1.

1 STUDY PERSPECTIVE

An attempt has been made in this research study to search the concept of
effective utilization of Human Resource Management with reference to some main
public and private hospitals of Peshawar in the KHYBER PUKHTUNKHAWA of
Pakistan. The intention in this work is to bring to light the real working of HRM in the
said hospitals of KHYBER PUKHTUNKHAWA, the province of Pakistan where
establishment of HRM in real sense is still awaited.

The old 'administration', consequently brought into existence the HRM which in strategic
and tactical meanings became autonomous.
We further extend our study in the light of the concept given by some prominent writers
on Human Resource Management.

George T 1997: The HRM is "a series of integrated decisions that form the employment
relationship, their quality contributes to the ability of the organization and the employees to
achieve their objective."

De Cenzo Robbins, 1996: In a more specific vein, the HRM is an approach consisting of
four functions, viz. staffing, training, development motivation and maintenance.

Torrington and Hall (1991): The HRM is "a series of activities which first enables working
people and their employing organizations to agree about the objectives and nature of their
working relationship and, secondly, ensures that the agreement is fulfilled."

Public and private hospitals recruit people for alike objectives. However, as the private
organizations generally get the better employees than the public sector does, things
happen to be different. Hospitals' HR i.e. doctors, nurses, pharmacists, dentists,
paramedic personnel, supervisors, managers and technicians etc., directly or indirectly,

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provide healthcare. The employees perform professional duties, primarily to improve
people's health (WHO 2006).

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

In the new millennium, the role of HRM is further changing, An HR manager should be
able to cope with the changing competitive trends and business environment, His role has
transformed into that of an active business partner with the management. The new trend
can ensure success continuity and escalating the organization for a future highly
competitive world. An HR management is successful when, besides administrative skills, it
can influence people's minds and counsel line management. Such changes are part and
parcel of the HR strategy, its organizational policy and its profile.

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

development than ever before. This is so, because trade unions, educational problems
and financial professionals are constantly confronted with the administrators. Well-trained,
competent administrators and HR managers are in great demand. The same is true for
other hospital personnel as well.

Human resource management functions have, of course, always been carried out in every
organization in one way or the other, but these functions may not have been performed
efficiently or economically. Importance of hospital human resource management must be
recognized, the workload of the general administrator may be reduced and better service
rendered to the patients through the establishment of a separate human resource
department.

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

also has to decide whether to recruit a full-time or part-time human resource manager. As
a common practice, a hospital with 200 or more employees can use the services of a full-
time human resource manager white a hospital employing lesser employees may also use
the services of a full-time HR manager. However, in such a case the HR manager should

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be assigned some additional responsibilities like purchase, public relations, transport
management, legal work. In hospitals with more than 300 employees, the HR manager
should be assisted.

`Hospital' is a simple and familiar word but it is not always understood in its entirety and
complexity. It cares for patients of all ages and backgrounds, some happy and others sad.
It houses various people inter-acting with each other such as cooks and doctors, cleaners
and nurses, technician and therapists, ambulance drivers and administrators of different
kinds, plumbers and clerks. It experiences hope and despair, sympathy and indifference,
love and hate, It is a place always open to all sort of people.

1.2 ELUCIDATION OF THE PROBLEM

In the present times, the fast pace socio-economic, scientific and technological progress
has influenced every sector of human activity and everywhere there is an increasing want
of new approach and adoption of new methods to bring closer the achievement of
objectives.

As for health sector, which is under increasing pressure due to prominent growth in
population and for other reasons, it is all the more obvious. Hospitals as healthcare
centers need reform and development not only with regard to facilities, but also in the
ways and techniques of providing services to the clients. To great extent, it is the
attitudes, skills-levels and qualities of the health care personnel on which factors the
reform and development depend.

The concept of human resource management is a tool to develop human capital and to
manage people at work properly and systematically so that human resource at work could
be utilize at maximum level for the achievement of the optimum organizational goals and
targets.

Like as in many other developing countries, in Pakistan, health care sector has not been
managed properly and has consequently failed to provide the necessary services of the
desired standard. This is largely due to the lack of proper management of resources which

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include the personnel i.e. human resources.

The resource management levels of both public and private hospital in Pakistan, so as to
provide foundations for HRM development in the health care sector in the country.

1.3 AIMS OF THE STUDY

To create awareness among workers about future skills, and to attain a comprehensive
understanding of their problems.

Ø To analyze effective utilization of Human Resource Management in hospitals.

Ø To explore effectiveness, efficiency and productiveness of public and private hospitals.
Ø To enable policy-makers in both public and private sectors improve the scientific
understanding of individual and group interactions and organizational structure related
to employment and productivity.
Ø To re-structure planning policy, salary set up, training and development,
communication channels, compensation, and motivational techniques.
Ø To explore the drawbacks and weaknesses of HRM methods in public and private
hospitals.

1.4 HYPOTHESIS

1. Between effective utilization of HRM and productivity of hospital employees and

success of the health care organization, there exists an association.
2. In comparison with public health care sector, there is greater job satisfaction among
employees of private healthcare sector because of effective HRM in the latter.
3. There is a link between hospital staffs (doctors and nurses') job satisfaction and
quality care provided to patients through client-provider relationship, guided by sound
policy of HR management.

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1.5 AREA OF STUDY

General area of this study is Pakistan with the city of Peshawar in the province of Khyber
Phuktunistan being specific areas.

PESHAWAR

Peshawar, one of Asia's oldest cities, is a Pakistani city of 3 million people and the capital
of Pakistan's, KHYBER PUKHTUNKHAWA .Peshawar is located roughly halfway between
Islamabad, the Pakistani capital, and Kabul, the Afghan capital. It is the last city of note in
Pakistan before the Khyber Pass on the Pakistan-Afghanistan border.
Peshawar through history has been held by Persians, Afghans and Arabs, and has been a
Buddhist and Islamic center of learning. The Taliban since the 2000s has attempted to
occupy the city in efforts to more decisively control northwest Pakistan.
Peshawar has certainly the best health-care services in the country with four medical
universities and some of the largest hospitals in the country.

