impact of quality human resource on health care providing industries-organizations

A comprehensive research based on secondary source of data

IMAPCT OF QUALITY HUMAN RESOURCE IN HEALTH CARE

PROVIDING INDUSTRIES / ORGTANIZATION

Submitted to: Dr. Abuzar Wajidi (PhD),

For the partial fulfillment of Master in Administrative Sciences (MAS)

Degree Program (2014-15)

Author:Muhammad Asif Khan s/o Abul Hasan Taj

MAS-Final (After PGDPA)[email protected]

Enrollment # MAS/PAD/EP-24672/2013Exam Seat # 1433020

mailto:[email protected]

My all efforts dedicated to my family

Research Report: Impact of Quality Human Resource In Health Care Providing Organizations

About Author

Author of this research report is the student of Mater of Administrative Sciences (MAS-Final after PGDPA), Department of Public Administration, University of Karachi, with an aim to complete his higher education (PhD) in the field of management, administrative & social sciences. He would like to conduct empirical research in the relevant subjects, to explore the new avenues in order to contribute his part for the improvement of the socio-economic condition of the society and to maximize the organizations' efficiency serving to the society either public or private.

This research effort is in consistence with his past research work of PGDPA, in which he tried to analyze the GDP impact on country's economy and try to explore other economic indicators to identify the economic wellbeing of the country. Life Expectancy at Birth is one of the indicator other then the GDP which determines the economic efficiency of a country. This said economic indicator directly belongs to the research topic and indicates the efficiency and effectiveness of the health system of the country as well.

This research study emphasize to analyze the importance of Human Resource (health-care workforce) in a Health care system of the country. Mostly the countries Health System comprises on the health care organizations owned and run by the government, operate by private entities and working under NGO.

It has been known by all of us that the country with higher GDP will expand more on health-care of the public as compare to the country with low GDP. The effectiveness of the health system does not belong only to the capital expenditures including the building & medical equipments, it also involved the human capital including practitioners, medical staff and paramedical staff. Most of the health-care systems they are still unable to utilize this resource in a highly effective manner.

Author: Muhammad Asif Khan (MAS-Final after PGDPA) 3


Acknowledgment

This research effort has been made to fulfill the degree requirement of the Mater in Administrative Sciences (MAS) degree program (2014-15). On the completion of this report I would like to acknowledge all of them, who have continually supported me to through the MAS studies.

Special thank goes to the research supervisor upon his continuous guidance, his supervision will enable me to complete this research effort. I would also like to thank the entire regular and the visiting faculty members of the Department of Public Administration upon their academic guidance and support.

I hope this research and academic knowledge will help me to attain excellence in my future professional career.



Preliminary

The aim to choose this research topic was to conduct an empirical research to find out the relationship between the health-care organizations and two variables human resource & new technological innovation in medical / health sciences and to identify the that which one is the most contributor in the health-care providing organizations performance. But due to unavailability of financial resources and due to time constraint, it was not possible.

It is believed that this research work provides concrete information regarding the topic and provides a sound knowledge to conduct the empirical research in order to identify that either human resource is the real contributor in the health-care organizations' performance or the credit goes to technological innovation in this regard.

In this research report the relationship has been discussed with the help of secondary source of data but an empirical research will provide more authentic information regarding the relationship of the variables. Because one of the statements in the past researches create a confusion, that the equipment without practitioner is useless or the practitioners are useless without equipments. But recent research reveals that some of the new technological equipments does not required any practitioner or expert, a layman can also operate them or there is no need of human to operate them. These equipments are completely capable to diagnose specific diseases at their own with the help of patient inputs.



Table of Contents

Abstract Background of study Methodology Applied Introduction Human Resource Management Definitions Human Resource Management Functions Key Issues pertaining to the Human Resources in to Health Care Literature review regarding the performance measurement in Health-Care

◦ History◦ Selecting the right measures◦ Health-care Performance Indicators (KPIs)

Literature review & analysis regarding the new technological impact on Human Resource performance related to the Health-care providing Industries

/ organizations.◦ The impact of human resources on health-care providing organizations.◦ The management of change New Technology◦ The impact of new technology ◦ The socio-technical systems concept

Literature review & analysis regarding HRM practices & impact of new technological innovation on human resource performancespecifically related to the Health-care providing Industries / organizations.◦ The role and effectiveness of human resource management◦ The impact of human resource management (HRM) practices on quality of health care service.◦ The factors that affect the performance of individuals working in health-care organizations.

Own observation regarding research topic Research findings Conclusion Recommendations Appendix-I Appendix-II Appendix-III

Research TopicImpact of Quality Human Resource In Health-Care Providing Industries / Organizations.



Purpose Of the StudyNow a days the Human Resource has been considered most vital resource of any organization,

in relation with the health-care providing organizations it becomes more important due to the sensitivity of the work, because a minor negligence will lead to the human casualty.Most of the studies related to health-care providing organizations provide us the informations that the customers (patients) of the health-care providing organizations are not satisfied with the performance of these organizations because of human resource (employees) performance or due to the unavailability of modern medical equipments in these organizations.

The sensitivity of the work and the importance of the health-care providing organizations and the low performance of the human resource (employees) reported by different sources in these organizations has brought me to identify the causes and reasons that directly or indirectly affect the human resource (employees) performance.

The basic purpose of the research study is to analyze and investigate, how and up to what extent, these two variables, human resource and new technology, are affecting the overall performance of these organizations and to find out that which one is the least or most contributor in the overall performance of the health-care providing industries / organizations.

Statement of ProblemThe performance of health-care providing organizations are depend upon technological

innovations in the field of Medical / Health Sciences rather than human resource (employees) capabilities.

Significance of StudiesThis research study aims to provide a clear understanding regarding the human input

(employees) and the physical input (new technology), their importance and the impact on health-care providing organizations' performance.

Objectives To evaluate and analyze the impact of quality human resource on health-care providing

organizations. The ultimate objective is to enhance the credibility, performance and efficiency of the health-

care providing organizations / industries. Another objective is to identify the ways to maximize the human contributions in the overall

performance of the health-care providing organizations.

Conceptual FrameworkIt is critical to provide clear distinction between these two important inputs, those have direct

influence on the health-care providing organizations credibility and performance, but the clear relationship can be described among them.

Hypotheses



Hypothesis: The capability of human resource (employees) has a direct impact on the services rendered / provided by the health-care providing industries / organizations.

Alternate Hypothesis: The capability of the human resource (employees) has minimal or no impact on the services rendered / provided by the health-care providing industries / organizations as compare to the new technology or innovations related to the health / medical sciences.

AbstractThe management of human resources in health-care institution is essential to enable the delivery

of efficient and effective medical services and to achieve patient satisfaction. This study aims to investigate how the impact of new technological innovation in health / medical sciences and patient care put an effect on the performance of the health-care providing institutions and to analyze how these innovations are putting an impact on performance of the health-care related human resource (employees) and that up to what extent despite of these rapid technological changes, the practicing human resources management is enable to increase the human resource performance, quality of health-care service and help them out to achieve patients’ satisfaction. The descriptive methodology was applied to demonstrate and analyze the previous literatures. The study shows that effective human resources management has a strong impact on health-care quality and improving the performance of hospital’s staff. The study suggests before starting performance development process as well as continuous development and training of staff performance, there is a need to measure the performance of the managers of human resources department in the health-care organizations.

The purpose of this research study is to gain a deeper understanding of the impact of human resources (employees) on health sector reform, the importance of HRM in all aspects of health-care organizations, the positive impact of increased job autonomy on employee outcomes, and the dynamics of employee engagement in health-care. The literature on the link between HR system perceptions and civility towards patients, specific roles for HRM in building shared values that can serve both the care needs of patients and the business needs of health organizations, the complex linkages between employees' perceptions of human resources systems and hospital performance, and the mechanisms through which HRM can enhance patient satisfaction in health care organizations is relevant to this discussion.

Background of the studyMost of literatures have showed the importance of human resources management in developing

the quality of health- care service and found that the incentives and providing motivation to work and follow the system of bonuses by competencies improve the performance of individuals working in health-care providing organizations and can make a significant difference between health organization with good performance measurement and appraisal of work force performance, implementation of reward systems for employees, professional development of workers, and maintenance of work force. The lack of studies that cover the topic of HRM on the quality of health-care could affect the development strategy of health-care providing organizations and without proper studies in this field may contribute to weakening the overall performance of health-care providing organizations. Therefore, this study attempt to analyze the main articles and literatures that discussed the role of HRM



in the health sector and attempt to find the common points of previous studies with regard to HRM. In addition to that this paper investigates the impact of HRM practicing on the quality of health service as referred by previous literatures.

One of the main goals of Human Resource Management (HRM) is to increase the performance of organizations. However, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. This study therefore adds to the literature by relating HR practices to three outcome dimensions:

Financial Outcomes, Organizational Outcomes, and Human Resource (Employees) Outcomes.

Furthermore, we will analyze how HR practices influence these outcome dimensions, focusing on the mediating role of job satisfaction.

This research also addresses the health care system from a country's perspective including the health-care providing organizations owned & run by the state, privately owned and operate under the NGO's, the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services.

Within many health care systems worldwide, increased attention is being focused on human resources management (HRM). Specifically, human resources are one of three principle health system inputs, with the other two major inputs being physical capital and consumables. Human resources (employees), 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. As well as the balance between the human and physical resources (new technological equipments), it is also essential to maintain an appropriate mix between the different types of health promoters and caregivers to ensure the system's success. Due to their obvious and important differences, it is imperative that human capital is handled and managed very differently from physical capital. The relationship between human resources and health care is very complex, and it merits further empirical examination and study.

Both the number and cost of health care consumables (drugs, prostheses and disposable equipment) are rising astronomically, which in turn can drastically increase the costs of health care. In publicly-funded systems, expenditures in this area can affect the ability to hire and sustain effective practitioners. In both government-funded and employer-paid systems, HRM practices must be developed in order to find the appropriate balance of workforce supply and the ability of those practitioners to practice effectively and efficiently. A practitioner without adequate tools is as inefficient as having the tools without the practitioner.

Methodology AppliedThe descriptive methodology has been applied to analyze the data and the data for this research

study has been collected & explored through secondary sources, which includes following:

Literature Review Extraction of relevant material from the Books related to the health care services Past Research Analysis related to the same topic Information gathered from medical science journals.



IntroductionMost of literatures have described the importance of human resources management in

developing the quality of health-care service through effectively implementing the HR practices within the health-care providing organizations and can make a significant difference between health organizations with good performance and health-care organization performs under or below average. Human Resources Management (HRM) is a vital management task in the field of health-care and other services sectors, where the customer facing challenges because of staff’s performance who have the experience and the quality of performance and that human resource management plays an active and vital role in the success of the health-care providing organizations. Human resource management is concerned with the development of both individuals and the organization in which they operate. HRM, then, is engaged not only in securing and developing the talents of individual workers, but also in implementing programs that enhance communication and cooperation between those individual workers in order to nurture organizational development. The primary responsibilities associated with human resource management include: job analysis and staffing, organization and utilization of work force, measurement and appraisal of work force performance, implementation of reward systems for employees, professional development of workers, and maintenance of work force. The maintenance of workforce includes not only the training of the employees to perform their current job effectively but also develop them for tomorrow to take the responsibility according to the new situation that mostly arises due to the introduction of new technology in the health-care related services.

Human Resource Management (HRM) DefinitionsHuman resource management (HRM) is the management of an organization's workforce, or

human resources. It is responsible for the attraction, selection, training, assessment, and rewarding of employees, while also overseeing organizational leadership and culture and ensuring compliance with employment and labor laws (Ulrich, 1996; O'Brien, 2009; Patrick, 2011).

