HR in Hospitals 376 v1

HR in Hospitals
Sub Code - 376
Developed by
Prof. Pallavi Soner
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Prin. L.N. Welingkar Institute of Management Development & Research
!
Advisory Board
Chairman
Prof. Dr. V.S. Prasad
Former Director (NAAC)
Former Vice-Chancellor
(Dr. B.R. Ambedkar Open University)
Board Members
1. Prof. Dr. Uday Salunkhe  2. Dr. B.P. Sabale  3. Prof. Dr. Vijay Khole  4. Prof. Anuradha Deshmukh 
Group Director  Chancellor, D.Y. Patil University, Former Vice-Chancellor  Former Director 
Welingkar Institute of Navi Mumbai  (Mumbai University) (YCMOU)
Management Ex Vice-Chancellor (YCMOU)
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Prof. B.N. Chatterjee Mr. Manish Pitke

Dean – Marketing Faculty – Travel and Tourism
Welingkar Institute of Management, Mumbai Management Consultant
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Dean – Finance Dean – Marketing
Welingkar Institute of Management, Mumbai Welingkar Institute of Management, Mumbai
Prof. Dr. V.H. Iyer Mr. Smitesh Bhosale

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Welingkar Institute of Management, Mumbai Founder of EVALUENZ
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Prof. Venkat lyer Dr. Pravin Kumar Agrawal

Director – Intraspect Development Faculty – Healthcare Management
Manager Medical – Air India Ltd.
Prof. Dr. Pradeep Pendse Mrs. Margaret Vas

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Welingkar Institute of Management, Mumbai Former Manager-Catering Services – Air India Ltd.
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Welingkar Institute of Management, Mumbai Management Books Publishing, Mumbai
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Welingkar Institute of Management, Mumbai Dean – Quality Systems
Welingkar Institute of Management, Mumbai
Prof. Bijoy B. Bhattacharyya Prof. B.N. Chatterjee

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Welingkar Institute of Management, Mumbai
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CONTENTS
Contents
Chapter No. Chapter Name Page No.
1 Human Resource Management 3-20

2 Evolution of Human Resource Management in Hospitals 21-45
3 Organization of Human Resource Department 46-73
4 Manpower Planning in Hospitals 74-94
5 Job Analysis, Job Description & Speciﬁcation for Hospital 95-124
Staff
6 Recruitment, Selection, Induction in Hospitals 125-160

7 Training and Development 161-183
8 Wage and Salary Administration 184-208
9 Working Conditions in Hospitals 209-224
10 Performance Appraisal: Techniques & Practices 225-253
11 Industrial Relations 254-295
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HUMAN RESOURCE MANAGEMENT
Chapter 1
Human Resource Management
Objectives:
After reading this chapter, you should be able to understand:
• Principles of HRM, Functions of HRM

• Difference between HRM, Personnel management, & Human Resource
Development
• What are the functions of HRM and what significance it plays in an
organisation
Structure:
1.1 Introduction
1.2 Principles of Human Resource Management
1.3 Difference between Human Resource Management, Personnel
Management, Human Resource Development
1.4 Functions of Human Resource Management
1.5 Significance of Human Resource Management
1.6 Summary
1.7 Self Assessment Questions
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1.1 INTRODUCTION
Human Resource management is the strategic and coherent approach to

the management of an organisation's most valued assets-the people
working there who individually and collectively contribute to the
achievement of the objectives of the business.
The terms Human Resource Management have largely replaced the term
personnel management as a description of the processes involved in
managing people in organisations. Human resource management is both
an academic theory and business practice that addresses the theoretical
and practical techniques of managing a work force.
Academic theory:
The goal of human resource management is to help an organisation to

meet strategic goals by attracting and maintaining employees and also to
manage them effectively. HRM approach seeks to ensure a fit between the
management of an organisation employees and the overall strategic
direction of the company.
Business Practice:
Human resource management comprises several processes. Together they

are supposed to achieve the above mentioned goal. These processes can
be performed in an HR department, but some tasks can be outsourced or
performed by line managers or others departments.
1. Manpower Planning or Workforce Planning

2. Recruitment
3. Induction and Orientation
4. Skills Management
5. Training and Development
6. Personnel Administration
7. Wage and Salary Administration
8. Time Management
9. Travel Management
10.Payroll
11.Employee Welfare
12.Personnel Cost Planning
13.Performance Appraisal
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• In a globally competitive and challenging business scenario, success in

business endeavour to a great extent is influenced by how human
resources are managed. The traditional man management practices have
already undergone a sea change. To meet the challenges of the next
millennium and for achieving organisational excellence, it would be
essential to have productivity-oriented work practices, assertive
professional management and responsible trade unionism.
• In terms of the growth rate, the healthcare industry in India is moving

ahead neck to neck with the pharmaceutical industry and the software
industry. There are vast differences in medical expenses in western
countries and that of India; India has become one of the favourites for
healthcare treatments. Due to the progressive nature of the healthcare
sector in India, several foreign companies are intending to invest in the
country.
• Existing healthcare organisations are expanding by opening hospitals in

new service areas and new organisations entering with state of art
equipments, latest technology and marketing strategies. Consequently,
competition in the healthcare sector is on the rise. Increased incomes
and awareness levels are driving the customers to seek quality
healthcare.
• One of the major problems of Hospital sector is the lack of Efficiency and
Effectiveness of Human Resources. Presently, the Human Resource
Department of hospitals are not focused on execution of the systematic
and scientific HR Practices plus issues concerning the satisfaction level of
employees.
• The providers in turn need to be more innovative in their approach and

offer quality services at competitive price. All this necessitates the
systematic Human resource Management by trained and professional
managers and administrators.
1.2 PRINCIPLES OF HUMAN RESOURCE MANAGEMENT
• Human resource management of an organisation represents one of its

largest investments.Therefore, it is of utmost importance to deal with its
human resources sympathetically and tactfully. Human resource
! !6
management is an approach to the management of people based on the

following fundamental principles:
1. Human resource management is concerned with integration by

getting all the members of the organisation involved so that they
may work together with a sense of common purpose.
2. Human resource policies of the organisation should be fair to all.

They should make a major contribution to the achievement of an
organisation's objectives as well as provide conductive atmosphere of
working to the employees so that their output is maximum.
3. Human resources are the most important assets and their tactful
management is the key to success of an organisation.
4. The culture and values of an organisation exert enormous influence

on the organisation. Therefore, organisational values and culture
should be accepted and acted upon by one and all in the
organisation.
• If the aforesaid fundamental principles are followed in letter and spirit,

human resource management will tap a reservoir of untapped resources,
develop a culture in which utmost emphasis will be placed on harmonious
superior-subordinate relationship, and will create an overall climate in
which the organisation and its human resources will be able to do their
best for each other.
• Human resources management evolved from the task-oriented nature of

personnel administration in the 1980s and 1990s to a strategy-focused
extension of the organisation in the 2000s. The transition into a strategic
partnership role supports an effective HR management system.
• Among this new genre of models, Ten C model of HRM is regarded as all
encompassing and a pragmatic model. The "Ten C" collection of HR
management principles was developed by HR management expert Alan
Price, in 1997, author of "Human Resource Management in a Business
Context." Price's 10 principles are “comprehensiveness, credibility,
communication, cost effectiveness, creativity, coherence, competence,
control, change and commitment."
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1. COMPREHENSIVENESS 
 
This includes all aspects of people management. The HRM strategy of an
organisation must include all the aspects of people management,
typically starting from recruitment to post separation programmes. This
involves the proper management of all aspects of the people you are
working with bearing in mind that human resources is the most valuable
resource your firm has. This means that the financial, health,
transportation, tools and anything employees need to work should be
well taken care of.
2. CREDIBILITY 
 
This means that staff trust top management and believe in their
strategies. The HR practices must build trust between staff and top
management and encourage employees' belief in HRM strategies. Firms
must ensure that they remain the best brand to most of their clients by
maintaining their credibility. They should put in place strategies that
ensure all employees have a clear sense of direction to a common goal.
3. COMMUNICATION 
 
This means objectives understood and accepted by all employees; open
culture with no barriers. The objectives of organisation and that of HRM
must be understood and accepted by all employees. The operating
culture in organisation must encourage openness and be free from all
barriers. Communication is very important in every organisation.
Through communication, firms can ensure there is flow of information
that is necessary for efficiency.
Figure 1.1 Principles of Human Resource Management
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! !9
4. COST EFFECTIVENESS 
 
This means the reward and promotion system must be fair i.e.
competitive fair rewards and promotion on systems. Companies should
ensure that they remunerate their employees accordingly. The
employees reward system should be able to sustain the organisation.
Budgets for HR departments often are insufficient to support all the
necessary HR activities, especially in areas such as recruiting, training
and development and employee relations. HR is not a revenue-
generating department, which is one reason budgets for HR
departments might be the first cut. HR typically is held to a higher
standard for illustrating return on investment in its activities. For
example, the expense of outsourcing administrative tasks may be a
cost-effective solution for small businesses that don't have the capital or
resources to support a full-time HR staff. The return on investment
includes efficient, high-quality services for employees, such as benefits
administration, payroll processing and retirement savings programs.
5. CREATIVITY 
 
This means competitive advantage comes from unique strategies. The
competitive advantage of the company must stem from its unique HR
strategies. Creativity is the key if a firm is to be efficient in human
resources management. Firms should adopt new ways of human
resources management as long as it fits their companies.
6. COHERENCE 
 
HRM activities and initiatives must from a meaningful whole. All the
steps taken by a firm in the management of human resources must be
in line with the mission and vision of the firm. Human Resources
managers should direct their focus on what the company needs and
employee abilities.
7. COMPETENCE 
 
This includes organisation's competency to achieve its objectives,
depending on individual competences. HRM strategy be crafted in such a
way that organisation becomes competent to achieve its objectives with
the support of individual competencies. It is an organisations
! !10
responsibility to ensure that their employees are skilled to do their

duties. Because the competence of a firm depends on that of its
employees, firms should do everything to increase employee capabilities
for example, by training them. Competence is a principle that supports
business development. It is also a factor in employees' job satisfaction
and how the organisation affects society. Successful businesses rely on
competent workers who understand their employers' performance
expectations. HR management sustains workforce competency through
providing training and orientation to upgrade and improve employees'
skills and job knowledge. The impact that competence has on society is
the production of safe and reliable products and services. Without
sufficiently high competence, the organisation exposes itself to potential
legal claims against the product it sells or the service it renders.
8. CONTROL 
 
Control deals with ensuring ensure performance is consistent with
business objectives. HRM policies and practices must ensure that
performance of HR is consistent with business objectives. Firms should
be able to take charge of their employees and ensure that productivity
and quality is achieved and maintained. Control should be exercised
carefully so that it does not seem like tyranny.
9. CHANGE 
 
Change is continuous improvement and development essential for
survival. The basic premise of HRM strategy must be that continuous
improvement and development is essential for survival. Change is
inevitable for businesses. The fastest business to embrace change in
management of their human resources is better placed to produce
better results.
10.COMMITMENT 
 
The last C Stresses upon that employee are to be motivated to achieve
organisational goals. Every organisation has objectives which they
intend to meet both for themselves and for their clients. To meet these
goals, firms need committed staff therefore it is the firms responsibility
to keep their employees motivated so as to ensure they are committed
to the organisations course. Job security acknowledges the intrinsic
! !11
need that employees have to demonstrate their commitment to the

business and their job duties. HR management fulfils that need through
ensuring staffing levels are consistent with the business needs and that
employees can reasonably expect they can be long-term employees.
The organisation illustrates its commitment to workers and invests in
their success by providing training opportunities, performance
evaluations and goal-setting activities. Society or the surrounding
community benefits from an employer's commitment to providing
employment opportunities that sustain the economy.
1.3 DIFFERENCE BETWEEN HUMAN RESOURCE

M A N A G E M E N T, P E R S O N N E L M A N A G E M E N T, H U M A N
RESOURCE DEVELOPMENT
Human resource development is the main function of human resource

management. Every organisation has the responsibility to develop its
human resources if it wants to remain operational and grow further. In the
modern times, human resource development is the No. 1 task for any
organisation. Its survival and growth depend on human resource
development. Organisations have now realised that employees are human
beings and if their talent is developed, they can be of immense help. This is
the reason that the employees in scientifically and professionally managed
organisations are being helped in a continuous and planned way so that
they can acquire capabilities required to perform various functions
associated with their present or future roles, develop their inner potentials
for their own as well as organisational development processes, and also
develop an organisational process and culture in which human relations are
better, and more emphasis is laid on teamwork which lead to professional
well-being, motivation and instil a sense of pride in the employees.
Human resource management is a process of bringing an organisation and

its employees together so that the goals of the employees as well as those
of the organisation are met. It is that part of the management process
which is concerned with the management of human resources in an
organisation. It tries to secure the best from employees by winning their
confidence and whole-hearted cooperation. Human resource management,
therefore, involves all managerial decisions, philosophy, policies and
practices that directly influence human resource. It is a process consisting
of acquisition, development, motivation and maintenance of human
! !12
resources. It means that human resource management includes human

resource planning, job analysis, job design, acquisition, training and
development, compensation, benefits and rewards, safety and welfare,
motivation, employee participation in management, organisational
development, performance appraisal, job evaluation, human relations,
employee counselling, and human resource information system.
Personnel management is concerned with the manpower planning,

recruitment, selection, orientation, salary administration, performance
appraisal, training, working conditions, safety, welfare, promotion, transfer,
collective bargaining, disciplinary action and resignation/ termination/
retirement. According to Filippo, "Personnel Management or Human
Resource Management is the planning organising, directing and controlling
the procurement, development, compensation, integration and
maintenance of people for the purpose of contributing to organisational,
individual and social goals". Filippo also emphasises that various
managerial functions relating to procurement and maintenance of people in
an organisation come under personnel management. The term "human
resource management” used synonymously with personnel management
signifies the staffing function of management. However, some people
distinguish between human resource management and personnel
management by including personnel responsibilities in respect of operative
positions (workers) under human resource management and those with
regard to managerial positions under staffing. But this distinction is useless
in practice. It is because human resource management is concerned with
the management of human resource of an organisation consisting of all
individuals engaged in any of the organisational activities at any level.
Some others distinguish between human resource management and
personnel management by stating that human resource management deals
with planning, recruitment, selection, orientation, training, performance
appraisal, promotion, transfers and separations while personnel
management deals with manpower planning, recruitment, selection,
orientation, training, salary administration, performance appraisal, working
conditions, safety, welfare, health services, promotion, transfer, separation,
communication, counselling, collective bargaining, disciplinary actions and
personnel audit. Thus human resource management deals only with bright
side of the personnel activities and personnel management deals both with
the bright as well as dark side of the personnel activities of an
organisation. Therefore, human resource management is a narrower term,
whereas personnel management is a wider term. The author does not
! !13
want to add further to this controversy and is personally against it. There is
no denying the fact, however, that human resource management is
characterised as being employee oriented with an emphasis on the
maximisation of individual skills and motivation through consultation with
the workforce so as to produce high levels of commitment to organisational
strategic goals. It is a resource to be used to its fullest capacity. It is an
asset to be invested in. As far as human resource management is
concerned, it is nonstrategic, reactive and preventive. Human resource
management certainly stresses those expectations which are not being
fulfilled through personnel management. Therefore, human resource
management is depicted as having an agenda which addresses business-
related issues and thereby contributes to the overall success of the
organisation in a proactive manner while personnel management is
depicted as having an agenda set for it by the more mundane
requirements of the day, in a more reactive manner. Thus some people
view personnel management as curative and human resource management
as preventive by nature.
In its essence, human resource management is a strategic approach to the

