Iv Competencies Required for Hr Professionals and Hrm Practices In

Dr. (Mrs) V.Sujatha, M.Com, M.Phil., Ph.D., Principal, Cauvery College for Women, Trichy-18.

CERTIFICATE

This is to certify that the thesis entitled, “HUMAN RESOURCE

MANAGEMENT PRACTICES IN SPECIALIZED HOSPITALS:

A STUDY ON COMPETENCIES OF HUMAN RESOURCE

PROFESSIONALS AT TIRUCHIRAPPALLI CORPORATION” is the result of the original research work carried out by Mrs. R. SEETHALAKSHMI , under my guidance and supervision and submitted to the Bharathidasan

University for the award of the Degree of Doctor of Philosophy in Commerce.

I also declare that this thesis or part of it has not been previously submitted to any other Institute or University for the award of any Degree or Diploma.

Place: Date : Research Advisor

Mrs. R. SEETHALAKSHMI, M.Com. M.Phil., Cauvery College for Women, Tiruchirappalli – 620 018.

DECLARATION

I R. SEETHALAKSHMI , hereby declare that the thesis entitled

“HUMAN RESOURCE MANAGEMENT PRACTICES IN

SPECIALIZED HOSPITALS: A STUDY ON COMPETENCIES OF

HUMAN RESOURCE PROFESSIONALS AT TIRUCHIRAPPALLI

CORPORATION” is my original work and that it has not previously formed the basis for the award of any Degree, Diploma, Associateship or other similar title. This work has been done under the guidance and supervision of

Dr. (Mrs) V. SUJATHA, M.Com. M.Phil., Ph.D., Principal, Cauvery

College for Women, Tiruchirappalli-18.

Research Scholar

Countersigned

ACKNOWLEDGEMENT

With a profound feeling of fulfillment and gratitude, I am pleased to offer my most humble and heartfelt thanks to GOD for his enriching and encouraging presence all along the way in this arduous, but challenging scholastic pursuit, facilitating my research work to successful completion.

I am happy to present my cordial and sincere thanks to the authorities of

Bharathidasan University, for granting me the necessary academic sanctions to pursue my research studies.

I take this opportunity to express my deep sense of gratitude and sincere thanks to my research guide Dr. V. Sujatha M.Com., M.Phil., Ph.D.,

Principal, Cauvery college for women, Tiruchirappalli for her constant encouragement, inspiring guidance for extensive reference and valuable suggestions. I offer my abundant gratitude, for the inspiring help and direction which was greatly instrumental, in the fruitful completion of my research work.

I am very much grateful to Dr. I. Francis Gnanasekar, M.Com.,

M.B.A., B.Ed., M.Phil, Ph.D., Associate Professor, Department of

Commerce, St. Joseph’s College (Autonomous), Tiruchirappalli, for his sustained interest and support in my career development and for his positive encouragement which instilled in me courage and confidence and to excel in my academic endeavor.

I am indebted to a great extent to Dr. G. Stephen Vincent, M.Sc.,

M.Phil., Ph.D., Reader, Department of Statistics, St. Joseph’s College (Autonomous), Tiruchirappalli. His guidance in application of statistical tools formed the authentic base for the conclusive evidences in the finalization of my research resource.

I am extremely grateful to the President Mr. M. Jeyaraman,

Secretary Mr. K. Rengarajan, Treasurer V. Ramanathan @ Sekar of

Cauvery College Governing Council, Trichy for giving me this great opportunity to upgrade my academic status and enhance my professional competency.

I owe my sincere debt of gratitude to Dr. N. Savithri, M.Com.,

M.Phil., Ph.D., Head Department of Commerce, Cauvery College for

Women, Tiruchirappalli, and all the faculties of the department for the optimistic encouragement and sustained support in my academic endeavor, to pursue my research project to fruitful completion.

I offer my grateful acknowledgement for the kind help and cooperation extended to me in my work by the management of the selected hospitals who gave me the permission to undertake my study in this area. I thank the Human

Resource professionals for distributing the questionnaire to the employees in the various departments and facilitating to offer sincere and rational response.

Also I convey my sincere thanks to all the employees of the hospitals for having spared their valuable time, to contribute for this study.

My cordial thanks to Library Authorities of Bharathidasan

University, Madras University and Indian Medical Association, Tiruchirappalli, who have permitted me to refer the Journals, Magazines and Books. I offer my sincere thanks to Ms. Regina John, MCA, Department of

Computer Science, Bishop Heber College, Trichy for providing the latest software tools, along with the appropriate technological support to facilitate the consolidation of my research work.

I am happy to offer my sincere thanks to Ms. Subha , Assistant professor in English, Cauvery College for Women, Tiruchirappalli, for effective assistance in my research working papers.

I wish to express my sincere thanks to Golden Net Computers for their diligent efforts in the perfect computerization of my research thesis.

A special mention of my heartfelt thanks to my dear friends for their abiding faith in my capabilities and their excellent support, accelerated interest at crucial times which motivated me to work with my research project towards successful completion as per time schedule.

Motivation and optimization are essential components for the success in my challenging endeavor. On a personal note, I wish to thank my family members for their understanding, adaptability by offering meaningful and timely help. My heartfelt thanks to my sister Archana , for encouraging support by creating a conducive environment which reduced my stress and strain of this onerous task to succeed in my set goal.

I gratefully remember all the invisible individuals, who have worked behind the screen, if not this thesis, would be a dream. I thank them all.

R.R.R. Seethalakshmi (Research Scholar)

CONTENTS

Page Chapter Title No.

I Introduction 1

II Review of Literature 27

III Profile of the Study Area and Hospitals 77

Competencies of HR Professional and Human Resource IV 103 Management Practices

V Analysis and Interpretation 150

VI Findings, Suggestions and Conclusion 241

Bibliography B 1

Appendix

I. Questionnaire Q 1

II. International Papers Publication Q 10

LIST OF TABLES

Table Page Title No. No.

1.1 Classification of Employees in Selected Hospitals as on 16 31.12.2010

5.1 Socioeconomic and Demographic Profile of Human 152 Resource Professionals

5.2 Respondents Currently Pursuing Training related to Human 155 Resource Management

5.3 Respondents Interested in Pursuing Training related to HRM 156

5.4 Respondents level of strategic contribution skill 157

5.5 Respondents level of Personal Credibility skill 159

5.6 Respondents level of HR Delivery 160

5.7 Respondents level of Managerial Skill 161

5.8 Respondents level of Administrative skill 162

5.9 Respondents level of Internal Consultations 163

5.10 Respondents overall Level of Competencies 164

5.11 Respondents overall Level of Performance of Human 165 Resources Activities

5.12 spearman’s correlation between demographic factors (HR 166 experience, education level, and income) and HR competencies

5.13(a) Correlation - Competencies of Human Resource Professionals 171 and their Performance in Human Resource Management Activity

5.13(b) ANOVA - Competencies of Human Resource Professionals 171 and their Performance in Human Resource Management Activity

5.13(c) Regression - Competencies of Human Resource Professionals 172 and their Performance in Human Resource Management Activity

5.14(a) One way ANOVA - Level of competencies among the HR 174 Professionals in four Selected Hospitals

5.14(b) Homogeneous Subsets - Competencies of HR Professionals 175

5.14(c) Descriptive Statistics - Level of competencies among the 176 HR Professionals in four Selected Hospitals

5.15 Employees - Respondent’s Classification on the basis of Age 178

5.16 Employees - Respondent’s Classification on the basis of Gender 179

5.17 Employees - Respondent’s Classification on the basis of 180 Educational Qualification

5.18 Employees - Respondent’s Classification on the basis of 181 Marital Status

5.19 Employees - Respondent’s Classification on the basis of 182 Domicile

5.20 Employees - Respondent’s Classification on the basis of 183 Family Type

5.21 Employees - Respondent’s Classification on the basis of 184 Cadre

5.22 Employees - Respondent’s Classification on the basis of 185 Department

5.23 Employees - Respondent’s Classification on the basis of 186 Experience

5.24 Employees - Respondent’s Classification on the basis of 187 Annual Income

5.25 Employees - Respondent’s Opinion towards Recruitment 188 and Selection

5.26 Employees - Respondent’s opinion towards Training and 190 Development 5.27 Employees - Respondent’s opinion towards Staff Promotion 191

5.28 Employees - Respondent’s opinion towards Performance 192 Appraisal Systems (PAS)

5.29 Employees - Respondent’s Opinion towards Career 193 Development

5.30 Employees - Respondent’s Opinion towards Incentives, 194 Compensation

5.31 Employees - Respondent’s Opinion towards Recognition 195 and Reward

5.32 Employees - Respondent’s Opinion towards Flexibility 196 Work Option

5.33 Employees - Respondent’s Opinion towards Job Design 197

5.34 Employees - Respondent’s Opinion towards Employee’s 198 Participation and Communication

5.35 Employees - Respondent’s Overall Opinion towards 199 Human Resources Practices

5.36 Dispersion of Gender on the basis of the Opinion on 201 Recruitment and Selection

5.37 Mann Whitney u test between Genders of the respondents 203 and HRM Practices

5.38 Chi-square - Association between the domiciles of the 207 respondents and the HRM Practices

5.39 Kruskal-Wallis test - the education qualification of the 209 respondents and the HRM Practices

5.40 Chi-square - Association between the experiences of the 214 respondents and the HRM Practices

5.41 Karl Pearson Correlation between Annual Income of the 217 respondents the HRM Practices

5.42 Karl Pearson Correlation between Age of the respondents 220 and the HRM Practices 5.43 Inter Correlation Matrix 222

5.44(a) One way ANOVA - Human Resource Management 224 Practices in four Selected Hospitals

5.44(b) Homogeneous Subsets - Human Resource Management 225 Practices in four Selected Hospitals

5.44(c) Descriptive Statistics - The Effectiveness of Human 226 Resource Management Practices in four Selected Hospitals

5.45 Respondents Opinion towards the Level of Motivation in 227 ABC Hospital

5.46 Respondents Opinion towards the Level of Motivation in 230 Gastro Care Hospital

5.47 Respondent’s Opinion towards the Level of Motivation in 232 KMC Hospital

5.48 Respondent’s Opinion towards the Level of Motivation in 234 Maruthi Hospital

5.49 Top three scores of facets of Motivation in Selected 237 Hospitals

5.50 Profile Analysis - Level of Job Satisfaction among the 238 Employees of Selected Hospitals

LIST OF FIGURES

Figure Page Title No. No. 1.1 Conceptual model of the study 19 2.1 Performance Appraisal System 54 3.1 Operational area of study 79 4.1 Managerial Skills 111 4.2 Performance Appraisal Techniques 122 4.3 Various stages of Career Planning and Development 126 4.4 Recognition and Reward 130 4.5 The Elements of Job Design 135 4.6 Motivational Determinants and Processes 139 4.7 Models of Job Satisfaction 146 5.1 Competencies of HR Professionals and their performance in Human 173 Resource Activities 5.2 Box plot - Dispersion of Gender on the basis of the opinion on 201 Recruitment and Selection 5.3 Pareto Chart- Respondents opinion towards the Level of Motivation 229 in ABC Hospital 5.4 Pareto Chart- Respondents opinion towards the Level of Motivation 231 in Gastro care Hospital 5.5 Pareto Chart- Respondents opinion towards the Level of Motivation 233 in KMC Hospital 5.6 Pareto Chart- Respondents opinion towards the Level of Motivation 235 in Maruthi Hospital 5.7 Profile Analysis - Level of Job Satisfaction among the employees of 239 Selected Hospitals

Chapter –––I–III

Introduction

CHAPTER – I

1.1 Introduction

1.2 Description of the research topic

1.3 Statement of the problem

1.4 Scope of the study

1.5 Objectives of the study

1.6 Hypotheses

1.7 Methodology

1.8 Sampling design

1.9 Pilot study

1.10 Sampling size

1.11 Questionnaire design

1.12 Conceptual model for the study

1.13 Tools for analysis

1.14 Limitations of the study

1.15 Chapterization 1

CHAPTER – I

1.1. Introduction

“If you wish to plan for a year, ‘Sow Seeds’;

“If you wish to plan for 10 years, ‘Plant trees’;

“If you wish to plan for life time, develop Men”.

One of the Chinese sayings goes like the above

Organizations are composed of people and they represent one of the most valuable assets of the organization. Since an organization claims to own capital and physical assets but not its people, this resource is seldom given proper attention. Thus Human Resources are the Bedrock for any organization to be successful (Jai Narain Sharma, 2002).

Within many Health Care Systems worldwide, increased attention is being focused on Human Resources Management (HRM). Human Resource

Management in hospitals have become a necessity to achieve utilization of

Human Resources, desirable working relationship among employees, individual employee development, high morale in the organization and continuous development and appreciation of Human Assets which depends on the effective implementation of HRM Practices in the organization. HRM

Practices to be carried out effectively which requires the competency of HR

Professionals who deal with the management of the human resource.

Lack of Human Resource Management capacity is one of the profound problems in all the health institutions. At the same time managing Human

Resource Management functions of health service institutions seems to be a neglected part, most of the human resource related activities are left to those who are not trained in managing human resource and also having other clinical responsibilities. This in turn, might result into mismanagement of the very scarce human resource in the health sector. Based on this fact, there is a need to professionalize this role and develop a cadre of well-trained Human Resource

Managers, especially in large and Specialized Hospitals. This would include expanding both the number of Human Resource Managers and the

Organizational view of their role, as well as updating their skills. These changes would enable Human Resource Managers to be more effective in leading and implementing positive solutions that in turn would improve the performance and satisfaction of employees. Therefore, this study is designed to explore the competencies required for HR Managers to implement the effective

HRM Practice which enhances the motivation and job satisfaction among the employees of Specialized Hospitals.

1.2. Description of the Research Topic

Human Resource Management (HRM) is concerned with the “people” in management. According to Armstrong (1987) functions of the Human

Resource Management are critically important and cardinal for the efficient and effective operation of a hospital as an organization.

According to Wendell L. French (1986), “Human Resource

Management is the systematic planning and control of a network of

3 fundamental organizational processes affecting and involving all organizational members. These processes include human resource planning, job and work design, job analysis, staffing, training and development, performance appraisal and review, compensation and reward, employee protection and representation and organization improvement”.

A HR manager in a hospital basically deals with staff, guides, and counsels and serves the line officers who include physicians, surgeons, radiologists, pathologists, anesthetietics, and matrons and so on, have direct responsibility for accomplishing the major objectives of the hospitals with the help of staff officers who comprise the Finance Officers, Accounts Officers,

Human Resource Managers and so on. Research in Human Resource

Management (HRM) has established that the success of any organization is highly influenced by the caliber of its Human Resource (HR), which in turn, is affected by the organization’s Human Resource Management Practices.

Armstrong (1987) further classifies responsibilities (activities) of HR

Managers in three general categories:

a) Service Provision

b) Advice

c) Guidance

a) Service Provision : The basic responsibility (activity) performed by

HR Managers is that of providing services to internal Customers (i.e.,

Management, line managers, team leaders, and employees). These Services

4 may embrace varied areas of HRM (i.e., HR Planning, recruitment and selection, and so on).

b) Advice : HR Managers provides advice on varied issues such as Job design, Safety and health requirements and the like. They perform the responsibilities of Counsellors and mentors as well as problem solvers by providing advice to individuals, team leaders and managers.

c) Guidance : The HR managers provide guidance to the management on

HR policies, procedures and implications of employee relations, pay increases, performance appraisal and so on.

Competencies of Human Resource Professional

HR competencies are said to be a set of characteristics contributing to the effective HR performance that enables an organization to carry out its strategies. Competencies are used in many facets of Human Resource

Management, ranging from individual functions such as recruitment and performance management to organizational strategic planning and design of organizational structure and culture. In general, competency is defined as a personnel related concept referring to a set of behavioral dimensions of one’s effective performance at work. Some authors suggest more precise definitions that describe competencies as the work-related personal attributes; knowledge, skills and values that individuals draw upon to do their work well.

Health reforms in the last 25 years focused largely on structural change, cost containment and the introduction of market mechanisms, and the

5 importance of the management of HR has often been overlooked. Pressures for efficiency and effectiveness are particularly pronounced in the hospital sector, which is the most resource-intensive component of the health care system. One important aspect of improving and maintaining service delivery in hospitals is, better to manage the HR function. At this point, the researcher realized the importance and complexities of HRM Practices developed by the HR

Professionals and does it influences the motivation and job satisfaction which are essential for the organizational performance in Specialized Hospitals at

Tiruchirappalli Corporation.

1.3. Statement of the problem

The world population for mid-year 2010, is estimated at 6.93 billion

(6,852,472,823) by the United States Census Bureau . Current Population of

India - India, with 1.21 billion (1,210,193,422) people is the second most populous country in the world (www.business-standard.com). The total population of Tamil Nadu comes around 7.21 Crores (7, 21, 38,958) as per the census calculation report 2011 (www.census2011.co.in). The population of

Tiruchirapalli as per the census calculation report 2011 is approximately

2,713,858 (www.census.tn.nic.in). Mortality rate (birth/death) of the world is

49.4 according to the United Nations and 42.09 according to the CIA World

Fact Book. Mortality Rate of India is 47.57 (2011) according to the CIA World

Fact Book. Mortality Rate of Tamil Nadu is 31 (Sample Survey Research,

2008). In Tiruchirappalli, Birth Rate (Per 1000 Population) is 16.6, Death Rate

(Per 1000 Population) is 5.8, and Infant Mortality Rate (Per 1000 Live Births) is 28.2. Life expectancy at birth total population is 66.8 years, for male 65.77

Years, female 67.95 years (2011) (www.indexmundi.com).

Life expectancy at birth is measure of overall quality of life in a country and summarizes the mortality at all ages. Life expectancy index is one of the three indices on which the human development index is built. Human

Development Index (HDI) is a composite index to measure the development of human resources in each country and four indicators are life expectancy, income per capita, the average number of years studying and the number of years of education. Development Goal is creating conditions where people can live long and healthy life, knowledge benefit, to enjoy a decent standard of living; and to participate in the decisions that affect them. Human Resource

Development Index as one of the important indicators of economic development for each country and is considered as effective role in economic development.

India ranks 119 on human development index while China ranks 89 on

Human development index between 169 nations in the United Nations. India, in some senses, faces an equivalent problem. Despite the fact that the country has experienced huge expansion in recent years and is usually painted as a people-friendly alternative to China, the U.N. report reveals that India has managed to improve the typical lifestyle expectancy of its citizens.

(www.worldexpojobs.com/human-resources/china-89th-india-119th-in-human- development-index-2.html)

Hence, areas that require to be addressed include the opening up of the hospitals. Traditionally, hospitals have been regarded as big institutions as a place for cure and can increase the life expectancy rate among the public which is one of the most important factor for the economic development. Hospitals are facing new and emerging threats – both man-made and natural – with increasing frequency. Some of these are foreseeable, such as floods, cyclone, earthquakes and conflicts, while others are emerging as new threat such as pandemics and the risk of chemical or nuclear fallouts. Thus, hospitals play a critical role in the event of a disaster and emergency. The performance of hospitals in any disaster situation does not depend upon only the surge capacity, but also it relate to the skill of employees at large, specially care givers. Hospitals must be able to effectively extend their ability to deliver uninterrupted medical care in the face of a prolonged event involving large numbers of victims. However, hospitals now need to re-think their traditional roles and look at aspects that they did not consider as part of health care.

Hence, the healthcare organizations like hospitals plays a vital role in providing a quality care to their patients for their long and happy life. In other words, the life expectancy or the mortality rates are given a prime importance as it is one of important indicator for the economic development.

Ageing populations place more demands on health services because of the increased livelihood of poor health associated with ageing. People of different classes, inspite of the constraints they opt to avail the services of the

8 hospitals for their healthy life. Unfortunately certain hospitals are not able to provide the quality healthcare services, because of the lack of Human Resource

Management. People management policies and practices influence the delivery of efficient, effective healthcare. Within a hospital, the competent HR

Professionals through the effective implementation of HR practices should make clear the employees about their roles and objectives and have their development needs met, are likely to perform their roles more effectively and thereby provide better patient care thus influencing patient mortality.

HRM Practices improve individual employee’s performance in ways that lead to reduced mortality. Employees with higher satisfaction levels leads to high performance and high employment security (which spills over into better patient satisfaction); and are therefore less likely to leave, leading to a retention of both human and social capital—vital in a context in which staff shortages are an international problem. Taken together these behaviors are likely to influence the quality of patient care and therefore patient mortality.

To address the above issues, research questions have been asked:-

1. What are the competencies required for HR in the Specialized

Hospitals?

2. How far the HR Professionals perform their activity in the Specialized

Hospitals?

3. What is the effective implementation of HRM Practices among the

selected employees in specialty hospitals at Tiruchirapalli Corporation?

4. What is the motivation level of the selected employees in specialty

hospitals at Tiruchirapalli Corporation?

5. Whether there is job satisfaction of the selected employees in specialty

hospitals at Tiruchirapalli Corporation?

Hence, this problem was initiated for the study on “HRM Practices in

Specialized Hospitals at Tiruchirapalli Corporation”.

1.4. Scope of the study

The outcome of the study will help Government, Hospital management and the society. The findings and suggestions made by the researcher will help to improve the standard of living of people in India. In other words, low rate of infant mortality, birth rate and death rate are the major economic facts which determine a countries economic growth and development. This idea posed by the enlightened citizens, such as the academicians, economic planners, political elites, technocrats, bureaucrats, social activists, media experts, development professionals and all other people who have enjoyed the fruits of the democracy forever is an unmixed blessing for the society and in turn the standard of living of the people will be in accordance to the standard maintained by the Indian Medical Association.

This study is much helpful to the policy makers in Specialized

Hospitals, as it focuses on HRM Practices through which the employees are well motivated and thus creates the satisfaction in work to provide better

10 quality care to their patients. It is proven fact all over the world that only satisfied employees can deliver quality services to their clients. It also reveals the competencies required for an HR Professional to develop the effective

HRM Practices for rendering quality services by the employees of all the cadres to their patients in the hospitals.

This study is much insightful to government hospitals where the least importance has been given to the HRM Practices. HRM systems are formulated at the organizational level, but experienced at both the individual and the team or group levels (e.g. individual appraisal; multidisciplinary team working). These would then lead to changes in the mediating variables at lower levels, such as the technical and interpersonal aspects of care. The effects of the mediators, however, would be felt at the organizational level in terms of the final outcome: patient mortality (Michael A. West et al. 2006).

1.5. Objectives of the study

The main objective of the study is to find out the HR Practices in

Specialized Hospitals at Tiruchirappalli Corporation.

The proposed project has the following specific objectives, such as

1. to find out the key competencies required by HR Professionals to

develop HRM Practices in Specialized Hospitals;

2. to explore the ability of HR Professionals in performing the Human

Resources Activity to develop the HRM Practices;

3. to expose the effective implementation of HRM Practices like

Recruitment and Selection, training and development, Staff promotion,

Performance Appraisal system and so on of the selected employees of

the specialty hospitals;

4. to examine the motivation level of employees of the selected employees

of the specialty hospitals; and

5. to know the job satisfaction level of the selected employees of the

specialty hospitals.

1.6. Hypotheses

The study is based on the following hypotheses

1. There is no significant association between the level of competencies of

HR professional and demographic factors such as age, years of

experience, education level and income of the HR professional-

respondents.

2. There is no significant association between Competencies of Human

Resource Professionals and performance of Human Resource

Professionals in Human Resource Management Activity.

3. There is no significant difference between the levels of competencies

among HR Professionals of all the four selected hospitals.

4. There is no significant difference due to gender towards various

dimensions of Human Resource Practices.

5. Domicile and HRM Practice level are independent. In other words

Domicile has no influence over the HRM Practice.

6. There is no significant difference between overall perception of various

dimensions of Human Resource Management Practices and different

groups of respondents based on educational qualification.

7. There is no significant association between experience of the

respondents and attitude of the respondents towards the various

dimensions of Human Resource Practices.

8. There is no significant association between Income of the respondents

and attitude of the respondents towards the various dimensions of

Human Resource Practices.

9. There is no significant association between age of the respondents and

attitude of the respondents towards the various dimensions of Human

Resource Practices.

10. There is no significant difference between the employee’s attitudes

towards the HRM Practices in all the four selected hospitals.

1.7. Methodology

The methodology for the study is analytical and descriptive keeping the objectives of the study in mind, both desk and field survey method has been adopted. The study is based on both primary data and secondary data. Primary data were collected with the help of interview schedule. The study covers HRM

Practices and the competencies of HR Professionals in Specialized Hospitals at

Trichirapalli Corporation. It also includes a survey of employees and HR

Professionals.

The survey targeted HR Professionals (and employees who combine the role of HR manager and their assistants) and employees in hospitals and was designed based on an extensive literature review. The survey also included questions for high level, middle level and low level employees other than HR

Professionals regarding the human resources practices in hospitals. The survey also addressed other issues such as the motivation and job satisfaction which were the most challenges in retention, for medical and paramedical staff.

The secondary data for the study have been collected from published sources and references have also been made to all these sources, important information pertaining to the study have been collected from different research journals, unpublished thesis and reports available at various libraries.

1.8. Sampling design

The Researcher had a discussion with the manager of Indian Medical

Association, Tiruchirapalli. As per Indian Medical Association report in

Tiruchirapalli Corporation; there are 197 hospitals, nursing homes and clinics.

Stratified random sampling has been adopted for which, the hospitals were stratified by size (number of beds) and no. of employees into the two categories: small (Less than 100 beds and employees), and large (100 and More than 100 beds and employees). Out of 197 hospitals, there are 40 hospitals

14 which have less than 50 beds and less than 100 employees. Only six

Specialized private hospitals which comprises of more than 100 beds and more than 100 employees. Then the researcher identified employees in the selected hospitals in these stratum. According to standard benchmark HR-to-employee ratio is 1.00 (one per 100 employees) for larger organization. (SHRM, Human

Capital Bench Marking Study, 2009). Hence there is a need for HR

Professionals where there are more than 100 employees. Among the six specialized private hospitals only four hospitals are satisfying the above conditions. The following are four Specialized Private Hospitals.

Selected Private Hospitals for the Study

a. ABC Hospital

b. KMC Specialty Hospital

c. MARUTHI Hospital

d. GASTRO CARE Hospital.

The above Specialized Hospitals are specialized in Cardiology,

Obstetrics and Gynecology, Elective Plastic Surgery services, Master health check up, 24 Hours services with more than 100 beds, and more than 100 employees.

1.9. Pilot Study

A pilot study was made by the researcher in the selected four hospitals to elicit the information on various aspects of HRM Practices. A draft

15 questionnaire was prepared for the purpose of pre-testing. The researcher selected at random 30 respondents for the pilot study after the collection of the data, the researcher checked the reliability of the data through cronbach’s alpha and the results confirmed that by a high consistency of 86.8 percent. The following were the chief identification by the pilot study:

1. It was observed by the researcher that, the meaning of the term Specialized

Hospitals and employees are as follows

Specialized Hospitals

Hospitals provide complete healthcare, ranging from diagnostic services to surgery, continuous nursing care, and specialized in Cardiology, Obstetrics and Gynecology, Elective Plastic Surgery services, Master health check up, 24

Hours services with more than 100 beds, and more than 100 employees.

Employees

Employees of the Specialized Hospitals were classified into three levels, high level, middle level and low level. Duty Doctors and Human Resource

Professionals come under High Level Employees. Front Office staffs,

Outpatient Staffs, Nursing (Matron, Staff nurses and Assistant Nursing maid),

Administration (Accounts Department), Lab Technicians, Radiologist and

Pharmacist come under Middle level Employees. Health Workers and House

Keepers come under Low Level Employees.

2. The researcher observed from the pilot study that the following Ten HRM

Practices implemented in the hospitals were (i) Recruitment and Selection,

(ii) Training and Development, (iii) Staff Promotion, (iv) Performance

Appraisal System, (v) Career Development, (vi) Incentives and Compensation,

(vii) Recognition and Reward, (viii) Flexibility Work Option, (ix) Job

Design and (x) Employee’s Participation.

3. The classification of employees is found out during the pilot study. The

classification is depicted in the table given below.

Table - 1.116 Classification of Employees in Selected Hospitals as on 31.12.2010

Category High Level Middle Level Low level Total Hospitals Sample Universe employees employees employees Sample no Sample no Sample no Total no of Total no of Total no of of employees of employees of employees ABC 10 8 194 129 46 13 260 150 Gatro Care 7 6 120 75 23 6 150 87 KMC 16 12 220 113 64 18 300 143 Maruthi 25 13 235 132 60 13 320 158 Total 1030 538

1.10. Sampling Size

The list of employees provided by the hospitals constitutes the universe

of the study. The total numbers of employees working in all the four

Specialized Hospitals are about 1030. Researcher met HR Manager of the

Hospitals for seeking the permission to take the survey from employees. Then,

17 the questionnaires were distributed to all the level of employees to fill in the questionnaire. Three reminders were given consecutively to collect the filled in questionnaire. 221 filled in questionnaires received back when the first reminder was given during the month of January 2011. Again 150 filled in questionnaires received back when the second reminder was given during the month of February 2011. After the third reminder around 167 questionnaires were received back during the month of March 2011. During the survey some of the employees were on maternity leave and some of them were on shift basis. Hence out of 1030 employees, the researcher was able to collect only from 538 respondents constituting 52 per cent of total employees.

1.11. Questionnaire Design

The questionnaire was framed for HR Professionals and to the

Employees of the Specialized Hospitals. The questionnaire framed for HR

Professionals, used a combination of open and close-ended questions to allow the HR Managers to better document their viewpoints regarding their competencies and their ability to perform Human Resource Activity, for this purpose HR Professionals (and those who combine the role of HR Manager and their Assistants) in hospitals were contacted. The questionnaire was divided into three parts. The first part of the instrument was designed to gather data on demographic and personal characteristics. The second part measures the competencies or skill, of the respondents. The respondents were asked to indicate their current level of competence in each dimension using a five-point

Likert type scale. The third part was designed to measure the respondent’s perceived ability to perform Human Resource Management Activities for developing the HRM Practices. The respondents were asked to indicate their ability to perform each activity using a five-point Likert-type scale.

The questionnaire framed for employees consists of four parts. The first part was designed to collect the data on demographic and personal characteristics. The second part is Human Resource Management Practice, which was used to measure Human Resource Management Practice. There are

35 items in the scale. The scale measures HRM Practices in terms of attitude towards HR department, recruitment and selection, training and development practices, performance appraisal practices, pay practices, and so on. The questionnaire was originally developed in English and then translated to Tamil for low level employees, as it is the primary language for the low level employees. The respondents were asked to indicate their opinion regarding the implementation of HRM Practices in each dimension using a five-point Likert type scale. The third part measures the level of motivation as perceived by the employees and the fourth part measures the level of satisfaction using the five point linkert Scale.

1.12. Conceptual Model for the Study

An attempt has been made in this research study to search the concept of effective implementation of HRM Practices in Specialized Hospitals. The intention in this work is to bring that only a competent HR Professional can

19 develop HRM Practices which results in motivation and job satisfaction among the employees and the end result is the organizational performance. This concept is depicted in the model given below.

Figure - 1.1 Conceptual Model

Competent HR Effective HRM Develop Professionals Practices s Enhances

Motivation of Job Satisfaction

employees of Employees

Organizational

performance

There is a positive and strong relationship between the effective implementation of HRM Practices, motivation and satisfaction among the employees resulting in the increased performance of the organization. The relationship is depicted in above model. Hence competent HR Professionals are needed to develop the effective HRM Practices and retain the employees in the organization for the delivery of quality services and thereby improving the organizational performance not only in the hospitals but also for the entire

Healthcare Industry.

1.13. Tools for Analysis

A database was created using Statistical Packages for Social Sciences

(SPSS). Data Editor with appropriate coding and statistical analysis was carried out. The following tools were applied to analyze the study.

(i) Spearman Correlation

Spearman correlation was used to test the relationship between the competencies of HR Professionals and demographic variable.

(ii) Regression Analysis

Regression analysis is used to find out the cause and effect relationship between the competencies of HR Professionals and the performance in HRM

Activity. In this research, Regression is used to find out the average relationship between two variables which are dependent on one another. The magnitude of one variable (dependent variable) is assumed to be determined by the function of the magnitude of the second variable (independent variable).

(iii) One – Way ANOVA (F test)

Analysis of Variance, abbreviated as ANOVA, was developed by

R.A. Fisher. It compares the variance between groups with the variance within groups. In this research one way ANOVA is performed to find out the significant difference between the competencies of HR Professionals of four selected hospitals and also used to test the effectiveness in the implementation of HRM Practices in all the four selected hospitals.

(iv) Box-plot Analysis

Box plot analysis was conducted to indentify the nature of data with reference to the employee’s attitude towards Human Resource Practices. It was non-symmetrical. Appropriate statistical tools were selected for further analysis.

(v) Mann – Whitney Test (or U test)

Mann – Whitney U Test is a non-parametric analog to the independent sample t-test. It is one of the known Non-parametric significance tests. In this research the Mann – Whitney U Test was applied to test the null hypothesis of whether two groups (male and female respondents) have identical thinking towards HRM Practices.