Naturally, the definition of human resource management would be incomplete without further explaining what the terms of ‘human resources’ and ‘management’. First and foremost, people in work organizations, endowed with a range of abilities, talents and attitudes, influence productivity, quality and profitability. People set overall strategies and goals, design work systems, produce goods and services, monitor quality, allocate financial resources, and market the products and services. Individuals, therefore, become ‘human resources’ by virtue of the roles they assume in the work organization. Employment roles are defined and described in a manner designed to maximize particular employees’ contributions to achieving organizational objectives (Zaria, 2007), these objectives mostly includes the increase of profitability, to enhance quality of work, to increase productivity and provide value to the customer and satisfied their needs. A common definition of HRM remains an enigma and, in many respects, what HRM is purported to represent has not moved beyond some key principles laid down in the 1980s (Fombrun et al., 1984; Hendry and Pettigrew, 1986; Guest, 1987; Storey, 1989; Armstrong, 2000).

“Human Resources Management is defined as a system of activities and strategies that focus on successful management of employees and working staff inside the organization to achieve the goals of the organizations (Bayars and Rue, 2006).”

Bratton and Gold (1999:11) interpreted the HRM as “That part of the management process that specializes in the management of people in work organizations. HRM emphasizes that employees are critical to achieving sustainable competitive advantage, that human resources practices need to be



integrated with the corporate strategy, and that human resource specialists help organizational controllers to meet both efficiency and equity objectives.” Some scholars claim that HRM can lead to specifically measurable business outcomes (Huselid, 1995).

Equally, HRM has its critics (Sisson, 1994; Legge, 1995) both of whom view HRM as a symbolic excuse to enhance managerial legitimacy where the management of individuals has been intensified within an enterprise culture (Keenoy and Anthony, 1992).

Human Resource Management Functions (HRM) FunctionsHuman Resource Management (HRM) includes all the functional area of management such as

production management, financial management, and marketing management. That is every manager from top to bottom, working in any department has to perform the personnel functions. HRM functions (also called processes) are carried out by the HR managers to fulfill the goals and objectives of the organization. As illustrated in Figure, they perform two sets of functions, namely managerial functions and operative functions.

Managerial Functions:The managerial functions are the basic functions performed by the HR managers in their

capacity as managers or heads of their own departments. In fact, all managers, irrespective of their departments, perform these functions.

Operative Functions:The operative functions, on the other hand, are specialized activities performed exclusively by

the HR managers, usually for all the departments. We shall first discuss the managerial functions.Functions of HRM Mathis (2006) states that the organization should use human resource

management input in the following organizational functions:

i. Establishment of a legal and ethical management systemii. Job analysis and job designiii. Recruitment and selection



iv. Health-care career opportunitiesv. Distribution of employee benefitsvi. Employee motivationvii. Negotiations with organized laborviii. Employee terminationsix. Determination of emerging and future trends in health carex. Strategic planning

While, Mc Kinnies (2012) concluded that HRM comprises five broad functions, which are:

i. Resourcing: Activities include HR planning, talent management, succession planning and ending the employment contract (including managing retirement and redundancy).

ii. Performance: Managing individual and team performance and the contribution of workers to the achievement of organizational goals, for example, through goal-setting and appraisals.

iii. Reward system: Designing and implementing reward systems covering individual and collective, financial and non-financial rewards, including pay structures, perks and pensions.

iv. Learning and Development: Identifying individual, team and organizational development requirements and designing, implementing and evaluating training and development interventions.

v. Employment relations: Managing employees, communication, handling union management relations, managing employee welfare and handling employee grievance and discipline.

Defining Human Resources in Health CareWithin many health care systems worldwide, increased attention is being focused on human

resources management (HRM). Specifically, human resources are one of three principle health system inputs, with the other two major inputs being physical capital and consumables. Figure depicts the relationship between health system inputs, budget elements and expenditure categories. Relationship between health system inputs, budget elements and expenditure categories.

Figure identifies three principal health system inputs:

Human Resources (All personnel related to the Health care organizations) Physical Resources (All required physical resources including the technological equipments) Consumables (Including drugs & disposable equipments)

It also shows the financial resources to purchase those inputs are of both a capital investment and a recurrent character. As in other industries, investment decision in health are critical because they are generally irreversible, they comment large amount of money to places and activities that are difficult, and impossible, to cancel, close or scale down.

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.



Source: World Health Report 2000 Figure 4.1 pg.75.

As well as the balance between the human and physical resources (technology), it is also essential to maintain an appropriate mix between the different types of health promoters and caregivers to ensure the system's success. Due to their obvious and important differences, it is imperative that human capital is handled and managed very differently from physical capital. Both the number and cost of health care consumables (drugs, prostheses and disposable equipment) are rising astronomically, which in turn can drastically increase the costs of health care. In publicly-funded systems, expenditures in this area can affect the ability to hire and sustain effective practitioners. In both government-funded and employer-paid systems, HRM practices must be developed in order to find the appropriate balance of workforce supply and the ability of those practitioners to practice effectively and efficiently. A practitioner without adequate tools is as inefficient as having the tools without the practitioner.

Key Issues Pertaining to Human Resources in Health Care

When examining health care systems, many general human resources issues and as well as

questions have been arisen. Some of the issues include the size, composition and distribution of the health care workforce, workforce training issues, the migration of health workers, and the level of



economic development in a particular country and socio-demographic, geographical and cultural factors.

The variation of size, distribution and composition within a county's health care workforce is of great concern. For example, the number of health workers available in a country is a key indicator of that country's capacity to provide delivery and interventions. Factors to consider when determining the demand for health services in a particular country include cultural characteristics, socio-demographic characteristics and economic factors. Workforce training is another important issue. It is essential that human resources personnel consider the composition of the health workforce in terms of both skill categories and training levels. New options for the education and in-service training of health care workers are required to ensure that the workforce is aware of and prepared to meet a particular country's present and future needs. A properly trained and competent workforce is essential to any successful health care system.

The migration of health care workers is an issue that arises when examining health care systems. Research suggests that the movement of health care professionals closely follows the migration pattern of all professionals in that the internal movement of the workforce to urban areas is common to all countries. Workforce mobility can create additional imbalances that require better workforce planning, attention to issues of pay and other rewards and improved overall management of the workforce. In addition to salary incentives, developing countries use other strategies such as housing, infrastructure and opportunities for job rotation to recruit and retain health professionals, since many health workers in developing countries are underpaid, poorly motivated and very dissatisfied. The migration of health workers is an important human resources issue that must be carefully measured and monitored.

Another issue that arises when examining global health care systems is a country's level of economic development. There is evidence of a significant positive correlation between the level of economic development in a country and its number of human resources for health. Countries with higher gross domestic product (GDP) per capita spend more on health care than countries with lower GDP and they tend to have larger health workforces. This is an important factor to consider when examining and attempting implementing solutions to problems in health care systems in developing countries.

Socio-demographic elements such as age distribution of the population also play a key role in a health care system. An aging population leads to an increase in demand for health services and health personnel. An aging population within the health care system itself also has important implications: additional training of younger workers will be required to fill the positions of the large number of health care workers that will be retiring.

It is also essential that cultural and geographical factors be considered when examining global health care systems. Geographical factors such as climate or topography influence the ability to deliver health services; the cultural and political values of a particular nation can also affect the demand and supply of human resources for health. The above are just some of the many issues that must be addressed when examining health care system and human resource.

How Does Human Resource Management Affect the Success of Health Care Organizations?

Proactive HR management is critical to a health care enterprise's success:Health care organizations have an immediate and direct impact on their patients’ quality of life.

The human resources function plays a critical role in how the organization functions and how well its



patients are served. In addition, whether a facility is for profit or not for profit or governmental owned, a good proactive HR department can have a significant positive impact on resource allocation issues.

Employment Actions:The job of recruiting, selecting, and terminating employees is a core responsibility of any HR

department. The face-to-face interview is a standard component of the selection process, and the nature of the work in health care facilities often dictates that additional testing be performed to assess candidates’ competency and integrity. This process must be fair and objective to assure the best results and shield the organization from legal repercussions. Good HR practices, especially clear communication of the organization’s expectations, can reduce the need for disciplinary terminations.

Compensation and Benefits:Costs in the health care industry continue to rise, in large part because of the cost of durable

goods, medications, and compliance issues, but also because of compensation. Developing an equitable compensation program that is competitive with other providers is a constant challenge. Employee benefits represent a key component of compensation, and many organizations offer benefits that are relatively low-cost but serve as a valuable recruitment or retention tool.

Development and Training:HR management includes providing employees with ongoing training to keep pace with ever-

evolving legal, regulatory and technological landscapes, as well as to improve the quality of patient care and achieve cost-cutting goals. While ongoing training helps to meet organizational objectives, it also is a significant factor in employee motivation and morale.

Succession Planning:Clearly defined plans to deal with vacancies in key positions help avoid financial losses and

other problems associated with a lack of leadership, as well as the potential for a domino effect if other top leaders following suit. While succession management is generally the responsibility of boards of directors, it’s often preferable for HR to develop and maintain succession plans and let boards review and sign off on them.Knowledge and Training of HR Managers:

In addition to a high degree of competence in human resource management, a health care organization's HR manager should be thoroughly grounded in the federal and state (provincial) laws that affect the industry. The nature of health care is so different from most other enterprises in terms of products and services that HR staff members ideally should have experience in other areas, including marketing, finance and accounting, and health care service operations. Such cross-functional experience enhances credibility and gives the department a much broader perspective in the development of policy and consultation with colleagues.

Ethics:Ethics is a complex issue in the health care field, and it falls to HR to ensure that the

organization has a code of ethics that is well-understood by all staff members. The code of ethics should include a clear anti-bullying policy. In those organizations that also perform research, a function of HR management is to establish institutional review board training in ethics guidelines.



Employee Morale:Morale can be a major factor in how employees perform their duties, and this in turn has a

significant impact on patients’ lives. A quality work environment, which includes worker-oriented initiatives like training and career development programs, work-life balance, transparent management, and employee empowerment programs, provides employees a strong incentive to perform well.

Unions / Employees Associations:When health care professionals form unions / associations, they often do so for reasons other

than pay. Nurses have formed unions / associations at numerous facilities due to concerns that cutbacks would have an adverse impact on patient care. Although the specific issues have been addressed, the unions / associations remain intact. HR management at a non-union health care facility must identify the issues of greatest concern to union-eligible staff and address them pro actively to forestall union organizing efforts.

What is Performance?Just what is performance anyway? By clearly understanding this, your life as a manager will be

so much easier. “Performance is simply the production of valid results.” There may be many other answers to this question, but it all boils down to: can the employee produce the results expected of them? It can recognize this via certain key performance indicators.

Organizations try to manage the performance of each employee, team and process and even of the organization itself. We're used to thinking of ongoing performance management for employees, for example, setting goals, monitoring an employee's achievement of those goals, sharing feedback with the employee, evaluating the employee's performance, rewarding the employee's performance or firing the employee. However, performance management applies to teams and organizations, as well.

Organizational performance involves the recurring activities to establish organizational goals, monitor progress toward the goals, and make adjustments to achieve those goals more effectively and efficiently. Those recurring activities are much of what leaders and managers inherently do in their organizations -- some of them do it far better than others.

HRM and Organizational Performance:One of the main goals of Human Resource Management (HRM) is to increase the performance

of organizations. Pfeffer emphasized the importance of gaining competitive advantage through employees and noted the importance of several Human Resource (HR) practices necessary to obtain this advantage. Huselid stressed the use of an integrated and coherent ‘bundle’ of mutually reinforcing HR practices over separate ones. Notwithstanding the substantial volume of research on the link between HRM and performance, the exact nature of this relationship within the health care sector remains unclear. This can be considered problematic, as studying HRM in the health care sector and its effect on performance has both practical and academic relevance.

However, performance is not a concept that can be easily defined and conceptualized. According to Guest, it is better to use the concept of ‘outcomes’ instead of performance. One can then distinguish three different outcomes:

1) Financial outcomes (profits, net margin, market share),2) Organizational outcomes (productivity, quality, efficiency, client satisfaction) and 3) HR outcomes (employees’ attitudes and behavior).



