Study on Human Resource Management Practices …...Study on Human Resource Management Practices in...

Study on Human Resource Management Practices in Hospitals and its

Impact on Employee Satisfaction

Dissertation Submitted to the

Padmashree Dr. D.Y. Patil University, Navi Mumbai,

Department of Business Management

in partial fulfillment of the requirements for the award of

the Degree of

Master in Philosophy (M.Phil) (Business Management)

Submitted by:

MRINALI BABURAO TIKARE

Roll No.: DYP - M.Phil - 010708009

Research Guide:

Dr. PRADIP MANJREKAR

Professor in Management,

Padmashree Dr. D.Y. Patil University, Navi Mumbai

Department of Business Management,

CBD Belapur, Navi Mumbai - 400 614

June, 2009

DECLARATION

I hereby declare that the Study titled “Study on Human Resources Management

Practices in Hospitals and Its Impact on Employee Satisfaction.” submitted for the

M.Phil. Degree at Padmashree Dr. D.Y. Patil University, Navi Mumbai,

Department of Business Management is my original work and the dissertation

has not formed the basis for the award of any degree, associateship,

fellowship or any other similar titles.

Place: Navi Mumbai

Date: June, 2009

Signature of the Student

Mrinali Baburao Tikare

CERTIFICATE

This is to certify that the dissertation titled “ Study on Human Resources Management

Practices in Hospitals and its Impact on Employee Satisfaction” is the bona-fide research

work carried out by Mrinali Baburao Tikare, student of M.Phil., at Padmashree Dr. D.Y.

Patil University, Navi Mumbai, Department of Business Management, in partial fulfillment

of the requirements for the award of the Degree of M. Phil. and that the dissertation has

not formed the basis for the award previously of any degree, diploma, associateship,

fellowship or any other similar title.

Place: Navi Mumbai

Date: June, 2009

Signature Signature of the Guide

Prof.Dr. R. Gopal Prof. Dr. Pradip Manjrekar

Director & Dean

Padmashree Dr. D.Y. Patil University, Navi Mumbai

Department of Business Management

ACKNOWLEDGEMENTS

I am grateful to Padmashree Dr. D.Y. Patil University, Navi Mumbai, Department of

Business Management for giving me an opportunity to pursue M.Phil. I wish to thank

Professor Dr. R. Gopal, Director & Dean, Padmashree Dr. D.Y. Patil University, Navi

Mumbai, Department of Business Management who has been a perpetual source of

inspiration and offered valuable suggestions to improve my M.Phil work.

I am beholden to my Research Guide Dr. Pradip Manjrekar, Professor, Padmashree Dr.

D.Y. Patil University, Navi Mumbai, Department of Business Management for abundant

guidance, support, and encouragement throughout my M. Phil Work.

I wish to express my gratitude to various people from the Hospital sector for providing me

valuable information.

I would like to express my thanks to my family, friends and colleagues for their unfailing

support.

Place: Navi Mumbai

Date: June, 2009

Signature of the student


PREFACE

In a globally competitive and challenging business scenario, success in business

endeavor to a great extent is influenced by how human resources are managed. The

traditional man management practices have already undergone a sea change. To meet

the challenges of the next millennium and for achieving organizational excellence, it would

be essential to have productivity-oriented work practices, assertive professional

management and responsible trade unionism. The impact of changing environment on

human resource management practices has necessitated this present modest study.

During the course of my job career in Hospital while having discussions with Hospital

Management professionals, it became apparent that the problem of Hospital sector is the

lack of Efficiency and Effectiveness of Human Resources. Presently, the Human

Resource Department of hospitals are not focused on execution of the systematic and

scientific HR Practices plus issues concerning the satisfaction level of employees. Hence,

to understand the above issues of the Hospital sector, this research work titled “Study on

Human Resources Management Practices in Hospitals and Its Impact on Employee

Satisfaction” was carried out.

Signature of the Student


CONTENTS

Chapter No. Title of Chapters

Page. No.

Chapter I Introduction 1 - 17

Chapter II Hospital: As Service Industry 18 - 39

Chapter III Literature Review 40 - 70

Chapter IV Research Methodology 71 - 81

Chapter V HR Practices in Hospitals 82 - 123

Chapter VI Data Processing and Analysis 124 - 187

Chapter VII Results, Findings and Discussions 188 - 205

Chapter VIII Conclusions and Recommendations

206 - 215

Chapter IX Bibliography

216 - 225

� Annexure

ABBREVIATIONS

The following abbreviations have been used in this Dissertation-

AC – Air Condition

ASST – Assistant

CEO – Chief Executive Officer

Dept. – Department

HCO - Health Care organization

HOD – Head of the Department

HR – Human Resources

HRM – Human Resource Management

ICU – Intensive Care Unit

IT – Information Technology

MBO - Management by Objectives

PA – Performance Appraisal

SQ – Service Quality

TDP – Training and Development Programme

TQM – Total Quality Management

STS - Strategic Training System

TTS - Traditional Training System

UT - Union Territory

Admin- Administrative

SD - Standard Deviation

CV - Coefficient Variation

List of Tables

Table Number

Title of The Table Page No

4.4.1 List of Selected hospitals, Bed capacity & Total Employees 74

4.6.1 Five Point Response Scale 76

4.6.2 Questionnaire & its relevant factors 77

6.1 Number of Sample Selected from each Hospital 125

6.2 Distribution of Respondents by Dept. wise 126

6.3 Distribution of Respondents by Dept. wise 126

6.4 Working with the same Hospital - years 126

6.5 Asian Heart Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 127

6.6 Most Favorable Responses : Mean, SD, CV 128

6.7 Least Favorable Responses : Mean, SD, CV 129

6.8 Bombay Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 130



6.11 Breach Candy Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 134



6.14 B.S.E.S. Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 137



6.17 Godrej Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 141



6.20 Hinduja Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 145


Table Number



6.23 H.N. Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 149



6.26 Jaslok Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 152



6.29 Lilavati Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 155



6.32 Nanavati Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 159



6.35 Prince Ali Khan Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 162



6.38 Saifee Hospital : HRM influencing on Employee Satisfaction: Mean, SD, CV 166



6.41 HRM influencing on Front Office Employees Satisfaction: Mean, SD, CV 170



6.44 HRM influencing on Doctor’s Satisfaction: Mean, SD, CV 173



6.47 HRM influencing on Nurses Satisfaction: Mean, SD, CV 176



Table Number


6.50 HRM influencing on Admin. Employees Satisfaction: Mean, SD, CV 179



6.53 HRM influencing on Para Medical staff Satisfaction: Mean, SD, CV 182



6.56 Twelve Hospitals HRM influencing on Employees Satisfaction: Mean, SD, CV 185



7.1 Satisfaction Aspects: Mean, SD, CV 205

EXECUTIVE SUMMARY

This study sheds light on the relationship between Human Resource Management (HRM)

practices with employee satisfactions. The objective of the study is to analyze the implementation

of Human Resource Management practices in Hospital Industry and its impact on perception of

employees which leads to Satisfaction or Dissatisfaction. Human Resources Management

function includes Job Analysis, Manpower planning, Recruitment, Selection, Induction, Training

and Development, Performance Appraisal, Compensation Management and Industrial Relation.

The study focuses on four functions i.e. Recruitment, Selection, Induction, Training and

Development, Performance Appraisal. It is observed that those hospitals following systematically

and scientifically Human Resources Management practices create high satisfaction level within

employees. These employees are more committed towards better performance. On the other

side in some well – known hospitals, HR Dept. is seen as a mere Cost Centre that ensures the

payroll is on time and Leave Record tracking is accomplished. In such hospitals employee

satisfaction level is on lower curve. In era of globalization where hospital sector is booming and

there is increasing demand of hospital services, all employees should be managed efficiently and

effectively by implementing systematically and scientifically Human Resources Management

practices.

As there is an urgent need to reshape HR function in hospitals in order to have a competitive

edge and to be of world class status, Hospital organizations are direly required to take stock

of their HR practices without losing any further time to mould HR department as per the need

of the hour.

Chapter 1

Introduction

In terms of the growth rate, the healthcare industry in India is moving ahead neck to neck with the

pharmaceutical industry and the software industry. Till date, approximately 12% of the scope offered by

the healthcare industry in India has been tapped. The healthcare industry in India is reckoned to be the

engine of the economy in the years to come. Growing at an enviable rate of 15% every year, the

healthcare industry in India is estimated to be a $40 million by 2012. There are vast differences in medical

expenses in western countries and that of India; India has become one of the favorites for healthcare

treatments. Due to the progressive nature of the healthcare sector in India, several foreign companies are

intending to invest in the country.

Existing healthcare organizations are expanding by opening hospitals in new service areas and new

organizations entering with state of art equipments, latest technology and marketing strategies.

Consequently, competition in the healthcare sector is on the rise. Increased incomes and awareness

levels are driving the customers to seek quality healthcare.

The providers in turn need to be more innovative in their approach and offer quality services at competitive

price. All this necessitates the systematic Human resource Management by trained and professional

managers and administrators.

Human resource management refers to the practices and policies needed to carry out the personnel

aspects of management. These include:

� Analyzing jobs;

� Planning manpower needs and recruiting competent people;

� Selecting best people;

� Appraising performance and potential on ongoing basis;

� Socializing, training and developing people;

� Managing compensation;

� Communicating;

� Building employee commitment and so on so forth.

A commitment HRM bundle includes diverse practices such as training, sharing information, employment

security, performance based compensation, employee participation, and ensuring employees’ well-being

(Chang, 2005). If every manager is good at managing HR along within his or her own functional area he or

she can avoid:

• Hiring the wrong person for the right job.

• Experiencing high employee turn over.

• Finding people not contributing their best.

• Poor time management.

• Having company taken to court because of discriminatory practices

• Having dissatisfied employees who always think about their salaries and perceive them to

be unfair and inequitable relative to others in the organizations.

• Failure to provide job related training which will eventually undermine the department's

effectiveness.

• Indulging in favoritism and nepotism at the cost of organizational effectiveness.

Today human resources occupy, more than ever, the center stage of all economic activities. It is

alarming time for all those organizations that wish to be successful in global markets to gear up

and implement desired shift in their prevailing human resource management practices and

leverage their human resources along with the other resources. Also to become more flexible and

innovative organizations need to adopt new ways of attracting, retaining and motivating

employees who are keen to learn and can contribute to the growth and development of the

organization. In an increasingly competitive market, survival and prosperity of business will

depend critically on the ways an organization manages its resources especially the human

resources. In the words of Clatfelter - 1997, The HRM functions to be streamlined, the HRM

activities to be handled more efficiently, or delivered in a more cost-effective manner. Lee and

Heard, 1998, suggested, ‘An HRM audit is an analytical tool that systematically and

comprehensively assesses a firm's HRM policies and practices against the firm's business

objectives’.

1.1 Staffing and Recruitment

Staffing includes human resources planning and forecasting, recruiting, and selecting employees.

Human resources planning and forecasting is the process that a firm uses to ensure that it has

the right amount and the right kind of people to deliver a particular level of output or services in

the future. Recruiting is the process used to form a pool of job candidates for a particular job.

Selection is the process of making a “hire” or “no hire” decision regarding each job applicant for a

job. (Crowley (1999); Czaplewski (2001).

Recruitment involves attracting a pool of applicants upon which selection procedures will later be applied.

Research suggests staffing effectiveness is both a function of the quality and quantity of the applicant pool

(Fisher, 1989).

Roshen Joseph and Gautam Ghosh have stated in their paper, "Reaching to People" (Power of

Millennium, Ascent, Times of India, 15th Jan, 2000), Recruitment is the entry step and if required care is

not taken then the organization will have to face adverse consequences. The use of IT applications can

enhance the efficiency of recruitment.

1.2 Induction

Induction is the process of welcoming, indoctrination and socialization of new employee to his job

and organization.

In words of Michael Armstrong, “Induction is the process of receiving and welcoming employee

when he first joins a company and giving him basic information he needs to settle down quickly

and happily and start work.”

1.3 Training

In the opinion of Edwin B. Flippo, “Training is the act of increasing the knowledge and skills of an

employee for doing a particular job.” Training in any process by which the attitudes, skills and

abilities of employees to perform specific jobs are improved, (Michael J. Jucious ).

Training is the process of systematically developing expertise in individuals for the purpose of

improving performance. (Barrett & O’Connell (2001) Stavrou-Costea (2005) found that

organizational productivity was related to training and development practices, employee relations

practices, and efficiency and flexibility challenges. Adequate training enables the generation of a

work force that is multi skilled, adaptable to rapid changes and has wide conceptual knowledge of

the production system (Pfeffer 1998).

Training and employee commitment is closely related which lead to higher productivity and

satisfied employee. Bartlett (2001) explored effects of training on organizational commitment and

found that perceived access to training produced the highest correlations with organizational

commitment. The results showed that employees perceived the availability of training as support

from their employer, which made them more committed to their organization. Developing human

capital through continuing training may increase the productive output from each employee either

through improvement in skill level or through improvement in morale and job satisfaction (Dessler,

2003).

Kubur and Prukopenko (1989) stated that lack of clear training policies, poor alignment between

training and wider development policies and the failure to link training design to the future needs

are the major drawbacks of many training systems in the developing nations. To control the

limitations of Training, Sethumadhavan - 1996, suggested Strategic Training System.

Strategic Training Systems (STS) Traditional training system (TTS)

Strategic training system may be defined as a training system which is derived designed primarily

based on short, medium and long term plans and objectives the Department (Sethumadhavan,

1996). Training in STS is a planned and careful activity, whereas the traditional training system

(TTS), it is random ritual or a number game. The need for linking the organizational strategy for

change with the training strategy was initially felt by only the manufacturing and service

organizations, operating in competitive and decontrolled markets. However, today even the Public

service organizations and the Govt. departments have started feeling the need of it (Irudayaraj,

Sethumadhavan & Srivastava 1995).

As opposed to STS, TTS is derived and designed mainly based on methods as individual training

need analysis which focus exclusively on the individuals (See Lynton & Pareek, 1990 Camp,

Blanchard & Huezczo, 1986; Kenny & Reid, 1986; Reily & Clarke, 1990). Typically the training

needs analysis in TTS is limited to the perceptions of the members of the target group or trainees.

However, what the trainees 'want' may be different from what they 'need' (Reily & Clark, 1990),

STS focuses more on the 'needs' than the 'wants'. Therefore, in STS, perceptions of seniors,

public and others are emphasized while developing the training plans and training programs. STS

unlike TTS, consciously more on leading the public service organizations rather than being lead

by organizations.

According to Schmidt, there is a strong correlation between job training satisfaction and overall job

satisfaction amongst employees in customer service positions. Employees value the training that they

receive, consider it an essential part of their job, and view it as a significant determinant of the satisfaction

that they experience on the job.

1.4 Performance Appraisal

According to Flippo, “Performance Appraisal is the systematic, periodic and an impartial rating of

an employee’s excellence in matters pertaining to his present job and his potential for a better

job.” Performance Appraisal is the process of evaluating how well employees perform their jobs

when compared to a set of standards, and then communicating that information to those

employees. (Mathis & Jackson (2003). A comprehensive and accepted evaluation system can

provide valuable feedback to employees and assist managers in making decisions regarding the

individual employee (Cleveland, Murphy & Williams 1989).

Shrinivas Kandula discussed in his paper ‘Integrated performance Management Model: A tool for creating

High performance culture’ 2006, A systematic performance management system is not widely prevalent as

it ears in professional discussions. Rao (2004), states that managers in India have an inherent disliking for

a systematic planning and monitoring of performance of employees. He further adds that subjective style

of top management coupled lack of awareness in defining key result areas are the influential factors for

poor performance management practices. In many instances, performance management is understood to

be a mere improved version of performance appraisal system. Performance management as a full fledged

system is pursued in very selective organizations in India, mostly present with new economy organizations

software, information technology enabled services, financial services, pharmaceuticals, green field

manufacturing set ups and rarely in old economy organizations. However, many organizations, both in

corporate and non-corporate government and private sectors, there is a growing realization of the need to

put in place a scientific performance management system capable of creating a high performance culture.

1.5 Benefits

It includes pensions, health insurance, supplemental unemployment insurance, wellness

programs, child care etc. Employers use benefits to attract and retain productive workforce.

(Lucero & Allen (1994)

1.6 Promotion

The promoted employees feel valued by the organization, and understand that the organization is

willing to invest in them in the long term (Pfeffer 1994).

1.7 Career Planning

Ganesh Shermon has stated in his article "Culture and Work Ethos: An Experience in

Organizational Building" (IJTD, Vol. XXIX, No.4, Oct.-Dec., 1999), that companies should

cultivate and nurture individual growth along with their corporate growth. HR has an important

role to play in order to identify what employees want from their career and then evaluate

alternatives and design appropriate career paths for them. He says productivity gain comes from

improved co-ordination as a result of increased employee involvement analysis, planning and

designing of career paths.

1.8 Job Satisfaction

Job satisfaction in the broadest: sense simply refers to a person's general attitude toward the job

or toward specific dimensions of the job (Hodson, 1991). Locke defined job satisfaction as, “A

pleasurable or positive emotional state resulting from the appraisal of one’s job or job experience.

Several studies have been conducted to find out the Determinants of Job satisfaction.

Fung-Kam [1998] identified four general theories: Need/value fulfillment theory; person-environment (P-E)

fit theory, the theory of career and the theory of work adjustment. The theory of need/value fulfillment

proposes that the discrepancy between individual needs and the extent to which the job meets these

needs is negatively related to job satisfaction and expectation gaps have been linked to the violation of the

psychological contract between employer and employee. Theory of P-E fit suggests there are person

characteristics that suit working environments better than others and working environment characteristics

that suit certain individuals better. Similarly Adams and Bond [2000] classified job satisfaction theories into

three groups: discrepancy theories, which examine the extent to which employees needs are satisfied in

the work place; equity theories, which highlight social comparisons in the evaluation of job rewards; and

expectancy theories which focus on employee motivations.

Hackman and Lawler [1971] believed that the employees' perception of their job rather than the jobs

objective characteristics was a more important determinant of job satisfaction. The two theories that have

been important in the development of an understanding of job satisfaction in nursing are Maslow's human

needs theory [1954] and Herzberg and Mausner's motivation-hygiene theory [1959]. Maslow identified two

types of needs; deficiency needs (physical, safety and belonging) and growth needs (self-actualization and

self esteem). Herzberg and Mausners' theory consists of intrinsic factors or 'motivators' that promote job

satisfaction and extrinsic factors or 'hygiene factors' that cause dissatisfaction.

Blegen [1987] synthesized findings from 48 studies and identified thirteen variables that were most

strongly associated with job satisfaction. These included stress, commitment, communication (with

supervisor and peers), autonomy (and locus of control), recognition, routinization, and fairness. A

secondary analysis of data from the 1977 Quality of Employment Survey found that task variety, relations

with co-workers, financial rewards and age were all positively associated with job satisfaction. Work

attitudes (supervisor support, work-group cohesion, variety of work, autonomy, organizational constraint,

promotional opportunities, work and family conflict, and distributive justice) were also important in

explaining the job satisfaction of registered nurses in the United States.

Different managerial styles and practices at the organizational unit level (e.g. ward) can have a direct

bearing on nurse satisfaction. The work of Adams and Bond [2000] highlighted the importance of

interpersonal relationships with nurses and other medical staff, workload and ward cohesiveness. A

number of studies have shown a positive association between autonomy and levels of job satisfaction and

which has been confirmed amongst nurses, Shoham-Yakubovich I, Carmel S, Zwanger L, Zaltcman T

[1989], Acorn S, Ratner PA, Crawford M [1997], Finn CP [2001].

Blegen [1987] found that job satisfaction correlated less strongly with age or years of experience, while

Shields and Ward [2001] found that increasing age, marriage, and children impacted positively on nurses'

satisfaction. The survey of NHS nurses found training had a positive impact on job satisfaction but

diminished with the number of training spells.

In a study of nurses working in the NHS, Clark AE, Oswald AJ [1996], individuals who stressed non-

pecuniary reasons (e.g. flexibility of hours, helping others) had significantly higher job satisfaction than

those who did not (e.g. attracted by job security, promotion prospects, pay). Not being graded fairly was

the largest negative determinant of overall job satisfaction and not having the hours to suit an individual's

preference had a negative impact.

1.9 Impact of Human Resource Management on Employee Satisfaction

HRM Practices and Management - Employee Relations

Chang (2005) examined HRM practices as a whole, measured at an organizational level and found

significant positive relationship with employees’.

An employee’s relationship with an organization is shaped by HRM actions such as recruiting, appraising

performance, training, and benefits administration through which employees come to understand the

terms of their employment (Rousseau & Greller, 1994). It has been shown that when the organization

nurtures relationships with employees, the result can lead to a real improvement in services provision to

customers (Schneider & Bowen 1995). Employees who feel that the organization provides them with a

supportive working environment, and see that the organization aspires to a high quality of service and

excellence, are often more willing to give customers the best service. When customers meet a satisfied

and enthusiastic employee, their perceptions of the service are likely to reflect the positive encounter

(Schneider, White & Paul 1998).

