CHAPTER
ONE
1 INTRODUCTION
Healthcare
organizations are a necessity in today’s life.
These include hospitals, nursing home, medical and dental clinics and
laboratories, physician offices and clinics and many other health laboratories.
From Health
system: Improving Performance (2000), the author reported that healthcare
business, especially hospitals is a complex path than many people thought by
seeing the huge big strong hospital buildings.
The business model is not the same like other most business as its
customers do not turn up willingly and happily, may be like hotels, even though
many regards healthcare organization as a hospitality business like
hotels. Plus also sometimes hospitals
may not get paid on what they bill, therefore jeopardize their cashflow and
there are times make this healthcare business a risky business. With uncertain revenue, cost not entirely
within control, regulatory control, maintenance of standard makes healthcare
management problems sometimes not easy to fix.
If hospitals
are to be very stringent on rules and regulations with regards to financial pay
before service, it will be regarded as inhuman without any social
responsibility (Health system: Improving Performance 2000). Hospitals are mandated to provide charity
care to those patients who fall within certain financial levels.
In healthcare
organization human resource factor is a crucial matter. No matter how high is the capital investment
on equipments, technologies and machines, the management cannot forego their
greatest resource that is human resource.
Equipments, machines and the technologies cannot give results without
the function or intervention of human.
Richards (2012) noted that since healthcare
organization is a hospitality industry, serving the public is the main
important factor. Unethical or
inappropriate treatment of the staff will jeopardize their service to
clients. The mission of the organization
to serve the public satisfactorily will collapse if the workforce does not
perform their duties satisfactorily to win the public’s heart.
Richards (2012) also stated that the
management needs to develop ethical principles and rules which shall be a
normal practice to ensure that the workforce stay and perform. These includes treating the people well,
provide acceptable benefits, fair compensation and other long term benefits
such as employees share option schemes.
Kabene et
al. (2006) noted that sometimes various levels of management need to
show care to their subordinate where the senior management should institute
mechanisms for various subordinates to participate in decision making and
consensus building should be cultivated at all levels. Another important issue is that to ensure
that human resource policies are just, impartial and non-discriminatory, so as
to treat all employees fairly with respect, implementing fair disciplinary
policies and protecting all employees evenly without fear or favor.
From
Kabene et al. (2006) show surveys of human resources professionals at workplace
where human intensive in nature such as hospitals reveals that there are issues
about what is ethical at the workplace.
In general the surveys indicated 10 most serious issues as follows:
1. Hiring,
training and/or promotion are based on favoritism.
2. Allowing
differences in pay, discipline, promotion, absentism and other bias move due to
friendship with management personnel.
3. Yielding
to sexual discrimination in promotion.
4. Disciplinary
action on each personnel is inconsistent.
5. Not
maintaining confidentiality.
6. Sex
bias on compensation.
7. Using
non performance factors in appraisals and neglecting the good performance of
the employee.
8. Arranging
with vendors and consulting agencies, thinking employees does not realize.
9. Situations
leading to personal gain.
10. Senior
management not performing to expectation.
CHAPTER 2
2 MANAGEMENT ISSUES – HUMAN RESOURCE
Mitchell (2012) stated that management
issue in healthcare organization, if listed shall be more than a dozen such as:
1. Financial
matter - involving operating cost, controlling cost, creating, generating and
defining revenue.
2. Human
Resource - management, staff matter, leadership, training and certification.
3. Charity
care - social obligation not to be seen as highly profit oriented.
4. Systems
and equipments - need to be highly equipped with the latest acceptable
technology available in the market.
Human resources
are one of the three principle health system inputs, with the other two major
main inputs being physical capital investment and consumables, which are
disposable items which are unlimitedly used and waste at the hospital (Mitchell
2012).
Mitchell (2012) also wrote that human
resources, when pertaining to healthcare, are meant and the different kinds of clinical
and non-clinical staff responsible for public and individual health
intervention. The most crucial of the
health system inputs, the performance of the systems can deliver depend largely
upon the knowledge, skills, attitude, morale and motivation of those
individuals responsible for delivering the health services.
2.1 Healthcare Institutional Ethics are
Broader than Clinical Ethics
The
researcher Zoubul (2005) noted that from his research, employees of healthcare
organizations have diverse backgrounds whether professional or
non-professional, e.g medicine, nursing, administrators, social work and
general workers. Each employee has a
personal sense of what is just or moral in their own way depending their level
of education and also professional background.
Due to this strong factor, organizations must focus on building a strong
ethical climate suitable for all at all levels by identifying core values and
beliefs that are visible to both patients and staff, who can adjust themselves
to live up to the expectations of the organization.