(vi) Chi-Square Test

The Chi-square is one of the simplest and widely used non-parametric tests in statistical work. Chi-Square, symbolically written as (χ2) is an appropriate test to find out the (i) the significance of association between two attributes (ii) test the homogeneity and (iii) to test the significance of population variance. Null hypothesis is that, the two attributes are independent.

In this research work the researcher has applied this test to find out whether the Domicile (rural or urban) of the employees-respondents has influence over the HRM Practice.

(vii) Kruskal-Wallis Test (or H test)

The non-parametric technique named Kruskal-Wallis test was used to test hypothesis for more than two groups. In this research, Kruskal-Wallis test is used to test the null hypothesis that whether there is significant difference between Overall perception of various dimensions of Human Resource

Management Practices and different groups of employees-respondents based on

Educational qualification.

(viii) Karl Pearson’s Correlation Co-efficient

The Correlation is a statistical tool which studies the relationship between two variables which are quantitative in nature.

In this research work the researcher has applied to find out change in income and age of the employees - respondents is found or apparently found to be associated with the change in the HRM Practices.

(ix) Pareto Chart Analysis

Pareto chart analysis was conducted to identify the level of motivation among the employees of selected hospitals. This theory of Pareto chart analysis provides guidance to evaluate the facets which contributes to the high level of motivation.

(x) Profile Analysis

Multivariate data analysis was used to deal with more than two facets of job satisfaction among the employees-respondents of four selected hospitals.

Profile analysis was conducted to know the high level of job satisfaction among employees of the four selected hospitals.

1.14. Limitations of the Study

1. Time factor is the major constraint and limitation of the researcher.

2. The respondents were employees of hospitals; hence it was difficult to

get the questionnaire filled by the employees who have night shifts.

3. The attitude of the employees towards HRM Practices may differ from

individual to individual. So opinion given by the employees may change

over time and situation.

4. The findings and suggestions of the study are confined only to Hospitals

in Tiruchirappalli Corporation area.

In spite of the above limitations, the researcher has taken a lot of efforts and has made sacrifices to achieve the objectives of the study.

1.15. Chapterization

The research study on “HRM Practices in Specialized Hospitals with special reference to employee’s perception in HRM Practices at Tiruchirappalli

Corporation” comprises of the following chapters.

The first chapter is an introductory chapter dealing with the

Introduction, Description of the Research Topic, Statement of the Problem,

Scope of the study, Objectives, Hypotheses, Methodology, Sampling Design,

Pilot Study, Sampling Size, Questionnaire Design, Conceptual Model for the study, Tools, Limitations of the study and Chapterization.

The second chapter deals with the Review of Literature.

The third chapter is the Profile of the Study Area and Specialized

Hospitals.

The fourth chapter deals with the competencies of HR Professionals and Human Resources Practices in hospitals.

The fifth chapter deals with the detailed Analysis and Interpretation of

Data.

The sixth chapter consolidates the Findings, Suggestions and

Conclusion.

References

1. Becker, Brain E., Huselid, Mark A, and Ulrich, Dave (2001). “The HR

Scorecard: Linking People, Strategy, and Performance”. Boston, MA:

Harvard Business School Press.

2. Jai Narain Sharma (2002), Human Resource Management, A Mittal

publication, pp195.

3. Michael a. West (2006), “reducing patient mortality in hospitals: The

role of Human Resource Management”, journal of organizational

behavior, (www.interscience.wiley.com). Doi: 10.1002/job.396.

4. Lawrence D. Prybil (2003), “Challenges and Opportunities Facing

Health Administration Practice and Education”, Journal of Healthcare

Management.

5. P. Subba Rao (2007), Essentials of Human Resource Management and

Industrial Relations, Himalaya Publishing House.

6. PG Aquinas (2006), Human Resource Management-Principles and

practice, Vikas publishing House Pvt. Ltd.

7. Powell, Jonathan (2007). “Fast-changing world of HR”. In Classified

Post. pp. 42.

8. S.P. Gupta (2007), Statistical Methods, Sultan Chand and Sons.

9. SHRM® Human Capital Benchmarking Study, 2009 Executive Summary.

10. www.business-standard.com, accessed 15 June 2011.

11. www.census2011.co.in, accessed on 17 July 2011.

12. www.census.tn.nic.in, accessed on 19 July 2011.

13. www.indexmundi.com, accessed on 21 July 2011.

14. www.worldexpojobs.com/human-resources/china-89th-india-119th-in-

human-development-index-2.html, accessed on 26 July 2011.

Chapter –––I–IIIII

Review of Literature

CHAPTER – II

2.1. Introduction

2.2. Significance of Human Resource Department in Hospitals

2.3. Competencies of Human Resource Professionals for implementing

effective Human Resource Management Practices

2.3.1. Relationship between HR Competencies and the demographic

factors

2.3.2. Relationship between HR Competencies and the HRM Practices

2.4. Human Resource Management Practices

2.5. Human Resource Management Practices and Motivation

2.6. Human Resource Management Practices and Job Satisfaction

2.7. Summary

CHAPTER- II

REVIEW OF LITERATURE

2.1. Introduction

The aim of any organization is to satisfy the employees with needs and wants. Thus proper Human Resources with efficiency and effectiveness should shoulder together to do the right things and to do the things right. Hence, research on HRM Practices in hospitals was carried out and it provides a timely examination of what might lead to better outcomes for employees and as a consequence, the organization.

An attempt has been made to review the research works already undertaken in the area of Human Resources Management. A review of selected studies has been given under different headings such as significance of Human

Resource Department in Hospitals, Competencies of Human Resource professionals for implementing effective Human Resource Practices, Human

Resource Management Practices, Human Resource Management Practices and

Motivation, Human Resource Practices and Job satisfaction.

2.2. Significance of Human Resource Department in Hospitals

The effective performance of an organization depends not just on the available resources, but its quality and competence as required by the organization from time to time. Various areas of management depend to a greater extent on the level of human resources development. The vitality of HR

28 to a nation and to an industry depends upon the level of its development. For the organization to be dynamic, growth-oriented and fast changing it should develop their HR.

Ethan A. Winning (2005) explains the necessities of HR Department.

From recruiting to orienting new employees, from writing job descriptions to tracking attendance, and from instituting and monitoring policies to monitoring benefits, there has been a need for an HR generalist to assist senior management in both establishing a structure to holding down costs of administration. As companies grow, there is a need to administer the HR function.

James Buchan (2004) examines broader evidence based on HRM in other sectors and examines some of the underlying issues related to good HRM in the health sector. It is not only the organizational context that differentiates the health sector from many other sectors, in terms of HRM. Many of the measures of organizational performance are also unique. "Performance" in the health sector can be fully assessed only by means of indicators that are sector- specific. These can focus on measures of clinical activity or workload (e.g. staff per occupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated) or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgery complications). The researcher also stresses the need for a "fit" between the HRM approach and the organizational characteristics, context and priorities, and for recognition that so-called

"bundles" of linked and coordinated HRM interventions will be more likely to achieve sustained improvements in organizational performance than single or uncoordinated interventions.

Thus the growing complexities of the organization necessitate the HR department for an organization. To administer the functions of HR department necessitates the HR Professionals. HR Professionals must be competent to implement the HRM Practices. Next review presents the competencies of HR

Professionals.

2.3. Competencies of Human Resource Professionals for implementing effective Human Resource Management Practices

In a dynamic environment, health managers need to combine leadership, entrepreneurial and administrative skills to meet the challenges that the changing socio-political, economic and technological landscape presents, as well as the expectations of patients, health professionals, politicians and the public.

Managers need to develop several competencies that will enable them to perform the functions effectively and efficiently in performing the Human

Resources Activities. Managerial competencies are ‘sets of knowledge, skills, and behaviors and attitudes that a person needs to be effective in a wide range of managerial jobs and various types of organizations’. The level of competencies among the HR Professional may be influenced by their demographic factors. Hence the relationship regarding HR Competencies and

30 the demographic factors are also considered for the study in addition to the relationship between HR Competencies and HRM Practices.

2.3.1. Relationship between HR Competencies and the Demographic Factors

Reza Tajaddini (2010) focused on the demographic factors and conceptual competencies. The results show that there are significant differences linked to gender, age, and management experience. Age and management experience are positively related to better technical, human and conceptual scores. Implications for educators, managers, and human resource professionals are presented.

Choi Sang Long, Wan Khairuzzaman Wan Ismail (2009) examines the relationship of demographic factors of HR Practitioners with HR

Competencies in the manufacturing companies of Malaysia. The findings show that the top rank HR Competencies are personal credibility and HR Delivery.

Furthermore, through spearmen correlation analysis, this study found that all demographic factors (HR experience, education level, salary and firm size) are significantly related to at least one HR Competency of this study.

Sunil J. Ramlall (2006) has examined the relationship between specific competencies and demographic factors like years of HR experience, education and compensation. The results showed that demographic factors influence the level of competencies.

2.3.2. Relationship between HR Competencies and the HRM Practices

Kassa Teshager Alemu M.A. (2011) investigated the competency gaps in HRM in the health sector in Ethiopia. The findings show that there is competency gap in HRM functions regardless of HR Managers high level of education in their respective clinical fields. On this ground, it has been concluded that hospital managers need additional HR related skills and knowledge to carry out these functions and therefore, an organized effort from the organization itself and other concerned bodies is of paramount importance to address this lack of HR management capacity.

Crouse, Paula (2011) examined the required competencies for effective

HRM Practice. Results indicated that major trends affecting HRM practice include shifting demographics, an orientation to an increasingly strategic role for HRM, and changing technology. Key roles identified by participants were internal consultant and strategic partner. Important competencies were described as technical, strategic, organizational management, interpersonal, and personal. Implications of these findings for HRM Practitioners are discussed.

Supic, Zorica Terzic (2010) explored the improvement of managerial skills of hospitals' top managers after a specific management training programme. Results after the training programme, all managers' skills had improved. The biggest improvement was in the following skills: organizing daily activities, motivating and guiding others, supervising the work of others, group discussion, and situation analysis. The least improved were: applying

32 creative techniques, working well with peers, professional self-development, written communication, and operational planning. Identified predictors of improvement were: shorter years of managerial experience, type of manager, type of profession, and recognizing the importance of the competencies.

Keith Townsend, Adrian Wilkinson (2010) highlights the importance and complexities of HRM in hospitals throughout the world. The findings shows that, one important aspect of improving and maintaining service delivery in hospitals is to better manage the HR function and this is possible only by a competent HR Manager.

Fadi El-Jardali, Victoria Tchaghchagian and Diana Jamal (2009) assessed the perception of HR Managers about the challenges they face and the current strategies being adopted, and also aims at assessing enabling factors including role, education, experience and HR training. The most frequently reported challenge was poor employee retention, lack of qualified personnel and lack of a system for performance evaluation. Some of the strategies used to mitigate the above challenges included offering continuing education and training for employees, improving salaries and developing retention strategies.

Hence the study concluded that, performance of Sound Human Resources

Management (HRM) Practices are based upon the level of competencies possessed by the HR Managers.

Choi Sang Long (2009) examines the vital competencies of Human

Resource (HR) Professionals in Malaysia. The competencies that are examined

33 in this study are business knowledge, strategic contribution, HR Delivery, and personal credibility and HR technology. The analysis revealed the

Competencies such as strategic contribution, business knowledge and HR technology have significant correlation with performance. Hence HR

Competencies those contribute to firm more effective performance.

Rubin Pillay (2008) aims to ascertain the skills and competency levels of hospital managers in South Africa and to determine whether there are any significant differences in competency levels between managers in different sectors. The results show that managers in the private sector perceived themselves to be significantly more competent than their public sector colleagues’ in most of the management facets. Public sector managers were also more likely than their private sector colleagues to report that they required further development and training.

Deb, Tepomoy (2006) being the conscience keeper for the organization,

HRD plays a pivotal role in making the employees adhere to ethical behavior in business through Training, Motivation and Education.

Khatri N., Wells J., McKune J., Brewer M. (2006) examines strategic

Human Resource Management (HRM) issues in a university and a community hospital. The findings indicate that the two hospitals lacked a clear understanding of their strategic intent and objectives; as a result, their Human

Resource (HR) Practices lacked coherence and direction. Whereas the community hospital understood the interrelationship between culture and

HRM, the university hospital did not. Moreover, the university hospital showed only a modest understanding of competencies needed in managing HR function, which hampered its ability to identify competent HR Managers and employees. The community hospital made significant gains in the past few years in managing its culture and people by recruiting a competent HR

Manager. The relationship between HR Practices and clinical outcomes was much less clear in the university hospital than it was in the community hospital.

Calhoun et al. (2004) assessed competencies which is a vital precursor to improve professional development and the alignment of individual development with the need of an organization or profession.

Travis et al. (2004) explains the importance of Human Resource

Management. Without good management, it is unable to improve efficiency, effectiveness and responsiveness in the delivery of health services or upscale interventions to achieve health goals.

Gough and Price (2004) explained the appropriate programmes based on the personal needs and experiences of health managers to train and to provide leadership and to ensure a sustainable improvement in the work context of health workers.

Lehman et al. (2002) explained the importance of HRM and competencies required for the HR Managers in Hospitals. Hospitals are important vehicles for the delivery of health care, and managers of these institutions are to a large extent responsible for operational visions and

35 objectives. However, despite the urgent need to develop managers in hospitals, it is important to identify the competencies that are important for effective health-care management as well as the proficiency of managers in these areas, as part of the overall management development process and in an effort to make training relevant.

William G. Wallick (2002) examined how competent are healthcare managers in carrying out the roles associated with organizational performance improvement. The results indicated that managers need to be knowledgeable about WLP roles and possess competencies associated with these roles to produce superior outputs for improved organizational performance.

Westera (2001) examined the competency-based approach to professional development which is well accepted in higher education and in human resource management literature where it is regarded as a critical part of the overall management development process, as it allows one to identify the gaps between current skills and the skills required.

James R. Lindner (2001) examined the perceptions of extension managers regarding their human resource management competencies and performance of human resource management activities. The study also sought to describe the relationship between human resource management competencies and performance of human resource management activities.

Because competencies establish the requirements needed to perform a job, competency models can be used: as an employee recruitment and selection

36 tool; as an employee assessment tool; as a tool to develop employee training and orientation curriculum; as a coaching counseling, and mentoring tool; and as a career development and succession planning tool. For competency models to be useful, competencies must be correlated to job activities. The findings revealed that there is a positive correlation between the competencies of managers and their ability to perform their human resources activities. The highest human resource management competencies were written comprehension, oral comprehension, written expression, information gathering, inductive reasoning, and problem sensitivity. Hence, it is concluded that only a competent HR Manager will be able to perform the human resources activities.

Henley (2000) has focuses on healthcare financial manager’s primary responsibility for spearheading corporate integrity programs that involve active participation of all managerial personnel. It is more important that all responsible persons in the organization recognize when conflicts may cause ethical standards to be breached, and help establish measures to prevent such breaches. Hence, the responsibility of ensuring ethical governance in business organizations is the major task of all managers.

Sunita Sigh, Sen Gupta (1999) has studied the competencies as the source of managerial effectiveness. Cultivating the competencies enhances individual and group effectiveness and lead to group headedness and a sense of psychological well-being. The overall findings indicate that given a supportive environment the employees in organizations would tend to use their competencies’ and thereby raise their effectiveness level to maximum.

Fraser Campbell (1999) presented the effectiveness indexing of HR

Managers. The method was qualitatively assessed through industry focus group and quantitatively validated through an empirical study. The measurement tool successfully measured each individual’s level of ability on each competence element and produced an individual effectiveness score for each manager. The application of the method resulted in the identification of three levels of effectiveness: a distinct and homogeneous “elite “group of very effective managers; a very low performing control group of former managers; and a group of managers that are adequately effective.

Ram Joshi (1995 ) explores into the personal and organizational factors contributing to managerial effectiveness. Data collected from two groups of

Managers - the effective and the “not-so-effective” revealed that on the whole a larger no of personality traits those organizational factors were found to be discriminating between the two groups. In general the effective managers were stable on their jobs, professionally qualified and satisfied with their careers.

Tsui & Ashford (1995) examined the relationship between four strategies for managerial response to the discrepancy expectations of constituents and managerial effectiveness as perceived by superiors, subordinates and peers. The findings of the study indicate that responsive managers make extra efforts to meet expectations of subordinates and they provide rational for their notable or not willing to comply with expectations.

Joshi, R.J. (1992) found that effective managers are participative than less effective managers. They are also younger having comparatively lesser working experience.

Das H. (1991) found that management as practiced in India is almost indistinguishable from the larger social role of the manager and training in leadership and interpersonal skills may be even more critical for managers operating in countries like India. They need skills to work, focus on producing results yet accommodate the needs of colleagues, friends and subordinates.

Skills in crisis management, employee counselling and oral communication may be critical to become an effective manager in the present day situation.

Michael, Maria and Henrik (1991) used a typology of managerial behavior developed by Luthans et al. (1998), manager and subordinate perceptions of managerial activities were obtained to ascertain the link between performances of these activities and perceived managerial effectiveness.

Disciplining and planning emerged as the most prominent contributors to subordinates ratings of section “effectiveness consistent with Luthans model of managerial effectiveness, perceived quality” and quantity of section functioning support the utilization of Luthans typology and highlight the importance of examining the differential impact of a range of manager activities on different facts of organizational effectiveness.

Valeri Stewart (1991) explores issues in training for managerial effectiveness, manager’s relative priorities, and direction of work in

39 organizations, organizational background and history and development of managerial training programmes.

Nwachukwu (1989) defined managerial effectiveness based on skills required at each level. At lower levels of management, technical skills are important; at middle management level, process skills are most essential whereas at senior level, conceptual skill is more relevant.

Warrier (1987) prepared case studies of six well known highly successful Indian managers. The objectives were to identify individual characteristics’ of successful managers. Some important characteristics’ perceived in these managers were the perceptions, work centrality, extra ordinary courage, democratic orientation and a contagious commitment.

Rao, Gangadhara (1986) emphasized the significance of HRD means building competencies, commitment and culture. All three are needed to make an organization function well. The culture provides the sustaining force for organizations.

The above review elucidated the importance of HR Manager in health care. This demonstrates the importance of managers in managing people effectively and implementing the HRM Practices. Effective leadership of teams is an important aspect in motivating and managing people and also important area for development in healthcare. Progressive HRM Practices in particular appraisal, identifying and meeting training needs, feedback on performance and

40 encouraging more team work, leads to improved performance of the employees. Thus effective implementation of HRM Practices by the HR

Professionals leads to high performance which is reviewed next.

2.4. Human Resource Management Practices

Sound Human Resource Management (HRM) Practices are essential for retaining effective professionals in hospitals and also for the effective performance of employees. Thus HRM strategies implemented by HR

Managers are becoming critical to the success of hospitals. The employee’s attitude towards the HRM Practices may be influenced by their demographic factors. In other words comparatively older and experienced employees may have the positive attitude towards the HRM Practices. The attitude of employee may differ from individual to individual with regard to the various dimensions of HRM Practices. This is evident from the review given below.

Alessandra Lazazara (2011) points up important implications for human resource professionals and employers with regard to how to implement the HRM Practices with regard to training for an ageing workforce scenario.

The demographic factor such as age is considered before providing the training opportunities. Further, though older workers enjoy fewer training opportunities, training is the most widespread policy for dealing with age discrimination.

Shubha Bhanu (2011) examines the impact of several demographic factors on the one of the HRM Practices, compensation of individuals and the gender wage differentiation, which prevails across the organizational sectors.

The majority of results indicate that on an individual level, the position in the organization, gender and age have a significant influence on compensation, whereas, factors such as education and ethnicity do not have any significant impact.

Dr. P.G. Arul (2011) identified the training needs of supervisors as one of the HRM Practices for interpersonal skills development and examines the influence of certain demographic factors on the training needs of supervisors towards interpersonal skills development.

Rosemont Boohene (2011) analyzes the resource management best practice principles in Graphic Communications Group Limited (GCGL) which is a state-owned entity. Its Human Resource Practices can be crucial to its performance. The purpose of this study therefore was to assess whether

GCGL’s Human Resource Management Practices, particularly recruitment and selection, performance appraisal, remuneration, and training and development practices influence its performance. Simple random sampling was used to select one hundred employees from GCGL. t-tests were carried out to examine the relationship between the selected HR Practices and corporate performance.

The results revealed that, from the perceptions of the respondents, there exists a positive relationship between effective recruitment and selection practices, effective performance appraisal practices and GCGL’s corporate performance.

Fraser Macfarlane (2011) has explored human resource practices in healthcare. Findings pointed out the five main approaches (“theories of

42 change”) as HRM Practices. They were adopted to develop and support the workforce: recruiting staff with skills in service transformation; redesigning roles and creating new roles; enhancing workforce planning; linking staff development to service needs; creating opportunities for shared learning and knowledge exchange. Each had differing levels of success.

Laura A Rowe, Sister Barbara Brillant, Emily Cleveland (2010) developed and implemented a 6-month training program in health management skills (i.e., strategic problem solving, financial management, human resource management and leadership) delivered by Yale University and Mother Pattern

College from Liberia, A self-administered survey was conducted of all participants completing the course to measure changes in self-rated management skills, the degree to which the course was helpful and met its stated objectives,

Respondents (n = 93, response rate 95.9 per cent) reported substantial improvement in self-reported management skills, and rated the helpfulness of the course and the degree to which the course met its objectives highly. Based on findings, the following suggestions were made. A framework of five elements for implementing successful management training programs that can be transferred and sustained in resource-limited settings, including: (1) short- course format focusing on four key skill areas with practical tools can be used;

(2) didactic training, on-site projects, and on-site mentoring can be included;

(3) collaboration with an in-country academic institution, willing and able to scale-up and maintain the training; (4) providing training for the in-country academic faculty; and (5) secure Ministry-level support to ensure participation.

Carl-Ardy Dubois (2009) had experiences the shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimize the available workforce and achieve the right number and mix of personnel needed to provide high-quality care.

Literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Review describes evidence about the benefits and pitfalls of current approaches to human resources optimization in health care. To conclude that in order to use human resources most effectively, health care organizations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organizational and institutional conditions.

Birgit Verworn (2009) reflected the demographic changes in the workforce which requires new Human Resource Management (HRM) strategies. The findings revealed that HRM strategies to be developed after considering the demographic factors of the work force.

Michael Haid (2008) addressing the four crucial HR Practices that the managers must have the skills to develop and implement the practices to motivate, guide, assess and to retain their teams. Four HR Practices— performance management, professional development, manager support and an organizational commitment to a larger social purpose. The practices were found to have a significant relationship to employees’ feelings of pride and satisfaction with the organization.

Ans De Vos (2008) has explored HR Managers' and employees' views on the factors affecting employee retention using the perspective of the psychological contract. The HR Managers survey indicates that retention practices focus more on the factors believed to cause employee turnover (career opportunities and financial rewards) than on those believed to affect employee retention (social atmosphere, job content, work-life balance). The focus on career opportunities is supported by the employee survey. The delivery of career opportunities had the strongest impact on employee loyalty while the impact of the delivery of financial rewards was much smaller.

Marie McHugh, Karen Johnston, Donna McClelland (2007) explores one issue relevant to Human Resource Management, that is, the management of hospital doctors in the NHS. The management of human resources is of crucial importance in enabling the delivery of efficient and effective services. Findings argued that HRM must play a pivotal role in the management of clinicians to ensure the effective and efficient delivery of NHS reforms. The challenges to

HRM and the medical profession that are inherent in this process are outlined.

Sharon C. Bolton (2007) examined the role of various management functions within the complex multi-layered and multi-faceted history and structure that is the National Health Service (NHS) hospital service and explore the legitimacy of the role of Human Resource Management (HRM). Qualitative research at an executive level demonstrates vocabularies of motives in action, where it appears that the role and status of HRM is potentially more dominant and influential in health sector.

Marie Dietrich Leurer (2007) explored the insights of experienced nurses regarding retention strategies. Seven retention strategies found are, consultation and communication with nurses, recognition, adequate staffing levels, supportive management, flexible work schedules, support for new nurses and professional development.

Anil Chandra Kumara (2007) provided a theoretical foundation and empirical evidence on the impact of HRM fit on Citizenship and Task

Performance (CTP) of employees. HRM Practices of the degree of formality of

HR planning and controlling procedures, whether pay increases are based on individual or group performance, and whether rewards are based on performance or qualifications and skills. Attention was also paid towards the identification of appropriate HRM Practices to be adopted in respective firms in order to enhance employees’ involvement. The appropriate practice to be adopted seems to be group plus individual performance-based pay increases in order to produce more positive CPTT. In this regard, it is suggested that qualifications and skills-based rewards system is appropriate to improve

Contextual Performance Towards Task (CPTT) and job.

Ghebregiorgis (2007) examines employee’s perception towards Human

Resource Management (HRM) and performance. It placed employees on a centre stage in analyzing HRM to provide theoretical insights. The findings indicate a positive attitude of employees to HRM Practices, such as promotion from within, staffing, equal employment opportunity, quality of training,

46 reasonable compensation and paid vacation and sick days. Moreover, the evidence also shows that productivity has been increasing while employee turnover, absenteeism, and grievances are low. However, the evidence also reveals that training was not integrated in a planned way to employee career development.

Margitta Beil-Hildebrand (2006) reported a case study in a German

Hospital and describes the implications that the “Management by walking about” approach had on healthcare employees. “Management by walking about” is widely seen as one of the favored procedures for increasing employee commitment and shared understanding as well as supporting high trust work relations. It concludes that that information on activities and planned face-to- face communication can have positive implications on employee attitudes to management-staff relations.

West et al. (2006) examined the relationship between the HRM system and patient mortality in 52 acute hospitals in England. It concludes that people management systems that emphasize a complementary set of “high involvement” HRM policies may be successful in contributing to high quality healthcare. This highlights that HR Practices and systems are associated with patient outcomes in health settings.

Ing-Chung Huang (2005) examined the effect of the demographic factors such as Marriage, gender, on the retention of employees. The HRM

Practices such as honored employee status, relative pay (both inter-firm and

47 intra-firm wages), speed of promotion, and economic cycles had a significant impact on how long the employees retained their jobs, but education level and individual performance did not. Due to the significant effects of individual- based factors, organization may endeavor to re-organize the compositions of workers’ various demographic characteristics through the HRM Practices like selection, training, and socialization. Only by the firm building up a supportive work environment and viewing their workers as important inputs, can it retain those workers of high human capital worth.

Edgar, F. & Geare, A. (2004) examined the relationship between HRM

Practices and the demographic categories of gender, ethnicity, age, occupation, length of service, and employment sector are examined. Findings indicate that employee demography, especially gender, ethnicity and employment sector, does influence employee attitudes towards HRM and should be given consideration in HRM research. The findings are discussed in terms of their relevance for the Asia Pacific region.

Guest and Conway (2004) conducted a survey on progressive HR

Practices. A composite measure of “good employer” was associated with higher levels of worker satisfaction, commitment, excitement, motivation and lower intention to leave. This highlights some of the characteristics associated with being a good employer and various outcomes, also highlights some of the unique characteristics of working in the NHS. It also included the health sector workers.

Srinivas R. Kandula (2003) observed that even through the objectives of HRM were the same across the organizations; they differed in their approaches and practices in attaining these objectives.

Claire Harris (2003) reviewed diverse literature, and to derive Human

Resource (HR) implications for healthcare researchers, policy makers and managers. The relationships have been found between a range of HRM

Practices, policies systems and performance. HRM Practices associated with patient outcomes such as mortality. HRM affects individual performance and its consequent impact on patient care. The paper shows that increasing autonomy for healthcare organizations in the UK, i.e. Foundation Trusts, may offer increased opportunity for locally tailored HR systems and practices.

Borrill et al. (2000) explored the links between team working and effectiveness in health care teams. In general these highlight the potential links between HRM Practices and systems of HRM Practices and various patient outcomes in the health sector.

Robert Wagner, Svatopluk Hlavacka, Ljuba Bacharova (2000) attempted to provide empirical evidence, in the context of acute hospital care, of the current human resource practices in the health sector of the Slovak

Republic. Using a sample of 72 acute care hospitals the research explored the perceived functions, typical customers and priorities of hospital human resource departments, ownership of a workforce plan, and the relationships between ownership of a workforce plan and type of hospital, as well as the

49 degree to which different human resource activities are given priority. Cross- tabulation procedure revealed statistically significant relationships between ownership of a workforce plan and the degree of priority given to having a quick, efficient and cost-effective recruitment and selection system and, the degree of priority given to ensuring that the human resource department has a workforce plan. It also indicates that, although the human resource staff in hospitals seems to be aware of their role in assisting hospital management in decision making, the human resource function in the Slovak hospitals still rather resembles that of a personnel administration than that of an important strategic human resource activity.

Sanrupt Misra (1992) dealt with the perspectives’ of HR and education, recruitment, Selection, induction and placement, Training and development of teaching personnel, their motivation and integration, Job satisfaction and performance appraisal and grievance handling.

Subbarao P. (1992) presented the various developments in HRM in a comprehensive form. An attempt was made to look into the current trends in the HR function with a view to outline the future development that were likely to take place in the years ahead.

Rao MG, Rao VSP & Rao PS (1991) analyzed various aspects of

HRM with special reference to the issues concerning Human Resources

Planning, Training, HRD, Industrial Relations, and Participative Management in public enterprises.

Singh JP (1989) explored that top management should examine the managerial culture of the group and the organization before introducing change through HRD interventions. Based on an analysis of 176 senior-level Indian managers significant differences was identified in the dimensions of culture among managerial groups categorized by sector (international, public and private) education and age. Based on their value, orientation, classified HRD interventions into three families and recommended the family of HRD interventions most suited to different cultural groups.

Ravishankar S. & Mishra R.K. (1985) provided an understanding system of HRM rather than merely the activities assigned to those who provided various personnel services for effective public enterprise management. A balanced and comprehensive grasp of the concept, problem, approaches and strategies of HRM was also given.

Thus Hospitals need effective Human Resources Management (HRM) to be able to deliver quality and safe care. According to evidence in the literature given above, effective HRM Practices lead to higher motivation and satisfaction. The next review focuses on the motivation as an outcome of the effective implementation of HRM Practices.

2.5. Human Resource Management Practices and Motivation

The implementation of HRM Practices influences the level of motivation. The various dimensions of the HRM Practices play an important role in increasing the level of motivation among the employees of Hospitals.

Hence it is the responsibility of HR Manager to motivate the employees through effective implementation of HRM Practices. This is evident from the review specified below.

Nils Gunnar Songstad (2011) explored health workers' experience of working conditions, and other HRM Practices linked to motivation to work.

The study emphasized the HRM Practices such as providing good working conditions, salary level, promotion, recognition of work experience, allowances and upgrading opportunities, were have been pointed out as a key factors in ensuring a motivated and well performing staff. The empirical focus is on rural public health services in Tanzania. It aims to situate the results in a broader historical context in order to enhance understanding of the health worker discourse on working conditions. Informants reported unfairness with reference to factors such as salary, promotion, recognition of work experience, allocation of allowances and access to training as well as to human resource management.

It also revealed that many health workers lack information or knowledge about factors that influence their working conditions. Thorough knowledge of health workers' experience of working conditions is needed to understand the determinants for motivation for work, and ultimately for the quality of health care. This study has focused on health workers' experience of working conditions in a rural district in Tanzania. The theme emerging across all cadres of health workers was dissatisfaction with the working conditions.

Katharina Janus (2010) explored the basic idea of pay for performance as one of the HRM tools for motivation of employees in health care. This

52 reviews the basic ideas of pay for performance (P4P) and its current challenges.

Taking into account HRM's experience (and evolution) in other industries, the interdependence and the impact of extrinsic and intrinsic motivators in health care are discussed. Suggestions are offered to manage motivation based on individuals’ intrinsic needs instead of relying solely on extrinsic motivators.

Inke Mathauer and Ingo Imhoff (2006) examined that; there is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. This shows that health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied Human Resources Management

(HRM) tools. The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. This entails acknowledging their professionalism and addressing professional goals such as recognition, career development and further qualification. It must be the aim of Human Resources

Management / Quality Management (HRM/QM) to develop the work environment so that health workers are enabled to meet their personal and the organizational goals.

Mrs. R. Nirmala (2004) focused on the interrelationship between social factors, work factors and leadership factors on individual work motivation. It

53 concluded that, Human performance = Ability to perform × Motivation to work. Hence it is the responsibility of every HR Manager to appreciate individual differences and use different styles to keep all employees well motivated to work.

Purcell et al. (2003) examined the impact of people management on organizational Performance, focusing on how and why the relationship exists.

11 Practices were identified in the model. The findings are drawn from case study Organizations, one being a clinical department in an NHS Acute Trust. It emphasized the importance of the line manager in “bringing policies to life”.

Within the health case study, found marked changes in employee attitudes in response to changes in people management practices and policies. Across the cases some HR policies and practices were shown to be important in terms of influencing outcomes such as commitment, satisfaction and motivation and these were those concerned with career opportunities, job influence, job challenge, training, performance appraisal, team working, involvement in decision making, work life balance and having managers who are good at leadership and who show respect. This explains some of the important aspects of HRM implementation and hence highlights “how” HRM policy is translated into practice for workers.