Hospitals located in the study area

(i) Lady Reading Hospital

Lady Reading Hospital is one of the oldest and largest public Teaching Institutes of the
country which provide state of Art, excellent curative and preventive services to the ailing
humanity of the Frontier Province.

Vision

The vision of the LRH is to be recognized internationally as integral to the center of

excellence and an international leader in patient health care through Customer
satisfaction, Resource Management, Technological Excellence, Teaching & Training.

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Mission

The mission of LRH is to provide highest attainable quality curative, preventive and pro
motive care, which is compassionate, ethical, accessible, acceptable, and affordable,
equitable services. The hospital also provides Training, Teaching, Research opportunities
and the working environment to the employees where they attain their highest potentials,
improve the professional skills of the staff through continuous education and research in
the areas of Medical services, Management of the patients care and Managerial
innovation.

AMENITIES (facilities)

There are 1450 beds available in the hospital with 26 teaching units, like three surgical,
three medical, two pediatric units, two gynecology and obstetric units, and each of
cardiology, neurology, neurosurgery, cardiovascular, cardiothoracic, orthopedic unit,
urology, dermatology, psychiatry, Eye, ENT, ephrology and pulmonology unit. All
inpatients services are supervised by a professor and in charge of that unit.

ROLE OF HUMAN RESOURCE AT LRH HOSPITAL

Human Resource Department at the LRHH ensures the following aspects:

Ø well-planned and quality hiring of personnel

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

Ø individual development centered on improving professional skills & performance

keeping in view future needs
Ø Proper utilization of human resource by motivation to improve the efficiency of
organization.

Apart from the above, the HRM works on better job satisfaction that reflects in lower
absenteeism and higher turnover is achieved. As another important obligation the

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

(ii) REHMAN MEDICAL INSTITUTE

Located at the gateway of Khyber, Rehman Medical Institute has revolutionized the
concept of medical care in the KPK. For the first time ever, the people of this area have
access to healthcare facilities of international standards.

The founder, Prof. Muhammad Rehman with a vision of providing quality healthcare
services to the people of this region, established the RMI which is now catering to all
major and minor disciplines of medical sciences.

AIMS & OBJECTIVES

The Rehman Medical Institute is committed to providing:

Ø Quality Healthcare Services through state of the art diagnostic facilities and
treatment of the highest possible standard in a comfortable, caring and safe
environment.
Ø Career Opportunities in an environment providing our employees with a purpose and
pride in the organization, through personal development and recognition for
performance excellence.
Ø Education and Training to health professionals while inculcating in them the ethics
and values of professional modes of practice.

(ii) HAYATABAD MEDICAL CENTER

The second largest Hospital in Peshawar-a Postgraduate training centre, equipped with
all the medical/surical specialities except a few like Cardio-Thoracic Surgery, Psychiatry,
burns.
Serves not only the western part of the city but also caters for patients coming from
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across the border. Many memories associated with it for those who have done their
housejob in it.

Mission

Through the discovery and dissemination of knowledge and application via service, the
HMC is committed to the development of human capacities.

1.6 Organization of study

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

Chapter 2: As a prelude to the study the current literature has been revised and only
those publications have been considered which are relevant to the topic of the study.

Chapter 3 In this chapter, research methodology has been presented. This study was
planned as a descriptive comparative study of private and public hospitals. To obtain the
required data, questionnaires and interviews were used. These questions were open-
ended as well as close-ended. More over, information obtained from the print media &
secondary data, too, was collected from the relevant journals and books. Information so
collected was statically analyzed using Word, Microsoft Excel software.

Chapter 4: This deals with the HRM in Pakistan's hospitals and health care environment.
Policy formulation, planning, management, development, and investment skill and
potential development aspects of HRM in Pakistani hospitals have been discussed.

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

Chapter 6: Finally, the conclusion driven from this study has been set out and
suggestions offered for the improvement of the HRM in Pakistani health-care sectors.

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2.1 Detailed Perspective

For the last around two decades, somewhat late though, Human Resource Management
has been systematically introduced in the health system and its importance appropriately
recognized in the establishment of human resource policy and management in the 'proper'
course. It is found that at present far more information is available on issues of health
system, finance and appropriate buyer/supplier structure as compared to Human
Resource Management prospects and its scope of influence.

Efforts and measures taken to assess the implications of evidence based on the impact of
Human Resource Management in the health sector can be referred to as relatively on a
low side in spite of growth of this evidence.

Factors like mortality rates in various hospitals, re-admission rates, duration of stay and
satisfaction of the patients were also probed into, in this study. It revealed that in-hospital
death rate increases with the increased number of sick patients in a population. The same
phenomenon was observed in the areas with less employment. Education was found to
be an important element to influence re-admissions. In areas consisting of people with
higher level of education, the hospitals showed lower ratio of re-admissions.

The study finally explored into as to what effect on health status did the use of hospital
and community nursing services have. It revealed that application of more or less than the
average quality of services produced significant effect in terms of statistics, though not
quite significance in practical terms.

2.2 Impact of Education on Health

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

Page 17
females were observed less likely to report better health. The same tendency was seen in
jobless respondents compared to the employed ones. Respondents dwelling in large cities
were more likely to report better health than those living in small cities. As against
respondents with lower incomes, those with lower-middle, middle, higher-middle and
higher-income were more likely to report better health. However, in the case of lower-
middle income, the difference was not notable. The state of health was observed to be
better among the respondents possessing higher level of education.

2.3 Readiness for Disasters

A study by J. Christopher Farmer and colleagues shows that readiness for disasters like
the Tsunami that hit South East Asia in 2003, could be greatly improved by better
management of the hospital resources and staff. By now, disaster medical response has
predominantly on pre-hospital issues such as triage, evacuation, and transport of
casualties. It has also largely assumed that hospital management would emerge as
planned.
Throughout the world, the hospitals short of staff and bed capacity are not in a state of
readiness for critical situations, Not only that these hospitals have not been able to cope
with such events in the recent past, rather hospital with large facilities, too, have found it
hard to overcome conditions caused by such disasters. For instance, following a terrorist
bombing in Bali in 2002, as many as 15 patients had to be sent to a hospital in Australia
for mechanical ventilation, however, this hospital had a capacity to provide treatment to a
maximum of 12 patients. Similarly, ICU beds fell short in the floods of 2001 in Houston,
Texas. Numerous examples of like incidents support the view that during a disaster
medical response, hospital capacity is the major rate-limiting factor.

