Management Competence and Decision-Making Effectiveness in Private Notfor-Profit Hospitals: Evidence of St. Francis Hospital Nyenga

Abstract

It is generally accepted that management competence is a key element in enhancing decision-making effectiveness within healthcare institutions, especially in private not-for-profit hospitals where managerial decisions directly influence service delivery, accountability, and utilization of limited resources. This paper explores how management competence and decision-making effectiveness are related in St. Francis Hospital Nyenga in Uganda. The research was inspired by the continuing concern that, despite the availability of trained and experienced managers, there seemed to be no evidence of the presumed benefits of managerial competence in institutional decisions. This article thus aimed to establish whether management competence was a significant factor in decision-making effectiveness and how the relationship was mediated by institutional circumstances. The research used both quantitative and qualitative methods, and a descriptive-correlational case study design. Data was collected from a sample population of 167 respondents, including members of the Board of Governors, top managers, middle managers, finance and accounting staff, and patients. The study received 140 returned questionnaires and 10 interview responses, yielding an overall response rate of 89.82%. Quantitative data were analyzed using descriptive statistics, Pearson correlation, and regression analysis, while thematic analysis addressed qualitative data. The findings revealed a very weak explanatory model, with F(1,138) = 0.209, p = 0.649, R = 0.039, R² = 0.002, adjusted R² = -0.006, and a standard error of estimate of 0.63051. The study also observed that the relationship between management competence and decision-making effectiveness was weak and not statistically significant, with a correlation coefficient of -0.020. The article found that management competence was not statistically correlated with decision-making effectiveness in St. Francis Hospital Nyenga. Results indicated that structural and institutional factors, such as centralized governance structures, constrained decision-making discretion, and financial restrictions, played a stronger role in influencing decision-making outcomes than personal managerial ability. The article contends that management competence is most valuable when supported by practical autonomy, robust internal systems, and governance arrangements that integrate responsibility with decision-making authority.