Dyer and Reeves noted that HR and organizational outcomes are more proximal outcomes, for example, closely linked to the HR practices adopted by an organization, whereas financial outcomes are more distant, as they are less likely to be directly affected by HR practices. Moreover, specific HR outcomes are often used as intermediate outcomes that bridge the ‘black box’ between HR practices and financial or organizational outcomes.

This multidimensional perspective of outcomes seems especially relevant for health care organizations, as financial outcomes are certainly not the only or even primary objective. Notwithstanding the large amount of research on HRM in health care, few studies have explicitly addressed the multidimensional character of performance and linked HR practices to various outcome dimensions. In this article, we therefore add to the literature by examining several outcome dimensions of health care organizations. To analyze this we will address is as follows:

To what extent are HR practices in health care organizations related to multiple outcome dimensions?

HRM and outcomes:Studying the relationship between HRM and performance outcomes is an important theme. In

an overview article, Boselie et al. identified the main research issues within the field. These primarily concern the conceptualization and measurement of the central concepts and several theoretical issues about their relationship. These issues remain important in the contemporary debate. The concept of performance has been discussed above. HRM is commonly defined as a set of employee management activities, but there is no consensus regarding which HR practices should be included in a ‘comprehensive HRM checklist’. Even more important is the question as to whether one should examine discrete HR practices or employ a systematic HRM approach. According to the systems approach, one should regard interrelated HR practices that affect performance as a ‘synergistic whole’. In this study we follow the systems approach, as this was proven valuable in earlier studies.

In addition to conceptualization, there are also important measurement issues concerning HRM. Does one measure HR policies at the company level (for instance by asking HR managers) or at the individual level (practices as experienced by employees)? Nishii and Wright refined this issue by distinguishing among intended, actual and perceived HRM. The notion behind this is that there may be differences within organizations among the HR policy designed by the HR department (intended HRM), the HR practices implemented by line managers (actual HRM) and the perceptions of employees (perceived HRM). We focus on perceived HRM, following the Thomas Theorem: if men define situations as real, they are real in their consequences. Thus, if employees believe that specific HR practices are employed in the organization, they will act according to that belief.

An important theoretical issue that has dominated the field in the last decade concerns the precise nature of the mechanism linking HRM and performance outcomes. This issue is called the ‘black box’, i.e., the mediating link between HRM and performance. In recent years, many suggestions have been made regarding the nature of this ‘black box’, but most scholars emphasize the perceptions and experiences of employees as the main linking mechanism. HR practices forge a psychological contract between employer and employee that in turn affects these perceptions and experiences. In this article, job satisfaction is used as a mediating variable linking HRM to various outcomes.

In the last two decades, several studies on HRM and performance have been conducted in the health care sector. In their review of health care studies, Harris et al concluded that HR practices are



often related to patient oriented performance outcomes. They also noted the importance of conducting additional research on the ‘black box’ issue. Furthermore, many health care studies relate HRM to organizational and HR related outcomes. However, studies focusing on financial outcomes - which have been extensively addressed in the private sector HRM literature - seem rather scarce.

Its contribution concerns two elements discussed in the literature. First, we apply a multidimensional performance perspective, and we will therefore consider three outcome dimensions: financial, organizational and HR. This is innovative because although many health care studies have analyzed care - an organizational outcome - and HR outcomes, financial indicators have received much less attention. Moreover, we are unaware of health care sector studies that have examined the relationship between HRM and these three outcome dimensions simultaneously. The second contribution concerns the ‘black box’ issue. Many studies use employee attitudes as an outcome variable. However, an important interpretation of the ‘black box’ implies that employee attitudes will mediate the link between HRM and performance. Using job satisfaction as indicator of employee attitudes.

Financial outcome:The net margin is defined as the ratio of a firm’s net profits to its total revenues. It indicates

what share of income earned is translated into profit. It is stated as a percentage: Net Margin = Net Profit / Total Revenues * 100

Organizational outcome:The organizational outcome is measured by focusing on client satisfaction. Clients can be asked

about their satisfaction with the treatment they received.

HR outcome:The HR outcome measure considered is absence due to sickness. Absence due to sickness can

be considered a key HR outcome as the decision of employees to be absent affects the available human resources and is a critical success factor for the continuation of work processes within the organization. For example, absenteeism due to sickness is calculated in percentages, using a standard formula developed by Vernet. In brief: for every employee, each day he/she calls in sick is multiplied by the part-time factor and disability factor pertaining to that day. These days are then summed and divided by the total number of working days. Maternity leave is excluded. This is calculated for the organization as a whole.

Another view to analyze the HR outcomes is the to evaluate the patient's feedback and complains regarding the services rendered by the employees of the hospital.

LITERATURE REVIEW REGARDING PERFORMANCE MEASUREMENT IN HEALTH CARE Health care organizations should be able to quickly improve their performance measurement systems by following some simple rules.

The changing nature of today's health care organizations, including pressure to reduce costs, improve the quality of care and meet stringent guidelines, has forced health care professionals to re-examine how they evaluate their performance. While many health care organizations have long recognized the need to look beyond financial measures when evaluating their performance, many still struggle with what measures to select and how to use the results of those measures. Because a growing number of health care professionals have readily adopted quality concepts, health care organizations



should be able to quickly improve their performance measurement systems by following a few simple rules. (Kicab Castaeda-Mndez)

History:A brief look at the evolution of quality in modern health care systems may help understand the

need to improve performance measurement. More than 30 years ago, a physician named Avedis Donabedian proposed a model for assessing

health care quality based on structures, processes and outcomes. He defined structure as the environment in which health care is provided, process as the method by which health care is provided, and outcome as the consequence of the health care provided. As a result, process management is limited, and often temporary, when the structure isn't also improved.

Two decades later health care adopted continuous quality improvement, which uses teams to improve processes. According to Donabedian's model, processes are constrained by the structures in which they operate. To date, few health care organizations have addressed these structures because health care senior managers have replicated the behavior of most industrial senior managers by focusing on the process level.

The popularity of Robert S. Kaplan and David P. Norton's balanced scorecard method--popularized in their book The Balanced Scorecard (1996, Harvard Business School Press)--expanded health care organization measures beyond financial analysis. They led to the development of measures in four or more areas, including patient/customer, financial, internal operations and clinical. However, in creating a balanced scorecard, many organizations failed to do the critical, difficult part: develop a cause-and-effect relationship among these measures. Consequently, health care organizations typically generate lists of strategies and goals as if they are independent of each other.

An additional impetus for health care organizations to adopt quality principles has been the Joint Commission on Accreditation of Health-care Organizations' standards. While the JCAHO standards have evolved during the past decade, swayed in part by the Baldrige criteria, health care organizations have been slow to use this organizational assessment as a way to drive performance improvement.

The demand from JCAHO for performance improvement drove many health care organizations to learn as much as possible about continuous quality improvement. They began implementing ideas such as: teams and facilitators with training on conflict resolution; problem solving with use of statistical tools and standardized problem-solving procedures; data collection, including patient, physician and employee satisfaction surveys; process management using clinical algorithms and practice guidelines with training on pathway development; and planning using balanced scorecards and performance measurements. With continuous quality improvement often delegated to levels below senior management, organizations struggled to integrate and justify their many initiatives.

Selecting the right measures:An effective measurement system integrates initiatives, aligns organizational units and

resources, and improves performance.Paradoxically, most people select measures before they decide how to use them. While it makes

sense to discuss selection and use of measures in that order, the effective order in practice is the reverse.

Organizations need performance measures in three areas:



To lead the entire organization in a particular direction. To manage the resources needed to travel in this direction. To operate the processes that makes the organization work.

Most organizations typically don't use leadership measures. However, many health care organizations have struggled to move beyond their heavy emphasis on financial measures to include leadership measures. With continuous quality improvement entrenched at the process level, these same organizations struggle to better manage their resources because they don't consider the effects of structures. Without an integration of clinical and financial measures, the same organizations will find it nearly impossible to effectively operate the processes they are so keen on improving.

To overcome these barriers, organizations need measures for three purposes:

Strategic--to drive strategies into action and change the organizational cultureDiagnostic--to evaluate the effectiveness of these actions and the extent of changeOperational--to improve continuously

Senior managers are responsible for ensuring that measures exist for these three purposes at the organizational level. These measures can be placed in a cycle to reveal the three phases that organizations with excellent performance go through (see Figure).

Unlike the usual approach to quality management, the strategic plan must direct teams focused on processes. That plan must have goals with clear measures. Then systems (structural elements run by senior management) and processes can be managed operationally according to continuous improvement principles. Finally, results from system and process measures are used to diagnose the effectiveness of the strategic plan's actions.

A strategic plan defines the specific cause-and-effect relationship through strategic measures. Performance improvement is accomplished by using measures of processes and outcomes to operate the processes.

Cause-and-effect relationships:By understanding how measurements will be used, it becomes easier to understand what

measures to have. Measures are needed to test various cause-and-effect relationships at the organizational, process and individual level. By their very existence, organizations create the basis for



interdependency among themselves (and partners) and their customers and employees (see Figure).

This interdependency weakens when one or more parties do not receive value or perceive the value as

insufficient. Organizations can strengthen this interdependency by integrating and aligning structures, processes, results, quality and costs. Strengthening the interdependency requires measuring the value each party needs.

Thus, health care organizations need to implement measures of business, patient and employee value. While many do, these measures typically are not developed in a way that shows this interdependency. They are not selected to show that a cause-and-effect relationship exists among the three types of values.

During the universal fee-for-service period, hospitals and health care professionals didn't need to worry about costs--as evidenced by the number of providers who until recently had charge and no-cost accounting systems. With the combination of managed care penetration and public ire about health care costs, health care organizations began focusing on costs and patient satisfaction. They now need to add employee satisfaction and value to finish the value-added picture.

The second cause-and-effect relationship organizations must test is their strategic plan. Kaplan and Norton define a strategy as a hypothesis about a cause-and- effect relationship. Therefore, a health care strategy postulates how (cause) a specific level of clinical quality (effect) will be achieved. The how must be explained by the specific level of organizational operations' effectiveness and efficiency. Organizational operations include information systems, process management, human resource management and the leadership system. These, too, must be arranged in a cause-and-effect relationship. Each component of the strategic cause-and-effect relationship requires effectiveness and efficiency measures.

The third critical cause-and-effect relationship is at the process level and explains how processes affect specific outcomes. When managing (maintaining and improving performance) and operating systems and processes, managers should continually increase their understanding of how processes affect outcomes. That understanding comes from establishing relationships between process measures and outcome measures. Too often, process improvement teams fail to establish that relationship because they focus only on process measures or only on outcome measures. Their resulting control system then becomes a barrier to effective continuous improvement. The organization has direct control over the process measures and can more easily collect data on these measures. Data on outcome



measures is often more difficult and more costly to collect. Understanding the relationship between the two measures helps reduce data-collection costs.

The three critical types of systems and process measures are quality, time and cost. Here again, there is a cause-and-effect relationship that supports an interdependency. The common perspective is that time; quality and cost are opposing forces. For example, a customer who wants a product or service sooner is often told by the supplier that it will cost more and that quality is not assured. However, by defining time as cycle time to complete a process and quality as defect-free, these forces will support each other. Reducing cycle time increases the amount of data on a process and creates more opportunities for a fixed period to improve quality.

Practical rules:While health care professionals, especially physicians, tend to shy away from leading and

managing organizations as businesses, their scientific background gives them one advantage in developing measures and analyzing the results. The approach described here is based on scientific principles of generating hypotheses about cause-and-effect relationships and testing those hypotheses.

The leadership part focuses on developing the measures for all three critical cause-and-effect relationships and analyzing the results. The management part focuses on deciding what action to take based on the analysis and then allocating resources to carry out those actions.

