02 Nov 2017
Dissertation submitted to Tata Institute of Social Sciences a Deemed University in partial fulfilment for the award of Master of Hospital Administration
I, Ms. Soumya Suresh, hereby declare that this project report entitled ‘An Assessment of the Hospital Practice in Strategic Human Resource Planning’ is the outcome of my own study undertaken under the guidance of Dr. M. Mariappan, Associate professor and chairperson, Centre for Hospital Management, School of Health system studies, Tata Institute of Social Sciences, Mumbai.
It has not previously formed the basis for the award of any degree, diploma, or certificate of this Institute or of any other institute or university. I have duly acknowledged all the sources used by me in the preparation of this project report.
Place:
Date: Ms. Soumya Suresh
Signature of the candidate
This is to certify that the dissertation entitled "AN ASSESSMENT OF THE HOSPITAL PRACTICE IN STRATEGIC HUMAN REOURCE PLANNING" is a bonafide record of independent project work done by Ms. Soumya Suresh, Reg. Number- 2011HO042 under my supervision, submitted to the Tata Institute of Social Sciences, School of health system studies in partial fulfilment for the award of Degree of " MASTER OF HOSPITAL ADMINISTRATION" and that the dissertation has not previously formed the basis for the award of any other degree, Diploma, associateship, Fellowship or other title.
Dr. M. Mariappan
Associate Professor, Chairperson
Centre for Hospital Management
School of health system studies
1
INTRODUCTION
2
LITERATURE REVIEW ON STRATEGIC
HUMAN RESOURCE PLANNING
3
STUDY DESIGN
4
ANALYSIS AND FINDINGS
5
DISCUSSION
6
RECOMMENDATIONS
7
CONCLUSION
8
REFERENCE
1
Leave policy for nurses
25
2
Direct patient care
26
3
Indirect patient care
27
4
Profile of HOD’s
29
5
Current staff position
28
6
Skill set and other requirements
29
7
Decision regarding man power requirement
33
Primary activities of human resource management
11
The process of strategic planning
14
Transition of human resource planning
17
This project has been an immense learning opportunity for me. I would like to thank Prof. C.A.K. Yesudian, Dean, School of Health system studies, Tata Institute of social sciences for giving me this opportunity.
I sincerely extend my gratitude towards my project guide Dr. M. Mariappan who has been a great support and source of motivation.
My deep sense of gratitude to the management and staff of the hospital for their kind support and guidance.
I also extend my heartfelt thanks to my parents without whom I would not be able to complete my project.
For a developing economy like India technical manpower is as essential as capital. Among the three major resources- men, material and money it is the men which determines the quality and quantity of output and performance. Skilled employees add value to the organisation and in fact are an asset to the country itself. As the work force gets younger there has been a change in the scenario of work force worldwide. It poses newer challenges in bridging the gap of demand and supply. Most of the organisations agree that their single major cost is in terms of managing their work force. Lot of efforts have been put in managing this major asset and also in controlling the costs effectively. Human resource drives the organisational performance. And therefore it is very essential for the organisation to ensure right kind of people for the right job at right time. This will ultimately increase the productivity of the organisation. From the traditional human resource management principles organisations have moved to strategic principles by linking human resource to the strategic goals of the organisation. This calls for strong linking of the HR personnel with the organisational line managers. Thus strategic human resource has become essential for the competitive advantage and competitive viability of the organisation. The strategy undertaken by the human resource personnel should be compatible with those of other department in the organisation. In fact very little research has been done in determining how this is done in an organisation. So as to achieve the desired objective of an organisation it is very important to plan the human resources both in terms of qualitative and quantitative manner. In large organisations human resource contributes to the major chunk of operational cost. Hospitals are no different from this. Hospitals are labour intensive in nature. It is often finding it difficult to get the right person for the right job at right time in hospital services. Basically hospitals are not having appropriate plans in terms of understanding the human resource requirements. In fact there has been no effort or less effort put in identifying the right sources of information with regard to demand and supply of human resources. This shows the failure of having human resource information system. There is no way for the hospitals to look at the strategic view of indenting appropriate staffing or key positions requirement.
Strategic planning of human resources involves clear understanding with regard to need, supply, forecasting of human resources, and ensuring achievement of such resources at the right time, right place, and right sources. It is to be noted that the human resources have a major role play towards achieving the corporate strategic goals of a hospital. There has been a shift from the traditional human resource management towards strategic human resource management. Pressure from escalating costs, difficulties in gaining competitive advantage in the increasing competitive world, impact of globalisation etc all explains to this reason. The strategic human resource management links those issues pertaining to the human resources to the overall strategy of the hospital. As they provide the "Corporate Intelligence" the personnel in the hospital can shape or mould the hospital. When it comes to allocation of the human resources various factors like the specialty- whether single or multi specialty, setup- deluxe rooms or general wards, structure etc all counts. In fact all the future challenges of organization whether technological, economical or political can be met only with proper planning of future requirements of personnel. In addition, to avoid high employee turnover and potential loss to the organization planning has become crucial for the hospitals at all times. Though Mintzberg (1994) has said that ‘the most successful strategies are visions, not plans’, planning is still important. In a way it has become very challenging now.
