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IMPACT OF HUMAN
RESOURCE MANAGEMENT
PRACTICES ON JOB
PERFORMANCE A
COMPARATIVE STUDY ON
PUBLIC AND PRIVATE
HOSPITALS

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ABSTRACT

HRM is often viewed as a mechanism for integrating human resource policies and
practices into the organization’s business strategy; and also as a more up-to-date
description, emphasizing that people are a resource to be managed just as much as any of
the organization’s other resources and that they are an asset rather than a cost. Without the
efficient use of human resources, management can never accomplish organizational
objectives. Therefore, creating and maintaining a motivated workforce is the central
responsibility of management everywhere. Management of human resources is a very
challenging job. It is not only concerned with managing people at work, but also with
managing a social system. It is a challenging job because of dynamic nature of human
element.

Human resources comprise of a large number of individuals of gender, age group,


socio-religious groups and of various educational or literacy standards. These individuals
exhibit not only similar behavior patterns and characteristics to a certain degree, but also
they have much dissimilarity. Each individual who works has his/her own set of needs,
drives, goals, and experiences and also possesses his/her own physical and psychological
traits. A person is not only a product of his biological inheritance but also a result of
interactions with his environment. Family relationships, religious influences, racial
background, educational accomplishment, and many other environmental factors affect
him/her. Among the environmental factors which influence his/her work behavior are
various organizational elements such as authority relationships; organizational goals,
procedures, rules and policies, informal group relationship, the type and manner of
supervision received by the employee and the like. The quality of an organization is, to a
large degree determined by the quality of people it employs (Gupta, 2012).

As health sector comprises of various occupations, HRM remains a challenge. As


opined by Agarwal, Garg and Pareek (2011), HRM is a planned approach to manage people
effectively for performance by providing a more open, flexible, and caring management
style so that the staff will be motivated, developed, and managed in a way that they can give
their best to support departments. And so, HRM plays a vital role in formulating and
safeguarding motivational and attitudinal aspects of the employees of health sector.

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HRM practices influence organizational performance by creating an impact on


employees’ attitudes, skills, abilities, knowledge, motivation and working patterns, (Delaney
& Huselid, 1996). The positive attitudes of employees would help them to contribute their
best to the organization. When they find satisfaction in their work, this could make them to
be committed to the organization as a result, their performance will be better.

Patient is the medium of input in a hospital environment. Nurses' satisfaction


is positively linked to patients’ satisfaction and to quality of care. Patient satisfaction is
an attitude, a person's general orientation towards a total experience of healthcare they
receive. Job satisfaction is an important component of hospital staff lives that can
impact on patient safety, staff morale, productivity and performance, quality of care,
retention and turnover, commitment to the organization and the profession with
additional replacement costs and further attempts to hire and orientate new staff .

Satisfaction like many other psychological concepts, is easy to understand but,


difficult to define. Priorities are necessary in hospital settings. Just because a doctor has
been employed by the hospital for many years, it does not mean that his patients, lab work
or demands are any more important than those of other doctors, or other members of the
staff.

The HR departments in various healthcare organizations have implemented several


functional changes by conducting a detailed review of the operations. Of these, talent
management is of paramount importance. Hence, attracting and retaining the much-needed
talent and preventing them in search of better opportunities remain a major challenge for
HR professionals in the healthcare sector. Considering the prevailing realities the healthcare
organizations must give talent management a top priority. They must attract and retain
qualified staff to ensure quality care. They must constantly monitor their employee’s value.
They must source and develop talent carefully, keeping employees engaged and committed,
while removing underperformers. And they must ensure that every manager in the hospital
system understands the rules of engagement and embraces a leadership role in talent
management.

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At this backdrop, the major research problem investigated in the study was gathering
information about the employees of both public and private sector healthcare service
providers in India for finding out the major effects of perceived HRM practices leading to
job satisfaction giving the outcome of organizational commitment, citizenship

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behavior & job performance as well as to measure the effect of employees’ job
dissatisfaction on negative word of mouth communication, for the formulation of
future HR strategy.

This study seeks to address these following research questions:

• Are the functional causal factors of employees’ perceived HRM practices and its
effects in the healthcare service environment found in existing body of knowledge
replicable while comparing public organization with private one?

• What is the nature and strength of relationship between HRM practices adopted and
employees’ job satisfaction in hospitals?

• How job satisfaction affects in reverse direction for spreading negative word of
mouth communication?

• What is the role of employees’ quitting intention in establishing the relationship


between job satisfaction and negative word of mouth communication?

• Do levels of employee perception on HRM practices and job satisfaction differ


based upon employee profiles and service provider types?

• Are there any relationships exist between job satisfaction, organizational


commitment and citizenship behavior?

• Does a suitable HRM practice in hospitals create an improvement in job


performances?

Based on the review of research articles and analyzing the gaps in the research, this
study intended to achieve following specific objectives derived from the broader purposes:

• To investigate the link between HRM practices & job performance by examining
employees’ job satisfaction, organizational commitment, organizational citizenship
behavior in both public & private sector hospital in India.

• To examine and compare empirically, the impact of human resource management


practices on employees’ job performance between public & private sector hospital in
India.

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• To find out the mediating role of employees’ quitting intention in the relationship
between job satisfaction and negative word of mouth communication.

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Chapter -1

INTRODUCTION

1.1 The Prologue


Human being is the superior most creation of Almighty because they can think,
perceive, react and dynamic. Therefore human resource if can be channelized effectively with
purpose it can cause wonders . Management of such resources to achieve goal in any
organization herculine task and remain ever challenging. Utilization of such resources
specially in organization like hospitals where life and death situation cause lot of stress in all
category of personal ever more challenging. The challenges multiplies due to first changing
medical technology and extending geometrical proportion to match human resource
continuously. The scenario of such challenges do different in public and private hospital.