Three actions to effectively lead are:

Develop measures to build the value-added interdependency Manage activities, time and quality to strengthen this interdependency Analyze performance to determine the effectiveness of those measures and

management

At the strategic level, the first two cause-and-effect relationships are combined.

Rule 1: Have your strategic cause-and-effect relationship explain how all three types of value will be

increased.Your top-level measures are the three types of value. After developing the strategies, develop

specific action plans, allocate resources and communicate the plan. When you are done, you should be able to answer the following questions:

Are strategies operationally defined? Are the causal relationships among the strategies clear? Will all constituents receive strategic value? Does everyone know what the strategic direction is and remain committed to it? Does each person know how he or she can contribute to the organization's success?

Rule 2:Measure time, quality and cost at the process level. Time and cost are relatively easy to define

and measure. The key to defining quality measures is in knowing the purpose of process steps and the outcome. Defining these purposes operationally yields quality measures.

Rule 3:



Develop information systems after deciding on the measures. Because few people have the luxury or inclination to develop information systems after having defined measures, they should always have information systems that are flexible enough to include any measures developed later.

Rule 4:Analyze results to test the three critical cause-effect relationships. The distinguishing feature of

excellent organizations is their analysis. They don't necessarily have greater ability; they are just committed to analyzing the data to see what works and what doesn't. Then they take action.

Health-Care Key Performance Indicators (KPI) and MetricsFollowing standards or indicators can be use to determine the performance or efficiency of the

health-care providing organizations / industries. These indicators and the prescribed standards are helpful to gauge the overall performance of the organization after implementing a reform program before introducing a reform program in any health-care providing organization.

Time to Health-Care Service:The time to health service key performance indicator (KPI) measures health-care providing

organization's ability to provide incoming patients with health care service in a timely manner. Prescribed standards to the different health-care services are as under:

Arrival to Physician Target 60 minutes Arrival to Bed Target 20 minutes Arrival to Nurse Target 40 minutes Arrival to Discharge Target 100 minutes

Lab Turnaround Time:The lab turnaround time key performance indicators (KPI) measures the ability of the Lab to

process lab required results. Prescribed standards of lab turnaround time for different tests are as under:

Lab Test Turn Around Target Time Amylase 24 hrs. ANA 168 hrs a PTT 72 hrs. Basic Metabolic Panel 24 hrs. Complete Blood Count 24 hrs. Electrotype panel 24 hrs. Comprehensive Metabolic Panel 48 hrs. Sedimentation Rate 96 hrs.

Emergency Response(ER) Waiting Time:Measure the amount of time patients are currently waiting before being seen by a physician in

emergency response. The prescribed standards for emergency response are as under:

ER Urgent Stable Wait Time 01:50 02:30



Number of Patients in ER:Provides key data about patients in the ER such as room number, urgency of their case, current

wait time and if they have been attended to by a nurse.

Current ER Occupancy:Measures how many are currently occupied in your ER compared to the total number of beds.

Average Length of Safety:Measures how long on average, patients stay in your hospital after having a specific procedure,

such as appendectomy. The prescribed standard for the average length of stay:

Length of stay-------Average 14 days or less

Other KPIs for Health-Care Providing Organizations:

Inpatient Flow: In patient raw mortality rate. CMS core Measure Harm events per 1000 patients days Bed turnover Readmission Rate Occupancy Rate Average Cost Per discharge Patient Satisfaction

Revenue Cycle: Total Operating Margin Account Receivable (A/R) days due to outstanding Total Accounts Receivable (A/R) days outstanding Total Accounts Payable (A/P) days outstanding Cash receipt to bed debt Claims Denial Rate Days of Cash on Hand

What is Quality?The term quality refers to the attainment of the customer needs in an effective and efficient

manner. Because if a good or service is unable to meet customers perceived value, it will be considered low quality goods or services irrespective of its worth.

What is Quality Human Resource?The term quality human resource refers to the human resource with ability to meet or exceed

customer requirements. The quality human resource is considered highly motivated, trained and highly



skilled in their respective areas and they have ability to translate organization's vision in to reality with other available resources.

In health-care organizations the patient satisfaction is not only depends upon the technology but also upon the human resource (employees) capability.

LITERATURE REVIEW & ANALYSIS REGARDING THE NEW TECHNOLOGICAL IMPACT ON HUAMAN RESOURCE PERFORMANCE RELATED TO HEALTHCARE PROVIDNG INDUSTIRES / ORGANIZATIONS

The impact of human resources on health-Care Providing OrganizationsWhen examining health care systems, it is both useful and important to explore the impact of

human resources on health sector reform taken by any country or an health -care providing organization. While the specific health care reform process varies by country to country and organization to organization, some trends can be identified. Three of the main trends include efficiency, equity and quality objectives.

Various human resources initiatives have been employed in an attempt to increase efficiency. Outsourcing of services has been used to convert fixed labor expenditures into variable costs as a means of improving efficiency. Contracting-out, performance contracts and internal contracting are also examples of measures employed.

Many human resources initiatives for health reform also include attempts to increase equity or fairness. Strategies aimed at promoting equity in relation to needs require more systematic planning of health services. Some of these strategies include the introduction of financial protection mechanisms, the targeting of specific needs and groups, and re-deployment services. One of the goals of human resource professionals must be to use these and other measures to increase equity in their organizations.

Human resources in health sector reform also seek to improve the quality of services and patients' satisfaction. Health care quality is generally defined in two ways:

1. Technical quality: Technical quality refers to the impact that the health services available can have on the health

conditions of a population.

2. Socio-cultural quality: Socio-cultural quality measures the degree of acceptability of services and the ability to satisfy

patients' expectations.

Human resource professionals face many obstacles in their attempt to deliver high-quality health care to the patients. Some of these constraints include budgets, lack of congruence between different stakeholders' values, absenteeism rates, high rates of turnover and low morale of health personnel.

Better use of the spectrum of health care providers and better coordination of patient services through interdisciplinary teamwork have been recommended as part of health sector reform. Since all health care is ultimately delivered by people, effective human resources management will play a vital role in the success of health -care providing organizations.

Staff Management



The two key areas that mangers have to be concerned with in their job roles are managing their staff and managing the machines and technology with which those staff have to work or perform their duties effectively and efficiently. How organizations and their managers can, and should, relate to these two main areas of their work has been the concern of Robert Blake and Jane Mouton in their work on The Managerial Grid (Blake R.R. And Mouton J.S.-1985 The Managerial Grid III. Hogan Page.). This is the device for representing the concern for production and for people shown by different mangers with a 1-9 scale being used to represent the degree of concern, 9 representing the high concern. The major points on the Grid and their meaning are shown in Figure below.

9 1,9 9,9

5,5Concern for People

1 1,1 9,1

1 9

Concern for productionPosition 9,1:

Efficiency in operations results from arranging conditions do work in such a way that in such a way that human elements interfere to a minimum degree, by being concerned with acquiring the latest and most efficient technology which itself strictly controls the human input into the work process. This approach may well lead to staff (Blake R.R. and Mouton J.S.-1985 The Managerial Grid III. Hogan Page.) frustration and demotivation through a lack of job satisfaction in feeling themselves to be essentially machine feeders and machine minders.

Position 1,9:This is the opposite approach where the thoughtful attention of the manager to the needs of this

staff for satisfying relationships leads to a comfortable, friendly organization atmosphere and working tempo, but whilst job sanctification and morale may be high, production may well not be as efficient as it could and should be. The danger is that more ruthless employers and managers of the 9,1 type will produce the same work at quicker rate and lower cost and that the pleasant, cushioned surroundings created by the 1,9 manger will only be short-term before bankruptcy and redundancy take place.

Position 1,1:This is the least satisfactory approach of all, where the manger puts in the least effort possible,

both with regard to his staff and production equipment in order to get the required work done and to sustain organization membership. The aim is purely to keep things ticking over to survive—a minimalist approach. In this situation, both the morale of the staff and the output of work are likely to be low and inefficient, leading to the twin problems of low motivation and uncompetitive production.

Position 5,5:



This is where an adequate level of performance is achieved through balancing the necessary to get the work out at a level of speed and efficiency which is competitive enough to provide an adequate level of the staff at a satisfactory level. It could be argued that this is the 'satisficing' level suggested by Herbert Simon.

Position 9,9:This is the optimum management approach, where work output and accomplishment is

achieved through committed, highly-motivated staffs that agree with, and believe in, the equal commitment to using the most efficient and productive as possible. The management's attitude to the staff is that they are as important in the production process as the latest technology they work efficiently with, and this also creates an interdependence between management and staff through their feeling of having a 'common stake' in the purpose, objectives and method of the organization, which leads to relationships of trust and respect.

It may be that some readers, particularly those who have always been employed to the Health Services, will even now shuddering at the mention of 'profit' in a research related to the health care management. Blake and Mouton are mainly concerned with profit-oriented commercial organizations. However, the current emphasis on privatization and the increasing use of performance indicators, should leave nobody, in any doubt that even a relatively low-key interpretation of the word “profit', as the most effective and efficient use of staff time and equipment to give them most cost-effective return. Although the Managerial Grid could be criticized as being somewhat simplistic, it could be argued that the gamut of specialist management books published each year could do with more means of illustrating the balance in outlook and concern that each manger has to have between concern for his staff and concern for high-powered, efficient technology.

The Management of Change New TechnologyCurrent technological advancement in the health services bears eloquent testimony to the fact of

organizational change. Not all change has been perceived as unequivocally good. However, where there is a net gain, the organization must learn to absorb the costs. For some workers change can be a painful process and involve jobless and redundancy. In other cases, life-time perceptions of working norms and practices may appear to be discounted, leaving workers emotionally stranded as their careers, together with their knowledge and skills, appear to founder on the rising tide of uncertainty.

For some this aspect of change provides an undoubted stimulus and challenge, particularly if changes are perceived as incremental and an expected and natural component of professional and career development. If training is also available, this is likely to facilitate change, but the degree of resistance may well depend upon the worker's perception of his new role and its status, given that salary is unaffected. More rapid change , as might occur with the privatization of a part of the health care services or the rapid introduction of new technology may give less time for personal adjustment and increase feelings of alienation at work (Blauner R.-1964 Alienation and Freedom—the) Factory Worker and His Industry, III Chicago, University of Chicago Press). Although Blauner's work on alienation specifically refers to factory employees, we believe his concepts are transferable to other large organizations. We therefore use this term in his work-related sense and not in the more general sense employed by Marx (Mc Lellan D-1970 Marx before Marxism. Harmondsworth, Penguin).

Organizations may be either reactive or proactive that is, planning to activate desired change rather than merely reacting to environmental impositions or client demands. This health care service



received much criticism for its reactive approach in responding to demand rather to evaluated need (Cooper M.H.-1974 Rationing Health Care, London Croom Helm) and more recently this reactivity has been identified with the lack of a general management process.

As we have seen corporate planning in health care involves the identification of need, planning how to meet that need and mobilizing the entire organization to carry out those plans in a concerted and organized way. This cannot be achieved in a static and insensitive organization whose members place a premium on stability or a high value on 'nostalgia' (clinging to old ways) at the expense of improved patient welfare.,

The Impact Of Technology:The development of technology and its applications in health care has brought enormous

benefits to both patients and the organizations which serves them. Among many examples are the developments of the medical application of ultrasonic, the pacemaker, the heart lung machine, nuclear medicine, radiology, radiotherapy, computerized scanners, and laboratory analyzers. The development of the fibre optics has allowed a new approach to the investigation and treatment of many quite different clinical conditions with fewer 'postoperative' consequences and at a lower marginal cost than the corresponding surgery.

Some of these are clinical, high profile examples of high technology appreciations and health workers can no doubt identify many more less dramatic bit no less significant contributions to the business of diagnosis and treatment. In terms of output modern technology allows us to investigate and treat substantially larger numbers of patients today as compare to past.

