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provide healthcare. The employees perform professional duties, primarily to improve

people's health (WHO 2006).

Another WHO report (2000) values HR as "the most important of the health system's

inputs".

In the new millennium, the role of HRM is further changing, An HR manager should be

able to cope with the changing competitive trends and business environment, His role has

transformed into that of an active business partner with the management. The new trend

can ensure success continuity and escalating the organization for a future highly

competitive world. An HR management is successful when, besides administrative skills, it

can influence people's minds and counsel line management. Such changes are part and

parcel of the HR strategy, its organizational policy and its profile.

Today, there is greater demand of efficient hospitals' administration and their HR

development than ever before. This is so, because trade unions, educational problems

and financial professionals are constantly confronted with the administrators. Well-trained,

competent administrators and HR managers are in great demand. The same is true for

other hospital personnel as well.

Human resource management functions have, of course, always been carried out in every

organization in one way or the other, but these functions may not have been performed

efficiently or economically. Importance of hospital human resource management must be

recognized, the workload of the general administrator may be reduced and better service

rendered to the patients through the establishment of a separate human resource

department.

When the administrator of a hospital decides to have human resource departments, he

also has to decide whether to recruit a full-time or part-time human resource manager. As

a common practice, a hospital with 200 or more employees can use the services of a full-

time human resource manager white a hospital employing lesser employees may also use

the services of a full-time HR manager. However, in such a case the HR manager should

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be assigned some additional responsibilities like purchase, public relations, transport

management, legal work. In hospitals with more than 300 employees, the HR manager

should be assisted.

`Hospital' is a simple and familiar word but it is not always understood in its entirety and

complexity. It cares for patients of all ages and backgrounds, some happy and others sad.

It houses various people inter-acting with each other such as cooks and doctors, cleaners

and nurses, technician and therapists, ambulance drivers and administrators of different

kinds, plumbers and clerks. It experiences hope and despair, sympathy and indifference,

love and hate, It is a place always open to all sort of people.

1.2 ELUCIDATION OF THE PROBLEM

In the present times, the fast pace socio-economic, scientific and technological progress

has influenced every sector of human activity and everywhere there is an increasing want

of new approach and adoption of new methods to bring closer the achievement of

objectives.

As for health sector, which is under increasing pressure due to prominent growth in

population and for other reasons, it is all the more obvious. Hospitals as healthcare

centers need reform and development not only with regard to facilities, but also in theways and techniques of providing services to the clients. To great extent, it is the

attitudes, skills-levels and qualities of the health care personnel on which factors the

reform and development depend.

The concept of human resource management is a tool to develop human capital and to

manage people at work properly and systematically so that human resource at work could

be utilize at maximum level for the achievement of the optimum organizational goals and

targets.

Like as in many other developing countries, in Pakistan, health care sector has not been

managed properly and has consequently failed to provide the necessary services of the

desired standard. This is largely due to the lack of proper management of resources which

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Mission

The mission of LRH is to provide highest attainable quality curative, preventive and pro

motive care, which is compassionate, ethical, accessible, acceptable, and affordable,

equitable services. The hospital also provides Training, Teaching, Research opportunities

and the working environment to the employees where they attain their highest potentials,

improve the professional skills of the staff through continuous education and research in

the areas of Medical services, Management of the patients care and Managerial

innovation.

AMENITIES (facilities)

There are 1450 beds available in the hospital with 26 teaching units, like three surgical,

three medical, two pediatric units, two gynecology and obstetric units, and each of

cardiology, neurology, neurosurgery, cardiovascular, cardiothoracic, orthopedic unit,

urology, dermatology, psychiatry, Eye, ENT, ephrology and pulmonology unit. All

inpatients services are supervised by a professor and in charge of that unit.

ROLE OF HUMAN RESOURCE AT LRH HOSPITAL

Human Resource Department at the LRHH ensures the following aspects:

Ø well-planned and quality hiring of personnel

Ø job description of its employees and proper structure/staffing of departments

Ø individual development centered on improving professional skills & performance

keeping in view future needs

ØProper utilization of human resource by motivation to improve the efficiency of organization.

Apart from the above, the HRM works on better job satisfaction that reflects in lower

absenteeism and higher turnover is achieved. As another important obligation the

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HRM helps maintain high moral and better human relation to win employee

commitment.

(ii) REHMAN MEDICAL INSTITUTE

Located at the gateway of Khyber, Rehman Medical Institute has revolutionized the

concept of medical care in the KPK. For the first time ever, the people of this area have

access to healthcare facilities of international standards.

The founder, Prof. Muhammad Rehman with a vision of providing quality healthcare

services to the people of this region, established the RMI which is now catering to all

major and minor disciplines of medical sciences.

AIMS & OBJECTIVES

The Rehman Medical Institute is committed to providing:

Ø Quality Healthcare Services through state of the art diagnostic facilities and

treatment of the highest possible standard in a comfortable, caring and safe

environment.

Ø Career Opportunities in an environment providing our employees with a purpose and

pride in the organization, through personal development and recognition for

performance excellence.