Human Resources are the backbone of an organization. Human Resource Management


is a way of thinking about the people who works in the organization. It also adopt the new way
of thinking a how these employees should work to be more productive. Now a days it is
accepted at employee as an as set of the organization to achieve the organizational goal.
Human Resource Managers recognized the investment in plant machinery is having same
value as the investment in human resource. HRM can be effective of every staff identify his or
her potential & contribute his potentialities towards the growth survival of the organization in
a competitive world (Goyal, 2005)

The need o HRM is felt in order to accomplish the organizational objectives through
people. The objective of HRM is to ensure organizational success through competent
workforce this can be possible if the organization performs all HR Practices such as
recruitment, selection, performance appraisal, training & development talent acquisition &
Management, career planning, motivation of employees, leadership (Gupta 2012)

The organizational objective can be achieved through the motivated workforce. The rapid
increase in globalization has created competitive environment which requires motivated, skilled
workforce to service these competition markets. Organizational flexibility is also required for

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survival casement satisfaction & retention of skilled employee in the organization these it is now
very challenging aspect for HRM to retain the highly skilled & multiples compete
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lies employee than in the past. Employee commitment and loyalty to the organization is also
vital for the productivity of the organization it is challenging a problematic for human resource
Management. It is a challenging job because of dynamic nature of human element.

Human resources comprise of a large number of individuals of variance gender, age


group, socio religious, socio economic groups of diversity in educational qualification. Each
individual who works in the organization is having various needs, goals. Attitudes, experiences
psychological traits, thus each individual is not having similar attitude to accept the work in a
positive manner & shows the commitment towards the organization- all individuals working in
the organization are having some characteristics similar to some extent but also having
dissimilarity in traits A person is a social being. So apart from biological inheritance he/she is
also needs interactions with environment to exist. A person behavior is the impact of his family
background. Educational qualification, experience, religious influence etc & also influenced
by the various organizational elements such as authority relationship, leadership informal
relationship. Supervision, organizational goals, policies. The quality of the organization
depends upon the quality of talent acquisition by the organization (Gupta 2012)

The goal of HRM function is to create work environment which recognize the
employees which in return receive recognition & Praise (Roth & Chifton 2004). The goal of
HRM is to create an environment where staff development & continues learning will be
carried out to provides support the organization’s mission. Most high level managers always
prepare the strategy to retain the employees for a longer period.

High commitment HR Practices affect employee commitment includes. “Staffing,


development, performance appraisal, competitive and equitable compensation, comprehensive
training development activities” (Whitener, 2001,P. 517)

Considering the substantial cost associated with tern over employer need to implement
HR practices reduce turn over as much as possible.

& Strong belief on organizational goals.

& Willingness to perform on behalf of the organization

& Desire to become the member of the


organization (Porter et al, 1974)

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Highly committed people are generally engaged in more citizenship behavior a shows
higher job performance in the organization (Taros 1997)
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Steers (1977) found that organizational commitment is strongly and positively related
to intent to stay in the organization. These it is negatively related to turn over intention.

Intention to quit is the psychological process that an individual thought of due to job
dissatisfaction, not receiving the desired outcome it is the last step to actual quitting & before
reaching this step an employee might have come across several decisions to reach at this level.
Low levels of job satisfaction, work environment, work cultures, lead to the initiation of the
thought process.

All turn over are not bad for the organization. It is a natural part or organization
operation, turnover provides opportunity to hire more talented employee having now ideas.
Skills, experiences, attitude a personalities. It also help to replace the Non productive worker
with more productive worker. There are many causes with are potential for turnover & are
related to HR practices. They are poor supervision, high stress, low pay, in adequate training
no chances of development, poor communication practices (Mushrush ,2002), thus leader must
have good communication & line of supervision with the subordinate so that they can easily
address the above issue in consultation with HR Manager before an employee get frustrated &
take decision to quit.

It is found that satisfied employee have better health and live longer .lesser anxiety
which encourage them to be more creative committed and productive & this is also required to
form a good environment in this organization. These it is beneficial for society as a whole. A
satisfied worker cab be more productive due to less absenteeism, more commitment, positive
attitude towards work, good work cultures, enthusiastic, optimistic, less medical cost. Goal of
high job satisfaction for employees can be explained tin terns of bath financial and social
responsibility (Robbins,1998)

Job satisfaction has been defined in a numerous ways.

Vroom (1964) defined job satisfaction as the positive attitude of an individual towards the role
which he/she is playing in the organization.

Hackman and Oldham (1975) Define the degree to which an employee is satisfied with his
job.

Cherrington (1994) researcher found two aspects to understand the job satisfaction i.e fact
satisfaction & overall satisfaction.

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Organization commitment is a psychological construed of an employee which bound


him to became a member of the organization.(Mathieu & Zajac ,1990)

Organizational commitment is the strength of a individual his involvement in a specific


organization. It can be characterized by three factors:

Role of people which is very vital for the accomplishment of organizational goal
performance of the employees required to sustain in the competitor market researcher focuses
in developing human resource management. The employees performance is complex and
demanding employees need to understand what he expect from the employees and the
employees should understand his job what to perform satisfaction commitment, and working
Environment is the pioneer of the discuses of the organization past review underlined the
significance of having incredible quality open can undermine partners certainty poor HRM
practices can be the significant reason for and poor practices are not likewise helpful for
creating and supporting cheerful job satisfaction job satisfaction can be full of feeling reaction
to the employment either completely worldwide Fulfillment or as to specific perspective i.e
pay supervision and so forth (Tett,meyer and jahn 1993).

The most essential variables that decide the employee satisfaction is the satisfaction
with pay as found by (wallac and schwab(1974) reported that it is positively related to
expectation of pay for the work done job satisfaction is directly or indirectly related to
enhanced in work performance, lower rates of absenteeism high level of employee motivation
lower the turnover(Bagley & Czajka,1993,Tharenael 1993) an individual principal choice of
employment can help to give meaning to his own existence & take care of daily life. So, if this
is poor satisfaction an individual will search for other opportunities for his existent 7 satisfy
basic need.(Hackman & Oldham 1976).

