A Study on Training Effectiveness in Private Hospitals of Odisha

Abani Kumar Panigrahy1 Sujata Mangaraj2 ______________________________________________________________________________

ABSTRACT
Training is a learning process that involves acquisition of knowledge, sharpening of skills, concepts competencies and bringing change in attitudes and behaviour of employees. This enhances their overall performance on the job. With the increasing trend of globalizations organizations have started competing on competencies i.e. the core sets of knowledge and expertise that give them an edge over their competitors. Training plays a central role in strengthening these competencies and becomes the backbone of organizational growth and sustainability. During the last two decades many service organizations like Banks, Hospitals etc have become commercial and lot of private players are encouraged by central and state governments to operate and provide health care facilities to people. Number of private medical college, hospitals, nursing homes and clinics have opened in metros and all the leading cities of India. This has resulted in shortage of trained and skilled manpower which has been a major concern for all private hospitals and the hospitals in Odisha are not exception to these phenomena. Numerous research works have been carried out in the field of training and development to assess its impact on organizational performance. Based on these findings, an attempt has been made to study the role of training and development in private hospitals of Odisha. This paper presents the perception of hospital staff regarding the usefulness of training and brings out some suggestions for improving the system. KEYWORDS: Training, Development, Training Outcomes, Effectiveness, Knowledge, Skills, Training Evaluation, Relationship.
____________________________________________________________________________
1

Professor, Department of Management Studies, Regional College of Management Autonomous, Bhubaneswar, Odisha. Email: profabani@gmail.com
2

Dean, Department of Management Studies, Regional College of Management Autonomous, Bhubaneswar, Odisha. Email: drsujatamangaraj@gmail.com

INTRODUCTION
The name hospital comes from latin hospes (host), which is also the root for the words hotel and hospitality. A hospital is an institution for providing health care to the patients, treating their ailments with specialized staff, equipment and medicines and often though not always providing long term patient stays. Over the last three decades, with the introduction of diagnostic and therapeutic techniques, modern hospitals have become highly scientific and complex institutions for health care facilities. The role of hospitals has greatly enlarged and it has moved from curative health to patient care organizations. In India, health care is delivered through both public and private sector organistions and the demand for hospitals have sufficiently gone up because of growing population and economy, expanding middle class population, increase both in chronic and degenerative diseases, growing pharmaceutical market comparable with world standards, inadequate infrastructure to meet the health care demands lack of adequate insurance back up etc. Since 1990s, health care systems have been facing difficulties to provide necessary medical infrastructure and staff to meet the increasing patients requirements. The state and central governments started realizing that government hospitals alone can no longer be capable to provide proper health care to people and therefore started encouraging private sector operations in health industry. With the growing economy, people are now capable to meet the cost of treatment in private hospitals having better infrastructure, doctors and nursing staff. The liberalization policy attracted many private players to open hospitals and extend advanced health care facilities during last two decades.

Advanced super specialty hospitals, nursing homes and clinics having ultra modern therapeutic facilities have opened in all the cities of India.

The state Odisha has also witnessed this upsurge of private hospitals and in Bhubaneswar alone there are 34 hospitals having huge infrastructure and qualified and trained manpower to provide best possible medical care during the episodes of ailments of patients. Besides there are three privately managed medical colleges viz. Kalinga Institute of Medical Science (KIMS), Hi-Tech Medical College & Hospital and Institute of Medical Sciences and Sum Hospital and many more small and medium size hospitals, nursing homes, clinics in the city.

This sudden rise in private hospitals has therefore created shortage of trained manpower (physicians, nurses, technicians etc.) resulting in great demand for hospital personnel. Despite the provision of best possible infrastructure, patients do not receive adequate attention and care commensurate with the cost paid by them. This leads to patient dissatisfaction and they are compelled to go to metros viz. Mumbai, Kolkata, Delhi, Chenai, Bangalore and Hyderabad to receive better treatment and care. With the growing complexities of diseases, and increased number of patients, it has become imperative to have qualified, knowledgeable and skilled medical staff in all public and private sector hospitals in Odisha.

A critical ingredient for building an effective and responsive health system is the health workforce which includes physicians, nurses, public health workers, policy makers, administrators, educators, clerical staff, scientists, pharmacists and health managers amongst others. Today, we are witnessing a growing challenge to maintain the needed numbers, quality, mix and distribution of personnel to meet the healthcare needs of the population.

Therefore efforts have to be made to constantly update the knowledge and skill of hospital staff through appropriate training and development processes.