2.2 Leadership Issues
Richards
(2012) noted that in healthcare organizations with medical facilities, there’s
usually one leadership position in each specialty. Most frequently, the person promoted into
management or manager level has technical skills, but not leadership
skills. Due to shortage of staff,
scheduling issues and monetary considerations, leadership training shall not be
the priority for the organizations.
Therefore there is for sure lack of true leadership and good management,
which means many staff have to rely on learned skills rather than good
direction. Worst of all process of
learning on leadership is base on trial and error.
2.3 Staffing
Hanna
(2010) noted that staffing is an ongoing issue in hospitals, care centers,
nursing homes, dialysis centers, clinics and other healthcare organizations
that need trained specialists that are ready to assist patients. The broad shortage of experienced nurses
means that many crucial duties fall to untrained or inexperienced assistants,
thereby driving up to chances of errors or negligence. With the medical insurance plan and health
care facility choices, demanding patients do not want to settle for a
second-best treatment. Healthcare
organizations must ensure they meet patient expectations if they wish to stay
competitive in industry.
From Health system: Improving Performance (2000), the author stated that, while
maintaining the number and qualified personnel, the management needs to balance
the operating cost. Management must
often find a balance between retaining the qualified and experienced staff to
provide outstanding care to patients and to reduce operating costs. While economist may say that healthcare
organization is capital intensive that need to invest on equipments and
technology, but operators of the healthcare still convinced that this is a
labour intensive industry. Staffing is a
major issue. How highly equipped a hospital can be, without the competence staff to man the
high-end equipment, the equipment may not be utilized on full capacity on time
and usefulness.
It must be noted that the clients
are all human that not only need care and attention but also have expectations
for remedy and cure for presenting themselves to hospitals. Staff normally face challenges not only to
cure sick patients but worst of all to face demanding patients who claimed that
they have insurance cover with high limit or they are willing to pay without
limitations but would not accept other than
the best, never a second-best treatment, prescription, medicine, care
and attention.
2.4 Training
From
Human Resources Management (1991), the researcher noted that clinical employees
of healthcare requires continuous training as to keep phase of new findings and also new invention of tools
and equipments. These clinical employees
need to perform effectively and efficiently.
An effective employee without adequate tools is as inefficient as having
the tools without the effective employee.
Training the right employee to have the right attitude and retain them
to use the tools and equipment effectively shall be medium and long term
process to ensure patients are being treated effectively.
Workforce training is also to
ensure that the workforce is aware of and prepared to meet the country and also
the organization future needs (Human Resources Management 1991). A properly trained and competent workforce is
essential to any successful healthcare organization.
Issues faced by the
organizations are that trained and competent workforce leave the organization
for better future with other organizations and some even migrate to other
countries with better offer and benefits (Khatri et al. 2006).
2.5 Resignation and Migration of staff
Khatri
et al. (2006) noted that migration of healthcare professional workforce is
common everywhere. The rural workforce
will migrate to urban areas. Those in
cities may even choose to migrate to developed countries for better financial
benefits. The researchers also noted
that human resource management require better workforce planning, giving
attention to the issues of pay, rewards, incentives, housing benefits and also
need to practice job rotation to resolve the poorly motivated and very
dissatisfied workforce. The resignation
of clinical workers is an important human resource issue that must be carefully
measured and monitored by the management.
2.6 Disruptive Behavior of Workforce
Porto
and Lauve (2006) wrote that anything that the hospital employee does that
interferes with the orderly conduct of hospital business, from patient care to
other social obligations in the hospital can be considered a disruptive
behavior. Disruptive behavior by
healthcare employees, among others are ethnic or racial jokes, disrespectful
language, outbursts of anger, sexual comments, throwing of objects or
instruments, criticizing other caregivers in front of patients, comments that
undermine a patient’s trust, failure to adequately address safety concerns
expressed by others and deliberate failures to adhere to organizational
policies (Porto and Lauve 2006).
The
impact of disruptive behavior can cause other employees to be uneasy working,
cause unnecessary stress and finally some will leave the organization created
unwanted turnover of workforce. Cost of
recruiting new clinician and to be well trained shall be costly on the
organization.
CHAPTER
THREE
3 FINDINGS AND DISCUSSION
My hypothesis to conduct this survey
at Pantai Hospital, Kula Lumpur is that, majority healthcare professional
workforce are satisfied employees of the organization.
A
simple survey was carried out among lower level and middle level professional
workforce at the healthcare organization at the end of October 2012. Samples of the survey questionnaire are given
as appendices.
The survey had resulted as
expected, proven my hypothesis is right, however the unsatisfied employees is
still determined high at 40 percent. Even
though majorities are satisfied and happy employees, the high rate of
unsatisfactory workforce is still a major issue that need to be addressed by
the management of this organization.