Subsequently the care service market focuses on buyer than seller (Lee, chen, chen and
chen,2010) with the developing rivalry and progressively business condition there lessening in
capacity to understand and future anticipate of environmental requirements of organization.
Organization needs employees who will move beyond the desired expectations.

(Morrison,1994 as litedin sahafi, et al 2013)

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The peculiarity of health care system has increased the requirement of OCB hospital
need to train the employees to put effort to discharge the duties efficiently & also to put extra
effort where & when required by the organization citizenship behaviors is most required and
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more essential in hospital as patients require unique care & positive behavior of medical & non
medical professional working in the hospital OCB has play the role to strengthen morale and
betterment of patients (Mardani –Hamole and Heydari ,2009) research proves that citizenship
behavior help to achieve organizational goal through improving performance of the employees
in the hospital (clue et al 2005) OCB will help to increase service efficiency, support as client
satisfaction.

Human resources are considered as capital to an organizations as it is encompass with


abilities, skills, talents, motivation, personalities, with lead to outcome of various
performances required for the organization .Due to the crucial performance management can
serve the very purpose by standardizing leadership across the organization, codifying best
practice and establishing minimum levels of leadership activity. It forces leaders to
communicate regularly with their employee which is a direct factor in developing and
improving the trust that has a tremendous impact on business success.

Moreover the growth, development and expansion of the organization is highly


exceptionally subject to their performance. The performance management system should address
both the task that need to be accomplished and the approaches on behaviors that the company
wants its employees to use. It should enable supervisor to prioritize work and recognize top &
bottom performers. It should build on a set of strategic goals and objectives that clearly
consistently cascade to the operational team and individual levels. At minimum leaders must be
able to clarify inspections, set objectives, identify goals, review result & provide feedback. The
performance management. Process should also allow supervisors to adjust objectives based on
changing organizational priorities and resources, and to directly address employee professional
development, critical because continuous bearing is key to improving performance.

These days health care organization confront comparative rivalry challenges like other
institution i.e bank, telecommunication, insurances etc. where client demanding for superb
quality services at competitive prices and conveyed with Politeness & courtesy .they are more
demanding to get good hospitality services at competitive prices. Health care institution is now
patient centre, where emphasis is on customer oriented marketing (Chao Chan, 2011). Because
a Specialist has been employed utilized by the hospital for a long time, it does not imply that
his patients, lab work or demand are any more important than those of different specialist of
different individuals from the staff.

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The HR Department in different health care organization have executed a few functional
changes by conduction review of operation. Of these talent management has fundamental
significant these attracting, retaining the talent and avoiding them looking for better opportunities
become a major challenge for HR professionals in the health care sector. Thus considering the
overreaching realities the health care organization must give priority to the talent management
rather than traditional Hr Practices they must pull in and hold qualified potential &
efficient staff to guarantee quality care. They must Monitor & evaluate the employee’s
competency to screen their values, they must ensure that every manager in the health care
sector should promote the leadership role in talent management.

Leaders must create a vision, motivates their workforce identify and remove obstacles
and create and sustain high performing teams. They must be able to resolve conflict and drive
cultural change. They must be able to clearly communicate to organizational priorities. the
reasons why those priorities are important and expected outcomes if those priorities are met on
conversely if missed. They also had standardized tools & procedures to ensure equity and
fairness across the organization.

The various factors i.g. the nature of relationship with their supervision the quality of
physical environment in which they work, the degree of satisfaction of the work, association
with the supervision & Soon.

It is important to notes that job satisfaction has a correlation with the performance of an
employee. The job satisfaction & Productivity might be impacted by various variables that is the
reason it is portrayed that happy. Satisfied worker is more productive. The connection between job
satisfaction and performance is consequence of Relationship between Leads. & Subordinates so.
The level of interaction shows the degree to Which an individual is satisfied with the job. There are
other factors with influence job satisfaction are the style. Self governance in work empowerment,
Culture, involvement in work. When one sees at the work life of medical Professional is shows that
the duly performance of such persons affect their private Life.

Patient is the medium of contribution to a hospital nurse’s satisfaction is empathetically


connected to patients and to nature of care. Patient satisfaction is a state of mind, man’s
general orientation of human services a experience from health care services job satisfaction is

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a vital segment of hospital staff experience that can effect on patients safety, security, nature of
a care maintenance & Turn over ,commitment to the organization, staff spirit, productivity and

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performance and the profession with extra replacement cost and future Endeavour to contact
and orient new staff.

Satisfaction like many mental ideas is to understand but difficult to characterize it.
Needs are necessity in hospital sitting base to the organization, subsequently their performance
will be better.

India has been in the cutting edge of different global developments in the health. In
general the Indian health care industry is experiencing a more and going to see huge changes
in the way of health care and role of different players in the business. The social insurance
benefit situation in India is required to advance into more created stage. With this more
management of human resources in health is a major challenge to health system development
in India. This leads to the planning & utilization of health care personnel in an effective
manner to face all the critical situations & future upcoming threats.

Today the organization is confronting real difficulties regarding employee retention.


Changing consumer inclination, work force difference, cross cultural interactions innovation,
technological threats, still competition, changes in government policies. The need of great
importance is making groups and cultivating multi skill & abilities among them while keeping
up high values of accomplishment .sound organization climate leads to the prompt work
fulfillment of the employee in the organization. Satisfaction of a person from the job is viewed
as one’s emotions or perspective with respect to the nature of the work assigned. According to
locks (1976) job satisfaction is a condition of feeling while at the same time performing the
assignment. Job satisfaction is influenced by job satisfaction is commonly identified as
multifaceted term which comprises of intrinsic of element of job. Intrinsic job satisfaction
elements are derived from career development. Work itself and the various opportunities for
growth. Development where as extrinsic Job satisfaction elements are derived from
compensation, work recognition reward. Relationship is co-workers .supervision (spector,
1997) Like employee satisfaction, customer satisfaction is also key element to retain customers
as well as retain employees in the organization. job satisfaction in staff nurses should be of
great concern to any health service organization (Branon,1990). Job satisfaction is concerned
to personal attitude and commitment of the employee to the organization.