Development of any organisation is not a mechanical process. Instead it will depend ultimately on the skill, quality and motivation of the people associated with it. According to Professor Lewis "growth is the result of human efforts". The process of evolution of human resource can be traced as personnel management to the human resource management and to the strategic human resource management. Since the organisations have moved from simple to complex in nature requiring special skills and maximum output, personnel management also have shifted from the simple -"carrot or stick" approach to "man power planning". In simple terms man power planning is a technique of correcting the imbalances between the man power demand and the man power supply in the organisation. An imbalance in supply and demand can create surplus or shortage of personnel. Thus it is essential to plan the human resources on a long term basis. Efficient managers are those who can for see the likely problems and unsuccessful managers are those who struggle with the unforeseen problems. What makes a difference here is planning.
Human resource management is that important aspect of the organisation that deals with the "people" attribute. HRM can be considered in two ways- first is the support function within the organisation related to its employees. It is involved in supporting the employees of the organisation who is rendering service directly or indirectly. Secondly HRM is a job or responsibility of everyone. All the line, top managers are involved in the HRM, whether they work exclusively in the HR department or not. HRM basically consists of four functions like staffing, training and development, motivation and maintenance. We can put many activities in human resource management under these four headings.
Organizations today recognise the role of people in meeting the objectives of the firm. This realisation has moved them to be very cautious in personnel related matters. Human resource management considers their prime responsibilities as assisting the organisation in achieving the strategic goals and also in urging their employees in attaining goals. These have to be carried out simultaneously. The role of human resource management is proactive, which means that it doesn’t respond to the organization when needed but supports the organisation in its personnel part with a strategic view. More over the organisation has also realised that its employees are its asset and it is the employees who bring competitive advantage to the organisation. Human resource management has to device policies and procedures and adequate planning in order to achieve this and maintain in future. Being an active partner in strategic process of the organisation the human resource management affirms the overall strategy of the organisation. For achieving this they work in coordination with the line managers and help the organisation in devising their culture, improving the performance and implementing changes wherever necessary.
Human resource management also help the organisation in identifying and implementing the lowest cost of human resource in view of the strategy of the organisation. This is very critical as it has been realised that depending on the specialty and type of hospital the human resource cost accounts to not less than 40- 50% of the total organisation costs. Therefore the strategic planners must also consider the cost factor while planning the human resource. They need to ensure the return over investment in the human resource part.
The growth of particular business strategies must be established on the fields of intensity that an organization has. Those HR managers must be able to anticipate what capacities employees will have to enforce the business strategy. Manpower practices and conditions, social values and modus Vivendi, and technological growths are some extraneous factors to consider.
"A human resource strategy is a vital constituent of the firm’s collective and business strategies, containing a set of well-coordinated objectives and activity programs directed at ensuring a long-term, sustainable advantage over the organizations competitors. A human resource strategy should be consistent with the organizations corporate and business strategies, along with the other managerial operational strategies.
Today the world of health care is rapidly changing as the demography; disease patterns are changing which in turn calls for advent of newer technologies and skills. Even as recent as a decade ago the scenario was different. That does not mean that changes were not happening those days. But now the changes are more challenging and very rapid also. Certainly the hospitals are dynamic in nature. To be viable in such a dynamic situation organizations have to deal with all the complex challenges. As change is unavoidable the life of the organisation depends on the leadership quality it possesses. Good leadership is making the impossibilities possible. It involves understanding the change, framing strategies that account for change and developing the will and ability for leading the change. Hospital faces a lot of changes in the field of care rendered to the patient in terms of complex technology involved, disease patterns, greater awareness and demand for quality care etc. Often these challenges are complimented with asymmetry of information in a much uncertain situation. These collective challenges point towards the need for ‘strategic management’. As part of an organization the human resource management must also be prepared to face these challenges. This means understanding and reacting to the needs of globalization, changing scenario in work culture, technological changes, skill mix, the contingent work force, changing employee preferences etc.
Strategic management is the basics for change, and that adds to the momentum of change in an organisation. It builds the gap between change and survival of an organisation. The word strategy has its origin in 19th century from the French word ‘stratégie’and Greek word ‘Strategos’ which means ‘general’. The Oxford dictionary defines strategy as ‘the plan of action designed to achieve an overall or long- term aim’. According to Tanuja Agarwal, Strategy is "the determination of the long term goals and objectives of an organisation and the allocation of resources necessary for carrying out these goals". This involves analysis of different domains like finance, marketing and human resources. As quoted earlier, organisations achieve their goals and objectives through the core competence of human resources.
Strategic planning is defined as the process of describing organizational aims and the activities needed to accomplish those aims. It calls for examining areas like finance, marketing, and human resources to find out the capabilities of the organization to encounter its objectives.
Strategic planning is an organizational direction activity which is used to fix precedence, sharpen energy and resources, fortify operations, assure that employees and other stakeholders are functioning toward common goals, lay down agreement around proposed outcomes/results, and measure and align the organization's direction in reaction to a changing environment. It is a conditioned effort that produces key decisions and actions that figure and lead what an organization is, who it serves, what it does, and why it does it, with a focus on the future. Good strategic planning formulates not only where an organization is departing and the actions required to make progress, but also how it will know if it is fruitful. The presumption implicit in strategic planning is that there is economic, social, political, technological, and militant change taking place that the leadership of the firm must sporadically evaluate whether it should offer its current products and services, whether it should start offering different products and services, or whether it should be operating and marketing in a fundamentally different way. Though strategies generally take considerable time to enforce, and thus is mostly long range in nature, the time span is not the primary focus of strategic planning. As a matter of fact, strategic planning, backed by the management of the strategy, constricts time. Competitive changes which usually take generations to develop instead occur in a few short years. Therefore, it is better to use "long range" and "short range" to depict the time it will take to attain a strategy instead to convey a type of planning.