However, in some quarters the arrival of high technology is not always well received. In fact, it may be feared by some workers whose working practices, skills and indeed, very employment may be threatened by its introduction. It is clear that technology itself is not to blame for this but rather the way it is employed within the organization. It is no solution to argue that providing redundancies are avoided there is little ground for objections to new technology. This would be to deny the intrinsic value and function of work and the social significance it gives to both individuals and groups a point overlooked by F.W. Taylor, the father of Scientific Management (Taylor F.W.-1947 Scientific Management, London, Harper & Row). This is in essence, forms the basis of the critique of Taylor's theories by Trist (Trist E.-1976 Critique of Scientific Management in terms of Socio-Technical Theory) ) who, with various co-workers from the Tavistock Institute, introduced the concept if Socio technical Systems. These two systems organizational change that are of immediate concern, namely the social consequences at work of change, deskilling and redundancy. We start by considering the influence of Taylor, recognizing that his theories are widely diffused and now form part of the culture of mangerialism--the manger's right to manage—which by its unqualified stance alone has done, and continues to do, much to inhibit goodwill and mutual respect between all sections of industry.

What is Scientific Management?Scientific management is based on the work of the US engineer Frederick Winslow Taylor

(1856-1915) who in his book The Principles of Scientific Management (1911) laid down the fundamental principles of large-scale manufacturing through assembly-line factories. It emphasizes rationalization and standardization of work through division of labor, time and motion studies, work measurement, and piece-rate wages.

Scientific Management, also called Taylorism is a theory of management that analyzes and synthesizes work flows. Its main objective is improving economic efficiency, especially labour



productivity. It was one of the earliest attempts to apply science to the engineering of processes and to management.

Applications: Scientific management theory is important because its approach to management is found in

almost every industrial business operation across the world. Its influence is also felt in general business practices such planning, process design, quality control, cost accounting, and ergonomics. Your knowledge of the theory will give you a better understanding of industrial management. You'll also understand how a manager can use quantitative analysis, an examination of numbers and other measurable data, in management to improve the efficiency and effectiveness of business operations.

Theorists: The founding father of scientific management theory is Frederick W. Taylor (1856-1915). He

was an American inventor and engineer. His two most important works were Shop Management (1903) and The Principles of Scientific Management (1911).

The husband and wife team of Frank Gilbreth, Sr. and Lillian Moller Gilbreth contributed to the theory. This duo continued the practice of time and motion studies started by Taylor, believing they could find the best way to perform each task studied.

Definition, Principles & Contributions: Scientific management theory seeks to improve an organization's efficiency by systematically

improving the efficiency of task completion by utilizing scientific, engineering, and mathematical analysis. The goal is to reduce waste, increase the process and methods of production, and create a just distribution of goods. This goal serves the common interests of employers, employees, and society.

Scientific management theory can be summarized by Taylor's Four Principles:

1. Managers should gather information, analyze it, and reduce it to rules, laws, or mathematical formulas.

2. Managers should scientifically select and train workers. 3. Managers should ensure that the techniques developed by science are used by the

workers.

Managers should apply the work equally between workers and themselves, where managers apply scientific management theories to planning and the workers perform the tasks pursuant to the plans. Briefly, Taylor observed that manual workers were 'inefficient', that is, they worked below maximum output because their mangers either managed by guesswork of assumed that the workers knew best how to carry out manual procedures and so left matters to them. Taylor set to work to analyze and measure in detail every movement that formed a part of each manual operation.,

According to Taylor, defining a 'fair day's work' was a purely technical matter, being prescribed by production engineers after work study and was therefore not a matter of opinion but science. It is sufficient to say that Taylor applied his 'scientific' principles to every aspect of work and established a major, influential and continuing 'school' of management theory. Taylor's motives were profit-oriented and he sought to reward his workers who wholly complied with his instructions with handsome bonuses directly linked to productivity. In this, however, he was largely frustrated as the



company owners could not accept that any manual worker could be given the opportunity for unlimited earnings even though linked to individual productivity. In later years Taylor was to express regret since, in his attempt to alter the layout of the plant and to change the traditional way of things he was not very popular.

The Socio technical Systems ConceptTaylor published accounts of his work in the early 1900s at about the same time as

mechanization was being introduced in the industries. This also involves heavily prescribing individual working methods and practices in order to accommodate the new machinery which promised to increase the productivity of every seam in which it was used. Small working groups, often family based, were required to split up and join large shift of men. Job functions were divided between shifts so that each man and each shift was responsible for only one function and therefore whole process was dependent upon each shift completing its allocated function on time.

Trist and Bamforth (an-examiner) (Trist E. and Bamforth K. -1951 Some Social and Psychological Consequences of the Longwall Method of coal-getting, Human Relations) identified that in the introduction of new technology important social considerations had been totally ignored. They realized that coal mining with its inherent danger and discomfort was essentially a group activity with a high degree of interdependence both within and between groups. Group maintenance, therefore, is an important factor in not only productivity but in the associated problems of absenteeism, sickness, accident rates, disagreements and stoppages. When, in 1951, a mine manager in the East Midlands Division V. W. Sheppard, initiated a composite arrangement for each shift which restores group autonomy, productivity and job satisfaction rose: absenteeism and labour turnover fell and health records improved. (Trist E. Op. Cit., P.84)

The essence of this experiment may be viewed as joint optimization of both the requirements of the technology and those of the work group in which the group had a certain degree of autonomy. The results of similar factory-based experiments in India Scandinavia support this statement. In keeping with Taylor, however, the pecuniary reward system appears to be a significant ingredient as,in all these experiments, participating workers able to earn an increase in pay.

If there any lesson to be learned from the Socio-technical Systems concept, perhaps to be transferred to areas of merging technical innovation, they were widely ignored. In 1973, Enid Mumford could assert that:

“Work systems are usually designed in technical terms to meet technical and business objectives, with little thought

given to the needs of people operating the system.” (Mumford E. -1973, Designing Systems for Job Satisfaction. Omega I, (4), 493-8.)

It might be argued that, because this work was related to the introduction of technology into the manual production industries, the experimental evidence is irrelevant in science-based industries, including some aspects of health care. Trist disagrees. He believes that the requirement for manual dexterity is decreasing in these activities, changing the role of the worker from a doer of the work to a user and manger of the technical tools he has acquired. This is a general trend and will apply equally wherever technology displaces manual work of any kind. Hence the prescribed element of work is reduced since it is contained within the machine, whereas the discretionary part is increased the worker monitoring performance and intervening where necessary. (Trist E., op. Cit., P.88).



Trist has stated that the reason for the workers presence:

“......is to assess the performance of the programme and, if necessary, to change it either himself of in conjunction with others at higher levels. No longer is there 'a split at the bottom of the bottom of the executive chain' which separates mangers and managed. Everyone is now on the same side of the 'great divide' and whatever fences there may still be on the common side would seem best kept low. A general change is in consequence taking place in all role-relations in the enterprise. This is the underlying reason for the bureaucratic model being experienced as obsolete and maladaptive, and also for a possible new role beginning to emerge for trade unions.” (Trist E., op cit., p.89)

With these brave words Trist describes here something skin to the Task Ideology of Harrison (Harrison R. -1972 Understanding Your Organization's Character. Harvard Bus. Rev. 50 (3) 119-28) and as Ideal Type; hardly the coalition of interests that characterize the Socio-technical Systems Concept. We would argue that where Task Ideology is dominant, an organization we may expect to see the introduction of new technology without loss of status for the 'displaced' workers, since their role self-perception will be enhanced as will be the degree of direction over their working tasks. However, when 'role' or 'power' ideologies are dominant, or are significant influences in an organization, the reverse can easily occur. In these circumstances, individual worker discretion is prescribed and handed down from above. If the skill of the worker is rendered obsolete by new technology his / her discretion, because of the perceived to have also decayed. The worker, therefore, comes to be seen as a 'button pusher' with neither skill nor discretion and with a consequent lowering of status and job satisfaction. There is also the tendency for management to impose change without consultation with the workforce of planning the change with them. This is vital if change is to be managed effectively. (Barnard C. -1948 Organization and Management. Harvard University Press).

We would regard the 'natural' organizational ideology or 'culture' of health teams, in operating theaters, in the community, in paramedical departments and laboratories and indeed in almost every care grouping, to be that of the Task Culture. That being so, we would expect health workers who possess both skill and knowledge to be able to evaluate new technology without fear, to adapt to its use, where appropriate, without being threatened and to enhance their role by its adoption. This means, of course that the health organization for its part must freely acknowledge the role and worth of its workers by confirming the increased discretion that will be their natural expectation.

However, the Health care organizations has a well developed, overall role culture prescribing job titles and role definitions and ascribing expectations of normative behavior to employees in most occupational groups, Harrison states “Predictability of behavior is high in the role-oriented organization, and stability and respectability are often valued as much as competence. The correct response tends to be more highly valued than the effective one. Procedures for change tend to be cumbersome; therefore, the system is slow to adapt to change”.

With such institutionalized rigidity an organization is unlikely easily to grant its imprimatur to de facto role development brought about by technology and in this sense one may continue to encounter , if in a milder and symbolic form, the undesirable elements that were identified by Trist and Bamforth in the longwall method of coal-getting.

There is also a strong power culture within health care which is the traditional prerogative of the medical profession. 'The different attitudes of the power and role orientations towards authority'. Says Harrison 'might be likened to the differences between a dictatorship and a constitutional monarchy.'



(Brown W. -1965 Exploration in Management. Harmondsworth, Elican, pp. 147-149). This is not to say that such an orientation cannot occasionally be useful both in the practice of medicine and in assisting organizational change but in general it rankles and annoys other health workers who regard themselves as coworkers with their medical colleagues but who fail to find honest definition, winners and losers: the status of the former is gained at the expense of the latter. This is not necessarily so in other organizational ideological types. Recognition of co-workers, therefore, may become improve relationships, and may even destroy them, as role changes because of new technology.

It is frequently identification with task ideology, as well as dedication to patient care, that provides the major maintenance factor in the service and paramedical professions of health care. Genuine and acceptable recognition is given and received within the task group from which the power ideologies tend inevitably to be excluded. The above par endeavored to highlight the interdependence of both the social and technical sub-systems within organizations. De Skilling:

The second important aspect of the introduction of new technology is that of de-skilling, or the fear of it, that has long brought conflict to industrial situation. Harry Braveman advanced the thesis that de-skilling has been a dominating process in the creation of modern work organizations. During his time of publishing he observed the impact of computers (new technology) on office skills from the 1950s on ward.

He sees the detailed division of labour as the means of control, destroying whole occupations and rendering the worker inadequate for carrying through any complete production process, as occurs for example on production lines. He also sees F.W. Taylor's Scientific Management movement as product of the need to control the activities of workers in ever-larger, monopolistic organizations. Taylor's ideas contained three main principles which are fundamental to all advanced work design, organization and method study and industrial engineering today. These are:

The gathering and development of knowledge of the labour processes; The concentration of this knowledge as an exclusive province of management; The use of this monopoly of knowledge to control each step of the labour process

and its mode of execution.

Scientific Management concepts have thus led to the divorce of production, the manual execution of the task, form the conceptual, brain-work functions—a separation of the two essential aspects of labour. Braveman shows that people are trapped into new production methods as competitors see the need to develop similar processes to compete effectively. Studies at Harvard (Bright J.R.-1958 Automation and Management, Boston, Harvard Business School) have produced evidence that automation had reduced skill requirements not only of the operating workforce but occasionally of the entire factory force, including the maintenance organization.

Neither is this effect confined to craftsmen. Within the organization Leavitt a Whisler (Leavitt H. J. and Whisler T.L.-1958 Management in the 1980s. Harvard Business Review 36(6), 41-8) see the impact of computers, programming and operational research on middle management roles as making them more highly structured and covered by sets of rules governing day-to-day decision making. New technologies allow up top management to control their middle management while top mangers become more innovative and creative, particularly with programmers and R&D (Research and Development) people moving into top positions. Because of highly programmed systems, middle managers will require and have less autonomy and skill.