Nayak (2003) focused on the need for appraisal in an organization to identify ways of improving business performance through improvement in individual performance, to bring about a common understanding between the

54 employees achievements and job related behavior-assess the employee’s contribution and uses that as a basis for stimulating and supporting the employee’s development. It concluded that “Performance appraisal is one of the best methods for motivating the employees and their all round development and achievement of organizations objective.

Figure - 2.1 Performance Appraisal System

Increase motivation Organization Retain Top talents

Develop employees Objectives of PAS Improve Performance Ensure accountability and Ownership

Employee’s Enhanced transparency

The main objective of PAS is to improve the performance of the organization through improved employee performance.

Whyte William (1996) observed that money was no longer a motivating factor, also it was found that power was the most important motivational tool – the power to set goals and standards, to regulate the working methods and to have a role in determining rewards.

Omer Bin Sayeed (1989) found that a positive management and worker relationship among individuals exist besides demographic and career factors and concluded that fringe benefits are more important in inducing the organization commitment than salary.

Thus the HRM Practices play significant role in increasing the motivation. Both motivation and satisfaction found to play important role in predicting work performance among the employees. Job satisfaction found to be significantly and positively related to work motivation which is presented in the next review.

2.6. Human Resource Management Practices and Job Satisfaction

A satisfied human resource is valuable and has no alternative. Human beings’ needs are dynamic and therefore to satisfy those, the Health care organization has to be dynamically thinking . The following reviews investigate the level of job satisfaction in relation to the various HRM Practices implemented in the organization. The effective implementation of HRM

Practices by the HR Professionals strongly associates with the job satisfaction and this is evident in the reviews given below. Hence the HR Manager through

HRM Practices can create job satisfaction among the employees.

Ravichandran (2011) proposes a conceptual model which links structural features and HR systems and practices to various outcomes.

Proposed model indicate that there was relationship between HRM Practices and job satisfaction which in turn to both organizational and individual outcomes such as intention to stay and employee turnover, performance, and absenteeism.

Hamdia Mudor (2011) attempts to propose a conceptual framework consisting of three Human Resources Management (HRM) practice (supervision,

56 job training, and pay practices), job satisfaction, and turnover, and explain the relationships among these variables. Job satisfaction played an important role to employees’ turnover because it would lead employee resigned when their job satisfaction is low. The results indicate HRM Practice a positively and significantly correlated with job satisfaction. Job satisfaction can reduce turnover of employee when there is high job satisfaction, vice versa. Thus, the organization needs to take a consideration about job satisfaction and apply

HRM Practice in the workplace in order to reduce turnover and gain the organization goals.

Carol Atkinson, Laura Hall (2011) aims to explore the influence of flexible working on employee happiness and attitude, and the role of this within a high performance work system (HPWS). – Employees perceive that flexible working makes them “happy” and that there are attitudinal/behavioral links between this happiness, discretionary behavior and a number of performance outcomes. There may be a need for organizations to focus more on employee happiness to encourage performance. HR Practitioners could reflect on the impact of HR Practices on happiness and which features of a job role are likely to promote job satisfaction.

James Buchan (2010) examines the issue of workforce stability and

turnover in the context of policy attempts to improve retention of health

workers. There are significant benefits to support policy makers and managers

to develop a broader perspective of workforce stability and methods of

monitoring it. The objective is to develop a better understanding of workforce

stability as a major aspect of the overall policy goal of improved retention of

health workers. This examines some of the limited research on the complex

interaction between staff turnover and organizational performance or quality

of care in the health sector, provides details and examples of the measurement

of staff turnover and stability, and illustrates an approach to costing staff

turnover. It concludes by advocating that these types of assessment can be

valuable to managers and Policy makers as they examine which policies may

be effective in improving stability and retention, by reducing turnover. The

very action of setting up a local working group to assess the costs of turnover

can in itself give managers and staff a greater insight into the negative impacts

of turnover, and can encourage them to work together to identify and

implement stability measures.

Ekaterini Galanou (2010) examined the correlation of the rewards systems and job satisfaction, based on a qualitative research. An attempt is also made to identify differences in rewards systems and the extent to which these differences influence job satisfaction among people in different organizational level. Qualitative evidence was found for the aspects of satisfaction in accordance with different kinds of rewards, focusing on the four hierarchical levels of an organization. One of the challenges of the study and its strength is the transitional stage that the organization is in, and the sub-cultures that have been created. Future research should measure crucial factors as behaviors,

58 attitudes, performance and how these results can be linked to contextual elements and to employment performance. This study contributes to increase job satisfaction awareness, which is important for organizational development.

Suzanne Young (2010) aims to explore the attitudes of managers and employees to high performance work practices (HPWS) in a medium sized rural Australian hospital. Findings indicate that managers play a key role in building social identification within the team and that organizations need to understand this role and provide recognition, reward, education and support to their middle and lower employees.

Persefoni Lambrou, Nick Kontodimopoulos, Dimitris Niakas (2010) investigated how medical and nursing staff of the Nicosia General Hospital is affected by specific motivation factors, and the association between job satisfaction and motivation. Furthermore, to determine the motivational drive of socio-demographic and job related factors in terms of improving work performance. It revealed that achievements were ranked first among the four main motivators, followed by remuneration, co-workers and job attributes. The factor remuneration revealed statistically significant differences according to gender, and hospital sector, with female doctors and nurses and accident and emergency (A + E) outpatient doctors reporting greater mean scores. The medical staff showed statistically significantly lower job satisfaction compared to the nursing staff. Surgical sector nurses and those greater than 55 years of age reported higher job satisfaction when compared to the other groups. The results are in agreement with the literature, which focuses attention to

59 management approaches employing both monetary and non-monetary incentives to motivate health care professionals. Health care professionals tend to be motivated more by intrinsic factors, implying that this should be a target for effective employee motivation. Strategies based on the survey’s results to enhance employee motivation are suggested.

Muhammad Masroor Alam, Jamilha Fakir Mohammad (2009) investigates the level of job satisfaction in relation to the various HRM

Practices implemented in the organization and intent to leave among Malaysian nurses. Findings, suggested that the nursing staffs were moderately satisfied with their job in all the six facets of job satisfaction i.e. satisfaction with supervisor, job variety, closure, compensation, co-workers and HRM / management polices and therefore exhibits a perceived lower level of their intention to leave the hospital and the job.

Jimmy Peltier and Andy Dahl (2009) explored the satisfaction of employees in a major urban hospital. The impact of human resource management practices such as employee engagement and empowerment on employee satisfaction and retention has been provided.

Liz Lee-Kelley (2007) demonstrated a relationship between learning organization theory and the potential to retain knowledge workers. It emphasizes that Human Resource (HR) Managers must recognize specific relationships between learning organization elements, job satisfaction facets

(comfort, challenge, reward, relation with co-workers, resource adequacy and

60 promotion) and turnover intent as they emerge for their knowledge workers.

Analysis of the survey showed evidence of a relationship between learning organization disciplines and turnover intent. All the learning organization disciplines discussed is correlated to at least one of the six job satisfaction dimensions, of which reward and challenge exerted the most significant influence upon turnover intent. This emphasizes that HR Managers should recognize specific career needs for their knowledge workers and that adopting appropriate strategies will increase retention.

Marina Kaarna (2007) evaluated the level of job satisfaction among the staff of parnu country hospital and to describe the variables related to job satisfaction. Job satisfaction items and other four items were selected as dependent variables. The independent variable consisted of a knowledge in planning) Relationship with Superior, Strategic knowledge of workplace,

Collegial relationship, Discussions with colleagues, Recognition, Sense of belonging. The key results of the study are the job satisfaction is moderately high. However there are significant differences in the correlations between the job satisfaction and the independent variables among the group of personnel. the findings of the study suggested that the HR Managers should (a) build up an effective relationship between them and subordinates (b) identify the negative working conditions which affect the staff, (c) appropriately delegate authority to his employees, (d) Keep the staff informed about the changes that will affect them, (e) express appreciation and recognition for the efforts of staff

61 members in accomplishing the work of heath care organization. In doing this the HR Managers will create a favorable working environment for hospital staff.

Syed Moshfiqur Rahman, Nabeel Ashraf Ali (2006) investigated reasons for high rates of Community Health Workers (CHW) attrition

(reduction in membership as through resignation) in Sylhet District in northeastern Bangladesh. Factors contributing to attrition included heavy workload; night visits, working outside of one’s home area, familial opposition and dissatisfaction with pay. This resulted the Motivation, appeared to be primarily important factor for self-development, to improve community health, and for utilization of free time. The most common factors cited for continuing as a CHW were financial incentive, feeling needed by the community, and the value of the CHW position in securing future career advancement. It concluded by motivating the CHW, the rate of job satisfaction can be increased and thereby reduce rate of attrition.

Steve Bradley (2004 ) investigated the relationship between Human

Resource Management (HRM) Practices and workers' overall job satisfaction and their satisfaction with pay. After controlling for personal, job and firm characteristics, it is shown that several HRM Practices raise workers overall job satisfaction and their satisfaction with pay. Satisfaction with pay is higher where performance-related pay and seniority-based reward systems are in place. Although HRM Practices can raise worker job satisfaction, if workplace

62 pay inequality widens as a consequence then non-union members may experience reduced job satisfaction.

Cowin, (2002) elucidate the concept of Job satisfaction. It is an elusive concept, which is defined within its extrinsic and intrinsic values. Extrinsic values encompass the tangible aspects of the job including wages, benefits and bonuses, whereas intrinsic values include status, recognition, personal and professional development, opportunities and other similar factors.

Tzeng, H.M. (2002) examined the impact of working motivational factors as well as job satisfaction factors as independent variables on nurse’s intention to leave in cross-sectional study in Taiwan. It found that low levels of motivation, emotional exhaustion and burnout and to the poor social image of the nursing profession influenced nurse’s intention to leave in Taiwan’s hospitals. Therefore it suggested that job satisfaction is a multi-faceted construct and should have both intrinsic as well as extrinsic factors to measure job satisfaction.

Pearson and Chong (1997) also examined the impact of job content and job information on organization commitment and job satisfaction among

Malaysian nurses in large public sector hospital. They found that job information is stronger predictor to nurse’s job satisfaction and therefore intrinsic factors such as job information and organization commitment also influence nurses job satisfaction.

Margaret Patrickson and Janny Maddern (1996) investigated the organizational responses to such pressures by four major South Australian hospitals and the level of involvement of hospital human resource staff in the staffing issues associated with strategic planning. With one exception, there was little contribution from qualified human resource professionals to staffing decisions involving medical and nursing personnel and little value was placed on their potential input by other professional groups. If suggested by writers on strategic human resource management, human resource practice is moving toward a more strategic approach, then there is a large credibility gap for human resource staff to overcome within the South Australian health service.

Ashok Gagate (1995) evaluated influential factors of white collar professional employee’s perception on job satisfaction. The influential factors include compensation, personal growth, job security and advancement of fair company policies. The result revealed that there were no significant differences in factors as perceived by professional employees belonging to different races, age groups and gender.

2.7. Summary

From the above review of literature it is concluded that only a competent, experienced HR Manager can motivate the employees and retain them in the organization with high satisfaction level through the implementation of HRM Practices effectively which results in improvement of the organizations performance.

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Chapter ––– IIIIIIIII

Profile of the Study Area and Hospitals

CHAPTER - III

3.1. A profile of Tiruchirappalli Corporation

3.2.1. History of Tiruchirappalli

3.2.2. A Panoramic vision of Tiruchirappalli

3.2.3. Hospitals in Tiruchirappalli Corporation

3.2. Profile of the Hospitals

3.2.1. ABC Hospital

3.2.2. Gastro Care Hospital

3.2.3. KMC Speciality Hospital

3.2.4. Maruthi Hospital

CHAPTER – III

PROFILE OF THE STUDY AREA AND HOSPITALS

3.1. A Profile of Tiruchirappalli Corporation

In this chapter an attempt is made to describe the existing profile of

Tiruchirappalli Corporation. This section deals with the location, population and hospitals. Tiruchirappalli Corporation comprises 65 wards and four

Administrative Zones: Sri Rangam, Ariyamangalam, Golden Rock and

Abhishekapuram.

3.1.1. History of Tiruchirappalli

Tiruchirappalli is one of the oldest inhabited cities in Tamil Nadu.

Woraiyur, which served as the capital of the Early Cholas from the 3rd century

BC to the 3 rd Century AD is a suburb of present-day Tiruchirappalli. This is supported by archaeological evidences and ancient literatures. There are also literary sources which tell that Woraiyur continued to be under the control of

Cholas even during the days of Kalabhra interregnum (A.D. 300 - 575). The oldest human-built dam, Kallanai, was built by Karikala Cholan across the

Cauvery River about 10 miles from Woraiyur.

One famous landmark in Tiruchirappalli is the Rock Fort, a big outcrop of rock, 83 meters in height. It is the only such outcrop of its kind. Because of it Trichy is also called as Rock City. On top of it is the Ucchi Pillayar Koil, a temple dedicated to the Hindu god Vinayaka (Ganesh), from where one can 78 enjoy a panoramic view of Tiruchirappalli. The temple was also used as a military fort by the Nayaks for some time. It is one of the most famous temple town of Tamil Nadu. It is the fourth largest town of Tamil Nadu. The important temples are Rock Fort Temple, Ranganathaswamy Temple and

Jambukeshwaram Temple.

3.1.2. A Panoramic vision of Tiruchirappalli

Tiruchirappalli also called Tiruchi or Trichy is a city in the Indian state of Tamil Nadu and the administrative headquarters of Tiruchirappalli District.

It is the fourth largest municipal corporation in Tamil Nadu and also the fourth largest urban agglomeration in the state. Tiruchirappalli is not only the important town in the district but also a Regional Metropolis extending its influence in many fields. It is situated at a distance of 325 kilometers (202 mi) south of Chennai and 402 kilometers (250 mi) north of Kanyakumari on the National Highway NH 45; it is located almost at the geographic centre of the state. The population of Tiruchirapalli as per the census calculation report

2011 is approximately 2,713,858 (www.census.tn.nic.in) . Tiruchirappalli, rock city is situated on the banks of river Cauvery. Trichy is a fine blend of temples and monuments and is a great travel destination. Dominated by the granite rock soaring 84 meters into the skyline, Trichy also hosts the Golden Rock

Locomotive Workshop, an Ordinance Factory, and NIT (National Institute of

Technology) - Tiruchirappalli was for some time under the Mughal rule.

Tiruchirappalli Corporation at the geographical center of state of Tamil Nadu with following set up. 79

Figure - 3.1 Operational Area of Hospitals

3.1.3. Hospitals in Tiruchirappalli Corporation

Tiruchirappalli has a great importance in Health Care industry, as it has

Government Head Quarters Hospital, Government Medical College, Bharat

Heavy Electricals Limited Hospitals, TB Sanatorium, Railway Hospital and leading private hospitals. As per Indian Medical Association report (2010), in

Tiruchirappalli Corporation; there are around 87 Hospitals, 57 Nursing Homes and 53 Clinics. Among 87 hospitals, there are about four specialty private corporate hospitals.

3.2. Profile of the Hospitals 3.2.1. ABC Hospital

Assured Best Care Hospital is a 100 bedded comprehensive multi specialty facility with a competent team of more than 25 dedicated doctors.

Other than doctors 300 employees are employed in this hospital. All the major specialties are headed by full time well qualified and experienced consultants.

Quite a number of doctors have international experience in treating patients.

The hospital is ideally located in the heart of the city in close proximity to the bus stand. Aesthetically designed and equipped with state of the art equipment comparable to any world class hospital, our stringent quality assurance ensures reliable and accurate test results.

It is worthwhile to mention the ABC offers the best in class patient care, medical ethics and academics. The medical team at ABC continues to provide excellent clinical care, consultancy engaging itself in the adoption and 81 implementation of advanced and updated technology to help patients reach new levels of function and recovery.

As part of our commitment to health awareness they frequently conduct preventive and primitive health education programs focusing on early detection and treatment of diseases.

ABC believes in the collaborative model of health care delivery which includes the specialists, patients and family, in order to ensure a holistic and complete pattern of recovery. Medical care is delivered with an emphasis on education. The doctors and paramedical team are committed to setting high standard of excellence in patient care.

Slogan

“Reanimate Life”

Facilities Available

Anesthesiology and Critical Care

Accident and Emergency

Cardiology

Colo – rectal Surgeries

Gastro Enterology (including Hepatology and all endoscopic

procedures)

Gynaeclogy and Obstetrics, Infertility Clinic – New born Unit

Facio Maxillary Surgeries 82

General medicine and Diabetic Clinic

ENT

Kidney Care (Dialysis and Kidney transplant)

General Surgery and Laparoscopic Surgeries

Neuro – medicine (Epilepsy, Head ache Clinic, stroke management and

all Neuromedical emergencies)

Neuro – Surgery (Head injury, Brain tumor & Spine Surgery)

Orthopaedic Surgeries (Including Hip & Knee Replacement)

Paediatric Medicine and Paediatric Surgeries

Urology

Pulmonology

Physiotherapy

Physiotherapy (Rehabilitation Service)

Satellite Blood Bank

Pharmacy

24 hours Lab Service

Restaurant

Health Check up

Psychiatry and Diet Counseling

Diagnostic video Endoscopy- Upper GI and Lower GI.

Therapeutic Endoscopy Upper GI and Lower GI.

Endoscopic Retrograde Cholaingio Pancreatography (ERCP). 83

Ultrasound Scan.

Major Gastro Surgical work (Oesophageal, Hepatobiliary & Pancreatic

surgeries).

Cardiology

Cardiac interventions

Advanced Facilities including Holters Machine, ECHO and Treadmill

Test.

Dedicated staff and doctors providing tireless round the clock service.

Well Equipped ICU and Triage.

Vision of Advance Cardiothoracic Surgical Unit.

Obstetrics and Gynecology

• Regular antenatal service at an affordable cost

• Pain free labour – epidural labour analgesia

• Counseling and management of recurrent pregnancy loss

• Effective preterm labour management

• Management of all medical and surgical problems associated with

pregnancy

• Evaluation and management of primary and secondary amenorrhoea

• Surgical management of post hysterectomy vault prolapsed including

colopexy

• Cancer detection including pap smears and hysteroscopic guided biopsy. 84

Pediatric

Pediatric Medical Facilities

• Neonatal Intensive Care Unit

• Pediatric Intensive Care Unit

• Pediatric Surgical Care Unit

• Basic Pediatric Care Ward

• Pediatric Clinic for Asthma and Immunization.

Diabetology

The Diabetology Team:

• Nephrologists

• Cardiologist

• Ophthalmologist

• Diabetology

• Obesity Surgeon

• Pediatric Surgeon

Nephrology and Urology

The department has modern facilities to manage all types of kidney diseases like failure, kidney stones and uro-oncology.

Highlights

• Sophisticated equipment including dialysis units and uro-dynamic

diagnostic. 85

• ESWL to treat kidney stones with minimal discomfort as an outpatient

procedure.

• Urinary stone-managed by non operative treatment like shockwave

lithotripsy

• Minimally invasive treatment like key hole surgeries with PCNL

(Percutaneous Nephro Lithotommy) and URSL (Uretero Renoscopic

Lithoclasty).

• Comprehensive work up.

3.2.2. Gastro Care Hospital

Gastro Care Hospital is a tertiary care 110 Bedded Specialty Hospital for treating patients with all gastro-intestinal diseases, Intensive Medical Care,

General Surgery, Orthopedics, Cardiology, Urology and Nephrology. About

150 employees are employed in this hospital. We have got all investigations to diagnose the digestive diseases. Certain investigations and surgeries are done exclusively in our centre. The capsule endoscopy is one such investigation, which is available only in our hospital in entire south Tamil Nadu. All major gastrointestinal surgeries like esophageal, pancreatic, hepatic and glad bladder surgeries have been done. Surgeries are done for all gastrointestinal cancers also.

This is the only centre in Tiruchirappalli in which all therapeutic endoscopic procedure is done. We are already in the panel of BSNL, ICICI,

Star Health (including Tamil Nadu Govt. Employees Health Insurance scheme 86 for working and retired as well as chief minister’s Kalaingar Insurance Scheme for Life Saving Treatments - “Kalaingar Kapeetu Thittam”), TTK Health care and most of the other TPAs and treating various claim patients / Health card holders and got Income Tax approval.

Slogan

“Care to Cure”

Specialties

• Gastro-Enter logy

• General Medicine

• General surgery

• Intensive Medical Care

• Urology

• Nephrology

• Orthopedics.

• Cardiology.

• OBS & Gynecology

Others

• Radiology & Imaging

• Pathology

• Micro Biology

• Physiotherapy 87

Facilities Available

1. Diagnostic video Endoscopy- Upper GI and Lower GI.

2. Therapeutic Endoscopy Upper GI and Lower GI.

3. Endoscopic Retrograde Cholaingio Pancreatography (ERCP).

4. C-ARM for interventional pancreatic – biliary procedures.

5. Ultrasound Scan.

6. Capsule Endoscopy (1 st in South Tamil Nadu).

7. Hi-tech Laparoscopy Unit.

8. Advanced harmonic scalpel.

9. Major Gastro Surgical work (Oesophageal, Hepatobiliary & Pancreatic

surgeries).

10. Intensive Gastro Care Unit.

11. Master Gastro Health check up.

12. Gastro Cancer Health check up.

13. Two Major and Minor OTs.

14. Ortho, Plastic, Gynae and Neuro surgeries.

15. Basic Health Check up.

16. Standard Health check up.

17. Separate Ortho Block.

18. Echocardiography and Color Doppler.

19. Treadmill.

20. Dialyzer Unit-7 88

21. Digital X-RAY.

22. Autoclave and ETO machines

23. 24 hours Blood Bank

24. 24 hours Bio-chemistry lab

25. 24 hours pharmacy

26. 24 hours Ambulance and Taxi Facility.

3.2.3. KMC Hospital

Kavery Medical Centre and Hospital is a 400 bedded comprehensive multi specialty facility with a competent team of more than 100 dedicated doctors. Other than doctors 300 employees are employed in this hospital. All the major specialties are headed by full time well qualified and experienced consultants. Quite a number of doctors have international experience in treating patients.

The hospital is ideally located in the heart of the city in close proximity to the airport, railway junction and the main bus stand. Aesthetically designed and equipped with state of the art equipment comparable to any world class hospital, our stringent quality assurance ensures reliable and accurate test results.

It is worthwhile to mention the KMC offers the best in class patient care, medical ethics and academics. The medical team at KMC continues to provide excellent clinical care, consultancy engaging itself in the adoption and 89 implementation of advanced and updated technology to help patients reach new levels of function and recovery.

As part of our commitment to health awareness they frequently have health education programs focusing on early detection and treatment of diseases.

KMC believes in the collaborative model of health care delivery which includes the specialists, patients and family, in order to ensure a holistic and complete pattern of recovery. Medical Care is delivered with an emphasis on education. The doctors and paramedical team are committed to set high standard of excellence in patient care.

Vision

To make Trichy the best Health Care destination in the southern region.

Motto

Their motto is not just treating illness or ailments but adding value to a person’s life but not just in terms of adding years but quality of life.

Hope

KMC hopes to showcase Trichy as an ideal health tourism destination in the coming years.

Slogan

“People caring for people”. 90

About the Managing Director

• Dr. S. Chandrakumar is a leading Anesthesiologist, with over 18

years of reputed clinical experience and managing multi specialty

hospitals

• One of the 5 members of CII health care panel of Tamil Nadu and

present vice chairman of Trichy CII health care panel. Life member in

Indian medical council and Indian society of anesthesiologists.

• He has been selected as one of the top 101 entrepreneurs by the

confederation of Indian industry for year 2007-2008.

• He has been awarded as one of the young Turks of Trichy zone 2008 by

Periyar Maniammai Trust.

• Founder and managing director of the multi- specialty hospital which

has 400 beds in Trichy with renowned brand value.

Medical Facilities Available

• General Medicine

• General Surgery

• Obstetrics & Gynecology

• Pediatrics &Neonatology

• Orthopedics

• Diabetology

• Dental

• ENT 91

• Dermatology

• Ophthalmology

• Toxicology

• Physiotherapy

• Chest Medicine

• Psychiatry

• Radio Diagnosis

• Cardiology & Cardiac Surgery

• Nephrology

• Neurology& Neuro Surgery

• Radiation Oncology

• Medical Gastroenterology

• Surgical Gastroenterology

• Surgical Oncology

• Urology

• Pediatric Surgery

• Plastic Surgery

• Facio Maxilliary Unit

• Hand Surgery

• Burns Unit

• Endocrinology 92

Other Services Hospital on Wheels

The ambulance has modern ambulatory Cardio Pulmonary Resuscitation

(CPR) Equipment, Ventilators, Defibrillators, Centralized Oxygen, suction and all life saving drugs. This is an ideal choice for transportation of seriously ill patients.

Corporate approvals

It is an approved hospital for the state and central government employees and also approved centre for various public sector under takings, insurance companies and TPA.

Health Check up Programmes

Health is not merely an absence of diseases, but it is related to quality of life instead heart diseases, cancers, diabetes, abnormal blood pressure, abnormal cholesterol, thyroid problems, kidney problems, osteoporosis and other diseases could be detected at early stages through regular screening programs even though these disease may not have symptoms in the early stages.

The focus on preventive health care, they have different health check up packages customized to address different disease risk profile, age and gender.

This allows for selection of a cost-effective packages suited to individual’s 93 need. Personalized care and highly qualified and experienced professionals recommendations are delivered on the same day.

Packages

• Basic, standard and executive health check up

• Perfect heart health check up

• Cancer health check up

• Child health check up

• Diabetes: Basic standard and comprehensive health check up

• Obesity health check up

Health Tourism

KMC has a well trained team, supported by expert consultants in tourism and health care, to cater to the medical needs of their patients from

Srilanka, Thailand, Singapore, Middle East and other Asian countries and developed nations such as UK and US.

3.2.4. Maruti Hospital

Maruti Multi Specialty Hospital is a landmark tertiary care health destination manager by Anjana Medicare services Pvt. Ltd. First of its kind in

Tiruchirappalli, the 120 bedded hospital has the state of the art technology advantage is complemented by the man power excellence providing 94 sophisticated and specialized medical care of affordable cost. About 320 employees are employed in this hospital.

Headed by Dr. Anand Krishnamurthy and Dr. A. M. Arun, the leaders with unstinted commitment, the expert team of doctors and support staff ensure the best care is delivered at all time with utmost dedication. It is their sacrament to enrich and preserve valuable human lives. We understand you and your needs.

From the moment of arrival into the hospital, we will notice that out hospital is unique. Our team is dedicated to bringing you a world of care with every visit. World-class medical care, friendly, devoted services and affordability are the key features in our every touch.

We have achieved laurels for being one of the best organized multi – specialty hospitals. The highly competent experts in various disciplines taking charge of patients care give the double advantage of safety and mental peace for the patients.

We emphasize on humane approach in patient care, which is obvious in every staff’s activities. Early detection and timely intervention is our mantra on undue delay is observed during administering treatment.

Together with the technology to match world-class standards and support services like pharmacy, laboratory and a good infrastructure we pledge to make your stay at the hospital peaceful and comfortable. Our superb 95 location, which has less traffic congestion and calm atmosphere, is supplemented with ample parking makes the hospital visits less cumbersome.

Specially services offering in addition to internal medicine and general medicine

1. Diagnostic Service Accuracy, Precision and Timely Reporting

Maruti Hospital features the most sophisticated and advanced technologies for the diagnostic purposes. In the safe hands of the internationally trained doctors, these latest technologies yield excellent outcomes, which in turn help in speedy recovery of the patients. Diagnostic facilities that are offered are:

CT SCAN – 8 slice

X-RAY and CR system

Ultra sound, echo, color Doppler

Endoscopy

Colonoscopy

2. Laboratory Services

At Maruti Hospital, computerized lab services offer a wide range of investigations for both inpatients and outpatients. Accuracy precision and timely reporting are the key factors of the lab services: that has brought in several accolades from across the globe. 96

The laboratories function with the latest computerized equipment for the clinical biochemistry, clinical microbiology and immunology section using immune chemistry with Glaxo ELISA reader routine basic screening tests for viral infection of liver like HbsAg, Hcv antibody and to screen AIDS (HIV I &

II) are done by experienced doctors and senior technicians and same ELISA reader hormone assays are carried routinely to rule out hypo and hyper function of Thyroid Gland and LH and FSH.

There is a fully fledged separate microbiology section where routine culture and sensitivity test for blood, pus, urine and body fluids and serology investigations like VDRL, ASO, CRP, RF, and TPHA are carried out by qualified microbiologists and senior technicians. With flame emission method, body fluid and blood electrolytes are investigated for routine and emergency cases. The lab service at the laboratory is authorized to take up all clinical pathology investigation including hematology.

3. Cardiology Services

Computerized Treadmill Test (CTMT)

ECHO

ECG.

4. Neurology Services Overview

The department is managed by senior neurological consultant surgeons backed by outstanding clinical staff and sophisticated equipments. 97

Dr.Ramakrishna Eeshwaran, one of our senior most doctor, is one of the top

Neuro professional in the state. The neurology department has facilities for investigation and treatment of diseases affecting the brain, spinal cord, muscles and nerves – round the clock.

Services Offered

Facilities for investigation and management of all types of neurological

problem

Degenerative disease strokes, epilepsy, muscle peripheral nerve diseases

24 hours intensive care unit for neurological emergencies

Facilities for micro neurosurgery are available

Spinal surgery including stabilization and discectomy

24 hours CT Scan facility

Fully equipped theatres with specialized neurological and

complimentary instruments

Expert anesthetic and nursing facilities

24 hours vigilant ambulance services

5. Nephrology and Dialysis

The hospital’s nephrology department is fully equipped with advanced facilities including Hemodialysis, Home dialysis right hand symbol CAPD left hand symbol, Hemofiltration, continuous hemodialysis and management of all kidney diseases. 98

6. Obstetrics & Gynecology Spectrums of Services available are

• Regular antenatal service at an affordable cost

• Pain free labour – epidural labour analgesia

• Counseling and management of recurrent pregnancy loss

• Effective preterm labour management

• Management of all medical and surgical problems associated with

pregnancy

• Evaluation and management of primary and secondary amenorrhea

• Surgical management of post hysterectomy vault prolapsed including

colopexy

• Cancer detection including pap smears and hysteroscopy guided biopsy.

7. Pediatrics and Neonatology Services Offered

Well baby clinic

Immunization clinic

High risk clinic

Outpatients and inpatients services

Pediatric intensive care unit

Pediatric surgery and neonatal surgical support available round the clock

Pediatric urology with endoscopy and reconstructive surgery as a

subspecialty is available

Upper G.I. endoscopy for children

Bronchoscopy for children 99

8. Neonatology

Neonatal intensive care unit – A tertiary unit with advanced equipment including high frequency ventilators caters to premature babies with special needs and those born after high risk pregnancies such as following in vitro fertilization. The unit provided pre and post-operative management of neonatal emergencies.

Mechanical ventilation including high frequency ventilation: The unit has mechanical ventilators to support babies with breathing difficulty. We have state of the art ventilators including high frequency ventilators, which is a gentler and better mode of ventilation in specific conditions.

The department encourages breast feed at the earliest and mothers express their milk in the nursery and very premature babies are started on expressed breast milk at the earliest. Mothers are also involved in the care of the baby: they are encouraged to hold the baby next to their skin which helps in establishing lactation and also improves the bonding with the baby.

10. Preventive Health Checkups

Early detection and timely intervention is the mantra at Maruti multi- specialty hospital. The hospital is passionate about increasing the awareness about preventive healthcare and in helping people take action to prevent health emergencies for them and their loved ones.

The hospital comprehensive health check up enables early detection of ailments, physical dysfunctions, infections caused by pollution, stress induced 100 disorder and takes timely corrective measures. Carried out in a hi-tech environment by team committed personnel, the hospital provides the most affordable preventive medical care packages.

11. The Health Packages include

Executive health check

Master health check

Woman health check

Employee health check

Infrastructure

State of the art operation theatres

Spacious consultation rooms

Separate sections for various specialties

Ordinary & deluxe wards

24 hours pathology and biochemistry lab

In house 24 hours pharmacy

Physiotherapy ailments and yoga therapy

Special cells for TPA patients

Special cells for medical tourism

Fully equipped ambulances

Spacious car parking 101

3.3. Summary

The researcher makes an attempt to study the operational area of the research and the profile of the hospitals. The various facilities available in the hospitals have been examined. The number of beds and the total number of employees have also been highlighted. 102

References

1. http://en.wikipedia.org/wiki/Tiruchirappalli

2. http://maps.google.co.in/maps?hl=en&tab=wl

3. http://www.easy4dial.com/trichy/ABC_Hospital-Thillai_Nagar-Trichy-

13152.html

4. http://www.gastrocaretrichy.com/main/index.php

5. http://www.kmcspecialityhospital.in/cms/main/ Chapter ––– IVIVIV

Competencies of HR Professionals and Human Resource Management Practices in Hospitals CHAPTER – IV

4.1. Introduction

4.1.1. Human resource planning in hospitals

4.1.2. Factors affecting Manpower

4.1.3. Human resource requirement in hospitals

4.1.4. Downsizing of manpower

4.2. Competencies of HR Professionals

4.2.1Competencies required for HR Professionals

4.3. Human Resource Management Practice (HRM)

4.3.1 Recruitment and selection

4.3.2 Training and development

4.3.3 Staff promotion

4.3.4 Performance appraisal system

4.3.5. Career development

4.3.6. Incentives and compensation

4.3.8. Flexibility work option

4.3.9. Job design

4.3.10 Employee’s participation and communication

4.4. Motivation

4.5. Job satisfaction

4.6. Summary

103

CHAPTER - IV

COMPETENCIES REQUIRED FOR HR PROFESSIONALS AND HRM PRACTICES IN HOSPITALS 4.1. Introduction

Every organization has various resources at its disposal which are described as the famous M’s - Men, Money, Materials, and Machines

(equipment). The task of management of any organization is the optimal utilization of these resources. In any organization, human resources are to be utilized to the maximum possible extent to achieve individual and organizational goals, hospitals are not an exception. No hospitals can be successful in the long run without having the right number and the right kind of personnel. Before selecting the right people for the right job, it becomes necessary to determine the quality and quantity of people required in an organization. This is the function of human resource planning in hospitals.