Based on the random survey, 40 percent are not happy working with this
particular healthcare organization even though felt that they like the
industry, healthcare organization, as the answer showed they are proud to work
in healthcare organization.
The human resource issues in
this hospital can be seen that there are issues between the superiors and their
subordinates. Level of trust and
tolerance is questionable base on unsatisfied level of 40 percent, however the
60 percent which showed the happiness may translate that favoritism may be a
culture from within this organization.
3.1 Human Resources Challenges in Hospital
(Discussion
with HR officer, however requested not to be named)
3.1.1
To Retain Employees
According
to HR officer (personal communication, November 20, 2012) states healthcare professionals are required
to work more than twelve hours a day and many are on calls, putting up their
nights at the hospitals. Many who had
served more than or close to twenty-five years are retiring, taking a break for
good and wish to enjoy their live with their families and make enough money
during their working lives. It is a
challenge to the human resource managers to replace those experience
professionals retiring from the hospitals.
Human resource managers are always
on their toe to recruit new young professionals and the toughest is to retain
them in the organization. Recruitment
may be easy but to retain them is a serious challenge.
Many ladies working in hospitals,
after working for a certain period, may choose to be fulltime housewife to have
more valuable time with their children.
Sending children to day care nursery are not cheap anymore and may
dilute high portion of their monthly salary, makes them to choose to retire
early due to family obligation. Working
schedule of 24/7 is becoming less attractive place for careers for the younger
generations.
3.1.2
Human Negligence
HR officer (personal communication,
November 20, 2012) noted that tendency of human negligence are very much higher
when demoralized employees are not being handled tactfully. Demoralized staff tend to have negative
attitude at work that may lead to negligence while performing their
duties. While hospitals are handling
precious commodity that is human being who are sick and life, thereby errors
and negligence should not be tolerated.
Doing things right the first time, has to be the motion and one error
shall be considered many.
Human resource managers and
department need to consistently monitor demoralized staff through their various
superiors to ensure the number is very minimal if cannot be zero. Motivation exercises, activities and courses
should be a continuous process even with a tight budget so that human
negligence due to demoralized staff attitude shall be avoided.
Human errors in the course of duty
may not be all covered by the indemnity insurance, even so covered will be
damaging on the organization’s name.
While dealing with human life, insurance coverage may never be the best
solution. Any act of negligence will
undermines the patient’s confidence in the hospital or other member of the
healthcare industry (HR officer, personal communication, November 20, 2012).
3.1.3
Culture
HR officer (personal communication,
November 20, 2012) said healthcare owners or providers or the representative
leaders had to be at their toe to the disruptive clinician behavior while
performing their duties. They had to
provide and maintain a positive healthy culture among employees so that the
juniors will be felt that their opinion being heard and considered, especially
when voicing out their opinions and concerns regarding the patient’s plan of
care and sometimes reporting of errors or disagreeing with those in positions
of authority. There have been studies to
prove that growing focus on the role of culture as a contributing factor in
medical errors.
Cultures were cultivated by human in
the healthcare organization and over a period of time shall become habitual and
later even though is wrong shall be the norm.
Wrong cultures but acceptable shall be detrimental to the organization
even though those in the organization felt that what they did was the right
thing in their own opinion. While errors
in the wrong culture will be on-going in a non-punitive environment, has also
proven that the focus attention on the importance of culture in preventing errors
and negligence (HR officer, personal communication, November 20, 2012).
Shortages of clinician personnel
have lead to healthcare organization to employ short term staffing solutions
such as locum. This in turn may also
lead to cultural differences among team members that impair effective
communication and teamwork.
Due
to internal culture norm, even though the wrong matter is well known but never
being handled. A quote from Walshe and
Shortell (2004),
It is often evident with hindsight that many
key people and stakeholders knew that something was seriously wrong and did
nothing about it. In the Bristol Royal
Infirmary case, for example, poor clinical practices and outcomes in pediatric
cardiac surgery were well known within the hospital, among referring
consultants at other hospitals and general practitioners (GPs) in the region,
and even among professional leaders at the Royal College of Surgeons and civil servants at the Department of
Health. Similar behavior was observed in
a similar failure in pediatric cardiac surgery in Winnipeg, Manitoba, in
1994. In
the same way, when serious problems in obstetric services at the King Edward
Memorial Hospital in Perth, Australia, were investigated in 2001, a long
history of dissent, concern, and repeated complaints and a trail of litigation
stretching back many years were revealed. In the case of Redding
Medical Center in California, where physicians undertook large volumes of
inappropriate and unnecessary procedures on largely healthy patients, it is
already evident that many hospital staff were aware of what was going on. It seems that often the only people who don’t know about the
problems are the unsuspecting patients and their families. (p.103)
In
order for a healthcare organization to have a wakeup call on their wrong
cultures being accepted as norms, the highest authority of the organization
have to implement systems whereby periodically study failures occurred within
the organizations and in order to get the sincere independent result, may
require an independent party or consultant to handle and address the issue, so
that every party at all levels speak up their mind without fear or favor.