acquisition, motivation, development of the organisation's human
resources. It is a specialised field that attempts to develop programmer,
policies and activities to further the satisfaction of individual and
organisational needs, goals and objectives. It is devoted to establishing
proper organisational culture and introducing programmes which reflect
and support the care values of the organisation and ensure their success.
Human resource management is the qualitative improvement of human
beings who are considered the most valuable assets of an organisation. It
is, no doubt, an outgrowth of the older process and approach. But it is
much more than its parent discipline, viz. personnel management. Its
approach is multidisciplinary from the beginning to the end, is more
comprehensive and deep rooted than training and development.
1.4 FUNCTIONS OF HUMAN RESOURCE MANAGEMENT
Human resource management is a staff function. Human resource

managers advise line managers throughout the organisation. Further-
more, personnel requirements of the organisation may vary from time to
time. The following functions of the human resource department try to
keep the organisation going smoothly and efficiently by supplying with the
! !14
right type of personnel in the right position, when they are needed.
However, it is the first and foremost duty of the human resource manager
to see that square pegs are not fitted into round holes.
1. Policy Formulation
2. Staff Function
3. Line Function
i. Procurement
ii. Development iii. Compensation
iii. Integration
iv. Maintenance
v. Records and Research and
vi. Personnel Information System
4. Control
5. Managerial
i. Planning
ii. Organising
iii. Directing and
iv. Controlling.
1. Policy formulations. One of the important functions of the human

resource management is to prepare new policies and revise the existing
ones in the light of the experience gained in the area of human resource
management. However, those organisations which do not formulate
policies for human resource management may find that they are not
meeting either their personnel requirements or their overall goals
effectively. To be meaningful, human resource policy formulation must
consider both the strategic plan and the external environment of the
organisation.
2. Staff functions. Line managers come across various problems in their

day-to-day management which can be solved satisfactorily with the
advice of the personnel or human resource department. These problems
may relate to employee's grievances in connection with distribution of
overtime work, promotion, transfer, disciplinary action, etc. Advice given
to them from time to time should be objective and legal; otherwise it
will spoil human relations at work.
! !15
3. Line functions. Line functions consist of procurement, development,

compensation, integration, and maintenance of the human resource of
the organisation to achieve the organisational goals. Candidates are
usually selected through newspapers, professional journals,
employment agencies, words of mouth and campus visit to colleges and
universities. Selection involves various techniques such as short-listing
the application forms, interviews, tests, reference checks, etc.
Orientation is designed to help the selected candidates fit smoothly into
the organisation. Newcomers are introduced to their colleagues,
acquainted with their responsibilities and informed about the
organisation's culture, policies and their behavioural expectations.
Training aims to increase employee's ability to contribute to
organisational effectiveness. It is designed to improve their skills in the
present job and to prepare them for promotion. Performance appraisal
is done to let an employee know about his performance. Low
performance may prompt corrective action such as additional training or
demotion, and high performance may merit a reward such as raise in
salary or promotion.The appraisal is done by the employee's supervisor,
but the human resource department is responsible to establish the
policies that guide performance appraisals. Promotion and separation
human resource management.
4. Control function. 'Personnel' is not just a benevolent helper, like other
staff groups, it is often assigned authority laden control roles that line
managers may view as restrictive. Two important control roles which
find place in management literature are auditing and stabilisation.
"Auditing refers to the monitoring by the human resource department of
the performance of line and other staff departments to ensure that they
conform to established personnel policy, procedures and practice in
various personnel areas. Stabilisation involves seeking approval of the
human resource department by the line managers before they take any
action. For example, granting annual increment,solving union's
grievances, taking disciplinary action against erring employees or
rewarding the others, etc. The underlying objective is to ensure proper
coordination between various departments vis-a-vis organisational
objectives".
5. Management functions. Like other functional departments, human
resource department also performs managerial functions like planning,
organising, directing and controlling in respect of human resource
department. Through planning, managers constantly shape and reshape
! !16
their organisations they decide in what direction they want their

organisations to go and accordingly, make the plans and decisions to get
there. By organising, managers shape relationship with organisational
structures and thereby lead employees into the organisation’s future. To
achieve the organisation's goal, it is necessary to make the
organisation's structures effective; otherwise the process of preparing
people to work efficiently may collapse. A sensible strategic plan and
sensible organisational structure result in the fulfilment of organisational
goals. To translate these decisions into actions, managers encourage
and support the people who carry out the plans and work within the
structures. The managerial effort to keep people focused on the goals of
an organisation involves the process of directing. Finally, controlling
helps the managers monitor the effectiveness of planning, organising
and directing and take corrective measures as needed. The process of
ensuring that actual activities conform to planned activities is called
controlling. Management control is a systematic effort to achieve
organisation's objectives.
Figure 1.2 Elements of Human Resource Management
! !17
Activity A
List down stages in the development of HRM.

…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………….
1.5 SIGNIFICANCE OF HUMAN RESOURCE MANAGEMENT
Importance of human factor, the only animate resource in the

accomplishment of organisational goals, has been growing rapidly. As
Ducker remarked, "the resources capable of enlargement can only be
human resources. All other resources stand under the laws of mechanics.
They can be better or worse utilised, but they can never have an output
greater than the sum of the inputs. Man alone, of all the resources
available to man can grow and develop".
Philosophy of management is also changing in tune with the growing

importance of human factor. The modern philosophy of management seeks
to take into account, the nature of man which confirms the McGregor's
theory. According to this theory man is potentially creative, trustworthy
and cooperative. He also possesses potential for growth, achievement and
constructive action with others. It is the job of the human resource
management to nurture and tap the employee's productive drives.
The importance of human resource management can also be judged from

the following points of view:
For the Organisation
(i) Maintaining adequate manpower supply through recruitment, selection,

placement,training and promotion policies.
(ii)Developing right attitudes and required skills among employees through

training, refresher courses, workshops and performance appraisals.
(iii)Maintaining high morale of workers through incentive schemes,

workers' participation in management and proper grievance handling
and redressal policies and procedures.
! !18
(iv)Developing good industrial relations by treating the workers as human

beings and thus reducing loss caused by unnecessary strikes and
lockouts.
For the Employees
(i) Improving quality of work life though various welfare measures.
(ii)Enhancing the dignity of labor through worker's participation in

management and treating them as human beings.
(iii)Raising workers morale by giving them opportunities for personal

development and job satisfaction.
For the Society
(i) Maintaining good industrial relations and thus minimizing loss caused by
frequent strikes and lockouts.
(ii)Increasing productivity through workers' participation and motivation.
(iii)Better utilization of human resource through proper recruitment,

selection, placement and training.
(iv)Maintaining adequate manpower supply through appropriate manpower

planning and training policies and procedures.
1.6 SUMMARY
Human Resource Management (HRM) is a management function that helps

an organisation to manage its Human Resources. The process of HR in an
organisation consists of manpower planning, job analysis, recruitment &
selection, motivation techniques, training and development, employee
welfare, performance appraisal, compensation administration and
separation. HRM in an organisation is affected by various factors in the
external (technological changes, globalisation, legal, political), and internal
environment (organisational strategy, unions, organisational culture). HRM
in the near future will be replaced by Strategic HRM, and in the distant
future it may also be replaced by HCM.
! !19
1.7 SELF ASSESSMENT QUESTIONS
1. What is HRM? What are its functions? How is the process of HRM
structured in an organisation?
2. Differentiate between HRM and Personnel Management.
3. Trace the evolution of HRM.
! !20
REFERENCE MATERIAL
Click on the links below to view additional reference material for this
chapter
Summary
PPT
MCQ
Video Lecture - Part 1
Video Lecture - Part 4 
! !21
EVOLUTION OF HUMAN RESOURCE MANAGEMENT IN HOSPITALS
Chapter 2
Evolution of Human Resource Management
in Hospitals
Objectives:
• How HRM evolved in India and other countries

• What are the objectives of Human Resource Management
• Prospects of HR as a profession in Hospitals
• What role does HR play in Hospitals
Structure:
2.1 Introduction
2.2 Evolution of HRM
2.2.1 Evolution of HRM In world

2.2.2 Evolution of HRM In India
2.3 Objectives of Human Resource Management

2.4 Human Resource Management as a Profession in Hospitals
2.5 Role of Human Resource Management in Hospitals
2.6 Summary
! !22
2.1 INTRODUCTION
We have already studied about the principles, functions, and significance of

Human Resources Management in the last chapter. Let us now see how
Human Resource Management originated. Human Resource Management in
its simplest definition means management of organisation’s manpower or
workforce or human resources.
HRM i.e. Human Resource Management, one of the most vital parts of any
organisation has a long history. Though human resource as included in
proper education few decades back but the concept of human resource
management is quite old. The concept of HRM gains more prominence
during the time of the industrial revolution. Though at that time the subject
was in its infant stage and till date several changes and new concepts
have been added into the subject to make it more realistic, practical and
useful for the organisations.
India is being widely recognised as one of the most exciting emerging

economics in the world. Besides becoming a global hub of outsourcing,
Indian firms are spreading their wings globally through mergers and
acquisitions. During the first four months of 1997, Indian companies have
bought 34 foreign companies for about U.S. $11 billion dollars. This
impressive development has been due to a growth in inputs (capital and
labour) as well as factor productivity. By the year 2020, India is expected
to add about 250 million to its labour pool at the rate of about 18 million a
year, which is more than the entire labour force of Germany. This so called
'demographic dividend' has drawn a new interest in the Human Resource
concepts and practices in India.
2.2 EVOLUTION OF HRM
2.2.1 Evolution of HRM in World
The evolution of the concept of Human Resource Management is presented

below:
A. Period before industrial revolution - The society was primarily an

agriculture economy with limited production. Number of specialised
crafts was limited and was usually carried out within a village or
! !23
community with apprentices assisting the master craftsmen.

Communication channel were limited.
Figure 2.1 Evolution of Human Resource Management
B. Period of industrial revolution (1750 to 1850) - Industrial

revolution marked the conversion of economy from agriculture based
industry. Modernisation and increased means of communication gave
way to industrial setup. A department was set up to look into workers
wages, welfare and other related issues. This led to emergence of
personnel management with the major task as
➡ Worker's wages and salaries

➡ Worker's record maintenance
➡ Worker's housing facilities and health care
An important event in industrial revolution was growth of Labour Union

(1790) - The works working in the industries or factories were subjected
to long working hours and very less wages. With growing unrest, workers
across the world started protest and this led to the establishment of
Labour unions. To deal with labor issues at one end and management at
! !24
the other Personnel Management department had to be capable of

politics and diplomacy, thus the industrial relation department emerged.
C. Post Industrial Revolution - The term Human resource Management

saw a major evolution after 1850. Various studies were released and
many experiments were conducted during this period which gave HRM
altogether a new meaning and importance.
A brief overview of major theories release during this period is presented

below:
• Frederick W. Taylor gave principles of scientific management (1857 to

1911) led to the evolution of scientific human resource management
approach which was involved in
➡ Worker's training
➡ Maintaining wage uniformity
➡ Focus on attaining better productivity.
• Hawthorne studies, conducted by Elton Mayo & Fritz Roethlisberger

(1927 to 1940) - Observations and findings of Hawthrone experiment
shifted the focus of Human resource from increasing worker's
productivity to increasing worker's efficiency through greater work
satisfaction.
• Douglas McGregor Theory X and Theory Y (1960) and Abraham Maslow's

Hierarchy of needs ( 1954) - These studies and observations led to the
transition from the administrative and passive Personnel Management
approach to a more dynamic Human Resource Management approach
which considered workers as a valuable resource.
As a result of these principles and studies, Human resource management

became increasingly line management function, linked to core business
operations. Some of the major activities of HR department are listed as-
1. Recruitment and selection of skilled workforce.

2. Motivation and employee benefits
3. Training and development of workforce
4. Performance related salaries and appraisals.
! !25
HR spawned from the human relations movement, which began in the early
20th century due to work by Frederick Taylor in lean manufacturing. Taylor
explored what he termed “scientific management" (later referred to by
others as "Taylorism"), striving to improve economic efficiency in
manufacturing jobs. He eventually keyed in on one of the principal inputs
into the manufacturing process-labor-sparking inquiry into workforce
productivity. Though we can say that the HRM started gaining its ground in
the 20th century but if we follow prehistoric society structure and examine
the role of group leaders it will clearly show that the principles of personnel
management are quite old. The Chinese are the first to follow employee
screening procedure in the year 1115 B.C. By the end of the 20th century a
post of personnel women officer was established. This post was governed
by females they were appointed as personnel manager and they were only
concerned about the safety and protection of working women and girls in
the factory.
HRM was earlier known by several other names as "Personnel Relation",

"Industrial Relations” and finally "Human Resource". With the advancement
in technologies and transportation facility more and more people started
joining offices and factories. The sudden surge in the numbers of
employees made it a bit difficult for the organisation to manage it properly.
Now the organisation began viewing the employee as an asset to an
organisation and to get the best from its assets the relevancy of human
resource department was realised. Different terms were coined to refer
human resource management including “Organisational Management",
"Manpower Management", "Talent Management", and simply “People
Management". The designation of "Labor Manager" or employee manger
came into existence in 1920's and most of such posts were created in the
engineering industry. The purpose of the employment manager was to
handle the day to day affairs of the employees and labourers working in
the factory. It includes managing their recruitment attendance, dismissal
and queries asked by the employees.
The era of 1930s was revolutionary in terms of economic development all

over the world. Many big corporate houses and new factories started their
career during this time. The demand of employees also raised high and it
became crucial to manage the welfare of employees and get the best from
them for the steady growth of the business. A need of personnel was
needed for the recruitment, training, motivating and evaluating employees
! !26
from time to time so that they can offer their best for the growth of the
organisation. The older industries like textile and mining were hit by the
recession and were not in a condition to adopt new techniques or hire more
labor as a result they don't need any recurring personnel or employee
manager. The profile of HRM became popular in most of the organisations
and industries in the 1980s. HRM started as a subject in many colleges and
universities. The various aspects of HRM come into prominence by 1990s.
Cornell University's School of Industrial Relations and Labor study was the
first business school in the world in the college level in HRM. In the first
decade of 2000, there was a strong movement to see HR as a strategic
partner for companies and not as a function of support.
2.2.2 Evolution of HRM in India
The history of development of human resource management in India is of

comparatively recent origin but Kautilya had dealt with some of the
important aspects of human resource management in his Arthshastra 400
BC. The government of those days adopted the techniques as suggested by
Kautilya, but in its modern sense, it has developed only just before
independence on a minor scale after independence on a major scale.
However, the liberalisation of markets and global linkages has created

transformation of attitudes towards human resource (HR) policies and
practices. Faced with the challenge of responding to the rationale of
Western ideas of organisation in the changing social and economic scenario
of Indian organisation, practitioners are increasingly taking a broader and
reflective perspective of human resource management (HRM) in India.
Strategic Human Resource Management Approach
With increase in technology and knowledge base industries and as a result

of global competition, Human Resource Management is assuming more
critical role today. Its major accomplishment is aligning individual goals
and objectives with corporate goals and objectives. Strategic HRM focuses
on actions that differentiate the organisation from its competitors and aims
to make long term impact on the success of organisation.
Today HR has become vital parts of the organisations and it is impossible to

set-up and run an organisation without proper HRM. A well-managed HR
! !27
department could improve the efficiency and performance of an

organisation.
RECENT CHANGES IN INDIA
Though not infant, HRD in India has not entered in it's adulthood. The first
dedicated HRD department started in 1975 at L&T. Uday Pareek and T.V
Rao in 1975 outlined a philosophy for the new HRD System. After L&T
accepted and started implementing their recommendations in full the State
Bank of India the single largest bank and its associates decided to
implement the Integrated HRD System approach and decided to create a
new HRD department. By the mid 80?s a large number of organisations in
India had established fully fledged HRD departments .In 1979 the first
workshop on HRD was conducted by IIM A by Dr. T.V. Rao , where the draft
of the book Designing and managing Human Resource System was
presented and tested. After that a large number of companies started
showing interest in having HRD departments.
However over the period of time HRD as a concept and practice have gone
through different stages of metamorphosis. In the mid-70s HRD
departments were started with a view to promote competence building
and work motivation. By the early 90?s, the focus of HRD changed from HR
for it's own sake to HR for business. Today in globally competitive market
it's presence and role is well understood.
Figure 2.2 Key drivers for contemporary Indian HRM trends.
! !28
2.3 OBJECTIVES OF HUMAN RESOURCE MANAGEMENT
The objectives Human Resources Management is concerned with the

personnel at work. The way in which the personnel are recruited, selected,
trained, developed and utilised by management largely determines
whether the organisation will achieve its objectives or not. Therefore, the
personnel available to the management in the organisation need to be
properly looked after, utilised and coordinated. It is through the combined
efforts of the management as well as of its personnel, the objectives of an
organisation cannot be achieved. Without concerted and combined efforts,
an organisation cannot accomplish its objectives. Now it is universally
recognised that the effectiveness with which personnel are coordinated and
utilised is directly responsible for the success of any organisation.
Therefore, human resource management aims at obtaining and
maintaining a capable work force so that the objectives of the organisation
can be achieved. 
! !29
Briefly, the following are the objectives of the human resource

management:
• Obtaining and developing the right personnel.