Positive Attitude and HRM

According to Eisenberger (1990), when employees believed that an organization was committed to its

HRM programs, they believed that the organization was committed to them. Therefore, employees

developed positive attitudes towards the company.

HRM practices are likely to have an impact on employee attitudes about work (Meyer and Allen,

1997), thus attitudinal factors such as job satisfaction or organizational commitment could be

assessed.

Employee Psychology Contract and HRM

According to Wright, Gardner, and Moynihan (2003) measuring HRM practices via employee’s perceptions

is crucial.

How jobs are advertised (“great advancement potential,” “opportunity for salary growth,”), the way an

organization is portrayed during the recruitment interviews (this organization provides plenty of training ),

comments made in performance appraisal reviews (“keep up the good work and we will move you up”),

compensation systems (wages based on time on the job, rank or performance), all send strong messages

to individuals regarding what an organization expects of them and what they can expect in return. Hence

HRM practices are seen to play an important role as message senders, shaping terms of the

psychological contracts (Rousseau & Wade-Benzoni, 1994).

Organization Performance and HRM

Huselid (1995) found that HRM practices such as employee recruitment and selection procedures,

compensation and performance management systems, employee involvement, and employee training

have a significant impact on employee turnover and productivity, and on short and long term corporate

financial performance. HRM practices affect organization performance greater when they are integrated

and implemented together (Pathak 2005). Baker (1996) found that employee-centered management

practices can improve organizational performance. Huselid (1995) analyzed the firm level impact of HRM

practices as a system, and found a strong relationship of high involvement HRM practices with

organizational performance.

Rondeau and Wagar (2001) investigated the effect of HRM practices on nursing home performance in

Canada. Their study of 283 nursing homes found that nursing homes with more "progressive" HRM

practices and a workplace climate that values participation, empowerment, and accountability tended to be

perceived as performing better on a number of valued organizational outcomes.

HRM and Employee Satisfaction

"Organizations cannot hope to achieve any kind of success with new programs when they ... lack

a foundation of employee commitment and trust". Therefore, managerial objectives of HRM

practices include improving employees' levels of job satisfaction, organizational commitment and

morale, as these are precursors to a firm's level of service, quality and innovation. To improve

organizational performance, HR professionals have to ensure that their firms' HRM practices

follow best practices and contribute to the meeting of the firm's objectives. (Capowski (1997)

Firms need to formalize their job descriptions, as clearly written job descriptions improve role clarity and

reduce role conflict and job tension, which were found to increase employees' level of job satisfaction

(Rogers, Clow and Kash, 1994). The increase in the level of job satisfaction occurred because employees

had a better understanding of their work requirements and therefore, had more realistic job expectations

(Ting, 1997).

Where staffing activities are concerned, initiatives that improve the service delivery of HR

recruitment activities led to more positive applicant reactions with the recruitment process. This

was found to attract higher applicant quality (Heneman, Huett, Lavigna and Ogsten, 1995).

Applicants who perceived the selection process more favorably were more satisfied with the

selection process, the job and the organization. Such positive attitudes led to more job

acceptance intentions (Macan, Avedon, Paese and Smith, 1994). In addition, the use of realistic

job previews (RJPs) during the recruitment process increased applicants' met expectations,

which led to increased job satisfaction and organizational commitment (Hom, Griffeth, Palich and

Bracker, 1998).

Employees also reported higher levels of satisfaction and commitment in organizations where

there is fairness in the assignment of work tasks (Witt, 1993). Perceived fairness in pay and

promotion also accounted for a significant amount of the variance in job satisfaction (Witt & Nye,

1992). Particularly, employees' overall levels of satisfaction were significantly increased by the

availability of a flexible benefit plan (Barber, Dunham and Formisano, 1992).

Where career management activities are concerned, employees who had mentors were more

satisfied with their jobs and the organization, than those without (Chao, Walz and Gardner, 1992).

This is because protégés received more career-related and social support from their mentors, as

well as higher salaries. Even in the absence of higher pay, firms that used career anchors

increased their employees' level of job satisfaction (Leavitt, 1996).

Employees' job satisfaction, organizational commitment and morale levels are important measures of the

return on the efforts by the HR department (Davidson, 1998; Kinicki, Carson and Bohlander, 1992).

However, Dillon and Flood (1992) found that the link between organizational commitment and HR

practices was, at best, inconclusive. They explained the results as being similar to those of

Herzberg (1959), in that personnel policies and practices can only reduce the dissatisfactions of

employees but cannot raise the levels of job satisfaction. If personnel practices do not increase

the levels of job satisfaction, then they cannot be expected to affect organizational commitment

and other organizational effectiveness measures.

1.10 Identification of Problems

From above discussion, it is observed that Human Resources Management has transitioned from

traditional personnel management to Strategic Human Resource Management to Human Capital

Management and Talent Management in general. However, it is to be noted that still there are

many service organizations implementing Traditional Personnel Management. The personnel

management has a limited scope and an inverted orientation. It viewed labor as a tool, the

behavior of which could be manipulated for the benefit of the organization and replaced when it is

worn-out. In era of globalization where service industries are booming and there is increasing

demand of services, all employees should be managed efficiently and effectively. This can be

only possible when organization will pay more attention on employee satisfaction. Capowski

(1997) rightly pointed out that managerial objectives of HRM practices should be to improve

employees' levels of job satisfaction.

The following are the problems of HRM practices faced by many service Industries –

• Hiring the wrong person for the right job.

• Experiencing high employee turn over.

• Finding people not contributing their best.

• Poor time management.

• Having company taken to court because of discriminatory practices

• Having dissatisfied employees who always think about their salaries and perceive them to

be unfair and inequitable relative to others in the organizations.

• Failure to provide job related training which will eventually undermine the department's

effectiveness.

• Indulging in favoritism and nepotism at the cost of organizational effectiveness.

1.11 Selection of Problem

By discussion with hospital industry experts, hospital Management academicians, it is observed that well

known, State of Art Hospitals in a Metropolitan City like Mumbai are facing all the above mentioned

problems and their employees are not satisfied. Thus, there is need to consider satisfaction factors apart

from Motivational Techniques.

On the basis of Researchability of the problem, and with the aim to make significant contribution to

Healthcare industry and its Clinical and Non-clinical employees, the problems of ‘HRM practices and its

impact on Employee satisfaction’ have been selected. At the same time the constraint of time and money

has been considered with respect to feasibility of the study.

1.12 The statement of the Problem

The problem to manage employees efficiently and effectively depends on the behavioral part of the

individual which comprised of satisfaction, dissatisfaction, perceptions and attitude, etc. The concept of

satisfaction is not only associated to Monetary and Motivational Mechanism, however, it is also

interconnected with HR functions like Recruitment, Selection, Induction, Training and Performance

Appraisal and so on.

The present investigation has been carried out with respect to the impact of the satisfaction levels of

employees varies with the systematic or unsystematic (disorganized) implementation of HRM practices.

Chapter 2

Hospital: as Service Industry

2.1 Healthcare Organization

In the healthcare industry, as in most other service industries, the interaction between patients and

healthcare service providers (professionals and other employees) is an integral part of the service process

(Conway & Willcocks 1997, Benbassat & Taragin 1998). Health Care Organizations should be encouraged

to take the role of the patient into consideration in the healthcare service process, and in order to achieve

high quality service (White 1999) respond to patients’ needs and expectations. Another issue that is likely

to challenge HCO management is the central role played by employees in Service quality achievement.

White (1995) reported cooperation between employees and managers as the key to providing high quality

care, because it can compensate for the constraints imposed by cost containment and managed care. In

pursuit of this objective, management might seek to implement progressive HRM practices that encourage

service oriented behavior and show concern for employees’ organizational and personal needs.

2.2 History, Growth and Classification of Hospitals in India

Since Independence, India has achieved remarkable progress in social, political and

economic fields. After the liberalization, this progress has been given further fillip, and

has been recognized by the advanced countries. In the area of medical science too,

commendable progress has been made during this period. Unfortunately, however,

hospital administration has lagged far behind. Even the most sophisticated and the so-

called modern hospitals in India continue to be governed by the stereotyped system of

hospital administration, viz. appointing the senior-most doctor as the Medical

Superintendent. He is entrusted with the responsibility of the entire administration of the

hospital, irrespective of whether or not he has undergone any formal (or even informal)

training in hospital administration.

Times have changed and specialization has become the order of the day. It is, therefore,

imperative to have separate specialists for general administrative and human resource

functions in hospitals. Secondly, with the tremendous expansion in health services, it has

become essential to have specialists or experts not only in these two fields, but also in

other fields of hospital administration, so that maximum efficiency can be achieved at the

minimum cost. Thirdly, the rapidly rising number of patients and the inadequate

expansion of hospitals and medical services have thrown the hospital administration

machinery completely out of gear. Hence, the need for better planning, organizing,

staffing, coordinating and controlling hospitals can hardly be overemphasized. Hospital

administration can no longer be left to continue in the hands of a person who is 'Jack-of-

all trades' and 'master-of-none'.

In the past, hospitals could, perhaps, afford the luxury of being unbusiness like and of

adopting hit-and-miss methods of management as a number of philanthropists made

huge donations to meet the ever-rising deficit in hospital budgets. Similarly, in the field of

human resource management, as long as the salary budget comprised only a small

portion of the total budget, hospital administration could afford to neglect the introduction

of scientific and progressive principles of human resource management. But they can no

longer afford to do so as salary and wages now represent 65 per cent or more of the total

hospital budget.

Let us examine a few definitions of the term 'hospital'. The word 'hospital' is derived the

Latin word hospitalis which comes from hospes, meaning a host. The English 'hospital'

comes from the French word hospitale, as do the words 'hostel' and ‘hotel’, “all originally

derived from Latin. The three words, hospital, hostel and hotel, although derived from the

same source, are used with different meanings. The term 'hospital' means an

establishment for temporary occupation by the sick and the injured·

Today hospital means an institution in which sick or injured persons are treated. A hospital

is different from a dispensary - a hospital being primarily an institution where in-patients

are received and treated while the main purpose of a dispensary is "distribution of

medicine and administration of outdoor relief.

Dorland's Illustrated Medical Dictionary defines a hospital as

‘an institution suitably located, constructed, organized, staffed to supply scientifically,

economically, efficiently and unhindered, all or any recognized part of the complex

requirements for the prevention, diagnosis and treatment of physical, mental and the

medical aspects of social ills; with functioning facilities for training new workers in many

special professional, technical and economical fields, essential to the discharge of its

proper functions, and with adequate contacts with physicians, other hospitals, medical

schools and all accredited health agencies engaged in the better-health programme.’

A hospital in Steadman's Medical Dictionary is defined as, “an institution for the care, cure

and treatment of the sick and wounded, for the study of diseases and for the training of

doctors and nurses.”

Blackiston's New Gould Medical Dictionary (McGraw-Hill, New York, 1956, p. 560)

‘Describes a hospital as an institution for medical treatment facility primarily intended,

appropriately staffed and equipped to provide diagnostic and therapeutic services in

general medicine and surgery or in some circumscribed field or fields of restorative

medical care, together with nursing care and dietetic service to patients requiring such

care and treatment.’

According to the Directory of Hospitals in India, 1988,

‘A hospital is an institution which is operated for the medical, surgical and/or obstetrical

care of in-patients and which is treated as a hospital by the Central/state government!

Local body/private and licensed by the appropriate authority.’

A close analysis of the above definitions reveals that no single definition is perfect in

defining a modern hospital and its multifarious services. Dorland's definition is

comprehensive but fails to visualize rehabilitative and follow-up aspects. Steadman's

definition is very simple and, to a great extent, highlights all the essential services. The

definition given in the Directory of Hospitals in India, 1988 is also very simple but too short

to cover all the aspects of a hospital. .

On the basis of the above definitions, we can evolve a comprehensive definition of a

hospital, highlighting all the essential services provided by a modern hospital:

‘A modern hospital is an institution which possesses adequate accommodation and well -

qualified and experienced personnel to provide services of curative, restorative and

preventive character of the highest quality possible to all people regardless of race,

Colour, creed or economic status; which conducts educational and training programmes

for the personnel particularly required for efficacious medical care and hospital service;

which conducts research assisting the advancement of medical service and hospital

services and which conducts programmes in health education’.

Modern hospitals are open 24 hours a day. Their personnel render services for the cure and

comfort of patients. In the operation theatre, skilled surgeons perform lifesaving surgery. In

the nursery, new-borns receive the tender care of trained nurses. In the laboratory, expert

technicians conduct urine, stool, and blood tests, vital to the battle against disease. In the

kitchen, cooks and dieticians prepare balanced meals that contribute to the patient's speedy

recovery.

2.3 Complexity of Hospital Industry

Though Hospitals have been compared to industry, there is a distinct difference. The product of a hospital

is service to people provided by its personnel with a variety of skills. The nature of the demand for Hospital

services is also distinctive to the hospital – as admission to the hospital for services is need driven. The

patient leaves his home, family, friends, his work place, and his way of life for a new environment i.e. the

hospital where he becomes one of the many. He is housed with strangers and carries out several intimate

functions in their presence. Moreover, he encounters the different hospital personnel performing different

functions.

2.4 Features of Hospital: Peculiarities associated with hospitals:

1) Vast range of services:

It includes medical research, improved surgical techniques, knowledge and application of newer

fields.

2) Changing Patient Profile:

Consist of different types of diseases requiring wide range of services.

3) High Cost:

Both these factors have resulted in steep increase in expenditure for starting and running a

hospital.

4) Increasing Use of sophisticated equipment:

Sophisticated equipment increases the cost of operating.

5) Critical role of employees:

Hospitals are labor intensive. Good quality health care requires expert and experienced medical

and paramedical staff.

6) Public Perception of Medical Services:

Public continues to look upon hospitals as institutions meant to provide their services to the

society as cheaply as possible.

7) Need for Innovative Financing:

2.5 Classification of Hospitals

Hospitals have been classified in many ways. The most commonly accepted criteria for

the classification of the modern hospitals are: (a) length of stay of patients (long-term or

short-term), (b) clinical basis, and (c) ownership control basis. The following is a

discussion on the third aspect.

Classification According to Ownership/Control

On the basis of ownership or control, hospitals can be divided into four categories,

namely, public hospitals, voluntary hospitals, private nursing homes and corporate

hospitals.

Public hospitals: Public hospitals are those run by the Central Government, state

governments or local bodies on non-commercial lines. These hospitals may be general

hospitals or specialized hospitals or both. General hospitals are those which provide

treatment for common diseases, whereas specialized hospitals provide treatment for

specific diseases like infectious diseases, cancer, eye diseases, psychiatric ailments, etc.

General hospitals can diagnose patients suffering from infectious diseases, but refer them

to infectious disease hospitals for hospitalization, as general hospitals are not licensed to

treat infectious-diseased patients.

Voluntary hospitals: Voluntary hospitals are those which are established and

incorporated under the Societies Registration Act, 1860 or Public Trust Act, 1882 or any

other appropriate Act of the Central or state government. They are run with public or

private funds on a non-commercial basis. No part of the profit of the voluntary hospital goes

to the benefit of any member, trustee or to any other individual. Similarly, no member,

trustee or any other individual is entitled to a share in the distribution of any of the,

corporate assets on dissolution of the registered society. A board of trustees, usually

comprising prominent members of the community and retired high officials of the

government, manages such hospitals. The board appoints an administrator and a medical

director to run such voluntary hospitals. These hospitals spend more on patient care than

what they receive from the patients. There is, of late, a trend among voluntary hospitals to

charge reasonably high fees from rich patients and very little from poor patients. Whatever

they earn from the rich patients of the private wards, spend on the patients of general

wards. However, the main sources of their revenue are public and private donations, and

grants-in-aid from the Central Government, the state government, and from philanthropic

organizations, both national and international. Thus, voluntary hospitals run on a 'no profit,

no loss' basis.

Private Nursing Homes: Private nursing homes are generally owned by an individual doctor

or a group of doctors. They admit patients suffering from infirmity, advanced age, illness,

injury, chronic disability, etc., or those who are convalescing, but they do not admit patients

suffering from communicable diseases, alcoholism, drug-addiction or mental illness. There

is, however, no uniform definition for nursing homes. The phrase may refer to out-of-home

care facilities that offer a range of services similar to many found in a hospital. These nursing

homes are run on a commercial basis. Naturally, the ordinary citizen cannot usually afford to

get medical treatment there. However, these nursing homes are becoming more and more

popular due to the shortage of government and voluntary hospitals. Secondly, wealthy

patients do not want to get treatment at public hospitals due to long queues of patients and

the shortage of medical as well as nursing staff leading to lack of medical and nursing care.

Corporate hospitals: The latest concept is of corporate hospitals which are public limited

companies formed under the Companies Act. They are normally run on commercial lines.

They can be either general or specialized or both.

What is Trust Hospital? (With Reference to Trust Hospital from Mumbai)

Where the Hospital is registered under The Bombay Public Trusts Act, 1950, it is considered

to be Trust Hospital.

The Bombay Public Trusts Act, 1950 provides machinery of charity commissioners to regulate the

administration of public religious and charitable trusts. It makes registration of all the public religious and

charitable trusts including the religious trusts created under Hindu Muslim and Christian personal laws

mandatory and prescribes certain norms for the maintenance and audit of budget, and accounts of such

trusts and further empowers the charity commissioners to inspect and supervise the property belonging to

a public trust and as well the proceedings of the trustees and books of accounts of such a trust.

That apart, the act also creates certain restrictions on the investment of public trust money and as well

alienation of immovable property of such a trust.

2.6 Types of Hospitals

(i) General hospital: All establishments permanently staffed by at least two or more medical

officers, which can offer in-patient accommodation and provide active medical and nursing care

for more than one category of medical discipline (e.g. general medicine, general surgery,

obstetrics).

(ii) Rural hospital: Hospitals located in rural areas (classified by the Registrar General of India)

permanently staffed by at least one or more physicians, which offer in-patient accommodation

and provide medical and nursing care for more than one category of medical discipline (e.g.

general medicine, general surgery and obstetrics).

iii) Specialized hospital: Hospitals providing medical and nursing care primarily for only one

discipline or specific diseases (e.g. tuberculosis, ENT, eyes, leprosy, orthopedic, pediatrics,

gynecological, cardiac, mental, cancer, infectious disease, and venereal diseases). The

specialized departments, administratively attached to a general hospital and sometimes located

in an annex or separate ward, may be excluded and their beds should not be considered in this

category of specialized hospitals.

(iv) Teaching hospital: A hospital to which a college is attached for medical/dental education.

(v) Isolation hospital: This is a hospital for the care of persons suffering from infectious diseases

requiring isolation of the patients.

(vi) Tertiary hospital: States and Central Governments set up tertiary hospitals in their capitals

where referred patients are treated such as AIIMS, New Delhi, P.G.I. Chandigarh, Sanjay Gandhi,

P.G.I., Lucknow, etc.

2.7 Types of Management

(i) Central Government / Government of India: All hospitals administered by the Government of

India, viz. hospitals run by the railways, military/ defence, mining/ESI/ Post & Telegraphs, or

public sector undertakings of the Central Government.

(ii) State government: All hospitals administered by the state union Territory government

authorities and public sector undertakings operated by states/UTs, including the police, jail, canal

departments and others.

(iii) Local bodies: All hospitals administered by local bodies, viz. the municipal corporation,

municipality, zila parishad, panchayat.

(iv) Private: All private hospitals owned by an individual or by a private organization.

(v) Autonomous body: All hospitals established under a special Act of Parliament/ state

legislation and funded by the central/state government Union Territory, e.g. AIIMS (New Delhi).

(vi) Voluntary organization: All hospitals operated by a voluntary body/a trust/ charitable society

registered or recognized by the appropriate authority under Central/ state government laws. This

includes hospitals run by missionary bodies and co-operatives.

(vii) Corporate body: A hospital runs by a public limited company. Its shares can be purchased

by the public and dividend distributed among its shareholders.

2.8 Functions of the Hospital

1. To provide care for the sick and injured: This can be done by accommodating them

according to their physical condition and financial status. When we talk of physical condition, we

mean that some patients are seriously ill and require admission in Intensive Care Unit

while others are not so seriously ill and can be' accommodated elsewhere (e.g. in deluxe

room, single room with AC and without AC, semi-private room and general ward)

according to their financial status. There may be some patients who may require

isolation. In that case, they should be kept in isolated rooms, but the building should be

kept always in a good state of repair, pleasing appearance and providing the patient

every mental and physical comfort. In every hospital, there should be sufficient

diagnostic and treatment facilities available such as medical laboratory, X-ray,

ultrasound, MRI and CT scan for diagnosis, and operation theatre for surgery, labor

room for delivery, nursery for children, physical therapy for rehabilitation of patients, so

that they may be properly treated.