2.4 Healthcare Supplies' Demand in Pakistan

Pallas has observed the guidelines for comprehensive health human resource planning
(HHRP) developed by TL Hall have been elaborated further (Pallas 1998). In fact the work
of Hall, Reid and the SHARP model (developed by Denton, Gafni and Spencer) has been

Page 18
advanced further. Their study has revealed that healthcare supplies' demand is on an
increase in Pakistan for its large population growth, technology changes in pattern of
disease, raised social expectations and the rapid development of health industry.
Following issues have been pointed out by them:
a. Poorly prepared practitioners
b. Unsound linkage among healthcare needs and education
c. Surplus physicians
d. Lack of female healthcare workers
e. Imbalance between urban and rural healthcare personnel and services
f. Poor linkage between national health policies and implementation
g. Lack of political will to enact policies
h. Unsatisfactory career structure
i. Insufficient funding for healthcare
j. Limited historical data.

They point out HRP process in Pakistan being overlooked and stress need of identified
issues to be incorporated in future health human resource planning (Pallas 1998).

This research work has been conducted on open-ended and close-ended questions style.
In a survey research, close-ended questions mode is taken to be decisive. As for
differences found in the quality of data acquired using close-ended or open-ended
questions, a systematic research is still needed, which should aim particularly at
differences in averages and division of data.

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3.1 Rationale of Study Design

A problem may arise when general open questions are asked at the end of the structured
questionnaires; Reasons of this problem could be the quality and quantity of data, unclear
analysis and reporting of this data, insufficient time and expertise needed for the purpose.
These questions could prove to be of optimum value provided that the researchers are
clear about the sort of data to be generated from these questions and study is carried out
with a strategic approach.
Larger part of closed questionnaires used in the survey contains closed questions asking
respondents to make selections from a particular number of options.

3.2 The Advantages of General Open Questions

In designing a questionnaire, general open questions prove of various uses. When a

researcher receives responses to the questionnaires, he may become confident to have
covered all relevant issues (Moser CA, 1971; Rossi PH, 1983; McColl E, 2001). The
responses might also complement answers to closed questions thereby satisfying the
researchers about validity of questionnaire, and may highlight specific problems. General
open questions may be used by a researcher as a usual exercise.

Another reason of these questions may be to enable respondents express their opinion.
On the other hand, closed questions, even if prepared from people's verbal views in focus
group and detailed interviews,, symbolize researcher's plan of working.

The open general questions may also reveal some important issues despite how good
structure of the questionnaire. Beyond some structured questions, the respondent may
wish to give details on particular issues. Some questions may be qualitative only keeping
in view a limited number of people or a small group only. In such situation, an open
question acts like a safety net and helps the researcher identify issues.

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3.3 Responses to General Open Question

Researchers have diversified views about responses to general open

questions whether being qualitative, non-qualitative or quasi-qualitative
(Steckler A, 1992, Bankankaite, 2003, Boulton 1996, Murphy E, 1998).
These questions show some features of qualitative nature viz., they
encourage respondents express their views in their own words, output is
not figurative but in textual form; techniques associated with qualitative
research may be used for analysis. Closed questions may impose
constraints on responses as these closed questions may be indicative of
the agenda for responses to general open questions.

Data on each case may lack conceptual richness. Recipients are asked non-directive
questions that bear little capacity for responses, for example, `Any other comments?' or is
there anything else you would like to say?'. Data extracted from general open questions
is determined by their details/depth, which comes from responses offered to the written
instructions for the recipients and what they actually write.

With the help of a thorough and quality analysis of data or using shorter responses as
safety net for new or complementary issues, the researcher can determine the status of
general open questions. This strategy may be helpful in publication process as well.

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3.4 Target Population

It is public and private hospitals that provide a target population. This target population
has been selected on the basis of inclusion criteria (see Table below). Before filling the
questionnaire, written consent by the respondents was obtained in order to approach the
target population primarily via letters.

Target Population

S. No. Name of Hospital Target population

1 Khyber teaching hospital 1,750
2 Lady reading hospital 3,500
3 Rehman Medical Institute 350
Total 5,600

Source: Prospectus of above hospitals.

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4.1 POLICY FORMULATION, PLANNING & MANAGEMENT
He
alth matters pertaining to human resources prove to very important and complex areas
that require certain modifications and reforms for the development and improvement of
health systems in various countries. In 1999 the issue of human resources development
was identified by the Regional Committee ( for the Eastern Mediterranean as a priority
area during 2001 and beyond. These issues must be considered at an early stage in
health systems reform and not be regarded as an "afterthought". Human resources
development is more often than on concentrated narrowly on planning and training only.
Developing an effective strategy for human resources is of utmost significance. A
workshop for this purpose was organized by the WHO and attended by representatives
from the Eastern Mediterranean Region in late 2000.

The national potentials of countries to formulate or update their national human resources
policy was strengthened through several consultations in the year 2000. In Lebanon, the
Ministry of Public Health was supported in projecting human resources for health needs
based on WHO models; a new policy is therefore expected as a result of the projection.
In Pakistan, a national policy was formulated by a WHO consultant and submitted to the
Federal Ministry of Health for discussion as a preparatory stage to draft a national plan
for human resourceE, development. In the Republic of Yemen, a mission of two experts
conducted an in-depth review on health and human resources for health and prepared a
detailed rc port; an updated national policy and plan, based on the results of the review,
is being prepared.