Strategic planning is in fact a group process which involve a number of key participants to develop and maintain strategy. It involves exchange of ideas, critical analysis of new ideas that are developed. An isolated department of an organisation can develop a strategy, but to be noted that it must be articulated with the common organisational strategy. Decision making is restricted to few key players here. They include senior staff, middle management and top management. An efficient leader will incorporate all the plans and ideas of his team.
The process of strategic planning starts with identification of the organisational objectives and goals. In accordance with the strategic goals of the organisation, human resource requirements are derived and put forwarded in terms of quantity and quality of the personnel required so as to accomplish the goals and objective. This is done by assessing the internal strength of human resource in the organisation. The needed data will be available in the Human Resource Information System(HRIS).A qualitative and quantitative assessment for the skill and number of existing staffs will be done by this assessment. The human resource personnel sub serves the top management in realising this.
In the 1980’s the construct of strategic planning was extended to strategic management. This development admitted not only the grandness of the dynamics of the environment and that organization may have to completely recreate them but also that ceaselessly managing and measuring the strategy are milestones to success. Thus, strategic management was demonstrated as an advance or doctrine for managing complex initiatives.
As far as health care organisations are concerned there are many benefits attached to the strategic management. Some of them are:
It bonds the organisation together with a common purpose and values.
It directly influences the financial performance of the organisation.
It provides the organisation a clear vision on its own by giving clarity in terms of concepts, goals, guidance, and consistency in its decisions.
It motivates the managers to think about the future by understanding the present and analysing it.
It motivates managers to communicate both vertically and horizontally in an organisation.
It also helps the managers to improve the overall coordination with in an organisation and enables them to meet the demands of all challenging situation.
Managers must know that once strategies are subject to different forces both with in and outside the organisation. Most of the times it will be a trial and error method, not following the proposed plan. Still without a plan it will be difficult for an organisation in decision making. Thus the framework of strategic planning is not a reality but a plan of action that would lead to reality.
From functional view human resources planning is the assessment of personnel requirements of organizations and the associated demands for management policies, programs and resources to gratify these requisites. It is the process of analysing and identifying the demand and availability of personnel so that the firm can meet its goals.
According to Walker (1980) HRP is "a management process of analysing an organisation’s human resource needs under changing conditions and developing the activities necessary to satisfy these needs".
HRP tries to answer the following questions:
What is the significance of present or proposed strategic plan with human resources?
What are the significances of proposed or present strategic plans for staffing?
The main objective of people creditworthy for doing human resources planning is to gain, grow and enforce the technology, tools, expertise and resources requisite to effectively do Human Resource Planning as an inherent part of the business planning processes. It should not be exercised in a vacuum. Therefore "Human resource strategies must be formulated within a company’s strategic business planning process." Human resource planning is a proactive process- as it will look upon the number and the type of people required and whether the firm will require additional employees. Being proactive it will anticipate any changes in industry, market, economy, society and technology. Previously strategic decisions were take in isolation without inclusion of decisions pertaining to HR. But today internal and external changes in an organisation has led to articulation of business planning with Human resource planning on a long term proactive perspective.
HR planning has been described as a crucial way to develop a clean-cut focal point of the purpose on the organisation’s business and it is a vital aid in describing the areas in which it must stand out in order to be productive.
Alike many organisational exercises, the potency of human resource planning bets on the circumstance within which it is applied. Several methods of conventional human resource planning are set aside only in the place of the certain particular objectives in mind (Walker, 1990). There are three basically different forms of HR planning aims. Functional objectives attempt to find present capacities and generalize current trends, with particular stress on nearly work requisites. These objectives underline the establishment’s ability to check performance, using past and present HR costs that add to budgets and other check mechanisms. Next class of objective comes down within the title of what texts generally pertain to as HR planning. The main objective of conventional HR planning is to integrate estimates about the types and numbers of workers who will be required to fit strategic demands, taking into account different programmes such as career development, executive training, external recruiting, succession planning, employee appraisal and retirement programmes. Operating data helps HR planners to precisely anticipate the costs and feasibleness of HR initiatives based on known qualities. These data can also be put among HR planning to base forecasts related to demand and supply. Adding to that, HR planners need precise operational knowledge about the personnel so as to understand the future of particular forecasts. For example, a decrease or a surplus of certain kind of skills means the extent of that particular skill contributes and whether that skill can be replaced by some other skills.
