Strategic Human Resource Management Practices and Performance of Employees in County Referral Hospitals in Kenya

Strategic human resource management (SHRM) practices are central to building a competent and motivated health workforce, yet county referral hospitals in Kenya continue to operate under conditions of understaffing, weak performance appraisal systems, poor compensation and frequent industrial unrest, all of which undermine employee performance. This study aimed at establishing the effect of strategic human resource management practices on employee performance in county referral hospitals in Kenya. The specific objectives were to determine the effect of training and development, establish the effect of employee assessment practice, establish the effect of compensation and benefits, and determine the effect of employee relations and engagement on employee performance in county referral hospitals in Kenya. The study was anchored on the Resource-Based View Theory, Goal-Setting Theory, Equity Theory and Human Capital Theory. A descriptive survey research design was used, targeting 147 HR managers, top management and supervisors in county referral hospitals in Kenya. Using the formula of Yamane (1967), a sample size of 107 respondents was selected through stratified random sampling to achieve proportional representation of the management categories. Data were collected using structured questionnaires with a five-point Likert scale and piloted at Mama Lucy Kibaki Hospital in Nairobi County with 10 respondents. Descriptive statistics (frequencies, percentages, means, standard deviations) and inferential statistics (multiple linear regression analysis) were computed using the Statistical Package for Social Sciences (SPSS) version 28, and results were presented in tables. The study found that training and development strongly predicts employee performance (B=0.490; β=0.386; p=.000), followed by compensation and benefits (B=0.539; β=0.357; p=.000), employee assessment practice (B=0.216; β=0.189; p=.041), and employee relations and engagement (B=0.149; β=0.183; p=.022). All predictors positively influence performance, confirming their significant contributions. The study concluded that training and development has the greatest positive impact on employee performance. Compensation and benefits also significantly enhance motivation, trust and retention, employee assessment practice improves focus and accountability, while employee relations and engagement has a smaller effect that is weakened by limited cross-departmental collaboration. The study therefore recommended that county referral hospitals invest in continuous professional development, e-learning and competency-based training; make employee assessment more participatory and feedback-oriented; maintain competitive salaries and strengthen non-monetary benefits; and reinforce communication channels, cross-departmental collaboration and team-based working structures to enhance employee productivity, job satisfaction and service delivery.