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Submitted By: Mehreen Abbas Submitted To: Ms. Deep Kiran Date of Submission: 11th August 2012 Institute of Business Management (IoBM)


INTRODUCTION The health care industry, one of the world's largest and fastest-growing industries is meant to deliver proper and accurate health care services in order to treat the patients. The major element of health care industry includes hospital sector within the economy that provides cure, prevention, rehabilitation and palliative services to the sick, injured, disabled or infirm or any other patients. The health care system in Pakistan has two possessions in parallel; public and private. Due to increased number of patients and lack of maintained infrastructure in public sector, the preference towards private hospitals has enlarged over the years as they have created the brand image of a promised quality care and treatment in the minds of its customers. The delivery of such health services are usually paid, however, due to economic crisis, inflation and increased poverty, most health care organizations especially in under developed countries have emerged the concept of building welfare trusts to treat the poor and needy. The evolution in the industry has created increased need of human resources as human factor is central to healthcare. But yet its proper management still require immense expertise to deal with, especially incases of large organizations when the setup is run by fundings through Board. The Patel Hospital, is one of those hospitals that provide services on welfare. Patel Hospital has achieved its mission of being dedicated to serve the humanity through efficient working of manpower that has enabled the hospitals position to withstand in the market. Upon closer view, the hospital is still striving hard to strengthen its image in the market. Therefore, this case has scrutinized and highlighted few human resource management issues faced by Patel Hospital.

THE HOSPTIAL Patel Hospital, a Project of Patel Foundation, located at Gulshan-e-Iqbal, Karachi is a non-profit private, teaching institution established to provide state-of-the-art medical treatment services. In 1999, the hospital started functioning with only 35 beds and now functioning with 200 operational beds, the hospital has successfully achieved the status of a tertiary-care hospital. Patel Hospital was established in by the renowned philanthropist of bantava memon community social worker Mr. Abdul Ghaffar Abdul Rehman alias Mithu Patel whose human intention and dedication has blessed so many people who come in contact with Patel Hospital either to obtain services or support. Consequently, Patel hospital has become the largest hospital in Gulshan-eiqbal and takes pride in being one of the premier hospitals of Karachi. The success of Patel Hospital lies in its enthusiastic, energetic, dedicated and hardworking team and it is an example for many who would want to join the stream of services for humanity. The hospital provides services in the following medical specialties: Angioplasty, Heart By-pass Surgery Blood Disorders and Cancer Treatment Bones and Joints Treatment Burns Treatment Child Health and Newborn Care Dentistry, Maxillo-facial Surgery ENT, Head and Neck Cancer Surgery Eye Treatment and Surgery Gastroenterology, Hepatitis, Liver Diseases General Surgery, Breast Cancer Surgery Hand and Reconstructive Surgery Heart Health Internal Medicine, Diabetes, Arthritis Kidney Diseases, Surgery and Dialysis Lungs and Respiratory Diseases Mental Health Neurosurgery, Brain and Spinal Surgery Plastic and Cosmetic Surgery Pregnancy and Child Birth Women Health

Hospital is also equipped to provide 24-hour Emergency, Radiology, Laboratory, Pharmacy and Intensive Care Services. The Hospital is equipped with Cath-lab (invasive and non-invasive cardiology), Endoscopy Suite and purpose-built outpatient and inpatient departments.

VISION: The vision of the Patel Hospital is to be an Institute of an International repute in the field of health care provision, teaching, training and research.

MISSION: The mission of Patel Hospital is to provide quality health care to all at affordable cost. Patel Hospital is committed in combating the shortage of nursing professional and in providing the competent nursing and paramedical professional capable of working in any setting by maintaining the required standards, providing leadership to enhance the health of the community, and to excel in providing education in a supportive environment where all individuals can flourish.

PHILOSOPHY: In lieu of the vision and mission, the hospital provides quality health care to all irrespective of affordability. All non affording patients are supported through support fund and zakat fund. Almost Rs12.5 million is spent every month in this regard that equals to more than 100,000 per month. Most of the patients requiring supports are Burns Patients, Cardiac patients, renal failure Patients and neonates etc.

PERFORMANCE REPORT: The Boards of Trustees of Patel hospital are pleased and satisfied with the growth of the hospital for the preceding year as the annual report of year 2011 shows slight increase in the revenue generated with a decrease in the liabilities of the hospital in comparison to year 2010, thus reflecting suitable performance.