• Providing effective motivation and leadership.
• Paying attractive remuneration and treating them like brothers and
sisters.
• Effective utilisation of human resources in the achievement of

organisational goals.
• Establishment and maintenance of an organisational structure and

desirable working relationships among all the members of the
organisation.
• Securing integration of the individual and informal groups with the

organisation, and thereby ensuring their commitment, involvement and
loyalty.
• Recognition and satisfaction of individual needs and groups goals.
• Provision of maximum opportunities for individual development and

advancement.
• Maintenance of high morale in the organization
• Continuous strengthening and appreciation of human assets.
From these objectives one can conclude that the emphasis has been laid on
the following: recruitment, selection, induction, providing adequate salary,
periodic appraisal, specific training, retirement, compensation, individual
development, providing employees' welfare, better working conditions, and
mutual confidence, etc. These are the life-blood of human resource
management.
! !30
2.4 HUMAN RESOURCE MANAGEMENT AS A PROFESSION

IN HOSPITALS
A hospital is a microcosmic community that operates like a small city,

presenting the same issues with a stronger dynamic due to the human
interaction factor. With functions that cover everything from performance
management to safety, Human Resources Management plays a vital role in
the health care workplace in ensuring the delivery of health care services
and facilitating optimal patient outcomes. In any health care setting, the
Human Resource department fills a variety of personnel needs that both
employers and employees encounter. The role of this department is to
manage all aspects of operations that are personnel related.
A.Examples of Specific Human Resources Management Functions Include:
• Hiring
• Physician and Nurse Recruitment
• Employee Orientation
• Personnel Management
• Benefits & Compensation Management
• Counseling
• Claims Handling
• Training and Performance Monitoring
• Professional Development Programs
• State and Federal Regulations Education
• Work place Safety and Sanitation
• Labor Mediation
• Administration - Employee Meetings
• Staff Morale & Retention
A-1 Personnel Management
The personnel department hires and fires employees and locates temporary
workers when needed. Management handles all the financial and time
related aspects of an employees work life. Human resource management
makes decisions about the personal health, progress and welfare of
workers.
! !31
A-2 Counseling
A human resources counsellor is a very specialised position that may

require advanced training and certification. In certain HR Counselling jobs,
a bachelor's degree in Counselling or higher is often mandatory.
Counselling at the work place can involve sessions with employees who
have marital, drug and alcohol related issues or family crises.
Education and Training
Many colleges and universities have programs leading to a degree in

personnel, human resources, or labor relations. Some offer degree
programs in human resources administration or human resources
management, training and development, or compensation and benefits.
Depending on the school, courses leading to a career in human resources
management may be found in departments of business administration,
education,instructional technology, organizational development, human
services, communication, or public administration, or within a separate
human resources institution or department. An advanced degree is
increasingly important for some jobs. Many labor relations jobs require
graduate study in industrial or labor relations. A strong background in
industrial relations and law is highly desirable for contract negotiators,
mediators, and arbitrators; in fact, many people in these specialties are
lawyers. A background in law also is desirable for employee benefits
managers and others who must interpret the growing number of laws and
regulations. A master's degree in human resources, labor relations, or in
business administration with a concentration in human resources
management is highly recommended for those seeking general and top
management positions.
Online Programs
Online degree programs make it possible for working adults to earn an
advanced degree whenever and wherever it`s convenient for them, rather
than having to rearrange work and family responsibilities around fixed
class schedules. This ability to continue earning a living while learning is
making school accessible to millions of working professionals who would
find it impossible to return to school otherwise.
! !32
A-3 Claims Handling
In any business a variety of circumstances can arise that require

employees to file a claim. These instances could include injury, layoff,
getting fired or an incident of harassment or related experience. Human
Resource professionals specialise in all areas of labor claims and have the
proper knowledge of state and federal laws regarding claims handling.
A-4 Training and Performance Monitoring
A primary task performed by human resources is quality control.

Employees can be trained to perform at optimal levels by utilising their
primary skills. Human Resources specialists develop tests to monitor skill
levels that can be administered during the hiring process or later in the
term of employment. Additionally, Human Resources Managers work
closely with both clinical and non-clinical department managers in order to
develop relevant professional development programs and provide useful
continuing education opportunities for employees.
HRM Objectives Supporting Functions
1. Legal compliance
Societal Objectives 2. Benefits
3. Union-management relations
1. Human resource planning
2. Employee relations
3. Selections
Organizational Objectives 4. Training and development
5. Appraisal
6. Placement
7. Assessment
1. Appraisal
Functional Objectives 2. Placement
3. Assessment
1. Training and development

2. Appraisal
Personal Objectives 3. Placement
4. Compensation
5. Assessment
! !33
B. Modern Advancements in the Field Provide More Opportunities
Human Resources have evolved dramatically in the last few decades into
an all inclusive management department. At one time, this part of a
business was solely clerical. It was delegated to the personnel department
who handled hiring, firing, book keeping and payroll. Advances in work
place management have opened the door for more specialised needs and
roles of employees. In turn, personnel departments grew into a highly
specialised field with either an internal or external human resources
department.
C. Summary of Common Human Resource Functions
Each departmental role is intricate which often leaves the employee or

employer wondering where and how to address certain concerns. A
guidebook is an easy, efficient way to provide a tool that will answer many
questions. Common issues outlined in a question and answer format offers
an easy to navigate guide that can be distributed to everyone. Human
Resource personnel usually gather the data to compile such a guide book
and distribute copies to all employees under their management.
D. Meetings between Staff, Employees and Administration
Human Resource Management maintains the lines of communication at all

levels to better manage business personnel. Regular meetings are an
efficient way to discuss issues and needs. Personal interaction opens
dialogue for suggestions and grievances between administration, staff and
employees. Meetings build trust and confidence in a company and assure
that quality control is in place effectively. Communication is a core tenet in
group dynamic principles. This part of the workplace interaction is guided
by human resource specialists. In a research series, communication will be
explored as a group dynamic to show its effectiveness in improving
employer-employee relationships and company productivity.
E. Human Resource Management is Vital in Health Care
Effective human resources management plays a crucial role in the success

of health care systems. Proper management of human resources is vital in
the recruitment and retention of clinical and non-clinical staff, maintaining
staff morale, providing opportunities for professional development, and in
! !34
the ability of a health care organisation to deliver quality health care

services and improve patient health outcomes.
F. Characteristics of Human Resource Manager
Human Resource management has drawn its knowledge and insight from
political science, psychology, sociology, economics, anthropology, history,
philosophy, commerce, management, laws, etc. but by synthesis it has
developed in to a science of its own. With these principles before him, the
human resource manager has to develop his own sense of responsibility,
knowledge and skill for working with people under specific social, economic
and emotional conditions.
Human resource management has organised professional associations

which maintain standards of performance and behaviour in a code of
ethics. It provides competent service with integrity and works for the
welfare of the human beings whom it serves. Human resource
management has been recognised as a profession by academicians and
industrialists because it has acquired all the qualifications of a profession
and has proved its worth. Human resource management possess all the
characteristics of any other profession which can be summarised as
follows.
Human Resource Management:
1. Requires special knowledge for the uniform performance of standard

practices and procedures;
2. Requires special competence achieved through intellectual training
which develops skills and requires the use of independent and objective
judgement;
3. Assumes a sharing of information among all members of the profession
4. Maintains a continuous flow of professional literature;
5. Has a code of conduct; it requires the provisions of specialized

education and the use of specialized knowledge and skills;
6. Requires a high degree of personal responsibility and accountability

from its members;
! !35
7. Demands primary allegiance to the profession from its members

8. Requires a certain standard of ethical practices from its members
These characteristics clearly prove that human resource management is a

profession, but its acceptance as a profession in hospitals will entirely
depend upon the competence of the individual hospital human resource
manager, who not only carries out functions of specialised hospital human
resource manager, who not only caries out functions of specialised hospital
human resource management but also of hospital general administration,
thus providing maximum satisfaction to the employees, effectively meeting
hospital goals and adequately contributing to the health of the community.
A Day in the life of a Human Resources Manager
Human resources managers handle personnel decisions, including hiring,

position assignment, training, benefits, and compensation. Their decisions
are subject to some oversight, but company executives recognise their
experience and skill in assessing personnel and rely heavily on their
recommendations. Although physical resources-capital, building,
equipment are important, most companies realise that the quality and
quantity of their output is directly related to the quality and commitment of
their personnel. Human resources professionals make sure that appropriate
matches are made between support staff and producers, between
assistants and managers, and between ehaviour to enhance productivity,
support the company's business strategy and long-term goals, and provide
a satisfying work experience for employees. A human resources
professional in a smaller firm is a jack-of-all-trades who is involved in
hiring, resource allocation, compensation, benefits, and compliance with
laws and regulations affecting employees and the workplace and safety and
health issues. This multiplicity of tasks requires individuals with strong
organizational skills who can quickly shift from project to project and topic
to topic without becoming overwhelmed. "You're the last line of defense
between your company and confusion," wrote one human resources
manager at a small firm,"and sometimes confusion wins." Strong
interpersonal skills are crucial for managers at small firms.
These managers spend much of their day handling questions, attending
budgeting and strategic planning meetings, and interviewing prospective
employees. The rest of the time, they take care of paperwork and talk on
the telephone with service providers (insurance, health care, bank officers,
! !36
etc.). At larger firms, human resources managers often specialize in one

area, such as compensation, hiring, or resources allocation. Compensation
analysts work with department managers to determine pay scales and
bonus structures. Hiring specialists (also known as recruiters) place ads in
appropriate publications, review resumes, and interview candidates for
employment. Allocation managers match assistants, support staff, and
other employees with departments that have specific needs. Sensitivity to
both personality issues and corporate efficiency are a plus for allocation
managers. The most difficult feature of the human resources professional's
job is handling the dirty work involved in the staffing of a company:
dealing with understaffing, refereeing disputes between two mismatched
personalities, firing employees, informing employees of small (or
nonexistent) bonuses, maintaining an ethical culture, and reprimanding
irresponsible employees. Performing these tasks can be disheartening for
human resources managers who are supposed to support and assist
employees, and many human resources managers feel that employees
dislike or fear them because of this role.
Academic requirements for a career in human resources vary, but most

employers prefer that each candidate have a bachelor's degree.
Undergraduates should pursue a balanced curriculum that includes
behavioural sciences, English, economics, general business, business and
labour law, accounting, and statistics. Master's degrees in human resource
management, industrial relations, organisational development,
organisational behaviour, and business administration are also considered
worthwhile. Each company has its own internal protocols, and most new
hires are trained in them when they begin. A human resources manager
must have strong interpersonal skills, and many employers conduct
multiple interviews that test a candidate's ability to relate to a diverse
group of people. Many human resources professionals feel that they must
focus too much on the financial aspects of their duties to allow them to
provide the assistance they want to give. Individuals who leave the
profession often go into career counselling, industrial psychology, guidance
counselling, and labour relations. Individuals who prefer the financial side
of being a human resources manager go into budgeting, inventory control,
and quality control management.
! !37
2.5 ROLE OF HUMAN RESOURCE MANAGEMENT IN

HOSPITALS
• The importance of human resource management in healthcare lies in the

fact that a well-managed human resources mode is vital for the provision
of efficient and quality healthcare. Many challenges exist in various
healthcare systems in the quest to ensure that the healthcare provision
of that region is the best it can be. One of the challenges in human
resources management is encountered during the selection of the
employees to fill the various positions in healthcare systems. Another
challenge is the management of both the non-clinical and clinical staff,
the size of the workforce, the training of workers, and the migratory
tendencies of some healthcare practitioners.
• When considering the role of human resource management in healthcare

from a global perspective, it is important to point out that different
countries may have some of their own peculiar set of challenges, which
may differ substantially from that of other healthcare models. For
instance, one major problem faced in the management of human
resources in developing countries is lack of adequate finances to recruit
the necessary healthcare workers. As such, the necessary model for
human resource management of healthcare in those countries may be
crippled by a lack of the financial wherewithal to facilitate the model.
These countries may also face a mass exodus of some of the more
qualified healthcare practitioners who immigrate to other countries with
better managed healthcare models.
• Another issue that is a part of the role of human resource management

in healthcare is the provision of necessary tools to selected employees in
order to ensure that they adequately perform their duties. A surgeon
may be the best in his or her field, but even his or her expertise can be
hampered if the necessary medical tools are not available. As such, part
of the role of human resource management is to make sure that the
different employees have the tools needed to effectively perform their
duties. Some of these tools include items like the necessary drugs,
antiseptic, enough hospital beds, surgical equipment and other
necessities for the clinical staff. The non-surgical staff may require tools
like computers, stationery and other important office equipment.
! !38
• During the process of employee selection, the role of human resource

management in healthcare is to ensure that the people with the best
skills are matched with the available identified jobs. This is facilitated by
the efforts of the human resources managers to advertise the positions,
conduct interviews, and make proper selections. Again, the selection will
be determined by the available financial resources. If the budget is
limited, the healthcare management will have to manage the resources
by hiring the best employees within the scope of its budget.
• The hospital, an institution dedicated to the attention of human suffering,

the treatment of human ailments and the promotion of general health of
the community, has to take care of the welfare of those who run it, i.e.
its personnel. Every individual engaged in the singular service of
promoting the cause and mission of a hospital is a vital link in its overall
chain, be he a skilled surgeon or an unskilled sweeper. The lower rungs
of hospital staff should never be bracketed as 'labor' in trade union
terms. They should be, in fact, considered as essential to hospital
functioning as a physician or a staff nurse.
Activity A
Visit a private hospital in your city. With specific reference to activities

found within health care organisations, describe how functions in HR dept.
developed or changed over time. In each instance, describe the activities
that might have initially existed and then accrued to form the basis of each
activity as it is known today.
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………….
Figure 2.4 HRM importance in Hospitals
! !39
Recent trends indicate that employees can no longer be viewed as a

