Dr. A. K. KHANDELWAL

ASSESOR OF NATIONAL ACCREDITATION BOARD FOR HOSPITAL AND HEALTH SERVICE PROVIDER

Medical Director

Anandaloke Hospital & Neuro Sciences Centre

IntroductionThe importance of the human resources management (HRM) to the success or failure of health system performance has, until recently, been generally overlooked. Health sector reform in many countries in the 1990s focused on structural change, cost containment, the introduction of market mechanisms and consumer choice but with little direct attempt to address HR aspects.In recent years it has been increasingly recognized that getting HR policy and management "right" has to be at the core of any sustainable solution to health system performance

The hospital utilises widely divergent groups of professionals, semi-professionals and nonprofessionals.It represents high interdependence among services.

A hospital’s success is largely dependent on the quality of work of its employees. The HR role is the most crucialin a hospital as it is more people oriented and intensive rather than equipment oriented.

HRM Characteristics in the health sectorHRM in health has to function in a sector with some unique characteristics. The workforce is large, diverse, and comprises separate occupations. Some have sector-specific skills; other can readily move from the health sector to employment in other sectors. The avowed first loyalty of those with sector-specific skills and qualifications (physicians, nurses, etc.) tends to be to their profession and their patients rather than to their employer.Health is also very labour-intensive – the proportion of the total spent on staff is much higher in health than in most manufacturing industries and in many service industries.

WHY HRD becomes imperative in health organizations ?

1. Manpower is the most important factor of production of services.2. Human resource costs are usually 60 to 70 per cent of the total cost of the hospital.

3. There is a shortage of quality and quantity of human resource in our hospitals.

4.There is high turnover among professionals and para-professionals due to brain drain. Therefore, how to retain employees has been a challenging task in hospitals.5. There is underutilisation and wastage of human resources in health care organisations due to lack of professional HRD functions.6. There is low motivation due to the poor working conditions, top management being out of touch with the people, inadequate growth opportunities and lack of cordial relationships among the staff.

How an organised HRD programmes will help?

To achieve and maintain good human relations within the hospital.

To enable each employee to make his/her maximum contribution to the recovery of patients.

To ensure respect and well-being of other employees

To ensure maximum development of an individual who provides quality care to the patient.

To ensure participation in decision making.

To ensure satisfaction of various needs of the patient in order to help realize the hospital’s goals.

Constituents of Health Care Organisations

Doctors who provide the medical treatment.

Nurses who take care of peripheral treatment.

Patients who are the ultimate customers.

Paramedical staff, which provide support services to the medical staff.

Non-medical staff, which provide maintenance, ancillary, supportive,administrative and other services.

HRD Model for HospitalsThere is a need for a conducive HR climate, which is reflected by values of openness, confrontation, trust, authenticity, proactivity, autonomy, collaboration and experimentation (also called the OCTAPACE culture).In the presence of these values, there exists harmony in HRD practices, which will result in concrete results.

OPENNESS

It is the spontaneous expression of feelings and thoughts and the sharing of these without defensiveness.

Both upward and downward communication should be encouraged.

CONFRONTATION

Facing rather than shying away from the problem.

TRUSTTrust should be developed between team member.It means accepting what other says at face value rather than looking for ulterior motives.

AUTHENTICITYIt is the congruence between what one feels , says and does.It reduces distortion in communication.

PROACTIVITY:

It means taking initiative, preplanning,and taking preventive action.

Both employer and employees should be proactive to slve the problem in early stage.

AUTONOMY:

It means using and giving freedom to planand act in one’s own sphere.

This is effective delegation.

ACHEIVEMENT- 42%

RECOGNITIONS-31%

WORK ITSELF-22%

RESPONSIBILITY-21%

ADVANCEMENT-12%

GROWTH-7%

SALARY-6%

CAUSES OF EMPLOYEES SATISFACTIONS

COMPANY POLICY AND ADMIN.-36%

SUPERVISION- 18%

RELTIONSHIP WITH SUPERVISOR-10%

WORK CONDITIONS-10%

SALARY-7%

RELATIONSHIP WITH PEERS-6%

PERSONAL LIFE-4%

CAUSES OF EMPLOYEES DISATISFACTION

COLLABORATION

It means working together to solve the problem and with team spirit.

EXPERIMENTATION

It means using and encouraging innovative approaches to solve problems.

Motivation can be defined as the willingness to exert and maintain an effort towards organizational goals. Motivation develops in each individual as a result of the interaction between individual, organizational and cultural determinants.