Traditional HRP: Reactive
Contemporary HRP: Proactive
Changes in business, economic, social, legal and technological environments
Human resource planning is the projection of the number of people required and the type of people in terms of skill mix required for the organisation so as to achieve the desired goals and objectives of the organisation. It might be expansion of the services in a hospital or addition of few radiology services or laboratory services to the existing system. Any expansion or modifications done structurally or functionally will require additional manpower to the hospital. As these are strategic plans of the organisation along with other objectives the objectives concerning the human resource should be aligned. For this the human resource department will work along with the line managers and heads of various departments as they can add more inputs to the planning process. They will be the ones who will be able to say about the technical skills expected from the personnel. Thus the objective is to find out the right candidate for the right post at right time. The primary role of people involved in human resource planning is to gain, develop and execute the tools, technology and skills and expertise required for the organisation. It should be focussed upon doing the human resource planning and development effectively and efficiently for the organisation. They should realise human resource planning as an integral part of business planning process. Therefore it is not done in isolation. It has to be articulated with the company’s business strategic planning process. Without a clear picture on planning whatever done will end up as mere guess work.
Available literatures on human resource has brought out that Human resource management plays an important role in gaining competitive advantage within an organisation. Therefore the chances of getting the strategic implementations successful will be negligible if it is not aligned with the strategies on human resource. Planning is vital to strategy since it distinguishes gaps in capacities which would forbid successful execution; surpluses in potentialities that suggest chances for increasing efficiencies and reactivity; and poor usage of extremely valued organisational resources because of incompatible HR practices. Hence it is not storming that connecting HR planning to strategy has turned to a famous topic among fellow members of the HR profession, who have attempted alternate ways to adjust objectives and usages with the pattern, growth and execution of organisational strategic targets and enterprises.
Human resource planning is really important that without this all planning will finally end up as a mere guess work. Even if the predictions or forecast is not always successful, it is still needed because the forecasts can be quite useful which will give a basis. Upon this basis it is able to avoid ad hoc problems to an extent. Therefore human resource planning should be articulated along with the organisational planning.
A dearth of particular category of employee or particular kind skills will affect the organisation in achieving its goals.
Rapid changes in technology, marketing, management etc., will result in need of particular category an skilled persons.
Changes within an organization in its design and structure will affect manpower demand.
Demographic changes like the altering profile of the manpower in terms of age, sex, education etc.
The Government policies in regard to reservation, child labour, working conditions etc.
Different labour laws affecting the demand and supply of labour.
Pressure from trade unions, politicians etc.
Human Resources Planning (HRP) expects not just the needed quality and quantity of employees instead decide the accomplish plan for all the occasions of human resource management .The major advantages of Human resource planning are:
It assures the corporate plan of the firm.
The HRP elucidates doubts and alters to the upper limit potential and enables the organization to have right kind of people at right time in right place.
It allows background for progress and growth of employees through training, development etc.
It aids in anticipating the cost of salary increasing, improved benefits etc.
It also helps to predict the cost of pay offs, incentives and all other cost of human resources which facilitates the formulation of budgets in an organization.
To forecast the changes in abilities, aptitude and attitude of personnel.
It results in the advancement of different origins of human resources to encounter the organizational goals and objectives.
It also aids in taking measures to amend human resource shares in the form of enhanced output ,business turnover etc
It facilities the control of all the functions, operations, contribution and cost of human resources
Planning process in a strategic way is often accomplished by networking with in and outside the organisation. The focus is therefore on strengthening the networking with the internal human resource professionals and external human resource persons which will be rooted in sharing information, technology, tools necessary for planning and development of personnel. The outcome depends on effective implementation of the developed tools and resources needed. Out of these a sustainable and feasible strategy has to be formulated. The most important thing to be noted here is that the strategy formulated should be articulated with the overall business strategy of the organisation. For this they will consult different human resource managers and all the line managers in the organisation. In order to ensure highest possible utilization of the tools they will work in close conjunction with the managers. This will be aimed in creating a sound personnel data base and tools for the line managers.
Though long term planning is advised the daily operational pressures would cause the long term planning to give way to short term planning. This might cause the plans ultimately to be less successful. It can be very expensive too. Quite lot of lead time is needed for recruiting, developing talented personnel. This will require long term economic plans. For a successful planning, all the factors need to be interconnected. The impact of short term planning will be to rely on current work force for all the organisational activities. But so as to achieve long term goals of an organisation it must have some changes made in the current human resources. It should be able to foresee the future needs of the organisation even in worst external scenario.
Now the focus has been shifted from long range planning to strategic planning. What long range means is to predict for a particular time in future the amount of demand of an organisation’s services and to analyse in what area that demand will occur in future. This is often used to determine the demand in certain situations like expansion, adding of more services to the existing situation, capital needs etc. But later when the industries became volatile and the external scenario became dynamic the long range planning was replaced by strategic planning. The idea behind long range planning is that the firm will continue its rendering of services so as to match with its demand. But the idea underlying behind the strategic planning is that there are lot of economic, social, political, technological and competitive changes happening. By understanding all these changes to analyse whether the organisation will be able to provide services that would meet these challenges or whether it should move to further new services and products. Though it will take considerable time to evolve a strategy, time span is not the important focus here. It might even take generations to evolve and implement a strategy. Therefore it is better to use ‘long term’ and ‘short term’ to describe the time that it will take for a strategy to implement.
