Impact of Quality Human Resources on Healthcare Performance

IMPACT OF QULAITY HUMAN
RESOURCE IN HELATH-CARE
PROVDING INDUSTRIES /
ORGANIZATIONS

Author Information:
Name: Muhammad Asif Khan
Education: Master in Administrative
Sciences (MAS)
Institution: Department of Public
Administration, University of
Karachi

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

Statement of Problem:
The performance of health-care providing
organizations are depend upon
technological innovations in the field of
Medical / Health Sciences rather than
human resource (employees) capabilities.

Significance of Study:
 This research study aims to provide a clear
understanding regarding the human input
(employees) and the physical input (new
technology), their importance and the
impact on health-care providing
organizations' performance.

Objectives:
 To evaluate and analyze the impact of quality
human resource on health-care providing
organizations.
 The ultimate objective is to enhance the
credibility, performance and efficiency of the
health-care providing organizations / industries.
 Another objective is to identify the ways to
maximize the human contributions in the
overall performance of the health-care
providing organizations.

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

Abstract:
 The purpose of this research study is to
gain a deeper understanding of the impact
of human resources (employees) on health
sector reform, the importance of HRM in
all aspects of health-care organizations, the
positive impact of increased job autonomy
on employee outcomes, and the dynamics of
employee engagement in health-care.

Abstract:
 The literature on the link between HR
system perceptions and civility towards
patients, specific roles for HRM in building
shared values that can serve both the care
needs of patients and the business needs of
health organizations, the complex linkages
between employees' perceptions of human
resources systems and hospital
performance, and the mechanisms through
which HRM can enhance patient
satisfaction in health-care organizations is
relevant to this discussion.

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

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

Methodology Applied:
 The descriptive methodology has been applied to
analyze the data and the data for this research
study has been collected & explored through
secondary sources, which includes following:
Literature Review
Extraction of relevant material from the Books
related to the health care services
Past Research Analysis related to the same
topic
Information gathered from medical science
journals.

Introduction:
 Human Resources Management (HRM) is
a vital management task in the field of
health-care and other services sectors,
where the customer facing challenges
because of staff’s performance who have
the experience and the quality of
performance and that human resource
management plays an active and vital role
in the success of the health-care providing
organizations.

Introduction:
 Human resource management is concerned with
the development of both individuals and the
organization in which they operate.
 HRM, then, is engaged not only in securing and
developing the talents of individual workers, but
also in implementing programs that enhance
communication and cooperation between those
individual workers in order to nurture
organizational development.

Introduction:
 The primary responsibilities associated with
human resource management include:
job analysis and staffing,
organization and utilization of work force,
measurement and appraisal of work force
performance,
implementation of reward systems for
employees,
professional development of workers, and
maintenance of work force.

Introduction:
 The maintenance of workforce includes not
only the training of the employees to
perform their current job effectively but
also develop them for tomorrow to take the
responsibility according to the new situation
that mostly arises due to the introduction of
new technology in the health-care related
services.

Human Resource Management
Definitions:
 Human resource management (HRM) is
the management of an organization's
workforce, or human resources. It is
responsible for the attraction, selection,
training, assessment, and rewarding of
employees, while also overseeing
organizational leadership and culture and
ensuring compliance with employment and
labor laws (Ulrich, 1996; O'Brien, 2009;
Patrick, 2011).

HRM Definition:
Naturally, the definition of human resource
management would be incomplete without
further explaining what the terms of ‘human
resources’ and ‘management’.
First and foremost, people in work organizations,
endowed with a range of abilities, talents and
attitudes, influence productivity, quality and
profitability.
People set overall strategies and goals, design
work systems, produce goods and services,
monitor quality, allocate financial resources, and
market the products and services.

HRM Definition:
Individuals, therefore, become ‘human
resources’ by virtue of the roles they assume
in the work organization.
Employment roles are defined and described
in a manner designed to maximize particular
employees’ contributions to achieving
organizational objectives, these objectives
mostly includes the increase of profitability,
to enhance quality of work, to increase
productivity and provide value to the customer and
satisfied their needs.

HRM Definition:
A common definition of HRM remains an enigma
and, in many respects, what HRM is purported to
represent has not moved beyond some key principles
laid down in the 1980s.
Bratton and Gold (1999:11) interpreted the HRM as:
“That part of the management process that
specializes in the management of people in work
organizations. HRM emphasizes that employees are
critical to achieving sustainable competitive
advantage, that human resources practices need to
be integrated with the corporate strategy, and that
human resource specialists help organizational
controllers to meet both efficiency and equity
objectives.”