commodity. The socialistic pattern of society, the advent of intervention by
the State and the overall idea of a Welfare State must make the alert
manager recognise the importance of human relations and his actions must
result in social justice. Workers today are more progressive in their
outlook. They are better organised today through trade unions. These
factors highlighted the need to motivate them in the right direction, to
develop their, morale and contribute to happier management-employee
relations. Human resource management can no longer be done by intuition
or hunch. The human resource manager must be familiar with the relevant
findings of the behavioural sciences. He should be aware of the
contributions made towards it by psychology, business management and
sociology, besides being conversant with the labor laws of the land.
Governing boards and administrators of industries as well as hospitals in

advanced countries like the USA, Canada, the UK, Germany and Japan
became conscious of the importance of human resource management long
! !40
ago. But in India, the governing boards and administrators in industries

alone have realised its importance. The time has now come for the
governing boards and administrators of government and voluntary
hospitals to adopt human resource management as a part of hospital
administration. There are several reasons for this:
1. The increasing size of hospitals has made impossible the continuance of

the employee employer relationship in which employee and employer
worked side by side, knew each other as individuals and understood
mutual problems. In small hospitals, such a relationship is still possible.
In big hospitals, supervisors have been introduced to function as links
between administration and employees, but in most cases, these
supervisors are only interested in getting the work done and are in need
of training in the human relationships which are involved in their own
work situation.
2. The increasing complexity of the various problems in dealing with

employee relations demands a specially trained individual who can give
these problems continued attention so that desirable working
relationships may be established among all employees of the hospitals.
3. One of problems confronting health-care institutions id the lack of

adequately-trained personnel. This shortage and the dangers it presents
to our expanding health-care needs have been stressed repeatedly by
health-care leaders. It is a vital problem that has already led to the
deterioration of hospitals services in India.
4. India is facing the problem of brain drain of its personnel. Previously,

the United States of America, Australia, Canada, Germany were literally
'snatching away our trained personnel and scientists'. Now the Arabian
countries too have started attracting them by offering attractive salaries
which no employer can afford to pay in India. Proper human resource
management can result in enhanced job satisfaction, making it more
attractive to remain in India to work.
5. During the last quarter century, numerous labor legislations, imposing

legal restrictions on employment in hospitals, have been passed. It is,
therefore, essential that a Human resource manager well versed in the
labor laws can be of immense service.
! !41
6. Proper employee selection, training and control play vital roles in

bringing about economy and efficiency in the operation of a hospital.
Employee selection, training and control require special skills, time and
effort which cannot, usually be provided by the person charged with the
general administration work of the hospital.
7. The rising costs of hospital care have an implication for hospitals similar
to that of rising productions costs in industry. It is essential that unit
costs of operation be reexamined to ensure optimum performance by
each employee. The worker must be given adequate training and
provided with the necessary tools for satisfactory work. He must be
given proper guidance. His working conditions must be congenial. All
this requires skills in selection, training, planning work-loads, motivation
and supervision.
8. There is belief that hospital employees are of the hospitals today have
unions to fight against poor working conditions, low salary scales and
allowances and few fringe benefits prevailing in hospitals in comparison
with those in industries.
These factors acquire even more significance when we recognise that

hospital personnel are not dealing with machines and tools, but with
human beings. The human beings with whom these employees are brought
in contact with, belong to four groups: management, medical staff,
patients and visitors (Figure 2.4).
Human resource management in hospitals has now become a necessity

and it has to achieve
a) Effective utilisation of human resources

b) Desirable working relationships among all employees
c) Maximum employee development
d) High morale in the organisation, and
e) Continuous development and appreciation of human assets
Figure 2.5 Environmental factors surrounding a hospital employee and as

industrial employee
! !42
Figure 2.5 Environmental factors surrounding a hospital employee and as

industrial employee
! !43
2.6 SUMMARY
An emerging dominant perspective is the influence of globalisation on

technological advancements, business management, education, and
communication infrastructure is leading to a converging effect on
managerial mindsets and business behaviours. And when India embraced
liberalisation and economic reform in the early 1990s, dramatic changes
were set in motion in terms of corporate mindsets and HRM practices as a
result of global imperatives and accompanying changes in societal
priorities. Expectedly, there has been a marked shift towards valuing
human resources (HR) in Indian organisations as they become increasingly
strategy driven as opposed to the culture of the status quo. Human
resource management functions have always been performed in hospitals
too. It is very important, in a period of rising costs and shortage of trained
hospital employees that every possible step be taken to reduce employee
'turnover'.
! !44
1. Discuss the significance of HRM in the performance of a hospital.
3. Explain two objectives of HRM in Hospitals.
! !45
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !46
ORGANISATION OF HUMAN RESOURCE DEPARTMENT
Chapter 3
Organisation of Human Resource
Department
Objectives:
• Human resource in the organization

• Policies in HRM, line-staff relationship and authority
Structure:
3.1 Human Resource in the Organization

3.2 Human Resource Policies
3.3 Line Staff Relationship
3.4 Summary
! !47
3.1 HUMAN RESOURCE IN THE ORGANIZATION
• In healthcare facilities, the individual in charge of HR usually reports to

one of the organisation's two top executives. The preferred reporting
relationship is with the president or Chief Executive Officer (CEO). In
some health care organisations, this individual is referred to as
administrator, director, or some other title. The next best choice is the
executive vice president or Chief Operating Officer (COO). This person
may be known by an-other title such as associate administrator or
assistant administrator that designates the number two executive in the
organisation. In many con-temporary health care organisations, people
heading HR departments re-port to the top executive. In a small facility,
there may be no second level of executive management so the human
resources head will be likely to report directly to the CEO.
• Having HR report to a level other than executive management is

inappropriate. Doing so impairs the potential effectiveness of the
department. Even reporting to the second executive level, COO, or
associate administrator can result in conflict with other organisational
departments that re-port to the CEO. The chief operating officer has
responsibility for all of the operating departments. This includes the
majority of employees other staff operations, for example finance,
typically report directly to the president or CEO. Instances can arise in
which finance and HR are in disagreement. It can seem like HR belongs
to operations alone when HR reports to the chief operating officer. In
such an arrangement, HR might be incapable of fair and equitable
dealings with others in the larger organisation.
• As more and more people are added to an organisation, whether it is an

industry, a hotel or a hospital, the management of human resource
becomes more essential and more complex. Human resource
management functions have, of course, always been carried out in every
organisation, but it does not mean that these functions have been
performed efficiently or economically. It is essential that the importance
of hospital human resource management be recognised, so that by the
establishment of a separate human resource department, the workload
of the general administrator may be reduced and better service rendered
to the patients.
! !48
• There are certain symptoms which indicate the need for establishing a
human resource department. An alert administrator will easily recognise
these symptoms: poor selection of employees, irrational pay scales, high
staff turnover, and increase in absenteeism and frequent employee
grievances, differences in total hours of work required for similar tat in
different departments, lack of adequate records concerning employees,
and absence of human resource policies.
• Once the administrator of a hospital decides to have a human resource

department, the question then arises as to whether there should be a MI-
time or part-time human resource manager. In general, a hospital
employing 200 or more employees can use the services of a full-time
human resource manager and a hospital employing less than 200
employees can also use the services of a full-time human resource
manager but he should be assigned some other responsibilities such as
purchase, public relations, transport management, legal work, etc. In
hospitals which employ more than 300 employees, assistance should be
given to the human resource manager. As the size of the hospital
increases, there will be specialisation within the human resource
department. The exact size of the staff of the human resource
department will depend upon the functions assigned, the degree to which
the hospital administration wishes those functions to be implemented
and the availability of funds for the implementation. One formula used as
a guide to determine the required size of the staff is that at each interval
of 200 employees, the staff of the human resource department should be
increased by one employee.' Establishing the human resource
department according to this formula makes it possible for it to assume
all the major functions considered to be a part of human resource
management. Normally, all hospitals have an organisational structure.
The place of the human resource department in the organisational
structure of a hospital is shown in the organisational chart.
Figure 3.1 Organisational Structure of a Hospital
! !49
(Solid lines indicate line functions and broken lines indicate staff
functions.)
This chart indicates that the human resource manager's function in a

hospital is basically a staff function. He is there to guide, counsel and serve
the line officers. The line officers have direct responsibility for
accomplishing the major objectives of the hospital. Physicians, surgeons,
radiologists, pathologists, anaesthetists, matrons, etc. are line officers.
Staff officers help the line officers in accomplishing their objectives. The
finance officer, accounts officer, human resource manager, etc. are staff
officers. A physician, whose objective is to provide the best medical care to
his patient is a line officer. The human resource manager's job is to assist
the physician in the recruitment and selection of his subordinate doctors.
The human resource manager is thus a staff officer. The human resource
manager and his department assist and generally act in an advisory
capacity with regard to other departments. This often causes resentment in
line officers because most of them feel that a person who does not belong
to their department has no business to interfere in their department
affairs. The human resource manager should therefore develop a patient
attitude to avoid conflicts and win the confidence of the line officers. He
should also follow a policy of passing on credit rather than of grabbing
credit. The human resource manager should play the role of a social
! !50
worker (i.e. the role of an enabler) instead of indulging in spoon-feeding

while dealing with the officers. Once the line officers are reassured they will
look forward to receiving assistance from the human resource manager
and his department.
1. INTERNAL ORGANIZATION 
 
While in the overall organisation chart of a hospital, a human resource
manager is placed as a staff specialist, his relationship with his
subordinates in his own department there is a chain of command from
top to bottom, just as in line departments. A good human resource
department should posses certain characteristics:
(a) the ability to replace key personnel with minimal loss
(b) the capacity to solve the personnel problems encountered;
(c) a clear understanding with other line and staff departments,because
they misunderstand and are often at loggerheads with each other,
and
(d)definite objectives. Since the human resource, including those of his
own department, he must be a man of high caliber who can lead his
department, guide others and report on various matters with
confidence to the administrator.
2. PLANNING IN HR 
 
Human resource management has the same five basic managerial
functions as any other management has. The first of these functions is
planning. Every organisation be it a business house, an industry or a
hospital, needs a human resource plan in which various programmes of
personnel work are tied together into a compact programme. The
efficiency of a human resource plan is measured by its contribution to
the accomplishment of the objectives of an organisation. Thus, a plan
will be treated as efficient if the cost involved in its operation is lesser
than the revenue obtainable. However, in hospitals, no human resource
plan should be taken up at any cost if it reduces service to the patients.
3. PHILOSOPHY IN HR 
 
Human resource philosophy represents those basic beliefs, ideals,
principles and views which are held by management with respect to the
remaining four management functions, namely, organising means
! !51
arranging the work for the effective accomplishment of objectives.

functions, namely, organising, staffing, directing and controlling
employees at work. Staffing involves choosing competent and suitable
personnel for different positions in the organisation. Directing entails
guiding and supervising personnel to bring about purposeful action
towards the desired objectives. Controlling ensures progress toward
objectives according to plans. The human resource philosophy should be
flexible so that it may be amended as conditions alter with the passage
of time.
4. OBJECTIVES OF HR DEPT. 
 
It is important to set the objectives of the human resource department
within the framework of hospital policies. Broadly speaking, the
objectives of most hospitals are service and efficiency. The objectives of
employees are good salary and working conditions, job security,
opportunity for advancement, etc. The important objectives visualised
by the human resource department of any hospital should normally
include (a) recruiting the best available candidates; (b) evaluating the
performance of employees for their promotion; (c) ensuring reasonably
good working conditions for the employees; (d) giving adequate and fair
emoluments to employees commensurate with their performance; and
(e) motivating employees to work harder.
5. TOOLS OF THE HUMAN RESOURCE DEPARTMENT 

 
Good tools are essential for good production.Human resource
management is no exception.In equipping the hospital's human
resource department, the first step should, therefore, be to determine
what tools are needed and what forms they should have for the greatest
efficiency. The tools for the human resource manager include the office
and its equipment, personnel records, personnel policies and access to
the information required to do the job.
6. LOCATION 
 
The location of the human resource office and the equipments provided
would to a great extent determine the efficiency of the human resource
department. The office should be centrally located, and within easy
reach to every department. It should be particularly close to the office
! !52
of the nursing service director and the administrator. If possible, the

location should be near the main gate of the hospital. A well furnished
and adequately equipped waiting room with desks at which application
forms may be filled up by the, candidates who come for job interviews
should be provided. A folder of pictures of hospital jobs and employee
activities and also a few current magazines should be provided in the
waiting room.
7. RESOURCES / EQUIPMENTS 
 
Filing cabinets, typewriters, computer, printer, electronic clock,
cyclostyling/photo copying machine, etc., should be provided in
sufficient number to make clerical routine as efficient and economical as
possible. Telephone and intercom facilities should be made available for
maintaining effective communication within and outside the hospital.
8. HUMAN RESOURCE INVENTORY 

 
Before the human resource manager can plan his programme, he should
orient himself about the personnel and their jobs by conducting a
human resource inventory. Detailed information should be collected
about each employee:
a. Name
b. Designation
c. Department
d. Immediate supervisor
e. Location of job
f. Dependents
g. Present address with telephone number, if any
h. Permanent address with telephone number, if any
i. Date of joining
j. Date of promotion, if any
k. Total salary and pay-scale at the time of joining
l. Total salary and pay-scale at present
m. Date of last salary increase
n. Hobbies
o. Background of family members
p. Any other information. 
! !53
The data necessary to know about the personnel may be gathered from
payrolls and existing employment records. The human resource
inventory will provide the following important information:
a. An overall picture of the personnel situation

b. Data for making a rough analysis of the turnover of personnel
c. Information as to the number and types of jobs in existence
d. The number of employees reporting to each supervisor
e. Data for making a rough study of salary schedules
f. Seniority list of personnel
g. Hobbies of personnel.
Once the personnel inventory is established, it should be revised

annually. It serves as a check against existing records. It may be
supplemented by such information as the employee’s new address,
addition in family or any other details. This inventory will also assist in
the following areas:
a. Determining the areas where short-term employment is needed

b. Studying the effects of transport facilities on employment
c. Assessing the ratio of supervisors to employees.
A. Human Resource Records and Forms
Just as it is necessary to maintain records of outdoor and indoor patients,

medico-legal cases, finance or accounts, similarly, the proper maintenance
of human resource records is essential. Some records are to be kept
because of statutory requirements; other records are for reference
purposes only. As the number of employees grows, it becomes more and
more difficult to remember all details. Human resource records must
include not only negative records of employees, like records of
absenteeism, warning, etc., but also positive records of their achievements,
promotions, training, etc. The human resource department should keep
this record up-to-date, accurate and also handy so that it can be referred
to when required. There are several reasons for keeping human resource
records:
a. Individual functional departments usually do not keep human resource

records of their employees with them. Their records are kept in the
human resource department and shared/supplied when required.
! !54
b. Government agencies frequently ask for various kinds of information

from time to time. This can easily be supplied on the basis of such
records.
c. Payroll is prepared from these records.
d. Training needs are determined from these records.
e. Personal details, family details, educational qualifications, experience,

present salary, etc., can be ascertained from human resource records
for the purpose of deciding promotions, transfers, etc.
The efficient operation of the human resource department demands that

forms to promote efficiency, be designed and put into use. Forms used in
hospitals may be divided into three categories:
a. Permanent records concerned with employees' positions.