Human Resource Management begins with human resource planning.

Dr. S.L. Goel (2007) discusses the nature, meaning and ingredients of manpower planning to ensure optimum performance and satisfaction among the hospital personnel through proper Manpower planning. He has rightly remarked that an important operational objective for the future is, therefore, to improve personnel systems, develop manpower planning and expand the opportunity for education and training of personnel in the hospitals, as it is the human capacities which transform the resources into active agent of production.

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4.1.1. Human Resource Planning in Hospitals

According to Beach (1975), Human resource planning has been defined as “Human resource planning is a process of determining and assuming that the organization will have an adequate number of qualified persons, available at the proper times, performing jobs which meet the needs of the enterprise and which provide satisfaction for the individuals involved”.

Human Resource Planning is the prime function of the hospital personnel manager but before he starts filling individual jobs, he should consider the overall management problem of making the best use of available human resources. Human resource planning starts with the analysis of the future needs of the hospital and its objectives. It determines organization structure, decides what job have to be filled and what their requirements are.

The type of hospital, the set-up and even the structure of the building counts when it comes to manpower allocation.

4.1.2. Factors Affecting Manpower a) Specialty : Dr. C.P. Kamle stated that the number of employees depends not

on the size of hospital but more on its speciality, ideally for multi-speciality

and super specialty hospitals the ratio of bed to employee should be around

1:6. This is an ideal situation and it is practiced in developed countries as

mandatory requisition. b) Setup : More classes of wards means more staff. For instance, a deluxe

room may have one staff for just 2 beds since the patients are charged

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higher and consequently demand better care. In medium class, one

employee can look after 6 patients. c) Structure : Col Rampal stated that a large hospital has more staff than other

hospitals because the building is designed to have separate wings. A ward

boy in one wing may not be able to give his best to all the wings on the

same floor. Hence staff must be increased. For example, non-core sector

like supporting staff, housekeeping can be outsourced.

4.1.3. Human Resource Requirement in Hospitals

Before the recruitment and selection of personnel the hospital Human

Resource Manager should analyze the requirements for human resources in terms of number of personnel needed for each type of job. According to the report of the Commission on University Education in Hospital Administration, a ratio of two employees per bed has been prescribed. This ratio is applicable to general `employee means, any person who works in any capacity in a hospital, e.g., doctors, nurses, pharmacists, medical laboratory technicians, physiotherapists, dieticians etc.

This ratio of two employees per bed cannot be applied on all hospitals.

The personnel required depend on the size of the hospital, type of hospital and degree of care of providers, area of the hospital, type of equipment used

(automatic, semi-automatic or manually operated). Under prevailing conditions, to manage every bed, whether in a small or big hospital, it required three to five personnel.

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Doctors-to-Beds Ratio

According to the Indian Medical Council, the doctor-to-beds ratio should be 1:5, but this ratio depends upon the type of hospital, such as maternity, pediatric, general and so on. However, it is desirable that the doctor-to-beds ratio should be 1:10 in general hospitals. (http://www.pdssp.gop.pk/downloads/

Presentations/MSDS-Health%20%28.pdf%29.pdf)

Nurse-to Beds Ratio

The nurses-to-bed ratio should be 1:3 according to the Indian Nursing

Council. The Council has further prescribed that for every 100 beds and to cover a 24-hours period, there should be 4 ward sisters and 30 staff nurses.

4.1.4. Downsizing of Manpower

Downsizing of manpower gives the correct picture about the number of people to be employed to complete given task in the predetermined period. It is used for achieving fundamental growth in the concern. It can work out the correct price by the resource building or capacity building. It aims at correct place, correct man on a correct job. Thus manpower planning must make the optimum utilization of the greatest resource available.

In a typical hospital set up, expenditure on salary amounts to roughly

25-30 per cent of total income or 30-35 per cent of total expenditure. Most hospitals are believed to operate with excess manpower. As competition increases and margins come under pressure, hospitals tomorrow will have no option but to rationalize manpower, which, in other words, would mean downsizing.

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Most times, downsizing has led to further chaos, mainly because of improper manpower planning. Health-care consultants stress on a multi-skilled workforce to carry multiple tasks in order to maintain optimum employee per bed ratio, a key to boost and sustain profits. To achieve this, manpower planning becomes crucial. But, such tasks are rarely undertaken in hospitals.

Most hospitals operate on excess man power, Dr K.C. Ojha stated that, ideally employee to bed ratio should be 3 per bed, three persons per bed could be a little stingy, 4-5 persons per bed is more acceptable.

Hence in Hospitals, to have a well organized management, effective manpower planning is essential strategy. Every HR Professionals should be competent to frame the man power plan systematically which enhances the effective implementation of HRM Practices.

4.2. Competencies of HR Manager

Managers, be males or females, should possess multiple competencies.

However, there are different opinions on the kinds of competency a manager must have. According to Dubois competency can be interpreted in three ways: capability, propensity and qualification. However, according to Lee, competency refers to some skills only, whereas in a broad sense, it means not only skills, but also the demonstration of being knowledgeable and comprehensible, or the ability to apply the knowledge and comprehension to a new context or new job.

Parry defines competency as a set of knowledge, attitude and skills, which could exert an influence on specified work performance, and it also symbolizes

108 the performance based on the reason, the feel and what can be done with this capability.

To improve the organization’s performance as a whole, hospitals should develop a series of training courses on managerial competencies. The effectiveness of these training courses, upon which the evaluation is based, so as to improve efficiency and plan the training proposal on managerial competencies, is an absolutely necessary component of human resource development.

A competency is an underlying characteristic of a person/organization which enables to deliver performance in a given job, role or a situation. Thus the performance of an organization or an individual will depend, on the relevant competencies possessed by HR Professional.

4.2.1. Competencies Required for HR Professionals

Organizations need to focus their efforts in the area of competencies and strengthen HR Professionals and outsource the other activities. This is very important as these competencies are fundamental to the success of the organization. The required competencies for the HR Managers in Health Care sector are as follows.

a) Strategic Contribution Skill

b) Personality Development

c) HR Delivery

d) Managerial Skills

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e) Administration Skill

f) Internal Consultations. a) Strategic Contribution Skill

HR Professionals involved in strategic level, manage the culture, facilitate rapid change, involvement in the strategic decision making and create market-driven connectivity of the operation (Boselie & Paauwe, 2004). In this competency area, culture management, rapid change efforts emerged as important factors for HR Professionals, making their impact on their organizations’ performance. b) Personal Credibility

HR Professionals need to deliver the results and to establish a reliable track record in an organization. Working well with others by building good relationship is vital in developing the ability to work together with others effectively. HR Professionals must also have effective writing and verbal communication skills (Boselie & Paauwe, 2004). They need to promise and deliver the results and to establish a reliable track record. Furthermore, working well with others by building good relationship is vital in developing the ability to work together with others effectively. c) HR Delivery

HR Professionals deliver operational HR activities to their organization in four major categories. First, by designing developmental programs and

110 challenging work experiences, done by offering career planning services, and facilitating internal communication processes. These efforts include both individual development as well as organization-wide development. Second, by structuring and HR measurement: restructuring the organization, measuring impact of HR Practices, and managing global implications of HR Practices.

Third, by attracting, promoting, retaining, and out-placing appropriate people.

Finally, by performance management in terms of designing performance-based measurements and reward systems and providing competitive benefit packages

(Boselie & Paauwe, 2004). d) Managerial Skills

A good manager is not only one who can ensure the smooth functioning of an organization, but also one who can also perceive challenges and use his/her critical thinking skills to solve long-term problems. A mark of a good leader is to be able to provide consistent motivation to his team encouraging them to attain excellence and quality in their performance. Six management skills can develop as a leader in working to create a quality effective team.

They are as follows

Observation

Monitor Employee Performance

Implementation of Professional Development Programs

Demonstrates Working Knowledge and Expertise

Good Decision Making

Ability to Conduct and Evaluate Research

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Excellent leadership is always pro active rather than reactive. By developing these six managerial skills builds a solid foundation for success.

Figure - 4.1 Managerial Skills

The culture of management

Consideration, Recognition Respect and trust And credit

Involvement Basic Managerial Fair and equitable And availability Philosophies treatment

Positive action on Emphasis on Individual basis End-results

Staff and Customer satisfaction

e) Administrative Skill

An ability and capacity acquired through deliberate, systematic, and sustained effort to smoothly and adaptively carryout complex activities or job functions involving ideas (cognitive skills), things (technical skills), and/or people (interpersonal skills). Skills of the HR Professionals that are required for success in administration, such as communicating, computing, organizing, planning, scheduling, or staffing. In addition HR Professionals must have the ability to multi-task and make use of time management skills, having knowledge in technological skills, adequate Internet skills and also Records management is essential as well. Administrative skills require lifelong

112 education and training in order to keep up with changing technologies and worldwide demands. f) Internal Consultation

Consulting skills is a combination of diagnostic and behavioral skills that enable professionals in supporting functions to collaborate with line managers to develop solutions to problems (Green, 2008). Like external consulting, the role of internal consultant exposes organization to a range of projects and activities with assorted clients. Only in this instance, the ‘clients’ will be other departments and teams within the same organization. As an internal consultant, HR Professionals have a real chance to enhance their practitioner standing by using expertise to make a valuable contribution to the functioning of other departments, solving problems, and delivering enhanced performance (Scott, 2008).

Thus Health managers, like the managers in any other sector, are expected to perform different managerial activities and one of these activities is

Human Resource Management (HRM). HRM to be carried out effectively requires the competency of those who deal with the management of the human resource, otherwise, whenever the human resource functions are not in the hands of competent people there would probably be a gap between what is theoretically believed to be and what may be placed in practice. Hence a competent HR Professional are needed to implement HRM Practices effectively. Hence the following are the various dimensions of HRM Practices which have to be implemented effectively by the HR Professionals.

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4.3. Human Resource Management Practice (HRM)

The various dimensions of the HRM Practices which are to be implemented effectively in the hospitals are specified below.

4.3.1. Recruitment and Selection

One of the most important responsibilities of the human resource management in hospitals is to recruit and select the right persons for the right jobs. Hence the hospitals have to evolve scientific, recruitment and selection policies. It is the duty of the human resource manager in the hospitals to evolve such a policy and recommend the same to the management. a) Recruitment

Once manpower requirements have been determined, recruitment is the next step in the staffing process. According to Byars and Rue, recruitments involve seeking and attracting a pool of people from which qualified candidates for job vacancies can be chosen. The basic purpose is to develop a group of potentially qualified people.

Subsystems of Recruitment

There are four subsystems in recruitments:

(a) Finding out and developing the sources where the required number and

kind of employees are available.

(b) Developing suitable techniques to attract desirable candidates.

(d) Stimulating as many candidates as possible and making them to apply

for jobs irrespective of number of candidates required.

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Hospitals usually need wide range of positions in term of skill and personality requirements. This situation is further complicated by the fact that in smaller hospitals, it is often necessary to combine jobs, so that a personnel manager may seek a combination of different skills in the same individual.

Recruitment Policy

Recruitment policy of any organization is derived from the personnel policy of the same organization. The Hospital authorities should frame a recruitment policy for the guidance of the personnel department. The management should clearly spell out the objectives and major principles they intend to pursue while recruiting employees.

The following factors should be taken into consideration by the hospitals while formulating recruitment policy:

i. Government’s reservation policies.

ii. Personnel policies of other competing organizations.

iii. Organization’s personnel policies.

iv. Recruitment sources.

v. Recruitment needs.

vi. Recruitment Cost.

vii. Selection criteria. b) Selection

After identifying the sources of manpower and stimulating them to apply for jobs in the hospitals, the hospitals management has to select the right

115 employees. The obvious guiding policy in selection is the intention to choose the best qualified and suitable candidates who can successfully perform the jobs.

4.3.2. Training and Development

After the selection process, the selected candidates must be given proper training to perform their work effectively. According to Edwin D. Flippo, “The purpose of training is to achieve a change in the behavior of those trainee and to enable them to do their jobs better”. Any training programme should try to bring positive changes in:

• Knowledge – It helps a trainee to know facts, policies, procedures and

rules pertaining to his job.

• Skills – It helps to increase technical and manual efficiency necessary to

do the jobs and

• Attitude – It moulds behavior towards co – workers and supervisors and

creates a sense of responsibility in the trainee.

Benefits of Training and Development

The benefits of Training and development are for both organization and for employees.

(a) Benefits to Organization

A programme of training becomes essential for the purpose of meeting the specific problems of a particular organization arising out of the introduction

116 of new lines of production, changes in design, the demands of competition and so on. The major benefits of training to an organization are:

1. Higher Productivity: Training can help employees to increase their level of

performance on their present assignment. Training increases the skill of an

employee in the performance of a particular job. Increased performance and

productivity, because of training, are most evident on the part of new

employees who are not yet fully aware of the most efficient and effective

ways of performing their job. An increase in skill usually helps to increase

both quantity and quality of output.

2. Better Organizational Climate: An endless chain of positive reactions result

from a well planned training programme. Increased morale, less supervisory

pressures, improved product quality, increased financial incentives, and

internal promotions and so on, result in better organizational climate.

3. Less Supervision: Training does not eliminate the need for supervision, but

it reduces the need for constant supervision.

4. Prevents Manpower Obsolescence: Manpower obsolescence is prevented

by training as it fosters the initiative and creativity of employees. An

employees is able to adopt himself to technological changes.

5. Economical Operations: Trained personnel will make economical use of

materials and equipment. This will reduce wastage in materials and

damages to machinery and equipments.

6. Prevents Industrial Accidents: Proper training can help to prevent industrial

accidents.

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7. Improves Quality: Trained employees are less likely to make operational

mistakes thereby increasing the quality of the company’s products.

8. Greater Loyalty: A common objective of training programme will mould

employees’ attitudes to achieve support for organizational activities and to

obtain better co operation and greater loyalty. Thus, training helps in

building an efficient and loyal work force.

9. To fulfill Organization’s Future personnel needs: When the need arises,

organizational vacancies can be staffed from internal sources, if an

organization initiates and maintains an adequate training programme.

10. Standardization of Procedures: Trained employees will work intelligent and

make fewer mistakes when they possess the required know-how and have

an understanding of their jobs.

(b) Benefits to Employees

1. Personal Growth: Employees on a personal basis gain individually from

training. They secure wider awareness, improved skill and enhanced

personal growth.

2. Development of new skills: Training improves the performance of the

employees and makes them more useful and productive. The skill

developed through training serves as a valuable personal asset to the

employee. It remains permanently with the employee.

3. Higher Earning Capacity: By imparting skills, training facilities higher

remuneration and other monetary benefits to the employee. Thus, training

helps each employee to utilize and develop his full potential.

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4. Helps adjust with changing technology: Old employees need refresher

training to enable them to keep abreast of the changing methods, techniques

and use of sophisticated tools and equipment.

5. Increased safety: Proper training can help prevent industrial accidents.

Trained workers handle the machine safely. Thus, they are less prone to

industrial accidents. A safe work environment also leads to a more stable

mental attitude on the part of the employees.

6. Confidence: Training creates a feeling of confidence in the minds of

employees. It gives safety and security to them in the organization.

4.3.3. Staff Promotion

Performance Appraisal is a basis for personnel decisions such as salary and wage increases, promotions, transfers, and separations, although other issues such as seniority measures are also taken into account. Of these, promotions, transfer and separation functions are effective methods to adjust the size of the workforce of an enterprise to changing situations to be accomplished with the advice and assistance of staff specialists.

There are several work situations in which an individual demonstrates the capacity to contribute towards organizational goals beyond the level of his or her present job and thus, can be considered for promotion. In organization settings, promotion related to the assignment of an individual to a position of higher responsibility or to one which involves the use of his or her particular education or experience. Therefore, promotion can be defined as a reassignment

119 of the individual to a job of a higher rank usually involving an increase in responsibility and accompanying pay, privileges, prestige, status, authority and so on. Upgrading can take the form of minor promotion, promotion within grade or horizontal promotion.

Promotion as a source of Recruitment in Hospitals

Promotion forms a recruitment source for Health Care. The process of promotion leads to an influx of one or more persons to fill a particular position or a series of positions caused by a single promotion. Suppose, a general manager is promoted to the position of a vice- president, this single initiation of action may have a chain reaction, causing an upward movement of anywhere from one to several individuals depending upon the organizational hierarchy.

Except in situations where there is adequate supply of promotable talent, vice- presidential promotion may cause recruitment from outside to fill potential vacancies, especially those in the middle or lower level. This path of demonstrated progression can exert a motivational impact on any ambitious individual contemplating joining an organization as well as on those who have put considerable length of service with it. This system of promotion, as opposed to infusion of high level talent from outside, is highly beneficial and forms a selling point for the organization.

4.3.4. Performance Appraisal System

According to Flippo, “Performance appraisal is the systematic, periodic and an impartial rating of an employee’s excellence in matters pertaining to his

120 present job and his potential for a better job.” performance appraisal is a method of evaluating the behavior of employees in the work spot, normally including both the quantitative and qualitative aspects of job performance. It is systematic and objective way of evaluating both work – related behaviour and potential of employees. It is process that involves determining and communicating to an employee how he is performing the job and ideally establishing a plan of improvements. Performance appraisal emphasis on individual development. Now it is used for evaluating the performance of all the human resources working at all levels of the organization. It evaluates the performance of technical, professional, and managerial staff.

Significance of Performance Appraisal

• Performance Appraisal provides valuable information for personnel

decisions such as pay increases, promotions, demotions, transfers and

terminations.

• It provides feedback information about the level of achievement and

behavior of subordinate. It also identifies individuals with high potential

who can be groomed for higher positions.

• It serves as a means of telling a subordinate how he is doing and

suggesting necessary changes in his knowledge, behavior and attitudes.

• It is useful in analyzing training and development needs.

• Performance Appraisal serves as a means for evaluating the effectiveness

of devices used for selection and classification of employees.

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• Performance Appraisal facilities human resource planning and career

planning.

• Performance Appraisal promotes a positive work environment, which

contributes to productivity.

• The existence of a regular appraisal system tends to make the

supervisors and executives more observant of their subordinates.

• Performance Appraisal records protect management from charges of

favouritism and discrimination. Employee grievances can also be

reduced as it helps to develop confidence among employees.

Performance Appraisal in Hospitals

HR Manager who has thorough knowledge about the job content, issues to be appraised; standards of contents, and who observes the employee while performing job will appraise the performance of the employees.

Methods of Appraisal

A number of different performing appraisal methods or techniques are available for evaluating the performance of the employees. These methods try to explain how management can establish standards of performance and device ways and means to measure and evaluate the performance of employees. These methods can broadly be divided into Traditional and Modern methods.

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Figure - 4.2 Performance Appraisal Techniques

PERFORMANCE APPRAISAL TECHNIQUES

TRADITIONAL METHODS MODERN METHODS

1. Straight Line Method 1. Result Oriented Method 2. Grading Method 2. Human Resource Accounting Method 3. Weight Check List Method 3. 360 degree appraisal Method

Traditional Methods

1. Straight line Method : In this technique, the evaluator assigns relative

ranks to all the employees in the same work unit doing the same job.

Employees are ranked from the best to the poorest on the basis of overall

performance.

2. Grading Method : Under this technique of performance evaluation, certain

categories of worth are determined in advance and they are carefully

defined. These selected and well defined categories include

Grade ‘A’ for outstanding

Grade ‘B’ for very good

Grade ‘C’ for average

Grade ‘D’ for poor

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These grades are based on certain selected features of employees such as knowledge, judgement, analytical ability, leadership qualities, self-expression, and so on. The actual performance of employees is compared with the above grades and employees are allotted grades that speak for their performance.

3. Weighted Checklist Method : The checklist provides to the evaluator

statements about work related behavior of the employees where every

statement is given equal importance. However, under weighted checklist the

item having significant importance for organizational effectiveness is given

weightage. Thus, in weighted checklist, weights are assigned to different

statements to indicate their relative importance.

This method has some demerits. It suffers from evaluator’s bias. A separate checklist is required for each job which increases the cost. It is also difficult to provide due weight age to the particular characteristic of the employee.

Modern Methods

1. Result Oriented Appraisal or MBO technique : The Result-Oriented

Appraisals are based on the concrete performance targets, which are usually

established by superior and subordinates jointly. This procedure has been

known as Management by Objectives (MBO). MBO a method of mutual

goal setting, measuring progress towards the goals, tacking action to assure

goal attainment, feedback and participation. It is result-oriented philosophy,

enabling an employee to measure progress towards a goal, which the

employee often has helped to set.

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2. Human Resource Accounting Method : Human Resource is a valuable

asset of any organization. This asset can be valued in terms of money.

When competent and well trained employees leave an organization, the

human asset is decreased and vice versa. Human resource accounting deals

with cost and contribution of human resources to the organization. Cost of

the employee includes cost of manpower planning, recruitment, selection,

induction, placement, training, development, wages and benefits. Employee

contribution is the money value employee service which can be measured

by labour productivity or value added by human resources. Difference

between cost and contribution will reflect the performance of employees.

Human resource accounting method is still in the transition stage.

3. 360 Degree Appraisal: It is the method of appraisal in which people

receive performance feedback from all the employees in the organization.

Thus, the feedback comes from all around them, 360 degrees. 360 degree

feedbacks assist each individual to understand his strengths and

weaknesses, and contribute insights into aspects of his work for

professional development.

4.3.5. Career Development

Douglas T. Hall defined a career as “an individually perceived sequence of attitudes and behaviours associated with work related experience and activities over span of the person’s life.” Career planning is the process by which one selects career goals and the path to those goals. Career development

125 is those personal improvements one undertakes to achieve a personal career plan. Career management is the process of designing and implementing goals, plans and strategies to enable the organization to satisfy employee needs while allowing individuals to achieve their career goals.

Significance of Career Planning

Career planning is necessary due to the following reasons:

To attract competent persons and to retain them in the organization.

To provide suitable promotional opportunities.

To enable the employees to develop and make them to ready to meet the

future challenges.

To increase the utilization of managerial reserves within an organization.

To correct employee placement.

To reduce employee dissatisfaction and turnover.

To improve motivation and morale.

Steps in Career Planning and Development in Hospitals include:

Analysis of individual skills, knowledge, abilities, aptitudes etc.

Analysis of career opportunities both within and outside the organization.

Analysis of career demands on the incumbent in terms of skills,

knowledge, abilities, aptitude etc., and in terms of qualification,

experience and training received etc.

Relating specific jobs to different career opportunities.

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Establishing realistic goals both short-term and long-term.

Formulating career strategy covering areas of change and adjustment.

Preparing and implementing action plan including acquiring resources

for achieving goals.

Figure - 4.3

Various stages of Career Planning and Development are shown

Dissatisfies with internal External Mobility career opportunities

Successful Satisfactory Matching the matching Career Providing Performing in New Career Planning individual and the Development progression Career career Mismatching Dissatisfactory

Upgrading Transferring, Develop the Appraising the Promotion individual and the Employee through career and finding Self Development Demotion the suitable career training conducted by the Organizations to meet the Career Development

4.3.6. Incentives and Compensation

The term compensation refers to all forms of financial payments and tangible benefits received by employees in exchange for their services with the organization. It constitutes a major part of the employment contract

(appointment letter) which seals the relationship between the organization and the employee. As business environments gets more complex, the challenge of compensation increases, requiring innovation, professional expertise and

127 vision, at the same time managing the costs of such programmes. The traditional compensation elements comprise a basic salary which is the root worth of a job. The basic salary moves along a salary grade that is fixed for various job positions. Many traditional organizations (especially in the public sector) still give employees salary grades.

Compensation and Incentives in Hospitals 1. Salary Grade for Hospital Employees

A salary grade is the minimum and maximum value of a job along a monetary scale. The scale pre-determines increments values to compensate for the increase in standard of living and acceptable performances. When the job position changes, so does the grade.

Middle Level - Superior position - 6500-500-9000-EB-650-12250-EB-800-16250

Lower Level - Subordinate position-3000-250-4250-EB-350-6000-EB-500-7500

The lower grade scale starts at a minimum of 3000 and a maximum of

7500.A new job entrant will start at the beginning of the scale. The scale has a span of 15 years from the minimum to the maximum, on the assumption that a job holder gets one increment each year. Between two larger values, a smaller figure which is the increment. The increments in this case are 250, 350, and

500. Each increment value has a span of five years. This means that the employee will continue to get an increment value each year for five years till he/she reaches the efficiency bar on the scale.

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Within the grade is Efficiency Bars (EB) which is points in the scale where the value of the increment increases. Crossing an efficiency bar means that the person has earned a higher value of increments based on his/her efficient performance which is tantamount to at least an average performance.

In this way, an employee can get a reasonable enhancement in family in recognition of the years of service put in with the organization. It is recognition for loyalty.

Basic Salary

The basic salary is an important component of a pay package. It influences other compensation elements like long term benefits (provident fund, gratuity, pension), leave entitlements, housing limits and so on. The basic salary is benchmarked with the competition to be on level fields to attract and retain good talent.

Benefits

Benefits are those compensation elements that improve the quality of life of the employees by providing them and their families with a level of financial protection. The objective of benefits is to attract and retain qualified and competent employees. The importance of benefits increases when there is a shortage of qualified and competent people in the labour market. It becomes critical when other organizations compete for the same pool of talent. Benefits constitute one and a half times the direct pay package.

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Benefits provided by the Hospitals for Employees

Benefits are including:

Health Care or Health Insurance

Life Insurance

Maternity leave for women employees with full pay

Emergency leave with pay

Medical leave with pay

Medical Insurance or reimbursement

Free accommodation in some location

The hospital provides the following benefits in addition:

Free duty meals

uniforms

Free counseling service

Compensation Management in Hospitals

The financial compensation system seeks to maintain satisfaction of human resources, reduction voluntary separation and complaints and grievances stemming from inadequate or inequitable wages, as perceived by the employees. The financial compensation system purports to induce and reward improved performance and forms an effective motivator. It is usually held that increases in pay should be determined on the basis of productivity and that those who produce more should be paid more. Productivity as measured by patient volume or number of shifts worked is the measure that the employees working in the hospitals are rewarded for financially. A strong second was

130 quality measures, which includes areas like satisfaction scores, documentation and adherence to guidelines. While there are differences among specialties, most aren’t huge. Pediatric hospitalists who do receive a bonus are a little more likely to receive a bonus based on productivity than their counterparts in internal medicine, but they’re slightly less likely to be paid based on quality measures.

Criteria for Payment Incentives for Employees in Hospitals

Productivity (number of admissions, shifts worked, RVUs)

Quality measures (satisfaction scores, guidelines)

Committee work

Beyond traditional financial targets, hospitals and health systems most frequently report patient satisfaction, clinical outcomes and employee satisfaction as measures linked to executives' bonuses.

4.3.7 Recognition and Reward

Organization expects efficient performance from their employees in order to contribute to the attainment of the individual goals. Organizations reward their employees who contributed to the achievement of organizational goals.

Figure - 4.4 Recognition and Reward

Organizational Effort Performance Individual Goals Goals

Rewards

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Intrinsic and Extrinsic Rewards

Intrinsic Rewards are the satisfiers that the employees get from the job itself. These rewards include, pride in one’s work, having a feeling of job accomplishment, being member of a team, job enrichment and so on. Extrinsic rewards include wage/salary, fringe benefits, welfare measure, promotion, incentives, and the like. These benefits are external to the job and come from management.

A reward is a physical token of appreciation of service, effort, or achievement. Rewards can be in cash or kind. Recognition is an official praise of service, effort, or achievement. Both are distinctly different from an incentive which is a pre-condition to receive a reward.

Reward and Recognition are more appropriate because they are not pre- conditions, but spontaneous appreciation of effort. Both intrinsic and extrinsic rewards must be given to the employees based on their performance.

Recognition

Recognition is one of several types of non-financial incentives. The term recognition program usually refers to formal programs, such as employee-of- the-month programs. Social recognition program refers to more informal manager-employee exchanges such as praise, approval, or expressions of appreciation for a job well-done. Performance feedback is similar to social recognition, but means “providing quantitative or qualitative information on task performance for the purpose of changing or maintaining performance and specific way”. Recognition (ranging from “good job” to more material awards)

132 has a positive impact on performance, either alone or in conjunction with financial rewards.

Recognition Schemes in Hospitals

The first consideration is that recognition is not conditional. In other words, recognition should be unexpected and a surprise. The selection process of employees for recognition must be fair and consistent. Recognition must always be done in public. It raises the status of the individual among his/her peers. It also raises self – esteem. Some methods of recognition practiced in hospitals are as follows.

Pat on the Back : It is the most powerful physical acknowledgement of appreciation. It costs nothing, but means a lot.

Words or Praise : These are made at briefings and other public gatherings.

Certificates of Recognition : These are documents that are framed and displayed with pride. They are useful for future job considerations. They are a physical proof of having achieved something worthwhile.

Trophies of Recognition : Organizations design purpose – build trophies of recognition with their logo. Organizational trophies are not the usual caps and salvers received in spot. They are uniquely designed table –top pieces that are ornamental and worthy of public display at home or office.

Gifts of Recognition : These are utility items at work or home. They are monogrammed with the company name and logo and even the name of the employee. Some examples are premium pens and watches, office table appointments, wallets, diaries, coffee-table books, lapel pins, tie-pins, and so on.

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4.3.8. Flexibility Work Option

Flexible work options offer creative approaches for completing work while promoting balance between work and personal commitments. These approaches involve use of non-traditional work hours, locations, job structures, flexible work arrangements. Outcomes are based on the staff member's achievement of results and use of competencies critical to achieving those results.

Guidelines for Success

The arrangement must support the organization's goals, including cost- effectiveness and customer service.

1. The assignment must be appropriate for the flexible work arrangement

and equipment, systems or materials must be available during non-

traditional hours or outside of the workplace.

2. The supervisor must approve the plan and be prepared to manage the

work under the conditions of the arrangement.

3. The individual's work style and history must support the demands of the

arrangement.

4. Special arrangements for communication and accountability must be

established.

5. An effort should be made to maintain a collegial environment, through

special opportunities for unit members to have shared hours and

constructive interactions.

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6. Written plans must be developed for the flexible work arrangement to

document the understanding between all involved parties.

7. A pilot time frame is often helpful for trying out a flexible work

arrangement prior to making a long term commitment to it by either

party (management or staff member).

8. All must be prepared to return to pre-flexibility arrangements if the

situation requires.

4.3.9. Job Design

Job design is defined as the process of deciding on the content of a job in terms of its duties and responsibilities; on the methods to be used in carrying out the job, in terms of techniques, systems and procedures and on the relationships that should exist between the job holder and his superiors, subordinates and colleagues. Two important goals of job design are:

(i) to meet the organizational requirements such as higher productivity,

operational efficiency, quality of product/service and

(ii) to satisfy the needs of the individual employees like interests, challenge,

achievement or accomplishment and so on. Finally the goal of the

design is to integrate the needs of the individual with the organizational

requirements.

Job design in hospitals involves:

Deciding tasks to allocate to each person in the organization,

In what sequence to perform them,

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Where to locate the job,

Who else should interact with their workplace and their immediate work

environment, what skills to develop in the staff?

Figure - 4.5 The Elements of Job Design

4.3.10. Employees Participation and Communication

Communication is a process by which information are transferred from one person to the other. Hence, for the communication to take place there must be some information to be conveyed and there must be two or more persons – one to deliver the message and the other to receive it. Communication is said to be prefect only when the receiver understands it in the sense the sender expected him to understand.

Communication is also significant as it performs various actions like;

(i) It acts as a basis for action

(ii) It facilitates planning

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(iii) It helps in decision-making

(iv) It acts as a means of coordination

(v) It improves relationship among peers, superior and subordinate

(vi) It improves motivation and morale.

Communication is said to be complete when the receiver has understood it in the same sense the sender has conveyed it. It is up to the sender to find out whether the receiver has understood the true meaning of the message. So a constant feedback becomes an essential component of the communication process.

Employees Communication in Hospitals

Communication in the organization performs mainly the following function:

• Information and knowledge are transmitted from one person to another

• Employee are motivated and directed only with the help of communication

• Employees attitudes and beliefs are moulded and their behaviour is

influenced positively with the help of communication; and

• It also performs the function of entertainment and the maintenances of

social relations among them. Scott and Mitchell summarized the

functions of communication.