Adequate training contributes more than any factor to the successful performance of employees. Numerous literature and references attest the importance of training for improving the efficiency and effectiveness for quality health care. In considering, what adequate training is, it is necessary to determine who should be trained, what should be training input, methods and resources to be used, the efficiency of the trainer to conduct the training etc. Training is a planned organized process which is synonimous to education. Both training and education are processes whereby learning experiences are planned to develop specific knowledge, skill and attitude to perform the job effectively. Organizing the trainees, the trainer, the facilities and other resources are the essential parts of implementing the training plan. Knowing how to do, having the skill to do, and also having the willingness, desire and freedom to do are the three absolute requirements for a person to perform well. These requirements can be fulfilled by integrated training and learning process involving employees at all levels.

OBJECTIVE OF THE STUDY

It is in the above backdrop a study was carried out in three private hospitals of odisha viz. Kalinga Hospital Pvt. Ltd, Hi-Tech Medical College & Hospital, Kalinga Institute of Medical Sciences. All the hospitals are located at Bhubaneswar, the capital city of the state. The purpose of the study is to examine the role of training, in private hospitals in Odisha, analyzing its impact and verify empirically the stipulated hypothetical propositions.

LITERTURE REVIEW
Available evidence suggests that a majority (about 60%) of private hospitals are owned by one individual, usually by a practicing doctor. These are classified as sole-proprietorship hospitals. A substantial number of private hospitals are likely to have a partnership model of organisation, with a very few belonging to corporate, public limited, or trust hospital (equivalent of not-for-profit) category. The size of sole proprietorship and partnership categories is likely to vary across states, but there are very few corporate public limited hospitals in these states If we also consider stand-alone clinics that cater to only outpatient services, the proportion of sole-proprietorship category is likely to comprise more than 80% of the private sector. Typically, most are small in size with not more than 10 beds and they are usually called nursing homes and operated by doctor-owners. The services provided range from simple treatment to sometimes sophisticated operations. The provision of laboratory and diagnostic services, and blood banks are usually limited to urban and semi-urban areas

With regard to practitioners the general practitioners are the single largest category of health care services utilised by the people. It is important to note here that the persons practicing medicine as private practitioners include a large number of unqualified practitioners. Hence, the exact number of practicing doctors in the country is not known. From the available data it is known that in 1991 there were 9.20 lakh registered doctors from all systems of medicine, out of which 3.65 lakh doctors were allopathic doctors and 5.55 lakh doctors were non allopathic doctors. Out of the total doctors in allopathic medicine an estimated 75% operate in the private sector, more so from the non allopathic segment.

Despite being the second fastest growing economy in the world, (with a GDP growth rate of 9.4% for the fiscal year 20062007) public spending on health care is among the lowest in the world. According to National Health Accounts total expenditure on health care is only 4.63% of Gross Domestic Product (GDP) out of which only 20% is public financed and rest 80% is private expenditure mostly out of pocket expenses. India ranks among the top 20 countries in its private spending on health care out of which 82% is from personal out of pocket money, employers pay for 9% of spending on private care and health insurance share is only 5-10%. Lack of public provision has resulted in the emergence of a large unregulated and urban centric curative private health sector which serves about 80% of health needs. . In the absence of any comprehensive health insurance coverage and increasing cost of health care more than 40% of all patients admitted to hospitals have to borrow money or sell assets, including inherited property and farmland, to cover expenses, and 25% of farmers are driven below the poverty line by the costs of their medical care . According to the National Family Health Survey II , only 23.5% of urban residents and 30.6% of rural residents choose to visit a government health facility as their main source of health care services.

The reason why Indians prefer private providers over public providers is the lack of quality care in public facilities. At primary care level the unavailability of doctors and/or drugs at the government health centres force the patients to choose the private practitioners. In secondary and tertiary centres overcrowding and lack of quality care in public hospitals is the main reason for choosing the private hospitals. In a recent survey carried out by Transparency International, 30% of patients in government hospitals claimed that they had to pay bribes or use influence to jump queues for treatment and for outpatient appointments with senior doctors, and to get clean bed sheets and better food in hospital.

HYPOTHESIS
Based on the literature review, the following hypotheses were framed in order to fulfill the objectives of the study. H1: Identification of Training needs in hospitals of Odisha help in successful design, implementation and evaluation of training programmes. H2: Design of Training Evaluation is based on training objectives.

H3: Knowledge, skill and positive attitude gained out of training makes the employees more effective in their Jobs.