Human resources management was supported through developing effective continuing

education programs, tailoring of postgraduate course; to fulfill urgent needs for qualified
professionals in specific specialties, establishment of new centers for human resources
development and through introducing new trends in management. Special attention was
given to the development of programs in family medicine and general practice. In the
area of postgraduate training, evaluation and support was provided to develop and
improve training of professionals in a number of specialties on demand. Family medicine

Page 23
and general practice programs attracted support in public health and related topics are
increasing in number in the countries of the Region. The Regional Office lent support to
these programs in order to encourage students and faculty to join and to help the
organizers maintain the high quality and relevance of courses in Pakistan.

A comprehensive survey has been initiated, as part of a WHO global project, to study the
situation of this important specialty in the countries of the Region to identify further needs
of new programs and to provide support to already existing programs. In Pakistan centers
were established to organize continuing education. Programs to update and develop
skills of the health workforce in different subjects were provided through enhancing
continuing education programs focusing on bask: skills programs.

4.2 INVESTMENT FOR HUMAN RESOURCE DEVELOPMENT &

INVESTMENT

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

vital component of the health system and health services development keep on being
made. As in the past, the process of collaboration with countries in taking corrective
measures to improve basic nursing and midwifery education and reorient the curricula
towards primary health care continued. Nursing and midwifery education has been
fortified in Pakistan where one nurse is available for eight doctors and only one doctor is
available to treat 2,300 patients. Federal and provincial governments still to plan to
produce a sufficient number of nurses and paramedical staff. Besides Pakistan,
shortages of nurses and midwives in many countries of the Region requires a critical
review of the nursing human resources situation in the Region for the purposes of
planning, development the management in order to meet the increased demand of
relevant services both quantitatively and qualitatively.
Pakistan was provided with support in the form of fellowships, rational training, supplies
and equipment to strengthen the teaching and training capabilities of the national allied
health institutes and to meet the continuing education and training needs of allied health
personnel (Annual Report of Regional Director, 2006).

Page 24
Some NGOs too have become actively involved in this field. HRSW 3-International is such
an NGO operating from the NWFP, Pakistan. It was established in the year 2000 and
registered with the Government of Pakistan under the Societies Act 1860. In the field of
social work, human resource and public health services, the HRSWS has made a good
reputation for itself,

4.2.1 Aims and Objectives of HRSWS

For a long time, the problems of inequity, scarcity of resources, inefficient and untrained
human resources, gender insensitivity and structural mismanagement confront the
healthcare system in Pakistan. With the precarious health status of the people and poor
indicators of health in the region, health care reforms were finally launched by the
government in 2001, which envisaged decentralization.

There are, however, numerous challenges and constraints in the system. The future
health of the nation depends on this decentralization initiative. Hopefully, this new system
shall result in the institutionalization of the health services at the district level. Most
importantly, it will help in strengthening the primary health care se vices catering to the
major fraction of the population.

Besides political commit rent, attitudinal, behavioral and cultural conditions conducive to
this system should be maintained (Sheikh BT, Rabbani F., 2004).

Though surprising but true that most of the developing countries are not spending more
than 2% of their gross national product (GNP) on health, resulting in poor coverage of
public health services. The Government of Pakistan spends about 0.8% of GNP on health
care, which is lower than some neighbouring countries such as Bangladesh (1.2%) and
Sri Lanka (1.4%) (World Bank, 1999),

Pakistan spends 80% of its meager health budget on tertiary care, services, which are
utilized by only 15% of the population. In contrast, only 15% is spent on primary health
care services, used by 80% of the population (Pakistan - Towards a Health Sector
Strategy, 1998).

Page 25
Looking at the above data, however, Pakistan seems way behind fulfilling its
commitment. Though the country has achieved a very healthy economic growth rate, but
it has not been pro-poor. This is evident from high unemployment and poverty levels.

Health expenditure in Pakistan is about US$ 17 per head per year, out of which $13 is
out-of-pocket private expenditure {World health report 2000).

As for determining the poverty factor, measured by the international standard of earning
less than $1 a day, at least one-third of the population is poor. On the other hand,
countries having a much smaller GDP size than that of Pakistan are far ahead of it in
literacy and other HD-related indicators.

As for economic growth, it is a necessary element, though not sufficient for human
development. No doubt, owing to resource constraint, it is difficult. for a developing
country like Pakistan to allocate sufficient funds for human development.

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

generated for raising the standard of living of the people. However, for this purpose a pro-
people growth: higher investment in labor intensive sectors like SMEs and agriculture are
needed so as to create greater employment opportunities.

It may be argued that without developing its human resources country cannot sustain a
high growth rate. Poor, illiterate, unskilled, sick and disgruntled' people are a serious
obstacle to development.

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

policies of Pakistan, which this policy focuses on health-and education as well as poverty
alleviation as essential elements for sustained economic revival and growth in Pakistan.

Page 26
Under this policy, in the health sector, the Government has taken steps to awareness.
Vocational education at sub-District and District levels includes health awareness
programs.

It reveals from the report that the mortality rate is high, hepatitis B vaccinations are
unavailable for the whole country, pregnancy complications have increased, and there is
no national health policy, drug policy and an accountability procedure to motivate doctors.

According to the report, it might be claimed that more money was spent on healthcare
but a majority of people still have no access to primary healthcare, emergency obstetrical
care or emergency healthcare in Pakistan.