2. Training of physicians, nurses and other personnel: They receive their training in

both theory and practice in approved schools and colleges. Therefore, a hospital being

a complex and specialized organization must employ highly trained personnel so that

they may train others. Particularly in the branch of medical and paramedical education,

different associations/councils play very important roles. They make surveys of

hospitals and accord their approval. Only these approved hospitals can provide training

in medicine, nursing, dietetics, pharmacy, physiotherapy, administration, medical social

work, medical record library, X-ray and medical record technology, etc. Capable boys

and girls should be attracted to such courses as a career which offers them fair

remuneration, opportunities for self-development and reasonable security.

3. Prevention of disease and promotion of health: It is the duty of the hospital to

cooperate with the government agencies. They can treat patients of communicable and

non-communicable diseases, notify to the recognized authorities of any communicable

disease of which it has knowledge, assist in vaccination programmes of the

government, etc.

4. Advancement of research in scientific medicine: In light of the broad social

responsibility for maintaining and restoring the health, it is an important function, but no

hospital is permitted to do direct experiments on patients. It must resort to necessary

tests in laboratories and on animals. They can do so by making observations of

functions of the body in health and in disease but they will have to main clinical record of

patients accurately for which they have to engage qualified trained medical record

technicians who will preserve the record in such a manner that it can be made available

for study at any time to physicians and surgeons.

2.9 Complications in Hospital Function

A hospital has many organizational and operational elements in common with hotels,

industrial organizations and educational institutions. However, a hospital is a unique

institution as it includes all activities present in each of the above-mentioned groups. The

difference between administrative work in hospitals and in other organizations can be

attributed to the existence of the following conditions peculiar to hospitals:

1.The consumers of the services provided in a hospital (the patients) are physically or

mentally ill and are rendered services within the four walls of the hospital. As compared

with most other institutions of business, government and education, this is an unusual

situation and presents quite different problems of management.

2.The customers of the hospital (the patients) have individual needs and require highly

personalized and custom-made services, the diagnostic, therapeutic and preventive

services provided by physicians, nurses and technicians, with the aid of expensive and

specialized equipments and medication are needs of each individual consumer.

3.In addition to the more common institutional services and functions such as food

preparation, general housekeeping, laundry, maintenance, purchasing, personnel, credit

and collection and public relations, the hospital also provides a wide range of scientific

and technical services such as nursing, diet therapy, anesthesiology, pharmacy, radiology,

clinical laboratory, physiotherapy and medical social work. Also, many of its services are

provided continuously, round the clock, every day of the year.

4. All these services involve many individuals-the ill customer himself, his emotionally tense

relatives and friends, physicians, technologists, clerks and manual laborers. These

individuals are working, suffering, eating and sleeping within a comparatively small space

and in an unusual atmosphere, highly charged with emotion and tension. Only a very

capable administrator can adequately understand and effectively deal with the human

relations problems arising from these constraints.

5.Nurses and certain other personnel must accept direction from both the matron and the

physicians under whom they work closely every day. The human relations problems in

such situations of dual authority are much more frequent, delicate, varied and complex

than in organizations where this situation does not exist.

6.Handicapped by low wages, rigid discipline and some apprehension of exposure to

disease, hospital personnel are expected to maintain a very high level of efficiency, as

their functioning affects the lives of patients.

7.Another way in which the responsibilities and activities of the hospital administrator differ

from his counterpart in other fields is in the amount and variety of training programmes

that the hospital has to provide. Training is provided for medical interns and residents (6

months to 1 year), nurses (3 to 4 years), X-ray technicians (2 years), medical laboratory

technicians (2 years), physiotherapists (4 years), pharmacists (2 years), medical social

workers (2 years), dieticians (2 years), nurse aides and nursing orderlies (l year).

Classroom, clinical and apprenticeship training methods are used in varying combinations.

The administrator is responsible for planning and operating these various training

programmes. Very few other types of institutions combine such major educational

responsibilities with other operating activities.

8.Just as administration in hospitals differs from that in most other fields, similarly, public

relations aspects and problems of hospitals are more pervasive, delicate and volatile. The

human elements-the consumers (patients), producers of care and services (doctors,

nurses and other personnel), the variety of community health agencies, the other

competing hospitals, the people in the community (relatives and friends of the patients)-

and the conditions and environment in which they are brought together (the hospital),

present public relations problems of a sort and variety vastly different from those of most

other institutions.

9.The efficiency and quality of health care services in any hospital is directly dependent on

the use of bio-medical equipments in diagnosis, surgery and therapeutic process. These

equipments invariably employ sophisticated technology made of complex systems. Hence,

the problem of maintenance and management of these bio-medical equipments is complex

because there is acute shortage of technical hands who have suitable and adequate

training in the maintenance and repairing of these specialized hi-tech equipments. At

times, spare parts and components are not available because the models of these

equipments undergo frequent change. Next, the local dealers in India by and large do

not provide worthwhile after sales service or repair. The poor hospital administrator is in

a fix whether to go for hi-tech bio-medical equipments or use conventional methods of

treatment. If he opts for the first, he either discards these equipments one after another

in view of the above mentioned factors, or enhances the cost of treatment. If he does

not opt for hi-tech biomedical equipments, he loses his clientele.

10. The introduction of Consumer Protection Act, 1986 and subsequently, the Supreme

Court judgment bringing doctors under the purview of this act have evoked diverse

reactions. While the public is happy about what they call it a long overdue judgment; but

the doctors and hospital administrators are not happy at all as it will worsen the patient-

doctor relationship and surely increase the cost of treatment. The poor hospital

administrator will have to attend consumer courts for no rhyme or reason in most of the

cases as the patients are not only misled by advocates, but the consumer courts issue

notices to doctors and hospitals without understanding the nature of complaints filed by

patients. In other institutions, such as hotel or industry chief executives can explain to the

advocate, in their office, the line of defence to be taken in the consumer courts before the

trial begins, but in case of hospitals, their hospital administrators will have to stand by the

side of their advocates to explain each step taken in the treatment of patients by doctors,

as neither the advocates nor the judges of the consumer courts possess any medical

expertise.

11.Hospital waste management is another peculiar condition to administrative work in

hospital and has become a burning issue these days for hospital administrators, as

increased awareness of health and its related problems amongst the general public has

led to the demand for comprehensive health care facilities which in turn require frequent

visits to hospitals by the patients to undergo various tests. This results in the escalating

amount of hospital waste generation in the environment. This hospital waste is not like

domestic waste, but a potentially hazardous waste. Its unscientific disposal can pose

serious problems to the public in general, and the hospital administrator in particular, as it

results in increased morbidity due to chemical and radioactive toxicity in the environment

and transmission of various diseases. The conventional waste disposal method does not

work at all. Hence the hospital administrator faces another peculiar problem what is not

faced by a chief executive of a business organization or a hotel in disposing of the waste

of their institutions.

This distinctiveness of hospital administrations, call for a high degree of professional

competence to do justice to the job. It is, therefore, obvious that hospital administration

should be entrusted to those who have the necessary training and the right kind of

attitude to perform this vital task.

2.10 Organizational Chart

Most of the hospital is having following organizational Chart.

Governing Board

Executive Committee

Director

Administrative Committee

2.11 Human Resource: Valuable Assets in Healthcare Industry

Human resources, when pertaining to health care, can be defined as the different kinds of clinical and non-

clinical staff responsible for public and individual health intervention. As arguably the most important of the

health system inputs, the performance and the benefits the system can deliver depend largely upon the

knowledge, skills and motivation of those individuals responsible for delivering health services.

Medical

Supt.

Nursing

Supt

General

Supt.

Financial

Controller

HRM in health has to function in a sector with some unique characteristics. The workforce is large,

diverse, and comprises separate occupations often represented by powerful professional associations or

trade unions. 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.

2.12 Categories of Employees and Functions:

Broadly speaking Employees are divided into four categories

� Doctors/ consultants/Surgeons – These people are highly qualified & professional.

Their main functions are clinical treatment, Patient care, Medical Audit, Education & Research.

� Nurses:

They are involved in Nursing care, Relationship, Ward Management, Education.

� Administrative Staff:

These people are involved in overall Management of the hospital. It also includes support services like

kitchen, Laundry, Engineering, C.S.S.D, Security, and HR Dept. Finance Dept. etc.

� Paramedical Staff:

It includes all technicians, pharmacist and so on.

2.13 Hospital Ethics

The code of ethics of hospitals goes hand in hand with the code of ethics of physicians.

Both of them are required to follow their ethics to render care to the sick and injured. As

far as the hospital code of ethics is concerned, it was developed nearly half century ago,

but the code of ethics of physicians has been in existence since the days of Hippocrates

who lived about B.C. 460-377. Today, the code of medical ethics has become the

fundamental law of the hospitals and is applicable to all its personnel, including the

trustees.

The trustees are required to employ a qualified administrator to keep accurate records, to

provide facilities consistent with community needs, to determine fair policies, to set

professional standards and to provide protection to the patients during their stay in their

hospital. There should be neither solicitation for patients nor undesired publicity of any

kind whatsoever. Similarly, personnel of the various professions and avocations are

required to maintain the dignity and honor of their profession by discharging their

responsibilities to ensure that all patients receive the best care without any unnecessary

delay; secrecy about their diseases is maintained and they are not harassed in any way-

neither by soliciting favors nor by accepting monetary rewards.

The major responsibility of the Administrator of a hospital is also to follow the hospital

ethics. His relationship with the trustees should be respectful, refraining from any violation

of their confidence. He should be courteous in dealing with patients and relatives. No

Administrator of any hospital can be successful without having cordial relationship with

the medical staff. It is his responsibility to understand their difficulties, if any, and solve

their problems immediately so that they may render care to the sick and injured to the

best of their ability.

The hospital code of ethics clearly states that to render care to the sick and injured, to

impart scientific knowledge to its personnel, prevention of disease and promotion of

health and advancement of research in health related fields are primary responsibilities of

the hospital. Though the hospital has many functions, but all are subordinate to its above-

mentioned responsibilities and must never be allowed to detract in any respect. The very

personal information given by a patient and observations made during examination and

treatment by the staff of a hospital should be held as a sacred trust and should never be

revealed except during academic discussions and in a court of law. Modesty of the

patient is very important. No one including the treating physician and the nurse has the

right to expose the patient unnecessarily. Violation of this rule means the loss of

confidence of a patient in the hospital staff. Therefore, each and every hospital personnel

including the physician, nurse, laboratory and X-ray technicians, physiotherapists, and

others should avoid all those acts which would lead to the loss of trust of the patient

because whatever a patient tells, he does so in good faith and expects that all the

information will be kept secret and used only for treatment purpose. Therefore, it is for

practical reasons that sincerity, reliability, sobriety and calm balanced temperament are

required of those who are caring for the sick and injured, otherwise, the hospital may lose

its respect not only in the eyes of the patient but also of the community because each

patient belongs to one community or the other.

Thus the hospital code of ethics acts as a Light House and fixes the responsibility on all

those including trustees, administrator, medical staff, administrative staff and other

personnel of the hospital who have anything whatsoever to do with the care of the patient

to make every effort to ensure that all patients receive the best possible care with

minimum delay, with utmost skill and efficiency and with the greatest of personal

consideration. They should not ask for any compensation or reward from any patient.

Thus, The Human Resource Development manager should exercise due care in the

selection in the personnel who can meet the requirements of the positions they occupy

and should provide salaries and conditions of service which are commensurate with their

qualifications, experience and status so that they may provide efficient and effective

service to the patients of the hospital where they work and may not violate hospital ethics

by indulging in unethical activities.

Chapter 3

Literature Review

3.1 HRM, Employee Satisfaction & Healthcare Industry

In past two decades many healthcare organizations across the globe have realized the importance of

human resources and have shown great concern towards their internal customers by investing in a big

way for their growth and development. In the liberalized economy, Indian healthcare organizations are

also learning to compete locally as well as globally but most of the Indian healthcare organizations have

been exploiting only apart of their inherent potential. The main reason behind it is that they have failed to

tap the actual potential. People are the greatest asset to a company; it is they who can give the strategic

advantage to an organization. So there is a dire need on the part of Indian healthcare organizations to

take initiatives to find out the root cause of the gap in corporate growth, goals, business strategies and

employee's ambitions and job satisfaction. The first and foremost condition to run a healthcare

organization successfully in competitive environment is to devise an efficacious and productive

performance management system to manage the performance of the employees in a meaningful manner.

How to improve HR practices so as to make them compatible to global standards is a question that needs

a great deal of research and analysis. Many scholars and experts have contributed their ideas and views

in terms of articles, research papers, etc. Some of the works reviewed are mentioned hereunder:

John T. Delaney and Mark A. Huselid (1996), In 590 for-profit and nonprofit firms from the National

Organizations Survey, we found positive associations between human resource management (HRM)

practices, such as training and staffing selectivity, and perceptual firm performance measures. Results

also suggest methodological issues for consideration in examinations of the relationship between HRM

systems and firm performance.

HRM Practices affects on Job satisfaction found by Alina Ileana, Petrescu, and Rob Simmons (2008). The

purpose of this paper is to investigate the relationship between human resource management (HRM)

practices and workers' overall job satisfaction and their satisfaction with pay. After controlling for personal,

job and firm characteristics, it is found that several HRM practices raise workers' overall job satisfaction

and their satisfaction with pay. However, these effects are only significant for non-union members.

Satisfaction with pay is higher where performance-related pay and seniority-based reward systems are in

place. A pay structure that is perceived to be unequal is associated with a substantial reduction in both

non-union members' overall job satisfaction and their satisfaction with pay. Although HRM practices can

raise workers' job satisfaction, if workplace pay inequality widens as a consequence then non-union

members may experience reduced job satisfaction.

Ching-Chow Yang (2005), study confirms that HRM significantly affects TQM practices. The study

concluded that HRM practices have a significantly positive effect on the implementation of TQM.

Implementing HRM practices can also have a significant effect on employee and customer

satisfaction. It also positively affected “employees' quality awareness” and “corporate image”. The

quality performances were also significantly affected by the implementation of TQM.

The management of a firm's human resources is important because it affects profitability and

competitiveness through its effects on employees' level of job satisfaction, commitment to the

organization, and other organizational citizenship behaviors. Hoon, Lee Soo (2000), The HRM

audit provides a means for managers to evaluate their firms' HRM practices and to assess how

these HRM activities are contributing to their organizational objectives. The results obtained

serves to encourage managers to develop a strategic approach to managing human resources as

well as in measuring the performance of HRM activities. Systematic analysis of performance can

help determine priorities that will lead to a more rational approach to the management of human

resources

HR has evolved from a mere administrative rubber stamp to a more active strategic business

partner striving for aligning the HR processes with the core processes for attaining business

excellence. Jyoti Budhraja (2008) discusses the latest and emerging trends in HR practices in the

contemporary scenario with a focus on Indian context. It also explores the role of HR as an

enabler in the ever-increasing business challenges.

Most business authorities believe that Talent Management (TM) has emerged as an important

global business challenge. In developed economies, employers anticipate many experienced

workers to retire, creating a vacuum of talent that will not be easy to fill; in developing economies,

talent needs are fueled by explosive business expansion and pending waves of retirements.

Typically, Talent Management has focused on attracting, developing and retaining talented

people. But that is not enough for the future. Organizations will need next generation talent

management. William J Rothwell (2008)

The new perspective in the functioning of an HR Manager, Seema S. (2008) explained the role of

the Human Resource Manager is changing in the competitive environment. He plays a crucial

role in the future of an organization. HRM supports Strategic Management. Talent acquisition and

retention has become a significant job of an HR Manager. The success of an organization

depends on deploying employees who can adapt to and be comfortable in the changing

environment. Acquisitions and mergers are taking place so rapidly that organizations have to

grow by themselves or get `swallowed' by others. There is an increasing demand for HR

personnel who are capable of managing the increasing workforce.

HR managers should develop themselves into capable "change managers" as long as the

economy is dynamic and evolving, discussed by K Mallikarjunan (2008). Organizational change is

generally called for because of external and internal factors, like competitive forces and consumer

patterns (external) and need for reorganization (internal) in the light of changing business

environment. To be successful in managing change, the HR team should pick up new

perspectives that will encompass not only the conventional HR tasks but also active participation

in business matters to the extent of gaining a degree of awareness of the business nuances.

Such awareness will enable the HR team to make useful contribution to the adaptive strategies of

the corporate towards the changing environment.

Sreekumar P. (2008) analyzes and compares certain critical HRM strategies with respect to the

management of knowledge workers and how the knowledge workers and those who manage

them can understand their roles better and contribute to the upgradation of human capital of their

firm.

Recruitment is the entry step and if required care is not taken then the organization will have to

face adverse consequences. Shefali Goyal (2008) highlights the impact of Internet on

recruitment. It also discusses the concept of e-recruitment from the perspective of employers and

job-seekers, and throws light on the growing world of job portals in e-recruitment arena in India.

Information Technology and Internet have changed the face of an organization. Never more has

the concept of "boundaryless organizations" been more apt than in today's world. Internet has

increased the reach of organizations both in terms of markets and manpower.

Shrinivas Kandula (2006) find out challenges in handling interview technique as a part of

selection is discussed in this paper. Exterior simplicity of interview technique has become the

encouraging factor for widespread use of the interview method for a variety of purposes. In order

to use the interview method rightly and for right purposes, the practitioner should be conscious of

the following challenges:

� Understanding and managing limitations of the interview method

� Understanding the background of interviewee

� Training of interviewers

� Formatting interview

� Understanding purpose/context

� Interviewer to be honest and straight forward

� Interviewers keeping self in high pedestal

� Warming up

� Advance briefing to interviewee

� Trap of symbol and artifacts

� Making generalizations

� See-off candidate with a positive mind

Michael A. Campion, Elliott D. Pursell, Barbara K. Brown (2006), A highly structured employment

interviewing technique is proposed, which includes the following steps: (1) develop questions based on a

job analysis, (2) ask the same questions of each candidate, (3) anchor the rating scales for scoring

answers with examples and illustrations, (4) have an interview panel record and rate answers, (5)

consistently administer the process to all candidates, and (6) give special attention to job relatedness,

fairness, and documentation in accordance with testing guidelines. Examination of psychometric

properties for hiring entry-level production employees reveals high inter-rater reliability and predictive

validity, as well as evidence for test fairness and utility. The levels of these properties are comparable to

those of a comparison battery of typical employment tests, and correlations with the tests suggest that the

interview has a strong cognitive aptitude component. Potential explanations for the effectiveness of this

structured interviewing technique are discussed.

Andrew (2004), discussed on, Triumphant Companies have recognized the role of HR in appropriate

selection of Employees. World economy has shifted from manufacturing to service and knowledge. The

new role of HR is to determine the perfect skill essential for the employees to accomplish the

organization’s strategy.

Training as a core function in theory as well as practice of human resource management.

Manishankar Chakraborty (2009). explains the actual need for training and its relationship with

the development of an organization, both monetarily and non-monetarily. Training has taken

center-stage and is often related to the developmental aspect of an organization. It is indeed

surprising to note that most companies put in place training schedules without even demarcating

the long and short-term implications such programs would have on the individual employee and

the organization as a whole.

Shrinivas Kandula (2006) focuses on deploying training strategies for managing change in

organizations. The paper is organized into three parts The first part explores the role of training

system in managing change in organizations, the second part deliberates the need to replace

traditional training system with strategic training system and the third part suggests training

strategies that are apt to manage change in organizations. The paper also illustrates the essential

ingredients of a rational training system like training policy, training needs analysis, design of

training programmes, selection of participants, selection of internal faculty, selection of external

faculty, time perspective, training purpose, training content, evaluation and audit. The paper

concludes, establishing that though managing change in organizations through training is a

Herculean task, it is not impossible to achieve if committed and sustainable efforts are put in.

Every year, millions of rupees are spent on training to improve behavioral orientation and social

skills of employees. Despite its importance, often criticism is leveled against behavioral training

and many managers are skeptical about its contribution and impact. Therefore, it is incumbent

upon all the human resource professionals not only to emphasize the importance of behavioral

training but also establish its contribution and credibility. This paper details ten important steps to

achieve this. These are:

• Identify employee behavioral training needs

• Identify organizational behavioral training needs

• Transform the needs into behavioral concerns

• Obtain endorsement to behavioral concerns document

• Refine behavioral concerns document

• Develop action planner for behavioral competency

• Audit the content effectiveness of behavioral action planner

• Implement behavioral action planner

• Evaluate effectiveness of behavioral interventions

The paper helps practitioners in sharpening the behavioral training intervention and building it as

a sophisticated and reliable technique like any other cutting edge technology whose efficacy can

be proved. Shrinivas Kandula (2006)

Shrinivas Kandula (2006) in his book emphasizes the need to follow a systematic training strategy and

process for real results out of training implementation. However, efficacy of training programmes is a big

question everywhere when it comes to behavioral training. The paper identifies 10 factors that contribute

to ineffective training intervention. These are:

� No necessity based training

� No training strategy

� No resource commitment

� No assessment of organizational and employee training needs

� No identification and classification of competencies

� No grading of competencies

� No faculty! coaching development efforts

� No curriculum and methodology development

� No individual team development plan

� No training audit

The ten factors indicated above which are lucidly described in the paper are helpful to human

resource and training managers to tone up their training system.

