HRM issues and challenges in healthcare

Among other resources of organizations, Human Resource is the most critical one that makes a difference in an organization’s performance. For employees to work for an organization with interest and commitment, it is true that organizations should place an effective Human Resource Management system in practice.

INTERNATIONAL JOURNAL OF MANAGEMENT (IJM) ISSN 0976-6502 (Print) ISSN 0976-6510 (Online) Volume 7, Issue 2, February (2016), pp 166-176 http://www.iaeme.com/ijm/index.asp Journal Impact Factor (2016): 8.1920 (Calculated by GISI) www.jifactor.com IJM A STUDY ©IAEME HRM ISSUES AND CHALLENGES IN HEALTHCARE Dr E Mubarak Ali Associate Professor, PG & Research Department of Commerce Jamal Mohamed College (Autonomous), Tiruchirappalli Mr S Abdul Aameed Ph.D Research Scholar, PG & Research Department of Commerce, Jamal Mohamed College (Autonomous), Tiruchirappalli ABSTRACT Among other resources of organizations, Human Resource is the most critical one that makes a difference in an organization’s performance For employees to work for an organization with interest and commitment, it is true that organizations should place an effective Human Resource Management system in practice Sound Human Resources Management practices are essential for retaining effective professionals in Hospitals Given the recruitment and retention reality of health workers in the twenty-first century, the role of Human Resource Management in hospitals should not be underestimated Health care is now an upcoming field Modern hospitals, which provide the latest medical facilities, now employ thousands of personnel including medical, paramedical and support staff Managing this vast human resource working in these hospitals is a major challenge as it requires round the clock Human Resource support Human Resource Management in hospitals has to function in a sector with some unique characteristics The workforce is relatively large, diverse, and includes separate occupations The management of human resources in Hospitals is essential to enable the delivery of efficient and effective medical services and to achieve patient satisfaction The effective human resources management has a strong impact on healthcare quality and improving the performance of hospital’s staff Key words: Human Resources Management, Health care Sector, Processes and Practices, HRM support to Health Care Quality Cite this Article: Dr E Mubarak Ali and Mr S Abdul Aameed HRM Issues and Challenges in Healthcare International Journal of Management, 7(2), 2016, pp 166-176 http://www.iaeme.com/IJM/index.asp INTRODUCTION Most of literatures have showed the importance of Human Resources Management on developing the quality of healthcare service (Yu, 2007; Michael, 2009; Patrick, 2011) and found that the incentives and providing motivation to work and follow the system of bonuses by competencies improve the performance of individuals working in hospitals (McKinnies, 2011) and can make a significant difference between health organization with good performance and health organization underperforms or below average(Edgar and Geare, 2005) Human resource management is the application of management principles to management of people in an organization (Aswathappa 2010) It is an 166 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication important part of managing any organization, particularly business organizations Human Resources Management (HRM) is a vital management task in the field of healthcare and other services sectors, where the customer facing challenges because of staff’s performance who have the experience and the quality of performance (Howard et al., 2006) and that human resource management plays an active and vital role in the success of the reform of the health sector 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 The responsibilities associated with human resource management include: recruitment, training, job analysis and staffing, organization and utilization of work force, measurement and appraisal of work force performance, implementation of reward systems for employees, development, wage/ salary administration, industrial disputes, social security and labor welfare, promotions professional development of workers, and maintenance of work force The lack of studies that cover the topic of HRM on the quality of healthcare could affect the development strategy in the healthcare sector of any country, and without proper studies in this field may contribute to weakening the overall performance of hospitals Therefore, this study attempt to analyze the role of HRM in the health sector and attempt to6find the common points to develop healthcare sector with regard to HRM In the healthcare industry, as in most other service industries, the interaction between patients and healthcare service providers (professionals and other employees) is an integral part of the service process (Conway & Willcocks 1997, Benbassat & Taragin 1998) Health Care Organizations should be encouraged to take the role of the patient into consideration in the healthcare service process, and in order to achieve high quality service (White 1999) respond to patients’ needs and expectations Another issue that is likely to challenge HCO management is the central role played by employees in Service quality achievement White (1995) reported cooperation between employees and managers as the key to providing high quality care, because it can compensate for the constraints imposed by cost containment and managed care In pursuit of this objective, management might seek to implement progressive HRM practices that encourage service oriented behavior and show concern for employees’ organizational and personal needs In recent times, these practices are Human resource being used as a tool for meeting the objectives of the organization, rather than being restricted to the traditional approach (Negi 2013) Human Resource Management is the process of bringing people and organizations together so that the goals of each are met (Rao 2005) This has emerged as one of