Comparative Study Between Public and Private Sector Hospitals

Comparative Study of Human Resource practices in Private and public sector hospitals
Final presentation
Members This is our team

Farah Agha
Hassan Javed
Hyder Nawaz
Shahid Nadeem
Comparative Study Of Public And Private Sector Hospitals
PRELUDE
One of the most ancient foundations of world Significant role in every societal placement Changing role of a hospital Complexity in modern needs Diagnostic paradigm Treatment facilities Interconnecting support services Change in clients profile In response to which:
New needs and wants
research Statement
A comparative study of human resource practices used in both public and private hospitals
INTRODUCTION
Hospital industry in Pakistan is in its developmental phase It has become an imperative that human side of the system also be calibrated
Reason is the introduction of new techniques, technologies and medical procedures
Study of Hospitals Management on Human Resource grounds become more necessary It is the human resource which is responsible for running all the new systems and procedures we are deploying
H s os it pi ls a s
O b b j e e c c t t i i v v e e
types of hospitals
There hospital segregations industry can be divided in four main
Research objectives
This research thesis would help in determining the various constitute of the service cultures in public and private hospitals. This research will infer the implication of the human resource concerning policies over the organization This would enable us to discover the reasons that are contributing in strengthening or weakening of the hospital service structure. It will advance public understanding of the role of the Human resource management and its vitality for efficient running of a hospital Improve literature on Human Resource practices and its scope for healthcare industry.
Scope of Study
Hospitals Selected:
Our cover
research the
will while
following
D o c t o r
Jin na h Govern Ho ment spi Shau Hospital tal kat Ge s Khan ner um al canc Priv er ateHo spi HospHos tal ital pita N ls Comparative Study Of Public And Private Sector Hospitals a
M e o H o s p it a l
aspects resource of the public
exploring the human department hospitals and in private
sector of Pakistan:
1.
Structure/ Hierarchy Management selection process and criterion
2.
3.
Organizations Culture, values Norms,
4.
Communication
Limitations
A very complex system involving wide variety of variables. It is very difficult to look into each of the variable that affects its HRMS. Due to the lack of doctors and staff participation we found it very hard to convince them to fill the questionnaire, they were not ready to give much time. Many Public hospitals were undergoing a physical structural change, because of which most of the concerned people were not available. We cannot cover all the Hospitals of Pakistan. Comparative Study Of Public will The research And Private Sector Hospitals therefore be restricted to
In subcontinent human resource effectiveness is achieved by using control HR theory rather than commitment model (Walton 1985, Arthur 1994) Waltons (1985) conceptual model hypothesizes that commitment work systems outperform traditional work systems in organization Effect of HRM is lower in highly institutionalized sectors than in a less institutionalized sector Quantitative approaches like operations research can be used to estimate the demand for doctors, nurses and other staff in the outpatient and in-patient sections of hospital
Comparative Study OfPublic And Private turn over index(ETI) Employee Sector Hospitals
Findings of literature review
Employee stability index (ESI) Absenteeism index(AI) Accident index for frequency
Findings of literature review (..)

If employees are effective, their contribution to the hospital will be effective, consequently the hospital will also be effective in accomplishing its goals Hackman & Oldham (1976) claims that if all the core dimensions exist in the job, carried out by people, they are well motivated to perform. The core dimensions of a job are:

Skill variety Autonomy Task identity Feedback Task Significance
It is understood if the first three are in the job,
Research Methodology
Research Type Applied form of research has been used to develop the thesis focusing on comparing the human resource practices of public and private hospitals in Pakistan. Data Type Primary data is used in this study. Questionnaire was designed for the collection of primary data. The reference period of this study is Comparative Study Of Public And Private Sector Hospitals from 21st December 2009 02th
Research Methodology(..)
Sampling Technique Stratified random sampling is used. Sample Population From all the hospitals which were selected for purpose of data collection, a sample of 60 personnel has been taken.
10people from each hospital were asked to fill in the questionnaire.
To ensure that right information is being collected we have selected personnel Comparative Study Of Public And Private Sector Hospitals having 2 3 years of work experience.
(..)
Data Collection Tools Different tools are used for data collection as to minimize potential bias caused by collecting data from single source. Questionnaire Interview Direct Observation Questionnaire Formation The questionnaire used structured questions Comparative Study Of Public And Private Sector Hospitals
(..)
Research Hypothesis If HR policy or system implementation is because of top managements decision then this system can be implemented any ware without discrimination If huge Financials investment make HR implementations more easy and trouble free then HR
Health Policie s
Ethnicit y
Politica l Culture
Involvement of Top Managemen t/ Owners Involvement of Doctors and Nurses Involvement of Administrati ve Staff Involvement of Low Level Employees (sweepers)
Recruitment and Selection System Work environment
Effectivenes s of Human Resource System
Compensation and benefits Structure and hierarchy Appraisal System
Medicare culture sense
Collaborati on
Cultural Openness
Motivation
Reward & Recognitio n
Effective HRS is a result of the involvement of all four possible levels in hospital system Hospital management is a teamwork effort HRM functions effectiveness is dependent upon some particular variables Positivity or negativity of these variables influence the HR management system to act as positive or negative i.e. efficient or In-efficient From the top are intervening variable Beneath the diagram are some moderating variable which support the system and facilitates the most likely positive situation to occur
Theoretical Framework
Analysis of Questionnaire
Part A
Question# 1&2
Human resource department is working efficiently in my hospital?
I know what is a human resource department wledge about human Resource Effiency of Huam Resource Department Department and what are its key functionalities ?
Question#2 detailed analysis

Doctors from Private Hospitals Doctors from Public Hospitals Managers from Private Hospitals
Managers from Public Hospitals Low-Level Employees from Private Hospitals Low-Level Employees from Public Hospita
Analysis of Questionnaire
Part B
Management recognizes individual efforts?

Doctors from Private Hospitals Doctors from Public Hospitals
Analysis
Employees from Private hospitals agreed to this notion Whereas people from public hospital most disagreed with the statement Lower level employees in both hospital has not been properly taken care off
Managers from Public Hospitals Managers from Private Hospitals
LLE from Public Hospital
LLE from Private Hospitals
Penalty system is fair and unbiased to everyone?

Doctors from Public HospitalsDoctors from Private Hospitals
Analysis
Mixed response Penalty system is unfair at all levels in public hospital as reported by respondents of confidence will be high in private hospital doctors Strongly disagreement from managers show that there has been some active case
Managers from Public Hospitals Managers from Private Hospitals Level
Reward system is unbiased?
Analysis
As we go along the hierarchical levels, we can see that the ratio of disagreement is increasing and it is highest when we come to lower levels of management. It means that top management is only concentration on upper levels and providing equal services to all levels
Selection system is just and unbiased?

Analysis
As we can see, ratio of agreement towards the statement is more in doctors and managers than it is in low level employees. And if we see cross functionally it is more in the personnel working in private hospitals rather than public hospital.
Commitment to work is rewarded?

Doctors from Public Hospitals Doctors from Private Hospitals
Analysis
In public hospitals collectively 83% of the sample population disagreed to this statement whereas in private hospitals 0% doctors said that handwork is not rewarded, on the other hand 33% of them agreed and 67% strongly agreed that hard work is rewarded But situation is more complex when we ago along the managerial levels in private hospitals. In managerial level 22% of the sample
Managers from Private Hospitals Managers from Public Hospitals
Freshness in work environment?

Analysis
Clearly private hospital is taking lead But only doctors are fully satisfied. Lower level employees still have some proportion in disagreement Public hospitals need to work a lot on changing its physical work environment
Availability of hosting services?

Analysis
Hosting services are only for upper managerial levels Lower levels in both hospitals are deprived of them
A unique answer is from administration staff in public hospitals where 100% of them disagreed to the notion that they are provided with any hosting services
Work place complaints?
Analysis
Public hospitals have more workplace complaints than private hospitals In lower managerial levels private hospitals employees also facing problems.
Policies and procedures are aligned with core values?