Evaluating a Training Development Program (TDP) can provide the management with abundant

information on the extent to which learning has bridged the gap between intended and actual

output accrued through the application of learning, the short falls of the training, etc. Itishree

Mohanty (2009) discussed the importance of the evaluation phase of a TDP which many

companies ignore. It also cites a few evaluation models that companies have adopted to

understand the benefits reaped out of their TDP's.

Performance management has started receiving its long-overdue attention from the businesses across the

world. This is a direct consequence of the realization that employees are the key to better organizational

performance. Rashmi Joshi (2008), looks at various critical components of Performance Management

System (PMS) and how it can be successfully implemented, taking a cue from the current trends and best

practices followed.

Shrinivas Kandula and B. Hari Bapuji (2006), captured the need to shift focus from appraisal

system to appraisal process. People hate being assessed but they welcome any practice that

facilitates them to understand their performance level. It is not an exaggeration to state that

number of employees who express satisfaction with performance appraisal is abysmally low in

comparison to those who complain against it. Organizations need to introspect the real reasons

for the failure of appraisal system, so that it can be turned into a potent weapon for organizational

performance. This paper hotly debates the negative factors associated with administration of

performance appraisal and provides remedies to overcome them. This is especially beneficial to

those managers who are making efforts to instill performance-oriented culture, rather than merely

eager to push a faceless performance appraisal system.

T. Kiran Kumar (2008) suggested that A Performance Management (PM) system enables the business to

measure, manage and optimize its performance and profitability by relating the employees' pay to

competency and contribution. It ensures a conducive business environment-enabled healthy performance

and brings all the employees under a single strategic umbrella. Integrating the components of PM and

managing it effectively isn't easy. In reality, companies have realized that it requires a high level of

coordination between information-sharing and timely review.

V.S. R. Subramanium (1975) Concluded different Performance Appraisal is needed for optimal motivation

of different sectors of manpower in an organization, and hence one grand performance Appraisal system

should be avoided.

Arvind Mishra, (1998), concluded that Performance appraisal can make a major contribution to individual

and organization success by creating an atmosphere of openness and trust.

HR practitioners ought to be able to forecast what type of work, pay and benefits, promotion system and

recognition an employee would desire and sculpt these around him. A good indicator of these desires

would be their career anchor, Dr. R. K. Premarajan, (2003)

Job satisfaction is popular concept in Industrial Psychology and Human resource Management. At various

times it has been linked to productivity, motivation, absenteeism, tardiness, accidents, mental health,

physical health and general life satisfaction. The credit for bringing this term in to currency goes to

Happock (1935), according to whom job satisfaction is “any combination of psychological, physiological

and environment circumstances that causes a person truthfully to say: I am satisfied with my job.”

Wilfred J. Zerbe , Dawn Dobni, GEdaliahu H. Harel (2004) shed light on the relationship between

satisfaction with human resource management (HRM) practices and employee performance. We

examined the proposition that employee perceptions of HRM practices predict their behavior toward

customers. Previous writers have based such hypotheses on theory formulated at the level of individual

employees, but have used analyses at organizational or aggregate levels. We therefore sought to

demonstrate individual-level relationships between employee perceptions and service behavior. We also

sought to contrast the role of satisfaction with HRM practices with that of employees' perceptions of how

service-oriented their organization's culture was, based on the position of marketing theorists that a

service culture is fundamental to promoting service behavior. Our study of airline service employees

showed that service culture had a direct effect on self-reported service behavior, and that HRM practice

perceptions had both a direct effect on self-reported service behavior and an indirect effect through

service culture. Specifically, satisfactions with leadership and with work demands were the strongest

predictors of service behavior. Service culture did not moderate the relationship between perceptions of

HRM practices and service behavior. Discussion focused on alternative explanations for the relationship

between organizational practices and service behavior and on the implications for organizations wishing to

promote service behavior.

Michael K. Mount (2005) has given evidence that employees perceive certain aspects of the appraisal

system in a global way, whereas managers differentiate among various components and see them as

distinct entities. Second, the relative importance of the factors differs between the two groups. The largest

portion of variance accounted for in the employee sample pertained to general satisfaction with the system

whereas for managers it pertained to the types of ratings made on the appraisal form.

V V. Manerikar (1980) discussed on Job satisfaction and Performance. For better performance there is

need of required abilities and skills to fulfill managerial role. The study further discussed on selection

strategies with well developed battery of psychological tests and interviews, As well as the role of

Sensitivity training and Transactional Analysis to understand the forces of behavior for job satisfaction.

Employee satisfaction serves as a stimulus for the organizational quality and productivity. Hina Sohrab

Kiani, Omama Khurshid (2006), provides support for some key factors serving as stimulators for employee

satisfaction. These factors are pay, job interest, leadership (encouragement, feedback, and performance

appraisal), and career growth, working environment, broadly defined job responsibility, organizational

objectives and trainings. These factors if not provided, result in dissatisfaction of employees. In addition to

this some new factors have been identified which were not made part of the survey initially but came

across on employees feedback. These factors include government policies, transport, good innovative

projects, company strength, social and economic values, political instability, natural disaster, location,

vendor management, weather, and family issues. it is proved that employee satisfaction impacts positively

on software quality and productivity. In brief, if the factors highlighted are given proper consideration, the

productivity and quality of organization will increase.

Service climate and job satisfaction is showing positive effect on service quality where as

turnover intention is having negative impact on service quality. From Electronic Thesis (2006) it is

found that there is positive and significant impact of HRM practices on service climate and job

satisfaction. It has also been found that HRM practices are negatively related to turnover intention

of the employees.

The importance of the recruitment process remains as one of the most important, yet under researched

areas in human resources management. While the utilization of recruitment sources is documented from

both employer (Malm, 1954) and applicant (Latham, 1985) perspectives, few studies have addressed the

relationship between recruiting sources and employee behaviors and attitudes. Of the existing studies,

researchers have largely focused on recruiting sources as they relate to employee behaviors, such as

tenure (Decker and Cornelius, 1979; Gannon, 1971; Reid, 1972; Taylor and Schmidt, 1983), absenteeism,

and performance (Breaugh, 1981; Taylor and Schmidt, 1983). Van M. Latham, Peter M. Leddy (1987)

empirically investigated the relationship between recruiting methods and the work attitudes of job

involvement, organizational commitment, and job satisfaction. Multivariate and follow-up univariate

analyses showed strong recruitment source effects, with employee referrals emerging as a better source

of recruitment than newspaper advertisements. These studies are conclusive in their findings, namely, that

informal sources of recruitment (employee referrals, walk-ins) are the best sources of longer tenured and

less absent employees, while formal methods of recruitment (newspaper ads, employment agencies) are

among the worst sources.

Alan M. Saks (2006) examined the psychological processes for the effects of recruitment source and

organization information on newcomers' job survival. Formal sources of recruitment were compared to

informal sources, and a model based on the realism and met expectations hypotheses for the effects of

information accuracy received from one's recruitment source and the organization on job survival was

tested. Employees recruited through informal sources of recruitment (employee referrals, rehires, and self-

initiated walk-ins) were found to have greater job survival in comparison to employees recruited through

formal sources of recruitment (newspaper and radio advertisement, and posters), and reported receiving

more accurate job information from their recruitment source, greater met expectations, and ability to cope.

The results of a path analysis indicated that the accuracy of information received from one's recruitment

source and the organization was significantly related to several of the hypothesized process variables of

the realism hypothesis that are related to subsequent job survival. Further, the results support the met

expectations hypothesis as one of the key psychological processes underlying the relationship between

information accuracy and job survival. The implications for future research and practice are discussed

from an information acquisition perspective that integrates the literature on recruitment sources and

socialization.

A refocus on human resources management in health care and more research are needed to

develop new policies. Effective human resources management strategies are greatly needed to

achieve better outcomes from and access to health care around the world. The importance of

human resources management (HRM) is improving overall patient health outcomes and delivery

of health care services. Health care organizations are not factories. They are highly knowledge-

intensive and service-oriented entities and thus require a different set of HR practices and

systems to support them. Naresh Khatri (2006) discussed, the current human resource (HR)

management practices in health care are consistent with the industrial model of management.

Drawing from the resource-based theory, he argues that HRs are a potent weapon of competitive

advantage for health care organizations and propose a five-dimensional conception of HR

capability for harnessing HRs in health care organizations. The significant complementarities that

exist between HRs and information technologies for delivering safer and better quality of patient

care are also discussed.

Stefane M Kabene, Carole Orchard, John M Howard, Mark A Soriano, Raymond Leduc (2000) addresses

the health care system from a global perspective and it studied Challenges in the health care systems in

Canada, the United States of America and various developing countries are examined, with suggestions

for ways to overcome these problems through the proper implementation of human resources

management practices. Finally he concluded that Proper management of human resources is critical in

providing a high quality of health care.

James Buchan (2006) clearly indicated that it is not only the organizational context that differentiates the

health sector from many other sectors, in terms of HRM. Many of the measures of organizational

performance in health are also unique. As noted in the discussion, "performance" in the health sector can

be fully assessed only with indicators that are sector-specific. These can focus on measures of clinical

activity or workload (e.g. staff per occupied bed, or patient acuity measures), on measures of output (e.g.

number of patients treated) or, less frequently, on measures of outcome (e.g. mortality rates; rate of post-

surgery complications). The challenge for researchers and policy analysts in the health sector is to bridge

the current knowledge gap – between what we know from the general evidence base on HRM inputs and

performance, and what we know from the health-specific evidence base focusing on sector-specific

outcome measures.

The other main lessons from the evidence base examined in this paper are the need to consider

"contingency" – that there must be a "fit" between the HRM approach and the characteristics, context and

priorities of the organization in which it is being applied; and the recognition that so-called "bundles" of

linked and coordinated HRM interventions will be more likely to achieve sustained improvements in

organizational performance than single or uncoordinated interventions. In the often "politicized" health

sector, this is an important message.

Finally, it should be noted that defining the "best practice" evidence base is one thing, but translating this

into widespread application of the appropriate bundle of HRM interventions is another. Both ‘Richardson

and Thompson and Guest’ highlighted the issue of the relative lack of "take up" of HRM good practice:

even when it has been verified by the studies quoted above, it is not evident in day-to-day practice in

many organizations. This highlights an important issue for any sector wishing to improve HRM practice:

deciding how best to disseminate good practice in HRM is as important as determining how to identify and

evaluate it.

Though departments are belonging to the same hospital, these departments seem to adopt

different human resource architectures. Hsin-Chih Kuo (2005) , his study applies both resource-

based view and strategic human management theory to explore two kinds of fit in strategic

human resource management for Taiwanese hospitals. The strategic human resource

management can be divided into two kinds of fit: vertical and horizontal. To explore the vertical

and horizontal fit of human resource management practices, this study adopted an embedded

case study design and treated individual department as analysis unit. After interviewing several

medical and administrative department leaders, this research finds that the combination of

resources will influence the human resource management practices.

Rather than viewing HR as a critical driver of organizational strategy and outcomes, most health care

organizations see HR as a drain on the organization's bottom line. Fottler, Myron D.; Erickson, Eric;

Rivers, Patrick A. (2006) discussed uses the popular Balanced Scorecard approach to align its measures

of HR performance to the organization's strategic plan. Only by aligning HR with the organizational

strategy will HR leaders truly get a seat at the leadership table. HR professionals can overcome

impediments and gain a seat at the table by learning the language of business and the ways in which

organizational leaders use data to drive their decisions.

HR staff must be specialists with strategic HR functions and not generalists who are confined to playing a

restricted and bureaucratic role. Ummuro Adano (2008) described the quality and integrity of the public

health sector can be improved only through professionalizing HRM, reformulating and consolidating the

currently fragmented HR functions, and bringing all the pieces together under the authority and influence

of HR departments and units with expanded scopes.

There is broad consensus that Canada’s healthcare employers must do more to support and develop their

staff within healthy and positive environments. Turning the corner on healthcare human resource

challenges requires nothing short of cultural transformation. Just as in other industries, the

transformational journey is step-by-step. The goal: building a high-trust culture that encourages innovation

and supports employees to deliver the highest-quality patient care and community services. Graham S.

Lowe (2005)

Contemporary performance appraisal (PA) has become an important tool in the overseeing of

employees in work. Little of the vast literature however, has focused on its effects on the

individual, beyond simple descriptions that inform its management implementation. G. Coates

(2000) firstly examines the changing nature of employee management under PA, before it

investigates the contemporary usage of PA and the effects on women. This is illustrated with

research, gathered from a case study in the Midlands. The article also examines the changing

focus of PA as a means through which the marginal and not so marginal performer can be

controlled. Analysis focuses on the use of subjective images of ‘women’, through PA, for creating

functionally flexible workers in a ‘quality’ environment. This analysis also examines

management’s attempts to ‘involve’ individuals in the formulation of their own work process. It

does this by focusing on the powerful subjective manipulation of knowledge over individuals. The

use of a hospital case study highlights some of these issues in relation to the changes taking

place in the public service sector. This sector faces fundamental transformations in its concept of

‘service’.

Nurses, as the largest human resource element of health care systems, have a major role in providing

ongoing, high-quality care to patients. Productivity is a significant indicator of professional development

within any professional group, including nurses. The human resource element has been identified as the

most important factor affecting productivity. Nahid Dehghan Nayeri, Ali Akbar Nazari (2009) explored

nurses' perceptions and experiences of productivity and human resource factors improving or impeding it.

Participants maintained that satisfactory human resources can improve nurses' productivity and the quality

of care they provide; thereby fulfilling the core objective of the health care system.

Shay S. Tzafrir & Amit B. A. Gur, (2000) have undertaken the study within an Israeli Health Care

Organization to examine the relationship between HRM practices, and Service Quality as well as

the mediating role of trust in management. Human Resources Management (HRM) plays a

central role in the exchange relationships between the organization’s management and its

employees. Though earlier studies investigated several facets of climate as possible mediators,

none of them have examined trust as a mediating variable that affects the relationship between

HRM practices and service quality (SQ). In the healthcare industry, as in most other service

industries, the interaction between patients and healthcare service providers (professionals and

other employees) is an integral part of the service process. Yet, the provided services are highly

professional, and the layman cannot always evaluate these services professionally. The current

research focused on SQ as was perceived by employees. The findings suggest that trust in

management affects perceived SQ directly, and mediates the relationship between employee’s

perceptions of feedback and SQ. These findings are discussed in terms of relativeness for HRM

policies and practices in HCOs.

C S Weisman, C S Alexander, and G A Chase (1980) collected Data from a two-wave panel study of staff

nurses in two hospitals are used to assess the relative importance of several types of independent

variables as determinants of job satisfaction. Both organizational and non-organizational determinants are

examined, with the formed including both perceptual and structural measures. Findings indicate that

perceptions of job and nursing unit attributes, particularly autonomy and task delegation, predict

satisfaction most strongly. In addition, a nurse's own characteristics are found to be more important than

either structural attributes of nursing units or job characteristics in predicting job satisfaction.

HRM does affect job and client satisfaction. Correlations between HRM and client satisfaction were

generally rather low. Employees’ satisfaction with their organization is a better predictor of client

satisfaction than job satisfaction. Job-related training showed no relation with job satisfaction, but a clear

relation with client satisfaction, while leadership style of their manager had a significant relation with job

satisfaction, and a more limited one with client satisfaction. Regular performance reviews are important for

job satisfaction and client satisfaction. Employee and client satisfaction can also conflict: more regular

schedules increase employee satisfaction, but decrease client satisfaction, Marlies Ott, Prismant, Utrecht,

Han van Dijk, Prismant, Utrecht (2005).

Simply introducing HRM practices or programmes, in the absence of an appropriately supportive

workplace climate, will be insufficient to attain optimal organizational performance. K V Rondeau, T H

Wagar (2001) examines the relationship between HRM practices, workplace climate and perceptions of

organizational performance, in a large sample of Canadian nursing homes. Results derived from analysis

suggest that nursing homes in our sample which had implemented more 'progressive' HRM practices and

which reported a workplace climate that strongly values employee participation, empowerment and

accountability tended to be perceived to generally perform better on a number of valued organizational

outcomes. Nursing homes in our sample that performed best overall were found to be more likely to not

only have implemented more of these HRM practices , but also to report having a workplace climate that

reflects the seminal value that it places on its human resources.

Improving the work environment so that it provides a context congruent with the aspirations and values

systems of nurses is more likely to increase the satisfaction of nurses and consequently have a positive

effect on individual, organizational and health outcomes. Rubin Pillay, (2009), highlighted the overall

dissatisfaction among South African nurses and confirmed the disparity between the levels of job

satisfaction between the public and private sectors. Health managers should address those factors that

affect job satisfaction, and therefore retention, of nurses in South Africa.

The human factor is central to healthcare, yet its proper management has remained beyond the reach of

healthcare organizations. Khatri, Naresh; Wells, Jack; McKune, Jeff; Brewer, Mary (2005) qualitative study

examines strategic human resource management (HRM) issues in a university and a community hospital.

The findings indicate that the hospitals lacked a clear understanding of their strategic intent and

objectives; as a result, their human resource (HR) practices lacked coherence and direction.

Sunil Maheshwari, Ramesh Bhat & Somen Saha (2008), attempted to analyze the commitment of state

health officials and its implications for human resource practices in Gujarat. Following initiatives were

identified to foster a development climate among the health officials: providing opportunities for training,

professional competency development, developing healthy relationship between superiors and

subordinates, providing useful performance feedback, and recognizing and rewarding performance.

Human resource plays a very significant role in effective performance of a hospital which

depends to a great extent on the quality of its staff. “The better the quality, the higher level of

performance.” Hospital is a place where, on one hand, we have highly skilled personnel such as

doctors and on the other; we have unskilled workers such as sweepers. Management has been

using the traditional tools which are basically coercive in nature (such as, punishment,

suspension, degradation and discharge) to control the employees but it is to be realized that

these coercive measures are never productive. To control the staff effectively, modern

management tools are to be adopted and coercive measures are to be replaced by persuasive

ones. Ram Nath Prasad (2005)

Sonal Shukla (2008) discovers in her Article that, Hospitals in India aiming for accreditation are

increasingly adopting credentialing and privileging to ensure that the physician or nurse in charge of the

patient's treatment has adequate education and training. Credentialing and privileging are seen as means

that allow a hospital to optimize the utility of its most crucial resources— the specialists— and provide

efficient and quality patient care. The concept, which is still in its infancy in India, is slowly gaining

momentum with the dawn of corporate healthcare and increasing numbers of hospitals choosing different

quality standards.

Recruitment is an extremely important function in personnel management. However, in

healthcare industry, it has remained neglected so far. Why it is so and what should be done?

Such questions cannot be ignored to remain unanswered. The current practice of recruitment in

majority of our hospitals (private sector) is based on the trial and error method. This method

advocates the ‘hire and fire’ policy i.e. employ a person, try him out and throw him if not found

suitable. Such an approach will never be appreciated in modern management sciences. Ram

Nath Prasad (2001) suggested recruitment is a specialized function and should be proceeded

with, in a methodical manner. Today, there are many recruitment agencies which are ably fulfilling

the needs of various industries. However, our healthcare sector lacks such services.

Ram Nath Prasad (2001) discussed that it is easy for a smaller hospital to develop personal rapport with

each of its staff compared to a big hospital with huge number of employees. Therefore an attempt can be

made to go into the depth of a personal problem of the employee and help him to sort out the same. Some

monetary help would also provide great relief to him. Such gestures would make the employees more

committed to the organization and also help them perform at their optimum level. To conclude, smaller

hospitals and nursing homes should understand that recruitment is a costly and time-consuming process.

Therefore all attempts should be made to keep the employees happy and well-informed. Cordial

relationship between a hospital and its employees would go a long way in providing efficient healthcare

services.

Hospital industry is a labor and capital intensive industry. Nowadays hospitals are trying their level best to

acquire most talented staff from different stream of skill sets for efficient operations. Competent manpower

is what sets a hospital exclusive from other service providers in market and builds a long lasting growth

oriented Brand Equity. Cost of recruiting potential employees is increasing day by day as methodology of

recruitment has also changed due to augmentation of media vehicles such as news papers, magazines

and web-based search for employment. After recruitment, hospitals like any other industry prefer to have

optimum input from employees for continuous delivery. Due to increase in number of service providers,

hospitals are focusing more on cost containment and quality services and therefore it becomes more

important that absenteeism and turnover are dealt with continuous monitoring to reduce cost of manpower

to hospital. “Absenteeism and turnover are types of withdrawal behavior that an employee exhibits when

he encounters personal and professional problems and the relative importance of a particular problem is

more then the other job factors in his life” by Ankush Gupta (2002).