b. Forms which may become a part of the permanent records once their
immediate use is over.
c. Temporary forms which are destroyed once their immediate purpose has
been served.
B. Permanent Records Concerned with the Employees
All records concerning an individual employee throughout his employment

at the hospital should be kept in a file. This file can also be used for
reference purposes after the employee has left the organization. It has
been found useful to record the following particulars:
a. Name
b. Father's name
c. Present address (sufficient space should be provided to record changes
in address)
d. Permanent address
e. Telephone number, if any
f. Birth place
g. Date of birth
h. Marital status
i. Dependent(s)' name, sex, age, relationship
! !55
j. Person to notify in case of emergency, with address and telephone

number, if any
k. Hobbies
l. Education
m. Experience
n. Test record if pre-employment and promotional tests are used
o. References
p. Employment record in the hospital
i. Date of joining
ii. Designation
iii. Department
iv. Pay-scale
v. Break-up of allowances
vi. Date of each change along with designation, department, pay-scale
and allowances
vii.Date and reason for leaving
q. Unauthorized absence record

r. Misconduct record, date-wise
s. Punishment record, date-wise
t. Commendation record
u. Special notes, if any, e.g. special health report, repeated loans taken.
C. Permanent Records Concerned with the Position
Permanent records concerned with the positions give the history of what
has happened in the various positions throughout the hospital.The
following constitutes the permanent record concerned with the position of
an employee:
(i) Job analysis. The breakdown of a job into various component parts.
(ii)Job classification. Grouping of positions having a sufficient number of

common characteristics to enable them to be grouped into a unit, e.g.
laboratory aid, nursing aid, pharmacy aid, etc.
(iii)Job evaluation. A system by which each position is rated on specified

factors and positioned in its relationship to every other job in the
hospital.
! !56
(iv)Job specification. A summary of the requirements of the job both from

the point of view of tasks to be performed and the qualifications
necessary to perform the tasks.
(v)Human resource planning. A thorough assessment of future staff needs

is required for recruitment, training and career-planning.
D. Forms which Become Permanent Record
These include forms which will become a part of the permanent record
once their immediate use is over. The most common ones are:
a. Requisition for new employee(s) and authorization for employment

b. Job application form
c. Medical fitness report
d. Employee probationary rating form
e. Employee annual rating form.
f. Temporary Forms
These are to be destroyed after use. They consist of the following
a. Introduction slips
b. Meal passes
c. Leave record (should be maintained for 3 years)
d. Attendance record (should be maintained for 3 years)
e. Permission to visit health clinic.
3.2 HUMAN RESOURCE POLICIES
• In the beginning of the present century, the words 'human resource

policies' and ‘human resource departments' were unheard of in hospital
administration. The matron, medical superintendent or business
manager, who were the immediate supervisors, were responsible for the
hiring and firing of employees. Training, promotions and other benefits
were handled by numerous supervisors without any rationale. The nature
of the handling of employees in hospitals depended primarily upon the
whims and fancies of these authorities.
• The haphazard and ad hoc manner in which human resource problems

were handled in the past is now considered as unsatisfactory by many
! !57
executives, whether they are in the fields of industry, hotel, business or

hospital.
• The change in their attitude has been due to: (a) the increasing power of
labor unions; (b) the introduction of legislation; (c) the expansion of their
enterprises; and above all (d) the fact that the enthusiastic support of
employees is of vital importance to the success of their organisation.
• Today each employee in the hospital wants to know the terms and
conditions of his employment, the regulations which govern his
employment, and the principles which guide the administration of the
hospital in its relationship with him. The body of such principles, rules
and regulations establishing working conditions and administration of the
hospital is known as the human resource policy of the hospital.
A. PRINCIPLES OF HR POLICIES
The human resource policies should be founded on three social principles:
1. Justice - a code to ensure equitable and consistent treatment to all

employees.
2. Human needs - a policy fulfilling human needs.
3. Democratic approach - for securing the willing co-operation of
employees. 
 
The human resource policies of a hospital should be clear-cut
statements of its aims and objectives, setting out clearly what are to be
achieved in the areas of employment training, remuneration, human
relations and welfare. Human resource policies are of two types:
(a)General policies stating broad principles governing the

administration's relations with the employees employed in the
hospital; and
(b)Specific policies which are the application of the general policies to

specific situations.
In order to achieve integration of all specific policies into a major pattern

for good employee relations, each of the specific policies must fit into the
broad application of the general policies.
! !58
These policies should fulfil the needs of both the employee and the
employer.
1. Needs of the employee. Adequate remuneration, job security, the urge

to contribute something worthwhile, recognition of creative abilities, the
feeling of being recognised as a human being, etc.
2. Needs of the employer. Achievement of organisational goals with the
optimum utilisation of available resources.
B. AIM OF HR POLICIES
Thus, a sound human resource policy must aim at:
1. maximising employees' satisfaction to enable each employee to. make

an effective contribution;
2. planning for the development of employees of all categories;
3. creating an organisational structure by clearly defining responsibilities

and establishing lines of authority, to prevent misunderstanding and
duplication of work;
4. encouraging employees' participation in the management of the

organisation to build trust and develop interest, not just in the job but in
the hospital as a whole and in the standards which it seeks to attain;
5. keeping in mind the human and social implications of organisation

management;
6. developing an effective system of communication to keep people

informed about all relevant matters, to remove doubts and avoid any
undercurrent of dissatisfaction; and
7. maximising utilisation of existing human resources.
C. ADVANTAGES OF HR POLICIES
There are various advantages of having human resource policies:
! !59
1. Policies promote consistency and fairness. They help to avoid confusion

and misunderstanding among employees.
2. Policies act as controls over the line managers and their employees.
3. Policies avoid repeated analysis of the same type of problems, resulting

in saving time and energy.
4. Policies ensure uniformity in application.
The human resource policies should be drafted in unambiguous language

so that the chances of misinterpretation are minimised. They should also
be in detail so that they cover each and every aspect of human resource
management and act as a true guide. Human resource policies generally
cover the following points:
1. Definition of the words such as hospital, administrator, management,

workman, board, executive committee, medical director, etc. (whatever
is applicable in that hospital)
2. Classification of employees, i.e. permanent, temporary, apprentice,
probationer, casual, etc.
3. Medical examination of the employee and medical-care facility for the
employee and his/her family members
4. Appointment (terms and conditions of appointment and job description)
5. Orientation and identification cards
6. Hours of work and shifts
7. Attendance and late coming
8. Salary and stipend
9. Promotion
10.Transfer
11.Personal search
12.Uniform
13.Locker
14.Provident fund scheme
15.Gratuity scheme
16.Incentive scheme, if any
17.Loan facility
18.Hostel rules
19.Housing rules
20.Private practice
! !60
21.Double employment
22.Re-employment policy
23.Part-time employee policy
24.Annual increment policy
25.Dearness allowance policy
26.House rent allowance policy
27.City compensatory allowance policy
28.Conveyance allowance policy
29.Uniform allowance policy
30.Training facility
31.Leave rules governing casual leave, festival leave, sick leave, annual
leave, maternity leave, study leave, leave without pay, etc., and
procedure for routing leave applications
32.Information concerning patient's conditions
33.Performance appraisal
34.Termination of employment and the notice thereof to be given by the
employer and the employee
35.Misdemeanour and misconduct
36.Procedure for disciplinary action (dismissal, suspension)
37.Grievance redressal procedure
38.Retirement
39.Authority to interpret human resource policies
40.Powers to amend human resource policies
41.Any other matter relevant to the terms and conditions of employment.
The human resource policies must place emphasis on the selection and
placement of the right type of employees, and facilities for their
education and training so that they may do their job efficiently and with
dedication.
D. QUALITIES OF GOOD EMPLOYEES

Employees of all types are found in an organisation. Thus they may be the
young or the middle aged, authoritarian, submissive or the type needing
reassurance, support, motivation, inspiration, etc. So the Human Resource
Manager should look for the employees whose own philosophy matches the
organisational philosophy. Such employees can take the organisation
to such heights for the following reasons:
1. Good employees take responsibility. They do any assigned task and are
always happy to be helping others and never like to sit idle. They always
seem to be doing something to make life easier for patients, visitors and
their colleagues. 
! !61
2. Good employees understand the financial position of their organisation.

They know what activities make money for their organisation. So they
focus on those activities.
3. Good employees keep their commitments so that the hospital can serve
their patients better.
4. Good employees of a hospital know that patients are their bread and
butter. They really take pain to serve patients and always show concern
and empathy.
5. Good employees do their jobs carefully even if the job is not their
favourite.
a. Good employees consistently do what is best for the organisation

while the others do what is best for them.
b. Good employees are disciplined and stay on track.
c. Good employees are consistent performers so that the management

can depend upon them.
d. Good employees are self-motivated. If they have nothing to do, they

utilise their time either in learning something or helping others.
e. Good employees give credit to others.
f. Good employees do more than what they are asked to do and they
do a better job than expected.
Every human resource manager should think of forming a team of such

employees who can deliver better goods and really serve the customers
(patients) and organisation to the best of their ability.
! !62
3.3 LINE-STAFF RELATIONSHIP
"All managers are, in a sense, HR managers, since they all get involved in
activities like recruiting, interviewing, selecting, and training." - Gary
Dessler
Yet most firms also have a Human Resource Department with its own
Human Resource Manager.
How do the duties of this HR Manager and his or her staff relate to "Line"
Managers' human resource duties? Before going over to answer this
question, we should know that HR managers are, in most of the cases even
now in this modern world, generally staff managers. They are responsible
for advising line managers (like those for production and sales) in areas
like recruiting, hiring, and compensation.
One major company outlined its line supervisors' responsibilities for

effective human resource management under the following general
headings:-
i. Placing the right person on the right job.

ii. Starting new employees in the organisation (orientation)
iii. Training employees for jobs that are new to them
iv. Improving the job performance of each person
v. Gaining creative cooperation and developing smooth working
relationships
vi. Interpreting the company's policies and procedures
vii.Controlling labor costs
viii.Developing the abilities of each person
ix. Creating and maintaining departmental morale
x. Protecting employees' health and physical conditions
In small organisations, line managers may carry out all these personnel
duties unassisted. But as the organisation grows, they need the assistance,
specialised knowledge, and advice of a separate human resource staff.
The human resource department provides this specialised assistance. Thus,

an HR manager will perform three distinct functions :-
! !63
1. A Line Function: An HR manager possesses a line authority over his own

department to accomplish the task and roles assigned to each employee
of the department. And since the majority of the decision is trickled
down from the corporate level, he actually exudes such power. His
suggestions also are taken as orders.
2. A Coordinative Function: An HR manager is also a coordinator of all the

decision, activities in the personnel area. This is referred to as functional
control. Whatever policies, procedures and objectives are set for the HR
manager implements on employees in the organisation.
3. A Staff Function: This is basically an advisory role played by the

manager whereby he only assists line managers, but that does not
mean his advice shall be taken finally. It all depends on the discretion of
the line manager. Such a function involves assisting on areas such as
training, evaluating, rewarding, counselling, promoting, and firing of
employees, etc. Many a times, HR managers also update the line
managers as well as top management regarding the current trends and
new methods of solving problems.
How Does a Human Resource Manager Have Line, Staff & Implied
Authority?
Both the functions and power of the office of human resources manager
have expanded as small businesses continue to employ human resources
methods as a component of their overall business strategies. The director
of personnel or executive in charge of a company frequently attends the
administrative management meetings where the company establishes its
strategies and procedures. Inside the company, human resources directors
hold power over both the revenue-producing and revenue-consuming
departments, as well as having assorted implied authorities.
! !64
Department Supervisors (Line) Personnel Specialists (Staff)

Activities Activities
Recruitment & Assist job analyst by listing specific Write job description and job
Selection duties and responsibilities of the job specification based on input from
in question and explain to HR future department supervisor
staffing needs and sorts of people
needed to be hired
describe 'Human requirements' of Develop personnel plans showing

job so HR can develope selection promo table employees.
test. Interview candidates and make
final selection design
Resourcing of qualified applications

and engage in recruiting activities
aimed at developing a pool of
qualified applicants.
Conduct initial serving interviews and

refer feasible candidates to
department
Training & Orient employees regarding the Prepare training materials and
Development company and job and instruct and orientation document and outlines.
train new employees.
Evaluate and recommended Advise CEO regarding development

managers developmental activities plan for manager based on CEO’s
stated vision of firm’s future needs.
Provide the leadership and Serve as resource for providing

empowerment that builds effective information regarding how to
work teams. institute and operate quality
improvement programs and team
building efforts.
Use the firm’s appraisal forms to Develop performance appraisal tools

appraise employee performance. and maintain recording of appraisal.
Assess subordinates career progress

and advise them regarding career
option.
Compensation Assist HR by providing information Conduct job evaluation procedures

regarding the nature and relative aimed at determining relative worth
worth of each job to serve as the of each job in the firm.
basic for compensation decisions.
Don the nature and amounts of Conduct salary surveys to determine

incentives to be paid to how other firms are paying the same
subordinates. or similar positions.
Decide on the package of benefits Serve as resource in advising line

and services the firm is to pay. management regarding financial
incentives and pay plan alternatives.
! !65
Labor Relations Establish the day-to-day climate of Diagnose underlying cause of labor
mutual respect and trust needed to discontent with an eye toward
maintain healthy labor management anticipating with the sorts of moral
relations. and lead to unionization efforts.
Consistently apply the tears of the Train line managers regarding the
labor agreement. interpretation of contract terms and
the legal pitfalls to be avoided during
the union organizing effort.
Ensure that the firm’s grievance Advise managers regarding how to

process is functioning in a manner handle grievances and assist all
consistent with the labor agreement parties in reaching agreement
and make final decision on regarding grievances.
grievance after investigating same.
Work with HR in negotiating the

collective bargaining agreement.
Employee Keep the lines of communication Advise line management regarding