the major functions of any enterprise This means focused human resources planning, recruitment, selection, placement, training, development, performance appraisal, compensation administration, incentives, employee benefits, social security, industrial relations, employee grievances, collective bargaining, personnel records and accounting and many other fields directly or indirectly related to management of human resources According to Niles (2013) the important role that human resource management activities play in the operations of a healthcare organization Human resources can be applied to any activity of the operations of an organization, regardless of the industry The role of HRM as briefly discussed has different functions in the health care management these are including legal and ethical issues of the treatment, health and safety of employees and patients, careers in health care, labor unions in health care, job analysis and design, recruiting and selecting employees, employee benefits, training and motivating employees, and terminating employees Strategic planning, including labor budget and forecasting, is addressed because of the contribution of HRM to successful strategic planning The increased diversity of the patient and employee, the effect of technology and the globalization of the economy on healthcare delivery, the new trend of medical tourism, and the increased focus on accountability in the delivery of services and teamwork education are exciting changes in health care, which ultimately will improve patient care DEFINING HUMAN RESOURCE MANAGEMENT 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).Naturally, the definition of human resource management would be incomplete without further explaining what the terms of 167 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication ‘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 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 (Zaria, 2007) Human resource, 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 According to MSH, human resource management is defined as the integrated use of systems, policies, and management practices to recruit, maintain, and develop employees to strengthen the capacity of an organization in meeting its desired goals (MSH 2009) HRM is a critical management area that is responsible for an organization’s most important asset, its people When an organization manages its investment in people wisely, the result is a satisfied and motivated workforce that delivers quality health services and an organization able to fulfill its mission, meet its health objectives, and enhance its competitive advantage 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 (Fombrun et al., 1984; Hendry and Pettigrew, 1986; Guest, 1987; Storey, 1989; Armstrong, 2000) Human Resources Management is defined as a system of activities and strategies that focus on successful management of employees and working staff inside the organization to achieve the goals of the organizations (Bayars and Rue, 2006) HRM deals with hiring and firing employees, staff development and paying salaries HRM plans and implements efficient processes, policies and procedures for the work force in the organization, such as recruitment, hiring and job placement, planning and appraising employee performance, rewarding and promoting staff Human resources management also provides support for the needs, concerns, and problems of employees and identifies ways to increase staff competence and commitment In this era of rapid and continuous change, human resources management is one of the organizational domains that can provide support for employees during internal change processes and help managers and leaders identify and implement processes for change (Ulrich 1997) 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.”Some scholars claim that HRM can lead to specifically measurable business outcomes (Huselid, 1995) Equally, HRM has its critics (Sisson, 1994; Legge, 1995) both of whom view HRM as a symbolic excuse to enhance managerial legitimacy where the management of individuals has been intensified within an enterprise culture (Keenoy and Anthony, 1992) However, HRM is the most misunderstood and poorly utilized system in the health sector today Many organizations face pressing human resource challenges, for example, staff shortages, attrition and absenteeism, and low morale- all of which can be addressed by an effective HRM system Although managers say that their employees are critically important, many organizations frequently neglect the management systems, practices and procedures needed to support this important resource HRM systems in developing countries are weak and fragmented in the majority of health care organizations Many not routinely staff human resource professionals and as a result vacancy rates soar, promotions lag, workloads increase with regularity, and morale is low In addition, without the guidance of human resource professional, managers not develop adequate HRM skills, a short fall that reduces their effectiveness HUMAN RESOURCE MANAGEMENT FUNCTIONS Human Resource Management (HRM) includes all the functional area of management such as production management, financial management, and marketing management That is every manager from top to bottom, working in any department has to perform the personnel functions HRM functions 168 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication (also called processes) are carried out by the HR managers to fulfill the goals and objectives of the organization HR managers perform two sets of functions, namely managerial functions and operative functions The managerial functions are the basic functions performed by the HR managers in their capacity as managers or heads of their own departments In fact, all managers, irrespective of their departments, perform these functions The operative functions, on the other hand, are specialized activities performed exclusively by the HR managers, usually for all the departments We shall first discuss the managerial functions Mathis (2006) states