Ø Education and Training to health professionals while inculcating in them the ethics

and values of professional modes of practice.

(ii) HAYATABAD MEDICAL CENTER

The second largest Hospital in Peshawar-a Postgraduate training centre, equipped with

all the medical/surical specialities except a few like Cardio-Thoracic Surgery, Psychiatry,

burns.

Serves not only the western part of the city but also caters for patients coming from

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across the border. Many memories associated with it for those who have done their

housejob in it.

Mission

Through the discovery and dissemination of knowledge and application via service, the

HMC is committed to the development of human capacities.

1.6 Organization of study

For the purpose of elucidation and elaborations, this study has been divided into the

following chapters:

Chapter 2: As a prelude to the study the current literature has been revised and only

those publications have been considered which are relevant to the topic of the study.

Chapter 3 In this chapter, research methodology has been presented. This study was

planned as a descriptive comparative study of private and public hospitals. To obtain the

required data, questionnaires and interviews were used. These questions were open-ended as well as close-ended. More over, information obtained from the print media &

secondary data, too, was collected from the relevant journals and books. Information so

collected was statically analyzed using Word, Microsoft Excel software.

Chapter 4: This deals with the HRM in Pakistan's hospitals and health care environment.

Policy formulation, planning, management, development, and investment skill and

potential development aspects of HRM in Pakistani hospitals have been discussed.

Chapter 5: Results of the study have been compiled and tabulated in this chapter.

Chapter 6: Finally, the conclusion driven from this study has been set out and

suggestions offered for the improvement of the HRM in Pakistani health-care sectors.

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2.1 Detailed Perspective

For the last around two decades, somewhat late though, Human Resource Management

has been systematically introduced in the health system and its importance appropriately

recognized in the establishment of human resource policy and management in the 'proper'

course. It is found that at present far more information is available on issues of health

system, finance and appropriate buyer/supplier structure as compared to Human

Resource Management prospects and its scope of influence.

Efforts and measures taken to assess the implications of evidence based on the impact of

Human Resource Management in the health sector can be referred to as relatively on a

low side in spite of growth of this evidence.

Factors like mortality rates in various hospitals, re-admission rates, duration of stay and

satisfaction of the patients were also probed into, in this study. It revealed that in-hospital

death rate increases with the increased number of sick patients in a population. The samephenomenon was observed in the areas with less employment. Education was found to

be an important element to influence re-admissions. In areas consisting of people with

higher level of education, the hospitals showed lower ratio of re-admissions.

The study finally explored into as to what effect on health status did the use of hospital

and community nursing services have. It revealed that application of more or less than the

average quality of services produced significant effect in terms of statistics, though not

quite significance in practical terms.

2.2 Impact of Education on Health

Patients with older age had lower self-reported health status. In comparison to males, the

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females were observed less likely to report better health. The same tendency was seen in

jobless respondents compared to the employed ones. Respondents dwelling in large cities

were more likely to report better health than those living in small cities. As against

respondents with lower incomes, those with lower-middle, middle, higher-middle and

higher-income were more likely to report better health. However, in the case of lower-

middle income, the difference was not notable. The state of health was observed to be

better among the respondents possessing higher level of education.

2.3 Readiness for Disasters

A study by J. Christopher Farmer and colleagues shows that readiness for disasters like

the Tsunami that hit South East Asia in 2003, could be greatly improved by better

management of the hospital resources and staff. By now, disaster medical response has

predominantly on pre-hospital issues such as triage, evacuation, and transport of

casualties. It has also largely assumed that hospital management would emerge as

planned.

Throughout the world, the hospitals short of staff and bed capacity are not in a state of

readiness for critical situations, Not only that these hospitals have not been able to cope

with such events in the recent past, rather hospital with large facilities, too, have found it

hard to overcome conditions caused by such disasters. For instance, following a terrorist

bombing in Bali in 2002, as many as 15 patients had to be sent to a hospital in Australia

for mechanical ventilation, however, this hospital had a capacity to provide treatment to a

maximum of 12 patients. Similarly, ICU beds fell short in the floods of 2001 in Houston,

Texas. Numerous examples of like incidents support the view that during a disaster

medical response, hospital capacity is the major rate-limiting factor.

2.4 Healthcare Supplies' Demand in Pakistan

Pallas has observed the guidelines for comprehensive health human resource planning

(HHRP) developed by TL Hall have been elaborated further (Pallas 1998). In fact the work

of Hall, Reid and the SHARP model (developed by Denton, Gafni and Spencer) has been

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advanced further. Their study has revealed that healthcare supplies' demand is on an

increase in Pakistan for its large population growth, technology changes in pattern of

disease, raised social expectations and the rapid development of health industry.

Following issues have been pointed out by them:

a. Poorly prepared practitioners

b. Unsound linkage among healthcare needs and education

c. Surplus physicians

d. Lack of female healthcare workers

e. Imbalance between urban and rural healthcare personnel and services

f. Poor linkage between national health policies and implementation

g. Lack of political will to enact policies

h. Unsatisfactory career structure

i. Insufficient funding for healthcare

j. Limited historical data.

