Imagine that you have been appointed the director of health at the Kaluyu Memorial Hospital in Nairobi, Kenya—a for-profit hospital. The facility is also a referral hospital and receives severe cases of accidents and chronic and communicable diseases, and it houses an HIV/AIDS ward. As you settle into your position, you realize that the employees always act scared as they approach their superiors. Some of the employees deliver files and leave your office in a hurry.
As you make your routine departmental visits, you observe tension among the nurses and doctors, and there is a sentiment that the nurses tend to do the majority of the work within patient care but the doctors get all the credit. You notice that the employees are always looking forward to the end of their shifts when they can go home. You notice that some of the doctors come back to work wearing the same unwashed clothes as the previous day. Too many employees are calling in sick, and many of them give weak reasons for their tardiness.
There is also a sense that doctors and nurses dominate other employees in similar positions. In meetings and conference calls, some employees are quiet and never participate. You notice that people with families tend to gather and talk quietly on breaks. The new mothers working for the hospital have to use bathrooms to pump breast milk for their infants, and the refrigerators do not work well. Looking at the financial statements of the hospital, you realize that the hospital’s expenses are higher than the industry standard, and it incurs losses year after yea