Human Resource Management
Functions:
Managerial Functions
Planning
Staffing
Directing
Controlling
Operative Functions
Procurement
Development
Compensation
Maintenance and
Motivation
Integration
Industrial Relations

Defining Human Resources in Health-
Care:
 Human resources, when pertaining to health
care, can be defined as the different kinds of
clinical and non-clinical staff responsible for
public and individual health intervention.
 As arguably the most important of the health
system inputs, the performance and the benefits
the system can deliver depend largely upon the
knowledge, skills and motivation of those
individuals responsible for delivering health
services.

Key Issues Pertaining to Human
Resources in Health-Care:
 When examining health care systems, many
general human resources issues and as well as
questions have been arisen. Some of the issues
include:
The size, composition and distribution of the
health care workforce,
The workforce training issues,
The migration of health workers, and
The level of economic development in a
particular country and socio-demographic,
geographical and cultural factors.

How Does Human Resource
Management Affect the Success of
Health Care Organizations?
 Proactive HR management is critical to a health
care enterprise's success
 Employment Actions
 Compensation and Benefits
 Development and Training
 Succession Planning
 Knowledge and Training of HR Managers
 Ethics
 Employee Morale
 Unions / Employees Associations

What is performance?
 Just what is performance anyway? By
clearly understanding this, your life as a
manager will be so much easier.
“Performance is simply the production of
valid results.”
 There may be many other answers to this
question, but it all boils down to:
“can the employee produce the results
expected of them?”
 It can recognize this via certain key
performance indicators.

Organizational Performance:
 Organizations try to manage the performance
of each employee, team and process and even of
the organization itself. We're used to thinking
of ongoing performance management for
employees, for example:
setting goals,
monitoring an employee's achievement of
those goals,
sharing feedback with the employee,
evaluating the employee's performance,
rewarding the employee's performance or
firing the employee.

Organizational Performance:
 However, performance management applies to
teams and organizations, as well:
Organizational performance involves the recurring
activities:
To establish organizational goals,
Monitor progress toward the goals, and
Make adjustments to achieve those goals more
effectively and efficiently.
Those recurring activities are much of what
leaders and managers inherently do in their
organizations -- some of them do it far better than
others.

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

HRM and Organizational Performance:
However, performance is not a concept that can
be easily defined and conceptualized. According
to Guest, it is better to use the concept of
‘outcomes’ instead of performance.
One can then distinguish three different
outcomes:
• Financial outcomes (profits, net margin, market
share),
• Organizational outcomes (productivity, quality,
efficiency, client satisfaction) and
• HR outcomes (employees’ attitudes and
behavior).

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

HRM and Outcomes:
 In the last two decades, several studies on HRM
and performance have been conducted in the
health care sector. In their review of health care
studies, Harris et al concluded that HR practices
are often related to patient oriented performance
outcomes. They also noted the importance of
conducting additional research on the ‘black box’
issue.
 Its contribution concerns two elements discussed
in the literature.

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

HRM and Outcomes:
 Financial outcome:
The net margin is defined as the ratio of a
firm’s net profits to its total revenues. It
indicates what share of income earned is
translated into profit. It is stated as a
percentage:
Net Margin = Net Profit / Total Revenues * 100
Organizational outcome:
The organizational outcome is measured by
focusing on client satisfaction. Clients can be
asked about their satisfaction with the
treatment they received.

HRM and Outcomes:
HR outcome:
The HR outcome measure considered is absence due to
sickness. Absence due to sickness can be considered a key HR
outcome as the decision of employees to be absent affects the
available human resources and is a critical success factor for
the continuation of work processes within the organization.
For example, absenteeism due to sickness is calculated in
percentages, using a standard formula developed by Vernet. In
brief: for every employee, each day he/she calls in sick is
multiplied by the part-time factor and disability factor
pertaining to that day. These days are then summed and
divided by the total number of working days. Maternity leave
is excluded. This is calculated for the organization as a whole.
Another view to analyze the HR outcomes is the to evaluate the
patient's feedback and complains regarding the services
rendered by the employees of the hospital.

LITERATURE REVIEW REGARDING
PERFORMANCE MEASUREMENT IN
HEALTH CARE

History:
 More than 30 years ago, a physician named
Avedis Donabedian proposed a model for
assessing health care quality based on
structures, processes and outcomes.
 Two decades later health care adopted
continuous quality improvement, which
uses teams to improve processes.

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

Selecting the right measures:
 An effective measurement system integrates
initiatives, aligns organizational units and
resources, and improves performance.
 Paradoxically, most people select measures
before they decide how to use them. While it
makes sense to discuss selection and use of
measures in that order, the effective order in
practice is the reverse.

 Organizations need performance measures
in three areas:
To lead the entire organization in a
particular direction.
To manage the resources needed to travel
in this direction.
To operate the processes that makes the
organization work.

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

• To overcome these barriers, organizations need
measures for three purposes:
Strategic--to drive strategies into action and
change the organizational culture.
Diagnostic--to evaluate the effectiveness of these
actions and the extent of change.
Operational--to improve continuously.