Security & Safety open between employees and the communication techniques that
managers so employees are kept can be used to encourage upward
abreast of important company and downward communication.
matters and have variety of vehicles
they can use to express concerns
and gripes.
Sure employees are guaranteed fair Develop a fair treatment process and
treatment as it relates to discipline, train line managers in its use.
dismissals and job security.
Continually direct employees in the Analyze jobs to develop safe practice

consistent application of safe work rules and advise on design of safety
habits. apparatus such as machinery guards.
Prepare accident reports promptly Promptly invest accidents analyze

and accurately. cause, make recommendations for
accident presentation and submit
necessary forms to occupational
safety and health administration.
I. Authority
Authority is the right to make decisions, to direct the work of others, and
to give orders. Authority refers to the rights inherent in a managerial
position to give orders and expect the orders to be obeyed. It is the right
to perform or command. It allows its holder to act in certain designated
ways and to directly influence the actions of others through orders. It also
allows its holder to allocate the organisation's resources to achieve
organisational objectives.
! !66
Barnard defines authority as the character of communication by which an

order is accepted by an individual as governing the actions that individual
takes within the system.
Barnard maintains that authority will be accepted only under the following
conditions:
1. The individual can understand the order being communicated.
2. The individual believes the order is consistent with the purpose of the
organisation.
3. The individual sees the order as compatible with his or her personal
interests.
4. The individual is mentally and physically able to comply with the order.
The fewer of these 4 conditions that are present, the lower the probability
that authority will be accepted and obedience be exacted.
Barnard offers some guidance on what managers can do to raise the odds
that their commands will be accepted and obeyed. He maintains that more
and more of a manager's commands will be accepted over the long term if:
1. The manager uses formal channels of communication and these are

familiar to all organisation members.
2. Each organisation member has an assigned formal communication

channel through which orders are received.
3. The line of communication between manager and subordinate is as

direct as possible.
4. The complete chain of command is used to issue orders.
5. The manager possesses adequate communication skills.
6. The manager uses formal communication lines only for organisational

business.
7. A command is authenticated as coming from a manager.
! !67
Authority was a major tenet of the early management writers, the glue
that held the organisation together. It was to be delegated downward to
lower-level managers. Each management position has specific inherent
rights that incumbents acquire from the position's rank or title. Authority is
related to one's position and ignores personal characteristics. When a
position of authority is vacated, the authority remains with the position.
The early management writers distinguished between two forms of
authority.
a. Line Authority
b. Staff Authority
c. Functional Authority
Let's have brief view about the different types of authorities.
a. Line Authority
Line authority entitles a manager to direct the work of an employee. It is

the employer employee authority relationship that extends from top to
bottom. A line manager directs the work of employees and makes certain
decisions without consulting anyone. Sometimes the term line is used to
differentiate line managers from staff managers. Line emphasises
managers whose organisational function contributes directly to the
achievement of organisational objectives. The most fundamental authority
within an organisation reflects existing superior subordinate relationships.
It consists of the right to make decisions and to give order concerning the
production, sales or finance related behaviour of subordinates. In general,
line authority pertains to matters directly involving management system
production, sales, finance etc., and as a result with the attainment of
objectives. People directly responsible for these areas within the
organisation are delegated line authority to assist them in performing their
obligatory activities.
b. Staff Mangers and Staff Authority
Staff managers have staff authority. A manager's function is classified as

line or staff based on the organisation's objectives. As organisations get
larger and more complex, line managers find that they do not have the
time, expertise, or resources to get their jobs done effectively. They create
staff authority functions to support, assist, advice, and generally reduce
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some of the informational burdens they have. Staff authority consists of

the right to advise or assist those who possess line authority as well as
other staff personnel. Staff authority gives some managers the power to
offer advice or suggestions to those managers with line authority, which
includes the right to propose new ideas in an attempt to make
improvements in line operations. While managers with staff authority do
not have the same direct power over subordinates as those with line
authority, they can provide useful propositions. Human resources
managers have staff authority in nearly every department, because they
provide advice and proposals on hiring levels, budgets and qualifications
for new employees. Staff authority enables those responsible for improving
the effectiveness of line personnel to perform their required tasks.
c. Functional control
The authority exerted by a personnel manager as a coordinator of

personnel activities. Here the manager acts as "the right arm of the top
executive."
I. Line versus Staff Authority
1. Line versus Staff Authority
• Line and Staff personnel must work together closely to maintain the
efficiency and effectiveness of the organisation. To ensure that line and
staff personnel do work together productively, management must make
sure both groups understand the organisational mission, have specific
objectives, and realise that they are partners in helping the organisation
reach its objectives.
• Size is perhaps the most significant factor in determining whether or not

an organisation will have staff personnel. The larger the organisation, the
greater the need and ability to employ staff personnel.
• As an organisation expands, it usually needs employees with expertise in

diversified areas. Although small organisations may also require this kind
of diverse expertise, they often find it more practical to hire part time
consultants to provide it is as needed rather than to hire full time staff
personnel, who may not always be kept busy.
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• Authority is the right to make decisions, to direct the work of others, and
to give orders. Line managers are authorised to direct the work of
subordinates. Staff managers are authorised to assist and advise line
managers in accomplishing their basic goals. HR managers are generally
staff managers.
II. Line Managers' HRM Responsibilities Most line managers are

responsible for line functions, coordinative functions, and some staff
functions.
III.Cooperative line and staff hr management: 

 
In recruiting and hiring, it's generally the line manager's responsibility
to specify the qualifications employees need to fill specific positions.
Then the HR staff takes over. They develop sources of qualified
applicants and conduct initial screening interviews. They administer the
appropriate test. Then they refer the best applicants to the supervisor
(line manager), who interviews and selects the ones he/she wants.
IV. Line Manager 

 
Authorized to direct the work of subordinates--they're always someone's
boss. In addition, line managers are in charge of accomplishing the
organization's basic goals. Line Managers' Human Resource
Management Responsibilities
1. Placement
2. Orientation
3. Training
4. Improving job performance
5. Gaining creative cooperation
6. Interpreting policies and procedures
7. Controlling labor costs
8. Developing employee abilities
9. Creating and maintaining departmental morale
10.Protecting employees' health and physical condition
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V. Staff Manager 
 
Authorized to assist and advise line managers in accomplishing these
basic goals. HR managers are generally staff managers.
Responsibilities Of Staff Managers- Staff managers assist and advise line

managers in accomplishing these basic goals. They do, however, need to
work in partnership with each other to be successful. Some examples of
the HR responsibilities of staff managers include assistance in hiring,
training, evaluating, rewarding, counselling, promoting, and firing of
employees, and the administering of various benefits programs.
VI.Human Resource Manager: 

 
An individual who normally acts in an advisory or staff capacity, working
with other managers to help them deal with human resource matters.
One general trend is that HR personnel are servicing an increasing
number of employees. The human resource manager is primarily
responsible for coordinating the management of human resources to
help the organisation achieve its goals. There is a shared responsibility
between line managers and human resource professionals.
The recognition of HR as a legitimate business unit has made it highly

strategic in nature and more critical to achieving corporate objectives. To
succeed, HR executives must understand the complex organisational
design and be able to determine the capabilities of the company’s
workforce, both today and in the future. HR involvement in strategy is
necessary to ensure that human resources support the firm's mission. The
future appears bright for HR managers willing to forge a strategic
partnership with other business units.
VII.Human Resource Executives vs Generalists vs Specialists
a. HR Executives- Executives are top-level managers, who report

directly to the corporation's chief executive officer or the head of a
major division.
b. HR Generalists-Generalists are people who perform tasks in a wide

variety of human resource-related areas. The generalist is involved in
several, or all, of the human resource management functions.
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c. HR Specialist-Specialist may be a human resource executive,

manager, or non-manager who typically is concerned with only one of
the functional areas of human resource management.
3.4 SUMMARY
As described earlier, HR is a staff organisation. The line and staff distinction

is extremely important when considering where HR is located and how it
operates. The manager in charge of HR has line authority only within HR.
As a staff operation that provides services, HR has no authority over any
employees outside of its departmental boundaries. The HR department
may be an organisation's expert and official voice regarding personnel
policies, compensation, and benefits and many of the legalities of
employment, but HR has no power of enforcement.
A small minority of HR professionals object to this contention. They operate

with a control model under which HR assumes some enforcement
authority.
Managers working in a health care organisation must understand that al-

though HR may ultimately report at or near the top of an organisational
structure, it is a staff operation. Its role is largely service and rendering
advice. As such, HR has no authority over any other operational areas or
departments in an organisation. The HR department exists to provide
advice, guidance, assistance, and whatever other services may be deemed
appropriate according to the mission of the organisation and the needs of
other departments.
1. Discuss the importance of Human Resource in a Healthcare

Organisation.
2. What are the principles of HR policies.
! !72
Case Study
A well-known financial house started an Industrial unit using new

technology under the name Royal Electronics Company. Their system of
Management in general was of the old type where everything was
centralised on a personal level. However, in case of new company, due to
various factors like distance, time etc., the industry was allowed to develop
on autonomous lines and was put in charge of U.K. trained Engineer.
Considering the various aspects, the industry was developing well. But due
to the lack of adequate attention to labour and industrial relations, a strike
developed. It generated tensions and fears among the executives left jobs
including Labour officer who felt insecure due to vacillation and
interference from top management.
Finally the strike was resolved. But some workers were still under charge
sheets. Their cases had been conducted by the new Labour Officer who had
joined at the height of strike one day the factory manager received a call
from the managing Director to dismiss the Labour Officer immediately. He
solicited reasons at least to justify his action, but to o avail. In fact the
Managing Director came personally, went to the Labour Officer directly and
gave him the dismissal letter. The Labour officer was appointed by the
Factory Manager and so went to him but the Manager could do nothing
now.
Questions:
1. Analyse the factors that led to a break down of industrial relations in the
Royal Electronics Company.
2. How should the cases of charge sheeted employees be dealt with?
3. What course of action will you suggest for the factory manager?
4. As a Labour Officer what would be your steps after receiving the letter
of dismissal from the Managing Director.
5. Give a suitable title to the case.
! !73
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !74
MANPOWER PLANNING IN HOSPITALS
Chapter 4
Manpower Planning in Hospitals
Objectives:
• Nature and Scope of Manpower Planning

• Need for and Objectives of Manpower Planning
• Steps for Manpower Planning
• Manpower Planning in selected industries
• Benefits of Manpower Planning
• Barriers to Manpower Planning
Structure:
4.1 Nature and Scope of Manpower Planning

4.2 Need for Manpower Planning
4.3 Objectives of Manpower Planning
4.4 Steps for Manpower Planning
4.4.1 Scrutiny of the Present Strength of Personnel

4.4.2 Anticipation of Manpower Needs
4.4.3 Developing employment programmes
4.4.4 Design training programmes
4.4.5 Fulfilling the Human Resource requirements
4.4.6 Investigation of Turnover of Personnel
4.5 Status of Manpower Planning in selected industries

4.6 Benefits of Manpower Planning
4.7 Barriers to Manpower Planning
4.8 Summary
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• Manpower Planning is the primary function of the hospital human

resource manager but before the stats filling individual jobs, he should
consider the overall management problem of making the best use of
available human resources. Just as the controller of finance budget for
the best use of financial resources, the human resources manager is
basically concerned with budget for the best use of human resources.
• Manpower planning calls for the integration of information, formulation of

policies and forecasting of future requirements of human resources so
that the right personnel are available for the right job at the right time.
• Manpower planning starts with the analysis of the future needs of the
hospital and its objectives. It determines organisation structure, decides
what jobs have to be filled and what their requirements are. Short-term
manpower planning -two year or so ahead is promoting planning. But the
really important planning is the long-term planning -five or ten year
ahead. In manpower planning the basic question of objectives
organisation structure and age structure of personnel have to be
considered.
4.1 NATURE AND SCOPE OF MANPOWER PLANNING
Nature of Manpower Planning:
• Manpower planning may be defined as a technique for the procurement,

development, allocation and utilisation of human resources in an
organisation.
• Manpower planning is the process by which the organisation ensures that

it has the right kind of people, at right time, at right place and they are
working effectively and efficiently and help the organisation in achieving
the overall objective. It is a continuous process. Of developing and
determining objectives, policies that will procure, develop and utilise
human resources to achieve the goal of the organisation.
• It views employees as scarce and costly resources, whose contribution

must be developed to the fullest by the management. It is also
concerned with the interaction between an organization and its total
environment.
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• Manpower planning, which is at times described as manpower

management, is basically concerned with having the right type of
personnel for the right job at the right time. This is done by studying
three types of forecasts:
1. Economic forecast
2. Hospital's expansion forecast
3. Employee's market forecast
• Systematic manpower planning is a must for every dynamic organisation.

The management has to meet the challenge of various pressures, such
as political, economical and technological, to ensure that the future of
the hospital remains bright under all circumstances. The emergence of
more hospitals in the vicinity and better opportunities offered by
hospitals coming up in developed, developing and underdeveloped
countries abroad can result in high employee turnover and a source of
potential loss.
Scope of Manpower Planning:
1. To make the list of current manpower.

2. To check how much current manpower is being utilised.
3. To find out how much manpower is required.
4. To make manpower procurement plans.
5. To make the training programmes.
4.2 NEED FOR MANPOWER PLANNING
Manpower planning is one of the important parts of overall human

resources system of the organisation. The quality of this system decides
the overall human resources quality in the organisation. It is very
important to study and evaluate Manpower planning process in order to
understand the overall status of human resources system in an
organisation. This is a forward looking process which decides future
requirement and quality of manpower to achieve organisational goals. This
process helps the organisation decide and achieve the human resources for
future needs. The process involves planning and forecasting of human
resources on the basis of organisational needs and how to arrange the
human resources. It is very important to have right kind of people at the
right time and right place in order to meet the individual and organisational
! !77
goals completely. Human resources plan is part of the overall business or

corporate plan of the organisation. In order to make an optimal human
resources plan it is necessary to study the organisation's objectives for the
given period.
Fig. 4.1 Reasons of Manpower Planning

Every hospital has to do manpower planning for the following reasons:
1. Shortage of certain categories of employees.
2. Advancement of medical science and technology resulting in need for
new skills and new categories of employees.
3. Changes in organisation design and structure affecting manpower

demand.
4. Government policies in respect to reservation of seats for SC/ST/OBC/

handicapped persons/women,and others.
5. Labour laws affecting demand and supply of labour.

6. International scenario of employment, e.g. employment of nurses,
doctors, para-medical personnel in USA, UK, Ireland, the gulf countries,
etc.
7. Introduction of computers.
4.3 OBJECTIVES OF MANPOWER PLANNING
Manpower planning involves all the steps of planning i.e. anticipating,

looking at present available human resources, forecasting of human
resources, and planning for future requirements on the basis of business
plans of the organisation. This is important for making arrangements of
manpower as and when needed as per the required quality in terms of
qualification, experience, competency etc.
Manpower Planning involves:
• integration of information;
• formulation of policies;
• identification and analysis of present work/requirement;
! !78
• forecasting and analysis of future requirement; and

• evolving appropriate policies.
• In order to make a proper human resources plan and forecasting the
future requirements it is important to look at both quantity and quality.
Organisations make use of human resources management system for
this purpose. Human resources management system is a computer based
system which provides all the details related to present human resources
inventory and helps in monitoring the availability of human resources.
The system provides all the details with respect to existing human
resources with their demography, educational qualifications,
competencies, skills, experiences, training programmes attended, and
performance management system records and succession plans etc. In
order to prepare a proper human resources plan these details are very
useful.
Manpower Planning in a hospital aims to:
• ensure maximum utilisation of human resources