that the organization should use human resource management input in the following organizational functions, they are, Establishment of a legal and ethical management system, Job analysis and job design, Recruitment and selection, Healthcare career opportunities, Distribution of employee benefits, Employee motivation, Negotiations with organized labor, Employee terminations, Determination of emerging and future trends in health care, Strategic planning While, McKinnies (2012) concluded that HRM comprises five broad functions, which are: i Resourcing: Activities include HR planning, talent management, succession planning and ending the employment contract (including managing retirement and redundancy) ii Performance: Managing individual and team performance and the contribution of workers to the achievement of organizational goals, for example, through goal-setting and appraisals iii Reward system: Designing and implementing reward systems covering individual and collective, financial and non-financial rewards, including pay structures, parks and pensions iv Learning and Development: Identifying individual, team and organizational development requirements and designing, implementing and evaluating training and development interventions v Employment relations: Managing employees, communication, handling union management relations, managing employee welfare and handling employee grievance and discipline THE ROLE AND EFFECTIVENESS OF HRM 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 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.) and 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 Adwan (2008) with his study entitled “The Reality of workforce planning in the nongovernmental health sector in the provinces of Gaza”, showed that institutions not engage workers in the planning processes of the workforce sufficiently, and that the influential considerations of administrative structure regulatory in the process of workforce planning is characterized by lack of clarity, as well as the professional experience in manpower planning and top management support for the process of workforce planning was ineffective 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 169 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication 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 COMPETENCIES OF HUMAN RESOURCES MANAGEMENT IN HEALTH CARE SECTOR Identification, Analysis and programming of the human resources and: It Includes Data collection, analysis, and determination of the overall human resources situation, availability, composition, structure, and distribution of human resources; the output of human resources by educational institutions Comparison with a particular pattern or standard to identify gaps and needs which can be determined using the best available methods, based on the characteristics of the health services system and the possibility of obtaining information Identification of problems and qualitative and quantitative needs for human resources in consultation with the authorities and relevant actors in the health services system Preparation of a plan to procure the most appropriate human resources to meet the identified needs Staffing: Ensures that the health system obtains a sufficient supply of human resources in all the necessary occupational categories to meet its objectives, as budgetary resources permit Includes personnel from the labour market, as well as personnel that is needed but not available in the labour market and who must be trained by educational institutions Performance management: Its objective is to optimise the productivity and quality of human resource performance in the health services It includes interventions for performance management as such ways of organising the work, technology management, formation of work teams, use of incentive systems and ways to evaluate this performance Labour relations and personnel administration: Ensures proper management of work contracts, remuneration systems, conditions for the social protection of workers which includes career appointments, incentive systems, relations between the employer and employees, collective working relationships – unions, collective bargaining and the search for effective communication modalities between administration and personnel, as well as ways to enable staff participation in key decisions that affect their performance with the resulting benefit to the population Development and Training: Ensures that all human resources in a health system are properly qualified and motivated Includes interventions that range from the ongoing identification of educational needs, the definition of work competencies, curriculum development, instructional design, education, in the most effective and suitable modalities to meet the established objectives, and evaluation of the competencies acquired It is a valuable strategy for improving performance and for changing the practices and attitudes of human resources Assurance of safety, and the work environment: Ensures the proper environment, conditions, and modes of work organisation to counteract the potentially negative impact of the nature of health work on the health of the staff themselves Most risks can be minimised with adequate precautions and preventive interventions that emphasise occupational safety and health promotion for the employer and employee alike HUMAN RESOURCE: VALUABLE ASSETS IN HEALTHCARE INDUSTRY Human resources, when pertaining to health care, can be defined as the different kinds of clinical and nonclinical 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 HRM in health has to function in a sector with some unique characteristics The workforce is large, diverse, and comprises separate occupations often represented by powerful professional associations or trade unions Some have sector-specific skills; other can readily move from the health sector to employment in other sectors The avowed first loyalty of those with sector-specific skills and qualifications (physicians, nurses, etc.) tends to be to their profession and their