Downward Communication

Downward Communication flows from higher level to lower level in the organizational hierarchy. The basic purpose of communication are: (i) To provide

137 specific task directives or instruction (ii) To provide information about task relationships (iii) To provide information about organization’s missions, objectives, policies, procedures, programmes (iv) To provide feedback about subordinate’s performance (v) To let the people the pride of being relatively well informed.

Upward Communication

Upward Communication flows from lower level to upper level in organizational hierarchy. Upward Communication is necessary to offer suggestions, to lodge complaints, ventilate grievances, to response to the counseling, opinion survey, exit interviews, to discuss in meetings and participate in decision-making.

Managers should encourage upward communication with view to: (i)

Create receptiveness of communication; (ii) Create a feeling of belongingness through a shared meaning; (iii) Evaluate communication; and (iv) Demonstrate a concern for the ideas and views of lower level employees.

Thus if the above mentioned HRM Practices are implemented effectively by the HR Professionals, this in turn motivates to develop a positive attitude among the employees towards the HRM Practices.

4.4. Motivation

Every human action is the result of a need or desire. One experiences a sort of mental discomfort as long as that need remains unsatisfied in him. The

138 moment the action is initiated he makes an attempt to get over the discomfort.

So what causes an action is the need or desire. What causes a need is called the stimulus. Therefore, the manager’s duty is to create the stimulus that causes a need which initiates action that leads to satisfaction. This should be a repetitive process for the action to continue. All this is called ‘motivation’ in management. Motivation is derived from the word motive. “A motive is an inner state that energizes, activates or moves and directs or channels behavior toward goals”. “Motivation represents an unsatisfied need which creates a state of tension or disequilibrium, causing the individual to move in a goal directed pattern towards restoring a state of equilibrium by satisfying the need”.

Motivation is a process that starts with a physiological or psychological deficiency or need that activates behavior or a drive that is aimed at a goal or

‘incentive’. Thus, the process of motivation lies in the meaning of and relationship among needs, drives and incentives.

Needs Drives Goals/Incentives (Deficiency) (Deficiency with (Reduction of drives and Direction) fulfills deficiencies)

Need: Need is deficiency. Need are created whenever there is a physiological or psychological imbalance.

Drive: Drive is a deficiency with direction. They are action-oriented and provide an emerging thrust toward goal accomplishment.

Incentives: Incentive is anything that will alleviate a need to reduce a drive.

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Figure - 4.6 Motivational Determinants and Processes

Cultural Determinants

Cultural Norms and Values

Organizational Determinants HRM Tools

Work Environment Organizational Culture

Individual Determinates Personality

Goals, Values and Movies Self-efficacy

"Will Do" "Can Do"

Motivation

Motivational Consequences Job Performance Work Satisfaction

Kanfer identifies two aspects of the internal motivation process: The

"will-do" aspect concerns the establishment of congruence between personal goals and the goals of the organization (goal setting). The "can-do" aspect concerns motivational effectiveness, the extent of individual resources that are mobilized to accomplish adopted goals (goal achievement). The result of this psychological process can be observed as motivational consequences with impact on the behavior (job performance), affection (job satisfaction) and

140 cognitive aspects (work attachment) of health workers. Kanfer's model offers a framework for the assessment of motivational determinants and the motivational process in greater detail, thereby going beyond the common and simpler distinction between motivators and satisfiers.

Human Resources Management (HRM) is the management of people in an organization. HRM tools comprise the policies, practices and activities at the disposal of managers to obtain, develop, use, evaluate, maintain and retain the appropriate number, skill mix and motivation of employees to accomplish the organization’s objectives. The HRM tools may affect motivation. These aspects are similarly assessed in the World health report 2006 .

Supervision schemes

Recognition schemes

Performance management

Training and professional development

Leadership

Participation mechanisms

Intra-organizational communication processes.

The organizational culture influences all these aspects, but changes in these aspects may also modify the organizational culture. Work conditions constitute an important motivational determinant. Comprehensive HRM therefore, also needs to look at and optimize the work conditions. If the employees are well motivated through effective implementation of HRM

Practices, the end result will be the job satisfaction.

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4.5. Job Satisfaction

Job satisfaction is defined as an attitude that individuals have about their jobs. It is an extent to which one feels positively or negatively about the intrinsic or extrinsic aspects of one’s job. Job -satisfaction has been an interesting construct for researchers in understanding employee behaviors and attitudes. It is an important work-related attitude in work force research for several reasons. First, satisfaction with the job is directly related to organizational commitment. Second, job satisfaction is either directly or indirectly related to an employee’s turnover intentions. Turnover intentions are perhaps the best indicator of future turnover. Thus job satisfaction can influence a variety of important attitudes, intentions and behaviors in a nursing work force. To accurately measure “job satisfaction”, a number of characteristics of the job may need to be evaluated if one hopes to obtain a broad measure of employee beliefs and attitudes about the job. These characteristics or facets may not be of equal importance to every individual.

For example, a nurse may indicate that she is very satisfied with her supervisor, salary and company policies, but is dissatisfied with other aspects of work, such as the actual work itself. Organizational research indicates that employees develop attitudes toward such job facets as work variety, pay, promotion, co-workers, company policies, and supervisors.

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Determinants of Job Satisfaction

Job satisfaction is a multi-variable and indescribable concept. There are number of factors that influence job satisfaction of employees. These factors can be classified into two categories.

a) Organizational and

b) Personal variables.

a. The Organizational Determinants of Job Satisfaction play a very Important Role

The employees spend major part of their time in organization so there are number of organizational factors that determine job satisfaction of the employees. The job satisfaction in the organizations can be increased by organizing and managing the organizational factors. The organization determinants of job satisfaction are as follows:

i. Wage

Wage can be described as the amount of reward that a worker expects from the job. Wages are an instrument of fulfilling the needs as every worker expects to get an appropriate reward. The wages are supposed to be fair, reasonable and equitable. A feeling of job satisfaction is felt by attaining fair and equitable rewards.

ii. Nature of Work

The nature of work has significant impact on the job satisfaction.

Job satisfaction is highly influenced by the nature of work. Employees are

143 satisfied with job that involves intelligence, skills, abilities, challenges and scope for greater freedom. Job dissatisfaction arises with a feeling of boredom, poor variety of tasks, frustration and failures.

iii. Working Conditions

Employees are highly motivated with good working conditions as they provide a feeling of safety, comfort and motivation. On contrary, poor working conditions brings out a fear of bad health in employees.

iv. Job Content

Factors like recognition, responsibility, advancement, achievement etc can be referred to as job content. A job that involves variety of tasks and less monotonous results delivers greater job satisfaction. A job that involves poor content produces job dissatisfaction.

v. Organizational Level

The jobs that are at higher levels are viewed as prestigious, esteemed and opportunity for self-control. The employees that are working at higher level jobs express greater job satisfaction than the ones working at lower level jobs.

vi. Opportunities for Promotion

Promotion can be reciprocated as a significant achievement in the life. It promises and delivers more pay, responsibility, authority, independence and status. So, the opportunities for promotion determine the degree of satisfaction to the employees.

144 vii. Work Group

There is a natural desire of human beings to interact with others and so existence of groups in organizations is a common observable fact. This characteristic results in formation of work groups at the work place. Isolated workers dislike their jobs. The work groups make use of a remarkable influence on the satisfaction of employees. The satisfaction of an individual is dependent on largely on the relationship with the group members, group dynamics, group cohesiveness and his own need for affiliation.

viii. Leadership Styles

The satisfaction level on the job can be determined by the leadership styles. Job satisfaction is greatly enhanced by democratic style of leadership. It is because democratic leaders promote friendship, respect and warmth relationships among the employees. On contrary, employees working under authoritarian and dictatorial leaders express low level of job satisfaction.

b) The Personal Determinants

The personal determinants also help a lot in maintaining the motivation and personal factors of the employees to work effectively and efficiently. Job satisfaction can be related to psychological factors and so numbers of personal factors determine the job satisfaction of the employees. They are as follows:-

i. Personality

The personality of an individual can be determined by observing his individual psychological conditions. The factors that determine the satisfaction

145 of individuals and his psychological conditions is perception, attitudes and learning.

ii. Age

Age can be described as a noteworthy determinant of job satisfaction. It is because younger age employees possessing higher energy levels are likely to be having more job satisfaction. In older age, the aspiration levels in employees increase. They feel completely dissatisfied in a state where they are unable to find their aspiration fulfilled.

iii. Education

Education plays a significant determinant of job satisfaction as it provides an opportunity for developing one’s personality. Education develops and improvises individual wisdom and evaluation process. The highly educated employees can understand the situation and asses it positively as they possess persistence, rationality and thinking power.

iv. Gender Differences

The gender and race of the employees plays important determinants of

Job satisfaction. Women, the fairer sex, are more likely to be satisfied than their male counterpart even if they are employed in small jobs. The job satisfaction can also be determined by other factors like learning, skill autonomy, job characteristics, unbiased attitude of management, social status

146 and so on. It is important for managers to consider all these factors in assessing the satisfaction of the employees and increasing their level of job satisfaction.

iv. Experience

Job satisfaction tends to increase with increasing years of experience.

But it may decrease after twenty years of experience particularly among people who have not realized their job expectations.

Figure - 4.7 Models of Job Satisfaction

Employee Employee Dissatisfaction Satisfaction

Factors leading to Satisfaction Factors leading to Dissatisfaction Good leadership practices Poor Pay Good manager relationship Poor Compensation Recognition Lack of promotion Advancement Poor benefits offering Personal growth Lack of job security Feedback and support Clear direction and objective

When these conditions are optimal, When these conditions are Job satisfaction will be eliminated. optimal, However, these factors do not Job satisfaction will be increased increase job satisfaction

The factors that are going to make some more dissatisfied are things like:

• poor pay

• poor compensation

• poor work conditions

• lack of promotions

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• poor benefits offering

• lack of job security

The factors that make an employee more satisfied are things like:

• good leadership in the organization

• good relationship with their manager

• recognition for their achievements (not necessarily monetary recognition)

• advancement in their careers

• personal growth and development

• feedback and support (meaningful feedback, not just naked criticism)

• clear direction and objectives

So there is a lot that can be done on the positive side to increase satisfaction. Hence a competent HR Professionals through effective implementation of HRM Practices motivates the employees which ultimately lead to the job satisfaction.

4.6. Summary

The present study takes a wide range of HRM Practices. The reaction from the employees is an essential part of the research process that helps us to convert HRM theories into practice in another setting and consequently inform theory through practice. This study offers empirical evidence about the nature of practices. HR Professionals need to analyze Key Competencies required for the development of HRM Practices and it should be provided in light of its impact in bringing change in both-the organization and the individual employee.

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REFERENCES

1. Beach and Dale (1975), The Management of people at work, 3 rd Ed,

New York, Macmillan.

2. Carol A. Dickenson (1996), Teaching HRM and Managerial Skills with

the 'Living Case', Asia Pacific Journal of Human Resources March 1996

Vol. 33, No. 3 39-52, doi: 10.1177/103841119603300304.

3. Col Rampal, director, HR, Hinduja Hospital, “The solution is to

economize without effecting patient care.

4. Dr. C.P. Kamle, International associate of American Institute of

Medicine and Hans Finne International.

5. Dr. K.C. Ojha, managing director, Hospic, Mumbai-based Hospital

Consultancy Firm.

6. Dr. S.L. Goel (2007), Hospital administration and management-Theory

and practice, Deep and Deep publications.

7. Gary Dessler (2009), Human Resource Management, PHI Learning

Private Limited, New Delhi.

8. Gary Dessler (2009), A frame work for Human Resource Management,

Dorling Kindersley (India) Pvt. Ltd., License of Pearson Education in

South Asia.

9. J. Jayasankar (2011), Human Resource Management, Margham Publications.

10. R.S. Dwivedi (2009), A Textbook of Human Resource Management,

Vikas Publishing House PVT LTD.

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11. S.L. Goel (2002), Quality Health care in India, Hospital Administration

and Management, volume 3, ISBN 81-7100-130-o, pp.291-297.

12. Sudhir Andrews (2009), Human Resource Management, Tata McGraw-

Hill Publishing Company Limited, New Delhi.

13. T.V. Ramakrishna, Hospital Engineering Services-July 1976, p.71,

hospital management-case studies-second series, Edited by Dr. K.K. Anand,

Malabika Shaw, Bombay Management Association.

14. www.authorstream.com/.../sachnil09-228347-managerial-skill-basics-...

15. http://www.wisegeek.com/what-are-administrative-skills.htm

16. www.slideshare.net/CHARU55/managerial-skillsppt2003-United States

17. www.citehr.com/research.php?q=managerial-skills-ppt

18. http://articles.timesofindia.indiatimes.com/2011-12-

09/news/30497771_1_global-education-global-issues-global-world,

Article Source: http://EzineArticles.com/71553,

Article Source: http://EzineArticles.com/71553 (Managerial Skill)

Chapter ––– VVV

Analysis and Interpretation CHAPTER – V

Competencies of Human Resource Professionals

5.1. Socioeconomic and demographic profile of the Human Resource

Professionals

5.2. Competencies of human resource professionals for effective

implementation of Human Resource Management Practices.

5.3. Relationship between the demography and competencies of Human

Resource Professionals.

5.4. Relationships between competencies of Human Resource Professionals

and their performance in Human Resource Management Activity

HRM practices, level of motivation and job satisfaction of employees

5.5. Demographic profile of employee – respondents

5.6. Professional profile of the respondents

5.7. Socio-economic profiles of the respondents

5.8. Human resources practices in specialized hospitals

5.9. The relationship between the employee demography and human

resources management practice.

5.10. Level of motivation

5.11. Job satisfaction

5.12. Summary

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CHAPTER – V

ANALYSIS AND INTERPRETATION

This chapter deals with the descriptive and statistical analysis of the primary data collected from the Human Resource Professionals (HR) and

Employees of the Specialized Hospitals in Tiruchirappalli Corporation. Two separate questionnaires were framed for 21 HR Professionals and 517 employees of the Specialized Hospitals. Hence analysis has been made for both Human Resource Professionals (HR) and for other employees.

This chapter has been divided in to four phases. The first phase deals with the Competencies of HR Professionals which includes, analysis of socioeconomic and demographic profile of the HR Professionals, Level of

Competencies, Level of performance of HR Professionals in HRM Activities and for the collected primary data, the hypotheses were framed and tested with the suitable statistical tools and the results are interpreted under the heading, testing of hypotheses.

The second phase deals with the Human Resources Management

Practices which includes demographic profile of the employee-respondents, professional profile of the respondents, socio-economic profile of the respondents, employees opinion towards various dimensions of HRM Practices and testing of hypotheses.

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The third phase deals with the level of motivation among the employees of all selected hospitals and the fourth phase deals with the level of job satisfaction among the employees of all selected hospitals.

Competencies of Human Resource Professionals

An attempt has been made by the researcher to study the socio-economic and demographic factors which have an influence over the competencies possessed by the HR Professionals-respondents. The cause effect relationship between the competencies and performance of Human Resource Activity has also been studied.

5.1. Socioeconomic and Demographic Profile of the Human Resource Professionals

Socioeconomic and demographic profile of the Human Resource

Professionals is depicted in the table 5.1 which deals with the Gender, Age,

Educational Qualification, Department, Income, Experience and Relationship with employees of the Specialized Hospitals in Tiruchirappalli Corporation.

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Table - 5.1 Socioeconomic and Demographic Profile of Human Resource Professionals

S. Gastro Total No. of Particulars ABC KMC Maruthi No. Care Respondents 1 Age 21-30 1 1 - 1 3 31-40 1 2 3 2 8 41-50 2 1 3 3 9 Above 50 1 - - - 1 Total 5 4 6 6 21 2 Gender Male 3 3 3 4 13 Female 2 1 3 2 8 Total 5 4 6 6 21 Educational 3 Qualification UG 1 1 1 1 4 UG with Diploma 2 1 1 2 6 PG 1 1 3 1 6 PG with Diploma 1 1 1 1 4 Total 5 4 6 6 21 4 Experience 4-6 3 - - 1 4 7-9 1 3 3 3 10 10 & above 1 1 3 2 7 Total 5 4 6 6 21

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5 Annual Income Below 1 1 2 3 7 Rs.1,50,000 Rs.1,50,000 and 4 3 4 3 14 above Total 5 4 6 6 21 Relationship with 6 employees HR Manager 1 1 1 1 4 HR Ass. Manager 1 1 1 1 4 HR Junior Officer 2 2 1 1 6 HR Executive 1 - 3 3 7 Total 5 4 6 6 21 Source: Primary data

Questionnaire was administered with 21 Human Resource Professionals of Specialized Hospitals in Tiruchirappalli Corporation, to study their competency level and their ability to implement the various Human Resource

Practices in hospitals. This study was conducted with 13 male Human Resource

Professionals of total targeted Human Resource Professionals and eight female

Human Resource Professionals in Specialized Hospitals at Tiruchirappalli

Corporation. The majority of Human Resources Professionals of ABC, KMC, and Maruthi hospitals are under the age group between 41-50.Six respondents of all the selected hospitals are post graduate and under graduate with diploma.

14 numbers of respondents are drawing annual income above Rs.1,50,000.

Human Resource Professionals were segmented on the basis of yearly

154 experience in field of management of Human Resources. Four respondents belonged to the experience category of 4-6 years. Ten respondents belonged to the category with 7-9 years of experience and seven respondents belonged to the experienced category of above ten years.

Human Resource Professionals - respondents were segmented on the basis of their designation. Four out of the total Human Resource Professionals, are HR Managers, four respondents are HR Assistant Managers, six respondents are HR Junior Officers and seven respondents are HR Executives of all the four selected hospitals.

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Table - 5.2 Respondents currently pursuing training related to Human Resource Management

Training related Gastro Total No. of ABC KMC Maruthi to HRM Care Respondents

Yes 4 2 5 1 12

No 1 2 1 5 9

Total 5 4 6 6 21

Source: Primary data

The above table depicts that, 12 Human Resource Professionals - respondents are currently pursuing training related to Human Resource

Management. Remaining nine of the respondents is not currently pursuing training related to HRM.

Training related to HRM is vital for Human Resource Professionals to implement effectively the Human Resource Practices in hospitals for better outcome. Hence Training related to HRM must be made mandatory by the organization for the HR Professionals.

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Table - 5.3 Respondents Interested in pursuing training related to HRM

Interested in Gastro Total No. of Training related ABC KMC Maruthi Care Respondents to HRM

Yes 5 4 6 5 20

No - - - 1 1

Total 5 4 6 6 21

Source: Primary data

Majority 20 Human Resource Professionals - respondents are interested in pursuing education or training related to HRM.

As expressed by the respondents, competency based Education and

Training related to Human Resource Management is necessary for Human

Resource Professionals to carry out the various HRM Practices. Therefore organization must take necessary steps to provide training related to HRM

Activities for all the HR Professionals.

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5.2. Competencies of Human Resource Professionals for Effective Implementation of Human Resource Management Practices

Competencies of Human Resource Professionals for effective implementation of Human Resource Management Practices include Strategic

Contribution Skill, Personal Credibility, HR Delivery, Managerial Skill,

Administrative skill and Internal Consultation. Questionnaire consisting of five point scales ranging from excellent to poor were administered among 21 HR

Professionals. By calculating the median, high level and low level are found out. When the value is less than median then it is considered as low level and when the value is at the median point and above median then it is considered as high level.

Table - 5.4 Respondents Level of Strategic Contribution Skill

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 2 2 4 2 10

Low level 3 2 2 4 11

Total 5 4 6 6 21

Source: Primary data

HR Professionals - respondents were segmented on the basis of opinion about their strategic Contribution Skill. Strategic Contribution Skill consists of three items. They are culture management, adapting to fast change and strategic decision making. Ten respondent’s falls in the high level and 11 respondents seem to be at the low level.

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As expressed by the respondents, HR Professionals are moderate in culture management, strategic decision-making and fast change. This result is indeed a concern because HR Professionals should be able to successfully implement the human resource management practices. Furthermore, if HR

Professionals are not able to facilitate change management processes and adapt learning to new change initiatives, they would have problems working with key individuals to ensure decisions are made quickly and to ensure resources are aligned with desired changes.

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Table - 5.5 Respondents Level of Personal Credibility Skill

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 3 3 4 4 14

Low level 2 1 2 2 7

Total 5 4 6 6 21

Source: Primary data

HR Professionals - respondents were segmented on the basis of opinion about their Personal Credibility skill. Personal Credibility Skill consists of three items. They are achieving the results, smooth relationship with employees and effective communication with employees. 14 respondents fall in the high level and seven respondents seem to be at the low level.

These findings show positive development to the HR Professionals because personal credibility competency is the foundation for a HR

Professional to become intimately involved at the strategic level in an organization once given the opportunity. Achieving the results, smooth relationship with employees and effective communication with employees are essential for enhancing the job satisfaction among the employees. Without this foundation of trust, HR Professionals may very well find themselves excluded from the strategy table.

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Table - 5.6 Respondents Level of HR Delivery

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 2 3 5 3 13

Low level 3 1 1 3 8

Total 5 4 6 6 21

Source: Primary data

HR Professionals - respondents were segmented on the basis of opinion towards their level in HR Delivery. HR Delivery consists of five items. They are selection of candidate, recruitment of right candidate, training and development, retaining the employees and legal compliance. 13 respondent’s falls in the high level and eight respondents seem to be at the low level.

Good Working environments and training and development are some of the key health human resources practice which have resulted in motivation and satisfaction among employees. Such strategies are essential in terms of planning, job satisfaction, and intent to stay in the hospitals and HR

Professionals - respondents shows the positive end in this type of skill.

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Table - 5.7 Respondents Level of Managerial Skill

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 2 2 4 3 11

Low level 3 2 2 3 10

Total 5 4 6 6 21

Source: Primary data

HR Professionals - respondents were segmented on the basis of opinion towards their level in Managerial Skill. Managerial Skill consists of two items.

They are motivation of employees and creation of team building among employees. 11 respondents falls in the high level and ten respondents seem to be at the low level.

Motivation of employees and making the employees to participate in decision making by creating a team building increases the level of satisfaction among the employees. Hence managerial skill is vital skill needs to be developed among the HR Professionals.

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Table - 5.8 Respondents Level of Administrative Skill

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 2 3 4 3 12

Low level 3 1 2 3 9

Total 5 4 6 6 21

Source: Primary data

HR Professionals – respondents were segmented on the basis of opinion towards their level in Administrative Skill. Administrative Skill consists of three items. They are grants / refusal of leave or over time, ensuring availability of people at work place, and maintaining records. 12 respondents falls in the high level and nine respondents seem to be at the low level.

HR Professionals need to combine all administrative skills to meet the challenges that the changing socio-political, economic and technological landscape presents, as well as the expectations of Patients, Health

Professionals, Politicians and the Public.

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Table - 5.9 Respondents Level of Internal Consultations

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 3 2 4 4 13

Low level 2 2 2 2 8

Total 5 4 6 6 21

Source: Primary data

HR Professionals - respondents were segmented on the basis of opinion towards their level in Internal Consultations. Internal Consultations consists of developing solutions to the employee’s problems. 13 respondents falls in the high level and eight respondents seem to be at the low level.

Developing solutions to the employee’s problem by the HR

Professionals create a positive working environment with a smooth relationship with co-workers and superiors which might lead to the satisfaction of employees.

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Table - 5.10 Respondents Overall Level of Competencies

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 2 3 4 3 12

Low level 3 1 2 3 9

Total 5 4 6 6 21

Source: Primary data

HR Professionals - respondents overall competency level is high.

However nine respondents are at low level. Base on these empirical findings, this study has been able to show that the competency assessment has become an important managerial developmental tool (James R. Lindner, 2001) which provides a basis for competency based training and development. These findings suggest a need for competency based training regarding Human

Resource Management. Hence competency based training programs are more flexible and durable than activity based programs to increase the level of competencies among the HR Professionals. This allows this study to yield a better understanding of what level of HR Competencies is exhibited by HR

Professional and the variables that influence performance of HR Activity.

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Table - 5.11 Respondents Overall Level of Performance of Human Resources Activities

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 2 3 4 3 12

Low level 3 1 2 3 9

Total 5 4 6 6 21

Source: Primary data

HR Professionals-respondents overall performance of Human Resources

Activities is high. Nine respondents are at low level. Performance of any activity requires certain knowledge competencies. Knowledge of Human

Resource Policies and Practices including laws and regulations involved in recruiting, selecting, compensation, and fair employment is needed to carry out

Human Resource Management Activities. Low Human Resource Knowledge competencies are a fundamental concern that should be addressed through a combination of formal education, training, and development in order implement the effective HRM Practices. Knowledge of administration and management principles, organizational planning, coordination, and execution are also needed to carry out Human Resource Management Activities.

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Testing of Hypotheses

In this section, an attempt has been made by the researcher to find out the cause effect relationship between the competencies of HR Professionals and the performance of HRM Activity.

5.3. Relationship between the Demography and Competencies of Human Resource Professionals

The primary aim of this research is to study the level of competencies among the HR Professionals for developing the effective HRM Practice. HR

Competencies are said to be a set of characteristics contributing to effective HR performance that enhance the motivation and job satisfaction among the employees. There are several studies indicates that the level and type of competencies possessed by HR Professionals are very much influenced by demographic factors such as the age, gender, years of experience, Income and education level (Reza Tajaddini, 2010, Choi Sang Long, 2009, Sunil Ramlall,

2006). Hence the following hypotheses has been framed to find out the relationship between demographic factors and the competencies of HR

Professional.

Hypothesis 1 Alternate Hypothesis

At least one of the competencies of HR Professional have significant relationship with the demographic factors such as age, years of experience, education level and income of HR Professionals.

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Null Hypothesis

There is no significant association between the level of competencies of

HR Professional and the demographic factors such as age, years of experience, education level and income of the HR Professional - respondents.

Level of Significance: α = 0.05, 0.01

Statistical Test

The competencies of HR Professional might be influenced by the demographic variable. In order to find the correlation between demographic variable and competencies of HR Professional which are in qualitative characteristics, Spearman’s Correlation is used to test the hypothesis.

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Table - 5.12 Spearman’s Correlation between Demographic Factors (Age, Experience, Education level, and Income) and HR Competencies

Age Experience Educational Qualification Income

Competencies Spearman Significance Spearman Significance Spearman Significance Spearman Significance RHO value value RHO value value RHO value value RHO value value

Strategic .276 .226 .304 .183 -.001 .996 .307 .175 Contribution Skill

Personal .263 .250 .234 .307 .367 .101 .300 .187 Credibility

HR Delivery .630 ** .002 .559 ** .008 .484 * .026 .608 ** .003

Managerial Skill .655 ** .001 .484 * .026 .056 .809 -.027 .908

Administrative .827 ** .000 .577 ** .006 .825 ** .000 .145 .365 skill

Internal .583 ** .006 .267 .243 -.008 .971 .228 .321 Consultations *Correlation is significant at the .05 level (2 tailed) ** Correlation is significant at the .01 level (2 tailed)

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Inference

All demographic factors are significantly correlates with at least one HR

Competency. Age has significant correlation with HR Delivery, Managerial

Skill, Administrative Skill and Internal Consultation (Significance value 0.002,

P < 0.01, .001, P < 0.01, 0.00, P < 0.01 & .006, P < 0.01). Experience has significant correlation with HR Delivery, Managerial Skill and Administrative

Skill (Significance value 0.008, P < 0.01, 0.26, P < 0.05 & 0.006, P < 0.01).

Education qualification has significant correlation with HR Delivery and

Administrative Skill (Significance value 0.026, P < 0.05 & 0.000, P < 0.01).

Lastly, Income is significantly correlated with HR Delivery (Significance value

0.003, P < 0.01). One significant finding is that all demographic factors (HR experience, education level, age and Income) correlate significantly with competency of HR Delivery. Hence the null hypothesis is rejected and alternate hypothesis is accepted. Therefore demographic factors of HR Professionals influence the level of competencies among the Human Resource Professionals of the Specialized Hospitals.

5.4. Relationships between Competencies of Human Resource Professionals and their Performance in Human Resource Management Activity

The secondary aim of this research is to find out the ability of the HR

Professionals in performing the various Human Resources Activities. The ability of HR Professionals is influenced by the various competencies.

Knowledge of Human Resource Policies and Practices including laws and

170 regulations involved in recruiting, selecting, compensation, and fair employment is needed to carry out human resource management activities.

Hence, competencies are correlated with performance of HRM Activities. The correlation presented here has been supported by various other studies. (Kassa

Teshager Alemu (MA), 2011, Fadi El-Jardali, 2009, James R. Lindner, 2001,

Choi Sang Long, 2008). Hence in order to find out the relationship between the competencies of HR Professionals and performances of HRM Activities the following hypothesis has been framed.

Hypothesis 2 Alternate Hypothesis

Increase in the level of Competencies of Human Resource Professionals enhances their performance in Human Resource Management Activity.

Null Hypothesis

There is no significant association between Competencies of Human

Resource Professionals and Performance of Human Resource Professionals in

Human Resource Management Activity.

Level of significance: α = .01

Statistical Test

Regression analysis enables to find out how far the variance in independent variable (competencies) contributes to the change in the dependent variable (HRM Activities). Hence this is the appropriate tool to test this hypothesis.

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Table - 5.13(a)

Competencies of Human Resource Professionals and their performance in Human Resource Management Activity – Regression Analysis

Model Summary b

Adjusted Std. Error of Model R R Square R Square the Estimate 1 .865 a .747 .734 1.34770 a. Predictors: (Constant), competencies b. Dependent Variable: hrm activity

Inference

It is inferred that R value is .865 and R 2 value is 0.747. The result shows that the competencies of HR Professionals to explain 74.7 percent of the

HRM Activity.

Table - 5.13(b)

ANOVA b

Sum of Model Squares df Mean Square F Sig. 1 Regression 102.157 1 102.157 56.244 .000 a Residual 34.510 19 1.816 Total 136.667 20 a. Predictors: (Constant), competencies b. Dependent Variable: hrm activity

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Table - 5.13(c)

Coefficients a

Unstandardized Standardized Coefficients Coefficients Model B Std. Error Beta t Sig. 1 (Constant) -8.982 10.180 -.882 .389 competencies .976 .130 .865 7.500 .000 a. Dependent Variable: hrm activity

Regression Equation: Y = -8.982 + .976x

For every one unit increase in the level of competencies among the HR

Professionals, there is 0.976 increase in their performance of Human Resource

Activity.

Inference

Calculated P-value (0.000) is given under the significance column. Since the P-value is less than 0.01, it implies that calculated regression coefficient is significant and null hypothesis is rejected and alternate hypothesis is accepted.

Competencies in independent variable contribute to the change in dependent variable HRM Activities. Therefore it is inferred that competencies really contribute to change in HRM Activities. Hence increase in the level of competencies of HR Professionals would contribute to the effective implementation of Human Resource Management Practices in the organization.

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Figure - 5.1 Competencies of HR Professionals and their performance in Human Resource Activities

Linear Regression hrm activity = -8.98 + 0.98 * competen R-Square = 0.75

70.00 AAA A y

t A

i 68.00

i t

c A

m r

66.00 A h

A A A A

64.00

A A

74.00 76.00 78.00 80.00 82.00 competencies

Inference

As per the regression line, there is upward line which indicates there is a perfect positive relationship between the competencies and the performance in

Human Resources Activities. R-Square is 0.75 which is 75 percent, which indicates there is strong relationship between the variables. Hence it is inferred that increase in the level of competencies increases the performance of Human

Resources Activities by the HR Professionals.

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One-Way ANOVA - Level of Competencies among the HR Professionals in four Selected Hospitals

Hypothesis 3 Null hypothesis

There is no significant difference between the levels of competencies among the HR Professionals of all the four selected hospitals.

Alternate Hypothesis

At least in one hospital, the levels of competencies significantly differ among the HR Professionals in all the four selected hospitals.

Level of significance: α = .01

Statistical test

One - Way ANOVA is used to test the hypothesis taking the hospitals as factors.

Table - 5.14(a)

ANOVA

competencies Sum of Squares df Mean Square F Sig. Between Groups 79.526 3 26.509 11.375 .000 Within Groups 39.617 17 2.330 Total 119.143 20

Inference

Calculated P-value (0.000) is given under the significance column. Since the p-value is less than 0.01, hence null hypothesis is rejected and Alternate hypothesis is accepted.

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Therefore to conclude there is a significant difference in the levels of competencies among the HR Professionals of the four Hospitals. In other words the level of competencies varies significantly among the HR Professionals of four hospitals. Hence the null hypothesis is rejected and alternate hypothesis is accepted.

Table - 5.14(b) Homogenous Subsets - Competencies of HR Professional s (Tukey-HSD)

Subsets for alpha = 0.05 No. of Hospitals Respondents 1 2 3

ABC 5 74.6000

Maruthi 6 76.8333 76.8333

Gastro care 4 78.2500 78.2500

KMC 6 79.8333

Sig. .128 .469 .375

Uses Harmonic mean sample size = 5.106

Inference

Means for groups in homogeneous subsets are displayed. Levels of competencies are similar among the HR Professionals of ABC Hospital and

Maruthi which is under subset one. Subset 2 is formed by Maruthi and Gastro

Care and subset three is formed by Gastro Care and KMC with highest score.