Dr Charulata Pamnani (2008) focuses on HR aspects should address key practices like creating and

maintaining a high performance work culture to enable the staff to adapt to change. A peculiar challenge

for healthcare organizations is the breadth of staff relationships. This is true even for a laboratory, the

variety of people contributing to the delivery of services range from doctors, quality managers, technicians,

phlebotomist, students and boys. HR aspects should address key practices like creating and maintaining a

high performance work culture and developing staff to enable them to adapt to change. For creating a high

performance culture, you need to have policies for: Recruitment, Training, Staff reviews, Grievances

resolution, Retention, Career Development.

Tests of ability and personality are used for selecting the right candidate for a job through

psychometric analysis. Sonal Shukla (2009) examines if these can be used as effectively in the

healthcare industry. There is considerable potential for using psychometric testing in the

healthcare industry. As more hospitals become professionally managed, and want to provide the

best possible treatment and care to their patients, they will require staff with the right

competencies. Psychometric tests can contribute to the selection and development of such

employees. Therefore, there is significant potential for psychometric tests in the healthcare

industry. "It is literally a green-field and has tremendous potential, provided it is done by qualified,

trained and authorized assessors. By the same token, it would die a premature death if treated as

a fad and done by amateurs, untrained and unauthorized assessors".

Ankush Gupta (2005) discussed Cost containment measures in relation to Human Resource

Management.

(a) Activity linked recruitment

Hospitals should evaluate the quantum of patient flow to the various departments and adhere to

the activity linked recruitment and deployment. The occupancy level of the wards and utilization

pattern of the OT should be critically scrutinized to find the optimum staff levels. It is always

advisable to pay more salary to the staff and get the optimum level of work done rather than over

staffing the hospital. The ideal bed to staff ratio is 1:4. Organizations with a ratio of less then 1:4

are ideally staffed but hospitals with bed to staff ratio more than 1:4 need to undertake right sizing

exercise.

(b) Automation of HR functions

Automation of HR functions may appear to be a costly and time-taking measure, but in the long

term it helps tremendously in cutting cost. For example, if a hospital has a provision of

computerized application bank, then huge amount of data can be stored and applications can be

retrieved on need basis and money can be saved as number of advertisement released will

reduce.

(c) Training & development interventions

Hospital's training programme should be focused around "Train the trainer" concept wherein HR

department should identify line managers who can effectively impart training and train them in

conducting in-house programme. This helps in cutting the cost of the external training programme

and also the effect will be much more as line managers will be using live examples to train the

staff.

(d) Multi-tasking of the staff

HR department should carry out through job analysis and write detailed job responsibilities. This

will help in eliminating the duplication of job activities and help in cutting the cost of HR. Also

opportunities to merge job responsibilities should be identified to implement the concept of

multitasking. For example, point Liftman cum security guard cum driver for hospital security. On

the job training should be implemented to execute multi-tasking.

(e) Reassessment of the employee benefits

In many hospitals, employees are given certain benefits like free hospitalization, medicines,

subsidized food, free beverages etc. in order to cut cost. Hospitals can set the limits and systems

wherein every employee benefit is accounted. For example, free medicine to the employee can

be given on hospital doctor's prescription only. Setting up limits, like medicine worth a fixed

amount will be given per annum per employee will help tremendously in cost containment.

Sidhartha Satpathy (2000) explained the role of the hospital administrator as a coordinator and conductor

in management of hospitals. With the advancement of management science, it has become imperative on

the part of mangers or administrators to regularly obtain feedback on human resource development

systems in various organizations. Performance appraisal is an integral link in the chain of effective

managerial operations, since it is the all powerful instrument directing individuals in achieving

organizational objectives. It plays a vital role in the entire process of individual and organizational

development. In no other setting are human beings more important than in hospital, because of the

peculiar personnel mix and the fact that practically everything in hospitals requires proper and systematic

team work. Motivation and morale of all the employees should be on high level and it is more essential for

group 'D’ staff because of the repetitive and menial nature of the job.

Human resource management practices with special reference to the latest developments of the

1990s such as environmental effects and managing diversity were investigated. The purpose of

the study was to unveil how the health care industry can benefit from these new concepts, as well

as to describe how the traditional health care facilities can adapt these new ideas. Junaid

Siddiqui, Brian H. Kleiner (1998) concluded from this research, that the health care industry

should adapt the latest methods to compete and survive, such as use more marketing tools to

attract human resource management personnel from other industries, promote diversity at the

work place, promote from within the company, and cross-train personnel whenever possible.

Health care industry has generally lagged behind other industries in securing high-performance

individuals and marketing personnel; however, with the development of health maintenance

organizations, this trend is changing.

Productivity and quality of service in an organization entirely depends on its ability to manage the

human resource. How to get 'people' involved and motivated for excellence at work? The key to

effective work performance is in understanding of Human Motivation based on needs. S.M. Garg,

N.K. Parmar, Rajvir Bhalwar, Kalpana Srivastava (2001) objectively discusses various issues

related with motivational needs of medical professionals. The overall results have highlighted low

level of motivation in career, unmet comfort needs, and low self-esteem among doctors. The

analysis of occupational role structure of "Doctors and Nurses" concluded that self-esteem and

pride in job depends upon social and professional standard of doctors in an organization. To

create a motivating environment, it is therefore imperative to dovetail in to the organization

structure and functioning an objective system to measure and meet the motivational needs of

doctors which may vary among specialists and non specialists during their career progression.

Use of various psychological tools which are available is also recommended in various areas of

Human Resource Management.

It has been said that managing change is a synonym for managing people through change. No

other industry has experienced more change in the past ten years than the health-care industry.

In order to regulate all of this change, managers in health-care organizations must identify new

ways to deal with the changes. The issues are as old as time: job satisfaction, cultural conflict,

and compensation. Galen Conant, (1998) addresses each of these key issues with the following

examples. A new nursing paradigm that was implemented at a hospital has significantly

increased job satisfaction. This paper also takes a look at ways to manage cultural conflict in a

diversified workforce.

3.2 Research Gap

After reviewing a good amount of literature on the subject following picture has emerged:

It came to light that a lot of work has been done in the field of HR and other related areas.

Authors who have communicated their views through books, journals, Research magazines,

research reports, etc. have touched upon various crucial aspects of HR.

Information about research studies/projects carried out at various higher educational institutes

was also collected so as to avoid duplication of efforts and find out gaps. Research studies that

were confronted during literature scanning are on the topics as Personnel Polices, Recruitment

Sources, Selection Process, Induction, Performance Appraisal, Training and Development,

Employee Satisfaction, Strategic HR and so on so forth. But there seems to be no research study

available on HR practices and its effect on employees’ satisfaction in Trust Hospitals from

Metropolitan city like Mumbai.

There appeared to be an urgent need to undertake a research study that exclusively discusses

about HR practices in the Hospital organizations in the emerging economic scenario of the

country. The study might try to find answer to the following questions:

• What is the current HR management scenario in Healthcare organizations?

• How HRM Practices are implemented in charitable Trust Hospitals?

• How do Hospital employees perceive HRM practices like Recruitment, Selection Process,

Induction, Training, performance Appraisal and Motivational techniques exercised by

Management?

• How do the above HRM Functions affect on hospital employees levels of satisfaction?

In this Research Study, the above said questions are addressed and appropriate answers are found out.

Chapter 4

Research Methodology

The present chapter aims at enunciating the research problem and giving precisely the objective and

scope of the study. The hypothesis formulated for this investigation, the design and method of study, the

tools and techniques adopted for the analysis and interpretation of data, and the characteristics of the

sample selected for this research are also outlined in this chapter.

In previous chapters, the study dealt with the concepts, its related explanations and the various problems

from the field of HRM and its execution, Employee satisfaction and Healthcare Industry. It can be

conceived that the problem to manage employees efficiently and effectively depends on the behavioral

part of the individual which comprises of satisfaction, dissatisfaction, perceptions and attitude etc. The

concept of satisfaction is not only associated to Monetary and Motivational Mechanism, however, it is also

interconnected with HR functions like Recruitment, Selection, Induction, Training and Performance

Appraisal and so on. The present investigation has been carried out on the following problem i.e. in what

way the satisfaction level of employees varies with the systematic or unsystematic (disorganized)

implementation of HRM practices.

The proposed study intends to assist Healthcare organizations to improve the efficiency and effectiveness

of employees, to discuss the aspects of Systematic HRM and how the same can be inculcated into

practice. To increase the satisfaction level of employees for better performance and enhancing the Brand

image of the hospital.

4.1 Scope of Study

The present study covers the Mumbai City and its suburbs. There are 45 hospitals which are registered

under THE BOMBAY PUBLIC TRUST ACT, 1950. Out of 45 hospitals nearly 25 hospitals are provided

with 100 or more bed capacity and out of these the investigator has selected only 12 hospitals due to

constraints of time and money.

The present study explores the HR practices in these hospitals and focuses on four functions i.e.

Recruitment, Training and Development and Performance Appraisal. It further analyzes the satisfaction

level of employees which is related to implementation pattern of above mentioned functions.

The study has not taken into consideration the practices of HR in respect of Class IV employees.

4.2 The objectives of the Study:

• To examine the trends of HR practices in selected hospitals.

• To find out the satisfaction levels of employees as a consequence of the HR Practices of the Hospital.

• To establish Relationship between HRM practices and satisfaction levels.

• To make recommendations to these selected hospitals in order to increase the efficiency and

effectiveness of its Human Resources.

4.3 Statement of Hypothesis

Alternative Hypothesis (H1): Systematic and scientific HRM practices leads to higher employee

satisfaction.

Null Hypothesis (Ho): Systematic and scientific HRM practices do not lead to higher employee

satisfaction.

4.4 Sample Design

The sample design has used the ‘Non Probability – Purposive Sampling method’. The deliberate selection

has been made to select the above hospitals to confirm the pre-determined criterion that is well known,

Tertiary care, Trust hospitals above 100 bedded capacities from Mumbai City.

The HR Manager or Asst. HR Manager of sampled hospitals was contacted in order to collect primary

data.

Generally in Hospital industry employees are categorized as Doctors, Nurses, Para Medical Staff, Front

Office & OPD staff and Administration Staff. To assess the Satisfaction Level of employees from each

hospital, the population is subdivided in to above Strata. From each stratum random samples are drawn

by using Disproportionate Stratified Sampling. 15 employees have been selected from each hospital and

three employees from above given category.

The following Twelve Trust Hospitals were included in the sample and surveyed:

Table No. 4.4.1: Selected Hospitals, Bed Capacity and Total Employees

SR.

NO.

Name of the Hospitals Total

Beds

Total

Employees

Class IV

Employees

1 Asian Heart Institute 130 720 Out Sourced

2 Bombay Hospital 830 4700 1000

3 Breach Candy Hospital 173 1000 300

4 BSES Hospital 100 500 Out sourced

5 Godrej Hospital 120 215 Out sourced

6 H. N. Hospital 320 727 200

7 Hinduja Hospital 351 2200 340

8 Jaslok Hospitals 359 800 700

9 Lilavati Hospital 310 1100 500

10 Nanavati Hospital 400 1260 500

11 Prince Ali Khan 164 400 225

12 Saifee Hospital 236 560 Out sourced

4.5 Data and Information Base

To carry out the study in a meaningful manner, an adequate amount of data and information was required.

An in-depth study of HRM Practices, Employee Satisfaction and Complexities of Healthcare Industry was

made through reviewing literature of Journals, Research Magazines, Books, PhD Thesis. The semi

structured interview method is adopted for In-depth Interviews with HR Manager or Asst. HR in order to

focus the discussion on the Implementation of HRM functions in their respective hospitals.

4.6 Data-Collection instrument

For this study, the survey-questionnaire instruments were used achieve the main objective of the study.

The design of questionnaire has been formulated after referring to extensive literature and through

discussion with well known HRD experts. A self-administered questionnaire was distributed to the

employees. The questionnaire given to the employees aimed to assess the HRM practices in their

hospitals. In addition, this also aims to find out the feeling of satisfaction level with HRM practices.

The Content of the questionnaire is covering first part of the background information like Name of the

Hospital, Department, Age and years of experience and the second part is about the HRM functions with

following sequence of Recruitment, Induction, and Job assignment, Training, Performance Appraisal and

Motivational Mechanisms. Its relevant Factors / Aspects have been considered for Data Processing.

(Table No.4.6.2)

The questionnaire was structured in such a way that respondents will be able to answer it easily. Thus, the

set of questionnaire was structured using the Likert format with a five-point response scale. A Likert Scale

is a rating scale that requires the subject to indicate his or her degree of agreement or disagreement to a

statement. In this type of questionnaire, the respondents were given five response choices. These options

served as the quantification of the participants' agreement or disagreement on each question item. Below

are the designated quantifications used in the questionnaire:

Table No. 4.6.1

1 Strongly Agree

2 Agree

3 Neutral

4 Disagree

5 Strongly Disagree

4.7 Field Work

The visit to above twelve hospitals is made to conduct the interview with HR Manager or Asst. HR. After

exhaustive discussion the authorization has been taken to fill up the questionnaire from samples which is

composed with different Departments.

4.8 Time Frame

The field work for data collection was carried out from May, 2008 to May, 2009, a period of twelve months. . It

was done in the working hours from 9.30 am to 5.00 pm.

The major difficulties faced were getting the appointment from HR Manager or Asst. HR Manager and

waiting for two to three hours for his interview. It has been observed that respondents were in diverse

moods which affected them on answering multiple choice questions.

Q.No Questions Important Aspects/ Factors

1 To fill vacant positions hospital is giving first preference to existing employees

Preference to Internal Recruitment

2 I feel my appointment is done by following systematic recruitment plan

Systematic Appointment Process

3 I enjoyed interview by receiving structured questions and being given opportunity to express my strength and feelings and opinions.

Structured Interview

4 My hospital is conducting formal and systematic Induction programme.

Systematic Induction

5 Within first month I got complete information about my hospital, its history, vision, mission, objectives, Financial Status and organization Culture.

Complete Information about Organization

6 I am satisfied that I have been given right job profile Satisfaction for Right Job Profile

7 I received accurate job description Accurate Job Description

8 After joining my manager clearly defines me job responsibilities Clear Job responsibilities

9 I have the tools and resources to do my job well Availability of Tools and Resources

10 I am getting opportunity to work on interesting projects Opportunity to work on interesting projects

11 I know my training Calendar Information about Training calendar

12 My supervisor makes sure that I have sufficient training Active Supervisor for individual training Needs

13 I have Access to company-sponsored training and seminars Accessibility to company Sponsored training

14 My manager/supervisor clearly communicates what is expected from me before appraisal period

Communication for expectation for performance

15 I am satisfied with current performance appraisal process Satisfaction with Appraisal process

16 I received my performance feedback Performance feedback

17 My manager guides me to improve performance Guidance for performance Improvement

18 I am aware of Connection between pay and performance Awareness about pay and performance Connection

19 I am satisfied with promotion system Satisfaction with promotion system

20 I am satisfied with salary structure Satisfaction with salary structure

21 I get Health care benefits, Retirement benefits Healthcare and Retirements benefits

22 I feel hospital is taking Health care of my family and children Healthcare benefits to my family

23 Listening to the perspectives of employee in employer/employee disputes

Listening of disputes

24 I would like to remain with this hospital till my tenure is complete Feeling of Job Stability

25 I have a clear path for career advancement Career Planning by Organization

Table No. 4.6.2: Questions from Questionnaire and Its Relevant Factors/ Aspects to Measure

4.9 Data processing:

(Editing, Coding, Entry, Tabulation, Statistical Analysis)

A little editing had to be done for correcting erroneous entries to the master data table of responses. This work

was simplified as most part of the interview schedule for the employees was precoded. Coding was specified to

a measure of scale viz. Likert scale and a range of the measure equivalent of +2 to the higher end of the

positive response which meant a strong agreement to a scale of -2 equivalent to lowest end of the scale of

negative scale which meant that the respondent strongly disagreed with the respective question he/she was

made to answer the measurement is denoted as follows…

+2 meaning strong agreement

+1 meaning somewhat agreement

0 meaning non responsive or non committal

-1 meaning somewhat disagreement

-2 meaning strong disagreement

All the responses with close ended questions were tabulated in the above format. Quantitative data was

analyzed using software package EXCEL. A mean for all the respective responses to the statements posed

to the employees was derived.

In many statistical studies, a conclusion is made as to whether a particular set of data is

significantly different from a control set of data. In order to make that conclusion, one must know

the variability of the data. The measure of variability used is nearly always the standard

deviation. The standard deviation is approximately equal to the average deviation from the mean.

Subsequently ranking of the questions was performed. The ranking was done in the order beginning from

questions with higher mean and lesser standard deviation.

Coefficient variation was calculated to know the volatility of responses. The coefficient of variation (CV) is

a normalized measure of dispersion of a probability distribution.

The responses with lesser coefficient of variation (CV) are stable answers. Finally the results thus

obtained to the whole set of responses were analyzed and the findings thus established were sorted again

to the most favorable response to the least favorable response and accordingly results of calculations thus

obtained were tabled along with the interpretations under the headings as most favorable responses to the

question posed on one end to the lesser or least favorable responses on the other to facilitate the testing

of the HYPOTHESIS of the study.

Finally, this thesis has been written after data processing, data analysis and findings. The

recommendations have been made to implement systematic HRM in hospital industry in order to achieve

higher levels of employee satisfaction.

4.10 Limitations of the Study

The present study has been carried out very carefully and systematically though it might suffer the

following limitations:

The twelve hospitals selection is based on Non Probability sampling which suffers from sampling bias,

and Purposive sampling does not represent the whole of the population.

Fifteen employees from each hospital is very less a number compared to total employees. In addition,

Disproportionate stratified Sampling does not give proportionate representation of Total population of

Strata.

Problems like incompleteness of information was confronted during the data and information collection

exercise.

In-depth interview with HR Manager or Asst. HR Manager suffers from overstating of the Efficiency of

HR Dept.

A survey method is subject to response error.

The study may not be of direct help to the hospitals to reshape their HR function by benchmarking

against the recommended HR practices as the implementation of these HR practices varies from one

hospital to another.

Chapter 5

HR Practices in Hospitals

HR practices prevai l ing in the twelve hospitals in Mumbai as fol lows:

5.1 Asian Heart Institute – Bandra, Mumbai

RECRUITMENT: A broad Manpower Planning exercise precedes the recruitment process. The

manpower planning is done keep in view the present and prospective requirements.

SOURCES OF RECRUITMENT: The hospital depends on the following sources for their

recruitment:

• Placement Consultants

• Walk- in Interviews

• References

• Internal Circulars for vacancies on intranet

• Campus recruitment

• Advertisement in newspapers

For Junior/Residential Doctors the recruitment sources are students of College of Physicians &

Surgeons.

SELECTION:

The hospital has adopted a multi-stage selection process which proceeds as follows:

a) Scrutiny of applications by HR Department, followed by a scrutiny by HOD

b) Short listed candidates are called for interview which is conducted by Head of Department and

HR Manager

c) Followed by written test to judge the aptitude of the candidates

d) Final interview by Vice Chairman.

The process stands completed when the selected candidates are given offer letters and advised

to appear for medical test.

For the selection of nurses there is a slight deviation. Depending upon vacancies, the nurses

appear for a walk-in interview with Nursing Director.

INDUCTION:

For induction, the hospital follows a formal and systematic process. The new entrants are formed

into groups of 15. They are put through the induction process on the 17th and 18th of each month.

The induction process consists of:

� The Head of HR briefs the employees on the various HR issues

� Presentation by various HODs about their respective departments

� General tour of the hospital

� Induction speech by the Vice-Chairman of the hospital.

TRAINING AND DEVELOPMENT:

Determining the Training Needs:

There is no practice of determining training needs. However, HODs recommend as to who are

the employees who need training. On the basis of this input, the HR Manager makes a training

calendar which includes both in-house and external training.

The in-house training focuses on the following:

� Behavioral skills

� Soft skills

� Communication skills

External training is resorted to when exposure to technical aspects are vital. During the course of

both the systems of training mentioned above, psycho-metric test are conducted.

Evaluation of Training:

In the case of nurses only, pre-training evaluation and post-training evaluation is conducted

PERFORMANCE APPRAISAL SYSTEM:

The performance appraisal system is organized and executed through an HR consultant who is

on the panel of experts of the hospital. As a first step the consultant discusses with the

employees of each department and finalizes the Key Result Areas and sets the goals. Against

these the performance is evaluated for different categories as under ---

For Executives Quarterly basis

For Nurses Half yearly basis

For other Staff Annual basis

For Probationers Half yearly basis

The appraisal process has the following pattern:

1) The employee rates himself on a form on a 1 to 6 scale

2) The employee and the HOD discuss the rating and record their joint scores alongside

3) All the forms are sent to the HR department where the data is converted into software and

computed

4) The final report thus compiled is forwarded to the Vice Chairman

5) His appraisal can lead to three possible outcomes

� Promotion decision

� Performance bonus

� Increment grade

PROMOTION POLICY

Promotion is only based on Performance.