patients rather than to their employer 170 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication THE IMPACT OF HRM ON THE QUALITY OF HEALTHCARE SERVICE 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 The most important recommendations by the study with regard to the condition of individuals working in the hospital, 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 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 findings 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 A study entitled “Determining staff requirements in hospitals”, Ozcan and Hornby (2005) 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 antiunion, 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 are, 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 and the failure to protect the rights of workers and individuals in hospitals during the transformation process in the health sector 171 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication MANAGING HUMAN RESOURCES IN HEALTH CARE SECTOR In a dynamic environment, health managers need to combine leadership, entrepreneurial and administrative skills to meet the challenges that the changing socio-political, economic and technological landscape presents, as well as the expectations of patients, health professionals, politicians and the public Without good management we will be unable to improve efficiency, effectiveness and responsiveness in the delivery of health services or upscale interventions to achieve health goals (Travis et al., 2004) Hospitals are important vehicles for the delivery of health care, and managers of these institutions are to a large extent responsible for operationalizing the visions and objectives that policy-makers have for the health and wellbeing of a nation (Lehman et.al 2002) However, despite the urgent need to develop managers in hospitals, it is important to identify the competencies that are important for effective health-care management as well as the proficiency of managers in these areas, as part of the overall management development process and in an effort to make training relevant In so doing, we will help to avoid ‘one size fits all’ approaches to health management as well as the unnecessary deployment of scarce resources Determining and assessing competencies is a vital precursor to improving professional development and the alignment of individual development with the need of an organization or profession (Calhoun et.al 2004) The competency-based approach to professional development is well accepted in higher education (Westera 2001), and in human resource management literature where it is regarded as a critical part of the overall management development process, as it allows one to identify the gaps between current skills and the skills required (Brown 2002, Jinabhai 2005) Appropriate programmes based on the personal needs and experiences of health managers can then be put in place to train managers to provide leadership and to ensure a sustainable improvement in the work context of health workers, and hence on the quality of care and health of the communities their organizations serve (Gough and Price 2004) ROLE OF GOOD HRM PRACTICES IN HOSPITALS In recent years, it has been increasingly recognised that getting HR policy and management “right” has to be at the core of any sustainable solution to health system performance In comparison to the evidence base on healthcare reform-related issues of health system finance and appropriate purchaser/provider incentive structures, there is very limited information on the HRM dimension or its impact In many countries, access to health professional training and employment is controlled by standards and entry requirements determined by the professions, and aspects of their work are regulated The health sector is a major recipient of public and/or private expenditure, and healthcare delivery is a politicised process Recent research has also highlighted a so-called “prime building block” of HRM – the principle of “AMO” There must be sufficient employees with the necessary Ability (skills, knowledge, and experience) to the job; there must be adequate Motivation for them to apply their abilities; and there must be the Opportunity for them to engage in “discretionary behaviour” – to make choices about how their job is done The authors suggest that organisations wishing to maximise the contribution of their workforce need to have workable policies in these three broad areas 10 THE FACTORS THAT AFFECT THE PERFORMANCE OF INDIVIDUALS WORKING IN HEALTH ORGANIZATIONS 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 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 organizational performance Organizations can benefit from effective HR practices by paying attention to employees’ safety issues, which in turn result in better organizational performance A study entitled “The filling in the Sandwich: HRM and middle managers in the health sector”, McConville and Holden (2003) 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 172 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication affected by, such practices Through a case study in two Trust hospitals, this study demonstrates that middle line managers, positioned between the service’s decision-making bodies and its employees, are bearing many of the consequences of the change process The effects of growing workloads, combined with altered expectations of their increasingly visible roles, have enhanced the tensions and role conflict inherent to their position The study found that the perception of line e manager are under resourced and found lack of time needed to manage their staff effectively Moreover, staff is being more closely managed, changing the nature of personnel management, and line managers throughout the service have regained responsibility for many aspects of HRM 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 A study entitled “HRM and the management of clinicians within the National Health Service (NHS)”, Marie et al., (2007) 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 