Cause and Effect Relationship:
 A strategic plan defines the specific cause-and-effect
relationship through strategic measures. Performance
improvement is accomplished by using measures of
processes and outcomes to operate the processes.
 By understanding how measurements will be used, it
becomes easier to understand what measures to have.
Measures are needed to test various cause-and-effect
relationships at the organizational, process and
individual level.

Cause and Effect Relationship:
 By their very existence, organizations create the basis
for interdependency among:
themselves (and partners) ,
their customers, and
 employees.
This interdependency weakens when one or more parties
do not receive value or perceive the value as insufficient.
 Organizations can strengthen this interdependency by
integrating and aligning structures, processes, results,
quality and costs. Strengthening the interdependency
requires measuring the value each party needs.

Practical Rules:
 While health care professionals, especially physicians,
tend to shy away from leading and managing
organizations as businesses, their scientific background
gives them one advantage in developing measures and
analyzing the results. The approach described here is
based on scientific principles of generating hypotheses
about cause-and-effect relationships and testing those
hypotheses.
 The leadership part focuses on developing the measures
for all three critical cause-and-effect relationships and
analyzing the results. The management part focuses on
deciding what action to take based on the analysis and
then allocating resources to carry out those actions.

Practical Rules:
Three actions to effectively lead are:
 Develop measures to build the value-added
interdependency.
 Manage activities, time and quality to strengthen
this interdependency.
 Analyze performance to determine the
effectiveness of those measures and
management .
At the strategic level, the first two cause-and-
effect relationships are combined.

Practical Rules:
Rule 1:
Have your strategic cause-and-effect relationship
explain how all three types of value will be
increased.
 Your top-level measures are the three types of
value. After developing the strategies, develop
specific action plans, allocate resources and
communicate the plan.
 When you are done, you should be able to
answer the following questions:

Practical Rules:
Rule 1:
 Can contribute to the organization's success?
Are strategies operationally defined?
Are the causal relationships among the strategies
clear?
Will all constituents receive strategic value?
Does everyone know what the strategic direction
is and remain committed to it?
Does each person know how he or she can
contribute to the organization's success?

Practical Rules:
Rule 2:
 Measure time, quality and cost at the
process level.
 Time and cost are relatively easy to define
and measure.
 The key to defining quality measures is in
knowing the purpose of process steps and
the outcome.
 Defining these purposes operationally
yields quality measures.

Practical Rules:
Rule 3:
 Develop information systems after
deciding on the measures. Because few
people have the luxury or inclination to
develop information systems after having
defined measures, they should always have
information systems that are flexible
enough to include any measures developed
later.

Practical Rules:
Rule 4:
 Analyze results to test the three critical
cause-effect relationships.
 The distinguishing feature of excellent
organizations is their analysis. They don't
necessarily have greater ability; they are
just committed to analyzing the data to see
what works and what doesn't. Then they
take action.

Health-Care Key Performance
Indicators (KPI) and Metrics
Following standards or indicators can be use to
determine the performance or efficiency of the
health-care providing organizations / industries.
These indicators and the prescribed standards
are helpful to gauge the overall performance of
the organization after implementing a reform
program before introducing a reform program in
any health-care providing organization.

Key Performance Indicators (KPI)
Time to Health-Care Service:
The time to health service key performance
indicator (KPI) measures health-care providing
organization's ability to provide incoming
patients with health care service in a timely
manner. Prescribed standards to the different
health-care services are as under:
Arrival to Physician Target 60 minutes
Arrival to Bed Target 20 minutes
Arrival to Nurse Target 40 minutes
Arrival to Discharge Target 100 minutes

Lab Turnaround Time:
The lab turnaround time key performance
indicators (KPI) measures the ability of the
Lab to process lab required results.
Prescribed standards of lab turnaround
time for different tests are as under:

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

Emergency Response(ER) Waiting Time:
 Measure the amount of time patients are
currently waiting before being seen by a
physician in emergency response. The prescribed
standards for emergency response are as under:
ER Urgent Stable
Wait Time01:50 02:30

 Number of Patients in ER:
Provides key data about patients in the ER such as room
number, urgency of their case, current wait time and if
they have been attended to by a nurse.
 Current ER Occupancy:
Measures how many are currently occupied in your ER
compared to the total number of beds.
 Average Length of Safety:
Measures how long on average, patients stay in your
hospital after having a specific procedure, such as
appendectomy. The prescribed standard for the average
length of stay:

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

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

What is Quality?
The term quality refers to the attainment of
the customer needs in an effective and
efficient manner. Because if a good or
service is unable to meet customers
perceived value, it will be considered low
quality goods or services irrespective of its
worth.