S.NO. 1 2 3 4 5 6 7

PATIENTS OPD IPD Admissions Emergencies Surgeries/Procedures Deliveries Dialysis Eye Operations

2010-11 99,406 12,100 53,658 12,410 2,097 8,884 515

2009-10 96,345 11,730 48,332 11,435 2,339 7,811 416

SKILL MIX Man power in the Patel hospital comprises a mix Clinical and Non-Clinical staff. Clinical staffing consists of Physicians including ER emergency rooms, Consultants, Surgeons, Senior registrar, RMOs, House officers, Nursing staff, Technicians, Therapists, Pharmacists, Dieticians etc to conduct OPDs and deal with in-patient hospitalization. However, non-clinical functions of this hospital are handled by staff members with specialties in other fields irrespective of medicine related. This includes staffing for various departments like Finance, Accounts, Material management, Information technology, House keeping staff etc.

ORGANIZATIONAL CULTURE The values of the Patel hospital have created moderate organization culture within the hospital which is undergoing towards intense improvement. The aim to provide compassionate and

quality care with an ethical and philanthropic approach has build up the organization set to work and move on. But unfortunately the concept and core mission of the hospital is not implanted in its employees to create synergy. Therefore, hospital has not come out with the outstanding position in the market as compared to other health institutes like AKU. Key tool to success of every organization is to build up strong culture, Patel hospital needs to focus it. it would have helped to build up a competitive edge among existing and newly emerging welfare hospitals. The mission and vision is not embedded within the hearts of its employees. Instead the employees (consultants) tend to focus more on generating their own business rather than providing benefit to the hospital.

HUMAN RESOURCES MANAGEMENT Patel hospital being medium to large organization driven by the Board of trustees decided to outsource the Human resource department to run its business functions. The idea was brought into action to reduce the investments in the assets and fee up these resources for other purposes. Also, to enhance the effectiveness more on business strategies rather tactics as well as to prevent converting variable costs to fixed costs. The management thought to improve the operational performance and to acquire the skills, expertise and innovation by purchasing HR services from a third-party provider as a substitute to provide HR for itself. The outsourcing was done through some renowned consulting firm at Patel hospital but turned out to be a sore point. The outsourced firm did not get the clear vision of the hospital and a factor of dishonesty to its profession had covered the whole scenario. The other reason was that the management was relying completely on the outsourced firm to solve every problem and operate every function of the human resource department like pay roll, recruitment, relocation, records management, compensation etc. Eventually, the firm became unsuccessful to drive and control the HR functions appropriately which ended up in showing flaws in the entire hospital, later identified by the board. The employees of the hospital were not aligned with the hospitals objectives and were not passionate to meet up the corporate objectives. Since HR act as a strategic business partner in todays world, lack of core HR function through outsourcing created

gaps in the employees performances. In order to keep the employees aligned with the organizations aims required continuous inculcation of such motivational messages through meetings, campaigns of team building trainings within each departments (via departmental heads) which did not happen.

PAYROLL The strong relationship of Human Resource Management and Payroll, key functions in any organization were very weak in Patel hospital. The outsourced firm did not manage day to day activities of the hospital accurately. The wrong processing of pay roll function had rapidly affected the staff and created discouragement, depressed morale and decreased the productivity of employees. There was a weak coordination of payroll section at the departmental level and the hospital broken up by developing a risk against it through potential of politics and employee repercussions. Pay roll functions had made a loss in adding value to the services of hospital.

ATTENDANCE MANAGEMENT No well-defined duty roster for the staff especially nursing and other technical staff which fell out in poor pay roll cut off dates. This in turn made the system highly complicated and resulted in delay of the salary transfer. Moreover, the lack of authentic attendance recording had created difficulties for the pay roll section to evaluate the office/roster timings. Consequently, the outsourced firm used to mark up attendance at their own without taking the departmental heads or the employees in loop which again used to create mess in the organization. Thus employees used to show their anger in different manners.

CONCEPT OF POLICIES IN HUMAN RESOURCE One of the major reasons of existence of human resource is to have a control all over the organization in terms of administration and to strictly implement the policies and procedures within the organization. Unfortunately the hospital was missing HR must dynamics in having policies on employee welfare and benefits, compensation policies, leave management, attendance schedule monitoring system. Due to missing policies, outsourced HR department was irresponsible of its intended function to initiate, recommend, implement and revise employee related policies and procedures. The existing policies were so insufficient to cope up the need of employees and to give value added services to employee to gain their commitment. Inadequate loan policies, insurance policies, pension policy, fund policy, performance appraisal policy, resignation policy, car loan policy, training and development policy, job descripition policies.