MOTIVATIONAL MECHANISM:

� Decent working condition

� Continuous Training and development to Nurses of Accredited work.

� Supportive system to enhance behavioral skills,

� Good food facility

� Good brand name and corporate image

5.2 Bombay Hospital- Marine Lines, Mumbai

RECRUITMENT: The responsibility for recruitment is decentralized as with the Medical Director

handling doctors’ recruitment, the Nursing Director managing nurses’ recruitment and the HR

Manager being responsible for the other categories of staff.

SOURCES OF RECRUITMENT: The moment HR Dept. gets a job requisition slip from any

department, it starts looking for prospective candidates using various sources of recruitment. The

following sources are used in this hospital ….

• Times of India

• Placement Consultants

• Job Portal (Naukri. Com)

• Data Bank

• Campus recruitment only for nurses

• Internal Circulars for vacancies

SELECTION:

The Selection process comprises the following actions:

1. Receipt of applications

2. Screening of applications where job description and job specifications are matched

3. The matter is then forwarded to the concerned Director

4. Candidates called up for preliminary interview

5. Short listing of candidates is done after three/four rounds of interview

6. Followed by medical test

7. Job offer made

The process is elaborate; however there is no effort on the part of the hospital to study the cost

effectiveness of the selection mechanism

Interview Panel:

For Doctors: Medical Director and Expert Doctors

For Nurses: Nursing Director and related professionals

For other positions: HR Director and concerned departmental Heads

INDUCTION:

The Hospital does not have a structured and formal induction process but employees get familiar

with the hospital system over time.



There is no system of determination of training needs. The training practices followed by the

hospital are:

In-house Training involves job rotation, job coaching, observation learning. The schedule also

contains lecture method containing:

� Behavioral training

� Hygiene aspects

� Personality development


External Training: The hospital encourages employees to attend computer courses outside for

which it reimburses the course fees

For those in the Officers rank and above, the hospital encourages higher education by

reimbursing the fees on the condition that the concerned employee will enter into a bond for a

further period of two to five years.


The formal Evaluation of Training Programme is not been conducted.

PERFORMANCE APPRAISAL SYSTEM

The Performance Appraisal System is conducted at three levels:

• Clerical and supervisory staff (C1 To C5 )

• Officers and above (S1 To S5)

• Director and Top Management

� Performance Appraisal for clerical and supervisory staff

For this category appraisal form is filled by Director of the Department. The form contains fifteen

factors which are measured on Likert Scale. From here the form is forwarded to HR Department.

The HR Department merely adds up the scores on the Likert Scale, department wise and

forwards the same to the Chairman. The Chairman peruses the scores of the High performance

staff and low performances staff and the recommendations thereon of the concerned

departmental Directors. Based on this he decides on the training needs and salary increment of

the staff. The entire Performance Appraisal system is a strictly confidential and to that extent

lacks transparency.

� Performance Appraisal for Officers

The Performance Appraisal System for Officers commences with the preparation of his Job

Description. The Director uses this Job Description for rating the performance of the Officer.

The details of the Performance Appraisal are transferred to the Chairman on-line to maintain

secrecy. The Chairman meets each Officer individually to discuss their contribution to the

organization through their job profile. Based on this discussion the Chairman rates each officer

using a grading system as A +, A, B +, B, C+, C. each of which denote a predetermined monetary

compensation.

� Performance Appraisal for Directors

The Chairman himself fills the Performance Appraisal forms of the Directors. This is followed by a

one-to-one meeting between them to discuss performance and contribution. Performance bonus

is paid on the basis of contribution made.

PROMOTION POLICY: Promotion is based on

� Qualification

� Experience

� Performance



� Stability in the job

5.3 Breach Candy Hospital –Mumbai

RECRUITMENT:

The manpower planning adopted by this hospital is more or less in line with the general industry

practice. However while firming up manpower; the hospital gives first preference to internal

sources.

SOURCES OF RECRUITMENT: Wherever required the hospital depends upon the following

external sources

1. Advertisement in Times of India

2. Placement consultants

3. References

They do not use job portals


Surgeons.

SELECTION:

Procedure for selection being followed is as under:

1. Filling up application forms

2. Scrutiny of application forms

3. Interview of prospective candidate

4. Issue of appointment letter

5. Medical fitness

Interview Panel:

The interview panel is comprised of General Manager (HR & Admin.) and the concerned

Department Director.

INDUCTION:

Formal induction is nonexistent in this hospital. However induction takes place after a new

incumbent joins the hospital and goes through the familiarization process.

TRAINING AND DEVELOPMENT


The importance which this hospital attaches to training emanates from the fact that it keeps aside

1- 2 % of its revenue for training.

Training Methods:

In-house training: Composed of topics in the area of Behavioral etiquettes and discipline.

External Training: IT Department: Persons of this department are sent to NIIT with whom the

hospital has a tie-up.

Nurses: They are deputed in turns to professional institutes for knowledge and skill enhancement

in areas related to their field.

HR Department:

Persons from HR department are sent for training programmes, conferences conducted by

specialized agencies.

Employee Development programmes:

The hospital encourages employees to go in for higher education by providing financial

assistance in the form of 50% reimbursement of the course fees. However the hospital insists on

the concerned employee signing a bond for compulsory service with the hospital for a period of

five years thereafter.


No follow up on training through an evaluation system.


The hospital has adopted a three -fold performance appraisal, system; 1) For employees at the

entry level who are still on probation 2) For confirmed employees 3) Executive staff

• For the first category the performance appraisal is done on a monthly basis by the HOD.

The appraisal is aimed at evaluating the employee in the area of his assigned work. The

appraisal report is then sent to the HR Department.

• For the second category, the performance appraisal is done on a yearly basis in a

confidential manner by the HOD.

• For the third category the performance appraisal is based on their

contribution/achievement on specific projects assigned to them. The projects assigned

relate to their field of work/responsibilities. The exercise of performance appraisal is

preceded by the Senior Management communicating to the concerned executives about

their performance expectations from the assigned projects.

PROMOTION POLICY:

Promotion is based on both performance and seniority. For lower level employees, it is based

purely on seniority while for higher level executives, performance is the sole criteria.


The motivational techniques centre around non economic and economic benefits.

The morale of the employees is kept high through activities like, picnics, lunch parties, and sports.

On the professional front, employees enjoy job stability in a well known hospital. The employees

have the privilege of free communication with superiors facilitated by the open door policy of the

hospital.

5.4 BSES Hospital – Andheri, Mumbai

RECRUITMENT: The hospital uses has a vast data base which among other things also helps

in the process of recruitment.


external sources -

1. Referrals


3. Internal advertisement through intranet


5. Data bank

SELECTION:

The hospital follows a multi-stage interview process for selecting its candidates. The steps

involved in the selection process are:

1. Short listing of CVs which done by HR Manager with the help of HOD of Concerned

Department.

2. The interviews are conducted in a sequential manner , (a) Preliminary interview conducted by

HR, the focus of the interview being culture related issues (b) Second round interview conducted

by HOD focusing on technical issues (c) the third round being conducted by Medical Director and

Director of Administration.

After selection the candidate is required to undergo medical fitness tests followed by issue of offer

letter and subsequently by appointment letter.

INDUCTION:

The induction programme of the selected candidates consists of the following:

(a) Issue of Induction Manual

(b) Conducted tour of the hospital for familiarization

(b) Meeting and Interaction with the HODs



For each employee a Training Identification form is filled by the HOD, which is forwarded to the

HR Department. The HR Department shortlists candidates for training based on details contained

in this form.

In-house training:

If the number of eligible candidates is in large number, the hospital goes in for in-house training

by outsourcing faculty persons.

Apart from the above, the hospital conducts sessions on soft skills and CME on every Friday with

the help of internal experts.

External Training:

For external training in behavioral and technical aspects, the hospital has a tie-up with L.R.

Institute of Management.



PERFORMANCE APPRAISAL SYSTEM:

Communicating Performance Expectations: There is no interaction between superior-subordinate

about performance expectation prior to filling up the Performance Appraisal Form.

The broad features of the Performance Appraisal System are:

1. The Performance Appraisal form and its design is continuously under year after year review.

2. The design is different for different categories of staff. Likewise the parameters for appraisal

also vary.

3. The parameters are evaluated on a five point scale.

The Performance Appraisal Form is first filled by immediate superior which if then sent to HOD for

review and later forwarded to HR Department. The entire process is highly confidential.

In the HR Department, the Performance Appraisal attributes are translated into numerical values

and scores are assigned to each employee.

Feedback on the Performance Appraisal is organized by the team comprising of HR Head and

Administrator. The scores obtained by an employee are discussed with him/her with the aim of

ascertaining the reasons for the level of performance indicated by the scores. The grade and the

reward for the concerned employee are firmed up in this meeting.

PROMOTION POLICY:

Promotions are based on seniority and performance.


� Open house every fifteen days

� Welfare committee

� Good work environment and working conditions

� Good arrangements for food

5.5 Godrej Hospital – Vikroli, Mumbai

RECRUITMENT: The recruitment process at the hospital starts with the HOD’s indicating the

manpower requirement for their departments.

SOURCES OF RECRUITMENT: The hospital depends on three sources for its manpower

requirement, viz., and advertisement in Times of India, Employee referral, and Circular on Notice

Board. For all categories of employees, including Doctors and Nurses.

SELECTION:

The selection routine goes through the following steps:



3. Aptitude test for all categories aimed at judging their technical capabilities. However, Doctors

do not have to go through the aptitude test.


5. Medical fitness

Interview Panel:

For Doctors: First round of interview by Medical Officer and HR Manager. Final interview

conducted by CEO.

For Nurses: Chief of Nursing, HR Manager and CEO

For other positions: HOD and HR manager

INDUCTION:

Induction programme is conducted twice in a month each lasting for one day with duration of 8

hours.

The different aspects covered in the induction programme are -

� Communication skill

� Speech technique

� Personality development



The hospital follows a policy of CME (Continuous Medical Education)

For Administration & Management, In-house training method is adopted. As far as Nurses are

concerned, they sent outside for up gradation of skills and knowledge. For the technicians, both

in-house and external training is resorted to.




The performance appraisal system covers the following category of employees -

1. Admin. Officers

2. Nursing Staff above Officers level

3. HOD’s

The basis of performance appraisal system is, Performance parameters set up, through the MBO

system. This involves setting of goals through mutual consent bring out four ‘Key Results Areas’

(KRAs) with time frames. The achievements vis-à-vis is reviewed every six months.

Subsequently, a final review is done at the end of the year.

The employee is required to state his performance levels in a FORM which depicts weightages

for the level of achievement in each KRAs. Further he is required to rate his achievement based

on the Weightage.

These forms of various employees are forwarded to HR Manager for final score. The HR

Manager discusses the final score with the concerned employee and CEO.

These forms are the basis for the concerned employees performance bonus and increment

PROMOTION POLICY:

It is wholly based on performance which includes additional responsibility reposed on the

employee.

MOTIVATIONAL MECHANISM

The sources of motivation in this hospital are:

1. It is a value based and ethical organization

2. A well tuned system for conflict management

3. Open door policy

5.6 Hinduja Hospital – Mahim Mumbai

In terms of HR processes, the staffs of the hospital have been classified into five categories of

employees:

� Doctors

� Nursing Staff

� A-H levels ( Which includes class -III and class – IV employees)

� I –L Levels (For Officers)

� P-M Levels (For Management Cadre)

The hospital uses a professional approach to handle manpower through initiatives like Human

Resource Planning. Moreover the hospital has adopted standard operating procedures in

managing the human resource function.

The hospital works on a system of departmentalization with a specific sanctioned strength for

each department. As and when vacancy arises in any department, the same is notified to HR

department through a system of “Performance Requisition Form”.

RECRUITMENT:

The hospital has a vast data base which among other things also helps in the process of

recruitment.


external sources


2. Internal advertisement


4. Job portal


Surgeons.

For nursing professionals, the source is their own Nursing College which is affiliated to

Maharashtra University Health Science. This College offers a B.Sc. Degree in nursing. All

students passing out from this college are placed in this hospital itself.

SELECTION

The steps involved in the selection process are:

1. Receipt and scrutiny of CVs/application forms

2. Calling candidates for preliminary interview

3. Short listing of candidates

4. Final interview

5. Medical fitness test

6. Appointment letter

Interview Panel:

For preliminary interview, the selection panel comprises of HR Manager and Department

Directors. For final interview, the composition is HR Director, Department Director, and Secretary

of Board.

INDUCTION

The employees of the official cadre are familiarized with the working system of the hospital

through a pre determined schedule whereby the staffs are required to visit and meet Directors of

different departments. In addition induction manual is handed over to them to study and

understand the working of the hospital in a comprehensive manner.

For nursing staff the induction programme is conducted group-wise using the lecture method

followed by a tour of the hospital. For the staff in the other categories, the responsibility for

induction rests with the concerned Departmental Heads


Determining the Training Needs: The training process is commences with training need

assessment revealed in the Performance Appraisal Data.

Training Methods

In-house training: Comprising topics such Personality development, Team building Leadership,

Behavioral skills and Communications skills.

External Training:

Staffs are sent to outside agencies for training in professional areas such as pathology,

Radiology, ICU, Maintenance, etc.

Employee Development programmes: The hospital does not consider the need for employee

development and as such no initiative is taken in this regard.




Communicating Performance Expectations- Ideally the performance appraisal system would

involve an interaction between the superior-subordinate wherein organizational goals/ strategies

in line with the role of employee and expectations are firmed up. However here this does not

seem to happen.

Performance Appraisal Method:

The basis of Performance Appraisal is a form which includes around fifteen factors centered

around, disciplines, behavioral aspects, punctuality and task achievement.

As a transparent gesture the superior involves the subordinate while assigning scores to the latter

on the fifteen factors indicated in the appraisal form. The evaluation method used is the scaling

technique 1…to ….5. The form is then forwarded to the HR Manager. The HR Department

compares the current rating with the performance ratings of earlier years.

PROMOTION POLICY

Promotion Policy takes into consideration the following factors:

� Eligibility period is three years in the existing post

� The person concerned should not have been charge sheeted

� He/She should not have taken leave without pay

� No late marks

MOTIVATIONAL MECHANISM: The hospital motivates its staff through

� Providing stability in employment

� Hike in salary to the extent of five percent to retain the employees

� Good work environment and working conditions

� Good arrangements for food

5.7 H.N. Hospital – Charni Road, South Mumbai

RECRUITMENT: The hospital is in the process of being taken over by Reliance and as such the

recruitment process is restricted.

For the Doctors, the hospital sources its requirement from students of COLLEGE of PHYSICIANS

& SURGEAONS. After two year tenure as Housemen, these doctors are absorbed as

Registrars.Specialists are appointed on Honorarium basis directly.

Nurses are inducted from internal as well as external sources. The internal source is the

hospital’s owns Nursing Training Institute which offers Diploma/Degree in Nursing. These

students are initially inducted as trainee nurses and later promote to the next level.

SOURCES OF RECRUITMENT: The main sources are:

• Through Times of India

• Consultancy agencies

• Internal Circulars for vacancies

Recruitment Policy of H. N. Hospital: In addition to the above details the policy for Administrative

and para-medical staff is to take them on contract basis

SELECTION

The selection routine goes through the following steps:



3. Personal interview

4. Appointment formalities

Interview Panel:

For Doctors: Medical Director, Panel of experts

For Nurses: Medical Director, Matron

For other positions: HOD and HR manager

Medical Examination: Medical examination of the selected candidates takes place in the hospital

itself to save the cost and inconvenience. The reports of the medical examination has to be

submitted to HR Department

INDUCTION

There is no practice of Induction in this hospital. The only familiarization exercise that takes place

is when the HOD introduces the new incumbent to other members of the section/department



No effort is made to determine the training needs of the staff, rather the training initiatives of the

hospital focuses on pre-determined training programmes for different levels.

Training Methods:

� Lecture method

� Audio-visuals

� On the job training

However technicians are sent out for training with emphasis on up gradation of skill on

knowledge.

Trainer:

� HR manger and

� Outside Expert Doctors

� Mechanical Training is arranged by Vendor and Technical Engineers.


The formal Evaluation of Training Programme is not been conducted.

Management Development Programmes: MDP programme is not conducted.

Higher Education:

If any employee wants to pursue Higher Education, HR dept. helps him by making flexi time but

monetary help is not being provided.


The hospital has so far not inculcated a system of Performance Appraisal.

PROMOTION POLICY

Whenever a vacancy arises, the same is intimated to those concerned who in turn will have to

apply for the same and will then be considered for the senior position.


Apart from stability of the job tenure and a brand image there is no cognizable efforts from the

hospital towards motivation.

Observations

The workers of this hospital are affiliated to four unions backed by prominent political parties. Such a situation constantly throws

up various IR issues which constantly engage the attention and time of the HR Manager.

5.8 Jaslok Hospital- South Mumbai

RECRUITMENT: In Jaslok Hospital all Department Heads prepared the Job- Requisition Form

and submit to HRD Dept. The Job Requisition Form contains Job specifications and Job

Descriptions.

The Hospital is recognized by COLLEGE of PHYSICIANS & SURGEAONS. The vacancies of

Houseman and Registrar are fulfilled by the Post Graduate students of COLLEGE of

PHYSICIANS & SURGEAONS. Specialists are appointed on Honorarium basis directly.

Nurses are recruited from internal as well as external sources. The hospital owns School of

Nursing which is affiliated with Mumbai University. These students are initially appointed as

‘trainee nurses’ and later promote to the next level.

SOURCES OF RECRUITMENT: The main sources are:

i. Through Times of India

ii. Internal Circulars for vacancies

Recruitment Policy of Jaslok Hospital:

The hospital is having preferred source of Recruitment that is advertisement in Times of India.

Only for Class IV employees’ hospital is using Internal Sources of recruitment.

The other policy of selection is, appointing only experienced person to reduce the cost of Training

SELECTION

The hiring procedure in the Jaslok hospital is having five stages. The selection processes begins

by providing Application Form. The form contains Biographical Data, Educational Attainment,

Work Experience, Salary and benefits, Personal Items.

Interviewing: It is conducted to assess the suitability of candidates.

During Interview: HR manager encourage the candidates to talk frankly. Privacy is maintained.

Interview Panel:

For Doctors: Medical Director, Medical Superintendent and HR manager conduct the interview.

For Nurses: Medical Director, Matron and HR manager conduct the interview.

For other positions: Head of the Dept. and HR manager conduct the interview.

Final Approval is given by Medical Director.

The Letter of Offer: The next step is to send an offer of appointment to the selected candidates.

Medical Examination: The responsibility of scheduling and conducting the medical examination

rest with the HR Dept.

INDUCTION





The hospital is providing training to Nurses only. The hospital is tied up with SNDT Nursing

Institute affiliated with Gujarat University. For enhancement of skills and knowledge the hospital is

sending Nurses if there is need of skills in job. Matron proposes the list of the Nurses and

forwards it to the HR Dept.

The hospital is not conducting IN- House or any Formal Training.


Every year Appraisal form is given to the Head of the Department. He gives rating to his

subordinates. After filling the form it is forwarded to HR Manager. The HR Manager compares his

rating with past records of employee to avoid favoritism or errors. With the recommendation of

HOD and ratings HR manager takes the decision of Promotion or grade Revision or Increment.

The hospital is using traditional method called Graphic Rating Scale.

The performance Report is being Confidential to avoid interruption from Trade Unions.

PROMOTION POLICY

Promotion is only based on seniority.


Apart from stability of the job tenure and a brand image there is no cognizable efforts from the

hospital towards motivation.

5.9 Lilavati Hospital - Bandra (West)

Lilavati Hospital is a premier medical institution in Mumbai which is known for quality services.

The main strength of the hospital is its manpower. The hospital uses diverse sources for firming

up its manpower requirements.

SOURCES OF RECRUITMENT: The hospital depends upon the following external sources –

1. Data Bank


3. Times of India

4. Job Portal (Times.com)

5. Display of vacancy notices in the Hospital Notice Boards


Surgeons. They also appoint specialist doctors on contract basis. Since the hospital does not

have its own nursing school arrangement, it always has a reserve panel of about 20 nurses to

serve as a balance in high requirement situations.

SELECTION

A very systematic procedure is followed by the hospital in the matter of selection of its personnel.