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Porter et al(1974) defined organizational commitment as a strong belief in and


acceptance of goals .objectives of the organization and readiness to put effort for the
accomplishment of organizational goals as well as the strong desire to become member of the
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organization. Employees whose needs are satisfied by the organization are more committed the
organization (kabenel etal 1977).

Commitment emphasizes the attachment to the organization and satisfaction emphasized on


the outcome from the specific job assigned to him (Mowday,steers & Porter1979)

HRM practices impact in organizational performance by making an effect on employee


inspiration. states of mind , ability, aptitude, motivation( Delaney and huselid 1996), When an
employee find satisfaction in their work they become more committed to the organization &
develop positive attitude which help them to contribute the scope of HRM is very wide. It is
concerned with organizing human resources in such a way that talent of employee can be
maximum utilized in the workplace ensuring personal satisfaction. Those HRM considers
economic, social, psychological, problems of peoples at work (Acqinas, 2011)

An attitude is inward feeling of an individual which is expressed by his behavior; it


comes out from feeling to action through his behavior. Attitude is like the minds paint brush
which colours every aspect of his life. Human behavior is directly affected & Influence by the
attitude of an individual. Every human being is having various viewpoints. Need from this
work assigned to him. They have different attitude towards their job career & organization.
Positive attitude toward the job makes an employee more productive. Career oriented more
committed towards the accomplishment of organizational goals. The most focal employee
attitude is closely related to its job satisfaction of the employee (waters & Roach,2003)

Job satisfaction is an attitude or mental feeling of favorableness of an individual about


his job. It is the pleasure on contentment associated with a job. An employee can be satisfied if
he compares the desired out come with the actual outcome.

The human resource specialist will be looking for the administrative aspect of people
management in the other side he/she will be involved in the business planning process. His
role is very vital in the business planning process as without human resource they strategy has
no value. The objective of HRM, Therefore are many and varied from different.

1.2 Research Problem and Research Questions


The Human Resource Management is the process of facilitating people to acquire
competencies and capabilities for the present and expected future roles. It not only develops
the individual capabilities but also unveils and taps their hidden potentials, further developing

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themselves and their organizations. The needed personal competencies would include
knowledge, attitude, skills and values.

Higher organizational effectiveness, machines, technologies, procedures and systems


are no doubt important; but what is more important is the quality of the individuals behind
them. Managing the human assets in any organization, be it hospitals or otherwise, is a far
more difficult proposition than managing the other physical and financial aspects. All
organizations, whether big or small, manufacturing or service-oriented, profit or non-profit
making, are basically human organizations. Hospitals or healthcare institutions are not
different from this and are very much dependent on their human resource. Managing qualified
human resource is a key to success and healthcare, as a labor-intensive sector, is bereft with
problems. Human resource plays a significant role in the effective performance of a hospital.

Organizations need to build on the existing competencies of the employees so that they
would continue to provide high quality services keeping abreast of the ever changing needs
and newer challenges. HRM in the hospitals entails specific roles and activities that would
garner the power of people and intensify their motivation. While doing so, HRM in hospitals
persuades them to reach fulfillment in and through work and leads them to achieve the goals of
the institution. To a great extent, success of a hospital depends on the quality and work efforts
of its personnel. Hence HRM is of critical importance in the efficient functioning of hospital.
Many researchers conducted their researches to determine the relationship between
Human Resource Management (HRM) practices and Employee Performance in developed
countries but few studies have been conducted in developing countries like India. Again, in
India, most of the empirical researches in this area have been done in the industries like,
banking, insurance, telecommunications, steel, textile, etc. There exists very less evidence in
the service sector like health care industry. From the study conducted by Hassan. S, 2016, it
was found that HRM practices like, Compensation, Career Planning, Performance Appraisal,
Training, and Employee Involvement have a positive impact on employee’s performance.
Hence, it is proved that independent variables contribute positively towards change in the
dependent variable. HRM practices like recruitment, selection and compensation strategies
have positive correlation with employee performance (Mohammad A H et al, 2014).

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HRM practices that are under the control and responsibility of supervisors and managers,
have positive impact on job satisfaction and organization performance (Begum F W et al, 2016).
Job satisfaction and organizational commitment are the leading issues in Human Resource

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Management, Psychology and organization oriented studies. Both the attitudes are mutually
interrelated and interdependent which influence each other (Rehman K, et al, 2013).
Organizations are mostly interested in retention of employees. This need of organization
makes job satisfaction and organizational commitment as more interested concepts to judge the
behavior of employees who are essential for the organization. Job satisfaction and
organizational commitment are the important concepts that determine the attitudes of
employees at the workplace ( Shah F T, et al, 2014). At present, the study on the relationship
between job involvement, organizational commitment and organizational citizenship behavior
are of major issues in hospital sector. Study done by Saxsena S, et al, 2015 found that there is a
significant impact of Job involvement and Organizational commitment on organizational
citizenship behavior. The results of the study showed that organizational citizenship behavior
significantly predicts job performance in healthcare organizations. However, social capital
found to be a significant mediator between organizational citizenship behavior and job
performance (Basu E, et al, 2017).

The process of effective people management is nothing but cultivating effective work
environments, enhancing employee participation and contribution to the organization's success
(Begum F. Wahidha, et al, 2016). Very less research studies have been conducted till today on
the relationship between HRM practices, job satisfaction, and employee performance in a
service sector of India. Furthermore, little research evidences are available which compares the
perceptions employees working in both public and private sector hospital industry.

Due to rapid changes and modifications in the business environment, consisting of


globalization and different technological innovations, the traditional strategies of competitive
advantage are not enough for success in today’s situation (Savaneviciene A, et al, 2012 ). The
increasing rate of competition in healthcare industry therefore requires the development of
internal potential, and for this, greater attention is to be given in hospital business systems
emphasizing that employees enable these systems to operate. Hence, human resources and
their management has become the vital managerial aspect in achieving sustainable competitive
advantage. Very less research studies are done in Indian healthcare business systems, in which
this type of analytical investigations is properly done.