Page 27
4.3 MAGNITUDE OF THE TRAINING & DEVELOPMENT PROGRAMS IN
PAKISTAN

With a view to consolidating its position in the world markets and achieving internal
economic balance and growth, the government has now taken up major economic
restructuring. Liberalization in terms of major changes in the industrial policy, as a part of
the economic restructuring programs, has brought in a lot of competition for the over-
protected industrial organizations in general. Foreign capital and direct participation of
multinational organizations in the corporate sector rave exposed the industrial
organizations to intense competition. The effect of such liberalization on the industrial
organizations has given rise to certain international developments in the form of global
trade restrictions. Certification as per the quality system standards (developed by the
international organization for standardization) o" the products of the industrial
organizations are now almost essential for going global. Total Quality Management
(TQM) is now a widely discussed issue in the corporate world, but it is absent in the
health care sector, not only in state hospitals but also in a number of private hospitals.
(Dipak Kumar Bhattacharyya, 2002)

4.4 ENHANCING CAPABILITY OF HOSPITAL EMPLOYEES

At present times, a trend has come that that health care is provide to the indigent and
uninsured. Because of industry-wide consolidation pressures, it is unlikely that 10 years
from now governments will find it strategically desirable to directly operate their own
public hospitals and clinics 3 or 4 more cost-effective choices are becoming available.
Apart from bringing a decrease in the public resources, the main force driving this change
is vigorous competition for treating the poor from private for-profit and nonprofit hospitals.
In most communities, even those on public assistance now have a choice of providers.
The advent of HMOs is leading to a fundamental restructuring of the whole health care
system. One of' shoot of this is a declining need for hospital beds. In the development of
a nation, health plays a fundamental role
Page 28
4.5 WORKER’S SKILL DEVELOPMENT:

A TRUE SOURCE OF NATIONAL WEALTH

The key to a strong economy, as usually argued, is money in the lands of factory owners
and rich investors. The appropriate view is that redistribution of money from the rich to
programs for the poor and the middle class is important. Neither opinion is adequate to
the economy of the 1990s and beyond - a world economy in which the true source of
national wealth is the accrued skills of the workforce coupled with the quality of the social
and the material infrastructure supporting them.
Available data gives us to know that the success of economy in Pakistan no longer
depends on the private investments of highly motivated capabilities. Rather, our nation's
future economic success depends instead on the skills anti insights of our Workforce, and
how well we link those skills and insights to the economy of the United Nations.
The role of government in Pakistan is to build our human capital and public resource
base and to bargain with global capital on our behalf, Our economic policy must be
adapted to the new realities of the world economy for the sake of survival and growth in
the 215` century.

Rich Pakistanis whose savings remain usually unknown, tend to decline to help the rest
of our population. But the saving of the foreigners are appearing on the scene to found
promising projects.

4.5.1 Obstacles in Human Resource Development in Pakistan

The greatest barrier to human development initiative is provided by the Establishment

Division and the Finance Ministry where the preexistent policy of maintaining status-quo
and sustaining the inflexible, unscientific and illogical rules, quite a few of which are
ultra-virus to the constitution of Pakistan.
The skills needed for human development initiative are of several types. First, among the
core skills are the problem solving skills required to put things together in unique ways.

Page 29
Identifying problems is yet another important issue as, without this, it is hard to
understand people's needs and the ways to meet these wants.
Third are the skills needed to link problem solver and problem identifiers. Problem
solvers, problem identifiers, and brokers are now called upon to join hands in stimulating
and uncovering the discoveries.

The work force possessing good basic education can easily bring the fruits of its labor to
the global economy, and can attract global capital for the performance of its complex
task. The experience acquired by performing these tasks promotes additional on-the job
training and experience. It, in turn, serves to hire global capital for more complex pursuits.
If Pakistan is strongly committed to economic development, it would be more convenient
for it to establish a virtuous relationship with global capital. Lacking educated workers and
highly qualified members of public service, many of our policy makers would not be able
to resolve the problem of unemployment and low wages. Even if Pakistan bargains for
global capital, it would still be challenging for it to attract good jobs unless it could offer an
educated workforce and effective communication systems.

4.5.1.2 Promotion of Female Education

The ability of mothers to provide adequate care for their families can be greatly improved
by uplifting female education. Female primary school enrolment of 26% (in 1990) is
extremely low and almost half that of their mall; counterparts. 80% women in Pakistan are
illiterate (compared to 50% men) - .a situation that has persisted throughout the 1980s.
Apart from the high reproductive burden, this poor educational level has negative
consequences for labor force participation: official female rates are only 6% overall
(Horwitz A., 1993).

3.5.1.3 WHO Collaboration for Health

The collaboration of WHO with the Government of Pakistan has existed ever since the
foundation of the organization, and has been faithful to the first article of its constitution
devoted to the attainment by all peoples of the highest possible level of health. This
collaboration was further strengthened with the establishment of the WHO country of ice
Page 30
in Pakistan in January 1960. Through this close partnership, WHO has been contributing
to health sector development in Pakistan, while the experience gathered from this and
other countries has played a positive role in shaping the strategic policies of the
organization. WHO has always designed its strategic interventions in a country on the
basis of the national priorities, using the "Health for All" approach as one of the critical
guiding principles for health sector development.

3.5.1.4 Lady Health Workers

In the later part of the same year (1993), the initiative of the Lady Health Workers (LHWs)
was jointly launched in Union Council Tamman of district Chakwal in the Punjab as a pilot
intervention. Young rural females with a high school certificate were inducted in an
intensive community based PHC training programme to subsequently deliver essential
PHC services to the households of their residential catchments areas, and bridge the
existing gap between the community and first level care facilities.

The programme was scaled-up in early 1994 throughout the country. The strength of the
LHWs now reached 70,000, and the government is working to further raise this force to
100,000 with recognized success in delivering essential PHC interventions. We strongly
hope that the current devolution process will seriously take advantage of this expanded
district health system network with added financial and human resources allowing it to
operate effectively.

Page 31
5.1 DATA ANALYSIS AND INTERPRETATION

Data has been analyzed by both the descriptive and inferential statistical methods, and
interpreted through frequency tables. The utilization of HRM in public and private
hospitals has been tested.

5.2 DATA MANAGEMENT

Questionnaires were edited simultaneously during the study and all the completed
questionnaires thoroughly scrutinized. Data was double entered and then validated and
corrected for any disparity. Finally, 10% of the questionnaires were checked randomly to
look for any error in the data entry.

5.3 DESCRITIVE STATISTICS

Questionnaire was divided into qualitative and quantitative parts. Both types of questions
have been separately analyzed and interpreted. The questionnaire comprised of three
sections: Section 'A' pertains to information relating to personal opinion on human
resource management. Section '2' is based on effective utilization of human resource
management in the hospital. While section '3' is based on the suggestions and
recommendations for improvement.

Page 32
5.4 SECTION 1

Personal Opinion on Human Resource Management.