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Table - 5.14(c) Descriptive Statistics Level of Competencies among the HR Professionals in four Specialized Hospitals

No. of Standard Standard Hospitals Mean Respondents Deviation Error

ABC 5 74.60 1.14 .509

Gastro Care 4 78.25 .50 .250

KMC 6 79.83 2.04 .833

Maruthi 6 76.83 1.60 .654

Total 21 77.41 2.44 .532

Inference

From the above table it is observed that the mean score 79.83 is highest among the HR Professionals of KMC Hospital. In other words the level of competencies is highest among the HR Professionals of KMC Hospitals. 78.25 is the second highest mean score among HR Professionals of Gastro Care.

Hence it is inferred that the HR Professionals of KMC Hospital are more competent than the other HR Professionals.

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Human Resource Management Practices

This section deals with the descriptive and statistical analysis of the primary data collected from the employees of the specialized hospitals in

Tiruchirappalli Corporation. In all the four selected hospitals, employees were

Duty Doctors comes under High Level Employees. Front Office Staff,

Outpatient Staff, Nursing (Matron, Staff Nurses and Assistant Nursing Maid),

Administration (Accounts Department), Lab Technicians, Radiologist and

Pharmacist comes under Middle level Employees. Health Workers and House

Keepers come under Low Level Employees.

An attempt has been made by the researcher to study the socio-economic and demographic factors which have an influence over the attitude of the employee-respondents towards the HRM Practices implemented in the specialized hospitals. Also the attitude of the employees towards the implementation of HRM Practices and level of motivation and job satisfaction among the employee-respondents are found out in this study.

5.5. Demographic Profile of Employee - Respondents

Demographic profile of the employees-respondents deals with age, gender, educational qualification, marital status, domicile and family type.

Questionnaire was administered with 517 employees in specialized hospitals at

Tiruchirappalli, to study the Human Resources Practices implemented in specialized hospitals by HR Professionals.

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Table - 5.15 Respondent’s Classification on the basis of Age

Gastro Total No. of Age ABC KMC Maruthi Care Respondents

20-25 77 23 46 46 192

26-30 28 36 54 52 170

31-35 16 11 28 31 86

36 & above 24 13 9 23 69

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of age. A

majority 77 number of respondents of ABC Hospital belonged to the category

of age group 20-25 and majority of 36 numbers of respondents in Gastro care,

54 numbers of respondents in KMC and 52 numbers of respondents in Maruthi

belonged to the category of age group 26-30.

Organizations shape the Human Resource practices in different

combination keeping in view demographic factors like age, gender, experience,

educational level and nature of appointment. Prior research exploring the

impact of the demographic variable of employee age shows that it is also

associated with attitudinal and behavioral difference (Edgar, F. & Geare, A.

(2004). In terms of HRM dimensions, age also influences employee attitudes

towards affirmative action policies, with increased age being associated with

more positive attitudes towards these policies.

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Table - 5.16 Respondent’s Classification on the basis of Gender

Gastro Total No. of Age ABC KMC Maruthi Care Respondents

Male 35 20 57 61 173

Female 110 63 80 91 344

Total 145 83 137 152 517

Source: Primary data

Questionnaire was administered with 517 employees in Specialized

Hospitals at Tiruchirappalli; to study the effectiveness in implementation of

Human Resources Practices by HR Professionals. This study was conducted with 173 male employees and 344 female employees.

A large number of studies comparing the behavior and attitudes of males and females report that gender differences do exist. The areas of HRM (training and development, recruitment and selection) are likely to be perceived as being more important to women than to men, and the application of equitable practice in these areas is also likely to be viewed more favorably by women than by men.

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Table - 5.17 Respondent’s Classification on the basis of Educational Qualification

Educational Gastro Total No. of ABC KMC Maruthi qualification Care Respondents High school and less than high 8 - - 11 19 school UG 90 39 70 97 296 MBBS/PG 33 3 29 13 78 Others 14 41 38 31 124 Total 145 83 137 152 517 Source: Primary data

Questionnaire was administered with 517 employees. Employee - respondents were segmented on the basis of educational qualification. Majority

90 numbers of respondents in ABC, 70 numbers of respondents in KMC and 97 numbers of respondents in Maruthi are under graduate followed by the respondents who come under “others” who represents the respondents completed their certificate courses, diploma courses in Nursing or other disciplines.

The Human Resource Management practices motivates employees to work harder and efficiently otherwise effectiveness of even highly skilled employees will be limited if they are not motivated enough to perform.

Behavior of employees within firm has important implication for the organization performance and that human resource management practices can affect individual employee’s performance through their influence over employee’s skills.

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Table - 5.18 Respondent’s Classification on the basis of Marital Status

Marital Gastro Total No. of ABC KMC Maruthi Status Care Respondents

Married 94 46 56 59 255

Unmarried 51 37 81 93 262

Total 145 83 137 152 517

Source: Primary data

Employee - respondents were segmented on the basis of marital status.

Majority 51 respondents in ABC, 37 respondents in Gastro care, 81 respondents in KMC and 93 respondents in Maruthi hospitals are unmarried.

As expressed by the respondents, Unmarried girls are recruited as receptionist, ANM and as outpatient staff as they have lesser family commitments when compared to the married staffs.

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Table - 5.19 Respondent’s Classification on the basis of Domicile

Gastro Total No. of Domicile ABC KMC Maruthi Care Respondents

Rural 50 13 7 20 90

Urban 95 70 130 132 427

Total 145 83 137 152 517

Source: Primary data

As expressed by the respondent’s, majority 427 respondents of all the four hospitals belonged to urban and the rest of the respondents belonged to rural area. Some studies show that minority groups experience discrimination during the recruitment and selection process. Rural group members making more job applications, this group received fewer job offers than members from the dominant group. Hence, recruitment and selection is an area likely to be considered more important by urban group members than is likely to be perceived by the people in rural area.

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Table - 5.20

Respondent’s Classification on the basis of Family Type

Gastro Total No. of Family ABC KMC Maruthi Care Respondents

Joint 71 72 74 84 301

Nuclear 74 11 63 68 216

Total 145 83 137 152 517

Source: Primary data

Employee - respondents were segmented on the basis of family type.

Majority of the respondents in ABC (71), Gastro care (72), KMC (74) and

Maruthi (84) are in joint family and rest of the respondents is in nuclear family.

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5.6. Professional Profile of the Respondents

Professional profile of the respondents includes cadre, experience, and working department of the respondents.

Table - 5.21 Respondent’s Classification on the basis of Cadre

Gastro Total No. of Cadre ABC KMC Maruthi Care Respondents

High level 3 2 6 7 18

Medium level 129 75 113 132 449

Low level 13 6 18 13 50

Total 145 83 137 152 517

Source: Primary data

Employee - respondents were segmented on the basis of Cadre. Majority with 449 numbers of the respondents belonged to the middle level. 50 respondents belonged to the low level and 18 respondents belonged to high level. Cadre has been classified as below:

Duty Doctors comes under High Level Employees. Front Office,

Outpatient Staff, Nursing (Matron, Staff Nurses and Assistant Nursing Maid),

Administration (Accounts Department), Lab Technicians, Radiologist and

Pharmacist comes under Middle level Employees. Health Workers and House

Keepers come under Low Level Employees.

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Table - 5.22 Respondent’s Classification on the basis of Department

Gastro Total No. of Department ABC KMC Maruthi Care Respondents

Duty Doctors 3 2 6 7 18

Front office 24 10 16 31 81

Nursing 46 50 56 40 192

Pharmacy 14 4 7 14 39

Administration 20 5 23 21 69

Technicians 25 6 11 26 68

House keeping 13 6 18 13 50

Total 145 83 137 152 517

Source: Primary data

Employee - respondents were segmented on the basis of departments.

192 respondents belonged to nursing department, 81 respondents belonged to front office, 69 respondents belonged to the department of administration, 68 respondents are technicians, 50 respondents belonged to the department of housekeeping and 18 respondents are duty doctors. The implementation of few

Human Resources Practices may have different impacts among different departments.

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Table - 5.23 Respondent’s Classification on the basis of Experience

Gastro Total No. of Experience ABC KMC Maruthi Care Respondents

0-3 87 26 35 62 210

4-6 57 44 48 63 212

7-9 1 8 38 26 73

10 & above - 5 16 1 22

Total 145 83 137 152 517

Source: Primary data

Employee - respondents were segmented on the basis of yearly experience in their field. Majority with 44 number of respondents in Gastro care, 48 number of respondents in KMC and 63 number of respondents in

Gastro Care belonged to the category with 4-6 years of experience followed by the 87 number of respondents in ABC belonged to the category with 0-3 years of experience.

As expressed by the respondents, work experiences are likely to be affected by the set of HR Practices and are also likely to have an influence on employee related outcomes. Length of service or experience may influence attitudes and belief systems which can be substantially different across cohorts of age dissimilarity.

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5.7. Socio-Economic Profile of the Respondents

Socio-economic profile of the respondents discusses the income of the employees.

Table - 5.24 Respondent’s Classification on the basis of Annual Income

Annual Gastro Total No. of ABC KMC Maruthi Income Care Respondents Below 62 4 15 46 127 Rs.50,000 Rs.50,000- 60 73 94 91 318 1,00,000 Above 23 6 28 15 72 Rs.1,00,000 Total 145 83 137 152 517 Source: Primary data

Employee - respondents were segmented on the basis of their annual income. Majority with 73 numbers of the respondents in Gastro care, 94 numbers of respondents in KMC and 91 numbers of respondents in Maruthi hospital are respondents with annual income between Rs.50,000-1,00,000 followed by 62 numbers of the respondents in ABC whose annual income is below Rs.50,000. Only meager percent of the respondents are drawing above

Rs.1,00,000 annually.

The financial compensation system seeks to maintain satisfaction of human resources. The financial compensation system purports to induce and reward improved performance and forms an effective motivator. The employees with high pay will be highly motivated than others. Income level of the employees will substantially influence over the HRM Practices.

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5.8 Human Resources Practices in Specialized Hospitals

Human Resources Practices implemented in the Specialized Hospitals includes Recruitment and Selection, Training and Development, Staff promotion, Performance Appraisal Systems (PAS), Career Development,

Incentives, Compensation, Recognition and Reward, Recognition and Reward,

Flexibility Work Option, Job Design and Employee’s Participation and

Communication.

Questionnaire consisting of five point scales ranging from strongly agree to strongly disagree were administered among 517 employees of the specialized hospitals at Tiruchirappalli Corporation. By calculating the median, high level and low level are found out. When the value is less than median then it is considered as low level and when the value is at the median point and above median then it is considered as high level.

Table - 5.25 Respondent’s Opinion towards Recruitment and Selection

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 131 44 101 95 371

Low level 14 39 36 57 146

Total 145 83 137 152 517

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Employees - respondents were segmented on the basis of opinion towards the Recruitment and Selection practice in Specialized Hospitals.

Recruitment and selection consists of three items. Majority of the respondents falls in the high level and rest are in the low level opinion.

Recruitment procedure that provides large pool of qualified applicants, paired with reliable and valid selection regimen, will have a substantial influence over the quality and type of employee’s. The Human Resource

Management Practices motivates employees to work harder and efficiently otherwise effectiveness of even highly skilled employees will be limited if they are not motivated enough to perform.

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Table - 5.26 Respondent’s Opinion towards Training and Development

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 131 47 101 83 362

Low level 14 36 36 69 155

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of opinion towards the Training and Development in Specialized Hospitals. Training and

Development consists of five items. Total of 362 numbers of the respondents in all the four hospitals falls in the high level and 155 numbers of respondents are in the low level opinion.

As expressed by the respondents, Training and Development is handled by the senior staffs in the department. Hence senior staffs should be well motivated to be efficient enough to train the employees. The respondents who fall under the low level may not be properly trained by the senior staff. Hence all the senior employees in every department must be well motivated by the HR

Professionals in order to train their juniors efficiently, so that the employees will have a high impact towards this practice.

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Table - 5.27 Respondent’s Opinion towards Staff Promotion

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 75 48 107 139 369

Low level 70 35 30 13 148

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of opinion towards the Staff Promotion in Specialized Hospitals. Staff Promotion consists of three items. 369 numbers of respondents of four hospitals falls in the high level and 148 numbers of respondents are in the low level opinion.

As expressed by the respondents, there is a positive and relatively a high opinion regarding the staff promotion. Staff Promotion is mainly based on the seniority and experience level of the individual rather than on performance.

Hence the employees who are working in the same organization for longer period are considered for the further promotion. If performance level is also considered for further promotion, each and every employee will be motivated to work efficiently.

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Table - 5.28 Respondent’s Opinion towards Performance Appraisal Systems (PAS)

Level of Gastro Total No. of ABC KMC Maruthi opinion Care Respondents

High level 132 53 94 95 374

Low level 13 30 43 57 143

Total 145 83 137 152 517

Source: Primary data

Employees – respondents were segmented on the basis of opinion towards the Performance Appraisal Systems (PAS) in Specialized Hospitals.

Performance Appraisal Systems (PAS) consists of five items. 374 numbers of respondents fall in the high level and 143 numbers of respondents have their opinion at low level.

Performance Appraisal promotes a positive work environment which leads to the satisfaction of employees. Majority of the respondents have high level opinion towards the effective implementation of this practice.

Performance Appraisal has been done in these selected hospitals only once in a year, hence the existence of a regular appraisal system tends to make the supervisors and executives more observant of their subordinates who will result the better performance.

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Table - 5.29 Respondent’s Opinion towards Career Development

Level of Gastro Total No. of ABC KMC Maruthi Opinion Care Respondents

High level 87 73 100 134 394

Low level 58 10 37 18 123

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of opinion towards the Career Development in Specialized Hospitals. Career Development consists of three items. 394 numbers of the respondents fall in the high level and 123 respondents have their opinion at low level.

As expressed by the respondents, the prime importance of career development programme has been given to the Staff Nurses, Technician’s.

Career development programmes are needed for all the levels of employees to improve their skills and to apply in the work for better performance.

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Table - 5.30 Respondent’s Opinion towards Incentives, Compensation

Level of Gastro Total No. of ABC KMC Maruthi Opinion Care Respondents

High level 123 46 98 143 410

Low level 22 37 39 9 107

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of opinion towards Incentives, Compensation in Specialized Hospitals. Incentives,

Compensation consists of three items. 410 respondents fall in the high level and 107 respondents have their opinion at low level.

As expressed by the respondents, the employees who are working in the night shifts are not been given any additional benefits or incentives. Employees work 8-9 hours in a day shift, while during the night shift they have to work for

12 hours. Hence the employees should be compensated well for the extra hours for their effective performance.

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Table - 5.31 Respondent’s Opinion towards Recognition and Reward

Level of Gastro Total No. of ABC KMC Maruthi Opinion Care Respondents

High level 125 49 93 65 332

Low level 20 34 44 87 185

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of opinion towards Recognition and Reward in Specialized Hospitals. Recognition and reward consists of five items. 332 numbers of the respondents fall in the high level and 185 numbers of respondents have their opinion at low level.

Reward and Recognition are more appropriate because they are not pre- conditions, but spontaneous appreciation of effort. Rewards and Recognitions are focused more towards the house keepers, employees in the low level, staff nurses and technician to improve their level of satisfaction. In turn this will enhance their performance which directly links to organizations performance.

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Table - 5.32 Respondent’s Opinion towards Flexibility Work Option

Level of Gastro Total No. of ABC KMC Maruthi Opinion Care Respondents

High level 139 74 104 134 451

Low level 6 9 33 18 66

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of opinion towards Flexibility Work Option in Specialized Hospitals. Flexibility Work

Option consists of three items. 451 numbers of the respondents fall in the high level and 66 numbers of respondents have their opinion at low level.

A positive attitude has been reflected by the respondents towards this practice. Appropriate flexible work arrangement and equipment, systems or materials are available during working hours. Organizations with formal flexible work programs have reported positive outcomes: Improved morale,

Ability to work in alignment with personal work rhythms/styles, and reduced stress.

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Table - 5.33 Respondent’s Opinion towards Job Design

Level of Gastro Total No. of ABC KMC Maruthi Opinion Care Respondents

High level 141 47 107 133 428

Low level 4 36 30 19 89

Total 145 83 137 152 517

Source: Primary data

Employees – respondents were segmented on the basis of opinion about

Job Design in specialized hospitals. Job Design consists of three items. 428 numbers of the respondents fall in the high level and 89 numbers of respondents have their opinion at low level.

Tasks are allocated to each person in the organization, and sequence to perform is instructed to all the level of employees. This may creates accountability among employees to accomplish the task given and drive them towards achievement.

198

Table - 5.34 Respondent’s Opinion towards Employee’s Participation and Communication

Level of Gastro Total No. of ABC KMC Maruthi Opinion Care Respondents

High level 137 69 73 82 361

Low level 8 14 64 70 156

Total 145 83 137 152 517

Source: Primary data

Employees - respondents were segmented on the basis of opinion about

Employee’s participation and Communication in specialized hospitals.

Employee’s participation and Communication consists of four items. 361 numbers of the respondents fall in the high level and 156 numbers of respondents have their opinion at low level.

As expressed by the respondents, there is two way communications between the employees and management. Employee’s attitudes and beliefs are molded and their behavior is influenced positively with the help of communication. There is Possibility for immediate feedback if there is more effective communication and in turn provides scope for employee satisfaction.

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Table - 5.35 Respondent’s Overall Opinion towards Human Resources Practices

Level of Gastro Total No. of ABC KMC Maruthi Opinion Care Respondents

High level 77 44 76 78 275

Low level 68 39 61 74 242

Total 145 83 137 152 517

Source: Primary data

From the above observation, it is strongly felt that, majority of

Employees-respondents have a positive opinion towards overall implementation of Human Resources Practices in the hospitals which enhance the motivation and job satisfaction among the employees. Even though majority of the employee-respondent’s opinion towards HRM Practices are high, there are also employees who fall under the low level opinion.

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Testing of Hypotheses

In this section, an attempt has been made by the researcher to find out the relationship between the employee demography and their attitudes towards

Human Resource Management Practices, by testing various hypotheses with suitable statistical tools and the results are interpreted.

5.9. The relationship between the Employee Demography and Human Resources Management Practice

The third research aim of this study is to expose the effective implementation of HRM Practices by the employees of the specialized hospitals. Employee’s attitude towards the HRM Practices implemented in the hospitals may be influenced by employee demographic factors. Therefore to establish the demographic differences which creates an impact in attitudes towards ten specific functional areas of HRM amongst a sample of employee groups in specialty hospital, Six demographic variables are examined - gender, age, domicile, experience (length of service), education qualification and

Income. These variables are those commonly cited as significant in various other studies (Edgar, F. & Geare, A., 2004, Birgit Verworn, 2009). Hence the following hypothesis has been framed.

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Table - 5.36 Box plot – Dispersion of Gender on the basis of the opinion on Recruitment and Selection

Case Processing Summary

Cases Valid Missing Total gender N Percent N Percent N Percent recruitment and selection male 173 100.0% 0 .0% 173 100.0% female 344 100.0% 0 .0% 344 100.0%

Figure - 5.2 Box plot – Dispersion of Gender on the basis of the opinion on Recruitment and Selection

8 recruitmentand selection N = 173 344 male female

gender

Inference

As per box-plot diagram, skewness of the data is exhibited. This suggests that the data is non-symmetrical. Hence this study requires non- parametric tests such as Mann-Whitney U test, Kruskal-Wallis Test, and Chi- square test.

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Hypothesis 4 Null Hypothesis

There is no significant difference due to gender towards various dimensions of Human Resource Practices.

Alternate Hypothesis

The attitude of the male and female respondents differs towards the various dimensions of the HRM Practices.

Level of Significance : α = 0.05, 0.01

Statistical Test

Since the scale of measurement is ordinal, Non parametric test – Mann

Whitney U test is used.

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Table - 5.37 Mann Whitney u test between Genders of the Respondents and HRM Practices ABC Hospital GASTROCARE HOSPITAL KMC HOSPITAL MARUTHI HOSPITAL HRM Male = 35 Female = 110 Male=20 Female=63 Male =57 female = 80 Male = 61 Female = 91 Practice Mean Mean Mean Mean rank u Status u Status u STATUS u STATUS rank rank rank P=.611 P=.746 P=.406 P=.068 Recruitment and M=75.80 M=43.42 M=71.61 M=84.19 1827 p>0.05 601.5 p>0.05 2131 P>0.05 2306.5 p>0.05 Selection F=72.11 F=41.55 F=67.14 F=71.35 insignificant insignificant insignificant insignificant P=.402 P=.382 P=.019 * P=.235 Training and M=77.80 M=38.05 M=77.90 M=81.43 1757 p>0.05 551 p>0.05 1772 P<0.05 2474 p>0.05 Development F=71.47 F=43.25 F=62.66 F=73.19 insignificant insignificant significant insignificant P=.037 * P=.256 P=.204 P=.928 M=60.86 M=37.00 M=73.78 M=76.14 Staff Promotion 1500 P<0.05 530 p>0.05 2007 p>0.05 2753 p>0.05 F=76.86 F=43.59 F=65.59 F=76.74 significant insignificant insignificant insignificant P=.856 P=.540 P=.056 P=.007 M=71.94 M=39.17 M=76.32 M=87.88 PAS 1888 p>0.05 573 p>0.05 1862 P<0.05 2081 P<0.05 F=73.34 F=42.90 F=63.78 F=68.87 insignificant insignificant significant significant P=.013 P=.230 P=.750 P=.297 Career M=85.99 M=36.85 M=70.21 M=80.38 1470 P<0.05 527 p>0.05 2211 p>0.05 2539 p>0.05 Development F=68.87 F=43.63 F=68.14 F=73.90 significant insignificant insignificant insignificant P=.008 P=.342 P=.417 P=.018 Incentives and M=86.99 M=38.05 M=71.45 M=85.18 1435 P<0.05 551 p>0.05 2140 P>0.05 2246 P<0.05 compensation F=68.55 F=43.25 F=67.26 F=70.68 significant insignificant insignificant significant P=.002 P=.911 P=.712 P=.028 Recognition and M=90.14 M=42.47 M=70.39 M=85.20 1325 P<0.05 620 p>0.05 2200 P>0.05 2244 P<0.05 reward F=67.55 F=41.85 F=68.01 F=70.66 significant insignificant insignificant significant P=.000 P=.719 P=.103 P=.156 Flexibility Work M=93.00 M=40.45 M=75.09 M=82.18 1225 P<0.05 599 p>0.05 1933 P>0.05 2429 p>0.05 Option F=66.64 F=42.49 F=64.66 F=72.69 significant insignificant insignificant insignificant P=.000 P=.161 P=.093 P=.344 M=88.14 M=36.10 M=75.01 M=80.16 Job Design 1395 P<0.05 512 p>0.05 1937 P>0.05 2552 p>0.05 F=68.18 F=43.87 F=64.72 F=74.05 significant insignificant insignificant insignificant Employees P=.006 P=.009 P=.382 P=.586 M=85.36 M=52.80 M=65.78 M=78.79 participation and 1492 P<0.05 414 P<0.05 2096 p>0.05 2636 p>0.05 F=69.07 F=38.57 F=71.29 F=74.97 communication significant Significant insignificant insignificant P=.204 P=.689 P=.286 P=.039 Overall HRM M=80.79 M=40.13 M=73.26 M=85.48 1652 p>0.05 592 p>0.05 2037 P>0.05 P<0.05 Practices F=70.52 F=42.60 F=65.96 F=70.48 2228 insignificant insignificant insignificant significant

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ABC Hospital

The attitude of Male and Female respondents differs towards the HRM

Practices. The mean rank of the male respondents are higher than the female in the Various dimensions of HRM Practices such as Career development,

Incentives and Compensation, Recognition and Reward, Flexibility work option, Job Design and Employee Participation and Communication. Whereas the mean rank of the female respondents are higher than male towards staff promotion. Hence null hypothesis is rejected and alternate hypothesis is accepted.

Since the majority of the employees in ABC Hospital are female and whose services are essential, the HR Professionals must pay more attention towards these female employees in developing their career, giving them incentives and compensation, recognizing their work and giving them the rewards.

Gastro Care Hospital

The view point of the male respondents differ significantly than that of the female respondents towards the employee participation and communication. Hence null hypothesis is rejected and alternate hypothesis is accepted. The high level employees are closer to the management than the other level of employees. Since the majority of the employees in high level are male they are encouraged to participate in decision making along with the

205 management. The female respondents can also be considered for a certain extent during the process of decision making.

KMC Hospital

The opinion towards the training and development and Performance appraisal system differs among the male and female respondents of KMC hospitals. The mean rank of the male respondents is comparatively higher than the female. Hence null hypothesis is rejected and alternate hypothesis is accepted. The perspective of male respondents towards Training and

Development and Performance Appraisal System are excellent as they are keen towards acquiring the competencies and assuming the responsibilities. HR

Professionals must take active interest in providing the training and appraising the work of female employees and motivate them to perform their work efficiently.

Maruthi Hospital

The male and female respondent’s outlook towards Performance

Appraisal System, Incentives and Compensation, Recognition and Reward and overall HRM Practices differ as the mean rank is highest in male than female.

Hence null hypothesis is rejected and alternate hypothesis is accepted.

Therefore female respondents are to be considered more to improve their efficiency in performance of their work.

206

Hence in all the four selected hospitals there is a difference of opinion in various dimensions of HRM Practices with high mean scores of male respondents than female. As this is a service industry and majority of the employees are female. Therefore it is suggested that comparatively female respondents are to be well motivated in all the four hospitals to perform their work more effectively.

Hypothesis 5 Null Hypothesis

Domicile and HRM Practice level are independent. In other words

Domicile has no influence over the HRM Practice.

Alternate Hypothesis

Domicile of the respondents influences their level of perception towards the various dimensions of Human Resource management.

Level of Significance : α = 0.05, 0.01

Statistical Test

In order to find out the association between the two attributes, chi- square test is been used to test the hypothesis.

Here there are two nominal or categorical variable domiciles and HRM

Practice level. Domicile is categorized as rural and urban. HRM is categorized as high level and low level and it is based on Cross Tabulation.

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Table - 5.38 Association between the Domiciles of the Respondents and the HRM Practices ABC Hospital Gastro Care Hospital KMC Hospital Maruthi Hospital HRM Practice χχχ2 P Status χχχ2 P Status χχχ2 P Status χχχ2 P Status p>0.05 P<0.05 P>0.05 p>0.05 Recruitment and Selection .240 .624 5.590 .018 .548 .459 1.535 .215 insignificant significant insignificant insignificant p>0.05 P<0.05 P>0.05 p>0.05 Training and Development .091 .763 7.064 .008 .548 .459 .270 .603 insignificant significant insignificant insignificant p>0.05 p>0.05 p>0.05 p>0.05 Staff Promotion .861 .353 5.144 .076 2.068 .150 1.224 .269 insignificant insignificant insignificant insignificant p>0.05 p>0.05 p>0.05 p>0.05 PAS .509 .476 6.451 .092 1.002 .317 .061 .804 insignificant insignificant insignificant insignificant p>0.05 p>0.05 p>0.05 p>0.05 Career Development 2.764 .096 1.769 .183 2.729 .099 1.468 .226 insignificant insignificant insignificant insignificant P>0.05 p>0.05 P>0.05 p>0.05 Incentives and compensation 2.473 .116 .233 .629 .729 .393 3.408 .065 insignificant insignificant insignificant insignificant P>0.05 p>0.05 P>0.05 p>0.05 Recognition and reward .879 .348 1.058 .304 3.490 .534 .072 .789 insignificant insignificant insignificant insignificant P>0.05 p>0.05 P>0.05 p>0.05 Flexibility Work Option 2.165 .141 2.386 .122 .388 .534 .220 .639 insignificant insignificant insignificant insignificant P>0.05 p>0.05 P>0.05 p>0.05 Job Design 2.165 .141 .151 .697 .192 .661 1.184 .276 insignificant insignificant insignificant insignificant Employees participation p>0.05 P>0.05 p>0.05 p>0.05 .902 .342 .024 .876 1.074 .585 1.803 .179 and communication insignificant insignificant insignificant insignificant p>0.05 p>0.05 P>0.05 p>0.05 Overall HRM Practices .798 .372 3.062 .080 .760 .383 .057 .544 insignificant insignificant insignificant insignificant

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Inference

The respondent’s opinion of both rural and urban area in ABC, KMC, and Maruthi hospital has similar attitude towards the HRM Practices. In other words the domicile of the respondents and the HRM Practices are independent and Domicile do not influence over the attitude of the respondents. Therefore null hypothesis is accepted and alternate hypothesis is rejected. Where as in

Gastro care there is a difference of opinion among the respondents of rural area and urban area towards the HRM Practices like recruitment and selection, training and development. The respondents from urban area have comparatively a high opinion towards the above mentioned practices.

Hypothesis 6 Null Hypothesis

There is no significant difference between Overall perception of various dimensions of Human Resource Management Practices and different groups of respondents based on Educational qualification.

Alternate Hypothesis

At least one group of the respondents based on educational qualification differs in their opinion towards various dimensions of HRM Practices.

Level of Significance : α = 0.05, 0.01

Statistical Test

For comparison of independent variable among samples of different groups, Non parametric test Kruskal –Wallis test is used to test the hypothesis.

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Table No -5.39 Kruskal –Wallis Test - The Education Qualification of the Respondents and the HRM Practices ABC Hospital Gastro Care Hospital KMC Hospital Maruthi Hospital N = 145 N = 145 N = 137 N = 145 HRM G1= 8, G2 =90, G2 =39, G2 =70, G1= 11, G2 =97, Practice G3 =33,G4=14 G3 =3,G4=41 G3 =29,G4=38 G3 =13,G4=31 Mean Mean Mean Mean P Status P Status P Status P Status Rank Rank Rank Rank G1 =63.69 G1 =65.41 G2=41.31 G2=67.88 Recruitment G2=74.42 P<0.05 P>0.05 P>0.05 G2=79.57 P>0.05 .015 G3=44.50 .955 G3=76.45 .322 .628 And Selection G3=83.02 Significant Insignificant Insignificant G3=69.38 Insignificant G4=42.48 G4=65.38 G4=45.61 G4=73.82 G1 =59.63 G1 =57.77 G2=35.54 G2=70.09 Training and G2=73.13 P<0.05 P<0.05 P>0.05 G2=80.79 P>0.05 .001 G3=51.83 .055 G3=78.91 .104 .232 Development G3=89.15 Significant Significant Insignificant G3=64.73 Insignificant G4=47.43 G4=59.43 G4=41.71 G4=74.66 G1 =52.50 G1 =72.14 G2=42.59 G2=65.61 G2=77.71 P<0.05 P<0.05 P<0.05 G2=76.41 P>0.05 Staff Promotion .001 G3=20.33 .238 G3=85.34 .027 .880 G3=80.12 Significant Significant Significant G3=71.15 Insignificant G4=43.02 G4=62.76 G4=37.64 G4=80.56 G1 =52.31 G1 =64.32 G2=43.87 G2=65.04 G2=76.51 P<0.05 P>0.05 P>0.05 G2=102.46 P>0.05 PAS .000 G3=49.00 .640 G3=78.38 .280 .107 G3=86.06 Significant Insignificant Insignificant G3=83.02 Insignificant G4=39.71 G4=69.14 G4=31.50 G4=71.68 G1 =77.69 G1 =73.86 G2=38.53 G2=64.62 Career G2=66.53 P<0.05 P>0.05 P>0.05 G2=76.44 P>0.05 .000 G3=33.67 .260 G3=75.00 .363 .358 Development G3=96.09 Significant Insignificant Insignificant G3=92.81 Insignificant G4=45.91 G4=72.49 G4=57.46 G4=70.79

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G1 =74.81 G1 =71.23 G2=39.92 G2=66.29 Incentives and G2=70.78 P>0.05 P>0.05 P<0.05 G2=78.05 P>0.05 .123 G3=34.33 .513 G3=84.50 .036 .122 compensation G3=84.41 Insignificant Insignificant Significant G3=94.19 Insignificant G4=44.54 G4=62.16 G4=59.36 G4=66.11 G1 =53.38 G1 =61.50 G2=40.18 G2=66.79 Recognition and G2=69.38 P<0.05 P>0.05 P>0.05 G2=79.29 P<0.05 .000 G3=32.50 .510 G3=80.76 .151 .030 reward G3=97.30 Significant Insignificant Insignificant G3=98.23 Significant G4=44.43 G4=64.11 G4=50.21 G4=63.98 G1 =65.63 G1 =72.91 G2=44.86 G2=66.74 Flexibility Work G2=71.08 P<0.05 P>0.05 P<0.05 G2=75.02 P>0.05 .019 G3=31.00 .427 G3=83.34 .052 .826 Option G3=86.82 Significant Insignificant Significant G3=76.27 Insignificant G4=40.09 G4=62.22 G4=57.00 G4=82.50 G1 =64.00 G1 =65.73 G2=43.82 G2=69.26 G2=70.66 P<0.05 P>0.05 P<0.05 G2=74.62 P>0.05 Job Design .025 G3=34.67 .687 G3=89.41 .000 .332 G3=85.39 Significant Insignificant Significant G3=74.27 Insignificant G4=40.80 G4=52.95 G4=64.00 G4=87.15 G1 =64.50 G1 =67.73 G2=43.78 G2=68.39 Employees G2=70.71 P>0.05 P>0.05 P>0.05 G2=77.63 P>0.05 participation and .224 G3=62.00 .147 G3=61.05 .235 .825 G3=82.50 Insignificant Insignificant Insignificant G3=82.12 Insignificant communication G4=38.84 G4=76.20 G4=70.21 G4=73.73 G1 =53.56 G1 =64.91 G2=42.18 G2=65.59 Overall HRM G2=73.69 P<0.05 P>0.05 P>0.05 G2=78.36 P>0.05 .000 G3=34.83 .870 G3=82.60 .112 .748 Practices G3=94.44 Significant Insignificant Insignificant G3=80.38 Insignificant G4=42.35 G4=64.91 G4=29.14 G4=73.18

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ABC Hospital

There is a difference in the attitude among the respondents of various groups based on educational qualification towards the various dimensions of

HRM Practices such as Recruitment and Selection, Training and Development,

Staff promotion, Performance Appraisal System, Career Development,

Recognition and Reward, Flexibility Work Option, and Job Design. The mean rank is highest among the respondents who are post graduate and completed

MBBS. Hence the null hypothesis is rejected and alternate hypothesis is accepted. Mean rank for the other groups of respondents are comparatively low, therefore HR Professionals should consider the educational qualification and based upon this, must take active interest in updating their skills, developing their competencies by providing adequate training facilities.