Analysis
Goodwill could be at stake Public hospitals are performing badly Complaints are also from managerial level and lower level managers from private hospitals It implies that there could be some fish under the carpet
Level of Ethnicity?
Analysis
Minimal in private At peak in public Dangerous level Very bad for overall efficiency
Training and refresher courses are provided?

Analysis
From both public and private sector only doctors got a chance for new knowledge Other levels are completely ignored Knowledge gap
Performance gap
Employees are motivated by management to excel in their field?

Analysis
Private hospitals motivate their employees at nearly all levels Public hospitals lack that soul in their structure
Specially lower level employees in public hospitals are totally neglected
New practices and procedures are introduced?

Analysis
After doctors from both the private and public hospitals managers from both hospitals are somewhat let to get their hands on new practices and procedures But a very minimal percentage
Could be because of their job nature
All hospitals have same culture no matter what?

Analysis
Show the monotony in employees work life Responses from private hospitals are positive than from public
Innovation is possible in hospitals?

Analysis
Knowledge and experience gap can be seen Only doctors agreed to the notion from both sides
Private hospitals employee response was more positive than publics Reason could be the knowledge environment they work in
Management Policies are consistent?

Analysis
Mixed response shows that favoritism is in the culture For some policies are consistent for some not
But public hospitals are behaving poorly Especially at lower managerial level
Employees are involved in decision making that directly affect them?

Analysis
Only doctors responded positively to this notion It means that level of autonomy is very low overall in hospital culture Less self confidence Delayed system response
Repeated error s could be some outcomes
Cross functional communication is encouraged?

Analysis
An overall heavy disagreement Less efficient work system Political structure Employee rivalry
Job description is properly communicated?

Analysis
For amusement part disagreement to this notion is mostly from private hospitals and specifically from managerial or lower level employees May take long to orient with system
Proper orientation is given to employees?

Analysis
Negative responses from public hospital Even from doctors side
New Ideas are welcome and accepted?

Analysis
Ideas are only accepted by doctors Managers and low level employees are left over Stagnant environment
Low morale
Work is properly assigned and checked?

Analysis
Only at lower levels in public hospitals Upper two levels are let go off Private hospitals response is overall positive In doctors area 17% of them strongly agreed which means that there could be a separate policy for doctors in one of private hospitals regarding work assignment
Internal Audit is done on Full scope?

Analysis
Doctors from private hospitals mostly denied this fact but other two level responded positively to the notion It means that there is a loop hole in audit done by hospital It could be because doctors them self are administrators
I am a part of this hospital and they care about what I say?

Analysis
Employee affiliation More in private less in public More in doctors than in other levels of public hospitals
What is the level of Autonomy given to employees?

Analysis
Doctors from both the sectors work in a some what autonomous environment An overall positive response is from private hospital where we can see people are responding positively at every level about autonomy
Feedback System is properly working?

Analysis
Another place where both the hospital came together in black spot Hospitals from Neither of the sector having a fully functional feedback system A little percentage of doctors said they agree. It means in one of the private hospital it could be running
Grievances are heard and properly heard after?

Analysis
Positive response from doctors and managers from private hospitals Whereas lower level employees showed disagreement
In public hospitals overall grievance handling is poor
Management is efficient in conflict resolution?

Analysis
Private hospitals management is more efficient in conflict resolution than public hospitals It shows the devotion with which management of hospital take their work
Compensations are timely claimed?

Analysis
Only managers from both sectors and doctors from private hospitals are giving a positive response to the question It could be because they are able to pull strings from within Doctors from public and LLE from both sectors are negating the notion by disagreeing
Conclusion
All the facilities are currently available only for upper managerial levels, like doctors, health care supervisors and administration staff Current hierarchical structures are not letting hospitals work efficiently Huge gap in service provided by private and pu8blic hospitals Private hospitals are more responsive than public hospitals for providing solutions to their personnel Low level employees face same situation in both public and private hospital, whereas Comparative Study Of situation inPublic And Private Sector Hospitals is worse than in public hospital
Conclusion
()
Gray Area One: Hierarchical Discriminations Certain managerial levels are bestowed with all the facilities which an HR system can offer, but at the same time a lower manger is deprived of all those facilities
E.g.. Workplace facilities are every employees right but they are only offered to doctors.
Concept of discrimination will evolve and disturb teamwork relation. Hospitals are run on the basis of collective teamwork efforts. to another it will simply effect the customer to the system which is a common
IMPACT:

If one element is Sector Hospitals Comparative Study Of Public And Privateun-cooperative
Conclusion
()
Gray Area Two: Hospital Management is a non-issue To the owners or guardians of the hospitals, management of hospital is a non issue. Its just a business of diagnosing a problem and curing it to the extent possible. Hiding themselves from the fact that now hospitals are more hybrid in nature and cater a more complex market need IMPACT:
In coming years the hospital industry is going to blank on the grounds, simply of the reason it will unable to cater the modern demands as a health care associate. now attached with
All Of Public And Private Sector Hospitals Comparative Studythe managerial functions are
Conclusion
()
Gray Area Three: Un-audited area There is no formal auditing or rigorous auditing protocol identified for hospital industry. In public sector, people do what they want to, and there is no one to ask them that how and why they are doing what they are. Auditing help people to restrain themselves from illegal activities Although auditing is done by government but its scope and strength is limited IMPACT:
This factor is weakening the hospital industry both financially and morally. Comparative Study Of Public And Private Sector Hospitals
Conclusion
()
Gray Area Four: Lack of awareness about patient rights and hospitals responsibilities Not every one coming to hospital is educated about the ethics of being in hospital Both hospital staff and patients dont know about their rights and usually cross the line and refuse other party to give due rights No Campaign is designed by the hospital to educate its employees as well as patients. IMPACT:
Chances of Clash between attendants and employees of hospital. Comparative Study Of Public And Private Sector Hospitals