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The major concern should go towards the goal of competitive advantages through the
higher level of employee perception about HR polices and their positive mindset. Therefore, it is
the need of hour in Indian hospital industries, to properly understand the reasons of employees’
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intention to quit from present organization and their mentality of spreading negative word of
mouth. Most of the private hospitals do not feel the good results of properly managing its
human resource and therefore leave policies to line managers and board of directors to handle,
who are in fact non-HRM experts to implement HR strategies, policies, processes,
programmes and practices. The worth of properly human resource management practices is
therefore lost in private hospitals of India and its impact on employee morale and
performances may take reverse turn.
At this backdrop, the major research problem investigated in the study was gathering
information about the employees of both public and private sector healthcare service
providers in India. The major effects of perceived HRM practices leading to job
satisfaction have to be analyzed in health care sector. The validity of the outcomes of job
satisfaction, like organizational commitment, citizenship behavior & job performance
are to be analyzed. Again, the effect of employees’ job dissatisfaction on negative word of
mouth communication, for the formulation of future HR strategy in health care sector
have to be studied.

This study seeks to address these following research questions:

• Do levels of employee perception on HRM practices and job satisfaction differ based
upon employee profiles and service provider types?
• What is the nature and strength of relationship between HRM practices adopted and
employees’ job satisfaction in hospitals?
• How job satisfaction affects in reverse direction for spreading negative word of mouth
communication?
• What is the role of employees’ quitting intention in establishing the relationship
between job satisfaction and negative word of mouth communication?
• Are there any relationships exist between job satisfaction, organizational commitment
and citizenship behavior?
• Does a suitable HRM practice in hospitals create an improvement in job performances?

1.3 Relevance of the Study


Hospitals, as one of the healthcare organizations face continuous pressure to become
productive and innovative and to provide quality healthcare. As new diseases are outburst,

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umber of patients is increasing day by day. It is imperative to have sufficient number of nurses
and they have to play an efficient role in the hospital.

High level of efficiency is evinced from the way the professionals are treated in any
institution. Many studies in the past prove and demonstrate that often they are not taken care
well in the hospitals. They undergo much of personal and professional stress. Carrying heavy
patient loads while lacking sufficient autonomy to implement procedures and make decisions
is an experience of frustration for them. Frequently nurses feel that they did not have the skills
or knowledge required of them to face difficulties like higher workloads. Frustration in the job
and difficulty in dealing with stress cause personal and professional discomfort. Nurses appear
to be leaving the hospital in search of less stressful environs with better schedules. As the
threat of a nursing shortage looms ever larger, employers, policymakers, and researchers alike
are interested in learning how nurses could be retained in the workplace.

HR department of the hospitals aims at achieving better job attitudes of nurses. They
adopt various HRM practices such as recruiting the best candidate, updating their knowledge
and skills by providing them proper and adequate training and offering them monetary and
non-monetary rewards in the Hospitals. These practices can improve their attitudes towards
job. Better attitudes towards job are expressed in job satisfaction and organizational
commitment. If they have better attitudes, they are motivated to have better job performance.
Their commitment increases. Better job performance boosts the reputation of the hospital, as
well. Therefore, this is an abundant responsibility of the HR management to ensure a high
level of satisfaction of nurses.

Chennai is a city with many private hospitals that have well-established HR


departments. They have well qualified HR managers, who devise and design suitable HRM
practices for the various groups of hospital personnel like doctors, nurses, administrative staff,
maintenance staff and the like. Therefore, it is crucial to analyze the nature of HRM practices
framed and adopted by private hospitals in India, specifically for nurses and doctors. The
extent of the impact of the specific HRM practices such as recruitment and selection, training
and development and reward and benefit on job satisfaction and organizational commitment of

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the hospital employees was the main area of the present study. The study has also attempted to
probe into the outcome of such impact on both job performance and intention to quit the job.

Healthcare is a process involving constant interaction with patients. As such the hospital
employees are actually sensitive to the working conditions and morale, and this ultimately
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affects the quality of service provided by them. A systematic and comparative study on
relationship between HRM practices and Job Performance in two best public and private
hospital of Odisha in this context is expected to be of great help to policy makers in
formulating guidelines for human resource management in hospitals. It would also be useful to
the HR managers in the effective implementation of various HR policies in both public as well
as private hospital industry which will increase the productivity and satisfaction of the
employees and benefit the management, which eventually will work to the advantage of the
end—users — the society as a whole.

1.4 Present Research Study Objectives


Based on the review of research articles and analyzing the gaps in the research, this study
intended to achieve following specific objectives derived from the broader purposes:

• To investigate the link between HRM practices & job performance by examining
employees’ job satisfaction, organizational commitment, organizational citizenship
behavior in both public & private sector hospital in India.

• To examine and compare empirically, the impact of human resource management practices
on employees’ job performance between public & private sector hospital in India.

• To find out the mediating role of employees’ quitting intention in the relationship between
job satisfaction and negative word of mouth communication.

1.5 Conceptual Model and Formulated Hypotheses

HRM Organizational
Job
Practices (IV) Commitment
Satisfaction
(MV)
(MV)

Job Organization
Citizenship
Performance
Behavior (MV)
(DV)

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Fig. 1.1 (a): Proposed conceptual model showing the effect of HRP

Based on past literature review, in the current research study, an integrative conceptual
model was proposed to assess the impact of human resource management practices (HRP) and
job performance (JP), [Figure1.1 (a)]. This model consists of human resource management
practices taken as the initial independent variable and job satisfaction (JS), organizational
commitment (OC), organizational citizenship behavior (OCB) & job performance (JP) as the
outcome variables.
Again, another proposed model was also taken showing the relationship between job
satisfaction, negative word of mouth communication (NWM) and employees’ intention to quit
(IQ), [Figure1.1 (b)].

IV: Independent Variable, DV: Dependent Variable, MV: Mediating Variable

Intention to Quit
(MV)

Job Satisfaction Negative Word of Mouth


Communication
(IV) (DV)

Fig. 1.1 (b): Proposed conceptual model showing the mediating effect of IQ.