Human beings are the most important assets in hospitals. Machines and other equipments which are integral parts of delivering health care require the human touch, expertise, and commitment for their full utilization and application in delivery of health care. Therefore planning of human resources is the key to any health care provision. The objective of human resource (HR) policy is
to attract, recruit, retain and develop competent personnel and
Create a continuously learning health care organisation. (B.Ray)
Human resource planning is the projection of the number of people required and the type of people in terms of skill mix required for the organisation so as to achieve the desired goals and objectives of the organisation. This means that human resource planning is an important add on to the strategic plans. But evidence shows that the connecting bridge between human resource planning and strategic management is not stressed in practice (Baird et al.1983, De sancto-1983; Ohan & Rynes-1983). Reason to this non utilisation is found in focus of human resource planning literature. Almost all the research focuses on human resource supply and demand forecasting (Zedeck & Casci-1984). Extra care may be taken in developing a statistical model of manpower planning, but little care is given to gaining managerial acceptance of such plans. Thus there exist a huge gap between available techniques and their use because important organisational realities are not projected in to the models (Zedeck & Cascio,1984)
Rapid environmental change, globalization, innovations to provide competitive products and services, changing customer and investor demands have become the standard backdrop for organizations. To compete effectively, firms must constantly improve their performance by reducing costs, enhancing quality, and differentiating their products and services. To improve firm performance and create firm competitive advantage, HR should focus on better and new set of priorities. These newly set priorities should be more organisational, business and strategic oriented and less focussed towards old traditional HR functions like staffing, training, appraisal and compensation. Business strategic priorities include team-based job designs, flexible workforces, quality improvement practices, employee empowerment and incentive compensation (Jing and Huang 2005).
SHRM was designed to diagnose firm strategic needs and planned talent development which is required to implement a competitive strategy and achieve operational goals (Huselid et al., 1997).
Apart from report proof on the strategic importance of human resource planning, studies of organisation practices give an indication of its arousing grandness for strategic applications. A study interviewed human resource executives from 137 companies to describe the reasons why their companies were following human resource forecasting, which an important part of human resource is planning. The most important three reasons were for bringing up their human resources (77.6 percent), for avoiding personnel shortages (73.1 percent), and to collect information for decisions (73.1 percent). Another set of reasons for human resource forecasting included the following: optimistic action efforts (63.6 percent), budgeting (62.1 percent), and career planning (59.7 percent)
Hospitals are labour intensive in nature. It is often finding it difficult to get the right person for the right job at right time in hospital services. Basically hospitals are not having appropriate plans in terms of understanding the human resource requirements. In fact there has been no effort or less effort put in identifying the right sources of information with regard to demand and supply of human resources. There is no way for the hospitals to look at the strategic view of indenting appropriate staffing or key positions requirement. This study is intended to assess the hospitals practice on human resource planning strategically.
The primary objective of the study was to make a comprehensive understanding of the strategic human resource planning in a hospital.
To explore the hospital practice and their approach to use the strategic human resource planning.
To identify a suitable method for assessing their future human resource requirement
To identify the ways or mechanism for utilization of the available human resources.
The endeavour is to arrive at the techniques that the hospital follows in planning their human resources strategically.
The hospital chosen for the study was a private speciality care centre with over 250 beds. There are over 1,000 employees working. For the purpose of study the heads of thirteen departments were chosen and interviewed with the help of questionnaires. Work load analysis among nurses was set in an acute care ward. Five nurses were chosen randomly from the employees. Only staff nurses who were directly involved in patient care were taken for the purpose of the study. Close observation over a period of time was undertaken.
The study has used various methods to arrive at the desired results. It has considered both primary and secondary data to derive the desired result and recommendations. The primary data was obtained by seeking expert’s opinion with the use of structured questionnaire and by interacting with various staff. Further data collection also involved extensive observation of the activities of the staff involved in the study. The secondary data were collected from the reliable sources from the hospital like Medical records department and human resource department.
The study involved two methods- seeking experts opinion and work load analysis of the nursing employees. Since extensive observation was required for work load analysis the researcher has followed the employee’s work schedule and has followed them continuously. Expert’s opinion required data collection tool for which a structured questionnaire was used. It was mainly intended to assess the practice of strategic human resource planning in their concerned department. The details of the study are as follows:
For assessing the activities, close observation of a sample size of five nurses were done over a continuous period of time. The time duration that they took for completing an activity was noted. It involved the following steps.
Establish key departments and activity areas.
List the major activities the cadre are involves and the time do they take for completing an activity.
Determine an activity standard- means the time period that they take in accomplishing an activity
Establish work timings, leave, offs
Establish the annual available time for each cadre, subtracting the sum total of public holidays, sick off days and annual leave from the number of days in an year.
Find out the category allowance- activities that each cadre do outside their job description.
For having an understanding of the institutions’ policy on the strategic human resource planning, opinion of various head of departments were sought. Interview was done with the help of questionnaire. Thirteen heads of various departments were interviewed to arrive at the conclusion.
There are many techniques available for forecasting the human resources in a hospital. Some of them include-
Managerial judgement- either by the use of rules of thumb or mere guess work. Even trial and error methods are also followed some times.
Ratio-trend analysis- it uses the data available so as to forecast the future.
Work load analysis
Mathematical model.
Skills/ expertise analysis.
Among all these work load analysis is the most accurate one as it requires least number of samples whom are observed on a continuous basis. Apart from this, this method has been promoted by the World Health Organisation. The approach used is a method known as Work load Indicators of Staffing Needs (WISN), which has been developed with the intention of shifting the staff requirement assessment from an institutional level of arbitrary predictions to a more systematic and scientific approach. This has been successfully implemented in many developing countries.