What is Quality Human Resource?
 The term quality human resource refers to the
human resource with ability to meet or exceed
customer requirements. The quality human
resource is considered highly motivated, trained
and highly skilled in their respective areas and
they have ability to translate organization's
vision in to reality with other available resources.
 In health-care organizations the patient
satisfaction is not only depends upon the
technology but also upon the human resource
(employees) capability.

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

The impact of human resources on
health-Care Providing Organizations
 When examining health care systems, it is both
useful and important to explore the impact of
human resources on health sector reform taken
by any country or a health -care providing
organization.
 While the specific health care reform process
varies by country to country and organization to
organization, some trends can be identified.
 Three of the main trends include efficiency,
equity and quality objectives.

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

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

Quality:
Human resources in health sector reform
also seek to improve the quality of services
and patients' satisfaction. Health care
quality is generally defined in two ways:
Technical quality:
Technical quality refers to the impact that
the health services available can have on the
health conditions of a population.

 Quality:
Socio-cultural quality:
Socio-cultural quality measures the degree of
acceptability of services and the ability to
satisfy patients' expectations.

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

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

Staff Management
 Better use of the spectrum of health care providers and
better coordination of patient services through
interdisciplinary teamwork have been recommended as
part of health sector reform. Since all health care is
ultimately delivered by people, effective human
resources management will play a vital role in the
success of health -care providing organizations.
 The two key areas that mangers have to be concerned
with in their job roles are managing their staff and
managing the machines and technology with which those
staff have to work or perform their duties effectively and
efficiently.

Staff Management
 The Managerial Grid:
How organizations and their managers can, and should,
relate to these two main areas of their work has been the
concern of Robert Blake and Jane Mouton in their work
on The Managerial Grid (Blake R.R. And Mouton J.S.-
1985 The Managerial Grid III. Hogan Page.).
This is the device for representing the concern for
production and for people shown by different mangers
with a 1-9 scale being used to represent the degree of
concern, 9 representing the high concern.

Staff Management
The major points on the Grid :
 Position 9, 1
 Position 1, 9
 Position 1, 1
 Position 5, 5
 Position 9, 9

The Management Of New Technology:
 Organizations may be either reactive or
proactive that is, planning to activate desired
change rather than merely reacting to
environmental impositions or client demands.
This health care service received much criticism
for its reactive approach in responding to
demand rather to evaluated need (Cooper M.H.-
1974 Rationing Health Care, London Croom
Helm) and more recently this reactivity has been
identified with the lack of a general management
process.

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

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

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

 However, in some quarters the arrival of high
technology is not always well received. In fact, it
may be feared by some workers whose working
practices, skills and indeed, very employment
may be threatened by its introduction.
 It is clear that technology itself is not to blame
for this but rather the way it is employed within
the organization. It is no solution to argue that
providing redundancies are avoided there is little
ground for objections to new technology..

What is Scientific Management?
 Scientific Management, also called
Taylorism is a theory of management that
analyzes and synthesizes work flows. Its
main objective is improving economic
efficiency, especially labour productivity.
 It was one of the earliest attempts to apply
science to the engineering of processes and
to management.

What is Scientific Management?
 Scientific management theory seeks to improve
an organization's efficiency by systematically
improving the efficiency of task completion by
utilizing scientific, engineering, and
mathematical analysis.
 The goal is to reduce waste, increase the process
and methods of production, and create a just
distribution of goods.
 This goal serves the common interests of
employers, employees, and society.

What is Scientific Management:
 Scientific management theory can be
summarized by Taylor's Four Principles:
Managers should gather information, analyze
it, and reduce it to rules, laws, or mathematical
formulas.
Managers should scientifically select and train
workers.
Managers should ensure that the techniques
developed by science are used by the workers.

What is Socio Technical systems Concept?
 If there any lesson to be learned from the Socio-
technical Systems concept, perhaps to be
transferred to areas of merging technical
innovation, they were widely ignored. In 1973,
Enid Mumford could assert that:
“Work systems are usually designed in technical
terms to meet technical and business objectives,
with little thought given to the needs of people
operating the system.”
(Mumford E. -1973, Designing Systems for Job
Satisfaction. Omega I, (4), 493-8.)

Deskilling:
 The second important aspect of the introduction
of new technology is that of de-skilling, or the
fear of it, that has long brought conflict to
industrial situation. Harry Braveman advanced
the thesis that de-skilling has been a dominating
process in the creation of modern work
organizations.
 Taylor's ideas contained three main principles
which are fundamental to all advanced work
design, organization and method study and
industrial engineering today.

Deskilling:
These are:
The gathering and development of
knowledge of the labour processes;
The concentration of this knowledge as
an exclusive province of management;
The use of this monopoly of knowledge to
control each step of the labour process
and its mode of execution.