Recommendations
Recommended Model: Hospital Autonomy
G e n e r a l Admin istrati ve
Recomme ndations
Recommendations
()
Administrative recommendations Training should be provided whoever runs the administration of a hospital Administration should be separated from the general medical functions Administrators must be provided with proper technical knowledge of management as to control a hospital systems in particular Like B-Tech +MBA (techno management) MBBS course could be changed to have some topic regarding regarding health care Comparative Study Of Public or certification could be management And Private Sector Hospitals
Recommendations
General recommendations
()
Cultural change is required Competency planning/management Appraisal system Control on ethnicity Training /refresher workshops for all levels Team based work structure should be promoted Physical workplace enhancements
Recommendations
()
Recommended Model: Partial Hospital Autonomy for Public Sector Hospitals
Recommendations
()
Public hospitals are generally responsible for 80% of recurrent government health sector expenditure Government therefore face the task not only of finding new resources to fund the high cost activities of hospitals, but also of utilizing existing resources more efficiently. Autonomy can both help in reducing financial burden of hospitals on governments and strengthening the efficiency and effectiveness of public hospitals Comparative Study Of Publicof Private Sector Hospitals The process And leading hospitals to an
de ti c ti n f o pi al
K D P r e y c e r i s f I s e o i n r o t m e n a r S n v M t c a r e n k u t i c e i n t v o g u a n r l s e u a o t f i o d n e c i s i o n
H F A P o u i d r s n m o p a i c i u n e t r c i s a R e s l m e t e s r I n o a n u t f r i c o r e n m a M t a i n o a n g e s m y e s n t e m
D e s i g n
m a k i n g
C P I M O A N e n o r u a n r d g t s f e a o u e o l n r r n s i o e s a z m u l o a y & s n f t c O i a E B e r A o n x g u n d t i t a e v o l T n d a i n h t i l z o M e n u a m o g a t y d h f t i e i o l a A o n s l u n t h o c n r S o i e m t c y e t r o i r o n
Recommendations
()
identification
Process of identification involves seven steps
Make a list of al public hospitals, and classify them according to the level of services they provide Estimate the sum total of government resources each hospital consume, both in absolute numbers as well as a percentage of total government
decision making
If the previous analysis indicates that: Some government hospitals are generally failing in their bid to maximize public welfare, or are doing so at high cost These hospitals consume a large share of government health budget in the form of capital infusions, subsidies and operational expense Then it can be concluded that: Public production of health in govt. Comparative Study Of Public And Private Sector Hospitals
process
After deciding to give autonomy the next step is to create enabling conditions to facilitate implementation There is a six step procedure for describing the issues, key players, resources and networks involved in a
design
D e s i g n
Overall A H P H Overall d P H orA r H e R md Overall A Reso o or P Hospital o Mr R H a i m Overall d A Decentrali c o or r P Hospital urce M R H specific s n i m Overall d A l Increase u c or o r P Hospital specific zation & M R H mob n i m Overall d A Autonomous hospital p r u c or o r Hospital private sector. t M R H specific devolution organization of hospital asP quasi i m d ilizat independent n Setting up e r u c or o r . Hospital i with M R specific h involvementOverall r n i m H ion u c o P me . Hospital governmentAand make it autonomous M H specific t board n i d Overalle A H r u c ore m r H . e R P specific n mn e Overall e d a m A Reso r u o or r P . Hospital od MR H a i t n Overalle d A m Decentrali r ore c m o r P . l Hospital urce M R H specific n o s n i t m d A m Increase l u or o r P Hospital e Overall e zation & c M R H specific mob n i mn Overall d A m pm Autonomous hospital t ore c o r . Hospital t private sectorr u M R H devolution organization of hospital asP quasi n i d ilizat independent specific t m n Setting up e r u c or o r a . Hospitale with i d M R specific h involvement m e n i t m Overall A H r u c o o . Hospital ion P government and make it autonomous n M specific t t i board H Overall m n i e d P e H r u c orA r H . e R specific m n n e md Overall m an A e Reso d r u o or r P . Hospital o MR H a i m a Overall m dt Ae e Decentrali r c o or n r P . l Hospital urce o M R H specific t s n i m Overall m d A e e l Increase i u c or o r P specific Hospitaln zation & M R H mob m n t i m d A e p Autonomous hospital r u c or n Overall m o r P Hospital private sector. t M R devolution organization of hospital asHquasi- e n i m t d ilizat independent specific Settingd n up e r u or c o r . Hospitaln i with a M R specific h H involvement m eOverall n i m r u c o P o . Hospitaln government andAmake it autonomous t ion M specific board i t H H Overall n t i e m A e d r u c orP r H . e R specific m a Reson n n em d m Overall A r u o or r P . d o Hospital e MR H a d A e c o r P . l Decentrali t ni m e or m Overall r Hospital urce a M R H s o Increase n i n m t specific e d A e l u or o r i Hospital m Overall c zation & M H specific n R e P m Overall m mob n t i m d A Autonomous hospital p r u c or o r P Hospital private sector. t M H specific n R as quasid devolution organization of hospital e t i m d ilizatn up Setting c o r a involvement e r u . Hospital with independent n i M R specific n or h n t i m me r Overall u c o P o ion H . A Hospital government and make it autonomous M H specific i t board H t i e m d A e orOverall n r u c r P e R H . m n n a n e Overall specific mmd A Reso u or e P r o r d Hospital . o MR a t n a l d A r Decentrali e i m m H e Overall or c o r P . Hospital urce M R H specific o s t n n i e m m d e Overall A Increase l u c or o r P i Hospital zation & M mob n n i m d m private sectorr specific e R m H Overall A p Autonomoust hospital u c o r . Hospital t M R H specific e or n d devolution organizationnof hospital asP quasi i m d Setting up ilizat independent t n e r u c or o r a . Hospital with i M R specific h Overall involvement m e n n i t m H o r u c o P . Hospital ion A government and make it autonomous M specific i t H Overall e m board i d P e H m r t n u c orA r H . e n R specific n n e a m d Overall m A e Reso r u o or r P . d Hospital o a MR H a e d m A e Decentralil i m r c o or t nOverall r P . Hospital urce M R H o specific s n i td m e m A e l i Increase u c or nOverall o r P specific Hospital zation & M R H mob n t or i n m Overall e d m r u m A p n Autonomous hospital c o r P Hospital private sector. t M R devolutiond e r n t i n m e d ilizat independent specific Setting up a organization of hospital asHquasiu c or o r . Hospital i with M R specific h involvement m e n t i n m r u c o . Hospital government ion And o and make it autonomous specific i e m Sector Hospitals M Comparative Study Of Public Private e board t n t i r u c . specific m n n ne a m e r u . d
Natur e and extent Auto of nomy auton and M omy healt od h el Int refor s ern ms of al Perfor A Org mance ut ani evalua on C zati tion o on criteria m se y
Overall A P H d or r R m o Hospital M i c specific n u r . e Overall A m P H d ore r R mn o Hospital M i t c specific n u r . e Overall m A P H e d or r R m o Hospitaln M t i c specific n u r . e m Overall A P H e d or r R n m o Hospital M t i c specific n u r . e Overall m A P H e d or r R n m o Hospital M t i c specific n u r . e Overall m A P H e d or r R n m o Hospital M t i c specific n

