The performance of Karen Hospital has been below its other rivals in provision of private healthcare services. There is evidence of studies that have examined the performance of the hospital in terms of their internal factors, customer perception, patient level satisfaction, and strategic management practices. There is scarcity of studies that have explored financial operations performance of the institution. This study sought to examine factors that affect financial operations performance at Karen Hospital. The study was guided by the following research questions: What is the impact of human capital management practices that affect the performance of financial operations in the finance department? How does the effectiveness of the performance measurement systems impact the performance of financial operations of finance staff? What is the role of leadership in attaining improved performance of financial operations? The study was anchored on the balanced scorecard, resource-based view, and situational leadership theories. Survey research was adopted and a structured questionnaire was distributed among 68 finance department staff from a population of 80. The descriptive-analytical methods used were percentages, averages, standard deviations, and frequencies that showed the trends and relationships within the data sets. Correlation analysis and regression analysis were respectively conducted to demonstrate association and effect between variables. The output indicated positive impact of HCMP on the performance of financial operations, that was significant at a 95 % confidence level. In terms of objective two, the results show that the performance of financial operations at Karen Hospital was positively and significantly impacted by performance measurement systems. Regarding the third objective, the output of the regression analysis indicated that an increase in leadership would contribute to the performance of financial operations at Karen Hospital. The study, then, concludes that Karen Hospital adopted human capital management practices of recruitment to keep the most qualified and experienced employees; that performance management system was not used to controlling and managing performance in the finance department of Karen Hospital; that positive relationships between leaders and employees resulted in enhancing engagement in delivering their duties at work. The study, recommends that strong policies guiding human management practices, performance measurement systems and leadership needs to be developed and engrailed in management of finance departments in hospitals in Kenya and the Karen hospital to specifically adopt positive human management practices like keeping experienced and qualified employees as well as promoting the internal ones to higher levels of management within the department and the organization at large, adopting performance management systems to help in the management of expectations and strengthen leadership to enhance the cohesion between team leaders and employees for better performance of the finance department and its operations at large.