THE RESEARCH METHODOLOGY

Sampling With a view to examine empirically the hypothetical statements stipulated, an opinion survey was conducted among the employees in the said organisations. The opinion survey covered 140 sample respondents selected on the basis of a random sampling method across the levels. The survey consisted of 65 respondents from Kalinga Hospital Private Ltd., 46 from Hi Hi-Tech Medical College & Hospital and 39 from Kalinga Institute of Medical Science (KIMS).

Data collection The present study is of a descriptive-cum-diagnostic type. Therefore, data have been collected from both primary and secondary sources. The primary data were retrieved through hospital visits, structured questionnaires and individual interviews. The respondents were requested to fill in a structured questionnaire.

The questionnaire contained 12 items having different type of questions in each item totaling to 72. The responded were requested to give their opinion in a five point Likert scale ranging from Almost True (AT) to Not at all true (NT).

DATA ANALYSIS
Demographic Profile Analysis of Respondents It may be seen from Table-1 below, that out of the 124 respondents 53 (42.14%) are doctors, 41(33.06%) are nursing staff, 23 (18.55%) are Para-medical staff and only

7(5.65%) are administrative staff. While analysing the gender of the respondents it was found that 75% of the respondents are men and 25% are women. The respondents are well distributed among all age groups, majority of the respondents, i.e., 37.1% belong to the age group of 31 - 40 years and 26.61% respondents belong to 41 - 50 years of age group. Out of the total population the majority of respondents (36.29%) belong to 3 to 4 lakhs per annum income group and 17.74% belong to the income group of 1 to 2 lakhs per annum. Out of the total population 94.35% of the population are professional degree holders, i.e.,

doctors, nurses and paramedical staff and 5.65% of the population have general degree that is, only graduates. With respect to years of experience majority of respondents (37.9%) belong to the experience group of 11 - 15 years and 23.39% of the respondents belong to more than 6 - 10 years of service. Table 1: Demographic Profile of Respondents Items Age Frequency Percent 57 40.71 42 30 24 17.14 17 12.14 102 72.86 38 27.14 98 70 42 30 27 19.29 25 17.86 23 16.43 39 27.86 26 18.57 30 44 25 35 6 59 39 33 9 21.43 31.43 17.86 25 4.29 42.14 27.86 23.57 6.43 Cumulative Percent 40.71 70.71 87.85 100 72.86 100 70 100 19.29 37.15 53.58 81.44 100 21.43 52.86 70.72 95.72 100 42.14 70 93.57 100

Gender Marital Status Income Level

Years of Service

20 - 30 yrs 31 - 40 yrs 41 - 50 yrs 51 yrs and more Male Female Married Unmarried 1 - 2 Lakhs 2 - 3 Lakhs 3 - 4 Lakhs 4 - 5 Lakhs 5 Lakhs and above 1 - 5 Yrs 6 - 10 Yrs 11 - 15 Yrs 16 - 20 Yrs More than 20 Yrs Doctor Nursing Staff Para-Medical Staff Administrative Staff

Profession

Reliability and Validity

We use validity and reliability technique in our research to test the questionnaire for its validity and reliability (Table-2). It helps to make our research free from any systematic and variable errors. Here in this analysis, the items used are Cronbachs Alpha, which measures the homogeneity of the items and it shows that all the items belong to the same cluster and dropping any item would not improve that one cluster. Further Table-2 reveals

that, the Chronbach alpha value of all the twelve factors used for the purpose of studying the effectiveness of training and development practices in private hospitals of Odisha are more than 0.5. This being a good measurement validates the questionnaire. Table 2: Item-Total Statistics
Sl. No. Factors
1 2 3 4 5 6 7 8 9 10 11 12 Training Objectives Formulation of Training Policy and Plans Participation selection Training need identification Training contents and Methodology Duration Infrastructure, Study Materials Training Evaluation Post Training Implementation Training Outcomes Relationship of Training with HR Practices Return on Investment (ROI) N of Items Cronbach's Alpha Scale Mean if Item Deleted 34.0152 34.5682 34.7803 34.3598 34.2917 34.3125 33.75 33.9318 34.5833 34.2311 34.4773 34.53 11 0.858 Scale Variance if Item Deleted 29.711 27.03 27.085 24.71 27.013 27.04 28.211 24.969 26.092 27.509 25.391 26.312 Corrected Item-Total Correlation 0.289 0.578 0.495 0.749 0.679 0.671 0.354 0.585 0.522 0.633 0.673 0.643 Cronbach's Alpha if Item Deleted 0.853 0.831 0.839 0.813 0.825 0.824 0.851 0.831 0.837 0.829 0.821 0.823

After reviewing the above analysis it can be concluded that the items used in the questionnaire are internally homogenous and internally consistent and at the same time all the items are good items.