Gastro Care

There are differences in attitude of the Respondents with the qualification of post-graduate whose opinion are high towards training and development than the other respondents. There is also a difference of opinion towards the staff promotion. The respondents with other qualification such as diploma or certificate course have the highest mean rank. Hence the null hypothesis is rejected and alternate hypothesis is accepted.

KMC Hospital

The view point of respondents differ significantly towards the various dimensions of the HRM Practices such as Staff promotion, incentives and

212 compensation, flexibility work option, job design as the mean rank is highest among the respondents qualified with PG and MBBS. Hence null hypothesis is rejected and alternate hypothesis is accepted. The skill of the employees with low qualification can be significantly improved by focusing more towards the monetary and non-monetary benefits.

Maruthi Hospital

The mean scores of respondents with qualification of Post graduate seems to be higher in Recognition and Reward than the other respondents. The respondents with higher qualification are recognized for their additional skills, and knowledge. Hence there is a significant difference among the respondents with regard to Recognition and Reward. Hence the null hypothesis is rejected and alternate hypothesis is accepted.

Performance can also be considered as the key factor in providing them with recognition and reward so that all the employees irrespective of educational qualification get an equal opportunity of being rewarded.

The success and growth of an organization depend largely upon the caliber and performance of its employees. Therefore, it is suggested that HR

Professional must take an effort to improve the quality of its employees for which the organization should design a training programme. Every training programme must be related to the specific needs of the individual employees.

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Hypothesis 7 Null Hypothesis

There is no significant association between Experience of the respondents and attitude of the respondents towards the various dimensions of

Human Resource Management Practices.

Alternate Hypothesis

Experience of the respondents influences the level of perception towards the various dimensions of Human Resource management.

Level of Significance : α = 0.05, 0.01

Statistical Test

In order to find out the association between the two attributes, chi-square test is been used to test the hypothesis.

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Table No -5.40 Association between the experiences of the respondents and the HRM Practices

HRM ABC Hospital Gastro Care Hospital KMC Hospital Maruthi Hospital Practice χχχ2 P Status χχχ2 P Status χχχ2 P Status χχχ2 P Status Recruitment p>0.05 P>0.05 P<0.05 P<0.05 .205 .902 5.029 .267 20.162 .000 11.053 .011 And Selection insignificant insignificant significant significant Training and p>0.05 P>0.05 P<0.05 p>0.05 2.539 .281 2.032 .730 11.768 .008 3.566 .312 Development insignificant insignificant significant insignificant p>0.05 p>0.05 p>0.05 p>0.05 Staff Promotion .107 .948 12.866 .117 4.620 .202 2.001 .572 insignificant insignificant insignificant insignificant p>0.05 p>0.05 p>0.05 p>0.05 PAS .782 .676 14.573 .266 12.785 .005 5.345 .148 insignificant insignificant insignificant insignificant Career p>0.05 p>0.05 p>0.05 P<0.05 .839 .658 2.522 .641 4.171 .244 7.724 .052 Development insignificant insignificant insignificant significant Incentives and P>0.05 p>0.05 P<0.05 P<0.05 .366 .833 2.759 .599 17.265 .001 19.951 .000 compensation insignificant insignificant significant significant Recognition and P>0.05 p>0.05 P<0.05 p>0.05 1.427 .490 2.132 .712 12.029 .007 2.829 .419 reward insignificant insignificant significant insignificant Flexibility Work P>0.05 p>0.05 P<0.05 P<0.05 .397 .820 3.360 .500 16.371 .001 8.525 .036 Option insignificant insignificant significant significant P>0.05 p>0.05 P<0.05 p>0.05 Job Design .397 .820 4.001 .406 13.051 .005 .879 .830 insignificant insignificant significant insignificant Employees p>0.05 P>0.05 P<0.05 p>0.05 participation and .446 .800 3.756 .440 14.118 .028 5.450 .142 insignificant insignificant significant insignificant communication Overall HRM p>0.05 p>0.05 P<0.05 p>0.05 4.971 .083 2.817 .589 12.458 .006 3.711 .294 Practices insignificant insignificant significant insignificant

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ABC Hospital

The length of time spent in an organization or the experiences of the respondents in ABC hospital do not influences their perception level towards the various dimensions of the HRM Practices. Hence the null hypothesis is accepted and alternate hypothesis is rejected.

Gastro Care Hospital

The experience of the respondents does not influence any of the HRM

Practices in gastro care hospital. Hence the null hypothesis is accepted and alternate hypothesis is accepted.

KMC Hospital

The experience of the respondents influences their attitude towards the dimensions of HRM Practices like Recruitment and Selection, Training and

Development, Incentives and Compensation, Flexibility Work, Option, Job

Design, employee’s participation and communication, Recognition and reward and overall HRM Practices. Hence null hypothesis is rejected and alternate hypothesis is accepted. Increased tenure in an organization is positively related to employee performance. Employees who remain working for the same organization over a considerable period of time have high positive opinion with the HRM policies and practices in these areas. Hence HR Professionals should motivate and retain the employees in the organization.

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Maruthi Hospital

There are significant differences in the attitude among the respondents towards the HRM Practices such as Flexibility Work Option, Career

Development, Incentives and compensation, Recruitment and Selection. Hence null hypothesis is rejected and alternate hypothesis is accepted.

These suggest that the HR Professionals should motivate and retain the employees in the organization which leads to the development of shared understandings and experiences. Increased tenure in an organization is positively related to employee well-being and employee performance.

Hypothesis 8 Null Hypothesis

There is no significant association between Income of the respondents and attitude of the respondents towards the various dimensions of Human

Resource Practices.

Alternate Hypothesis

Income of the respondents has significant influence on the overall perception of various dimensions of Human Resource management.

Level of Significance : α = 0.05, 0.01

Statistical Test

To find out whether the change in one variable (Income) is found or apparently found to be associated with the change in the other variable (Human

Resource Practices).Hence, the statistical tool, Karl Pearson’s co-efficient of correlation is used to test the hypothesis in finding out such relationship.

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Table - 5.42 Karl Pearson Correlation between Annual Income of the Respondents the HRM Practices

HRM ABC Hospital Gastro Care Hospital KMC Hospital Maruthi Hospital Practice r P Status r P Status r P Status r P Status Recruitment P<0.05 p>0.05 P<0.05 p>0.05 .389 .000 ** .060 .588 .190 .026 * .077 .349 And Selection significant insignificant significant insignificant Training and P<0.05 p>0.05 P>0.05 P<0.05 .221 ** .008 .200 .070 .167 .051 .245 .002 ** Development significant insignificant insignificant significant P<0.05 p>0.05 p>0.05 p>0.05 Staff Promotion .202 .015 * .033 .764 .128 .137 .051 .535 significant insignificant insignificant insignificant P<0.05 p>0.05 p>0.05 P<0.05 PAS .384 .000 ** .077 .489 .140 .102 .195 .016 * significant insignificant insignificant significant P<0.05 p>0.05 p>0.05 P<0.05 Career Development .269 .001 ** .024 .832 .034 .697 .163 .045 * significant insignificant insignificant significant Incentives and P<0.05 p>0.05 P<0.05 P<0.05 .223 .007 ** .152 .169 .175 .041 * .243 .003 ** compensation significant insignificant significant significant Recognition and P<0.05 p>0.05 P<0.05 P<0.05 .553 .000 ** .011 .918 .259 .002 ** .316 .000 reward significant insignificant significant significant Flexibility Work P>0.05 p>0.05 P<0.05 p>0.05 .156 .061 .096 .387 .221 .010 * .101 .216 Option insignificant insignificant significant insignificant P>0.05 p>0.05 P<0.05 p>0.05 Job Design .138 .099 .068 .544 .297 .000 ** .071 .385 insignificant insignificant Significant insignificant Employees participation P<0.05 P>0.05 p>0.05 P<0.05 .247 .003 ** .135 .223 .059 .495 .203 .012 * and communication significant Insignificant insignificant significant Overall HRM P<0.05 p>0.05 P<0.05 p>0.05 .389 .000 .144 .195 .190 .026 * .077 .349 Practices significant insignificant Significant insignificant

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ABC Hospital

With the increase in the income of the respondent, increases the level of perception among the respondents towards HRM Practices. Since the correlation (r) value is positive there is a positive relationship between the income and the attitude of the respondents towards the HRM Practice. Hence null hypothesis is rejected and alternate hypothesis is accepted.

Gastro Care Hospital

The level of income does not influence the attitude of the respondents of

Gastro care hospital towards any of the HRM Practices. Hence null hypothesis is accepted and alternate hypothesis is rejected.

KMC Hospital

There is a marginal change in the attitude of the respondents towards the various dimensions of HRM Practice with the increase in the level of income.

Correlation value given under the head “r” is positive. Therefore there exist a positive relationship between Income and attitude of the respondents towards the HRM Practices such as Recruitment and selection, Incentives and compensation, Recognition and reward, flexibility work option, job design, and employee participation and communication. Hence null hypothesis is rejected and alternate hypothesis is accepted.

Maruthi Hospital

Increase in level of income impacts a minor change in the attitude of the respondents towards the HRM Practices like Training and development,

219

Performance appraisal system, Career Development, Incentives and

Compensation, Recognition and Reward and Employee’s Participation and

Communication. Hence null hypothesis is rejected and alternate hypothesis is accepted.

There is only a marginal change in the attitude of the respondents of

ABC, KMC and Maruthi Hospitals towards the HRM Practices with the increase in the level of income. This suggests that income of the respondents is less important factor to be considered by the HR Professionals for the effective implementation of HRM Practices.

Hypothesis 9 Null Hypothesis

There is no significant association between age of the respondents and attitude of the respondents towards the various dimensions of Human Resource

Practices

Alternate Hypothesis

Age of the respondents has significant influence on the overall perception of various dimensions of Human Resource management.

Level of Significance : α = 0.05, 0.01

Statistical Test

To find out if the magnitude of one variable (age) changes as the magnitude of the other variable (HRM) changes. In this situation Karl

Pearson’s co-efficient of correlation is used to test the hypothesis to find out such relationship.

220

Table - 5.42 Karl Pearson Correlation between Age of the respondents and the HRM Practices

ABC Hospital Gastro Care Hospital KMC Hospital Maruthi Hospital P P P P P P HRM Practice P Status Status Status Status Status Status Status Status Pearsons Pearsons Pearsons Pearsons Pearsons Pearsons Pearsons Correlation Correlation Correlation Correlation Correlation Correlation Correlation Correlation

Recruitment p>0.05 p>0.05 p>0.05 P<0.05 .009 .919 .115 .158 .032 .775 .192 .025 * and Selection insignificant insignificant insignificant significant Training and p>0.05 p>0.05 p>0.05 P<0.05 .052 .535 .022 .792 .037 .737 .181 .034 * Development insignificant insignificant insignificant significant p>0.05 p>0.05 p>0.05 p>0.05 Staff Promotion .064 .445 .026 .750 .126 .255 .040 .644 insignificant insignificant insignificant insignificant p>0.05 p>0.05 p>0.05 p>0.05 PAS .057 .492 .016 .848 .025 .819 .136 .113 insignificant insignificant insignificant insignificant p>0.05 p>0.05 p>0.05 p>0.05 Career Development .107 .202 .142 .080 .096 .387 .028 .742 insignificant insignificant insignificant insignificant Incentives and P<0.05 p>0.05 p>0.05 P<0.05 .249 .003 ** .138 .090 .001 .991 .196 .022 * compensation significant insignificant insignificant significant P<0.05 p>0.05 p>0.05 P<0.05 Recognition and reward .256 .002 ** .158 .052 .161 .146 .157 .067 significant insignificant insignificant significant Flexibility Work P<0.05 p>0.05 p>0.05 P<0.05 .266 .001 ** .007 .930 .075 .498 .246 .004 ** Option significant insignificant insignificant significant P<0.05 p>0.05 p>0.05 P<0.05 Job Design .164 .049 * .006 .945 .026 .819 .252 .003 ** significant insignificant insignificant Significant Employees participation p>0.05 p>0.05 P<0.05 p>0.05 .132 .114 .021 .798 .278 .011 * .130 .130 and communication insignificant insignificant Significant insignificant p>0.05 p>0.05 p>0.05 P<0.05 Overall HRM Practices .131 .117 .057 .486 .077 .490 .183 .033 * insignificant insignificant insignificant Significant

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ABC Hospital

Age of the respondents found to impact less significantly towards the various dimensions of HRM Practices like incentives and compensation, recognition and reward, flexibility work option and job design. Hence the null hypothesis is rejected and alternate hypothesis is accepted. With the increase in the age of respondents, their knowledge is developed also they tend to understand importance of various practices and develops a positive attitude towards the HRM Practices.

Gastro care Hospital

The demographic attribute of age has an influence over the attitude of the respondents towards employee participation and communication. Hence null hypothesis is rejected and alternate hypothesis is accepted.

KMC Hospital

Age-related differences exist for employee’s attitude towards the importance of recruitment and selection, Training and development, incentives and compensation, recognition and reward, flexibility work option and job design. Older employees consider these areas to be more important than younger employees and increased in their age is associated with more positive attitudes towards these practices. Hence null hypothesis is rejected and alternate hypothesis is accepted.

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Maruthi Hospital

It is found that age does not influences employee attitudes towards HRM

Practices. Hence null hypothesis is accepted and alternate hypothesis is rejected.

It is suggested that HR Professionals should consider the appropriate age as a factor for the appropriate designation for recruiting the employees, as age also plays a role towards the perception of various dimensions of HRM

Practices.

Table - 5.43 Inter Correlation Matrix

H1 H2 H3 H4 H5 H6 H7 H8 H9 H10

H1 1

H2 .589 ** 1

H3 .525 ** .522 ** 1

H4 .489 ** .552 ** .497 ** 1

H5 .672 ** .623 ** .654 ** .650 ** 1

H6 .637 ** .585 ** .605 ** .552 ** .839 ** 1

H7 .710 ** .662 ** .672 ** .687 ** .848 ** .793 ** 1

H8 .639 ** .604 ** .625 ** .667 ** .821 ** .809 ** .841 ** 1

H9 .655 ** .580 ** .630 ** .642 ** .793 ** .762 ** .850 ** .906 ** 1

H10 .546 ** .374 ** .367 ** .460 ** .541 ** .508 ** .574 ** .590 ** .536 ** 1

** Correlation is significant at the 0.01 level * Correlation is significant at the 0.05 level.

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H1 - Recruitment and selection

H2 - Training and Development

H3 - Staff promotion

H4 - Performance Appraisal Systems (PAS)

H5 - Career Development

H6 - Incentives, Compensation

H7 - Recognition and Reward

H8 - Flexibility work option

H9 - Job Design

H10 - Employee’s participation and Communication.

Inference

It is inferred from the above that, there exist significant associations among the various dimensions of Human Resource Practices namely,

Recruitment and selection, Training and Development, Staff promotion,

Performance appraisal systems (PAS), Career development, Incentives,

Compensation, Recognition and Reward, Flexibility work option, Job Design,

Employee’s participation and Communication.

224

One-way ANOVA - Effectiveness of Human Resource Management Practices in four Selected Hospitals

Hypothesis 10 Null hypothesis

There is no significant difference between the employee’s attitudes towards the HRM Practices in all the four selected hospitals.

Alternate Hypothesis

Significant differences exist among the employees attitude towards the

HRM Practices in all the four selected hospitals.

Level of Significance : α = 0.05, 0.01

Statistical test

The employee’s attitude towards the implementation of effectiveness in

HRM Practices have to be compared among the four selected hospitals. Hence

One Way ANOVA and the post hoc test is used.

Table -5.44(a) Human Resource Management Practices in four Selected Hospitals

ANOVA

hrm practices Sum of Squares df Mean Square F Sig. Between Groups 51474.033 3 17158.011 361.687 .000 Within Groups 24336.138 513 47.439 Total 75810.170 516

225

Inference

The p-value, given under the head Sig. is .000. Since the significance value 0.000 is less than 0.05 (p < 0.05), there is a significant differences in the attitude of the respondents towards the HRM Practices. Therefore to conclude there is a significant difference in the implementation of HRM Practices among four Hospitals. In other words implementation of HRM Practices depends upon the competencies of the HR Professionals of the selected hospitals. Hence the null hypothesis is rejected and alternate hypothesis is accepted.

Table -5.44(b) Homogenous Subsets Human Resources Management Practices in four Selected Hospitals Tukey HSD No. of Subsets for alpha = 0.05 Hospitals Respondents 1 2 3 ABC 145 151.6759 Maruthi 152 153.7664 Gastro care 83 166.0241 KMC 137 174.9737 Sig. .084 1.000 1.000 Uses Harmonic mean sample size = 121.866

Inference

Means for groups in homogeneous subsets are displayed. Attitude of the respondents towards the implementation of HRM Practices are similar among the employees of ABC Hospital and Maruthi which is under subset one. Subset

2 is formed by Gastro Care and KMC Hospital is under subset three with the highest mean score.

226

Table -5.44(c) Descriptive Statistics The Effectiveness of Human Resource Management Practices in four Selected Hospitals

No. of Standard Standard Hospitals Mean Respondents Deviation Error

ABC 145 151.68 5.13 .426

Gastro Care 83 166.02 6.49 .712

KMC 137 174.97 7.89 .639

Maruthi 152 153.77 7.52 .643

TOTAL 517 161.38 12.12 .533

Inference

The mean scores reveal that the employees of KMC hospital have high level of attitude towards the HRM Practices (mean score = 174).Subsequently to the KMC, the mean score of the employees in the Gastro care is 166 followed by Maruthi (mean score = 153) and ABC (mean score = 151).

Therefore the HRM Practices are comparatively implemented effectively in the KMC Hospital, followed by Gastro Care, Maruthi and ABC Hospitals.

227

5.10. Level of Motivation among the Employees of Selected Hospitals

The fourth aim of this study is to find out the level of motivation among

the employees of the specialized hospitals. With respect to existing human

resources, the low level of employee’s motivation has often been identified as a

central problem in hospitals and has a negative impact on the performance of

employees. It is therefore an important goal of human resources management in

the hospitals to strengthen the level of motivation from heads of health

facilities to auxiliary staff by the effective implementation of various HRM

Practices. HRM Practices play an important role with respect to increase the

motivation of employees. The level of motivation is thus influenced by the

various dimensions of HRM Practices. This is supported by various other

studies (Inke Mathauer, 2006, Nils Gunnar Songstad, 2011).

Table - 5.45 Respondents Opinion towards the Level of Motivation in ABC Hospital

Opportunity Suitability of Upward given Reward and Supervision Opinion work Communication To learn and recognition grow

F P CP F P CP F P CP F P CP F P CP

Disagree 14 9.7 9.7 29 20.0 20.0 78 53.8 53.8 33 22.8 22.8 49 33.8 33.8

Undecided 18 12.4 22.1 52 35.9 55.9 36 24.8 78.6 24 16.6 39.3 42 29.0 62.8

Agree 65 44.8 66.9 59 40.7 96.6 29 20.0 98.6 83 57.2 96.6 54 37.2 100

Strongly 48 33.1 100.0 5 3.4 100 2 1.4 100 5 3.4 100 - - agree

Total 145 100 145 100 145 100 145 100 145 100

228

Cont...

Cordial Involvement in Development of Working Relationship with Job Security Decision Career Environment Opinion Co-Workers

F P CP F P CP F P CP F P CP F P CP

Disagree 70 48.3 48.3 20 13.8 13.8 35 24.1 24.1 41 28.3 28.3 19 13.7 13.1

Undecided 47 32.4 80.7 16 11.0 24.8 85 58.6 82.8 80 55.2 83.4 1 .7 13.8

Agree 27 18.6 99.3 99 68.3 93.1 23 15.9 98.6 22 15.2 98.6 60 41.4 55.2

Strongly .7 100.0 10 6.9 100 2 1.4 100 2 1.4 100 65 44.8 100 agree 1

Total 145 100 145 100 145 100 145 100 145 100 F – Frequency P – Percent CP – Cumulative Percent

Inference

Questionnaire consisting of five point scales ranging from strongly agree

to strongly disagree were administered among 145 employees of the ABC

hospital at Tiruchirappalli Corporation to study the level of motivation among

the employees. Motivation of employees in the specialized hospitals consists of

ten items. Majority 44.8 per cent of the respondents strongly agreed that they

are provided with good working environment followed by 33.1 per cent of the

respondents strongly agree that they are given the work suitable to their skills.

The level of motivation among the employees is depicted in Pareto chart which

provides guidance to analyze about the core facets (by summing up the scores

of the individual variables) in which the employees are well motivated by the

HR Professional’s.

229

Figure - 5.3 Pareto Chart - Level of Motivation among the Employees of ABC Hospital

5000 100

90 4000 80

70 3000 Percent 60

2000 40 sum of variables of sum 30

1000 20

10 606 582 534 495 475 440 427 420 0 394 390 0 good workingwork suitingconditicordial the relationship skirecog nitionupward communicationencouragementjob securitycareer developmentparticipationoppurtunity in dec to learn

Facets of motivation Inference Sum of variables of all ten items of motivation are taken for analyzing the level of motivation among the respondents of ABC hospital. The first three high scores are revealed for good working condition, providing the work suiting to their skill and cordial relationship with employees. The first three facets contribute to the forty percentage of motivation among the employees. Therefore the HR Professional should increase the level of motivation by concentrating on the other facets by conducting programmes frequently for the developing the skills of all the levels employees. Technicians and staff nurses can also be consulted regarding the medical opinion and employees in the administration can also be consulted for the decision making relating to the management aspects.

230

Table - 5.46 Respondents opinion towards the level of Motivation in Gastro Care Hospital Opportunity Suitability of Upward given Reward and Supervision Opinion work Communication To learn and recognition grow F P CP F P CP F P CP F P CP F P CP Disagree - - - 3 3.6 3.6 ------Undecided 3 3.6 3.6 3 3.6 7.2 2 2.4 2.4 - - - 3 3.6 3.6 Agree 43 51.8 55.4 55 66.3 73.5 35 42.2 44.6 23 27.7 27.7 45 54.2 57.8 Strongly 37 44.6 100 22 26.5 100 46 55.4 100 60 72.3 100 35 42.2 100 agree Total 83 100 83 100 83 100 83 100 83 100 Cont...

Cordial Involvement in Relationship Development of Working Job Security Opinion Decision with Co- Career Environment Workers F P C F P C F P C F P C F P C Disagree 1 1.2 1.2 2 2.4 2.4 1 1.2 1.2 2 2.4 2.4 2 2.4 2.4 Undecided 4 4.8 6.0 1 1.2 3.6 2 2.4 3.6 1 1.2 3.6 - - - Agree 50 60.2 66.3 45 54.2 57.8 50 60.2 63.9 40 48.2 51.8 26 31.3 33.7 Strongly 28 33.7 100 35 42.2 100.0 30 36.1 100 40 48.2 100 55 66.3 100 agree Total 83 100 83 100 83 100 83 100 83 100 F – Frequency P – Percent CP – Cumulative Percent

Inference

Questionnaire consisting of five point scales ranging from strongly agree

to strongly disagree were administered among 83 employees of the Gastro care

hospital at Tiruchirappalli Corporation to study the level of motivation among

the employees. Motivation of employees in the selected hospitals consists of

ten items. Majority of the respondents strongly agree that they are well

motivated and this has been depicted in the Pareto chart.

231

Figure - 5.4 Pareto Chart - Level of Motivation among the Employees of Gastro Care Hospital

4000 100

3000 80

70 Percent

60 2000 50

sum of variables 30 1000 20

10 392 383 376 367 366 364 362 358 354 345 0 0 reward andgood recogniti workingopputunity environcareer to learn developmentsuitabilitysupervision of workcordial relationshipjo b securitychoise ofupward decision communication

Inference

Sum of variables of reward and recognition, working environment, opportunity to learn scores high than all the other facets. As expressed by the respondents, rewards are given to the low level employees in the form of Cash

Award and for the middle level employees, Cash Award as well as certificates are given in order to encourage them to work effectively. Performances of the employees can also be recognized and these performances can be considered for their promotion for all the level of employees. HR Professionals of gastro care must concentrate on the upward communication which is essential for the all the level of employees in carrying out their work effectively and efficiently as this facet of motivation has least score.

232

Table - 5.47 Respondent’s Opinion towards the Level of Motivation in KMC Hospital

Opportunity Suitability of Upward given Reward and Supervision Opinion work Communication To learn and recognition grow

F P CP F P CP F P CP F P CP F P CP

Undecided 2 1.5 1.5 2 1.5 1.5 1 .7 .7 - - - 1 .7 .7

Agree 68 49.6 51.1 65 47.4 48.9 58 42.3 43.1 77 56.2 56.2 89 65.0 65.7

Strongly 67 48.9 100 70 51.1 100 78 56.9 100 60 43.8 100 47 34.3 100 agree

Total 137 100 137 100 137 100 137 100 137 100 Cont...

Cordial Involvement in Relationship Development of Working Job Security Opinion Decision with Co- Career Environment Workers

F P C F P C F P C F P C F P C

Undecided 2 1.5 1.5 1 .7 .7 - - - 2 1.5 1.5 2 1.5 1.5

Agree 92 67.2 68.6 72 52.6 53.3 76 55.5 55.5 71 51.8 53.3 83 60.6 62.0

Strongly 43 31.4 100 64 46.7 100 61 45.5 100 64 46.7 100 52 38.0 100 agree

Total 137 100 137 100 137 100 137 100 137 100 F – Frequency P – Percent CP – Cumulative Percent

Inference

Questionnaire consisting of five point scales ranging from strongly agree

to strongly disagree were administered among 137 employees of the KMC

Hospital at Tiruchirappalli Corporation to study the level of motivation among

the employees. Motivation of employees in the selected hospitals consists of

ten items. Majority of the respondents strongly agree that they are well

motivated. The core facets of motivation are depicted in the Pareto chart.

233

Figure - 5.5 Pareto Chart-Level of Motivation among the Employees of KMC Hospital

7000 110

6000 100 90

5000 80

70 Percent 4000 60

3000 50 40

sum sum of variables 2000 30

20 1000 10 625 616 613 611 610 609 608 598 594 589 0 0 oppurtunityupward given communicationsuitability to cordial of work relationshipcareer developmentjob securityReward goodand recogniti workingsupervision environchoise of decision

Inference

Sum of variables of facets of motivation is calculated for analyzing the level of motivation among the respondents of KMC Hospital. As expressed by the Employees-respondents, they are given the opportunity to learn and grow, there is clear communication from superiors, and also the work given to them suits their skill. These three facets score above all the other facets and contribute to thirty per cent of the motivation. As expressed by respondents; there is direct interaction with supervisor. Positive approach is followed to supervise the medical and Para medical employees. The mistakes committed by the employees are handled in an understanding way. Weakness of the employees is communicated in non threatening way especially for the low level employees as their service is vital in maintaining a healthy working environment in the hospitals.

234

Table - 5.48 Respondent’s Opinion towards the Level of Motivation in Maruthi Hospital

Opportunity Suitability of Upward given Reward and Supervision Opinion work Communication To learn and recognition grow F P CP F P CP F P CP F P CP F P CP Disagree 5 3.3 3.3 6 3.9 3.9 21 13.8 13.8 43 28.3 28.3 41 27 27 Undecided 36 23.7 27.0 31 20.4 24.3 32 21.1 34.9 24 15.8 44.1 23 15.1 42.7 Agree 78 51.3 78.3 95 62.5 86.8 79 52.0 86.8 59 38.8 82.9 72 47.4 89.5 Strongly 33 21.7 100 20 13.2 100 20 13.2 100 26 17.1 100 16 10.5 100 agree Total 152 100 152 100 152 100 152 100 152 100 Cont… Cordial Involvement in Relationship Development of Working Job Security Opinion Decision with Co- Career Environment Workers F P C F P C F P C F P C F P C Disagree 39 25.7 25.7 13 8.6 8.6 13 8.6 8.6 58 38.2 38.2 12 7.9 7.9 Undecided 40 26.3 52.0 57 37.5 46.1 61 40.1 48.7 18 11.8 50.0 64 42.1 50 Agree 70 46.1 98.0 52 34.2 80.3 57 37.5 86.2 66 43.4 93.4 46 30.3 80.3 Strongly 3 2.0 100 30 19.7 100 21 13.8 100 10 6.6 100 30 9.7 100 agree Total 152 100 152 100 152 100 152 100 152 100 F – Frequency P – Percent CP – Cumulative Percent

Inference

Questionnaire consisting of five point scales ranging from strongly agree

to strongly disagree were administered among 152 employees of the Maruthi

Hospital at Tiruchirappalli Corporation to study the level of motivation among

the employees. Motivation of employees in the selected hospitals consists of

ten items. The respondents agree with the following facets of motivation such

as suitability of work, upward communication, and cordial relationship. Pareto

chart depicts the facets of motivation.

235

Figure - 5.6 Pareto Chart - Level of Motivation among the Employees of Maruthi Hospital

6000 110

100 5000 90

80 4000

70 Percent

60 3000 50

40 2000

sum of variables 30

1000 20 10 595 585 555 554 550 542 524 519 493 484 0 0 suitabilityupward of work communicacordial relationshipoppurtunity tion good to learnworkingjob security conditireward andsupervision recognitichoise ofcareer decision development

Inference

Suitability of work, upward communication and cordial relationship with co-workers scores high than the other facets of motivation which contributes to thirty percent of motivation among the employees. There is only a slight difference in the attitude of the respondents regards to the other facets of motivation, as there are only minor differences in the sum of variables. As expressed by the respondents, the HR Manager has allocated the job according

236 to the suitability and skills of the employees. Very Few employees are not satisfied with their allocation of work as those employees who have completed their degree in Hospital Management have been placed in the front office as receptionist, telephone operator and so on instead of recruiting in the administration department. This leads to the dissatisfaction among few employees. There is healthy inter-personal relationship between majority of the co-workers which is essential for the effective performance and job satisfaction. Despite the above fact career development has the least score.

Therefore it is suggested that HR Professionals must give opportunities to update the employee’s skills for their elevation in their career for the better output.

237

Table - 5.49 Top three scores of facets of motivation in Selected Hospitals

ABC Gastro care KMC Maruthi

Opportunity Good working Reward and Suitability of 1 given to learn condition recognition work and grow

Good Suitability of Upward Upward 2 working work communication communication condition

Opportunity Cordial Suitability of Cordial 3 to learn and relationship work relationship grow

Inference

The top three facets of motivation of the selected hospitals are given.

The employees of ABC and Gastro care hospitals are well motivated by providing good working environment for the employees to perform their work.

Employees are well motivated with the suitability of work and cordial relationship with co-workers in ABC, KMC and Maruthi Hospital. Upward communication is the top second scorer in both KMC and Maruthi Hospital.

The above mentioned facets are well focused by the HR Professionals in all the four hospitals. Only in Gastro Care, reward and recognition being the top scorer. In other words employees of Gastro care are well motivated by the providing rewards and recognizing their work. Therefore HR Professionals of all the other hospitals must concentrate towards rewards and recognition and all other facets so as to increase the level of motivation among the employees in all the aspects.

238

5.11. Job Satisfaction among the Employees of Selected Hospitals

The fifth research aim of this study is to find out the level of job

satisfaction among the employees of the specialized hospitals. The level of job

satisfaction is influenced by various dimensions of HRM Practices. The

relationship between Human Resource Management (HRM) Practices and the

employees overall job satisfaction is supported by several studies. (Steve

Bradley, 2004, Ekaterina Galanou1, 2011, Hamdia Mudor, 2011). The effective

implementation of the HRM Practices enhances the level of Job Satisfaction

among the employees.