ENDING EMPLOYEMENT- RESIGNATION, LAY OFFS, TERMINATION: Ending of employment for positive reasons like a new job, resignation or retirement as well as ending of employment for negative reasons such as layoffs, downsizing, job termination or firing, both needs HR Fixed protocols and policies. No protocols for the resignation of employees were at Patel Hospital. Even there was lack of concept for notice period. Most of the times the resigned employee gets additional pay due to lack of track record as there is manual attendance management system. The hospital gets huge kick backs with such kind of situation.Employee termination and lay offs which is crucial to any organization were again lacking fixed criteria for the termination of an employee.

UNCLEAR EMPLOYEE STATUS: Some employees were facing difficulties to know their employment status in the hospital, whether they were on probation or permanent. Even if they used to approach the staff of consulting firm the employees could not get the accurate answer. Hence the employee status was unclear. There was no proper and accurate monitoring of employees probation period, sometimes the probation period used to get extended without any intimation or the confirmation used to get delayed intentionally or unintentionally due to which the sense of dissatisfaction with the job emerged within the employees.

NEW ROLES AND CHANGE IN FOCUS There is no existence of concepts for new or changing competency requirements in the development of corporate strategies. The outsourced human resource firm did not pay attention in partnering with management. In scenario of upcoming global and technological changes, when Patel Hospital was flourishing its business in the era of economic crisis (past recent years) the outsourced firm did not opt the role of an advisor to assist in strengthening the relationships between employees and senior management. This created lack of synergism in the organization,every employee was playing their part to strengthen their position in the hospital and no one was thinking as a team.

RECRUITMENT AND SELECTION The recruitment and selection process among the HR functions had grown considerably with dominant and rapid changes over the recent years. It is extremely important to clearly define the role of human resources in recruitment and selection process as it measures the success of whole hiring process. At Patel, the major flaw existed in the process of hiring as it was majorly based on reference hiring. The recruitment and selection process were not clear and distinct. The consulting firm used to recruit and select without bringing into consideration the core

competencies required for the fulfillment of the job position. Most of the times there was direct recommendations by departmental heads. The resultant of such hirings created monopoly against other employees and management because of increased family or friends hirings at the job positions. Thus, the hospital politics has emerged out. There was a strong need for the company to recognize the value and importance of HR functions, to recruit and retain the best workforce to give the maximum output. The board needs to realize that recruitment and selection are those functions which drives the business forward and influences business strategy.

SALARY STRUCTURE Salary and compensation which is one of the attractive and motivational factor among employees is not problematic. Salary structure is based on grading system which has not been updated since years. The existing salary structure is not up to the standard to attract, motivate and retain employees especially in cases of new hiring, the salary becomes debatable. Due to the old point of view (10 years old grading system with defined salary) very few employees are attracted towards this hospital. No employees are happy with the structure and are switching means turnover was high. The hospital never gives the salary comparable to the market. 1 registered nurse with 5 years diploma and 3 years of AKU experience if receiving 20K at AKU never gets the salary equal to it rather it would get 15K at max. There was one man show only based on one degree appraisal, and which also doesnt have the fixed policy.

PERFORMANCE APPRAISAL Performance appraisal is a part of rewards and career development for an employee. One of the short comings of Patel hospital is that the outsourced HR was lacking its expertise to evaluate and monitor the yearly performance of employees.

The hospital does not have any accurate performance management system that aligns its employee performance goals with corporate performance goals. No use of recent technology. Currently companies are increasingly focusing on strategic HR, aligning human resources initiatives with the overall goals of the organization to improve business success but Patel hospital is far behind these strategies and this is a big challenge for this hospital to exist in the market.

TRAINING AND DEVELOPMENT: TnD act as an integral part of the human resource development activity but the hospital employees were deficient of any such program. There was no personal development programs offered and TNA system did not exist.

OTHER DEFICIENCIES Man power planning is also one of the weaknesses of this hospital. No proper headcounts are defined per department. The job positions also lacked job descriptions for some employees. No HR software existed to manage its functions. The documentation track record was poor and plenty of certificates of employees were either missing or fake. No proper delegation o work. There is no element of confidentiality in the hospital. Ad hockism was so common at the site. Looking insights of this hospital and comparing it with the changing market trends and increasing cost of doing business with existing and newly emerging welfare organizations, post a big challenge for operations of its business set up in the current scnario.