The prediction of this statement has been moderated to some extent by economic and other factors including organizational culture and tradition. However, organizations are now poised on the threshold of an information technology explosion, which, we believe, will effect a substantial change in the way large organizations are managed. Although the capability of fulfilling Leavitt and Whisler's prophecy is at hand, new technology is likely to place more information in the hands of middle and first line mangers. In the Health care organization with accountability pushed downwards, if this actually occurs, the authority to act, to take decisions and to manage must be similarly delegated. Junior mangers are likely to demand an acceptable degree of autonomy or room to move as well as the right to contribute to the overall objective setting process. Once again industry has the choice of complementing systems that meet human and social needs as well as technological and business requirements, rather than placing all the emphasis on the latter.

It is evident that many skills have been and will be made redundant by new technology. Such is mankind's identity with work, many people are likely to experience a feeling of society's rejection of their skills and of the contribution they have made and which has provided a social identification for them over many years. Some workers may fear loss of respect or of status or even of employment itself when alternative ways of meeting society's needs are found and implemented. The introduction of technology into production processes has long been a focus of conflict. (Pelling H-1963 A History of British Trade Unionism. Harmondsworth, Penguin, p.28)

An example of the de-skilling in the Health care industry can be illustrated by the displacement of the traditional skills of the practical chemist in both the pharmacy and the clinical chemistry laboratory. Some clinical chemistry workers have largely abandoned the glass burette and volumetric pipette for complex automatic chemical analyzers which frequently use quite different chemical reactions than were employed in manual analysis. Indeed, skills acquired in operating and maintaining early analyzers of the 1960s, 70s and 80s have already been displaced by yet more complex and sophisticated and instruments of the current era and this process is likely to be continue.

As new technology becomes ever more widely applicable to medicine many more occupational skills could be threatened and will require to undergo metamorphosis if some workers are to avoid loss of employment or, at least, reduced job satisfaction.

Changes we have described have an important bearing upon staff the acquisition of basic but highly portable skills rather than those specific techniques which characterized the apprenticeship training model. Because in older times one's occupation and craft were believed no to change substantially, skills learned during an apprenticeship would effectively support the workers through his work life. This model is inadequate for the science-based professions. If skill displacement is to result in re-skilling and role development then training and retraining must become an involuntary feature of organizational activity, the cost becoming an overhead of the effective use and implementation of advancing technology.

Since this applies to both to knowledge as well as to skill acquisition, many health professions are moving 'up-market' for their recruits, seeking higher educational attainment with wider employment applicability than was deemed necessary before. In the light of such developments, graduate-only entry does not now seem to us an unjustifiable objective for health care professions provided that the discretionary element of their work remains high.

Redundancy:The third problem associated with new technology is that it may facilitate staff redundancy,

although its track record thus far has not wholly supported this genuine fear amongst the health care



related workers / employees. The dumping of workers whose skills are no longer required or whose role is no longer compatible with changing technological requirements is waste of human resources. This ought not to occur except by mutual consent. In case of employee redundancy due to new technological requirements the employer and the employees must show flexibility in case of employee redundancy arrangements.

Thurley (Thurley K. Personnel Management in the UK: An Urgent Case for Treatment) has called for a new range of employment contracts protecting emplacement but no job security and thereby eliminating waste by the utilization of the potential of people for a variety of jobs during their careers. In this, the reward system of an organization would need to include worker development as flexibility would become a key characteristic of the new high-tech workers.

Such a commitment to each satisfactory employee would raise morale and facilitate technological progress by the elimination of uncertainty and the maximization of co-operation. Some health authorities already operate a tentative policy in this direction. However, many workers remain fearful that automation, new technology and computers will be used as tools of economic displacement and will be deployed preferentially to human resources in an attempt to reduce the labor-intensive high costs of the Health Care Related services.

Future Employment Level:This is a convenient point at which to examine the evidence as to the likely effects of

introducing new technology into the health services. Most, but by no means all, of this technology is computer-based. That is to say a computer, or a microprocessor, is incorporated into a machine or instrument in such a way as to render some human tasks, whether manual, clerical or administrative, unnecessary. As computers are also expected to become increasingly useful in the area of decision making the breadth of this influence on working practices is potentially very wide. Some writers have predicted that the nature of work itself will be catastrophically changed. Clearly some analytical tools are needed with which to identify and assess the expected changes.

Rajan and Cooke propose a model for the examination of the effects on employment of information technology in the financial service industry. (Rajan A. and Cooke G.-1986 The Impact of Information Technology on Employment in the financial Services Industry. Nat. Wes. Bank Qurat. Rev. Augus issue, 21-35) While their model lacks universal applicability it may nevertheless have relevance in other service industries such as the Health care organizations. Rajan and Cooke identify a number of factors that influence employment, some of which are capable of moderating adverse effects on employment and others that might accelerate them. These are economic, social and organizational factors.

In the health services generally there has been some investment in new technology, arguably of a broader and different kind from that of other service industries. While this may have led to some occupational re-skilling, employment levels, in health care since beginning have also continued to rise, particularly in the professions supplementary to medicine. It is mainly these professions which have borne the brunt of the introduction of new technology.

Of course, employment levels are determined by many factors of which new technology is one. However, one factor in the Health care services which is in common with banking is the continual rise in the amount of work undertaken. In the health service there has been a phenomenal increase in, for example, the work of the medical laboratories, the pharmacy and clinical activities of all kinds. The effect of the steady reduction in the numbers of hospitals beds brought about by faster postoperative rehabilitation probably outweighs any impact that labour saving technology has made.



Economic Moderator:The economic moderators that characterized health care center on the steady growth in demand,

and as Culyer has put it, ‘the utilization of health services has, on almost every indicator, increased continually since beginning. The more efficient the system becomes at meeting needs, the more needs may be met. In the present context, demand, as indicated by, say the length of hospital waiting lists (and waiting time) has not been satiated by any means, including new technology. In health care new technology has usually required the acquisition of new skills, or new employees, but th overall number of posts has continued to increase. Where individual worker productivity has risen it has quickly become saturated by increased client demand. By considering the demand side as well the supply it is evident that the relationship between new technology and unemployment in health care is from a simplistic one.

As it appears in other service oriented organizations i.e. banking, new technology has itself created the possibility of new avenues of services in the health care and stimulated demand. Renal dialysis, bone marrow cancer treatments, and transplant technology generally, are examples of this phenomenon. Neither should this or any other treatment be reviewed solely as clinical activity. For example, the use of many new drugs associated with these treatments requires monitoring by measuring the blood level of the drug, or its metabolite, in the circulation of the recipient. Special patient monitoring and follow-up are required. Various 'function' tests will be conducted by paramedical staff. Special physiotherapy, perhaps counseling and rehabilitation, may be requested. These are some of the knock on effects of the technology which permits these new treatments and which themselves stimulate demand.

Because all such treatment is necessarily administered on an individual basis, expansion in the service is likely to require some additional trained staff whose work may be made more effective by new technology rather than be entirely replaced by it. The principal economic factor in the implementation of new technology is Exchequer funding. As we have seen, capital monies are largely divided between building and equipment which will include new technology. Therefore, the funding of technological innovation will largely depend upon the shortage of capital monies gives rise to local income generation by selling services--for example occupational health services or executive health screens—this is deemed like to result in a positive influence on both staffing levels and equipment utilization.

The persistence of lengthy waiting lists in the Government owned hospitals with the virtual absence of these in the Privately owned Hospitals indicates that demand in this 'private' market is relatively low at the prevailing price. Therefore, any increase inefficiency in the Government Health Management System is likely to stimulate demand further. The recognition and development of consumer awareness by means of Health Management Scheme, (Halpern S. -1986 HMOs: Maintenance or Management. Health Serv. J.96( 5010), 1018-19) Good Practice Allowance of GPs, or by generally raising public expectations will have a similar effect.

Social Moderators:Social factors moderating the impact of new technology are also varied. Unlike the experience

of other service oriented industries i.e. banking where significant number of customers still prefers personal service to using an automatic cash dispenser or service till, the health care patient has little need at present to make such a choice. However, we may in future emergence of direct patient interrogation by computer. Several systems have been successfully developed and are in regular,



though limited, use at various medical centers in developed countries. They are generally specific to the particular symptoms and diagnostic areas such as abdominal pain or specific problems such as alcoholism. In these systems the patient sits alone with the computer and responds to questions displayed on the screen by pressing one of four buttons to answers 'yes' or 'no' or 'don't understand'.

The counterpart of the clinical is the 'expert system' which may be interrogated interactively by the doctor to obtain probable diagnoses for signs, symptoms, and history and test results fed in by the enquirer. Experience has already shown that user resistance, amongst other things, is likely to play some moderating part in the introduction of these facilities.

Ultimately we believe that the operation of consumer choice will mean that patients will opt for the approach to diagnosis and treatment that best meets their needs. In the majority of the cases this will favor strategies that are technically and economically efficient. One important facet of computer / client interaction is that a computer need never be rude, aggressive or observing to any patient, it need never be forgetful in questioning or judgmental in response. A computer can be programmed to be infinitely patient and to give straight and uncomplicated replies. Furthermore it is feasible to combine medical 'expert systems' with direct client interrogation facilities to provide commercial 'do-it-yourself' diagnostic kits for home use. Our guess is that such a development would be most likely to raise further the public consciousness of health issues and lower the threshold at which demand is made on the professional health services.

Organizational Moderators:Organizational moderators relate both to policy and to its likely effect upon staff. This in turn

relates mainly to an organization's propensity to change and the manner in which that change occurs.Investment in new technology may also mean a loss of return on previous investment in people

and in older technology and the 'wasting' of much experience through de facto occupational redundancy. Since staff are usually regarded as the most important investment a company can make, most organizations may be expected to consider ways of optimizing the return on this and indeed on all their investments including new technology.

With respect to the implementation of change, the statement by Griffiths that ' The effectiveness of the Health Care System depends on the staff it employs, and a better run service will mean a more satisfied customer, a happier working environment and a more satisfied staff, is the traditional and legitimate view of most successful organizations including the Government Health Care System. The sub-culture maintained by such an attitude is a valuable source of motivation and most organizations may be expected to seek to preserve, enhance and make us of it during any change brought about the introduction of new technology.

A further point implied by Rajan and Cooke is that where there exist a multiplicity of tasks associated with the operation of an enterprise the automation of one aspect of task, as in the case of, say, a word processor, may have little impact on overall staffing levels, especially where the machine can be used more to improve the quality of the production of service than to speed production. (Rajan A.and Cooke E. op.cit., p.31)

Accelerating Factors:As compare to the other service rendering organizations it appears in the Health care providing

organizations, also, growth and demand have been the chief moderator of staffing levels in the face of new technology. To regulate the demand and to accelerate the technological impact on employment can be done through the right combination of tight financial controls, together with strong directives from



the government, both to increase the economic efficiency and wide-ranging computer-based information systems, such as the data requirements (DHSS-1984 Report of Steering Group on Health Services Information: Implementation of Programme (HC(84)10, London, DHSS) , may be sign respect and help to establish a tendency to maximize staff savings from increased productivity.

Management Information is most economically gathered as by-product of normal activity and many special manual and computer systems at present solely used for the collection of dare are likely to have short and uneconomic life cycles. The continuing emphasis on community networks linking hospitals, community health centers an general practitioners is growing and may be expected to expedite the deployment and integration of computer systems and related technology generally.