The process begins with the receipt resumes in the hospital, which are first read by the HR

Director, followed by a scrutiny by the HOD. Subsequently, after a discussion on the issue

between the HOD and the HR Director the prospective candidates are short listed. The next

activity in the process is the issue of interview call letters. On the designated day, the candidates

are put through a process of written test, interview by a panel, following which appointment letters

are issued to the successful candidates on the same day.

The natures of written tests for the different categories of personnel are….

Nurses: Technical paper related to the profession

Admin & Others: The paper is aimed to judge the general knowledge by combining essay writing,

objective type of questions and numerical ability tests.

Doctors: there is no written test for Doctors.

Interview Panel:

Nurses; Nursing Chief, HR Director and ICU Doctors

Admin & Others: HOD and HR Director

Doctors: Medical Superintendent, HR Director, HOD of the concerned Department

INDUCTION

The induction programme of the hospital is very comprehensive and systematic as described

below:

The induction starts with the new entrants being given a Manual of the hospital. On every 1st and

15th day of the month, the incumbents are put through the induction programme which comprises

mainly of lecture sessions with the help of Power Point Presentations covering aspects like,

background of the hospital, customer following, services provided, general expectations from

hospital staff, disciplinary matters, and personal benefits. The induction programme concludes

with a tour of the entire hospital.



The entire staff is exposed to training in turn.

� Doctors Nurses and Para Medical Staff are required to attend the Continuous Medical

Education (CME) which is conducted every week.

� Nurses are subjected to specialized training by a specialist tutor.

� Based on the recommendation of HOD, Nurses, Doctors and Para Medical Staff are also

sponsored for outside training programmes

� For Front Line Staff there is the facility of in-house training and they are also deputed to

professional institutes for aspects such as soft skills.

Apart from training, the hospital encourages staff for higher education by providing time flexibility

through shift adjustment




The Performance Appraisal System is an appraiser- appraisee interface to bring out and

communicate performance expectations. The review period is January to December of each

year. The appraiser is trained to conduct the performance appraisal.

The Performance Appraisal process begins with a discussion across the table between the

Individual (appraisee) and the supervisor (appraiser) during the course of which the performance

appraisal form is filled. The forms are the sent to the Functional Head/Director for his review and

remarks. Later the form reaches the HR Department where they are analyzed and the details are

checked for consistence for the last three years. The gradation of factors indicated in the

Performance Appraisal form is done on a 1 to 10 scale. .

Those employees whose scores are below average are being communicated the findings with a

directive that they should improve.

PROMOTION POLICY

The basis of the promotion policy in this hospital is merit – cum – service criteria. Only those

whose performance rating is above average with long term service are considered for promotions

However at any point of time only 15 to 25% of such candidates get promoted.

MOTIVATIONAL MECHANISMS

The sources of motivation in this hospital are:

1. Free medicines

2. Subsidized canteen

3. Death Relief Fund

4. Accident Policy

5. Get together

6. Sports

5.10 Dr. Balabhai Nanavati Hospital - Vileparle Mumbai

RECRUITMENT: At Nanavati Hospital the recruitment process starts with the declaration of

vacancies following which the HR department is authorized by the Heads of Departments to fill up

the vacancies.

SOURCES OF RECRUITMENT: The main sources for senior nurses, Administrative staff and

Para-medical staff are:

� Through Times of India

� Internal Circulars for vacancies

� Timesjob.com

The prospective candidates sourced from the above are entered in the hospitals Data Bank and

regularly updated after enquiring from the candidates about their availability for recruitment

In addition to the above sources, nurses are recruited from the hospitals own School of Nursing.

These students are initially appointed as ‘trainee nurses’ and later promoted to the next level.

In so far as doctors are concerned, The College of Physicians & Surgeons is the major source for

recruitment. Specialists are appointed on Honorarium basis directly.

SELECTION

The hospital follows the normal selection routine as is followed by the major hospitals such as -

1. Issue of application forms

2. Schedule of interviews

3. Conducting interview


5. Medical examination

Composition of Interview Panel:

For Doctors: Medical Superintendent, Director (Medical Services), Director (Medical

Administrator)

For Nurses: Medical Superintendent, Director (Medical Services), Director (Medical

Administrator), Matron and Vice President (HR).

For other positions: Director (Medical Services), Head of the Dept. and HR manage.

Final Approval is given by Medical Director.

INDUCTION





There is no formal system for determining training needs.

Training Methods:

1. In-house training for all categories of employees using the Lectures

And Audio-visual aids Methods

2. External Training

The hospital is having a tie-up with Institute of Health Management Bangalore and deputes

concerned employees for training programmes conducted by the Institute

As far as are concerned, they are deputed to vendors for up gradation of technical skills.


The focus of the performance appraisal system in this hospital is for Probationers and is termed

as Probation Appraisal System. This is carried for those on probation after three months where

after it is decided whether the employee can be confirmed as regular employee.

Contrary to the normal practice, this hospital does not have a Performance Appraisal System for

established employees.

PROMOTION POLICY

The hospital does not believe in the concept of career growth of employees. As such they do not

have a policy of promoting employees to higher levels


The motivational initiatives of the hospital present two main dimensions

Open Door Policy: The Vice President follows an open door which encourages employees to give

their points of view, opinions, and grievances if any.

Job Satisfaction: The employees are given an opportunity to carry out jobs for which they have a

flair and capability.

The other motivational factors are; stability of the job tenure and a brand image.

5.11 Prince Ali Khan Hospital - Byculla

The employees of the hospital are categorized as under:

• Managerial & Executive positions

• Class III for clerical l posts

• Class IV for orderlies

For Managerial and Executive positions, the hospital follows a policy of retainership on contract

for a period of one year which is renewable every year. For class III and class IV employees,

there is a regular process of recruitment, probation and confirmation.


recruitment:

• Job portals

• Employee references


SELECTION

The selection procedure for doctors is walk-in interviews. For other employees:

a) Screening of applications

b) Scrutiny by chief of operational and personnel in-charge and concerned HOD and clinical

coordinator. These officers send their recommendations about the candidates to the HR

Department. The HR Department schedules the interviews.

c) The same officers mentioned above conduct the interviews.

d) This is followed by issue of offer letters and medical test.

INDUCTION

The induction process is restricted to nurses only. The programme consists of an assistant from

the front office conducting a general tour of the hospital. This is follow by the Head of the nurses

giving the rest of the information about the hospital, its policies etc.


Determining the Training Needs: Training needs of employees is decided on the basis of the

HODs recommendation on the basis of ‘Performance Appraisal form’. The in-house training is

conducted by executives focusing on focusing on -

• Behavioral skills

• Soft skills

• Communication skills

For nurses and Para medical staff, external training is resorted to for which, the hospital has a tie-

up relevant institutes in Bangalore and Chennai.


The evaluation process consists of a form to be filled by the trainee; which is reviewed by the

HOD.


The performance appraisal is done on a three monthly basis. The system consists of a form being

jointly filled by the rater and rate indication performance expectations. The same is forwarded to

the CEO for his recommendations. The form is subsequently sent to records.

PROMOTION POLICY

Promotions are given only on performance based.

MOTIVATIONALMECHANISM

• Decent working condition

• Free good quality meals,

• Mobile phones to all executives

5.12 Saifee Hospital – Charni Road

As in the case of other hospitals, Saifee follows a structured process for staffing.


recruitment:

• Data bank

• Job portals

• Employee references

• Placement agencies



Surgeons.

SELECTION

The hospital has adopted a multi-stage selection process which proceeds as follows:

a) Receipt of applications

b) Scrutiny and short listing by HR

c) Subsequent scrutiny focusing on technical aspects by concerned HODS

d) Interview call-up and conducting of interview in two stages. The interview panel consists of

HOD, HR, Superintendent, and Doctors. The process stands completed when the selected

candidates are given offer letters and advised to appear for medical test.

INDUCTION

The hospital follows a formal induction system. The induction process starts with the

representative of the HR department taking the new incumbents on a tour of the hospital and

explaining the structure and jobs performed.

On a monthly basis a group induction programme is conducted in a classroom atmosphere

wherein the following aspects are covered-

� Introduction and background of the hospital

� Policies formed and pursued by the hospital

� Formal introduction o the different HODS



Training of employees is considered, if the HOD feels the need for it. External training is resorted

to for proficiency in technical aspects, under approval from the Medical Director. On completion of

training the concerned employee is expected to submit a training report.

The in-house training focuses on the following:

� Behavioral skills

� Soft skills



The hospital regularly carries out training evaluation.


At the outset the management informally communicates to the employee its expectations fin

broad terms. The employee and his immediate superiors discuss and record in a form the

performance parameters, the purpose being to maintain transparency.

These forms are subsequently sent to the HODs. The HODs enter their remarks and then the

forms are sent to HR department. The HR Department computes the details and rates them on a

five point scale and then works out the average. This is formulated in a report form and sent to

the Medical Director. Based on this, the Medical Director takes decisions ob promotion, increment

etc. as the case deserves.


They have well defined grievance procedure which is strictly followed. In addition -


� Supportive system to enhance behavioral skills,

� Good food facility

� Good brand name and corporate image

Chapter 6

Data Processing, Data Analysis and Interpretation

The data and information collected for the study has been subjected to a process of analysis and

interpretation with a view to arrive at a fairly accurate picture about the status of HR aspects and

employee satisfaction For the measurement of the responses Likert’s Summated Scale has been used.

Applying the Stevens Measurement method, – numerical values has been assigned to the multiple choice

responses by using the rule of interval measurement. The choice of interval measures has been made

keeping in view the concepts of “equality” and arbitrary zero”

Responses have been recorded in terms of scale points as Strongly Agree +2, Agree +1, Neutral 0,

disagree -1 and Strongly Disagree -2.

For Statistical Analysis the Mean (Average) is used for Measure of Central tendency and Standard

Deviation is used for Dispersion.

For facilitating analysis of data, the following have been done:

� Statistical tables have been prepared using computerized tabulation

� The variables are depicted in columns and rows.

� One way frequency tables have been prepared to present the distribution of one variable like

hospitals, Department, Age and working with same hospitals.

� Two way tables have been prepared on Excel Sheet with more variables like hospitals, Department,

Age and working with same hospitals in compare to HRM practices.

� In addition to these tables, Tabulation and ranking is also made on Mean, Standard Deviation and

Coefficient Variations.

For graphical representation, Vertical Bar Charts have been prepared to exhibit Mean of responses in

compare to HRM Aspects. (Questions)

Table 6.1: Number of Hospitals, Total Employees and Number of sample selected from each hospital

SR.

NO.

Name of the Hospitals Total

Employees

No. of Sample

Selected

Percent to Total

1 Bombay Hospital 4700 15 0.31%

2 H. N. Hospital 727 15 2.06%

3 Nanavati Hospital 1260 15 1.19%

4 Godrej Hospital 215 15 6.97%

5 Breach Candy Hospital 1000 15 1.5%

6 Lilavati Hospital 1100 15 1.36%

7 Hinduja Hospital 2200 15 0.68%

8 Jaslok Hospitals 800 15 1.87%

9 BSES Hospital 500 15 3%

10 Saifee Hospital 560 15 2.67%

11 Asian Heart Institute 720 15 2.08%

12 Prince Ali Khan 400 15 3.75%

TOTAL 14182 180 1.26%

Table No.6.2: Distribution of Respondents by Department wise

Department No. of Respondents

Doctor 36

Nurses 36

Paramedical 36

Front Office 36

Administrative Staff 36

Table No.6.3: Distribution of Respondents by Age-wise

Age No. of Respondents

20 to 25 49

26 to 35 68

36 to 45 39

46 to 55 18

55 and above 6

Table No.6.4: Working with the same Hospital

Years No. of Respondents

Less than One Year 29

1 to 2 Year 44

3 to 5 Year 45

6 to 10 years 33

More than 10 years 29

Table No.: 6.5

Asian Heart Institute: HRM Practices influencing On Employees Satisfaction

Q. No. Factors Mean Standard

Deviation Coefficient

Variation

1 Preference to Internal Recruitment 1.2 1.08 90.194

2 Systematic Appointment Process 0.67 1.18 176.27

3 Structured Interview 0.4 1.12 280.31

4 Systematic Induction 0.93 0.88 94.684

5 Complete Information about Organization 0.73 1.16 158.58

6 Satisfaction for Right Job Profile -0.1 1.06 -795.1

7 Accurate Job Description 0.2 1.01 507.09

8 Clear Job responsibilities 0.2 1.01 507.09

9 Availability of Tools and Resources 0.07 0.96 1441.7

10 Opportunity to work on interesting projects 0.13 0.74 557.42

11 Information about Training calendar 0.2 0.77 387.3

12 Active Supervisor for individual training Needs 0.13 0.83 625.36

13 Accessibility to company Sponsored training 0.33 0.82 244.95

14 Communication for expectation for performance 0.47 0.74 159.26

15 Satisfaction with Appraisal process -0.1 0.88 -1326

16 Performance feedback 0.47 0.74 159.26

17 Guidance for performance Improvement 0.47 0.74 159.26

18 Awareness about pay and performance

Connection 0 0.53 0

19 Satisfaction with promotion system -0.2 0.68 -338.1

20 Satisfaction with salary structure -0.2 0.41 -207

21 Healthcare and Retirements benefits 0 0.65 0

22 Healthcare benefits to my family -0.2 0.68 -338.1

23 Listening of disputes -0.1 0.64 -480

24 Feeling of Job Stability 0.13 0.74 557.42

25 Career Planning by Organization 0.2 0.77 387.3

Mean and Standard Deviation of Responses

-0.50

0.00

0.50

1.00

1.50

Question

Me

an

an

d S

tan

da

rd D

ev

iati

on

Mean SD

Mean 1.20 0.67 0.40 0.93 0.73 -0.1 0.20 0.20 0.07 0.13 0.20 0.13 0.33 0.47 -0.0 0.47 0.47 0.00 -0.2 -0.2 0.00 -0.2 -0.1 0.13 0.20

SD 1.08 1.18 1.12 0.88 1.16 1.06 1.01 1.01 0.96 0.74 0.77 0.83 0.82 0.74 0.88 0.74 0.74 0.53 0.68 0.41 0.65 0.68 0.64 0.74 0.77

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Table No. 6.6: Most Favorable Responses

Q. No. Most Favorable Factors M SD CV



5 Complete Information about Organization 0.73 1.16 159

2 Systematic Appointment Process 0.67 1.18 176

Interpretations

The Asian Heart hospital gives priority to Internal Recruitment. Hospital management gives first preference

to existing employees to fill the vacant positions. Employees feel very satisfied on being considered for

filling the vacant positions as indicated by the strong positive response where the Mean stands at 1.2 and

standard Deviation at 1.08.

Employees show positive response to Systematic and Comprehensive Induction and Orientation

Programme by presenting .93 and .73 mean and 0.88 and 1.16 standard Deviation.

The Systematic Appointment is also positively indicated.

Table No. 6.7: Least Favorable Responses

Q. No. Least Favorable Factors M SD CV

21 Healthcare and Retirements benefits 0 0.65 0

18 Awareness about pay and performance Connection 0 0.53 0

15 Communication for expectation for performance -0.1 0.88 -1326

6 Satisfaction for Right Job Profile -0.1 1.06 -795


19 Satisfaction with promotion System -0.2 0.68 -338

22 Healthcare benefits to my family -0.2 0.68 -338


The zero mean and the standard deviation thereon of 0.65 and 0.53, indicate that employees have neutral

response towards healthcare and retirements benefits and Awareness about pay and performance

Connection.

The response in matters such as; Communication for expectation of performance’, getting right job

profile; listening of Disputes by HR dept. indicate a mean score of -0.1 and standard deviation varies from

1.06 to 0.64. which falls in the area of highly volatile.

While responding to issues such as; satisfaction about promotion system, Healthcare benefits to my

family, Satisfaction with salary structure the scores seem somewhat skewed perhaps because of lack

frank responses to the questions in this regard. This is demonstrated by mean of -0.2 and 0.68, 0.41 is

Standard Deviation.

Table No.6.8:

Bombay Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficient

Variation

1 Preference to Internal Recruitment 1 0 0

2 Systematic Appointment process 1 0 0

3 Structured Interview 1 0 0

4 Systematic Induction -1.1 0.8 -75

5 Complete Information about Organization -0.2 1.01 -507

6 Satisfaction for Right Job Profile 0.6 0.74 123


8 Clear Job responsibilities -0.4 1.4 -351

9 Availability of Tools and Resources -0.6 0.83 -138

10 Opportunity to work on interesting projects -0.1 0.8 -1198

11 Information about Training calendar -1 0.93 -93

12 Active Supervisor for individual training Needs -0.5 1.13 -211

13 Accessibility to company Sponsored training 0.4 0.83 207



16 Performance feedback -0.7 0.98 -146

17 Guidance for performance Improvement 0 0.93 0


Connection -0.2 0.68 -338

19 Satisfaction with promotion system -0.2 1.01 -507

20 Satisfaction with salary structure 0.47 0.52 111

21 Healthcare and Retirements benefits 0.6 0.74 123

22 Healthcare benefits to my family 0.8 0.41 51.8

23 Listening of disputes 0.6 0.51 84.5

Table No.6.9: Most Favorable Responses


25 Career Planning by Organization 0.47 0.52 111


1 Preference to Internal Recruitment 1 0 0

2 Systematic Appointment Process 1 0 0

3 Structured Interview 1 0 0





-1.50

-1.00

-0.50

0.00

0.50

1.00

1.50

2.00

Question

Me

an

an

d S

tan

da

rd D

ev

iati

on

Mean SD

Mean 1.00 1.00 1.00 -1.07 -0.20 0.60 0.73 -0.40 -0.60 -0.07 -1.00 -0.53 0.40 -0.73 -0.60 -0.67 0.00 -0.20 -0.20 0.47 0.60 0.80 0.60 0.73 0.47

SD 0.00 0.00 0.00 0.80 1.01 0.74 0.46 1.40 0.83 0.80 0.93 1.13 0.83 1.33 0.91 0.98 0.93 0.68 1.01 0.52 0.74 0.41 0.51 0.46 0.52

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Interpretation

Bombay Hospital management gives first preference to existing employees to fill the vacant positions.

Employees feel very contented on being considered for filling the vacant positions and for Systematic

Appointment and Structured Interview. The strong positive response is indicated by its average of 1and

standard Deviation of Zero.

Employees feel satisfied on receiving Healthcare benefits to their families which is indicated by 0.8

averages and by 0.41 Standard Deviation.

HR Dept. maintains Accurate Job Description and makes it available to the concern employees. The

desire to stay on the job till the completion of the tenure is positively shown by mean of 0.73 and Standard

Deviation of 0.46.



17 Guidance for performance Improvement 0 0.93 0




18 Awareness about pay and performance Connection -0.2 0.68 -338

8 Clear Job responsibilities -0.4 1.4 -351

12 Active Supervisor for individual training Needs -0.5 1.13 -211





11 Information about Training calendar -1 0.93 -93

4 Systematic Induction -1.1 0.8 -75

The zero mean and 0.93 standard deviation indicates that Employees are non committal towards

Guidance for performance Improvement.

The Hospital Employees revealed minor dissatisfaction in the matter of their interest being considered and

their getting an opportunity to work on projects of their interest as indicated by the mean of -0.1 and

standard Deviation at 0.8

The mean like -0.2, -0.4, -0.6, -0.7 with Standard Deviation varying from 0.68 to 1.4 respectively

demonstrates that Employees were ridden with fear and anxiety when responding to issues such as

Clarity of job responsibility, transparency in performance appraisal process and feedback, Information

about promotion and not understanding the connection between pay and performance.

The knowledge about training Calendar and Supervisor’s assessment for Training Needs have shown that

employees are uneasy in their response to this issue as indicated by -0.5 and -1 mean with 0.93 and 1.13,

standard Deviation.

The mean -0.2 and -1.1 with Standard Deviation of 1.01 and 0.8 confirms poor implementation of induction

programme.

Table No. 6.11:

Breach Candy Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficie

nt

Variation



3 Structured Interview 0.67 0.72 109

4 Systematic Induction 0.33 0.9 270


6 Satisfaction for Right Job Profile 0.93 0.88 94.7

7 Accurate Job Description 0.8 0.86 108


9 Availability of Tools and Resources 0.67 0.9 135


11 Information about Training calendar 0.47 0.83 179




15 Satisfaction with Appraisal process 0.73 0.7 96



18 Awareness about pay and performance Connection 0.6 0.74 123

19 Satisfaction with promotion System 0.33 1.05 314


21 Healthcare and Retirements benefits 1.2 0.56 46.7


23 Listening of disputes 0.93 1.1 118


-0.2

0

0.2

0.4

0.6

0.8

1

1.2

1.4

Question

Me

an

an

d S

tan

da

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Mean SD

Mean 1.07 0.87 0.67 0.33 0.73 0.93 0.8 0.93 0.67 0.8 0.47 0.8 0.6 1.07 0.73 0.93 0.93 0.6 0.33 -0.1 1.2 1.13 0.93 0.67 0.67

SD 0.88 0.35 0.72 0.9 0.88 0.88 0.86 0.8 0.9 0.77 0.83 0.77 0.91 0.8 0.7 0.7 0.88 0.74 1.05 1.1 0.56 0.74 1.1 0.72 0.98

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25












Interpretations

24 Feeling of Job Stability 0.67 0.72 109


Employees seem to be very satisfied with the Healthcare benefits to their family and retirement benefits

which is indicated by Mean Of 1.2 and 1.13 with 0 .56 and 0.74 Standard deviation.