Redundancy:
 The third problem associated with new
technology is that it may facilitate staff
redundancy, although its track record thus far
has not wholly supported this genuine fear
amongst the health care related workers /
employees.
 The dumping of workers whose skills are no
longer required or whose role is no longer
compatible with changing technological
requirements is waste of human resources.

Redundancy:
 This ought not to occur except by mutual
consent. In case of employee redundancy
due to new technological requirements the
employer and the employees must show
flexibility in case of employee redundancy
arrangements.

Future Employment Level:
 This is a convenient point at which to examine
the evidence as to the likely effects of introducing
new technology into the health services.
 Most, but by no means all, of this technology is
computer-based. That is to say a computer, or a
microprocessor, is incorporated into a machine or
instrument in such a way as to render some
human tasks, whether manual, clerical or
administrative, unnecessary.

 As computers are also expected to become
increasingly useful in the area of decision making
the breadth of this influence on working practices
is potentially very wide. Some writers have
predicted that the nature of work itself will be
catastrophically changed. Clearly some analytical
tools are needed with which to identify and assess
the expected changes.

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

Economic Moderator:
 In health care new technology has usually
required the acquisition of new skills, or new
employees, but the overall number of posts has
continued to increase.
 Where individual worker productivity has risen
it has quickly become saturated by increased
client demand.
By considering the demand side as well the
supply it is evident that the relationship between
new technology and unemployment in health care
is from a simplistic one.

Economic Moderator:
The principal economic factor in the
implementation of new technology is
Exchequer funding.
Capital monies are largely divided between
building and equipment which will include
new technology.

Economic Moderator:
 Therefore, the funding of technological
innovation will largely depend upon the
shortage of capital monies gives rise to local
income generation by selling services--for
example occupational health services or
executive health screens—this is deemed
like to result in a positive influence on both
staffing levels and equipment utilization.

Social Moderator:
 Social factors moderating the impact of new
technology are also varied.
 Unlike the experience of other service oriented
industries i.e. banking where significant number
of customers still prefers personal service to
using an automatic cash dispenser or service till,
the health care patient has little need at present
to make such a choice. However, we may in
future emergence of direct patient interrogation
by computer.

Organizational Moderator:
 Organizational moderators relate both to
policy and to its likely effect upon staff. This
in turn relates mainly to an organization's
propensity to change and the manner in
which that change occurs.

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

Accelerating Factors:
 As compare to the other service rendering
organizations it appears in the Health care
providing organizations, also, growth and
demand have been the chief moderator of
staffing levels in the face of new technology.

Accelerating Factors:
To regulate the demand and to accelerate the
technological impact on employment can be done
through the right combination of tight financial controls,
together with strong directives from the government,
both to increase the economic efficiency and wide-
ranging computer-based information systems, such as
the data requirements (DHSS-1984 Report of Steering
Group on Health Services Information: Implementation of
Programme (HC(84)10, London, DHSS) , may be sign
respect and help to establish a tendency to maximize
staff savings from increased productivity.

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

What is clear is that OD addresses the problems
of organizational change by working inside the
organization, tapping into the ideas, experience
and energies of its constituent workers
individual, or in groups, to effect agreed changes
that are mutually beneficial.
 Lewin, in his field force theory (Lewin K.-1951
Field Theory in Social Science, London, Harper &
Row) put forward a model of organizational
change based upon three steps:

1. Unfreezing the Current Situations'
Controlling Forces
2. Finding an Implementing Change
3. Refreezing the New Situation's
Controlling Forces

 There are several ways in which different OD
strategies may be classified depending upon their
context and approach. These are summarized
broadly by Williams as:
Team Development
Inter-Group Development
Total Organizational Development
Improving the Match between People and Jobs
Improving the Match between Organizations
and their Environment

PAST RESEARCH REVIEW & ANALYSIS
REGARDING HRM PRACTICES &
IMPACT OF NEW TECHNOLOGICAL
INNOVATION ON
HUMAN RESOURCE PERFORMANCE
SPECIFICALLY RELATED TO
HEALTH-CARE PROVIDING INDUSTIRES /
ORGANIZATIONS

The Role and Effectiveness of Human
Resource Management:
Arabah Hajj (2012) has done research on
"Evaluation of the efficiency of the use of human
resources for health in public hospitals”
 An Empirical Study on a sample of hospitals”. The
study emphasized on the importance of previous
indicators to measure the efficiency of the performance
of human resources in hospitals, especially public
hospitals, which are in urgent need to assess the
efficiency of the performance human elements, and
doing precise measure will help the hospital
management to strive towards improving how to use
these resources.

The Role and Effectiveness of HRM:
The study recommended the following:
 The need to pursue the efficient use of human
resources for health constantly, and even non-
health (which is unrelated to health work, security
guards, maintenance workers, etc.).
 Prepare a map showing the distribution of human
resources for health for all individuals working in
the hospital, based on the distribution of the family,
and the specialty for all health professions and
medical professionals, making it easier to refer to
them when there is a defect or waste in the use of
these resources.