Subject: Study is based on two criteria i.e. Public and private hospitals. Out of 362
respondents, 35.4% were from public hospitals and 64.6% from Private hospitals.
Table 1: Type of Hospital (n=362)

Type n %

Public Hospital 128 35.4

Private Hospital 234 64.6

Hospitals

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

Table 2: Hospital Status (n=362)

Hospital n %

KTH 106 29.3

LRH 212 58.6

RMI 22 6.1

Source: Questionaire

Page 33
Q-1 what is the purpose and objectives of HR department in your hospital?

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

increase the efficiency and effectiveness of work; 19.3% said that they have no HR
management in their hospitals; 28.7% agreed that Human Resource Management
maintains and manages resources; 9.1% said that it managed employees and their
records, and 3.6% were of the opinion that HR fulfilled the needs of internal and external
customers.

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

Objective of HR department in hospitals n %

To increase the effectiveness and efficiency 121 33.4

No HR department exists but one is needed 70 19.3

To manage employees and their records 33 _

9.1

To fulfill the needs of internal and external customers 13 3.6

To maintain and manage the resource system 104 28.7

To make the organization work more smoothly 21 5.8

Source: Questionaire

Page 34
Q-2 Why is human resource planning necessary in a hospital?

Out of 362 respondents, 34.3% agreed that HR planning makes the services system
more effective, 24.6% employees said that the HR planning increases proper utilization of
services to community and 14.6% said HR planning makes working atmosphere better
and more harmonious.

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

Variable n %
To make working atmosphere better and more 53 15
harmonious
To make maximum used of resources 36 9.9
To create better relationship between employees and 21 5.8
bosses
bosses
it is necessary in patient care services system 124 34

To keep proper person at proper place 6 1.7

For management and improvement 9 2.5
For proper utilization of their services in relation to 89
community 24.6
To provide an environment that builds leadership 11 3

To achieve the organizational goals 13 3.6 I

Source: Questionaire

Page 35
Q-3 Are you satisfied with the supervision system of your hospital?

75% employees were satisfied with their supervision system, while 25% were not and
wanted to improve the hospital supervision system.

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

Variable n %
Yes 272 75.1
No 90 24.9

Source: Questionaire

Page 36
Q-4 What methods do hospitals use to assess their training methods?

46% respondents said that evaluation is the best method to assess their training, while
14.4% wanted to assess training through supervision observation and survey. 21% said
that there was no method available in their hospitals.

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

Variable n %
At present there is no method 76 21
Appreciation, meeting and punishment 24 6.6
To check the output after training sessions 31 8.6
Through practical procedure 13 3.6
Evaluation 166 45.9
Monitoring through supervisor observation and 52 45.
14.4
survey
Source: Questionaire

Page 37
Q-5 What motivation techniques are used for employees in your organization?

105 employees (29%) said that there was no such technique applied in their hospitals,
while 21.5% intimated that performance appraisal was a good motivation technique.
12.7% said that they were satisfied with their incomes and that was the technique for
motivation, while 15.2% believed in training being a useful motivation technique.

Table 7: Motivation techniques used for employees (n=362)

Variable 'n %
No such techniques at present 105 29
Letter of appreciation and constant reward 45 12.4
Training 55 15.2
Positive attitudes 33 9.1
Employees are satisfied with their income 46 12.7
Performance appraisal 78 21.5

Source: Questionaire

Page 38
Q-6 what are the drawbacks and weaknesses in your administration system of
hospital?

166 employees did not know about the weaknesses of the administration system, while
19.6% said that political influence weakened the administration system and 18.2% said
too much hierarchy is a big drawback.

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

Variable n %
Don't know 166 46
Outside influence and politically grouping 71 20
Administrative interference by the high authorities 15 4.1
No systematic approach 11 3.1
Lack of proper supervision 11 3.1

Lack of communication 22 6.1

Too much hierarchy 66 66 18

Source: Questionaire

Page 39
Q-7 What would be your recommendations for improving the quality of human
resource?

362 employees 117 (23.3%) recommended that proper selection of employees and
proper utilization according to their ability, improved the quality of human resources, while
13% said that giving better incentives to employees would improve the work and 20%
said that regular promotion and encouragement would improve the quality of work.

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

Variable n %
Better incentives for hard workers 47 13,0
Regular promotion and encouragement of staff 73 ~ 20.2
Training at HR level with frequent interval, rewards 40 11
Hire and fire power without outside interference 10 2.8
Merit and only merit 12 3.3
Proper selection and utilization according to ability 117 32.3
There should be HRM in every organization 25 6.9
Increase communication and interest 38 10.5

Source: Questionaire

Page 40
4.5 SECTION 2
Effective Utilization of Human Resource Management in the Hospital

Q-1 . Can the effective utilization of HRM in hospitals be analyzed?

48.9% said that HRM was effectively used in their hospital, 31.8% said it was sometime
used effectively and 19.3% response said that HR was not used in their hospital.

Table 10: Effective utilization of HR in your hospital (n=362)

Variable n %
Always 177 48.9
Sometimes 115 31.8
Never 70 19.3

Source: Questionaire

Page 41
Q-2. Does HRM explore the importance of efficiency and effectiveness in
hospitals?

239 (66%) employees believed that HRM was important for the hospital and 34% said
that it was not necessary.

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

Variable n %

Always 239 66
Sometimes 123 34
Never - -

Source: Questionaire

Page 42
Q-3. Are the employees motivated by adopting fair promotion policies in
hospitals?

A total of 105 employees (29%) said that they were always motivated by fair promotion
policies, 59% said that sometimes they were so motivated and 11.9% were of the view
that promotion system of the hospital was not satisfactory.

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

Variable ' n %
Always 105 29
Sometimes 214 59.1
Never 43 11.9

Source: Questionaire

Page 43
Q-4. Is employees' criticism encouraged by the hospital management?

49 employees (13.5%) said that employees' criticism was always encouraged by their
hospital, 68.8% said that sometimes their criticism was encouraged by the management,
and 17.7% said that employees' criticism was never allowed in hospital.