3.2 Workforce Optimization Means A More
Effective Healthcare System
According to Jaskiewicz and Tulenko
(2012), hospitals that are able to identify needs, attract, motivate and retain
skilled and high morale employees will determine the success of the
hospitals. Those skilled workforce and
motivated employees will operate under various organizational and patient
demands in a quickly evolving and complex environment. It is crystal clear that hospitals depend on
the dedication, engagement and ongoing performance of their employees to
deliver services effectively.
Jaskiewicz and Tulenko (2012) also
noted that human resource manager will require to analyze the strengths and
weaknesses of the people in the hospital.
Those that need to be trained will require to incur cost on the hospital
to train the employees. However those with attitude problems may be difficult
to be addressed. The management will
need to find formulas to develop the capabilities of each and every individual
in the hospital, especially the professional workforce which require more time
and experience to undertake duties and responsibilities.
Human resource managers may also
need to work closely with the employees’ supervisor in order to revive the
organization in case is necessary for the growth of the hospital.
Working conditions, part of the
broader human resources management are important in terms of creating a
conducive acceptable conditions for effective and efficient work delivered by
the workforce, boosting morale and reducing turnover and attrition. Lack of attention to the working conditions
became a serious matter of human resource management that if left unattended
may be detrimental to the hospital and to remedy it later may be costly
(Jaskiewicz and Tulenko 2012).
Management need to emphasize to the
supervisors and managers the need to ensure a positive practice environment
including regular and continuous supportive supervision, health and safety
issues, clean environment at the staff rest area, a manageable workload
especially to pregnant or senior employees and availability of drugs, supplies
and equipment in working conditions.
Manageable workload is crucial and
plays high importance of service delivery to patients as it is regarded as
defining role in the level of productivity and quality delivered by the
workforce towards the patients.
CHAPTER FOUR
4 CONCLUSION
Human
resource is definitely an issue at hospitals, as this business is labour
intensive and the business cannot carry on without human intervention. Handling humans who are active in nature as
humans have emotions, anger, restless, needs and worst of all humans are
demanding. The client of hospitals are
also human and mostly demanding, especially in private hospitals where they are
required to pay heavily directly or through their insurance. When the patients who require the services
are also demanding and have emotions, there are times when these two emotions
of the human may not meet and cause anger on each of them. Nevertheless the hospital staff will be the
one that has to give in, but that shall be a point where these staff will
protest, normally silently.
The protest action will then be
problematic to the hospital management as the staff may react to the extent of
resignation which the hospital will start losing experience and trained
employees.
Management of hospitals will
have to find ways to optimize their workforce to run the organization
effectively.
CHAPTER FIVE
5 RECOMMENDATIONS
Healthcare
organizations such as hospitals need to address human resource issue positively
and timely so that the services shall not be jeopardized. Being a labour intensive industry, the
management has to always look out for any loopholes in managing human in their
internal administration.
Hospitals
can be regarded as a hospitality industry like hotels where patients are their
clients and services to clients which are actually their patients is the utmost
importance towards growth and profitability.
Employees are the front liners in accepting the patients or their family
when they walk in to a hospital and later the patients shall be treated again
by professional and non-professional workforce.
Any unhappiness created by these employees at various levels of services
will leave a black dot in the patient’s mind as well as their family members
that will lead to words of mouth and lead to low level of patronize. In this competitive environment where there
are quite a number of hospitals in an urban area will benefit the clients to
choose another hospital for other engagements.
Therefore
besides having the latest equipments and effective drugs, the services thrown
by employees are equivalent to the other requirements. The management need to emphasize to
themselves and supervisors of the importance to care for the employees so as to
avoid employees to neglect their duties during attending patients at any level
either by professional or non-professional levels.
Department
managers or head of departments are to regulate regular meetings and
discussions with employees and to be sensitive with any notations thrown by
those unsatisfied employees. Remedy
actions are required to be taken despite of all the constraint to settle or minimize
the grievances that may take place without notice. When handling human emotions, the main issue
is to boost the morale of employees and make them feel that they are being
cared and free to voice up their opinion and to be seemed that justice to them
prevailed. High morale employees will
not complain or voice grievances in any small matter, therefore services to
patients will not be in jeopardy and in long term the hospital will be
patronized with more patients and shall be more lucrative and profitability
enhanced.
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