FEATURES OF SOUND MOTIVATION SYSTEM

To motivate employees positive and reward based approach should be followed. stick policy should be used for reforming erring employees.

This carrot and stick policy should be followed in balanced manner.

A objective appraisal system should there with aim of improve employees efficieny.

Participative and consultative style of management and supportive supervision should be adopted.. Career and personal development training programs

Good grievances handling system should be there

There should be good intra-organizational communication processes.

INNER MOTIVATORS

A person's inner drives push and propel him/her towards an employer, a particular job, career, line of study, or other activity (such as travel or recreation). It is these drives that Maslow delineates in his hierarchy of needs, and which we must understand and internalize, use as guidelines in our efforts to help employees feel motivated.

Self-Actualization

Ego

Social Needs

Safety Needs

Physiological Needs

MASLOW'S HIERARCHY OF NEEDS

MASLOW'S HIERARCHY OF NEEDS

Applied to workers, it translates as follows:Physiological Needs     Basic physical needs:  the ability to acquire food, shelter, clothing and other basics to surviveSafety Needs     A safe and non-threatening work environment, job security, safe equipment and installationsSocial Needs     Contact and friendship with fellow-workers, social activities and opportunitiesEgo     Recognition, acknowledgment, rewards

Self-Actualization     Realizing one's dreams, using one's gifts, talents and potential.

EXTERNAL MOTIVATORS

The outer (external) motivators are the mirror image the employer or outside world offers in response to the inner drives.

These are:

Good salary

Old age security benefits

Medical and other insurance coverage

An atmosphere of teamwork and cooperation Social activities

Reward and recognition programs

Incentive programs

ACHEIVEMENT- 42%

RECOGNITIONS-31%

WORK ITSELF-22%

RESPONSIBILITY-21%

ADVANCEMENT-12%

GROWTH-7%

SALARY-6%

CAUSES OF EMPLOYEES SATISFACTIONS

COMPANY POLICY AND ADMIN.-36%

SUPERVISION- 18%

RELTIONSHIP WITH SUPERVISOR-10%

WORK CONDITIONS-10%

SALARY-7%

RELATIONSHIP WITH PEERS-6%

PERSONAL LIFE-4%

CAUSES OF EMPLOYEES DISATISFACTION

PRESENT CONDITIONS and HR SuggestionsThe uniqueness of a hospital is that the working environment is unpleasant and the client system that one deals with is sick (unhealthy). This makes theenvironment difficult and demanding for an individual. The following suggestion are useful.

DoctorsThe doctor’s role in the hospital is becoming complex day by day. With the advancement in diagnosis and treatment for various diseases becoming multifaceted and intricate, stress levels for doctors remain high. In such a scenario, the following is recommended:1. Clearly define and distinguish the roles for doctors so they do not have conflicting expectations from others.2. The doctors are highly burdened with their work because they keep on hopping to various hospitals as well as their private clinics. In such cases, their work schedule should be managed properly or some policies should be framed.

They should be given training in soft skills so as to treat their patients better.4. They should be encouraged to attend medical seminars to update their knowledge about various diseases and their treatment.

NursesNurses are the main support staff for doctors. They spend the maximum time with patients and are intensively involved with them. Their work causes maximum stress and burnout experiences as they are expected to handleand treat patients with high degree of efficiency, effectiveness and involvement.At times they hold negative perceptions of achievement, recognition, advancement or even the work itself, with its lack of autonomy or advanced technology.

Recommendations are as follows:1. Their career paths should be broadened so that they may experience meaningfulness, achievement and recognition in their work.2. Self-role integration among nurses should be increased so that they can make use of their other skills like interpersonal and communication skills.3. They should be trained in soft skills as they deal with a sick client system.4. They must be imparted training which result in win–win situations.5. Teamwork should be encouraged and training should be provided for this.6. Periodic meetings with doctors and other staff members and proper feedback system for nurses should be implemented.

7. Nurses should be given the opportunity to be more creative in treating patients through yoga and other modern physical and mental exercises.8. They should be given training in developing confrontation abilities and approaches for creative problem solving.9. Participation in various seminars for continuous medical education should be encouraged.10. They should express feelings, share ideas, meet and interact with people to avoid stressful situations.11. Forums and counselling desks should be formed where important personal as well as work-related problems may be solved.12. Besides, special attention should be given to areas of patient orientation, social values with focus on patients’ well-being, attitudes towards patients, service skills, making patients happy and providing emotional support to them.