H1: Human resource management practices exert a significant impact on employees’ job
satisfaction in healthcare sector.

H2: Job satisfaction is having a significant impact on organizational commitment.

H3: Organizational commitment has a significant impact on organizational citizenship behavior.

H4: Organizational citizenship behavior creates significant effect on employee job performance.

H5: Human resource management practices exert a significant impact on employees’ job
performance.

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H6: Employees’ job satisfaction has remarkable influence on negative word of mouth
communication.
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H7: Employees’ job satisfaction has significant effect on quitting intention of hospital
employees.

H8: Intention to quit of hospital employees has significant effect on negative word of mouth
communication.

1.6 Research Methods and Design


For the purpose of the study, two best performing hospitals of Odisha state in India, namely
SCB from public sector and SUM from private sector, were selected and the respondents were
selected on the basis of stratified random sampling. In the first stage of sampling, all the employees
of hospitals were stratified base on their current position and then within each stratum, sample
employees were randomly selected referring random number table. A total of 484 sample
respondents (261 sample respondents from public sector hospital i.e. SCB and 223 sample
respondents from private sector hospital i.e. SUM) comprising of doctors, paramedical staff, HR
and administrative staff from different departments were selected for this study. Initially 600
samples were planned covering 300 employees each of both private and public sector hospitals.
Because of less accessibility to employees, unwillingness of the employees to provide data, time
and budgetary constraints restricted the sample size to 484.

A structured questionnaire was used to collect data from the sample respondents having
measurement scale items derived from past literatures (Tsaur and Lin, 2002; Babin and Boles,
1998; Mowday et al, 1982; Podsakoff and Mackenzie, 1994; Williams and Anderson, 1991;
Moorman and Blakely, 1995; George and Jones, 1997; Fiedler, 1993), whose detail description
is given in chapter 3. All of the measurement scale items under all dimensions of the study
were first tested by checking their validity and reliability, and finally the modified survey
instrument data were taken for final data analysis. All data were collected with respect to all
scale items in a 5-point Likert scale, ranging from 1 indicating strongly unfavorable response
category to 7 indicating strongly favorable response category.

The data was collected both from primary and secondary sources. The primary sources
include data collection through the use of structured questionnaire and interaction with key
personnel of both the hospitals. The data from the secondary sources include research journals,
books, magazines, websites, etc.

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-15-
e data collected through survey instrument were entered into an Excel spread sheet and
then transferred to SPSS-20 data sheet for further processing. Cross tabulations were made to
understand the underlying relationships among the variable under study keeping the broad
objectives in mind. Statistical tools like chi square test, paired sample t-test, one way ANOVA,
simple and hierarchical regression analysis, etc were used to test the formulated hypotheses
and draw some other important findings. Finally, for structural equation modeling purpose,
Amos-17 software package was used. Structural models were developed and tested on the
basis of Confirmatory Factor Analysis (CFA), after studying measurement models.

1.7 Scope and Limitations


While this study proposed to investigate the relationships between various aspects of
HRM practices in healthcare service sector and employees’ job satisfaction, constructs such as
organizational commitment, citizenship behavior, and job performance, etc., the moderating
effects of different socio-economic profiles and employee life style on these above mentioned
relationships were not specified in the model. As is common in the literature, this study
assumed the predefined relationships among the study variables and analysis was done
accordingly. This study looked at the functional and psychological aspects of hospital
employees in maintaining their job and delivering medical services to the public.

The sample for the study was 484 employees of two hospitals located in two cities
only, which may not be a proper representation of the population. Because of paucity of time
and cost, the study was done with a small sample base, hindered the generalization of the
results. Though the samples were selected through a random method, but due to non-
cooperation from the respondents, finally data were collected from respondents selected
through purposive sampling to represent the customers in age, sex, education, and occupation
variations. Most of the data were collected from hospital employees during their work
delivery, and that is why respondents could not perfectly internalize the importance of the
survey. Similarly, the conservative attitudes of the female and aged respondents created
inappropriate data content of those groups in the sample. Lack of earlier researches in this field
in Odisha state, restricted the scope and direction of the present study.

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1.8 Summary

In this chapter, the major objective was to highlight the importance of healthcare service
company operations in general. At present, in India, healthcare industry has been growing over
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the years. This chapter also discussed about the need of changes in the context of modernization of
HRM practices and its impact on various aspects of hospital employees. Such impacts indicated
about the broad research problem for investigation. The section delineates the relevance of the
broad research problem and establishes its significance. While having the broad problem into
consideration the effective scope and limitation of the study was also highlighted in this section.
The section delves into various research models existing and proposed conceptual model for the
research. The conceptual models guide the formulation of the various hypotheses taken in this
study. Eight distinct hypotheses could be derived to be tested. The methods and design of research
adopted in the study was also discussed in this chapter.

1.9 Thesis Structure


This thesis is fragmented into following chapters as mentioned below:

Chapter-1 deals with introduction to the topic under investigative analysis, broad research gap
& problem, significance of the study, research study objectives, conceptual model, formulation
of hypotheses, research design and methods adopted, scope and limitations of the study, and
various operational definitions of study constructs.

Chapter-2 delineates a through past literature review related to the present study.

Chapter-3 highlights about survey instrument design & measurement scales used for all the
variables under study along with its reliability and validity tests.

Chapter-4 discusses the conceptual framework and theoretical bases for all the variables used in
the final study.

Chapter-5 presents an evolutionary scenario of growth and progress of Indian healthcare


service industry. It also discusses about the two major hospitals taken for the study.

Chapter-6 describes all types of descriptive frequency data analysis and interpretation, details
about the inferential statistical data analysis and interpretation of the various tests conducted
for different hypotheses as outlined in the previous chapters, and finally the results of
investigation of model building for the study, validated through structural equation modeling.

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Chapter-7 presents the summary of findings, managerial & policy implications and future
direction of research.

