, L., & Ahmed, A. H. (2015). Effects of workplace stress on employee performance in the county governments in Kenya: A case study of Kilifi County Government. International Journal of Scientific and Research Publications5(10), 1-8.

Korir, I., & Kipkebut, D. (2016). The Effect of Reward Management on Employees Commitment in the Universities in Nakuru County-Kenya. Journal of Human Resource Management4(4), 37-48.

Kuule, Y., Dobson, A. E., Woldeyohannes, D., Zolfo, M., Najjemba, R., Edwin, B. M. R., … & Wilkinson, E. (2017). Community health volunteers in primary healthcare in rural Uganda: factors influencing performance. Frontiers in public health5, 62.