They point out HRP process in Pakistan being overlooked and stress need of identified

issues to be incorporated in future health human resource planning (Pallas 1998).

This research work has been conducted on open-ended and close-ended questions style.

In a survey research, close-ended questions mode is taken to be decisive. As for

differences found in the quality of data acquired using close-ended or open-ended

questions, a systematic research is still needed, which should aim particularly at

differences in averages and division of data.

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3.3 Responses to General Open Question

Researchers have diversified views about responses to general open

questions whether being qualitative, non-qualitative or quasi-qualitative

(Steckler A, 1992, Bankankaite, 2003, Boulton 1996, Murphy E, 1998).

These questions show some features of qualitative nature viz., they

encourage respondents express their views in their own words, output is

not figurative but in textual form; techniques associated with qualitative

research may be used for analysis. Closed questions may impose

constraints on responses as these closed questions may be indicative of

the agenda for responses to general open questions.

Data on each case may lack conceptual richness. Recipients are asked non-directive

questions that bear little capacity for responses, for example, `Any other comments?' or is

there anything else you would like to say?'. Data extracted from general open questions

is determined by their details/depth, which comes from responses offered to the written

instructions for the recipients and what they actually write.

With the help of a thorough and quality analysis of data or using shorter responses as

safety net for new or complementary issues, the researcher can determine the status of

general open questions. This strategy may be helpful in publication process as well.

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3.4 Target Population

It is public and private hospitals that provide a target population. This target population

has been selected on the basis of inclusion criteria (see Table below). Before filling the

questionnaire, written consent by the respondents was obtained in order to approach the

target population primarily via letters.

Target Population

S. No. Name of Hospital Target population

1 Khyber teaching hospital 1,750

2 Lady reading hospital 3,500

3 Rehman Medical Institute 350

Total 5,600

Source: Prospectus of above hospitals.

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4.1 POLICY FORMULATION, PLANNING & MANAGEMENT

He

alth matters pertaining to human resources prove to very important and complex areas

that require certain modifications and reforms for the development and improvement of

health systems in various countries. In 1999 the issue of human resources development

was identified by the Regional Committee ( for the Eastern Mediterranean as a priority

area during 2001 and beyond. These issues must be considered at an early stage in

health systems reform and not be regarded as an "afterthought". Human resources

development is more often than on concentrated narrowly on planning and training only.

Developing an effective strategy for human resources is of utmost significance. A

workshop for this purpose was organized by the WHO and attended by representatives

from the Eastern Mediterranean Region in late 2000.

The national potentials of countries to formulate or update their national human resources

policy was strengthened through several consultations in the year 2000. In Lebanon, the

Ministry of Public Health was supported in projecting human resources for health needs

based on WHO models; a new policy is therefore expected as a result of the projection.

In Pakistan, a national policy was formulated by a WHO consultant and submitted to the

Federal Ministry of Health for discussion as a preparatory stage to draft a national plan

for human resourceE, development. In the Republic of Yemen, a mission of two experts

conducted an in-depth review on health and human resources for health and prepared a

detailed rc port; an updated national policy and plan, based on the results of the review,

is being prepared.

Human resources management was supported through developing effective continuing

education programs, tailoring of postgraduate course; to fulfill urgent needs for qualifiedprofessionals in specific specialties, establishment of new centers for human resources

development and through introducing new trends in management. Special attention was

given to the development of programs in family medicine and general practice. In the

area of postgraduate training, evaluation and support was provided to develop and

improve training of professionals in a number of specialties on demand. Family medicine

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and general practice programs attracted support in public health and related topics are

increasing in number in the countries of the Region. The Regional Office lent support to

these programs in order to encourage students and faculty to join and to help the

organizers maintain the high quality and relevance of courses in Pakistan.

A comprehensive survey has been initiated, as part of a WHO global project, to study thesituation of this important specialty in the countries of the Region to identify further needs

of new programs and to provide support to already existing programs. In Pakistan centers

were established to organize continuing education. Programs to update and develop

skills of the health workforce in different subjects were provided through enhancing

continuing education programs focusing on bask: skills programs.

4.2 INVESTMENT FOR HUMAN RESOURCE DEVELOPMENT &INVESTMENT

Investments in the development of nursing and midwifery resource in the region, as a

vital component of the health system and health services development keep on being

made. As in the past, the process of collaboration with countries in taking corrective

measures to improve basic nursing and midwifery education and reorient the curricula

towards primary health care continued. Nursing and midwifery education has been

fortified in Pakistan where one nurse is available for eight doctors and only one doctor is

available to treat 2,300 patients. Federal and provincial governments still to plan to

produce a sufficient number of nurses and paramedical staff. Besides Pakistan,

shortages of nurses and midwives in many countries of the Region requires a critical

review of the nursing human resources situation in the Region for the purposes of

planning, development the management in order to meet the increased demand of

relevant services both quantitatively and qualitatively.

Pakistan was provided with support in the form of fellowships, rational training, supplies

and equipment to strengthen the teaching and training capabilities of the national allied

health institutes and to meet the continuing education and training needs of allied health

personnel (Annual Report of Regional Director, 2006).