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

Variable n %

Always 49 13.5

Sometimes 249 68.8

Never 64 17.7

Source: Questionaire

Page 44
Q-5. Do hospitals provide beneficial incentive schemes to their employees?

72 (19.9%) employees said that the hospital always provided incentives to their workers,
59.7% said that the hospital provided incentives sometimes and 20.4% said that no
incentive was provided in their hospital.

Table 14 Hospital provides benefits (n=362)

Variable n %

Always 72 19. 9

Sometimes 216 59.7

Never 74 20.4

Source: Questionaire

Page 45
Q-6. Are hospital employees encouraged by restructuring their salary structure?

21.5% said that the hospital always encouraged the employees by restructuring their
salaries, 60.5% said that their salaries were restructured sometimes and 18% said that
the hospital never restructured, their salaries.

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

Variable n %
Always 78 21.5
Sometimes 219 60.5
Never 65 18

Source: Questionaire

Page 46
4.6 SECTION 3

Suggestions and Recommendations for Improvement.

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

efficiency?

Variable Public hospital Private Hospital Total

Yes 76 (24.9%) 229 (75.1%) 305
No 52 (91.2%) 5 (8.8%) 57
362

75% private hospital employees' opinion was that HRM increased efficiency and
effectiveness, while 24.9% public hospital employees agreed that HRM increased
efficiency.

Page 47
Q-2 Has safety often been managed as effectively as some other business
functions?

Variable Public hospital Private Hospital Total

Yes 73 (41.2%) 104 (58.8%) 177
No 55 (29.7%) 130 (70.3%) 185
362

Out of 104 private employees (58.8%) said that safety had often been managed
effectively, 70.3% said that safety was not managed effectively, while 41.2% public
hospital employees said that safety was often managed effectively.

Page 48
Q-3 Do the hospital's health and safety rules provide quality services to
Employees?

Variable Public hospital Private Hospital T o t a~l

Yes 53 (21.2%) 197 (78.8%) 250
No 75 (67.0%) 37 (33.0%) 112
362

Private hospital management provides better health and safety rules as compared to that
of the public hospitals.

Page 49
Q-4 Does the communication system work effectively in hospitals?

Variable Public hospital Private Hospital Total

Yes 96 (37.2%) 162 (62.8%) 258
No 32 (30.8%) 72 (69.2%) 104
362

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

Page 50
Q-5 Does the implementation of new technology reduce the number of jobs?

Variable Public hospital Private Hospital Total

Yes 38 (25.5%) 111 (74.5%) 149
No 90 (42.3%) 123 (57.7%) 213
362
.

Private hospital employees (74.5%) said that implementation of new technology reduced the
number of jobs, while 25.5% public hospital employees said that it not reduce the number of
jobs.

Page 51
In the context of present-day exercise and tradition in the developed states of the world,
'administration' techniques have given rise to Human resource management. This is so
because the said techniques did not have the potential to change the conditions of the old
customary industry, business, services and certain governance aspects in the
perspective of the Second World War where-after a large growth in the industries and
business was seen in many countries world over. It is worth acknowledging that previous
studies pertaining to job analysis and testing helped development of certain staffing
procedures for the present era.
The human resource managers today have very different responsibilities and obligations
as compared to those of their predecessors. Presently, the personnel management is
assigned prominent emphasis and respect in the overall corporate hierarchy.
Consequently, there is a constant rise in the demand for these professionals and the
compensations they are paid.
It will be observed that human resource management has yet to make its presence felt in
Pakistan like many other practices and techniques of the present time. Although to some
extent in the private sector, HR management has been introduced, however, for the
purpose of becoming integrated into country's system, it has to become an inseparable
part of the governance policy. The required kind of manager and the specific managerial
skill market are not still adequately available at the critical mass level in the country.
Subject of the subject is as to how far the new trend has made it headway in Pakistan's
health-care sector.
To cover the objective of the study, the following three hospitals (two public i.e. state-run,
and one private) were selected:

1. The Lady Reading Hospital, Peshawar

2. The Khyber Teaching Hospital, Peshawar

3. The Rehman Medical Institute, Peshawar.

Page 52
The Rehman Medical Institute is private while the rest of the two (Lady Reading Hospital
and Khyber Teaching Hospital) are public sector hospitals. The study reveals that only
one hospital, the RMI, enjoys a well established and functional HR department integrated
into its setup. In the two public-sector hospitals, on the other hand, no human resource
management exists, and they operate through the obsolete government administration
policies and procedures.

6.1 Functions of RMI, HR Department

The HR department of RMI carries out the following functions:

1. Integration of HRM with policy and decision making

2. Suitable staffing

3. Formulation of job-descriptions

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

efficiency.
5. Provision of individual development of the personnel focuses on performance-
enhancement, and failure to current as well as anticipated future needs.

6. Improving employer-employee relationship for achievement of objectives

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

formulating sound policies of recruitment, training services condition, discipline
retirement records leading to creation of a versatile work-force

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

9. Helping to maintain high moral and better human relationships for the sake of
employee-commitment
10. Creating self-respect in the hospital employees.

11. Training and development

Effectiveness of this methodology is evident from the responses of the employees to our
questionnaires and interviews. Compared to the performance of the private Hospitals, the
position of state hospitals leaves much to be desired. The following summarize data will
support this opinion.

Page 53
6.2 Statistical Results & Findings

Hypothesis Test Results

This comparison of the public and private hospitals has been carried out. According to
our hypothesis, effective utilization of human resource management brings about
efficiency and effectiveness among employees as well as organization, and an element of
association emerges between the two groups. The alternative hypothesis is that the said
two groups do not have association.
On the basis of our hypothesis, which is sufficiently supported with evidence, we
conclude that there is no association between the two groups. In private hospitals 95.5%
employees reported HRM to have been effectively utilized. The lack of potentiality and
capability in employees creates mismanagement in hospital; we have significant evidence
to prove our hypothesis and conclude that in private hospitals, 46.1% employees reported
that lack of capability in employees created mismanagement in the hospital while, 77.3%
private employees concluded this aspects happen sometimes.