Table 3: Descriptive Statistics Sl. No.

1 2 3 4

Factors
Training Objectives Formulation of Training Policy and Plans Participation selection Training need identification

Mean
4.0947 3.5417 3.3295 3.7500

Std. Deviation
0.72077 0.80290 0.90274 0.93006

N
140 140 140 139

5 6 7 8 9 10 11 12

Training contents and Methodology Duration Infrastructure, Study Materials Training Evaluation Post Training Implementation Training Outcomes Relationship of Training with HR Practices Return on Investment (ROI)

3.8182 4.3598 4.1780 3.5265 3.8788 3.6326 4.1023 3.9884

0.70650 0.91630 1.08679 1.01287 0.68142 0.92568 0.85495 0.86321

140 136 135 138 140 134 140 140

It has been observed in the Table-3 above that, out of the total twelve factors the total mean score of the 6th factor i.e. duration of training programme is highest which consist of only one variable i.e. The duration of the in-service training programmes, is adequate. The second in the order is 7th factor i.e. Infrastructure Study Materials which consists of two variables such as Training agencies have all the basic infrastructure facilities such as library, laboratory equipments, audio-visual aids and proper boarding and lodging facilities, relevant and useful study materials are provided during the in-service training programme. However these two factors can be ignored because they contained only one or two variables. The next consideration is for the 11th factor of the table i.e. Relationship of Training with HR Practices. This factor consists of 7 variables which provides a correlation between Training functions vis-vis HR practices in private hospitals. In other words
these seven variables contribute towards the improving HR practices in private hospitals of Odisha.

Regression Analysis
The Multiple regression analysis has been used in our research work to study significance of all the 12 factors and finding the effectiveness of training programme in the private hospitals of Odisha. We also made an analysis of specific variables of each factor that contributes towards improving the overall effectiveness of employees of the hospitals.

Further, in Table no.4 and 5, the t-test of the regression analysis have been done on the factor Relationship of Training with HR Practices which was found to be contributing to the effectiveness of training (refer table 3). This factor in turn consists of 7 variables as indicated in Table no 4 (RT1 to RT7). All these 7 variables are found to be satisfying the

collinearity test. Therefore, the regression analysis can be considered as a valid approach to test the significance. The p-value of the t-test of the constituent variable RT3 (Retention of employees increases after attending training) is not significant for measuring the relationship of training with HR practices. The rest of the six constituent variables are quite significant towards measuring the relationship of training with HR practices. Table 4 : Relationship of Training with HR Practices (Coefficients) Un standardised Coefficients Std. B Error (Constant) 0.243 0.104 RT1 RT2 RT3 RT4 RT5 RT6 RT7 0.193 0.154 0.028 0.156 0.156 0.128 0.110 0.021 0.020 0.019 0.021 0.020 0.021 0.024 Standardised Coefficients Beta 0.285 0.209 0.040 0.210 0.238 0.196 0.101 t 2.346 9.346 7.833 1.461 7.411 7.945 6.133 4.534 Sig. 0.020 0.000 0.000 0.145 0.000 0.000 0.000 0.000 Collinearity Statistics Tolerance VIF 0.403 0.526 0.500 0.469 0.416 0.368 0.754 2.483 1.903 2.002 2.131 2.402 2.717 1.327

Table 5 : Training Outcomes (ANOVA) Sum of Squares 109.201 12.920 122.121 df 14 249 263 Mean Square 7.800 0.052 F 150.321 p-value 0.000

Regression Residual Total

Further, in table no. 6 and 7 the t-test of the regression analysis have been done on the factor Training Outcomes which was found to be contributing to the effectiveness of training (refer table 6). This factor in turn consists of 14 variables as indicated in table no.6 (TO1 to TO14). All these 14 variables are found to be satisfying the collinearity test. Therefore, the regression analysis can be considered as a valid approach to test the significance. The p-value of the t-test of the 11 constituent variables like TO1, TO2, TO3, TO5, TO6, TO8, TO9, TO10, TO11, TO12 and TO14 are quite significant for measuring the training outcomes which also simultaneously contributes to the effectiveness of