• assess future requirement;
• determine recruitment sources;
• identify training needs for staff development; and
• have better employee - employer relationship.
• The human resources planning system identifies the development
requirements of individual employees so that they can be useful in
future. Manpower planning system plans to achieve optimum utilisation
of existing human resources and planning for the future requirements.
The objective of Manpower planning system is :
(i) to recruit and retain the human resources of required quantity and
quality
(ii)to foresee the employee turnover and make the arrangements for
minimising turnover and filling up of consequent vacancies
(iii)to meet the needs of the programmes of expansion, diversification etc.
(iv)to foresee the impact of technology on work, existing employees and

future human resource requirements:
(v)to improve the standards, skill, knowledge, ability, discipline etc.
! !79
(vi)to assess the surplus of shortage of human resources and take

measures accordingly
(vii)to maintain congenial industrial relations by maintaining optimum level

and structure of human resources
(viii)to minimise imbalances caused due to non-availability of human

resources of the right kind, right number in right time and right place
(ix)to make the best use of its human resources, and
(x)to estimate the cost of human resources.
• In order to compare the present human resources to the future

requirement on the basis of growth, expansion plans, identification of
skills and competency gaps and then making and developing plans for
arrangement of human resources needed in future is the basic process of
Manpower planning. The process takes care of all the aspects of
manpower including the requirement of future skills and competencies.
The comparison is made with a view to look in the future requirements of
number as well as competencies. All such requirements are aligned with
the future requirements of the organisation which are derived from
business requirements. Manpower planning provides a deliberate basis
for taking human resource decisions in anticipation of the future
changes. The process of Manpower planning is not only concerned with
manpower demand projections or employee turn over projections but
also helps in planning for retirements, succession planning and
replacements in a systematic manner. Manpower planning has become
an important strategic function for the entire organisation. This is a
required not only to achieve current goals and objectives but also to
create a competitive edge. The human resources planning system also
helps in increasing the efficiency of an employee by providing opportunity
such as transfer, deputation, rotation and promotion etc. The plan helps
individual employee clear his roles and responsibilities in order to achieve
the goals of the organisation. Recent growths witnessed by various
sectors in Indian industries have thrown lot of challenges. In order to
meet the human 78 resources requirement of the firm in present times of
talent shortage, human resources planning become more and more
important.
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• The main objective of manpower planning is to work towards optimum

and effective utilisation of the available manpower. In other words, it
means having the right person for the right job. Manpower planning
could be short term or long term.
FACTORS AFFECTING MANPOWER PLANNING IN HOSPITALS:
Several factors affect Manpower Planning in hospitals. These factors can be

classified into external factors and internal factors.
A. External Factors: External Factors include:
i. Government Policies: Policies of the government like labour policy,

industrial relations policy, policy towards reserving certain jobs for
different communities and sons-of the-soil etc.,
ii. Level of Economic Development: Level of economic development

determines the level of HRD in the country and thereby the supply of
human resources in the future in the country.
iii. Business Environment: External business environmental factors

influence the volume and mix of production and thereby the future
demand for human resources.
iv. Information Technology: Information technology bought amazing shifts

in the way how do businesses operate? These shifts include business
process reengineering, enterprise resources planning and supply drain
management. These changes brought unprecedented reductions in
traditional human resources and increase in software specialists.
However, these changes reduced the demand for even software
specialists at a later stage. Added to this, the computer-aided design
(CAD) and computer-aided technology (CAT) also reduced the existing
human resources.
v. Level of Technology: Level of technology determines the kind of human

resources required.
vi. International Factors: International factors like the demand for and
supply of human resources in various countries.
! !81
B. Internal Factors: Internal Factors affecting manpower planning

include:
i. Company strategies: Hospital polices and strategies relating to

expansion, diversification, alliances etc. determine the human resources
demand in terms of quality and quality.
ii. Human resources policies: Human resources policies of the company

regarding quality of human resources, compensation level, quality of
work life etc. influence human resources plan.
iii. Job Analysis: Fundamentally, human resources plan is based on job

analysis, job description and job specification. Thus, the job analysis
determines the kind of employees required.
iv. Time horizons: Companies with a stable competitive environment can

plan for the long run, whereas firms with and unstable competitive
environment can plan for only short-term range.
v. Type and quality of information: Any planning process needs qualitative

and accurate information. This is more s with human resources plan.
vi. Trade unions: Influence of trade unions in hospitals regarding the

number of working hours per week, recruitment sources etc., and affect
manpower planning.
Fig. 4.2 Factors affecting Manpower planning in a hospital
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Activity A
What is Manpower Planning? List down some of the factors affecting

Manpower Planning in hospital.
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………….
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4.4 STEPS FOR MANPOWER PLANNING
Manpower planning covers the total activity of the personnel functions such
as recruitment, selection, training, career development, staff appraisal, etc.
Manpower planning involves the following steps:
1. Scrutiny of the present personnel strength

2. Anticipation of manpower needs
3. Developing employment programmes
4. Design training programmes
5. Investigation of turnover of personnel
4.4.1 Scrutiny of the Present Strength of Personnel
Preparing an inventory of present manpower -An inventory is prepared

which contains the present number of employees, their qualifications,
technical qualification, technical abilities, skills, and other information such
as preferred location, etc.
The scrutiny of the present personnel strength is the corner-stone in

manpower planning. This helps in management development, in
determining training needs, and in the optimum utilisation of personnel
wherever they are needed most. An examination of present staffing can
further determine the exact number of personnel required and their skill-
levels. Before a manager makes forecast of future manpower, the current
manpower status has to be analysed. For this the following things have to
be noted-
• Type of organisation
• Number of departments
• Number and quantity of such departments
• Employees in these work units
Once these factors are registered by a manager, he goes for the future
forecasting.
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4.4.2 Anticipation of Manpower Needs
Forecasting future demands for employees: By studying the present human

resources, gap in competencies and number of people are identified and
future requirement of the organisation is generated. This activity is termed
as forecasting. Forecasting of human resources is based on future growth
plans and the future organisation structure of the organisation. The care is
taken to take understand the competencies required for future and the
projections are made on the basis of numbers as well as competencies
required. Forecasting of human resources is done with quantitative as well
as qualitative methods.
The anticipation of the needs for manpower generally involves taking an

inventory of the existing personnel who are 'in stock' today, and what can
be expected to be in stock tomorrow. This forecast is prepared every year
for the next five years. It's objective is to determine the number of
personnel likely to be needed on account of any reason whatsoever
promotion of employees to higher posts, losses that are likely to occur
through resignations, dismissals, retirements, etc. Ultimately, the net
requirements of the hospital are indicated. Once the factors affecting the
future manpower forecasts are known, planning can be done for the future
manpower requirements in several work units.
The Manpower forecasting techniques commonly employed by the

organisations are as follows:
i. Expert Forecasts: This includes informal decisions, formal expert

surveys and Delphi technique.
ii. Trend Analysis: Manpower needs can be projected through extrapolation

(projecting past trends), indexation (using base year as basis), and
statistical analysis (central tendency measure).
iii. Work Load Analysis: It is dependent upon the nature of work load in a
department, in a branch or in a division.
iv. Work Force Analysis: Whenever production and time period has to be
analysed, due allowances have to be made for getting net manpower
requirements.
! !85
v. Other methods: Several Mathematical models, with the aid of computers

are used to forecast manpower needs, like budget and planning
analysis, regression, new venture analysis.
Fig.4.3 Manpower Planning Process
!  
! !86
4.4.3 Developing employment programmes
Once the current inventory is compared with future forecasts, the

employment programmes can be framed and developed accordingly, which
will include recruitment, selection procedures and placement plans.
4.4.4 Design training programmes
These will be based upon extent of diversification, expansion plans,

development programmes,etc. Training programmes depend upon the
extent of improvement in technology and advancement to take place. It is
also done to improve upon the skills, capabilities, knowledge of the
workers.
4.4.5 Investigation of Turnover of Personnel
Labour turnover, as the words imply, means the rate of change in the
number of employees, i.e. the number of employees leaving and joining an
organisation during a certain period. A study of labor turnover is helpful in
manpower planning. A high turnover is a warning to the hospital
authorities that something is wrong with the personnel policies and
practices of the hospital. It may be due to wrong selection, placement, low
salary, poor working conditions, lack of promotional avenues, etc. A high
rate of turnover not only costs in terms of money but also harms the
reputation of a hospital, lowers the team-spirit of the remaining employees
and reduces the quality of patient-care.
Some of the important factors which result in employees quitting their jobs
are:
1. Low salary
2. Better prospects in other hospitals
3. Poor working conditions
4. Transport problem
5. Housing problem
6. Marriage in case of female employees
7. Health grounds
8. Family circumstances
9. Further studies
10.Maltreatment by superiors
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11.Unfriendly relations with colleagues

12.The attraction of going back to one's native place
13.The attraction of going to a foreign country
The exit-interview is a useful tool to study labor turnover. When an

employee is leaving, he is generally willing to be candid and may share his
bitter experiences. The organisation’s weak spots are revealed, which can
ultimately help reduce turnover and in building the morale of the remaining
employees in the hospital.
The exit-interview form (Form 4.4) should be filled up by the human

resource department. Any responsible person of the human resource
department should conduct the exit-interview of an outgoing employee on
the last day of his leaving. He should report his findings to the human
resource manager and chief executive of the hospital for taking corrective
measures so that other employees may not leave the hospital for the same
reasons.
An exit-form should also be filled up by the concerned department head.

Form 4.4 is a specimen of this. While filling up this form, the Department
Head need not interview the employee who is leaving. He should fill up the
form on his own and forward it to the personnel department for analysis
and record purposes.
Form 4.4 EXIT INTERVIEW FORM
Name and Address of the Hospital

EXIT-INTERVIEW FORM
(To be filled up by the head of the human resource department)
Name:______________________Designation:____________Department:___________
Employment:Permanent/Temporary/Leave vacancy/Casual/Apprentice_______________
Pay-scale at the time of joining : ____________________________________________
Total Salary: Rs._____________/p.m.
Pay-scale at the time of leaving : ____________________________________________
Total Salary Rs._____________ /p.m.
Date of joining: Date of leaving :____________________________________________
! !88
Age:____________ Set:_____________
Marital status: Single/Married/Separated/Divorced/Widow(er)
Why did you join this hospital?______________________________________________
Why are you leaving this hospital? If it is for any of the reasons listed below, please tick
as many alternatives as appropriate. If it is for some other reasons, please state.
Personal Reasons Economic Reasons Involuntary Others

Health grounds Better pay in another Advised to resign Poor working
hospital: conditions
Name
Getting married Better prospects in Terminated Distance and

another hospital: transport problem
Family Name : ………….. Retrenched circumstances
Further studies Starting own practice Any other reason Housing problem
Maltreatment byAny other reason superiors:
Name:_______________________________
Unfriendly relations with colleagues: Name:

Going to native place/abroad
Voluntary retirement
Any other reason
As a place of work, can you say that this hospital is excellent/very good/good/fair/poor
'Please tick at the appropriate place)
Do you think that your relations with your superiors were excellent/very good/good/fair/
poor (Please tick at the appropriate place)
Should there be any vacancy in future, would you like to serve again at this hospital?
Yes/No. (Please tick at the appropriate. place)
If not, can you give reasons for this decision ?

…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
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Please give your suggestions for further improvement of this hospital.

…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
Date : …………………. Signature of the Employee
How far does the head of the department agree with the comments of the employee?
…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
Signature of the Head of the human resource department
Direction of the head of the Hospital, If any

…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………………………
Signature of the Head of the Institution
The Head of the human resource department should objectively analyse

the information received through the exit-interview conducted by the
human resource department and the information given by the concerned
department head through the exit-form. He should then forward his
observations and recommendations to the Head of the hospital so that
corrective measures may be taken to reduce the turnover.
4.5 STATUS OF MANPOWER PLANNING IN SELECTED

INDUSTRIES
The details related to the existence of Human resources planning systems

in the sample organization were obtained from the human resources
department of the sample industries.
1. In Reliance Industries Limited, Human HR planning is done at the

project/ expansion stages. All the levels are filled up according to the
organization structure created at the time of project/expansion. This
was the first human resources system which was implemented in
Reliance.
! !90
2. In case of Blue Star, HR planning is done at the beginning / expansion

of project, for replacement of manpower on account of resignation/
termination; vacancies are approved and filled up.
3. Hindustan UniLever Limited: It is observed that Human Resources

planning is done at the time of project implementation in case of new
projects and expansion of existing project. The organisation structures
are drawn and the vacancies are filled accordingly. After the completion
of projects, for replacement of manpower on account of resignation/
termination; vacancies are approved and filled up.
EXAMPLE
Manpower planning for a Retail Outlet. 

If we need to decide the number of employees required to operate a retail
store, how do we go about it?
1) THE TOTAL AREA OF THE STORE: Assuming that an average

employee will be able to manage 300 sq feet hence if the retail outlet is
of 20000 sq feet then we would require 60 employees.
2) THE TYPE OF PRODUCTS SOLD AT THE STORE: A retail outlet selling

electronic goods like laptop would require personalised attention from
its customers in order to explain and give demonstration model wise,
whereas a retail outlet selling groceries would require a generalised
attention towards its customers because every customer walks in will
not ask detail about a branded salt or a chilly powder.
3) THE AVERAGE WALK-INNS OF THE STORE: i.e. the average number

of customers visiting the retail store on a daily basis. If retail outlet has
more number of customers visiting then the employee strength has to
be increased compared to a low walk in store.
Activity B
List down the steps involved in manpower planning of any organisation.

…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………….
! !91
4.7 BARRIERS TO MANPOWER PLANNING
Manpower planning is as important is not so easy to make. The planners

face various problems while formulating human resource plans. The major
ones are discussed as follows:
1. Manpower plans suffer from inaccuracy as it is difficult to prepare long-

range forecasts accurately. There could be changes in economic
conditions, technology, market and labor force conditions which may
make the long-range plans unreliable.
2. Most of the times, operating managers or non-HR managers are not

involved in the manpower planning which renders the planning
ineffective. A successful planning has to involve the efforts of the
operating as well as the HR managers.
3. Imbalance may occur between short-term and long-term HR needs.

Many managers, due to pressures, may focus on getting the work done
while neglecting the long term need of grooming the people for greater
responsibilities.
4. Under Utilisation of Manpower: The biggest obstacle in case of

manpower planning is the fact that the industries in general are not
making optimum use of their manpower and once manpower planning
begins, it encounters heavy odds in stepping up the utilisation.
5. Degree of Absenteeism: Absenteeism is quite high and has been

increasing since last few years.
6. Lack of Education and Skilled Labour: The extent of illiteracy and the
slow pace of development of the skilled categories account for low
productivity in employees. Low productivity has implications for
manpower planning.
7. Manpower Control and Review:
a. Any increase in manpower is considered at the top level of

management
! !92
b. On the basis of manpower plans, personnel budgets are prepared.

These act as control mechanisms to keep the manpower under
certain broadly defined limits.
c. The productivity of any organization is usually calculated using the
formula:
Productivity = Output / Input
But a rough index of employee productivity is calculated as follows:

Employee Productivity = Total Production / Total no. of
employees
d. Exit Interviews, the rate of turnover and rate of absenteeism are

source of vital information on the satisfaction level of manpower. For
conservation of Human Resources and better utilisation of men
studying these condition, manpower control would have to take into
account the data to make meaningful analysis.
e. Extent of Overtime: The amount of overtime paid may be due to real

shortage of men, ineffective management or improper utilisation of
manpower. Manpower control would require a careful study of
overtime statistics.
Few hospitals in India do not have sufficient records and information on

manpower. Several of those who have them do not have a proper retrieval
system. There are complications in resolving the issue in design, definition
and creation of computerised personnel information system for effective
manpower planning and utilisation. Even the existing technologies in this
respect are not optimally used. This is a strategic disadvantage.
4.8 SUMMARY
Human Resource Management is a process where people and organizations

are brought together so that the goals of each are met. Manpower planning
or Human Resource planning is the process of forecasting an organization's
future demand for, and supply of, the right type and strategy of
organization, growth cycle of an organization, environmental uncertainties
and labor market. It is important as it determines future manpower needs,
is a foundation for other HR functions and is useful in creating highly
talented manpower. 
! !93
1. What are the steps involved in Manpower Planning?
2. Why is manpower planning required?
3. What are the barriers that are faced while planning the manpower
requirements in an organisation?
! !94
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !95
JOB ANALYSIS, JOB DESCRIPTION & SPECIFICATION FOR HOSPITAL STAFF
Chapter 5
Job Analysis, Job Description &
Specification for Hospital Staff
Objectives:
• Planning of Job analysis for various departments

• Job description in hospitals
Structure:
5.1 Planning job requirements and job descriptions

5.2 Job Analysis
5.3 Job Description
5.4 Job Specification
5.5 Stay in Interview
5.6 Doctor-to-Beds Ratio
5.7 Nurse-to-Beds Ratio
5.8 Human Resource Strength in various departments
5.8.1 X-Ray department