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hapter-7

SUMMARY AND CONCLUSION

7.1 INTRODUCTION

This study addressed several issues in the work environment as they relate to two
national level hospital units established at Odisha state of India; one was of public sector and
the other one was of private service providers. Previous studies involved analytical
investigations on study components of this research and in different business settings. In
reviewing other studies for this analysis, there appeared to be an absence of discussion when
describing the relationships between HRM practices, employee job satisfaction, employees’
organizational commitment, employees’ behavior of organizational citizenship, and job
performance with the organizations in large public and private healthcare service sectors with
different types of employee cadres and functional departments.

Human resource management (HRM) practices are the essential factors for improving
employee performance in healthcare industry (Gile P. P, 2013). It has received substantial
attention in recent research activities. There is a urgent requirement to develop systems
approach of evaluating the structural and process dimensions and apply comprehensive model
to analyze the relationships between strategic HRM and employee performance at micro and
macro level. An effective implementation of suitable and timely HRM practices not only
improves employee performances in hospitals, but also enhances the level of patient
satisfaction in long run (Elarabi H. M, et al, 2014). Basically HR practices like recruitment and
selection of staff members, training and development of employees are found to be major
predictors of organizational performance in healthcare industry (Hameed S. A, et al, 2016).
Top management team members of hospitals should develop appropriate human resource
policy and emphasize on proper human resource practices to have higher level of employee
satisfaction and build effective human resources (Rahman M, et al, 2103).

Specifically, the purpose of this study was to determine the affects of HRM practices for
hospital employees on employees’ job satisfaction, employees’ commitment, citizenship behavior

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and performance in two different set ups, public and private organizations. Further, the study also
checked if the differences in the opinions of different employee profiles in relation to all study
variables exist. The three employee types taken in this study were: (a) doctors, (b)
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paramedical staff, and (c) administrative staff. Employees’ experiences were also taken into
consideration in both public and private hospitals. Again, the presence of mediating role of
employees’ quitting intention on the relationship of job satisfaction and negative word of
mouth communication was investigated separately for public and private hospital employees.

A 77-item survey instrument was initially considered in order to analyze the required
relationships among different study variables. All the items for measurement were extracted
from past literatures (Tsaur and Lin, 2002; Babin and Boles, 1998; Mowday et al, 1982;
Podsakoff and Mackenzie, 1994; Williams and Anderson, 1991; Moorman and Blakely, 1995;
George and Jones, 1997; Fiedler, 1993). Then statistical techniques were used to determine
validity and reliability of the measurement scale items. From these analyses, almost all the
dimensions’ scale items got reduced except HRM practices.

Data used for the study were collected through an employee opinion survey conducted
in the beginning of year 2016, by personal contact approach at two hospitals, SCB (public) and
SUM (private). Employee participation was on convenience time and voluntary. The final
sample sizes of SCB and SUM were 261 and 223 respectively. Employees completing the
survey were also asked to respond about their employee cadres and other profiles.

This research study was somehow exploratory in nature, done in the state Odisha of
India. The study was mainly based on field survey covering two major hospitals located in two
cities of Odisha state. The sources of data were mainly primary. Data were collected through
one tailor-made questionnaire, with a view to measure the perceptions and attitude of
employees about the study variables. Respondents (employees) were asked to give their
opinion on a five-point Likert scale.

The data collected through fully tested instrument were processed through SPSS-20
and Amos-17. Cross tabulations are made to understand the underlying relationships among
the variable keeping the broad objectives in mind. In order to test the significance of the mean
differences of two variables, paired sample‘t’ test was used. Then, to know the existence of
variance in outcome variables of study, one way ANOVA technique was applied. Further,
regression analysis was primarily used for testing of formulated hypotheses. Lastly, through
structural equation models the complex relationships among various variables of the study
were investigated.

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7.2 Major Findings

One of the major and significant contributions achieved in the present study was the
combination of all relationships as they pertain to HRM practices (HRP), job satisfaction (JS),
organizational commitment (OC), organizational citizenship behavior (OCB), intention to quit
(IQ), negative word of mouth (NWM), and job performance (JP). The present study found few
strong and little poor relationship throughout the model in most of the hypotheses tested, while
analyzed separately for public and private hospital employees. However, in overall, except the
relationship between HRP and JP, all others were found to be significant. At this backdrop, the
followings were the major findings of the study as perceived by the employees of both public
and private healthcare service providers.

& Most of the sample respondents were from age of 21 years to 40 years, having job
experiences of 3 to 6 years.

& Employee qualification and joining status play no role in choosing public or private
hospitals to work with. However, experience maters a lot.

& Employee perception on HRM practices was found to be higher in public hospitals as
compared to private hospital.

& However, in private hospital, the level of organizational commitment and job
performance were found to be higher in comparison to public hospital.

& In both public and private healthcare service providers, employees’ attitude on negative
word of mouth communication was found to be least.

& From paired sample ‘t’ test it was found that the g ap between public and private
hospital employees’ job satisfaction level was highest and public hospital employees
were more satisfied in comparison to private hospital.

& Age of the employees in public hospital had significant impact on job performance,
where as it had impact on HRM practices in private hospital. Joining status and
employee qualification had almost no impact on the any of the study variables of both
type hospitals.

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& Types of employees in private hospital had influence on HRM practices, where as in
public hospital, the experience in current organization had impact on this variable.

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• In private hospital, total job experience of employees had significant influence on


HRM practices and organizational commitment.

• Through regression analysis, it was also found that, all the employees taken together
did not show any variation in their job performance due to HRM practices; rather HRM
practices had significant impact on organizational citizenship behavior.

• It was also seen that job satisfaction had no effect on employees’ quitting intention, but
this quitting intention had mediating role in the relationship between job satisfaction
and negative word of mouth communication.

• Through simultaneous analysis (SEM), it was also confirmed that HRM practices had no
impact on job performances, but it had influence on organizational citizenship behavior.

The quantitative analyses related to hypotheses tests which were used to draw the major
findings are briefly described in table 7.1.