strong, well-motivated and highly trained medical profession is critical to the success of the national healthcare reform, in the delivery of both services to patients and government reforms and 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 A study entitled “Human resource management and performance in healthcare organizations”, Harris et al (2007) 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 A study entitled “Managing professionals: exploring the role of the hospital HR function”, McDermott and Keating (2011) 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 11 HUMAN RESOURCE ISSUES IN HEALTH CARE INDUSTRY The large health infrastructure follows a more or less similar pattern across the states This system faces several managerial problems which are well-recognised and which limit its effectiveness Following are some of the limitations which are faced by Health Care Industry 12 INADEQUATE ASSESSMENT AT THE TIME OF RECRUITMENT The procedure adopted for recruitment should use procedures which are clearly understood by candidates and which are open to public scrutiny apart from being fair, giving candidates who meet the stipulated minimum requirements equal opportunity for selection The primary criterion for selection of candidates should be merit and ability Apart from the eligibility criteria requirements, the system is deficient in assessing the soft skills of candidates like their ability to withstand stress, communication skills, psychological testing, values, attitude, and personality of an individual, etc 173 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication 13 INADEQUATE TRAINING Training is the basis for human resource development Several problems have emerged in the area of training over the past few years Basic medical education has a heavy focus on urban curative care and is provided in tertiary care settings This does not prepare doctors for their roles in the rural primary health care system There is hardly any system of induction training for medical officers of the primary health centres when they join the government health system Furthermore the medical officers not have any public health or management training even though they are supposed to manage the staff under them There is no training for health education, interpersonal communication, doctor-patient and doctor-staff interactions, and counselling The technically oriented training does not help to bridge the gap between the doctor – who is regarded as supreme – and the clients who are usually poor and illiterate The Independent Commission on Health in India observed that the standard of teaching in training schools for auxilliary nurse-midwives was very low and that “the main reasons for substandard patient and community care are: substandard training, especially in the staff-nurse, midwife, and auxilliary nurse-midwife training courses, the lack of a proper system of training; and absence of regular reorientation courses.” 14 CENTRALISED PLANNING AND TARGET-ORIENTED PERFORMANCE APPRAISAL Central level planning has, over the years, killed many initiatives at the state level to adapt or augment health and family planning programmes to local needs States lack public health expertise to develop new health programmes and are not allowed to take direct assistance from foreign donors or to collaborate with foreign partners in the health area without clearance from the central government It has been seen that during the process of performance appraisal, the process of writing ACRs was routine (subjective and generalised) rather than reflective of the individual’s capability (objective and customised) in absence of any output indicators While reporting, the officer tended to tread a middle path so as to avoid controversy and unnecessary explanations Moreover, the reviewing officer was not intimately associated with the working of the officer being reported upon to make any realistic opinion 15 REWARDS NOT LINKED TO PERFORMANCE In the health system, there are no concrete rewards except promotions and salary increments All promotions and increments are linked to seniority in the system and vacancy available For many posts, promotions are few anyway The current system of annual confidential reports does not reflect performance as these reports are written as a routine procedure, indicating satisfactory performance except in very extreme cases Postings and transfers are also not based on performance but on “government’s wish”, for which there is a lot of scope for political and administrative contacts to be used The staff who stay at their place of posting and provide 24-hour service get the same salary as the staff who are absent or are available for only three to four hours a day In such a system, many settle for the minimum acceptable level of performance Further training is of little help as staffs not see any personal benefit of the training 16 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, The development of personnel management process, 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, The need to measure the performance of the managers of HRD 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) 17 CONCLUSIONS The study encounters the challenges in relation to HRM These challenges are lack of staff satisfaction, lack of commitment and initiation, lack of team spirit, poor working condition, under staffing, lack of skilled manpower, high turnover, absenteeism and conflict among staff members are the main challenges faced by hospital managers in relation to HRM, which would have been addressed by putting efficient and effect HRM practices in place The management of human resources is essential to 174 Dr E Mubarak Ali and S Abdul Aameed, “HRM Issues and Challenges in Healthcare” – (ICAM 2016) International Journal of Management (IJM), ISSN 0976 – 6502(Print), ISSN 0976 6510(Online), Volume 7, Issue 2, February (2016), pp 165-176 © IAEME Publication 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 healthcare quality, and most of literatures 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