Organizational Development:So far we have discussed some of the factors that may be expected to influence staffing strategy

in the Health Care service rendering organizations. In spite of today's preoccupation with technological development we remain firmly of the occupation that any organization's most important a valuable asset is its staff. It is because of new technology, changes in the labour market and of economic factors generally that our most pressing problems within organizations concern change. By this we mean, for example, changes in job functions, professional groupings and alignments, goal affinities and skill requirements. In particular, the possibility of incremental (Lindholm C.E.-1969 The Sceence of Muddling Through. In: Ansoff H.I. (ed.) Business Strategy. Harmodsworth) change in exacerbated any new technology within both many organizations and their various environment.

It has been recognized that there will always be differences of opinion between workers and that the value of conflict organizations is far from being always negative. However, the question we are addressing is how are we to achieve an control change in an organization as complex and sensitive as the Health Care providing organizations.

In part the answer lies in obtaining the agreement of all, or at least a majority, of staff to identify with, implement and maintain new working practices, workload norms and organizational changes that will-make our practice of health care more effective. By involving staff at the beginning of change exercise rather then confronting them with a ready-made decision and action plan, the organization increases its chances of long-term success. Conflicts of values may be openly discussed an uncertainties of outcome, a source of much stress and resistance to change, may be placed in the hands of those directly affected and hence to some extent may become self-determining. It is this consensual strategy which forms one of the distinguishing features of organization development (OD).

Williams (Williams A. -1981 Organization Development. In: Cowling A.G. And Mailer C.J. B. (eds) Manging Human Resources. London, Edward Arnold) defines organization development (OD) as term which is applied to certain types of planned efforts at bringing about organizational change. We need not be concerned here to find a more elaborate definition since we wish to avoid categorization and the possible exclusion of otherwise helpful knowledge and methodology. What is clear is that OD

addresses the problems of organizational change by working inside the organization, tapping into the ideas, experience and energies of its constituent workers individual, or in groups, to effect agreed changes that are mutually beneficial. For this an OD specialist is usually employed. Such specialists frequently bear the title of management consultant. This is pit, for in our view it does nothing to differentiate them from any other kind of management 'expert'.

Traditionally, management experts in general have employed a diagnosis and prescription technique, often known as 'hit and run'. A management consultant would typically use a 'Top Down'



approach looking at organizational structure, business policy, staffing and outputs. A perspective solution to the problem would be tendered (together with a hefty invoice for service rendered) and the organization left to implement a de facto, management-imposed change as best it could.

Lewin, in his field force theory (Lewin K.-1951 Field Theory in Social Science, London, Harper & Row) put forward a model of organizational change based upon three steps:

1. Unfreezing the Current Situations' Controlling Forces: These include current conceptions, working practices or ideological beliefs. For this, workers

may be placed in learning situations such as being exposed to new technology job methodologies in order to create dissatisfaction with the existing situation and thus create a desire for change. In practice this does not always work and more coercive techniques have been employed, particularly where change is required rapidly. The threat of redundancy and the acquaintance of staff with the fact of managerial power, say, for example, to change unilaterally contracts of employment, may 'unfreeze' attitudes and bring agreement that change is after all possible. However, this holds within it the dangers of long-term member pain by the workforce and entrenched dissatisfaction.

2. Finding an Implementing Change:Only when the unfreezing is complete is it worth embarking on the quest for change and

involving workers in a search for preferred alternatives which satisfy the aspirations of all parties. This serves to emphasize that a change agent or OD worker required to be invited to assist staff in their quest and not to be unilaterally imposed as the agent of management to browbeat workers into submission. However, where Stage I does not call for such measures the OD worker can have valuable part to play. For example, where problems arise with inappropriate role perceptions between different groups of co-workers the OD worker will use his or her skills to bring such groups together, help them to communicate effectively and facilitate new patterns of work an behavior.

3. Refreezing the New Situation's Controlling Forces:When change is agreed its implementation needs to be established by positive reinforcement.

This may take the form of rewards inherent in the new system of work and it is important to recognize that change decisions are unlikely to stick if no such rewards are forthcoming. For example, some of the spectacular failures of some medical computer systems, may be attributable to just this lack of reward. In any case steps need to be taken to refreeze the forces maintaining the new situation remembering that transient behavioral change may be analogous to a remission rather than a cure. This further emphasizes the need for the OD worker to support each project until all stages are complete, i.e. not only assisting with diagnosis and treatment but with convalescence as well.

There are several ways in which different OD strategies may be classified depending upon their context and approach. These are summarized broadly by Williams as:

Team Development Inter-Group Development Total Organizational Development Improving the Match between People and Jobs Improving the Match between Organizations and their Environment

PAST RESEARCH REVIEW & ANALYSIS REGARDING HRM PRACTICES & IMPACT OF



NEW TECHNOLOGICAL INNOVATION ON HUMAN RESOURCE PERFORMANCE SPECIFICALLY RELATED TO HEALTH-CARE PROVIDING INDUSTIRES / ORGANIZATIONS:

There are various studies that cover the topic, the role and effectiveness of human resource management in general and the impact of HRM on the quality of health care service, these studies also discussed the factors that affect the performance of individuals, due to the new technological innovation, or by the HRM practices in health-care providing organizations. In addition to that many studies discussed the functions of HRM such as planning, employment, training, performance assessment, incentives and rewards for human resources. In the following section, we demonstrate the main researches that discussed HRM in health sector:

THE ROLE AND EFFECTIVENESS OF HUMAN RESOURCE MANAGEMENT

Arabah Hajj (2012) has done research on "Evaluation of the efficiency of the use of human resources for health in public hospitals:

An Empirical Study on a sample of hospitals”. The study emphasized on the importance of previous indicators to measure the efficiency of the performance of human resources in hospitals, especially public hospitals, which are in urgent need to assess the efficiency of the performance human elements, and doing precise measure will help the hospital management to strive towards improving how to use these resources.

The study recommended the following:a. The need to pursue the efficient use of human resources for health constantly, and even

non-health (which is unrelated to health work, security guards, maintenance workers, etc.).b. Prepare a map showing the distribution of human resources for health for all individuals

working in the hospital, based on the distribution of the family, and the specialty for all health professions and medical professionals, making it easier to refer to them when there is a defect or waste in the use of these resources. The study revealed that institutions do not engage workers in the planning processes of the workforce sufficiently, and that the influential considerations of administrative structure regulatory in the process of workforce planning is characterized by lack of clarity, as well as the professional experience in manpower planning and top management support for the process of workforce planning was ineffective. The study recommended to prepare plans and clear vision in a professional and systematic approach to develop human resources in the hospital, with the need to involve employees in the planning of human resources to become part of their thinking and their work and to help them to practice work in a professional sound, and encourage them to commit to the hospital, the study also urge to create a separate department for personnel affairs in the health institutions and the use of external expertise in order to determine the needs of the health institution of human resources.

Mukhaimar and Taamenah (2004) with their studies entitled "Recent trends for the hospital management: concepts and applications”:

The researcher found that although the quality of the plans and organizational structures and preparing them according to the scientific methods, the hospital management could fail in achieving the planned objectives as a result of its failure to perform routing function, which is designed to influence the behavior of the various categories of personnel in the hospital, and urge them to contribute to high



level of performance towards the goals of their units in particular and to their hospital in general. In addition to that the study concluded that the function of director of the hospital is not only to provide diagnostic and treatment services and associated procedures , but it also drew attention to the feelings of the various categories of workers in the hospital, including doctors, technicians and administrators, and therefore understand the conditions under which work will be done in the shade, it also must be given their morale and satisfaction for the work that they have in the same level when they provide diagnostic and therapeutic services.

THE IMPACT OF HUMAN RESOURCE MANGMENT (HRM) PRACTICES ON THE QUALITY OF HEALTHCARE SERVICE

Salah Mahmoud Diab (2012) in his study entitled "Measuring the dimensions of the quality of medical services provided in the Jordanian government hospitals from the perspective of patients and staff’:

The study found an increase rate to quit job among doctors and nurses working in hospitals and the Ministry of Health, and the low degree of satisfaction and low desire among the staff to continue working in the hospital, and this giving impact to the low quality of health services provided to patients, in the absence of effective HRM practices. The most important recommendations by the study with regard to the condition of individuals working in the hospital:

a. The provision of material and moral incentives for employees working in government hospitals to generate their desire to continue to work and provide medical services appropriately.

b. Training courses for workers in the hospitals in the area of the dimensions of medical service quality, and to deepen the quality concept between the staff and to achieve the quality dimensions at the best degree.

Al Kudhat Mohammed (2004), with his study entitled "Methods of selecting staff in King Abdullah in the light of technological developments,":

One of the main finding of this study is the existence of a positive relationship between the personality traits of those who have been recruited and technology employed in the hospital. In addition to that the contrast of views of the staff about the availability of specialist personal attributes required. It also revealed the existence of the impact of high technology in the analysis and design work and job classification and the nature of the work.

A study entitled “Determining staff requirements in hospitals", Ozcan and Hornby (2005).: The study found that one of the reasons for poor performance of employees in government

hospitals in Turkey, was mainly due to lack of interest by the managers of head departments in government hospitals to provide better conditions to hospital’s staff and develop incentives system. The study recommended the adoption of incentives system and rewards for staff and nurses who perform good and choosing a group each month as a role model for individuals working in the hospital and pay them special bonuses to encourage other staff who have not been selected, and the study emphasized that adopting this system will improve the performance of all individuals working in the hospital dramatically.

Valverde and Ryan (2006) in their research entitled “Distributing HRM responsibilities: a classification of organizations”:



The aim of this study to show that HRM is not the sole responsibility of HR departments, but also of other agents inside and outside the organization, such as top and line managers, and external HRM service providers. The researcher examined how organizations distribute HRM activities and responsibilities among these agents; he also attempts to classify organizations according to agent distribution and to explore whether a number of internal and external context characteristics affect this distribution. The finding of this study shows that the model of HR function adopted by an organization may not be contextually determined, but instead it is a matter of corporate choice. That is, companies actually choose what type or model of HRM they want and distribute the responsibilities of their various agents accordingly, rather than being determined by organizational contingencies. The researcher concluded that a large number of organizations have proved very useful in identifying a wide range of behaviors in the distribution of HR responsibilities.

Rosemary Lucas (2002) with her study entitled "Fragments of HRM in hospitality? evidence from the 1998 workplace employee relations survey":

The study carried out to verify the rehabilitation of the health sector in Britain from the perspective of human resource management and aimed to assess the dimensions of human resources related to the rehabilitation of the health system and the formation of a new health sector. The study found that employees are more likely to perceive their managers as anti-union, and to represent themselves in dealing with employment issues such as challenging management about their work, in disciplinary proceedings, and in seeking a pay increase. The study pointed out the importance of human resource management in the success or failure of the health sector and the health sector in most countries focuses on changes in building the organization, contain costs, customer choice. The study emphasizes on the importance employees’ performance and how to attract professionals to the health sector.The main findings of the study:

The existence of a strict centralization in most hospitals, which limits the development of the work of individuals and nurses.

The lack of a new approach to develop the work in the event of performance failure. The failure to protect the rights of workers and individuals in hospitals during the

transformation process in the health sector.

THE FACTORS THAT AFFECT THE PERFORMANCE OF INDIVIDUALS WORKING IN HEALTH ORGANIZATIONS

Chan and Mak (2012) with their study entitled “High performance human resource practices and organizational performance the mediating role of occupational safety and health”:

The aim of this study is to examine the relationship between high performance human resource practices (HPHRP) and organizational performance. The results showed that the mediating role of perceived safety climate in the relationship of HPHRP and organizational performance is confirmed. The finding suggests that organizational emphasis on safety issues contributes to establishing effective HPHRP and driving organizational performance. Organizations can benefit from effective HR practices by paying attention to employees’ safety issues, which in turn result in better organizational performance.