In the hospital where study was conducted, there was around 350 nursing staff present across different departments. Five nurses from an acute care ward was chose for the purpose of study. The activities done by them were categorised as direct patient car and indirect patient care. Further break up of each activity were done so as to denote the time that they spend on each single activity. There were 3 shifts followed by the nurses, the timings were flexible in these three shifts. The department in which study was conducted followed three shifts with a six hours long morning and evening shift and twelve hours long night shift.
As per the standards nurses were given the following number of leaves an year:
Leave
Number of days
Weekly offs- 52 days
52
General holidays
12
Earned leave
14
Casual leave
12
Sick leave
3
Restricted holidays
2
Activities are categorised as follows with the time duration they take for each activity:
Direct patient care activities
Indirect patient care activities
Activity
activity standard
frequency
inspection of patients
15
9%
Vitals
18
11.18%
changing fluids
14
8.70%
Suction
11
6.83%
Dressing
23
14.29%
other direct bed side care
24
14.91%
attending to doctor rounds
32
19.88%
medication administration
24
14.91%
Total
161
As per the WISN method, activity standard is the time duration that a nurse takes for completing the mentioned activity. Here the average time out of five nurses is noted in the activity standard. Activity standard is the time duration that a well motivated and experienced nurse will take in finishing an activity at a particular given time. Direct patient care activities involve everything that a well motivated and well trained nurse does which will directly influence the patient in his/he course of treatment and wellness. Frequency has been denoted depending on the total time spent for the direct care. Here nurses spend 161 minutes altogether
Activity
activity standard
frequency
inspection of medicines available
10
6.33%
hand over receive
21
13.29%
pharmacy order placing
11
6.96%
file writing
36
22.78%
phone calls
15
9.49%
lab orders
11
6.96%
receiving drug from chemist
11
6.96%
receiving admission
14
8.86%
handing over
29
18.35%
total
158
Indirect patient care involves all those activities which are not directly related to the care given to the patient. It was noticed that they spend almost equal time in indirect activities as in direct activities. Of all the activities file writing and other documentation work is the longest. Hand over also takes considerable lot of time. Other activities like placing lab orders, pharmacy calls etc takes up the same amount of time.
The following formula as given by the WHO has been used to determine the staffing requirement.
Where;
Intermediate-total personnel requirement = Total annual workload/standard workload
Standard workload = Total available working time per year
Activity standard
Category allowance factor = 1
1-(Total Category Allowance)
Total available working time in a year = total working days in an year- total
number of non working days
Total number of non working days = 95 days
Total number of non working weeks = 95 days/ 6 working days in a week
= 15.83 weeks
Number of working weeks = 52- 15.83
= 36.17 weeks
Working days = 36.17* 6
= 217.02 days/yr
Working hours =217.02* 6
= 1302.12 hours/yr
Activity standard =319 mints for 6 patients in 6hrs shift
=53.17 mints for one patient in 6 hrs
= 212.67 mints for one patient in 24 hrs.
Therefore activity standard = 3.5 hrs per patient per day
Standard work load = total available working time per year
Activity standard
= 1302.12/ 3.5
= 372.03 patients per yr
d. category allowance = 5% allowance for in service education
= 1/ 1-0.05
= 1.05
e. Total work load in the facility as per records from MRD = 14461 patients per yr
Therefore, intermediate- total personnel requirement = Total annual workload
Standard workload
= 14461
372.03
=38.87* 1.05
This calculation come up with the precise number of staff required as per the working ability of a single staff. Category allowances and time for personal rest in a day has also been considered.
The requires number of staff is 40 where as the department has only 36 at present. A shortage of 4 staff has been noted.
Thirteen heads of various departments have been interviewed for knowing the institute’s approach towards the strategic human resource planning in the hospital. As said before that the human resource team along with all the line managers and top management plays an important role in strategic planning of the human resources. All the decisions which are undertaken will directly influence the organisation. Therefore care must be taken while planning. From the interviews held with the help of questionnaires analysis has been made which is as follows:
Sr. No
Agee
Sex
Current department
Work experience in the department
Total years of experience
Number of years in managerial position
1
38
F
pharmacy
10
15
10
2
42
M
MRD
3.6
22
15
3
31
M
BILLING
9
9
5
4
40
M
Associate manager-Tower 1&2
5
5.5
2
5
31
F
Dietics
1.5
9
6
6
44
M
Accounts
1
17
14
7
37
F
Blood bank
1
5.6
1
8
39
F
Nursing
1.4
12
10
9
M
radiation therapy
17
18
6
10
42
M
medical administrator
2
24
17
11
30
M
House keeping
5
7
5
12
30
F
Quality
2.6
8
8
13
35
M
Maintenance
12
12
8
Out of the thirteen HOD’s interviewed five are females and remaining eight are men. Departments with the importance and availability of heads for the purpose of study were chosen for the interview. All the HOD’s are in the age group of 30- 44. Four of them have work experience above six years in the same department. Whereas seven of them have below 5 years of experience in the same department. When total years of experience are considered everyone have above 5 years, the maximum being 22 yrs. This shows the level of knowledge and capability of the heads in carrying out the functions of the department efficiently. Average years of experience in the managerial position being 5 years, the least being one year and the highest being seventeen years. This profile shows that the managers chosen for the study are the right people who can make judgements upon the demand of human resource and planning of the personnel.