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Some NGOs too have become actively involved in this field. HRSW 3-International is such

an NGO operating from the NWFP, Pakistan. It was established in the year 2000 and

registered with the Government of Pakistan under the Societies Act 1860. In the field of

social work, human resource and public health services, the HRSWS has made a good

reputation for itself,

4.2.1 Aims and Objectives of HRSWS

For a long time, the problems of inequity, scarcity of resources, inefficient and untrained

human resources, gender insensitivity and structural mismanagement confront the

healthcare system in Pakistan. With the precarious health status of the people and poor

indicators of health in the region, health care reforms were finally launched by the

government in 2001, which envisaged decentralization.

There are, however, numerous challenges and constraints in the system. The future

health of the nation depends on this decentralization initiative. Hopefully, this new system

shall result in the institutionalization of the health services at the district level. Most

importantly, it will help in strengthening the primary health care se vices catering to the

major fraction of the population.

Besides political commit rent, attitudinal, behavioral and cultural conditions conducive to

this system should be maintained (Sheikh BT, Rabbani F., 2004).

Though surprising but true that most of the developing countries are not spending more

than 2% of their gross national product (GNP) on health, resulting in poor coverage of

public health services. The Government of Pakistan spends about 0.8% of GNP on health

care, which is lower than some neighbouring countries such as Bangladesh (1.2%) and

Sri Lanka (1.4%) (World Bank, 1999),

Pakistan spends 80% of its meager health budget on tertiary care, services, which are

utilized by only 15% of the population. In contrast, only 15% is spent on primary health

care services, used by 80% of the population (Pakistan - Towards a Health Sector

Strategy, 1998).

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Looking at the above data, however, Pakistan seems way behind fulfilling its

commitment. Though the country has achieved a very healthy economic growth rate, but

it has not been pro-poor. This is evident from high unemployment and poverty levels.

Health expenditure in Pakistan is about US$ 17 per head per year, out of which $13 is

out-of-pocket private expenditure {World health report 2000).

As for determining the poverty factor, measured by the international standard of earning

less than $1 a day, at least one-third of the population is poor. On the other hand,

countries having a much smaller GDP size than that of Pakistan are far ahead of it inliteracy and other HD-related indicators.

As for economic growth, it is a necessary element, though not sufficient for human

development. No doubt, owing to resource constraint, it is difficult. for a developing

country like Pakistan to allocate sufficient funds for human development.

Therefore, by way of enhancing the pace of growth, sufficient resources can be

generated for raising the standard of living of the people. However, for this purpose a pro-

people growth: higher investment in labor intensive sectors like SMEs and agriculture are

needed so as to create greater employment opportunities.

It may be argued that without developing its human resources country cannot sustain a

high growth rate. Poor, illiterate, unskilled, sick and disgruntled' people are a serious

obstacle to development.

The development of human resources is an important issue in the current development

policies of Pakistan, which this policy focuses on health-and education as well as poverty

alleviation as essential elements for sustained economic revival and growth in Pakistan.

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Under this policy, in the health sector, the Government has taken steps to awareness.

Vocational education at sub-District and District levels includes health awareness

programs.

It reveals from the report that the mortality rate is high, hepatitis B vaccinations are

unavailable for the whole country, pregnancy complications have increased, and there isno national health policy, drug policy and an accountability procedure to motivate doctors.

According to the report, it might be claimed that more money was spent on healthcare

but a majority of people still have no access to primary healthcare, emergency obstetrical

care or emergency healthcare in Pakistan.

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4.3 MAGNITUDE OF THE TRAINING & DEVELOPMENT PROGRAMS IN

PAKISTAN

With a view to consolidating its position in the world markets and achieving internal

economic balance and growth, the government has now taken up major economic

restructuring. Liberalization in terms of major changes in the industrial policy, as a part of

the economic restructuring programs, has brought in a lot of competition for the over-

protected industrial organizations in general. Foreign capital and direct participation of

multinational organizations in the corporate sector rave exposed the industrial

organizations to intense competition. The effect of such liberalization on the industrial

organizations has given rise to certain international developments in the form of global

trade restrictions. Certification as per the quality system standards (developed by the

international organization for standardization) o" the products of the industrial

organizations are now almost essential for going global. Total Quality Management

(TQM) is now a widely discussed issue in the corporate world, but it is absent in the

health care sector, not only in state hospitals but also in a number of private hospitals.

(Dipak Kumar Bhattacharyya, 2002)

4.4 ENHANCING CAPABILITY OF HOSPITAL EMPLOYEES

At present times, a trend has come that that health care is provide to the indigent and

uninsured. Because of industry-wide consolidation pressures, it is unlikely that 10 years

from now governments will find it strategically desirable to directly operate their own

public hospitals and clinics 3 or 4 more cost-effective choices are becoming available.

Apart from bringing a decrease in the public resources, the main force driving this change

is vigorous competition for treating the poor from private for-profit and nonprofit hospitals.

In most communities, even those on public assistance now have a choice of providers.