A study entitled “The filling in the Sandwich: HRM and middle managers in the health sector”, Mc Conville and Holden (2003):

The study showed the central role of line managers in implementing human resource management, is widely acknowledged and examined how far employees affect, or are affected by, such practices. Through a case study in two Trust hospitals, this study demonstrates that middle line managers, positioned between the service's decision-making bodies and its employees, are bearing many of the consequences of the change process. The effects of growing workloads, combined with altered expectations of their increasingly visible roles, have enhanced the tensions and role conflict inherent to their position. The study found that the perception of line manager are under resourced and found lack of time needed to manage their staff effectively. Moreover, staff is being more closely managed, changing the nature of personnel management, and line managers throughout the service have regained responsibility for many aspects of HRM. The main finding of this study is that as Trusts become established, and managers gain confidence in their staff management skills, longitudinal studies would be useful in building a picture of the development of both middle management roles and the functioning of HR specialists/advisors. Clearly, in units where the specialist HR/personnel is contracted out, the effects on managers' roles and the extent of changes in the nature and quality of HRM need to be explored.

A study entitled “HRM and the management of clinicians within the National Health Service (NHS)”, Marie et al., (2007):

The study concluded that the management of human resources is of crucial importance in enabling the delivery of efficient and effective services. The aim of this study is to explore one issue relevant to Human Resource Management, that is, the management of hospital doctors in the National Health Service (NHS). The finding argues that HRM must play a pivotal role in the management of clinicians’ to ensure the effective and efficient delivery of health care reforms in Britain The study concluded the following:

a. A strong, well-motivated and highly trained medical profession is critical to the success of the national health-care reform, in the delivery of both services to patients and government reforms.

b. It requires the medical profession to acknowledge and accept the potential contribution of HRM to the management of doctors, a contribution that hitherto has generally been disregarded as purely administrative and often irrelevant.

A study entitled “HRM practice and employee attitudes: different measures–different results”, Edgar and Geare (2005):

The study aimed to test the relationship between HRM practice and employee work-related attitudes and examine whether different approaches to measurement of HRM gives different results. The finding shows that if managers want to maximize employee’s attitudes, then implementing lots of practices is not sufficient. Practitioners need to be aware that the way they implement their HRM practices may be a more important determinant of employee attitudes than the number of practices they put in place.

A study entitled “Human resource management and performance in health-care organizations”, Harris et al. (2007):

The purpose of this study is to compare the evidence from a range of reviews concerned with



the links between human resource management (HRM) and performance. The aim of the paper is to review this diverse literature, and to derive human resource (HR) implications for health care researchers, policy makers and managers. The study finds that relationships have been found between a range of HRM practices, policies systems and performance. The study concluded that Trusts may allow for increasing tailoring of HR practices to suit local circumstances, and the potential impact of any HR practice or set of practices on performance may be mediated by the effect of the implementation process on mental models of individuals and thus on HR outcomes such as motivation, commitment and satisfaction.

A study entitled “Managing professionals: exploring the role of the hospital HR function”, McDermott and Keating (2011):

The objective of this study is to examine the role of the HR function in the management of professional and non-professional staff in the acute hospital sector. The study finds that in two of the three cases the human resource (HR) function predominantly provides services to non-professional workforce groups. However, the effective and strategic management of professionals is undertaken in the third case, without a professional HR function. The study suggests that HRM as “the management of people and work” was being practiced, if not by the HR function. As a result, a focus on formal HRM structures in hospital organizations is insufficient to capture the manner in which people and particularly strategically valuable workforce groups and work are managed.

A study entitled "Effects of HRM on client satisfaction in nursing and care for the elderly", Ott and Dijk (2005):

This study showed that HRM is supposed to increase job satisfaction. But does it also increase client satisfaction? The study sets out to discuss this issue. The finding from this research indicates that HRM does affect job and client satisfaction, and showed that the 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. The study recommend a regular performance reviews for job satisfaction and client satisfaction, emphasizing that employee and client satisfaction can also conflict: more regular schedules increase employee satisfaction, but decrease client satisfaction.

The researcher distinguishes seven HRM activities:

a. A personal development plan.b. Additional job-related training during the past two years.c. Job performance review during the past two years.d. Regular departmental meetings (at least monthly).e. A protocol in case of a labour-shortage.f. Predictable work schedules.g. A leadership style of the manager which is transparent and supportive.

The conclusion indicates that employee satisfaction seems mostly affected by the management style of the unit manager, and to a lesser degree by performance reviews and predictable work



schedules, while client satisfaction correlates primarily with job related training and somewhat with performance reviews and a supportive leadership style.

Own Observations Regarding Research TopicDuring my summer internship training program at International Center for Chemical &

Biological Sciences (ICCBS), University of Karachi, I have observed many addressable issues related to HR practices. During my internship I was attached with the Project Office of Dr. Panjwani's Center of Molecular & Drugs Research (PCMD), an integral part of ICCBS. Before discussing these issues in details, I would like to give brief intro of the organization. ICCBS is multifaceted research organization and developed by the Government of Pakistan with the help of international donor agencies to produce scientist in the field of Chemical & Biological Sciences. From its beginning this organization has been indulged in to different areas related to Biological & Chemical Sciences besides its academic activities. Following activities of the ICCBS directly related to health-care service:

Drug Research Disease preventions Diagnostic Services

Being a state owned organization the HR practices are followed under the prescribed government rules and regulations. The employees are hired on permanent basis, mostly related to the academics, other all staff has been hired on ad hoc basis or temporary. This employment practice is causing staff dissatisfaction those who has been hired on temporary basis. It is no doubt that organization has been certified by many international organizations but this can not produce the desired results until unless the HR practices will be implemented in true spirit. Because all procedures are only documented there is no real outcome has been measured against these practices nor it has been observed that before and after effect of these standards on organization efficiency or total out come.

Employee satisfaction is main cause to increase organizational efficiency. So following steps must be taken by the ICCBS management to get the desired results.

They must clearly distinct their academic and business related objectives, it will require the business re-engineering process after that ICCBS will enable to set its vision according to new requirements.

The staff other then the academic purpose will be higher separately on regular basis, they must really aware about their purpose of hiring and their performances will be evaluated against their define job descriptions.

The ICCBS is comprising on both new and old technologies some of its new units are highly equipped with the new modern technology and gadgets. On the other hand some of its labs are working with the old technology. To increase the effectiveness of the research work the all old labs must be equipped with latest technology and to control the employee redundancy all the employees must be trained accordingly, the job rotation in this regard is the best tool to apply.

Research FindingsThis research is based on the on-going academic research work and descriptive analysis to get

an overview of the impact of quality human resource in health-care providing industries / organizations.



Therefore, the research is conceptual in nature and analytical method is being used to give account the role and effectiveness of human resource management in general and the impact of new technology on human resource performance, the impact of good human resource management practices on the quality of health-care service, also discussed the factors that affect the performance of individuals as well as the health-care providing organizations. Data and information are collected through the libraries, recognized journals both local and international. In other words, it is conceptual analysis in which taken into consideration mainly previous research.

Research describe that the Human resource, new technology and organizational performance has significant relationship. Both variables play important role for the organizational performance. It is evident that the new technology will bring unemployment itself but on the other hand it creates new job opportunities for the skilled workforce. To elaborate that which one plays more effective role in the overall organization performance requires an empirical research on the topic. One thing is evident Quality of Human Resource always does an impact on overall organizational performance.

It was found that HR practices are indirectly linked to over all outcomes of the health-care organizations or it can be easily say that the Human Resource Management plays an important role for the enchantment of organizational efficiency and maximizing output of the available resources.

Various key success factors emerge that clearly affect health care practices and human resources management. This research reveals how human resources management is essential to any health care system and how it can improve health care models. Challenges related to the health-care services are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected research studies allowed a deeper understanding of the practical and crucial role of human resources management in health-care organizations.

There is no tailor made available which is acceptable universally for every organization. Organizations must choose the best HR model according to their requirements specifically considering the nature of business. But the research studies provide the information regarding the strategies that an organization can adopt within the available resources. These strategies could be labor intensive or technology intensive. It’s all depends upon the organizations capability, if they have sufficient capital they can choose the technology intensive strategy through introducing new technology. In other case they can choose labour intensive strategy through investing in their Human Resource (employees) enhancing their capabilities to perform their duties in more effective and efficient manner. This can be done through training and motivating employees. This strategy also includes cost but as compare the technology it requires less investment. It is also described that the technology intensive strategy will also comprises the training cost of the employees due to the introduction of new technology.

Research also describe that the HRM practices of any organization does not put direct impact on client (patient) satisfaction. But they can increase employee satisfaction which can leads to the client satisfaction. The training activities of the HRM create the employee satisfaction, and leadership style of the organization leads to the job satisfaction of the employees.

Research study also describe that the High Performance Human Resource Practices (HPHRP) is very much related to the work environment. It is observed that the employees working in safe and healthy environment performs better then the employees with less safe environment.

Research study reveals that the HRM practices are not only the responsibility of the HR managers. The line and middle managers plays very crucial role for the implementation of HR policies and practices, so the coordination and communication between HR Manager and the Line mangers must very clear and distinctive. Because the lack of communication for miscommunication will lead to



an adverse affect on HR related practices.

ConclusionThe management of human resources is essential to enable the delivery of efficient and

effective medical services and to achieve patient satisfaction, the study shows that human resources management has a strong impact on health-care quality, and most of literatures show the importance of human resources management to achieve the goals of health-care providing organizations, and emphasize to develop the performance of hospital staff and nurses through periodic training in order to improve the quality of health-care service, also a strong, well-motivated and highly trained medical profession is critical to the success of the health-care reform. The practices of human resource management are very important in health sector and modern hospitals need alternative approaches for practicing HRM successfully. The senior management in hospitals should have a clear strategic direction and clear objectives to improve the management of employees and staff in the hospital.

The HR of health-care providing organizations can be dividing into two categorizes:I) Medical Staff (Doctors, Physicians, Practitioners, other Paramedical Staffs)II) Non-Medical Staff (Administrative staff, Marketing, HR, Accounts, etc.)

Proper management of all human resources is critical in providing a high quality of health care. 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.

RecommendationsThe Reviewing of previous literatures that cover the field of HRM in hospitals and health

organizations shows the need for further improvement in any health organization. However, this study sets the following recommendations:

1. Setting a strategy for human resources management according to the requirements of new era.2. Before introducing a new technology in an organization, inputs from the workforce must be

acquire by the management. 3. To increase the human resource out put both intrinsic and extrinsic rewards must be used by the

management.4. Organization culture plays very important role in adaption of new technology. Organization

with clear distinction of authorities and powers among the different levels of employees will adapt changes quicker than others. Because team work plays a vital role in the implementation of change process.

5. The development of personnel management process must be continue to aligned the organizational workforce according to the new technological requirement.

6. Engage the staff of the hospital in the larger functional tasks in order to give them more confidence in the health institution in which they work.

7. Continuous development and training of staff performance.8. The need to measure the performance of the managers of human resources department in the

hospital before starting performance development process, and these measures include (leadership ability, self-qualification, risk management, strategic thinking, decision-making, innovation, management experience, and communications)

9. The aptitude of the employees is not enough to perform a task effectively. Workers with the



right aptitude and attitude will become more productive.

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Appendix-I

Research Questions:Following questions and issues has been discussed and analyzed throughout the research study.

What is human resource management?

How Human Resource Management does affect the success of health-care organizations?



What is performance?

What are Key Performance Indicators (KPI) for the health-care organizations?

How human resource performance put an impact on organizational performance?

To what extent are HR practices in health care organizations related to multiple outcome

dimensions?

Impact of new technology on human resource performance within health-care providing

organizations?

To identify the relationship between new technology and human resource performance and its

impact on health-care providing organizations output?

To identify the HR practices that can maximize the human resource output according to the new

technological requirements?

What is scientific management?

What is Quality?

What is Quality Human Resource?

Appendix-II

Synopsis Writing Approval:



Appendix III



Data Approval:


impact of quality human resource on health care providing industries-organizations

Health & Medicine