Sr. No
Employees working under the supervision of respondent
Whether the department has adequate number of staff
Required staff if less than adequate
Whether there is a gap between existing and required
If "yes" plans in meeting the gap
1
22
less than adequate
Pharmacy attenders-2, Pharmacists-4
yes
suggests to HR
2
29
less than adequate
Attenders-2
yes
suggest to HR
3
25
optimum
NA
no
4
30
optimum
NA
no
5
6
optimum
NA
no
6
8
less than adequate
Senior Manager-1
yes
suggest to HR
7
9
less than adequate
attenders-2, technicians-2.
yes
suggest to HR
8
350
less than adequate
staff nurses, ANM's-5
yes
seeking interns, by working overtime,
9
22
optimum
NA
yes
trainees, students
10
700
less than adequate
11
219
less than adequate
Helper-7
yes
suggest to HR, chief administrator
12
1
 Less than adequate
executives-2
yes
suggest to HR
13
21
 less than adequate
 electrician
no
suggest to HR
From this table it is evident that Nursing has the highest number of employees, medical administration since it s a mix of many departments can’t be taken as an isolated department as such. And the least number in quality department. And out of the thirteen respondents nine of them reports that they have lea than adequate staff in their department. Billing, administration, clinical nutrition and radiation therapy have the optimum number of employees as per the head of the department. In pharmacy where at present 22 employees are there; require more number of assistants and pharmacists. Likewise each department head has expressed their requirements in terms of numbers. They believe that they require more number of employees so as to reach to the optimum level. All of the heads used to suggest to the human resource manager about the requirement and no other alternate plans were deployed from their side. But in nursing department the head tries to manage the shortage of the staff by hiring interns from various nursing colleges and schools and also divides the work load among the existing employees. This strategy could manage the situation on an emergency temporary basis. Radiation therapy department also seeks interns and students so as to cop up with the increasing work load or increasing demand. No other managers are directly involved in the plans to meet the gap.
Sr. No
Criteria for meeting the staff requirement
Whether staffing projection done for next five years
Adequate qualified and skilled personnel present
Number of shifts present
Common mode of arising internal demand for new employees i
Decision making authority in hr issues
1
based on work load
No
yes
3
70%-resignation of an employee, 30%- expansion of department
HOD and HR
2
based on work load
No, planning for 1 yr
yes
2
80%-resignation, 10%- promotion of present staff, 10%- expansion
HOD and HR
3
work load
No, only annual projection done
yes
2
100%- resignation
HR
4
 Work load
No. annual projection done
yes
2
60%- resignation, 30%- long leave, 10% -promotion of present employee
CAO, HR
5
As per IDA 1:30 but in hospitals 1:50
NO
yes
80%- expansion of department, 20%- resignation
chief dietician, HR
6
work load and over experience
no, 1 ye planning done
yes
1
60%- resignation, 20%- expansion of department, 20%-promotion of an employee
Asst.GM, HRD
7
on basis of work load, Work timings
no, only for the next year
yes
3
50%- resignation of staff, 10% -long leave, 40%- expansion of department
HRD and Asst.GM
8
As per INC recommendations
no, only for 1 yr
yes
3
60%- resignation, 40%- expansion of department
HR and HOD
9
As per AERB 1 teletherapy machine: 2 technologists
no
yes
3
60%- expansion of department, 35%- promotion of present staff, 5%-transfer/ resignation of current employee
HR and HOD
10
work load and nature of work
no
yes
2
50%- expansion of department, 50%- transfer / resignation of employee
HR
11
work load
no
yes
3
expansion-95%, resignation-5%
Manager HK and HR
12
work load analysis
no
yes
1
NA
HR
13
work load
no
yes
3
50% - resignation, 50%- long leave
HR
From this table it is very evident that different departments use different assessment criteria for demand assessment. Most of the managers with the experience they gained in managing have an idea about the trend of work load and the number of employees who can manage the work. Therefore it is only with their own experience they assess the work load and come up with the approximate number of employees required to carry out the work load efficiently. There is no scientific basis to this guess work or managerial judgement. Departments of Nursing, Dietics and Radiation therapy follows guidelines set by the concerned governing regulatory bodies. Other departments give suggestions directly to the human resource departments. Also no department has made a strategic projection for the next five years; all the departments have made projections for the next financial year. This shows the lack of strategy planning. All the departments have no doubt in saying that their department has enough skilled employees. Out of the thirteen managers nine of them points out that resignation being the most common reason for arising an internal demand in the department. This accounts to more than 50% (>50%). This resignation can be due to getting better opportunities, going abroad for work, personal issues etc. Three out of the thirteen says that the demand arousal may be due to expansion of the department which accounts for more than 50%. Other major reasons being said is promotion of an existing employee and long leave of employee. Again nine out of thirteen have pointed out that the key decisions pertained to their department is taken together by the HOD and human resource team. The rest think it is the responsibility of the human resource department
Sr. No
strategies to cope up emergency staff shortage
Persons involved in staff selection
responsible authority for strategic planning in the department
technique followed for human resource planning in the department
1
extra work load for others
head of medical services
Hr team
work load analysis
2
over load on others, emergency recruitment by the HRD
MRO
HOD, HR team
assessment of employee
3
extra work load for the billing in charge
no
VP-finance, HR team
work load analysis, no thumb rules
4
overtime for existing staff
CAO
HOD, CAO, HR team
experts opinion
5
overload on others
yes, HMS, chief dietician
HRD
trend analysis
6
reserve volume of staff
only CFO
hr team
work load
7
overtime work
only Blood bank officer involved.