The policy of internal recruitment, acquiring right job profile and getting clear job responsibilities makes

employees in high spirits to work with the hospital. This fact is supported by Mean of 1.07 and 0.93 and

Standard deviation of 0.88 and 0.80

The positive mean 1.07 and 0.93 is a sign of good Performance Appraisal System. Employees are

contented with clarity in communication of Performance expectations, performance Feedback and

Guidance for performance Improvement. (Standard Deviation is 0.88, 0.8 and 0.7)

The mean 0.93 and Standard Deviation 1.1 demonstrating that, Management is ‘actively listening’ to the

Disputes of employees.



19 Satisfaction with promotion system 0.33 1.05 314



The employees are satisfied with the promotion system as well as implementation of systematic induction

which is indicated by 0.33 mean with 1.05 and 0.9 Standard Deviation.

The negative mean -0.1 with 1.1 Standard Deviation is sign of disappointment with the Salary Structure.

Table No. 6.14:

B.S.E.S Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficient

Variation

1 Preference to Internal Recruitment 0.33 1.05 314







8 Clear Job responsibilities 0.47 0.92 196


10 Opportunity to work on interesting projects 0.47 0.92 196


12 Active Supervisor for individual training Needs 0.33 0.98 293

13 Accessibility to company Sponsored training 0.87 0.35 40.6




17 Guidance for performance Improvement 0.6 0.99 164

18 Awareness about pay and performance Connection 1.07 0.59 55.7


20 Satisfaction with salary structure 0.67 0.62 92.6

21 Healthcare and Retirements benefits -0.4 1.06 -264





-1.5

-1

-0.5

0

0.5

1

1.5

Question

Me

an

an

d S

tan

da

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Mean SD

Mean 0.33 1.13 0.47 1.13 0.73 0.47 0.33 0.47 0.4 0.47 0.47 0.33 0.87 -0.2 0.73 1.27 0.6 1.07 0.33 0.67 -0.4 -1.1 0.93 0.53 0.27

SD 1.05 0.35 0.92 0.35 0.59 1.30 0.98 0.92 0.99 0.92 0.99 0.98 0.35 1.32 0.70 0.46 0.99 0.59 0.98 0.62 1.06 0.70 0.70 0.74 1.10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25




2 Systematic Appointment process 1.13 0.35 31





Interpretations:

The positive mean 1.27 and low Standard Deviation 0.46, is representing a high level of satisfaction on

performance feedback.

Systematic Appointment and Systematic Induction are the encouraging factors for employees which are

indicated by positive mean 1.13 and low Standard Deviation 0.35.

The employees are seized with the relation between pay and performance. (Mean is 1.07 and Standard

Deviation is 0.59)

Employees have expressed their contentment about their views being heard in resolving disputes which is

shown by the mean 0.93 and Standard Deviation 0.7.









21 Healthcare and Retirements benefits -0.4 1.06 -264


The mean 0.33 and Standard Deviation ranging from 1.05 to 0.98 exhibited that employees are seeking

the policy of internal recruitment, Accurate Job Description, information on promotion. At the same time

they feel that supervisor should analyze their training needs to achieve best job performance.

The response of employees about career planning fort the employees by the management is negative as

revealed by the Mean of 0.27 and Standard Deviation of 1.1)

The set of expectations and its communication for best performance is highly insisted by employees which

are exposed by negative Mean -0.2 with 1.32 Standard Deviation.

The aspects like Healthcare benefits to my family and Retirements benefits are symptomatic of

unhappiness among employees indicated by -0.4 and -1.1 with 1.06 and 0.7 Standard Deviation.

Table No. 6.17:

Godrej Hospital: HRM Practices influencing On Employees Satisfaction



Variation














14 Communication for expectation for performance 0.4 1.35 338












-0.50

0.00

0.50

1.00

1.50

2.00

Question

Me

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Mean SD

Mean 0.40 0.87 1.07 1.13 1.33 0.33 0.20 0.67 0.27 -0.07 0.40 0.40 1.07 0.40 1.07 -0.13 0.20 -0.330.20 0.67 1.73 0.93 0.40 0.53 0.73

SD 0.63 0.83 0.26 1.06 1.05 1.40 0.56 0.49 1.22 0.80 1.24 1.18 1.33 1.35 1.39 0.74 1.08 1.11 0.94 1.23 0.46 0.80 1.12 1.19 1.03

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25










Interpretations:

The employees of the Godrej hospital are very happy with the Healthcare and Retirements benefits which

is signified by the highest mean 1.73 with low Standard Deviation of 0.46. At the same time they feel

obliged about Healthcare scheme to their family which is indicated by 0.93 and 0.8 Standard Deviation.

The mean 1.07, 1.33 and 1.13 with 0.26, 1.05 and 1.06 Standard Deviation demonstrates that the new

workforce enjoys the Structured Interview, Systematic Induction as well as comprehensive information

about organization.

The employees express satisfaction with Performance appraisal Process which is revealed by 1.07 mean

with 1.39 Standard Deviation.

The mean 1.07 with 1.33 Standard Deviation implies that staff is having Accessibility to company

Sponsored training.










The employees are quite upset for unavailability of Tools and Resources which is exposed by 0.27 mean

with 1.22 Standard Deviation.

The staffs of the hospital are seeking for Performance feedback and clear Guidance for performance

Improvement. At the same time they want to identify the connection between pay and performance. These

aspects are exhibited by -0.1, 0.2 & -0.3 mean with 0.74, 1.08 & 1.11 Standard Deviation.

The Accurate Job Description as well as Opportunity to work on interesting projects is also disconcerted

which corresponds to the mean of 0.2 and -0.1 with 0.56 and 0.80 as Standard Deviation.

The lucid Information about promotion is also on agenda of employees which is supported by 0.2 mean

and 0.94 Standard Deviation.

Table No. 6.20:

P.D. Hinduja Hospital: HRM Practices influencing On Employees Satisfaction



Variation


2 Systematic Appointment process 1.27 0.46 36.14


4 Systematic Induction 1 0 0



7 Accurate Job Description -0.1 1.13 -844




11 Information about Training calendar -0.9 1.06 -122


13 Accessibility to company Sponsored training -0.2 1.26 -632






Connection 1 0 0

19 Satisfaction with promotion system 1 0 0


21 Healthcare and Retirements benefits 1 0 0

22 Healthcare benefits to my family 1 0 0


24 Feeling of Job Stability 1 0 0


-1.00

-0.50

0.00

0.50

1.00

1.50

Question

Me

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an

d S

tan

da

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Mean SD

Mean 0.87 1.27 0.33 1.00 0.87 0.87 -0.13 0.13 -0.33 0.80 -0.87 0.33 -0.20-0.87 -0.67 0.33 0.33 1.00 1.00 -0.60 1.00 1.00 -0.20 1.00 -0.07

SD 0.83 0.46 0.82 0.00 1.06 0.35 1.13 1.19 1.11 0.41 1.06 0.82 1.26 1.13 1.18 0.82 1.23 0.00 0.00 0.91 0.00 0.00 1.01 0.00 0.88

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

25 Career Planning by Organization -0.1 0.88 -1326




4 Systematic Induction 1 0 0

18 Awareness about pay and performance Connection 1 0 0

19 Satisfaction with promotion system 1 0 0

21 Healthcare and Retirements benefits 1 0 0

22 Healthcare benefits to my family 1 0 0

24 Feeling of Job Stability 1 0 0

Interpretations:

Systematic appointment and systematic induction are the special attributes indicated by the Mean of 1.27

and 1 with 0.46 and zero Standard Deviation.

The employees expressed satisfaction on the Awareness about pay and performance Connection and

having satisfaction for promotion system.

The Retirements benefits, Healthcare benefits to family and feeling of job satisfaction are the core

motivational aspects for employees, is evidenced by the mean of 1 and 0 Standard Deviation.



25 Career Planning by Organization -0.1 0.88 -1326

7 Accurate Job Description -0.1 1.13 -844








The mean -0.1 and 0.88 Standard Deviation exposed the misgivings of employees in the matter of career

planning by the Management.

The factors like Accurate job description and Availability of Tools and Resources are the sore point with

employees which is represented by -0.1 and -0.3 with 1.13 and 1.11 Standard Deviation.

The employees of the hospital are discontented about Training calendar ;Accessibility to company

Sponsored training which is indicated by Negative mean -0.9 and -0.2 with 1.06 and 1.26 Standard

Deviation.

The dissatisfaction with Performance Appraisal process and clarity in Communication of expectations for

performance are revealed by -0.7 and -0.9 mean with 1.18 and 1.06 Standard Deviation.

The mean -0.2 and -0.6 with 1.01 and 0.91 Standard Deviation shows signs of frustration with salary

structure and concern for dispute by management.

Table No. 6.23:

H.N. Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficie

nt

Variation
















16 Performance feedback 0.2 1.26 632


18 Awareness about pay and performance Connection 0.47 1.19 254




22 Healthcare benefits to my family 0.6 1.06 176



0.00

0.50

1.00

1.50

2.00

Question

Mean

an

d S

tan

dard

Devia

tio

n

Mean SD

Mean 0.80 1.27 0.87 0.60 1.47 0.93 0.80 0.47 0.13 0.13 0.33 0.40 0.27 0.40 0.67 0.20 0.20 0.47 0.33 0.27 0.87 0.60 0.80 0.60 0.80

SD 0.94 0.46 0.52 0.83 1.06 0.88 0.86 1.13 0.74 1.06 0.98 1.18 0.88 1.12 1.18 1.26 1.21 1.19 1.18 1.44 0.92 1.06 0.94 0.99 1.15

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25








Interpretations

The Management of H.N. hospital is providing comprehensive information about organization is

acknowledged by employees which are exhibited by 1.47 mean with 1.06 Standard Deviation.

Systematic Appointment and Structured Interview are the strength of the hospital, supported by 1.27 and

0.87 mean with 0.46 mean and 0.52 Standard Deviation.



Acquiring Right Job Profile is the sign of accomplishment for employees which is demonstrated by 0.93

mean and 0.88 Standard Deviation.

Employees are contented with Healthcare and Retirements benefits. (Mean 0.87 and 0.92 Standard

Deviation.)









The employees are annoyed with the salary structure which is revealed by 0.27 mean and 1.44 Standard

Deviation.

The mean 0.27 with 0.88 stands for the lack of Accessibility to company Sponsored training.

The employees expressed uneasiness about Performance feedback and Guidance for performance

Improvement which is indicated by 0.20 mean with 1.26 and 1.21 Standard Deviation.

The employees were in disagreement about the hospital providing Opportunities to work on interesting

projects supported by the mean 0.13 and Standard Deviation 1.06

Limited Availability of Tools and Resources are irritating employees supported by 0.13 mean with 0.74

Standard Deviation.

Table No.6.26:

Jaslok Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficie

nt

Variation




4 Systematic Induction -1 0.93 -93






















-1.50

-1.00

-0.50

0.00

0.50

1.00

1.50

Question

Me

an

an

d S

tan

da

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Mean SD

Mean 0.47 1.20 0.87 -1.00 0.67 0.20 0.20 0.13 0.13 0.47 -0.13 0.20 -0.20 -0.27 0.27 0.07 0.20 0.67 0.53 0.80 0.80 0.80 0.73 0.73 0.60

SD 0.83 0.41 0.92 0.93 0.82 1.26 1.15 1.13 1.13 0.92 1.06 1.08 1.01 1.16 1.10 1.16 1.01 0.62 0.74 0.56 0.41 0.41 0.59 0.59 0.74

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25








Interpretations

The new employees of Jaslok Hospital are enjoying the structured interview process and systematic

Appointment. This feeling of pride is indicated by Mean 1.2 and 0.87 with 0.41 and 0.92 Standard

Deviation.

Most of the employees are satisfied with salary structure, Retirement Benefits and healthcare provision for

their families. (Mean is 0.8 and Standard Deviation is 0.56 and 0.41)







4 Systematic Induction -1 0.93 -93

The mean 0.07 and -0.3 with 1.16 Standard Deviation reveals the need for Improvement in performance

Appraisal system. Employees are uncomfortable while responding to questions like Performance

Feedback; communication for performance expectations before appraising period.

To employees feel very much curbed when Training Calendar is not disclosed and when they are denied

access to Company sponsored training. This is evaluated on the basis of mean of -.01 -0.2 with standard

deviation of 1.06, 1.01.

The mean -1 with Standard Deviation 0.93 is a sign of poor implementation of induction programme.

Employees have demonstrated the need of systematic and comprehensive Induction Programme.

Table No.6.29:

Lilavati Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficie

nt

Variation






6 Satisfied for Right Job Profile 0.73 0.7 96












18 Awareness about pay and performance Connection 0 1 0







-1.00

-0.50

0.00

0.50

1.00

1.50

Question

Me

an

an

d S

tan

da

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Mean SD

Mean 0.60 0.47 0.87 0.47 -0.53 0.73 0.73 0.80 1.20 0.80 0.67 1.27 -0.13 0.07 0.47 -0.07 0.73 0.00 -0.60 -0.13 0.40 -0.40 -0.07 0.20 0.07

SD 1.12 0.92 0.52 1.13 0.74 0.70 0.70 1.01 0.41 0.77 0.90 0.59 0.99 1.03 1.13 1.22 1.16 1.00 0.74 1.13 0.91 0.74 0.80 0.94 0.80

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25










Interpretations

The Mean 1.27 with 0.59 Standard Deviation reveals the Management’s awareness about the employees’

capabilities and job requirements and evinces keen interest on the training needs for good performance.

Employees seem to be happy about the availability of tools and resources required for the performance of

their jobs which is Shown by 1.27 Mean and 0.41 Standard Deviation.

The factors like Structured Interview, Clear Job responsibilities, Opportunity to work on interesting projects

are positively indicated by 0.87 and 0.80 mean with 0.52, 1.01 and 0.77 Standard Deviation.




Connection 0 1 0








The employees of the Lilavati Hospital remained tight lipped with the question of Awareness about pay

and performance link. (Mean is 0 and 1 Standard Deviation)

The mean -0.1 varies through 0.8 to 1.13 Standard Deviation are the symbol of Volatile responses towards

the aspects like Performance feedback, salary structure, Accessibility to company Sponsored training and

apathy to listen disputes.

The employees are showing frustration over not getting Healthcare benefits to their family indicated by -

0.4 mean with 0.74 Standard Deviation.

The employees are totally in the dark about Information on the Organization as well as their promotion

which is revealed by -0.5 and -0.6 mean with 0.74 Standard Deviation.

Table No. 6.32:

Nanavati Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficient

Variation
















16 Performance feedback 0 1.36 0



Connection 0.33 0.98 293








0.00

0.50

1.00

1.50

Question

Me

an

an

d S

tan

da

rd D

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Mean SD

Mean 0.47 1.13 0.40 0.27 0.87 0.87 0.80 0.67 0.33 0.53 0.33 0.80 0.53 0.13 0.40 0.00 0.20 0.33 0.53 0.53 1.27 1.33 0.33 0.60 0.93

SD 0.74 0.35 0.74 0.88 1.06 0.64 0.68 1.18 0.90 1.06 1.05 0.77 0.99 1.19 0.99 1.36 1.15 0.98 0.99 0.92 0.88 0.82 0.90 1.06 1.03

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25





2 Systematic Appointment process 1.13 0.35 31




Interpretations

The Mean 1.33 and 1.27 with 0.82 and 0.88 Standard Deviation are the sign of contentment for Healthcare

benefits to family and Retirements benefits.


The Systematic Appointment, Right Job Profile and Information sharing about Organization are the

strengths of the Nanavati hospital which is revealed by 1.13 and 0.87 Mean with 0.35, 0.6 and 0.64

Standard Deviation.

The employees seem to be happy as Management is making career plan for them, indicated by the Mean

0.93 and Standard Deviation 1.03.






16 Performance feedback 0 1.36 0

The Mean 0.27 with 0.88 Standard Deviation depicts the least response towards Systematic Induction.

The employees expressed disappointment about the lack of systematic Performance Appraisal System;

clarity in communication of setting target or Expectations; Performance Feedback and Guidance for

Performance Improvement. These aspects are indicated by mean ranging from 0.20, 0.13 and Zero with

1.15, 1.19 & 1.36 Standard Deviation.

Table No. 6.35: Prince Ali Khan Hospital: HRM Practices influencing on Employees Satisfaction

Q. No. Factors Mean

Standar

d

Deviatio

n

Coefficient

Variation








8 Clear Job responsibilities 1 0.38 37.8



11 Information about Training calendar 0.93 0.26 27.7

12 Active Supervisor for individual training Needs 1 0.38 37.8



15 Satisfaction with Appraisal process 1.27 0.46 36.1

16 Performance feedback 1 0.53 53.5


18 Awareness about pay and performance Connection 1 0.65 65.5

19 Satisfaction with promotion system 1.33 0.49 36.6







-0.50

0.00

0.50

1.00

1.50

2.00

Question

Me

an

an

d S

tan

da

rd D

ev

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Mean SD

Mean 0.53 1.00 1.07 0.27 -0.07 0.60 0.67 1.00 0.20 0.93 0.93 1.00 0.33 1.33 1.27 1.00 1.13 1.00 1.33 1.13 1.13 0.93 1.53 1.27 1.20

SD 0.74 0.00 0.26 0.80 0.59 0.74 0.62 0.38 0.86 0.46 0.26 0.38 0.90 0.49 0.46 0.53 0.35 0.65 0.49 0.74 0.52 0.26 0.52 0.46 0.41

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25






15 Satisfaction with Appraisal process 1.27 0.46 36.1








Connection 1 0.65 65.5

16 Performance feedback 1 0.53 53.5

8 Clear Job responsibilities 1 0.38 37.8

12 Active Supervisor for individual training Needs 1 0.38 37.8


Interpretations

The employees feel satisfied when their disputes are being listened by Management which is supported by

Positive Mean 1.53 with low Standard Deviation.

The employees are expressing contentment with Performance Appraisal System, Clear indications for

Performance Expectations, Performance Feedback and guidance for performance improvement. These

aspects are indicated with mean varies from 1.33, 1.27, 1.13 and 1 with 0.49, 0.46, 0.35 and 0.53

Standard Deviation.

The information about promotion well in advance indicated by employees having 1.33 Mean with 0.49

Standard Deviation.

The Mean 1.27 and 1.20 with 0.46 and 0.41 Standard Deviation corresponded to Feeling of Job stability

among employees and visualizes their career with the hospital which is planned by Management.

The employees are satisfied with salary structure, Healthcare and Retirements benefits. They are also

conscious about pay and performance Connection. (Mean 1.27, 1.13 & 1 with Standard Deviation 0.46,

0.74 & 0.65)

The new employees are enjoying Systematic Appointment, Structured Interview and Clear Job

responsibilities, which are demonstrated by the mean 1.07 and 1 with 0.26, 0.65 and zero Standard

Deviation.

The supervisor or Head of the Department constantly looking for the updates regarding job knowledge and

skills and evaluate their subordinates to equip with updates for best performance. It is revealed by the

mean 1 and 0.38 Standard Deviation.






The mean 0.27 and 0.80 standard deviation indicates that Employees are non committal towards

Systematic Induction.

The Hospital Employees exposed the fact of limited tools and Recourses. (Mean is 0.20 and standard

Deviation 0.86)

The volatile responses are shown by the mean -0.1 and 0.59 Standard Deviation towards Complete

Information about Organization.

Table No. 6.38:

Saifee Hospital: HRM Practices influencing On Employees Satisfaction


Deviation

Coefficient

Variation











11 Information about Training calendar 1 0.65 65.5








Connection 1.27 0.46 36.1




22 Healthcare benefits to my family 0.53 0.83 156



0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

Question

Me

an

an

d S

tan

da

rd D

ev

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Mean SD

Mean 0.87 1.13 1.27 1.13 0.27 1.20 1.07 1.20 0.87 0.93 1.00 1.13 0.67 0.80 0.73 0.53 1.07 1.27 0.80 0.13 0.13 0.53 0.93 0.93 1.20

SD 0.52 0.64 0.46 0.83 0.80 0.56 0.46 0.56 0.83 0.46 0.65 0.64 0.72 0.56 0.70 0.83 0.26 0.46 0.41 0.83 0.99 0.83 0.46 0.26 0.41

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25





Connection 1.27 0.46 36.1









11 Information about Training calendar 1 0.65 65.5

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