Table - 5.50 Profile Analysis - Level of Job Satisfaction among the Employees of Selected Hospitals Gastro ABC KMC Maruthi Facets of job satisfaction Care (Mean) (Mean) (Mean) (Mean) Present job 3.38 4.4 4.46 3.71 Training Facilities 3.11 4.3 4.34 3.4 Promotion Opportunities 2.76 4.4 4.19 2.99 Performance Evaluation System 2.91 4.5 4.05 3.43 Monetary and non-monetary benefits 2.86 4.1 4.08 3.79 clarity of instructions 3.13 4.3 4.4 3.61 Relationship with superiors 3.06 3.8 4.3 3.54 opportunity to use skills 2.99 4.4 4.4 3.55 Appreciation for performance 2.96 4.03 4.29 3.14 HRM Practices 2.8 4.21 4.5 3.69 Grand Mean 2.99 4.24 4.3 3.48

239

Figure - 5.7 Profile Analysis - Level of Job Satisfaction among the Employees of Selected Hospitals

Inference

The level of Satisfaction with the present job, training facilities,

Monetary and non-monetary benefits, clarity of instructions, and opportunity to use skill and abilities is high among the employees of Gastro care and KMC

Hospitals. Satisfaction level with regard to the promotion opportunities and

Performance Evaluation System is high in Gastro care. The level of satisfaction among the employees of KMC hospital is high in Relationship with superiors, appreciation for the performance and overall HRM Practices. A universal opinion is that the respondents of KMC hospital are highly satisfied with their job, followed by the respondents in Gastro Care Hospital.

240

5.12. Summary

The present chapter presents the data analysis. The primary data collected are compiled and processed with the help of statistical tools for conclusive evidence. Overall findings showed that the HR Professionals of

KMC Hospitals are more competent, resulting in effective implementation of

HRM Practices, thus enhancing motivation and high job satisfaction among the respondents of KMC Hospital.

Chapter ––– VIVIVI

Findings, Suggestions and Conclusion CHAPTER - VI

6.1. Findings

Competencies of Human Resource Professionals

6.1.1. Socioeconomic and demographic profile of the Human Resource

Professionals

6.1.2. Competencies of HR professionals

6.1.3. Findings of Hypothesis Testing

Human Resource Management practices

6.1.4. Demographic profile of Employee – respondents

6.1.5. Professional profile of the Employee – respondents

6.1.6. Socio-economic profile of the Employee – respondents

6.1.7. Human Resources Practices in Specialized Hospitals

6.1.8. Findings of Hypothesis Testing

6.1.9. The effectiveness of Human Resource Management Practices in

four Specialized Hospitals

6.1.10. Level of motivation

6.1.11. Job satisfaction

6.2. Suggestions

6.2.1. Suggestions for HR Professionals

6.2.2. Suggestions regarding the effective implementation of HRM

Practices.

6.3. Conclusion 241

CHAPTER - VI

FINDINGS, SUGGESTIONS AND CONCLUSION

The study based on the responses of the HR Professionals and

Employees at various levels by administering a questionnaire. This study facilitated the consolidation of findings on Human Resource Management

Practices in Specialized Hospitals and competencies of Human Resource

Professionals at Tiruchirapalli Corporation.

6.1. Findings Competencies of Human Resource Professionals 6.1.1. Socioeconomic and Demographic Profile of the Human Resource Professionals • The majority of Human resources professionals of ABC, KMC, and

Maruthi hospitals are under the age group of 41-50.

• Six respondents of all the selected hospitals are post graduate and six

respondents are under graduate with diploma.

• 14 respondents of all selected hospitals are drawing annual income

above Rs.1,50,000.

• Ten respondents of selected hospitals belong to the category with 7-9

years of experience.

• Four out of the total Human resource professionals, are HR Managers,

four of the total Human resource professionals, are HR Assistant

Managers, six out of the total Human Resource Professionals, are HR

Junior Officer and seven out of the total Human Resource Professionals,

and are HR Executives. 242

6.1.2. Competencies of HR Professionals

HR Professionals – respondents were segmented on the basis of opinion about their level of:

Strategic contribution skill: Ten respondents falls under high level and

11 respondents seem to be at the low level.

Personal Credibility skill: 14 respondents fall under high level and seven

respondents seem to be at the low level.

HR Delivery: 13 respondents falls under high level and eight

respondents seem to be at the low level.

Managerial Skill: 11 respondents falls under high level and ten

respondents seem to be at the low level.

Administrative skill: 12 respondents falls under high level and nine

respondents seem to be at the low level.

Internal Consultations: 13 respondents falls under high level and eight

respondents seem to be at the low level.

Overall competency level: HR Professionals – respondents overall

competency level is high. However nine respondents are at low level.

Overall Level of Performance of Human Resources Activities

HR Professionals-respondents overall performance of Human Resources

Activities is high. 243

6.1.3. Findings of Hypothesis Testing

By applying Spearman’s Correlation, it is found that all demographic factors are significantly correlates with at least one HR Competency.

Age has significant positive correlation with HR Delivery, Managerial

skill, Administrative skill and internal consultation.

Experience has significant positive correlation with HR Delivery,

Managerial Skill and Administrative Skill.

Education qualification has significant correlation with HR Delivery and

Administrative Skill.

Income is significant correlation with HR Delivery.

Hence the null hypothesis is rejected and alternate hypothesis is accepted. Therefore demographic factors of HR Professionals influence the level of competencies among the Human Resource professionals of the specialized hospitals.

By applying regression analysis, it is found that for every one unit increase in the level of competencies among the HR Professionals, there are

0.976 increases in their performance of Human Resource Activity. Hence increase in the level of competencies of HR Professionals would contribute to the effective implementation of Human Resource Management Practices in the organization.

By applying one way ANOVA, it is found that, the level of competencies varies significantly among the HR Professionals of four 244 hospitals. Hence the null hypothesis is rejected and alternate hypothesis is accepted. It is evident from post-hoc test that the HR Professionals of KMC

Hospital are more competent than the other HR Professionals of ABC, Maruthi and Gastro Care Hospital.

Human Resource Management Practices 6.1.4. Demographic Profile of Employee - Respondents

• Employees-respondents were segmented on the basis of age. A majority

77 number of respondents of ABC Hospital belong to the category of

age group 20-25 and majority of 36 numbers of respondents in Gastro

care, 54 numbers of respondents in KMC and 52 numbers of

respondents in Maruthi belong to the category of age group 26-30.

• This study was conducted with 173 male employees and 344 female

employees.

• Majority of the respondents in ABC (90 respondents), KMC (70

respondents), Maruthi (97 respondents) are undergraduate.

• Majority of the respondents in ABC (51 respondents), Gastro care (37

respondents), KMC (81 respondents), Maruthi (93 respondents) are

unmarried.

• Majority 427 respondents of all the four hospitals belong to urban and

the rest of the respondents belong to rural area.

• Majority of the respondents in ABC (71 respondents), Gastro care (72

respondents), KMC (74 respondents) and Maruthi (84 respondents) are

in joint family and rest of the respondents is in nuclear family. 245

6.1.5. Professional Profile of the Employee - Respondents

• Employee-respondents were segmented on the basis of Cadre. Majority

449 numbers of the respondents belong to the middle level. 50

respondents belong to the low level and 18 respondents belong to high

level.

• Employee - respondents were segmented on the basis of departments of

selected hospitals. 192 respondents belong to nursing department, 81

respondents belong to front office, 69 respondents belong to the

department of administration, 68 respondents are technicians, 50

respondents belong to the department of housekeeping and 18

respondents are duty doctors.

• Majority 44 number of respondents in Gastro care,48 number of

respondents in KMC and 63 number of respondents in Gastro Care

belong to the category with 4-6 years of experience followed by the 87

number of respondents in ABC belong to the category with 0-3 years of

experience.

6.1.6. Socio-Economic Profile of the Employee - Respondents

Employee - respondents were segmented on the basis of their annual income. Majority with 73 numbers of the respondents in Gastro care, 94 numbers of respondents in KMC and 91 numbers of respondents in Maruthi hospital are with annual income between Rs.50000-100000, followed by 62 numbers of the respondents in ABC whose annual income is below Rs.50000. only meager percent of the respondents are drawing above Rs.100000 annually. 246

6.1.7. Human Resources Practices in Specialized Hospitals

Employees - respondents were segmented on the basis of opinion about the

Recruitment and selection practice in specialized hospitals: Majority of

the respondents of all the Hospitals falls in the high level and rest are in

the low level opinion.

Training and Development: Total of 362 numbers of the respondents in

all the four hospitals falls in the high level and 155 numbers of

respondents are in the low level opinion.

Staff Promotion: 369 numbers of respondents of four hospitals falls in

the high level and 148 numbers of respondents are in the low level

opinion.

Performance Appraisal Systems (PAS): 374 numbers of respondents fall

in the high level and 143 numbers of respondents have their opinion at

low level.

Career Development: 394 numbers of the respondents fall in the high

level and 123 respondents have their opinion at low level.

Incentives and Compensation: 410 respondents fall in the high level and

107 respondents have their opinion at low level.

Recognition and Reward: 332 numbers of the respondents fall in the

high level and 185 numbers of respondents have their opinion at low level.

Flexibility Work Option: 451 numbers of the respondents fall in the high

level and 66 numbers of respondents have their opinion at low level. 247

Job Design: 428 numbers of the respondents fall in the high level and 89

numbers of respondents have their opinion at low level.

Employee’s Participation and Communication: 361 numbers of the

respondents fall in the high level and 156 numbers of respondents have

their opinion at low level.

Overall implementation of Human Resources Practices in the hospitals,

majority of Employees – respondents have a positive opinion towards

overall implementation of Human Resources Practices in the hospitals

which enhance the motivation and job satisfaction among the

employees.

6.1.8. Findings of Hypothesis Testing Demographic factors and attitude of employees towards HRM Practices

Findings based on Gender of the respondents: By applying Mann

Whitney U test, it is found that

The attitude of Male and Female respondents differs towards the HRM

Practices in ABC Hospital.

The opinion towards the training and development and Performance

appraisal system differs among the male and female respondents of

KMC hospitals.

The male and female respondent’s outlook towards performance

appraisal system, Incentives and compensation, recognition and reward

and overall HRM Practices differs in Maruthi Hospital. 248

The view point of the male respondents differs significantly than that of

the female respondents towards the employee participation and

communication.

Hence in all the four selected hospitals there is a difference of opinion in various dimensions of HRM Practices with high mean scores of male respondents than female.

Findings based on Domicile of the respondents: By applying Chi-

Square tests, it is found that, the respondent’s opinion of both rural and urban area in ABC, KMC, and Maruthi hospital has similar attitude towards the HRM

Practices. In other words the domicile of the respondents and the HRM

Practices are independent and domicile do not influence over the attitude of the respondents. Therefore null hypothesis is accepted and alternate hypothesis is rejected.

Where as in Gastro care there is a difference of opinion among the respondents of rural area and urban area towards the HRM Practices like recruitment and selection, training and development. The respondents from urban area have comparatively a high opinion towards the above mentioned practices.

Findings based on Educational Qualification of the respondents: By applying Kruskal Wallis Test, it is found that 249

• There is a difference in the attitude among the respondents of various

groups based on educational qualification in ABC Hospital towards the

various dimensions of HRM Practices such as Recruitment and

selection, Training and development, Staff promotion, performance

appraisal system, career development, Recognition and reward,

flexibility work option, and job design. Hence the null hypothesis is

rejected and alternate hypothesis is accepted.

• The view point of respondents in KMC Hospital differ significantly

towards the various dimensions of the HRM Practices such as Staff

promotion, incentives and compensation, flexibility work option, job

design as the mean rank is highest among the respondents qualified with

PG and MBBS. Hence null hypothesis is rejected and alternate

hypothesis is accepted.

• The mean scores of respondents with qualification of Post graduate

seems to be higher in recognition and reward than the other respondents

in Maruthi Hospital. The respondents with higher qualification are

recognized for their additional skills, and knowledge. Hence there is a

significant difference among the respondents with regard to Recognition

and reward. Hence the null hypothesis is rejected and alternate

hypothesis is accepted.

• There are differences in attitude of the Respondents in Gastro care with

the qualification of post graduate whose opinion are high towards

training and development than the other respondents. Hence the null

hypothesis is rejected and alternate hypothesis is accepted. 250

Findings based on Experience of the Respondents: By applying Chi- square test, it is found that

• The length of time spent in an organization or the experiences of the

respondents in ABC hospital do not influences their perception level

towards the various dimensions of the HRM Practices. Hence the null

hypothesis is accepted and alternate hypothesis is rejected.

• The experience of the respondents in KMC Hospital influences their

attitude towards the dimensions of HRM Practices. Hence null

hypothesis is rejected and alternate hypothesis is accepted.

• There are significant differences in the attitude among the respondents

in Maruthi Hospital towards the HRM Practices. Hence null hypothesis

is rejected and alternate hypothesis is accepted.

• The experience of the respondents does not influence the any of the

HRM Practices in Gastro Care Hospital. Hence the null hypothesis is

accepted and alternate hypothesis is accepted.

Findings based on Income of the respondents: By applying Karl

Pearson’s co-efficient of correlation, it is found that

• With the increase in the income of the respondent in ABC Hospital,

increases the level of perception among the respondents towards HRM

Practices. Hence null hypothesis is rejected and alternate hypothesis is

accepted. 251

• There is a marginal change in the attitude of the respondents in KMC

Hospital towards the various dimensions of HRM Practice with the

increase in the level of income. Hence null hypothesis is rejected and

alternate hypothesis is accepted.

• Increase in level of income impacts a minor change in the attitude of the

respondents in KMC Hospital towards the HRM Practices. Hence null

hypothesis is rejected and alternate hypothesis is accepted.

• The level of income does not influence the attitude of the respondents of

Gastro care hospital towards any of the HRM Practices. Hence null

hypothesis is accepted and alternate hypothesis is rejected.

Findings based on Age of the respondents: By applying Karl

Pearson’s co-efficient of correlation, it is found that

• Age of the respondents in ABC Hospital found to impact less

significantly towards the various dimensions of HRM Practices. Hence

the null hypothesis is rejected and alternate hypothesis is accepted.

• Age-related differences exist for employee’s attitude in KMC Hospital

towards the importance of recruitment and selection, Training and

development, incentives and compensation, recognition and reward,

flexibility work option and job design. Hence the null hypothesis is

rejected and alternate hypothesis is accepted.

• It is found that age does not influences employee attitudes in Maruthi

Hospital towards HRM Practices. Hence null hypothesis is accepted and

alternate hypothesis is rejected. 252

• The demographic attribute of age has an influence over the attitude of

the respondents in Gastro care Hospital towards employee participation

and communication. Hence null hypothesis is rejected and alternate

hypothesis is accepted.

6.1.9. The effectiveness of Human Resource Management Practices in four Specialized Hospitals

By applying one way ANOVA test it is found that there is a significant difference in the implementation of HRM Practices among four Hospitals. In other words implementation of HRM Practices depends upon the competencies of the HR Professionals of the selected hospitals. Hence the null hypothesis is rejected and alternate hypothesis is accepted. HRM Practices are comparatively implemented effectively in the KMC Hospital, followed by Gastro Care,

Maruthi and ABC Hospitals.

6.1.10. Level of Motivation

The Pareto chart exhibits top three facets that has the highest level of motivation (by summing up the individual variables) where the employees are well motivated by the HR Professionals of four hospitals.

• Level of motivation is high among the employees-respondents of ABC

Hospitals towards the following facets of motivation; they are working

condition, providing the work suiting to their skill and cordial

relationship with employees. 253

• Level of motivation is high among the employees-respondents of Gastro

care Hospitals towards the following facets of motivation; they are

Reward and Recognition, Working environment, opportunity to learn

and grow.

• Level of motivation is high among the employees-respondents of KMC

Hospitals towards the following facets of motivation; opportunity to

learn and grow, Upward communication and suitability of work.

• Level of motivation is high among the employees-respondents of

Maruthi Hospitals towards the following facets of motivation; suitability

of work, Upward communication and cordial relationship.

6.1.11. Job Satisfaction

It is exhibited from the Profile Analysis, that the respondents of KMC and Gastro care hospitals are highly satisfied with their the present job, training facilities, Monetary and non-monetary benefits, clarity of instructions, and opportunity to use skill and abilities than the employees of other hospitals.

6.2. Suggestions

In the light of the above findings, the following are the suggestions provided with reference to the study in HRM Practices in hospitals.

6.2.1. Suggestions for HR Professionals

The above findings revealed a positive relationship between the competencies possessed by the HR Professionals and their performance in the 254

HRM Activities, Performance of any activity requires certain knowledge competencies. Hence

1. This suggests a need for competency based training for the HR

Professionals so that their level of performing the human resources

activities can be increased to implement the effective HRM Practices.

2. Experience and Age of the HR Professionals should be considered before

recruitment by the organization as the demographic factors influence the

competency level of HR Professionals. Experienced person with high age

can be recruited as HR Professionals.

3. Recruitment and selection can be based on experience, skill and

qualification of the employees. Before the recruitment and selection of

personnel, the HR Manager should analyze the requirements for human

resources in terms of number of personnel needed for each type of job.

4. Managers can enhance the motivation and job satisfaction among the

employees by taking into account the following practices:

By creating a team building

Opportunity given to employee to participate in decision making.

Through Genuine Appreciation

Through Recognition

Through Inspiration

Through Compensation

Through development of career among the employees. 255

5. HR Professionals should consider age as a factor for the appropriate

designation for recruiting the employees, as increase in age of the

respondents, increases the positive attitude towards the HRM Practices.

6. HR Professionals should motivate and retain the employees in the

organization which leads to the development of shared understandings and

experiences. Increased tenure in an organization is positively related to

employee well-being and employee performance.

6.2.2. Suggestions regarding the effective Implementation of HRM Practices

A Health Care Institute’s success depends increasingly on the knowledge, skills, and motivation of its work force. Effective implementation of HRM Practices in hospitals enhances motivation and job satisfaction among the employees. Hence the effective implementation of HRM Practices improves employee’s performance. The implications regarding the HRM

Practices for hospitals are considerable. They are as follows:

1. HR Professionals of ABC Hospital must pay more attention towards the

nursing department which plays a substantial role in the hospital, as it has

the largest population, and its nursing quality impacts the operation of the

hospital. Therefore they must be focused in developing their career, giving

them incentives and compensation, recognizing their work and giving them

the rewards. Equal consideration should also be given towards educational

qualification of the employees and based upon this, must take active interest

in updating their skills, developing their competencies by providing 256

adequate training facilities. Incentives must be given to the employees who

are working in the night shift .Hence employees should be well motivated

by providing compensation for the extra hours of work, which ultimately

leads to their effective performance.

2. The success and growth of an organization depend largely upon the caliber

and performance of its employees. Therefore, it is suggested that HR

Professional of Gastro Care must take an effort to improve the quality of its

employees by encouraging employees to share their ideas and when the

employees participate in implementing their ideas their morale goes up.

This improves productivity and lowers costly employee turnover. In order

to improve the performance of employees, the training programme should

be designed in such a way that every training programme must be related to

the specific needs of the individual employees.

3. HR Professionals of KMC Hospital must take active interest in providing

the training and appraising the performance of employees frequently and

motivate them to perform their work efficiently. Employees must be

encouraged to participate in decision making and thus sharing their ideas

before all other employees and management. Performance can also be

considered as the key factor in providing them with recognition and reward

so that all the employees irrespective of educational qualification get an

equal opportunity of being rewarded. 257

4. HR Professionals of Maruthi Hospital must pave a way for the development

of career of employees and must provide opportunity to learn and grow.

Career development programmes are needed for all the levels of employees

to improve their skills and to apply in the work for better performance.

Employees performance must be recognized and pay for performance can

be implemented which help to ensure quality by encouraging collaborative

efforts across all employees of the hospitals resulting in the better

performance. Frequent appraisal must be done on the employee’s

performance and their performance level can be taken as a basis for further

promotion.

5. HR technology like total quality management, Kaizen can be implemented

in the hospitals for the continuous improvement and for rendering quality

care to the patients by employees. Kaizen (pronounced ki-zen) is the

Japanese word for continuous improvement. The methodology of Kaizen

described in Kaizen Desk Reference Standard Kaizen as a technology

encourages the development of the right people, the right focus, and the

right attitude toward all else.

6. The necessity of good working condition in hospitals cannot be over

emphasized. Good working condition keeps employees cheerful and thus

contributes towards greater efficiency. 258

The good working condition such as

Adequate welfare services such as housing, transport, canteen, fair-price

shop, counseling and so on should be provided to all the employees.

The number of working hours can be restricted to 48 hrs in a week, so

that basic social needs at home and in community can be taken care of.

Security of employment in all respects must be provided by the hospital

authorities.

The employee’s safety and their health should be ensured.

The HR Professionals should carefully develop appropriate policies and practices for promotions and transfers, working conditions, wages, grievances handling, fringe benefits, satisfactory hours of work and adequate rest pausing.

HR Professional should also be able to recognize and appreciate the good work done by the employees and give respect for their creative suggestion. Proper delegation of authority, freedom to work will also help increases job satisfaction.

6.3. Conclusion

To enable hospitals to deliver good quality, safe healthcare, improving

HR Management is critical. There is a need for a cadre of competent HR

Managers who can fully assume these responsibilities and who can continuously improve the status of employees at their organizations by effectively implementing the HRM Practices. It is evident from this study that the HR Professionals of KMC Hospital are more competent than other HR 259

Professionals of other selected hospitals. The reaction of employees in the study of HRM assumes a central place, as they are the main subjects of its practices. Analysis clearly supports the notion that employee perceptions provide a broader view of evaluating HRM systems. HRM Practices such as recruitment / selection, training / development, and compensation and so on has been evaluated. It can be concluded that the findings justify overall positive picture of the state of HRM Practices in ABC, Gastro care, KMC and Maruthi

Hospital. In addition, it is also observed that the implementation of HRM

Practices is effective in KMC Hospital also employee’s satisfaction is higher in

KMC Hospital. Hence the effective implementation of HRM Practices reflects in the level of motivation and job satisfaction among the employees. Such attitude may help to boost the employee morale and motivation. Accordingly, employees may co-operate wholeheartedly and put discretionary efforts to achieve organizational objectives. Hence it is concluded that only a competent

HR Professionals will be able to implement effective HRM Practices which enhances motivation and job satisfaction among the employees which ultimately leads to Organizational performance.

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Website Gireesh Sharma, Top 10 Human Resources Best Practices, Integrated Human Capital and Talent Management Studies, http://www.empxtrack.com http://www.human-resources-health.com/content/7/1/84 http://journals.lww.com/healthcaremanagerjournal/Abstract/2007/01000 /The_Department_Manager_and_Effective_Human.6.aspx http://www.indianjournals.com/ijor.aspx?target=ijor:jmr&volume=11&i ssue=2&type=toc http://www.proquest.co.uk/en-UK/catalogs/databases/detail/ibss-set- c.shtml http://www.ajhp.org/content/64/12/1299.full B 11

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Appendices

Questionnaire Q 1

QUESTIONNAIRE FOR EMPLOYEES

Employees perception in HRM Activities - High level, Middle Level and Low Level Employees

Personal profile Name : Age :

Gender : Male Female Marital status : Unmarried Married

Domicile : Rural Urban Family type : Joint family Nuclear

Cader : High level Middle Level Lower Level Department : 1. Duty Doctors 2. Front Office 3. Nursing 4. Pharmacy 5. Administration 6. Technicians

7. House Keeping Educational qualification: High school & Less than High School

Under Graduate MBBS / Post Graduate Others (pls specify): (Diploma, certificate courses)

Years of experience : 0-3 4-6 7-9 10 and above 10 years Annual Income :

Q 2

A HRM Practices i. Recruitment and selection 1. Selection is purely based on experience, skill and qualification Strongly agree 5 4 3 2 1 strongly Disagree 2. Recruiting the right person for the right position. Strongly agree 5 4 3 2 1 strongly Disagree 3. Structured, standardized interview & intelligence test are used for selection. Strongly agree 5 4 3 2 1 strongly Disagree ii. Training and Development 1. Development of employees are seen as an important part Strongly agree 5 4 3 2 1 strongly Disagree 2. HR professionals in this organization take active interest in the juniors for i To update the job skills Strongly agree 5 4 3 2 1 strongly Disagree ii To teach the nature of the job & providing access to new technology. Strongly agree 5 4 3 2 1 strongly Disagree iii To help in acquiring the competencies or the new skills. Strongly agree 5 4 3 2 1 strongly Disagree iv To help in assuming the responsibilities Strongly agree 5 4 3 2 1 strongly Disagree iii. Staff promotion 1. Training program are considered for further promotion Strongly agree 5 4 3 2 1 strongly Disagree 2. Promotion is based on additional qualification Strongly agree 5 4 3 2 1 strongly Disagree 3. Experience is of high order for promotion Strongly agree 5 4 3 2 1 strongly Disagree

Q 3 iv. Performance appraisal systems (PAS) The objectives of performance appraisal systems are Personal Development, Right man for Right job, Fair remuneration. 1. The above objective is clear to all. Strongly agree 5 4 3 2 1 strongly Disagree 2. The present performance are recognized for higher performance Strongly agree 5 4 3 2 1 strongly Disagree 3. Frequent appraisal system is done. Strongly agree 5 4 3 2 1 strongly Disagree 4. Performance appraisal reports are based on objective assignment and actual performance valuation Strongly agree 5 4 3 2 1 strongly Disagree 5. Utilization of appraisal results which provides feedback in supportive manner Strongly agree 5 4 3 2 1 strongly Disagree v. Career development 1. There is a clear path for the development within the organization. Strongly agree 5 4 3 2 1 strongly Disagree 2. The career aspirations within the company are known by immediate supervisors. Strongly agree 5 4 3 2 1 strongly Disagree 3. The policies of organization facilitate development in Career. Strongly agree 5 4 3 2 1 strongly Disagree vi. Incentives, Compensation 1. Incentive system is fair Strongly agree 5 4 3 2 1 strongly Disagree 2. Reasonable compensation are given. Strongly agree 5 4 3 2 1 strongly Disagree 3. Offering incentives for continued employment Strongly agree 5 4 3 2 1 strongly Disagree Q 4 vii. Recognition and Reward 1. Additional qualification, Knowledge, Skill are being recognized. Strongly agree 5 4 3 2 1 strongly Disagree 2. Efforts are taken to retain the best employees. Strongly agree 5 4 3 2 1 strongly Disagree 3. The top management of organization makes effort in identifying and utilizes the potentials. Strongly agree 5 4 3 2 1 strongly Disagree 4. There is encouragement for innovations and flow of ideas Strongly agree 5 4 3 2 1 strongly Disagree 5. There are mechanisms to reward good work done or any contributions made. Strongly agree 5 4 3 2 1 strongly Disagree viii. Flexibility work option 1. The present working hours are convenient. Strongly agree 5 4 3 2 1 strongly Disagree 2. Comfortable with the present work load assigned. Strongly agree 5 4 3 2 1 strongly Disagree 3. There is equal distribution of work and this helps in job enrichment Strongly agree 5 4 3 2 1 strongly Disagree ix. Job Design 1. The psychological in your organization is very conducive and employees enjoy performing their duties. Strongly agree 5 4 3 2 1 strongly Disagree 2. Creating new roles for employees. Strongly agree 5 4 3 2 1 strongly Disagree 3. Allocation of exact work to the proper person. Strongly agree 5 4 3 2 1 strongly Disagree x. Employee’s participation and Communication. 1. Chances are given to participate in the decision making. Strongly agree 5 4 3 2 1 strongly Disagree Q 5

2. Opportunity are provided to suggest the improvements Strongly agree 5 4 3 2 1 strongly Disagree 3. Superiors keep open communication and effective relationship with the employees. Strongly agree 5 4 3 2 1 strongly Disagree 4. Superiors provide constructive feedback Strongly agree 5 4 3 2 1 strongly Disagree

B. Motivation 1. I am given the work which suits my skill. Strongly agree 5 4 3 2 1 strongly Disagree 2. There is a clear upward communication. Strongly agree 5 4 3 2 1 strongly Disagree 3. I am given the opportunity to learn and grow. Strongly agree 5 4 3 2 1 strongly Disagree 4. I am recognisized for performing the work efficiently. Strongly agree 5 4 3 2 1 strongly Disagree 5. I am encouraged to develop and cared by the supervisor. Strongly agree 5 4 3 2 1 strongly Disagree 6. My opinion seems to count for decision making. Strongly agree 5 4 3 2 1 strongly Disagree 7. I have cordial relationship with co-workers. Strongly agree 5 4 3 2 1 strongly Disagree 8. I have job security. Strongly agree 5 4 3 2 1 strongly Disagree 9. I am given opportunity for my development of career. Strongly agree 5 4 3 2 1 strongly Disagree 10. I am provided with adequate working condition to carry out the work effectively. Strongly agree 5 4 3 2 1 strongly Disagree Q 6

C. Job satisfaction 1. I am Satisfied with the present job. Strongly agree 5 4 3 2 1 strongly Disagree 2. I am satisfied with the training facilities. Strongly agree 5 4 3 2 1 strongly Disagree 3. I am satisfied with the promotion opportunities. Strongly agree 5 4 3 2 1 strongly Disagree 4. I am satisfied with the performance evaluation system. Strongly agree 5 4 3 2 1 strongly Disagree 5. I am Satisfied with monetary and non monetary benefits. Strongly agree 5 4 3 2 1 strongly Disagree 6. I am Satisfied with the clarity of instructions provided by the superiors. Strongly agree 5 4 3 2 1 strongly Disagree 7. I am Satisfied with the relationship with the superiors. Strongly agree 5 4 3 2 1 strongly Disagree 8. I am Satisfied with the opportunities given to use the skills and abilities. Strongly agree 5 4 3 2 1 strongly Disagree 9. I am Satisfied with the appreciation for the effective performance. Strongly agree 5 4 3 2 1 strongly Disagree 10. I am Satisfied with the overall implementation of Human Resources Practices. Strongly agree 5 4 3 2 1 strongly Disagree Q 7

QUESTIONNAIRE FOR HR PROFESSIONALS

Competencies of HR Professionals and their ability to perform the HRM activities

Personal Details

1. Name : 2. Name of the organization :

3. Gender : Male Female 4. Age

5. Education Level a.Under Graduate B.UG with diploma C. Post Graduate

d. Post Graduate with Diploma 6. Years of Experience: 7. Define your relationship with the employee.

A.HR director B.HR manager

C.HR Ass.manager D.HR senior officer

E.HR junior officer

F.HR executive

8. Annual Income : 9. Currently pursuing training related to HRM. Yes No

10. Interested in pursuing education or training related to HRM. Yes No

A. Competencies required for developing the HRM Practices Fill in one response for each question. 5 = Excellent, 4 = Very Good, 3 = Satisfactory, 2 = Fair, 1 = Poor Q 8

I. Strategic contribution skill 1. Culture Management 1 2 3 4 5 2. Adapting to fast change 1 2 3 4 5 3. Strategic decision making 1 2 3 4 5

II. Personal Credibility 1. Achieving the results 1 2 3 4 5 2. Effective relationship With employees 1 2 3 4 5 3. Communication with Employees 1 2 3 4 5

III. HR Delivery 1. Selection of 1 2 3 4 5 Candidate 2. Recruitment of right Candidate 1 2 3 4 5 3. Training and Development 1 2 3 4 5 4. Retaining the Employees 1 2 3 4 5 5. Legal Compliance 1 2 3 4 5

IV. Managerial Skill 1. Motivation of employees 1 2 3 4 5 2. Team building 1 2 3 4 5

V. Administrative Skill 1. Grants / refusal of leave or over time 1 2 3 4 5 2. Ensuring availability of people at work place 1 2 3 4 5 3. Maintaining records 1 2 3 4 5

VI. Internal Consultations 1. Develop solutions to The employees problems 1 2 3 4 5 Q 9

B. Ability to Perform Human Resource Management Activity For each of the following questions, please ring your answer. 5 - Strongly 1 - Strongly 4 - Agree 3 - Neutral 2 - Disagree Agree Disagree

1. Developing and Maintaining Positive Work Environment Disagree 1 2 3 4 5 Agree 2. Administering Wages and Benefits Disagree 1 2 3 4 5 Agree 3. Ensuring Safety and health at Worksites Disagree 1 2 3 4 5 Agree 4. Selecting and Hiring Employees Disagree 1 2 3 4 5 Agree 5. Legal Aspects of Recruiting and Selection Disagree 1 2 3 4 5 Agree 6. Organizing and Designing Jobs Disagree 1 2 3 4 5 Agree 7. Orienting, Training, and Developing Employees Disagree 1 2 3 4 5 Agree 8. Complying with Legal Aspects of Compensation Disagree 1 2 3 4 5 Agree 9. Complying with Fair Employment Laws and Regulations Disagree 1 2 3 4 5 Agree 10. Human Resource Planning and Policy Development Disagree 1 2 3 4 5 Agree 11. Identifying and Coaching to Resolve Employee Problems Disagree 1 2 3 4 5 Agree 12. Motivating Employees Disagree 1 2 3 4 5 Agree 13. Analyzing Jobs and Writing Job Descriptions Disagree 1 2 3 4 5 Agree 14. Appraising and Counseling Employees for Performance Disagree 1 2 3 4 5 Agree Thank you very much for your time spared to fill in the questionnaire.

International Papers Publication Q 10

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