The advent of HMOs is leading to a fundamental restructuring of the whole health care

system. One of' shoot of this is a declining need for hospital beds. In the development of

a nation, health plays a fundamental role

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4.5 WORKER’S SKILL DEVELOPMENT:

A TRUE SOURCE OF NATIONAL WEALTH

The key to a strong economy, as usually argued, is money in the lands of factory owners

and rich investors. The appropriate view is that redistribution of money from the rich to

programs for the poor and the middle class is important. Neither opinion is adequate to

the economy of the 1990s and beyond - a world economy in which the true source of

national wealth is the accrued skills of the workforce coupled with the quality of the social

and the material infrastructure supporting them.

Available data gives us to know that the success of economy in Pakistan no longer depends on the private investments of highly motivated capabilities. Rather, our nation's

future economic success depends instead on the skills anti insights of our Workforce, and

how well we link those skills and insights to the economy of the United Nations.

The role of government in Pakistan is to build our human capital and public resource

base and to bargain with global capital on our behalf, Our economic policy must be

adapted to the new realities of the world economy for the sake of survival and growth in

the 215 ` century.

Rich Pakistanis whose savings remain usually unknown, tend to decline to help the rest

of our population. But the saving of the foreigners are appearing on the scene to found

promising projects.

4.5.1 Obstacles in Human Resource Development in Pakistan

The greatest barrier to human development initiative is provided by the EstablishmentDivision and the Finance Ministry where the preexistent policy of maintaining status-quo

and sustaining the inflexible, unscientific and illogical rules, quite a few of which are

ultra-virus to the constitution of Pakistan.

The skills needed for human development initiative are of several types. First, among the

core skills are the problem solving skills required to put things together in unique ways.

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Identifying problems is yet another important issue as, without this, it is hard to

understand people's needs and the ways to meet these wants.

Third are the skills needed to link problem solver and problem identifiers. Problem

solvers, problem identifiers, and brokers are now called upon to join hands in stimulating

and uncovering the discoveries.

The work force possessing good basic education can easily bring the fruits of its labor to

the global economy, and can attract global capital for the performance of its complex

task. The experience acquired by performing these tasks promotes additional on-the job

training and experience. It, in turn, serves to hire global capital for more complex pursuits.

If Pakistan is strongly committed to economic development, it would be more convenient

for it to establish a virtuous relationship with global capital. Lacking educated workers and

highly qualified members of public service, many of our policy makers would not be able

to resolve the problem of unemployment and low wages. Even if Pakistan bargains for

global capital, it would still be challenging for it to attract good jobs unless it could offer an

educated workforce and effective communication systems.

4.5.1.2 Promotion of Female Education

The ability of mothers to provide adequate care for their families can be greatly improvedby uplifting female education. Female primary school enrolment of 26% (in 1990) is

extremely low and almost half that of their mall; counterparts. 80% women in Pakistan are

illiterate (compared to 50% men) - .a situation that has persisted throughout the 1980s.

Apart from the high reproductive burden, this poor educational level has negative

consequences for labor force participation: official female rates are only 6% overall

(Horwitz A., 1993).

3.5.1.3 WHO Collaboration for Health

The collaboration of WHO with the Government of Pakistan has existed ever since the

foundation of the organization, and has been faithful to the first article of its constitution

devoted to the attainment by all peoples of the highest possible level of health. This

collaboration was further strengthened with the establishment of the WHO country of ice

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in Pakistan in January 1960. Through this close partnership, WHO has been contributing

to health sector development in Pakistan, while the experience gathered from this and

other countries has played a positive role in shaping the strategic policies of the

organization. WHO has always designed its strategic interventions in a country on the

basis of the national priorities, using the "Health for All" approach as one of the critical

guiding principles for health sector development.

3.5.1.4 Lady Health Workers

In the later part of the same year (1993), the initiative of the Lady Health Workers (LHWs)

was jointly launched in Union Council Tamman of district Chakwal in the Punjab as a pilot

intervention. Young rural females with a high school certificate were inducted in an

intensive community based PHC training programme to subsequently deliver essentialPHC services to the households of their residential catchments areas, and bridge the

existing gap between the community and first level care facilities.

The programme was scaled-up in early 1994 throughout the country. The strength of the

LHWs now reached 70,000, and the government is working to further raise this force to

100,000 with recognized success in delivering essential PHC interventions. We strongly

hope that the current devolution process will seriously take advantage of this expandeddistrict health system network with added financial and human resources allowing it to

operate effectively.

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5.1 DATA ANALYSIS AND INTERPRETATION

Data has been analyzed by both the descriptive and inferential statistical methods, and

interpreted through frequency tables. The utilization of HRM in public and private

hospitals has been tested.

5.2 DATA MANAGEMENT

Questionnaires were edited simultaneously during the study and all the completed

questionnaires thoroughly scrutinized. Data was double entered and then validated and

corrected for any disparity. Finally, 10% of the questionnaires were checked randomly to

look for any error in the data entry.