The study recommended to prepare plans and clear
vision in a professional and systematic approach to
develop human resources in the hospital, with the
need to involve employees in the planning of human
resources to become part of their thinking and their
work and to help them to practice work in a
professional sound, and encourage them to commit
to the hospital.
 The study also urge to create a separate department
for personnel affairs in the health institutions and
the use of external expertise in order to determine
the needs of the health institution of human
resources.

Mukhaimar and Taamenah (2004) with their studies entitled
"Recent trends for the hospital management: concepts
and applications”
 The researcher found that although the quality of the
plans and organizational structures and preparing them
according to the scientific methods, the hospital
management could fail in achieving the planned
objectives as a result of its failure to perform routing
function, which is designed to influence the behavior of
the various categories of personnel in the hospital, and
urge them to contribute to high level of performance
towards the goals of their units in particular and to their
hospital in general.

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

The Impact Of Human Resource
Management Practices On The Quality Of
Health-Care Services
Salah Mahmoud Diab (2012) in his study entitled
"Measuring the dimensions of the quality of
medical services provided in the Jordanian
government hospitals from the perspective of
patients and staff’:
 The study found an increase rate to quit job among doctors and
nurses working in hospitals and the Ministry of Health, and the
low degree of satisfaction and low desire among the staff to
continue working in the hospital, and this giving impact to the low
quality of health services provided to patients, in the absence of
effective HRM practices.

The Impact Of HRM Practices On The Quality
Of Health-Care Services
The most important recommendations by the study
with regard to the condition of individuals working
in the hospital:
a. The provision of material and moral incentives for
employees working in government hospitals to
generate their desire to continue to work and
provide medical services appropriately.
b. Training courses for workers in the hospitals in the
area of the dimensions of medical service quality,
and to deepen the quality concept between the staff
and to achieve the quality dimensions at the best
degree.

Al Kudhat Mohammed (2004), with his study entitled
"Methods of selecting staff in King Abdullah in the
light of technological developments“
 One of the main finding of this study is the existence of a
positive relationship between the personality traits of those
who have been recruited and technology employed in the
hospital.
 In addition to that the contrast of views of the staff about
the availability of specialist personal attributes required.
It also revealed the existence of the impact of high
technology in the analysis and design work and job
classification and the nature of the work.

Ozcan and Hornby (2005) has a study entitled
“Determining staff requirements in hospitals“
 The study found that one of the reasons for
poor performance of employees in
government hospitals in Turkey, was mainly
due to lack of interest by the managers of
head departments in government hospitals
to provide better conditions to hospital’s
staff and develop incentives system.

The study recommended the adoption of
incentives system and rewards for staff and
nurses who perform good and choosing a group
each month as a role model for individuals
working in the hospital and pay them special
bonuses to encourage other staff who have not
been selected, and the study emphasized that
adopting this system will improve the
performance of all individuals working in the
hospital dramatically.

Valverde and Ryan (2006) in their research entitled
“Distributing HRM responsibilities: a classification
of organizations”
The aim of this study to show that HRM is
not the sole responsibility of HR
departments, but also of other agents inside
and outside the organization, such as top
and line managers, and external HRM
service providers.

The researcher examined how
organizations distribute HRM activities and
responsibilities among these agents; he also
attempts to classify organizations according
to agent distribution and to explore whether
a number of internal and external context
characteristics affect this distribution.

The finding of this study shows that the model of HR
function adopted by an organization may not be
contextually determined, but instead it is a matter of
corporate choice. That is, companies actually choose
what type or model of HRM they want and
distribute the responsibilities of their various agents
accordingly, rather than being determined by
organizational contingencies.
 The researcher concluded that a large number of
organizations have proved very useful in identifying
a wide range of behaviors in the distribution of HR
responsibilities.

Rosemary Lucas (2002) with her study entitled
"Fragments of HRM in hospitality? evidence from
the 1998 workplace employee relations survey“
 The study carried out to verify the rehabilitation
of the health sector in Britain from the
perspective of human resource management and
aimed to assess the dimensions of human
resources related to the rehabilitation of the
health system and the formation of a new health
sector.

The study found that employees are more likely
to perceive their managers as anti-union, and to
represent themselves in dealing with employment
issues such as challenging management about
their work, in disciplinary proceedings, and in
seeking a pay increase. The study pointed out the
importance of human resource management in
the success or failure of the health sector and the
health sector in most countries focuses on
changes in building the organization, contain
costs, customer choice.

The study emphasizes on the importance
employees’ performance and how to attract
professionals to the health sector.
The main findings of the study:
The existence of a strict centralization in most
hospitals, which limits the development of the
work of individuals and nurses.
The lack of a new approach to develop the
work in the event of performance failure.