 HR team
work load
8
overtime work for the existing staff, adjustment of work accordingly
In terms of raising the demand
HOD, HR manager
INC recommendations, trend analysis
9
inter unit exchange of employees
no
HOD, HR team
guidelines by AERB, work load
10
overtime for existing staff
no
COO, Hr team
work load
11
overtime for existing staff
CAO
Hr team
 Work load
12
hr team
 Work load analysis
13
overload on others
no
 Hr team
Work load assessment
Here it has come to the conclusion that during an emergency shortage of employees, ten out of the thirteen departments puts overload on the existing employees. This is a clear indication of the lack of proper manpower planning. The radiation therapy unit instead look for calling people from the other unit so as to cope up with the work load. The accounts department has a set of reserve volume of employees so as to work during shortage of employees. Nursing department also put overtime work load on the existing employees. Out of the thirteen four of them says that none influences the employee selection. But the rest says that top management including the concerned head of the department influences the employee selection. For the
Strategic human resource planning seven of the respondents believes that it is the responsibility of the Human resource department alone. But others believe that it is the combined efforts of the heads or line managers of the unit and the human resource team. Finally to the question of the technique followed by the team in strategic human resource planning nine of them answered that they follow simple work load assessment so as to plan for the future. Nursing, Radiation therapy said that they follow the guidelines set by the regulatory authority. The manager of administration said that his department follows the managerial judgements and opinion by the experts in planning of the human resources. Clinical nutrition department follows the trend analysis by close observation of the past data on volume of patients.
This study was intended to understand the practical applications of strategic human resource planning in hospitals. The primary objective of the study was to make a comprehensive understanding of the strategic human resource planning in a hospital compared to the existing theory.
For that the researcher conducted interviews among the head of departments for knowing their opinion on human resource planning with the help of questionnaires. Interacting with over 13 HOD’s gave an understanding that there were no centralised techniques followed for human resource planning. They also lacked proper awareness on the importance of human resource planning. The study also revealed lack of strategic focus related to human resources. Therefore a better coordination between the human resource team and the line managers is the need of the hour. There should also be provision for developing their awareness on the importance of skilled and adequate employees.
The study using WISN technique describes the method of determining the institutional staff requirements which is based on the amount and type of work the employee carry out. It tries to quantify the staff required in each category so that the demand can be met. Here the reliance is on work load of the past year. This technique has been developed and promoted by World Health Organisation. This technique has been tested and proved in hospitals across globe.
Here in this study, the staffs required have been found as 40 when compared to the actual staffing level of 36. A shortage of 4 staffs has been noted. Thus the optimum level of staff brought out that the department is experiencing a shortage of staff. The available staff can allotted based on the change in work load on daily basis. Optimum number of staffs would decrease the work load on the present staff and overtime work. Therefore the managers must be encouraged to monitor their staff level based on the
This study methodology is a practical approach that can be followed by hospitals. This study can be conducted along with other study; usually a combination of study is undertaken which gives more accurate results. Here managerial study also was conducted in the setting so as to know the approach of the organisation. Usually in practice managerial judgement is followed and no scientific technique is followed. And during emergency shortage of staff the existing staffs have to bear the work load. Planning of human resources can avoid all these shortage.
Planning activities can bring the departments together which will also help in increased sharing of information and better coordination. It was also noted in the study that managers lacked proper awareness on scientific techniques and thus they followed guess work or by managerial judgements on demand assessment.
So as to change the attitude of people towards manpower planning, proper awareness on the importance of human resource planning to be provided. This would change their perception on the manpower planning. Also they must be made aware that the cost of not planning is higher than the cost of proper planning. Emergency staff shortages can bring negative outcome in patient care activities. Also the level of skills expected from the staff should meet the demand. Result of manpower shortage will be poor quality of treatment and thereby loss to the organisation. Therefore the need for finding out the optimum number of staff in a department is very important. Over staffing can also bring loss to the organisation.
A combination of methods can be used for accurate results in planning of human resources. Usually managerial judgement along with trend analysis or work analysis can be relied upon. Work load analysis gives a better result as demonstrated by the WHO model. Therefore for the study purpose work load analysis has been used. This model can be an effective tool for the existing departments so as to identify optimum number of people required in different cadre.
Strategic human resource management is all about finding the right number of people for the right job at right time. It ensures that an organisation is never deprived of the right kind and number of people whenever required. Future expansion or other demands will be forecasted using suitable technique. This study aimed to assess the hospitals practice in strategic human resource planning has conducted work load analysis and experts interview seeking the opinion of heads regarding the planning of human resource planning. This study lays a foundation on techniques that can be followed practically for the hospitals and the hospital has to take it further by applying these techniques in their manpower planning. The other recommendations that can be given are:
To form a close link between the human resource
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