5.3 DESCRITIVE STATISTICS

Questionnaire was divided into qualitative and quantitative parts. Both types of questions

have been separately analyzed and interpreted. The questionnaire comprised of three

sections: Section 'A' pertains to information relating to personal opinion on human

resource management. Section '2' is based on effective utilization of human resource

management in the hospital. While section '3' is based on the suggestions and

recommendations for improvement.

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5.4 SECTION 1

Personal Opinion on Human Resource Management .

Subject: Study is based on two criteria i.e. Public and private hospitals. Out of 362respondents, 35.4% were from public hospitals and 64.6% from Private hospitals.

Table 1: Type of Hospital (n=362)

Type n %

Public Hospital 128 35.4

Private Hospital 234 64.6

Hospitals

29% samples were taken from the KTH,58.6% from the LRH , and 6.1% from RMI

Table 2: Hospital Status (n=362)

Hospital n %

KTH 106 29.3

LRH 212 58.6

RMI 22 6.1

Source: Questionaire

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Q-1 what is the purpose and objectives of HR department in your hospital?

In response, 33.4% employees were in favor of Human Resource Management to

increase the efficiency and effectiveness of work; 19.3% said that they have no HR

management in their hospitals; 28.7% agreed that Human Resource Management

maintains and manages resources; 9.1% said that it managed employees and their

records, and 3.6% were of the opinion that HR fulfilled the needs of internal and external

customers.

Table 3: Purpose and objectives of HR department in hospitals (n=362)

Objective of HR department in hospitals n %

To increase the effectiveness and efficiency 121 33.4

No HR department exists but one is needed 70 19.3

To manage employees and their records 33 9.1

To fulfill the needs of internal and external customers 13 3.6

To maintain and manage the resource system 104 28.7

To make the organization work more smoothly 21 5.8


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Q-2 Why is human resource planning necessary in a hospital?

Out of 362 respondents, 34.3% agreed that HR planning makes the services system

more effective, 24.6% employees said that the HR planning increases proper utilization of

services to community and 14.6% said HR planning makes working atmosphere better

and more harmonious.

Table 4: Why HR planning necessary in a hospital (n=362)

Variable n %

To make working atmosphere better and moreharmonious

53 15

To make maximum used of resources 36 9.9To create better relationship between employees andbosses

21 5.8

bosses

it is necessary in patient care services system 124 34

To keep proper person at proper place 6 1.7

For management and improvement 9 2.5For proper utilization of their services in relation tocommunity

89

24.6

To provide an environment that builds leadership 11 3

To achieve the organizational goals 13 3.6 I


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Q-3 Are you satisfied with the supervision system of your hospital?

75% employees were satisfied with their supervision system, while 25% were not and

wanted to improve the hospital supervision system.

Table 5: Are you satisfied with the supervision system (n=362)

Variable n %

Yes 272 75.1

No 90 24.9


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Q-4 What methods do hospitals use to assess their training methods?

46% respondents said that evaluation is the best method to assess their training, while

14.4% wanted to assess training through supervision observation and survey. 21% said

that there was no method available in their hospitals.

Table 6: Method to assess the training (n=362)

Variable n %

At present there is no method 76 21

Appreciation, meeting and punishment 24 6.6

To check the output after training sessions 31 8.6

Through practical procedure 13 3.6

Evaluation 166 45.9 Monitoring through supervisor observation and 52 14.4


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Q-6 what are the drawbacks and weaknesses in your administration system of

hospital?

166 employees did not know about the weaknesses of the administration system, while

19.6% said that political influence weakened the administration system and 18.2% said

too much hierarchy is a big drawback.

Table 8: Drawbacks and weaknesses in your organization (n=362)

Variable n %Don't know 166 46

Outside influence and politically grouping 71 20

Administrative interference by the high authorities15 4.1No systematic approach 11 3.1

Lack of proper supervision 11 3.1

Lack of communication 22 6.1

Too much hierarchy 66 66 18


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Q-7 What would be your recommendations for improving the quality of human

resource?

362 employees 117 (23.3%) recommended that proper selection of employees and

proper utilization according to their ability, improved the quality of human resources, while

13% said that giving better incentives to employees would improve the work and 20%

said that regular promotion and encouragement would improve the quality of work.

Table 9: Recommendation for improving quality of HR (n=362)

Variable n %

Better incentives for hard workers 47 13,0

Regular promotion and encouragement of staff 73 ~ 20.2

Training at HR level with frequent interval, rewards 40 11Hire and fire power without outside interference 10 2.8

Merit and only merit 12 3.3

Proper selection and utilization according to ability 117 32.3

There should be HRM in every organization 25 6.9

Increase communication and interest 38 10.5


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Q-2. Does HRM explore the importance of efficiency and effectiveness in

hospitals?

239 (66%) employees believed that HRM was important for the hospital and 34% said

that it was not necessary.

Table 11: HR explore the importance of efficiency in hospital (n=362)

Variable n %

Always 239 66

Sometimes 123 34

Never - -


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Q-3. Are the employees motivated by adopting fair promotion policies in

hospitals?

A total of 105 employees (29%) said that they were always motivated by fair promotion

policies, 59% said that sometimes they were so motivated and 11.9% were of the view

that promotion system of the hospital was not satisfactory.

