Social Entrepreneurship and Organisational Performance of Public Referral Hospitals in the Lake Region Economic Bloc, Kenya

Kenya's public referral hospitals operate under persistent financial, human-resource and infrastructural constraints while being expected to provide accessible, equitable and high-quality healthcare. This study examined the relationship between Social Entrepreneurship and Organisational Performance among public referral hospitals in the Lake Region Economic Bloc, Kenya. Anchored in Resource Dependence Theory and Stakeholder Theory, the study adopted a positivist philosophy and an explanatory cross-sectional survey design. Data were obtained from 415 healthcare professionals serving as key informants drawn from 83 public referral hospitals across six counties. Social Entrepreneurship was modelled as a reflective-formative higher-order construct comprising Process and Results, while Organisational Performance comprised Financial Perspective, Internal Business Process and Quality of Care. The model was estimated in SmartPLS 4.1.1.8 using the disjoint two-stage procedure and 5,000 bootstrap resamples. Social Entrepreneurship had a positive and statistically significant association with Organisational Performance (β = .118, t = 2.454, p = .014, BC 95% CI [.022, .211]). Hospital-clustered and random-intercept mixed-model sensitivity analyses retained the positive direction and statistical conclusion; the mixed model yielded B = .085, p = .027 after accounting for Strategic Orientation, Hospital Level and respondent nesting. Its practical contribution was nevertheless small (f² = .015) after Strategic Orientation and Hospital Level were accounted for. The complete predictor set explained 16.6% of the variance in Organisational Performance (adjusted R² = .160), while Q²predict of .141 indicated out-of-sample predictive relevance. The study's contribution lies in testing Process and Results jointly as a higher-order Social Entrepreneurship capability against multidimensional performance in public referral hospitals. The findings position Social Entrepreneurship as a complementary capability that can support stakeholder collaboration, socially directed innovation and resource mobilisation, but cannot substitute for adequate public financing, staffing, medicines, equipment, infrastructure and institutional reform.

Organisational Performance, PLS-SEM, Public Referral Hospitals, Social Entrepreneurship, Stakeholder Collaboration

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