K e y n
e v e n i o n s
P H F A o r u i d s o n m p c a i i u n t r c i a R e s l m e t e s r I n o a n u t f r i c o r e n m a M t a i n o a n g e s m y e s n t e m
Key Interventions
Last Words
We suggest that an important starting point is abroad agreement between the key stakeholders on the overall mission of autonomy, and on the specific mandate of the public hospital. Just as important is a focus on results and outcomes, rather than on rules and procedures. And finally, it is critically important to lay out clear and unambiguous guidelines on the roles, responsibilities, and power of each player, as well as the sanctions to be imposed for failure to fulfill these responsibilities.
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Comparative Study Between Public and Private Sector Hospitals

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Comparative Study of Human Resource practices in Private and public sector hospitals

Members This is our team

Comparative Study Of Public And Private Sector Hospitals

New needs and wants

Reason is the introduction of new techniques, technologies and medical procedures

Comparative Study Of Public And Private Sector Hospitals

aspects resource of the public

exploring the human department hospitals and in private

Structure/ Hierarchy Management selection process and criterion

Organizations Culture, values Norms,

Findings of literature review

Findings of literature review (..)

Skill variety Autonomy Task identity Feedback Task Significance

It is understood if the first three are in the job,

Comparative Study Of Public And Private Sector Hospitals

10people from each hospital were asked to fill in the questionnaire.

Recruitment and Selection System Work environment

Effectivenes s of Human Resource System

Compensation and benefits Structure and hierarchy Appraisal System

Medicare culture sense

Reward & Recognitio n

Comparative Study Of Public And Private Sector Hospitals

Comparative Study Of Public And Private Sector Hospitals

Question#2 detailed analysis

Comparative Study Of Public And Private Sector Hospitals

Management recognizes individual efforts?

Managers from Public Hospitals Managers from Private Hospitals

LLE from Public Hospital

LLE from Private Hospitals

Comparative Study Of Public And Private Sector Hospitals

Penalty system is fair and unbiased to everyone?

Managers from Public Hospitals Managers from Private Hospitals Level

LLE from Public Hospital

LLE from Private Hospitals

Comparative Study Of Public And Private Sector Hospitals

Reward system is unbiased?

Doctors from Private Hospitals Doctors from Public Hospitals

Managers from Public Hospitals Managers from Private Hospitals

LLE from Public Hospital

LLE from Private Hospitals

Comparative Study Of Public And Private Sector Hospitals

Selection system is just and unbiased?

Managers from Public Hospitals Managers from Private Hospitals

LLE from Public Hospital

LLE from Private Hospitals

Comparative Study Of Public And Private Sector Hospitals

Commitment to work is rewarded?

Managers from Private Hospitals Managers from Public Hospitals

LLE from Public Hospital

LLE from Private Hospitals

Comparative Study Of Public And Private Sector Hospitals

Freshness in work environment?

Managers from Private Hospitals Managers from Public Hospitals

LLE from Public Hospital

LLE from Private Hospitals

Comparative Study Of Public And Private Sector Hospitals

Availability of hosting services?

Managers from Private Hospitals Managers from Public Hospitals

LLE from Public Hospital

LLE from Private Hospitals

Comparative Study Of Public And Private Sector Hospitals

Work place complaints?