(i) HRM and Efficiency & Effectiveness

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

this regard, too, on the basis of significant evidence to prove our hypothesis, we conclude
that there is no association between the two groups, and 59% private hospital employees
said that HRM is important for efficient and effective working of a hospital.

(ii) Understanding of Employees

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

enhance their productivity. However, there is no association between the employees of
public and private hospitals. Private hospitals employees (66.7%) relate that hospital tries
to improve understanding of employees to increase productivity.

Page 54
 (iii) Employees' motivation & promotion policies

There is a difference between two organizations. Private hospitals adopted fair promotion
policies, while public hospital employees were not satisfied with the promotion policies of
their hospitals.

(iv) Incentive schemes for Employees

Private hospitals always provided beneficial incentive schemes to their employees; while
public hospitals did not do so. Hospital employees get encouraged by restructuring of
their salary set up. Private management has restructured the employees' salaries, but
public hospitals have not.

(v) HRM Utilization for increased Effectiveness & Efficiency

As per study, 75% private hospital employees' opinion was that HRM increased
efficiency and effectiveness, while 24.9% public hospital employees agreed that HRM
increased efficiency.
Today's organizations and employees are becoming more empowered so hospitals
redesign its practices to meet their needs. Private hospitals gave more empowerment to
their employees as compared to public health hospitals. 200 private hospital employees
(65.8%) said that workers wanted their pay on the basis of their performance, while
34.2% public hospital employees responded that it was not necessary. According to 52.
5% public hospital employee’s bonuses were more effective motivation tool than
increased salaries, while 47, 5% private hospitals employees agreed with this opinion.

(vi) Participative management in hospitals

Participative management has not succeeded in hospitals. Private hospital employees

(63.3%) said that participatative management succeeded in hospitals while 36.7% public
hospitals respondents said that participatative management was good for success. Out of
104 private employees (58.8%) said that safety had often been managed effectively,
Page 55
70.3% said that safety was not managed effectively, while 41.2% public hospital
employees said that safety was often managed effectively.

(viii) Communication System in Hospitals

The communication system performs effectively in hospitals. In private hospitals,

communication system works effectively as compared to public hospitals.

(ix) Use of New Technology

The implementation of new technology reduces the number of jobs. Private hospital
employees (74.5%) said that the implementation of new technology has reduced the
number of jobs, while 25.5% public hospital employees said that it has not reduced the
number of jobs.

The two state hospitals, the LRH, KTH In both there is no human resource management
to speak of. Both are run by the government rules and regulations in all matters and are
not autonomous. To be more exact, these hospitals are run like some ministerial office or
department. As far human resources are concerned, the personnel are governed by the
various government rules e.g. Establishment Rules, Efficiency and Discipline Rules, etc.
These rules and regulations do specify punishments for misdemeanors. But as for
rewards, which encourage workers to do better and better, these rules offer no
encouragement. The only rewards, if they can be so lubricated, are the annual increment
and, the occasionally promotions. There are no fiscal awards save very occasional
advance increments or an allowance, furthermore jobs-descriptions are sketchy and
procedures are neither uniform nor efficient. Human relations are, by and large, a matter
of individual choice or whim; the organization takes practically no measures to support
such relations.

Page 56
6.3 Measures Proposed

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

1. There is an immediate need of the governance shift from the traditional administration
to modern management, incorporating human resource management, in the interest
of better governance and greater public good.
2. The state (or public) hospitals should have greater autonomy in decision and policy
making and the administrative over-burden which means that various ministries,
secretariats and directorates should be lessened of this burden to a feasible and
practical level.
3. The public and the private health-care intuitions ought to have a closer cooperation
between themselves. An assessment need to be carried out of the feasibility of local'
governing bodies for state hospitals for the healthcare services point of view instead
of from the economy point of view alone. There should be a revision of the services
rules and conditions in state hospitals in order to incorporate HRM practices. In this
regard, depending upon its size, there should be a human resource department or
section in each state hospital and only an HRM professional should head such
departmental section.
4. At the highest level, particularly in the healthcare sector, human resource
management should form an integral part of national planning.

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

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

Page 57
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George T. Milkovich and Johri W. Boudreau, (1997). Human Resource Management,

Chicago, Irwin, p.2.

Horwitz A., (1993). Human Resource Development and Nutrition, chapter 4.

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Page 59
 Appendix-1

Questionnaire

Section No 1 -Answer the following questions:

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

hospital?
____________________________________________________________________
___________________________________
2 Why human resource planning is necessary in a hospital?
____________________________________________________________________
___________________________________
3 Are you satisfied with the supervision system of your hospital?
____________________________________________________________________
___________________________________
4 What methods do hospitals use to assess their training methods?
____________________________________________________________________
___________________________________
5 What motivation techniques are used for employees in your
organization?
____________________________________________________________________
___________________________________
6 What types of incentives are provided by the hospital to motivate
employees to increase profits?
____________________________________________________________________
___________________________________
7 What are the drawbacks and weaknesses in your administration
system of hospitals?
____________________________________________________________________
____________________________________
8 What would be your recommendations for improving quality of
human Resource?
____________________________________________________________________
_____________________________________

Page 60
 Appendix-2

Questionnaire

Section No 2 - (Tick the suitable one)

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

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

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

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

5
Does hospitals provide beneficial incentive schemes to their employees?
(Always, Sometimes, Never)

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

Page 61
 Appendix-3
Questionnaire

Section No 3 - (Tick the correct one)

1 HRM is effectively utilized in hospitals to increase effectiveness and efficiency.

(yes/ no)
2
Do all workers want their pay to be based on their performance? (yes/ no)
3 Do bonuses tend to be more effective motivational tool than increased salary.
(yes/ no)
4 Safety has often not been managed as effectively as some other business
functions. (Yes/ No)
5 The hospital's health and safety rules provide quality services to employees.
(Yes/ no).
6
Does the communication system work effectively in hospitals? (yes/ no)
7 Does the implementation of new technology reduce the number of jobs. (Yes/
no).

Page 62