The Factors That Affect The Performance of
Individuals Working In Health
Organization:
Chan and Mak (2012) with their study entitled
“High performance human resource practices and
organizational performance the mediating role of
occupational safety and health”
 The aim of this study is to examine the
relationship between high performance
human resource practices (HPHRP) and
organizational performance.

Individuals Working In Health Organization
 The aim of this study is to examine the
relationship between high performance
human resource practices (HPHRP) and
 The results showed that the mediating role
of perceived safety climate in the
relationship of HPHRP and organizational
performance is confirmed.

 The finding suggests that organizational
emphasis on safety issues contributes to
establishing effective HPHRP and driving
 Organizations can benefit from effective
HR practices by paying attention to
employees’ safety issues, which in turn
result in better organizational performance.

Mc Conville and Holden (2003) A study entitled
“The filling in the Sandwich:
HRM and middle managers in the health sector”
The study showed the central role of line
managers in implementing human resource
management, is widely acknowledged and
examined how far employees affect, or are
affected by, such practices.

 The main finding of this study is that as Trusts
become established, and managers gain
confidence in their staff management skills,
longitudinal studies would be useful in building a
picture of the development of both middle
management roles and the functioning of HR
specialists/advisors.
 Clearly, in units where the specialist
HR/personnel is contracted out, the effects on
managers' roles and the extent of changes in the
nature and quality of HRM need to be explored.

Marie et al., (2007): A study entitled
“HRM and the management of clinicians within the
National Health Service (NHS)”
 The study concluded that the management of
human resources is of crucial importance in
enabling the delivery of efficient and effective
services. The aim of this study is to explore one
issue relevant to Human Resource Management,
that is, the management of hospital doctors in the
National Health Service (NHS).

 The finding argues that HRM must play a
pivotal role in the management of clinicians’ to
ensure the effective and efficient delivery of
health care reforms in Britain.
The study concluded the following:
a. A strong, well-motivated and highly trained
medical profession is critical to the success
of the national health-care reform, in the
delivery of both services to patients and
government reforms.

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

Edgar and Geare (2005): A study entitled
“HRM practice and employee attitudes: different
measures–different results”
 The study aimed to test the relationship
between HRM practice and employee work-
related attitudes and examine whether
different approaches to measurement of
HRM gives different results.

The finding shows that if managers want to
maximize employee’s attitudes, then
implementing lots of practices is not
sufficient.
Practitioners need to be aware that the way
they implement their HRM practices may
be a more important determinant of
employee attitudes than the number of
practices they put in place.

Harris et al. (2007): A study entitled
“Human resource management and performance in
health-care organizations”,
 The purpose of this study is to compare the
evidence from a range of reviews concerned with
the links between human resource management
(HRM) and performance.
 The aim of the paper is to review this diverse
literature, and to derive human resource (HR)
implications for health care researchers, policy
makers and managers.

 The study finds that relationships have been
found between a range of HRM practices,
policies systems and performance.
 The study concluded that Trusts may allow for
increasing tailoring of HR practices to suit local
circumstances, and the potential impact of any
HR practice or set of practices on performance
may be mediated by the effect of the
implementation process on mental models of
individuals and thus on HR outcomes such as
motivation, commitment and satisfaction.

McDermott and Keating (2011): A study entitled
“Managing professionals: exploring the role of the
hospital HR function”,
 The objective of this study is to examine the role
of the HR function in the management of
professional and non-professional staff in the
acute hospital sector.
 The study finds that in two of the three cases the
human resource (HR) function predominantly
provides services to non-professional workforce
groups.

 However, the effective and strategic management
of professionals is undertaken in the third case,
without a professional HR function.
 The study suggests that HRM as “the
management of people and work” was being
practiced, if not by the HR function. As a result, a
focus on formal HRM structures in hospital
organizations is insufficient to capture the manner
in which people and particularly strategically
valuable workforce groups and work are managed.

Ott and Dijk (2005): A study entitled
“Effects of HRM on client satisfaction in nursing and
care for the elderly"
 This study showed that HRM is supposed to
increase job satisfaction. But does it also increase
client satisfaction? The study sets out to discuss
this issue.
 The finding from this research indicates that
HRM does affect job and client satisfaction, and
showed that the correlations between HRM and
client satisfaction were generally rather low.

 Employees’ satisfaction with their organization is a
better predictor of client satisfaction than job
satisfaction. Job-related training showed no relation
with job satisfaction, but a clear relation with client
satisfaction, while leadership style of their manager had
a significant relation with job satisfaction, and a more
limited one with client satisfaction.
The study recommend a regular performance reviews
for job satisfaction and client satisfaction, emphasizing
that employee and client satisfaction can also conflict:
more regular schedules increase employee satisfaction,
but decrease client satisfaction.