Table 12: Employees motivated by the promotion policies (n=362)

Variable ' n %

Always 105 29

Sometimes 214 59.1

Never 43 11.9


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Q-4. Is employees' criticism encouraged by the hospital management?

49 employees (13.5%) said that employees' criticism was always encouraged by their

hospital, 68.8% said that sometimes their criticism was encouraged by the management,

and 17.7% said that employees' criticism was never allowed in hospital.

Table 13: Employees criticism is encourage by hospital management (n=362)

Variable n %

Always 49 13.5

Sometimes 249 68.8

Never 64 17.7


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Q-5. Do hospitals provide beneficial incentive schemes to their employees?

72 (19.9%) employees said that the hospital always provided incentives to their workers,

59.7% said that the hospital provided incentives sometimes and 20.4% said that no

incentive was provided in their hospital.

Table 14 Hospital provides benefits (n=362)

Variable n %

Always 72 19. 9

Sometimes 216 59.7

Never 74 20.4


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Q-6. Are hospital employees encouraged by restructuring their salary structure?

21.5% said that the hospital always encouraged the employees by restructuring their

salaries, 60.5% said that their salaries were restructured sometimes and 18% said that

the hospital never restructured, their salaries.

Table 15: Employees are encouraged by restructuring their salary (n362)

Variable n %

Always 78 21.5

Sometimes 219 60.5

Never 65 18


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4.6 SECTION 3

Suggestions and Recommendations for Improvement.

Q-1 Is HRM effectively utilized in hospitals to increase effectiveness and

efficiency?

Variable Public hospital Private Hospital Total

Yes 76 (24.9%) 229 (75.1%) 305

No 52 (91.2%) 5 (8.8%) 57

362

75% private hospital employees' opinion was that HRM increased efficiency and

effectiveness, while 24.9% public hospital employees agreed that HRM increased

efficiency.

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Q-2 Has safety often been managed as effectively as some other business

functions?


Yes 73 (41.2%) 104 (58.8%) 177

No 55 (29.7%) 130 (70.3%) 185

362

Out of 104 private employees (58.8%) said that safety had often been managed

effectively, 70.3% said that safety was not managed effectively, while 41.2% public

hospital employees said that safety was often managed effectively.

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Q-4 Does the communication system work effectively in hospitals?


Yes 96 (37.2%) 162 (62.8%) 258No 32 (30.8%) 72 (69.2%) 104

362

In private hospitals, the communication system works effectively as compared to that in the

public hospitals.

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Q-5 Does the implementation of new technology reduce the number of jobs?


Yes 38 (25.5%) 111 (74.5%) 149

No 90 (42.3%) 123 (57.7%) 213

362

.

Private hospital employees (74.5%) said that implementation of new technology reduced the

number of jobs, while 25.5% public hospital employees said that it not reduce the number of

jobs.

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The Rehman Medical Institute is private while the rest of the two (Lady Reading Hospital

and Khyber Teaching Hospital) are public sector hospitals. The study reveals that only

one hospital, the RMI, enjoys a well established and functional HR department integrated

into its setup. In the two public-sector hospitals, on the other hand, no human resource

management exists, and they operate through the obsolete government administration

policies and procedures.

6.1 Functions of RMI, HR Department

The HR department of RMI carries out the following functions:

1. Integration of HRM with policy and decision making

2. Suitable staffing

3. Formulation of job-descriptions

4. Motivation of personnel in order to improve individual as well as organizational

efficiency.

5. Provision of individual development of the personnel focuses on performance-

enhancement, and failure to current as well as anticipated future needs.

6. Improving employer-employee relationship for achievement of objectives

7. Redesigning work processes and jobs in accordance with changing needs

formulating sound policies of recruitment, training services condition, discipline

retirement records leading to creation of a versatile work-force

8. Promoting job-satisfaction as evinced by low absenteeism and higher turn-over.

9. Helping to maintain high moral and better human relationships for the sake of

employee-commitment

10.Creating self-respect in the hospital employees.

11.Training and development

Effectiveness of this methodology is evident from the responses of the employees to our

questionnaires and interviews. Compared to the performance of the private Hospitals, the

position of state hospitals leaves much to be desired. The following summarize data will

support this opinion.

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6.2 Statistical Results & Findings

Hypothesis Test Results

This comparison of the public and private hospitals has been carried out. According to

our hypothesis, effective utilization of human resource management brings about

efficiency and effectiveness among employees as well as organization, and an element of

association emerges between the two groups. The alternative hypothesis is that the said

two groups do not have association.

On the basis of our hypothesis, which is sufficiently supported with evidence, we

conclude that there is no association between the two groups. In private hospitals 95.5%

employees reported HRM to have been effectively utilized. The lack of potentiality and

capability in employees creates mismanagement in hospital; we have significant evidence

to prove our hypothesis and conclude that in private hospitals, 46.1% employees reported

that lack of capability in employees created mismanagement in the hospital while, 77.3%

private employees concluded this aspects happen sometimes.