Table 7.1: Summary of statistical findings of hypotheses tests


Research Statements Public Hospital Private Hospital Total Sample
Hypotheses of Respondents
Hypotheses Results Remarks Results Remarks Results Remarks
HRP
B= -0.25 B= -0.03 B= -0.18
H1 affects JS p < 0.01 Supported p > 0.05 Rejected p < 0.05 Supported

JS affects
B= -0.07 B= -0.02 B= -0.24
H2 OC p > 0.05 Rejected p > 0.05 Rejected p < 0.01 Supported

OC affects
B= 0.120 B= 0.031 B= 0.312
H3 OCB p < 0.05 Supported p > 0.05 Rejected p < 0.01 Supported

OCB
B= 0.038 B= 0.225 B= 0.214
H4 affects JP p > 0.05 Rejected p < 0.05 Supported p < 0.01 Supported

HRP
B= 0.086 B= 0.012 B= 0.000
H5 affects JP p > 0.05 Rejected p > 0.05 Rejected p > 0.05 Rejected

JS affects
H B= 0.033 B= 0.021 B= 0.147
6
NWM p > 0.05 Rejected p > 0.05 Rejected p < 0.01 Supported
JS affects
B= 0.010 B= 0.029 B= 0.013
H7 IQ p > 0.05 Rejected p > 0.05 Rejected p > 0.05 Rejected

IQ affects
B= 0.497 B= 0.043 B= 0.303
H8 NWM p < 0.01 Supported p > 0.05 Rejected p < 0.01 Supported

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HRP affects B= 0.310 B= 0.027 B= 0.202


H5 ' Supported Rejected Supported
OCB p < 0.01 p > 0.05 p < 0.01

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Based on the above results of hypotheses tests and SEM analysis in chapter 6, the
proposed conceptual models are now modified to final empirical research model both for
public and private healthcare service providers as given by fig 7.1 (a) and 7.1 (b). Figure 7.1
(a) represents the modified relationships among HRP, JS, OC, OCB, and JP. Figure 7.1 (b)
represents the evidence based relationships among JS, IQ, and NWM.

Fig 7.1 (a): Final empirical research model (Effect of HRP)

HRM Job Organizational


Practices Satisfaction Commitment

Job
Organisation
Performance
Citizenship
Behaviour

Fig 7.1 (b): Final empirical research model (Effect of JS)

Intention to
Quit

Job Negative Word

Satisfaction of Mouth
Communication

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.3 Managerial Implications

The emerging changes in the Indian economy, especially, the Indian healthcare sector
calls for adoption of efficient and effective HRM strategies. The strategic decisions should
take into account the relevant competitive, economic, political, regulatory, legal, technological
and socio-cultural factors, in addition to the strengths and weaknesses of the healthcare service
providers, among other factors. The efficient and effective HRM strategy should encompass
employee competitiveness, improved service quality, and process innovation. In the light of
the research findings, the followings are few managerial implications for better HRM
strategies of both public and private hospitals in India.

• It is important for the healthcare service providers to improve the HR policy


dimensions for achieving better level of job satisfaction among the employees.
Effective implementation and monitoring activities of HR practices are highly
required for organizational growth.

• Most importantly, since the perception of employees in relation to negative word of


mouth communication is highly linked with job dissatisfaction through quitting
intention, proper employee counselling activities have to be adopted and employee
motivation programmes are to be frequently organized in healthcare service industry.

• To achieve high degree of commitment in the concerned hospitals, employees have


to be satisfied related to their job environment.

• Hospital employees feel that they are the brand ambassadors of their organization
mostly because of suitable HRM practices adopted and feeling of high commitment.
High level of citizenship behaviour is the major factor for delivering quality service.

• HR practices should not be oriented to the job performance of employees; rather


these should be restructured for employee welfare, satisfaction, commitment and
their retention in long run.

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• Appropriate exit interview has to be implemented while an employee wants to quit,


so that there will be lesser chance to spread negative word of mouth communication
in the healthcare industry.

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7.4 Scope for Further Research

The present study is concerned with a broad picture of employee perception and
attitude providing healthcare services in public as well as private sector in India. Similarly, the
service takers’ (patients) views in this aspect could be considered. In this study there is no
comparison of how the employees perceive the patients’ expectations relating to various
parameters of healthcare services, so that suitable strategies for quality delivery of service may
be established. This would have provided a new direction for policy makers in hospitals, which
needs further research. For analysis of HRM practice impact on job performance other valid
and reliable survey instruments might be used, which needs further research and huge
literature review. Similarly, another application of the present survey instrument can be studied
by grouping the employees with more varying life styles. Further, an analysis of hospital
characteristics in different clusters may reveal attributes that are critical for ensuring higher
effect of HRM practice in designing a competitive strategy. The present study can also be
conducted in other types of service sector like telecommunication, hospitality and tourism.

References

& Elarabi Hassan Mohamed, Johari Fuadah, (2014), The impact of human resources
management on healthcare quality, Asian Journal of Management Sciences and
Education, Vol 3, No 1, pp: 13-22

& Fiedler, A.M. (1993). The effect of vision congruence on employee empowerment,
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& George, J.M. and Jones R. (1997). Organizational spontaneity in context, Human
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& Gile Philipos P, (2013), The Effect of Human Resource Practices on Employee
performance in Hospitals: A Systematic Review, Working Paper of Public Health,
Azienda Ospedaliera Nazionale, No 16, pp: 1-15

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& Hameed S. Abdul and Mohamed N. Shaik, (2016), HRM Practices and Organizational
Performance in Hospitals, IOSR Journal of Business and Management, Vol 18, Issue
11, pp: 34-41.

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[15] Moorman, J.W., and Blakely, G.L. (1995). Individualism-collectivism as an individual


difference predictor of organizational citizenship behavior, Journal of organizational
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[16] Mowday, R.T., Porter, L.W., Steers, R.M. (1982). Employee-Organization linkages: the
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[19] Tsaur, H., Lin, C.Y. (2002). Promoting service quality in tourist hotels: the role of
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[20] Williams, L.J. and Anderson, S.E. (1991). Job satisfaction and organizational
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