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

The conclusion indicates that employee
satisfaction seems mostly affected by the
management style of the unit manager, and
to a lesser degree by performance reviews
and predictable work schedules, while client
satisfaction correlates primarily with job
related training and somewhat with
performance reviews and a supportive
leadership style

RESEARCH FINDINGS,
CONCLUSION AND
RECOMMENDATIONS

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

Research Findings:
 One thing is evident Quality of Human Resource
always does an impact on overall organizational
performance.
 It was found that HR practices are indirectly linked
to over all outcomes of the health-care organizations
or it can be easily say that the Human Resource
Management plays an important role for the
enchantment of organizational efficiency and
maximizing output of the available resources.
Various key success factors emerge that clearly
affect health care practices and human resources
management.

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

Research Findings:
 There is no tailor made available which is acceptable
universally for every organization. Organizations must
choose the best HR model according to their
requirements specifically considering the nature of
business. But the research studies provide the
information regarding the strategies that an
organization can adopt within the available resources.
These strategies could be labor intensive or technology
intensive. It’s all depends upon the organizations
capability, if they have sufficient capital they can choose
the technology intensive strategy through introducing
new technology.

Research Findings:
 In other case they can choose labour intensive strategy
through investing in their Human Resource (employees)
enhancing their capabilities to perform their duties in
more effective and efficient manner. This can be done
through training and motivating employees. This
strategy also includes cost but as compare the
technology it requires less investment. It is also
described that the technology intensive strategy will also
comprises the training cost of the employees due to the

Research Findings:
 Research also describe that the HRM practices of
any organization does not put direct impact on client
(patient) satisfaction.
But they can increase employee satisfaction which
can leads to the client satisfaction.
 The training activities of the HRM create the
employee satisfaction, and leadership style of the
organization leads to the job satisfaction of the
employees.
Research study also describe that the High
Performance Human Resource Practices (HPHRP)
is very much related to the work environment.

Research Findings:
 It is observed that the employees working in safe
and healthy environment performs better then the
employees with less safe environment.
Research study reveals that the HRM practices are
not only the responsibility of the HR managers. The
line and middle managers plays very crucial role for
the implementation of HR policies and practices, so
the coordination and communication between HR
Manager and the Line mangers must very clear and
distinctive. Because the lack of communication for
miscommunication will lead to an adverse affect on
HR related practices.

Conclusion:
The management of human resources is essential to
enable the delivery of efficient and effective medical
services and to achieve patient satisfaction, the study
shows that human resources management has a strong
impact on health-care quality, and most of literatures
show the importance of human resources management
to achieve the goals of health-care providing
organizations, and emphasize to develop the
performance of hospital staff and nurses through
periodic training in order to improve the quality of
health-care service, also a strong, well-motivated and
highly trained medical profession is critical to the
success of the health-care reform.

Conclusion:
 The practices of human resource management are
very important in health sector and modern
hospitals need alternative approaches for practicing
HRM successfully.
 The senior management in hospitals should have a
clear strategic direction and clear objectives to
improve the management of employees and staff in
the hospital.

Conclusion:
The HR of health-care providing organizations can be
dividing into two categorizes:
Medical Staff (Doctors, Physicians, Practitioners,
other Paramedical Staffs
Non-Medical Staff (Administrative staff, Marketing,
HR, Accounts, etc.)
 Proper management of all human resources is critical in
providing a high quality of health care. A refocus on
human resources management in health care and more
research are needed to develop new policies. Effective
human resources management strategies are greatly
needed to achieve better outcomes from and access to
health care around the world.

Recommendations:
The Reviewing of previous literatures that cover the
field of HRM in hospitals and health organizations
shows the need for further improvement in any
health organization. However, this study sets
the following recommendations:
 Setting a strategy for human resources management
according to the requirements of new era.
 Before introducing a new technology in an
organization, inputs from the workforce must be
acquire by the management.

Recommendations:
 To increase the human resource out put both
intrinsic and extrinsic rewards must be used by the
management.
 Organization culture plays very important role in
adaption of new technology. Organization with clear
distinction of authorities and powers among the
different levels of employees will adapt changes
quicker than others. Because team work plays a vital
role in the implementation of change process.

Recommendations:
 The development of personnel management process
must be continue to aligned the organizational
workforce according to the new technological
requirement.
 Engage the staff of the hospital in the larger
functional tasks in order to give them more
confidence in the health institution in which they
work.
 Continuous development and training of staff
performance.

Recommendations:
 The need to measure the performance of the
managers of human resources department in the
hospital before starting performance development
process, and these measures include (leadership
ability, self-qualification, risk management, strategic
thinking, decision-making, innovation, management
experience, and communications)
 The aptitude of the employees is not enough to
perform a task effectively. Workers with the right
aptitude and attitude will become more productive.

Impact of Quality Human Resources on Healthcare Performance

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