(i) HRM and Efficiency & Effectiveness

HRM works on exploring the importance of efficiency and effectiveness in hospitals. In

this regard, too, on the basis of significant evidence to prove our hypothesis, we conclude

that there is no association between the two groups, and 59% private hospital employees

said that HRM is important for efficient and effective working of a hospital.

(ii) Understanding of Employees

The hospitals are engaged in efforts to improve the understanding of employees so as to

enhance their productivity. However, there is no association between the employees of

public and private hospitals. Private hospitals employees (66.7%) relate that hospital tries

to improve understanding of employees to increase productivity.

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70.3% said that safety was not managed effectively, while 41.2% public hospital

employees said that safety was often managed effectively.

(viii) Communication System in Hospitals

The communication system performs effectively in hospitals. In private hospitals,communication system works effectively as compared to public hospitals.

(ix) Use of New Technology

The implementation of new technology reduces the number of jobs. Private hospital

employees (74.5%) said that the implementation of new technology has reduced the

number of jobs, while 25.5% public hospital employees said that it has not reduced the

number of jobs.

The two state hospitals, the LRH, KTH In both there is no human resource management

to speak of. Both are run by the government rules and regulations in all matters and are

not autonomous. To be more exact, these hospitals are run like some ministerial office or

department. As far human resources are concerned, the personnel are governed by the

various government rules e.g. Establishment Rules, Efficiency and Discipline Rules, etc.

These rules and regulations do specify punishments for misdemeanors. But as for

rewards, which encourage workers to do better and better, these rules offer noencouragement. The only rewards, if they can be so lubricated, are the annual increment

and, the occasionally promotions. There are no fiscal awards save very occasional

advance increments or an allowance, furthermore jobs-descriptions are sketchy and

procedures are neither uniform nor efficient. Human relations are, by and large, a matter

of individual choice or whim; the organization takes practically no measures to support

such relations.

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6.3 Measures Proposed

All the facts and observations give us to reach the following conclusion:

1. There is an immediate need of the governance shift from the traditional administration

to modern management, incorporating human resource management, in the interestof better governance and greater public good.

2. The state (or public) hospitals should have greater autonomy in decision and policy

making and the administrative over-burden which means that various ministries,

secretariats and directorates should be lessened of this burden to a feasible and

practical level.

3. The public and the private health-care intuitions ought to have a closer cooperation

between themselves. An assessment need to be carried out of the feasibility of local'

governing bodies for state hospitals for the healthcare services point of view instead

of from the economy point of view alone. There should be a revision of the services

rules and conditions in state hospitals in order to incorporate HRM practices. In this

regard, depending upon its size, there should be a human resource department or

section in each state hospital and only an HRM professional should head such

departmental section.

4. At the highest level, particularly in the healthcare sector, human resource

management should form an integral part of national planning.

It is believed that performance of the healthcare sector of Pakistan can be greatly

improved and enhanced through a proper implementation of the proposed measures.

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Appendix-1

Questionnaire

Section No 1 -Answer the following questions:

1 What is the purpose and objectives of HR department in your

____________________________________________________________________ ___________________________________

2 Why human resource planning is necessary in a hospital?____________________________________________________________________ ___________________________________

3 Are you satisfied with the supervision system of your hospital?

____________________________________________________________________ ___________________________________

4 What methods do hospitals use to assess their training methods?____________________________________________________________________ ___________________________________

5 What motivation techniques are used for employees in your

____________________________________________________________________ ___________________________________

6 What types of incentives are provided by the hospital to motivateemployees to increase profits?____________________________________________________________________ ___________________________________

7 What are the drawbacks and weaknesses in your administrationsystem of hospitals?____________________________________________________________________ ____________________________________

8 What would be your recommendations for improving quality of

____________________________________________________________________ _____________________________________

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Appendix-2

Questionnaire

Section No 2 - (Tick the suitable one)

1Is the effective utilization of HRM in hospitals can be analyzed? (Always,Sometimes, Never)

2Does HRM explore the importance of efficiency and effectiveness inhospitals? (Always, Sometimes, Never)

3Are Employees motivated by adopting fair promotion policies in hospitals?(Always, Sometimes, Never)

4Employees criticism is encouraged by the hospital management? (Always,Sometimes, Never)

5Does hospitals provide beneficial incentive schemes to their employees?

(Always, Sometimes, Never)

6Does Hospital employees are encouraged by restructuring their salarystructure? (Always, Sometimes, Never)

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Appendix-3

Questionnaire

Section No 3 - (Tick the correct one)

1 HRM is effectively utilized in hospitals to increase effectiveness and efficiency.(yes/ no)

2Do all workers want their pay to be based on their performance? (yes/ no)

3 Do bonuses tend to be more effective motivational tool than increased salary.(yes/ no)

4 Safety has often not been managed as effectively as some other businessfunctions. (Yes/ No)

5 The hospital's health and safety rules provide quality services to employees.(Yes/ no).

6Does the communication system work effectively in hospitals? (yes/ no)

7 Does the implementation of new technology reduce the number of jobs. (Yes/no).

effecutive utalization of hrm

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