training in private hospitals of odisha. The rest three constituent variables indicate insignificant result towards measuring the training outcomes (The participants become more computer-savvy and try to use computer software in their daily work, Participants develop soft skills, and their team work, communication, decision making etc improves after training and Participants of training programme learn to be more vigilant about the safety and security of the patients and their attendants). Table 6 : Training Outcomes (Coefficients) Un standardised Coefficients Std. B Error (Constant) -0.245 0.127 TO1 TO2 TO3 TO4 TO5 TO6 TO7 TO8 TO9 TO10 TO11 TO12 TO13 TO14 0.040 0.109 0.080 0.031 0.032 0.150 -0.013 0.073 0.131 0.115 0.085 0.094 0.025 0.144 0.026 0.015 0.024 0.017 0.025 0.021 0.026 0.022 0.015 0.012 0.018 0.025 0.018 0.022 Standardised Coefficients Beta 0.047 0.226 0.108 0.059 0.048 0.207 -0.018 0.091 0.211 0.248 0.134 0.095 0.039 0.205 t -1.931 1.539 7.111 3.362 1.843 1.273 7.210 -.523 3.402 8.544 9.675 4.851 3.811 1.371 6.452 p-value 0.055 0.000 0.000 0.001 0.066 0.002 0.000 0.601 0.001 0.000 0.000 0.000 0.000 0.172 0.000 Collinearity Statistics Tolerance VIF 0.455 0.422 0.414 0.410 0.300 0.515 0.359 0.595 0.696 0.648 0.553 0.678 0.528 0.421 2.198 2.372 2.416 2.442 3.336 1.943 2.789 1.680 1.438 1.544 1.809 1.474 1.893 2.373

Table 7: Relationship of Training with HR Practices (ANOVA) Sum of Squares df Mean Square F p-value Regression 203.722 7 29.103 344.324 0.000 Residual Total
R Square

21.638 225.360

256 263
0.904

0.085
Std. Error of the Estimate 0.291

DISCUSION
This empirical study reveals that, the employees of private hospitals in Odisha are mostly satisfied on the overall training and developmental activities organized for them. The respondents have expressed satisfaction towards training policies and plans to fulfill the objectives, participant selection criteria, identification of training heads, training contents and methodologies, duration of training programmes, infrastructure study materials, training evaluation and post training implementation systems.

However, the study suggests that more number of computer application programmes are to be conducted for hospital staff to enable them to use the computer facilities and IT infrastructure available in the hospitals for their day to day activities. This will enhance their effectiveness in performing the job.

The doctors, nurses and paramedical staff of the hospitals posses requisite technical skills to undertake their respective jobs. They have also expressed satisfaction regarding the training programmes being arranged for them to enhance their job knowledge and technical skills. However, proper communication with patients and their attendants, taking

appropriate decisions for treatment of patients, and working in a team are also essential for improving their efficiency and effectiveness on the job. Regular programmes on soft skill development will contribute towards development of these skills so that and the hospital staff can perform much better after this training. The inter personal relationship will greatly increase and there can be team cohesiveness. Very often patients and their attendants reach the hospitals in critical conditions and in utter despair they run from pillar to post for meeting doctors, conducting investigations, organizing blood and medicines etc. In the state their anxiety, they sometimes lose their valuable belongings like cell phones, money purse, reports and other items. Besides the security staff, it is expected that other staff members of the hospital may be little vigilant towards their safely. Awareness training programmes in this direction will be helpful to enable the staff members to take this extra care so that the patients and their family members can be relieved of the tensions. This will also add to greater patient satisfaction.

With the increasing number of private hospitals there is always a demand for qualified and skilled manpower and the employees conveniently find better job opportunities for change. This adds to regular attritions in all hospitals of Odisha. More over the patients feel disappointed, when they fail to meet the same doctor for continuity of the line of treatment. Besides improving the service and working conditions, it is also necessary to organize regular training programmes for them for updating their skills. Training contents may also include the HR policy promotion and incentive plans, employee benefit plans etc. That will bring greater awareness to the staff and reduce the attrition rate.

CONCLUSION
This study reveals that the employees of private hospitals of Odisha are satisfied with the training development systems being adopted for improving their skill and knowledge. This system needs regular review and monitoring in order to fulfill the current and future job requirements. It is also required to compare with training facilities being adopted in the advanced hospitals in India and abroad and imbibe some of the best practices into the system. The identification of training needs through performance appraisal system (self

and superior) can be a useful method for identifying training needs more objectively.

The discussions above can be considered for making value additions in the training and development processes of private hospitals of Odisha. This will lead better patient care and increase employee satisfaction.

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