5.8.2 Physiotherapy
5.8.3 Medical Lab
5.8.4 Pharmacy
5.8.5 Laundry
5.8.6 Food Service
5.8.7 Sanitation and Housekeeping
5.8.8 Security
5.8.9 Central Sterilisation and Supply Department
5.8.10 ECG Department
5.9 Summary
! !96
5.1 Planning job requirements and job descriptions
Manpower planning consists of studying job requirements and preparing

job descriptions. The requirements of each and every job must be
thoroughly studied through job analysis. The requirements for a job vary
according to the nature of the job itself. However, a certain work ethic must
be cultivated to succeed in any job and this is fundamental to an
individual’s sense of himself as a worker, as part of production relations
and a fundamental economic being. The basic requirements for a job
remain the same no matter what the job is, where it is located or what
professional and educational qualifications are required for it. These are as
follows:
Discipline: Nothing is possible without discipline. Any job requires a

fundamental core of discipline from the worker or the employee and this is
a quality which is independent of age, post, stature, job and so on.
Discipline is absolutely indispensable and provides the impetus for work
that can be strenuous, repetitive, boring and even unsatisfactory at times.
Enthusiasm: Enthusiasm for work is also a pre-requisite for any job. An

innate love for the job, which in modern parlance is known as job
satisfaction, is a core requirement for any job.The drive to succeed, to
innovate, to do well and to make one's profession into one's livelihood is a
critical drive which needs to be present in the employee or cultivated as
soon as possible. No job, however perfectly carried out, can evoke the
feeling of satisfaction of a job well done without the instinct for success.
Qualifications: This is a more material, tactile need for a job which can be
conveyed through degrees and certificates. However education is not
limited to what is taught in colleges or vocational training courses. It is the
burning desire to learn more, to reach the depths of knowledge about a
particular field of interest, to complete the job and learn from it that marks
the true enthusiast and the truly learned.
Soft Skills: Soft skills include those skills which ensure that a job is
executed well, and the employee can carry himself in the proper manner
too. For example, good and smooth communication, computer skills,
proficiency in language if needed, presentable appearance, the ability to
manage crises are all soft skills which are fundamentally important in any
job and which must be cultivated consciously.
! !97
Thus, the requirements of a job, though specific to it, cover also a general
spectrum. These make for better employees and better individuals.
5.2 JOB ANALYSIS
Job analysis is the process of examining a job to identify its component

parts and the circumstances in which it is performed. It is necessary to be
familiar with this technique because its application is quite wide and
extends across the whole range of staff management functions:
i. Recruitment. It aims at filing jobs by recruitment, transfer or promotion.

ii. Training. It is intended to decide the contents of the programme.
iii. Salary. It is designed for finding the correct grading of individual posts.
iv. Safety. It is meant for identifying job hazards.
v. Annual performance appraisal. It evaluates the performance of
employees annually.
Its range is comprehensive and it is, therefore, essential for every

supervisor to know this technique. The mechanics of carrying out this work
of job analysis are demanding on the resources of both the functional
management who prepare the job analysis and the line management who
analyses it.
The steps in conducting job analysis are as follows:
1. The analysis should commence with a fairly brief statement of initial

requirements such as aptitude, educational qualification, training and
experience.
2. The next main item should be a description of the responsibilities under

broad headings such as physical effort (amount of physical effort
required for moving, lifting, duration, etc.), mental effort (the degree of
intelligence needed); and responsibilities (for controlling staff, material,
equipment, cash, etc.).
3. Environment and conditions of service are to be considered and

analysed such as physical surrounding (indoor, outdoor, temperature,
humidity, noise, etc.), accident hazards, shift duties, prospects of
advancement, occupational illness, etc.
! !98
4. The constraints, difficulties and pressure of the job should also be

brought out. For instance, in the case of an accountant responsible for
preparation of consolidated figures for the top management, the time by
which these figures must be prepared and its impact on his other duties
during this period must be spelt out.
Job analysis should, therefore, be concerned with realities and practical

possibility. It should indicate how a job is taken care of within the limits of
human capacity. It is a tool of the management aimed at eliciting detailed
information about a job. At the same time it can act as a personnel
problem-solving device.
5.3 JOB DESCRIPTION
Job description is a broad statement of the purpose, scope, duties and

responsibilities of a particular job. This is a resultant of the job analysis. It
provides the detailed factual information required by candidates and
selectors alike in order to obtain a thorough knowledge of the requirements
of a job. To avoid confusion and misunderstanding, a job description should
be prepared jointly by the human resource department and the concerned
department head. A broad format for job description is given in Form 5.2.
The job description is not a legal document. However, it helps when there
are differences between the job holder and his Department Head. The job
description should be reviewed from time to time, particularly at the time
of annual appraisal, because the job itself changes due to advancement in
technology, laws, requirements, etc.
5.4 JOB SPECIFICATION
A job specification can be defined as a list of various qualities which the

person doing the job should possess. It is prepared by analysing the job
description. The job description is translated in terms of qualifications
required and personality requirements. These requirements can be
grouped under the heads:
1. Mental requirements which include intelligence needed and educational

and professional qualifications.
! !99
2. Physical requirements which include age, height, health and eyesight,

etc.
3. Skills requirements such as dexterity required for doing a job,

communication, human relations and leadership skills.
FORM 5.2
JOB DESCRIPTION
Job title:……………………………………… Department: ………………………………………..
Accountable to*:………………………… Pay scale: ……………………………………………
(Here mention the e.g. matron in case job title of the individual responsible for
the supervision of the job holder, of staff nurse, electrical engineer in case of an
electrician, etc.)
Job summary: ……………………………………………………………………………………………………………

……………………………………………………………………………………………………………………………………
Job Duties:
1.
2.
3.
4.
5.
Any other duty assigned by the Department Head.
Qualification: …………………………………………………………………………………………………………….
Experience: ………………………………………………………………………………………………………………
Efforts: ……………………………………………………………………………………………………………………..
Working conditions: …………………………………………………………………………………………………
! !100
4. Responsibility requirements in relation to machines, equipment, fellow

workers, work schedules, etc.
5. Experience requirements to do the job efficiently.
6. Working conditions requirements such as physical surroundings.
5.5 STAY IN INTERVIEW
• Stay in interview for Human Resource managers has become an

indispensable tool to retain their workforce by making them feel
appreciated and motivated. Contrary to exit interview, stay in interview is
conducted to understand the reasons why employees with to continue
working for the organisation. It is all about their work, the environment,
the practices and the behaviour of the supervisor's managers that appeal
to them and motivate them to stay on.
• Stay in interview is held to understand the issues an employee may be

facing. So, the Human Resource manager should get feedback from time
to time by conducting stay in interviews while an employee is still on the
job as he conducts the exit interview.Though stay in interview is
conducted while an employee is working and exit interview when an
employee is leaving, both are important from human resource
management point of view, but stay in interview is more important to
retain employees.
• Stay in interview and exit interview can prove to be crucial as they may
actually bring forth an issue that the manager may have hitherto
ignored. They can be used to judge if the expectations of the employees
have been met and the promises fulfilled. In short, stay in interview
helps an organisation correct certain things before an employee decides
not to work with it any more. Stay in interviews have always been
conducted but under different nomenclature in the form of performance
appraisal.
• The concept of stay in interview is a positive approach. It focuses on

what is going right rather than what is going wrong. Stay in interviews
can be conducted periodically by the immediate supervisor with the help
of an assistant of human resource department. They should bring the
information collected from the employees in the knowledge of the
! !101
concerned department head of the employee as well as the human

resource manager and try to utilise the information in the best interest of
the hospital.
• This ratio of 2 employees per bed cannot be applied in Indian hospitals

because the personnel required depend on the size of the hospital, type
of hospital and degree of care it provides, area of the hospital, type of
equipment used (automatic, semiautomatic, or manually operated), etc.
Under prevailing conditions, to manage every bed, whether in a small or
big hospital, it requires 3 to 5 personnel.
5.6 DOCTOR-TO-BEDS RATIO
According to the Medical Council of India, the doctor-to-beds ratio should

be 1:5, but this ratio is applicable only to those hospitals which are
attached to medical colleges and where the doctors are required to
participate in teaching programmes of the medical colleges.This ratio
depends upon the type of hospital, such as maternity, paediatric, infectious
diseases, referral, general, etc. However, it can be recommended that the
doctor-to-beds ratio should be 1:10 in general hospitals. The ratio of 1
doctor for 10 in-patients will imply an in-built facility for examining 30
outdoor patients approximately. If a doctor has to look after more than this
number of patients, he will not be able to do full justice to the patients.
5.7 NURSE-TO-BEDS RATIO
• The nurse-to-beds ratio should be 1:3, according to the Indian Nursing

Council The Council has further prescribed that for every 100 beds and to
cover a 24-hour period there should be 4 ward sisters and 30 staff
nurses and for fractions of 100, the staff should increase in the
proportion of 1 ward sister to 25 beds and 1 staff nurse to 3 beds. When
the bed strength is between 150 and 400, in addition to the nursing
superintendent, there should be an assistant nursing superintendent, and
when the bed strength is 401 to 700 and for every 300 beds in excess of
700, there should be an additional nursing superintendent. There should
be separate staff for special departments with a sister-incharge of the
operating room and a sister-in-charge of the casualty department. The
out-patients department should have a sister-in-charge and a minimum
of one staff nurse for each out-patient clinic operating daily, but not less
than a total of two in the department.
! !102
• In case, some patients happen to be serious in a particular ward

requiring more attention of the nurses, Ward In-charge can ask for extra
nursing staff to provide sufficient nursing care to those patients at that
time. There can also be a possibility of deploying some nurses elsewhere
if there are fewer patients in a ward at a particular time so that they can
be properly utilized. Most of the hospitals assign duties of the nurses
shift wise and ward wise and some hospitals also keep a group of floating
nurses to assign them wherever they are needed in the wards, operation
theatre, labor room, post-operative recovery room, etc. to facilitate the
working of the department.
• The nurse-to-beds ratio also depends upon the kind of ward. The
recommended nurseto- beds ratios for the various kinds of wards in a
hospital are given in Table 5.3. However, needs may vary from one
hospital to another, depending on the size of the hospital and services
rendered. Thirty per cent leave reserves personnel should also be
provided.
• The nurse-to-beds ratio given in Table 5.3 according to the kind of ward
has been found to be ideal, keeping in view the high quality of nursing
care which is a must for convalescing patients in hospitals. A nurse is to
perform different procedures and functions at different time, such as on
admission of a patient, discharge of a patient and care during the stay of
a patient in the morning, afternoon, evening and at night.
• Patient's care at the time of admission. The staff nurse welcomes a

patient with a smile, removes the bed cover, makes him feel comfortable,
arranges for fresh drinking water, checks his weight, temperature and
blood pressure, enquires about the history of the illness, orientates the
patient to his surroundings (such as use of the call bell, bedpan, music
system, television. fridge, microwave, barber, meal timings, light, fan,
etc.) sends the diet requisition, records his general condition, informs the
doctor about the admission and answers queries of the patient and the
relatives.
• Morning care of the patient. This care is given to the patient in the
morning by the dayshift nurse. She visits the patient in his room, greets
him, gives a sponge bath changes his clothes, rubs talcum powder,
changes bed sheets and pillow-cover, checks his temperature and blood
pressure, administers morning medicine, makes the round with the
! !103
doctors assists the diet-aides in giving breakfast, brings fresh water,

sends the patients for X-ray, sends urine and stool specimens, if ordered
to laboratory department, arranges for breakfast lunch, etc.
5.8 HUMAN RESOURCE STRENGTH IN VARIOUS

DEPARTMENTS
• Afternoon care of the patient. This care is given to a patient by the day-
shift nurse after he had his lunch. She draws the window curtains to
darken the room so that the patient may take a nap. After the patient
has woken up from his afternoon nap, she pulls the curtains, offers the
bedpan, washes and dries the patient's hands, straightens linen and
remakes the corners of the bed, places the call-bell within the patient's
reach, checks temperature and blood pressure, administers medicine and
injections, combs the patient's hair, prepares him for evening tea and for
receiving his visitors, etc.
Activity A
Describe the various methods used to collect job related data in an

organisation. List down some of the problems faced while conducting job
analysis.
…………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………….
• Evening care of the patient. This is the care given to the patient by
the P.M. shift nurse. She takes the report about the patient from the
morning shift staff, checks temperature and blood pressure, administers
medicine and injections, sees that the patient has been provided the
prescribed diet, straightens the bed sheets, places the patient in a
comfortable position for sleep, switches off the lights of the room and
switches on the night lamp, if required, etc.
• Pre-morning care of the patient. This is the care which is given to the
patient generally between 5 and 7 A.M. by the night nurse. She greets
the patient, provides the bedpan, collects urine and stool specimens, if
required, assists the patient in brushing his teeth, washes his face,
straightens the bed sheets and makes the patient comfortable, etc. If the
patient has any problem at night, she contacts the doctor-on-call, makes
! !104
entries in the nurses' note-sheets about the general condition of the

patient and finally reports to the day-shift nurse before going off duty.
• Care at the lime of discharge of the patient. Preparation for the

patient to return home should actually begin the moment he enters the
hospital. The whole aim of the hospitalisation is to try to help an
individual recover speedily so that he may again take his place in society.
If this is not possible, he should be prepared to continue his treatment at
home. Many patients feel some anxiety about returning home. The nurse
should recognise symptoms of fear and give them reassurance
accordingly.
• When the doctor decides to discharge a patient, the nurse informs

the patient and his family members so that they make the necessary
arrangements. She sends the chart for billing, explains the discharge
policy to the patient and relatives, hands over the bill to the patient's
relatives, collects home medicines from the pharmacy for the patient,
requests the doctor to prepare the discharge summary, etc. When the
patient’s relative returns after paying the bill, she receives the discharge
slip from him, signs it, gives the medical certificate, home medicines and
discharge summary to the patient, explains follow-up policy, checks
hospital belongings, accompanies the patient to the exit gate of the
hospital, enters the patient's name and accurate time in the discharge
census, informs the admission office and the diet kitchen about the
departure of the patient, and disinfects and prepares the bed for the next
patient.
• The ratios given in Table 5.3 have been derived after consultations with
experienced nursing staff and after minutely observing the day-to-day
nursing procedures which are performed by the nursing staff in different
wards. However, the human resource manager and the nursing
superintendent in mutual consultation with each other can increase or
decrease the nurse-to-beds ratio. If they increase the nurses, it will
further improve the quality of nursing care and if they decrease the
nurses, it will adversely affect the patients.
Fig 5.3 Nurse-to-beds Ratio for Different Wards
Ward Nurse Beds Remarks

Medicine 1 3
! !105
Surgery 1 3
Casualty 1 2
ICU 1 1
CCU 1 1
Pediatrics 1 4 if mothers are allowed to stay with the

patients
Pediatrics 1 2 if mothers are not allowed to stay with the

patients
Gastroenterology 1 3
OB & Gynae 1 3
Labour Room 1 3 (Per OT Table)
Operation Theatre 2 1
Orthopedics 1 3
Well baby nursery 1 3
Special nursery 1 1
Dialysis 1 1
Neurology 1 3
Psychiatry 1 3
Dermatology 1 3
Cardiothoracic Surgery 1 1
ENT 1 3
Eye 1 3
Neuro Surgery 1 3
Oncology 1 3
Plastic Surgery 1 3
Urology 1 3
Post Operative Room 1 1
5.8.1 X-Ray department
! !106
In multispecialty hospitals, radiological services may be divided into three

different sections of the radiology department:
1. Diagnostic radiology
2. Therapeutic radiology
3. Nuclear medicine
• But in general hospitals only the services of diagnostic radiology are

generally available and the patients for therapeutic radiology and nuclear
medicine are referred to multispecialty hospitals. The main function of
the radiology department is to assist clinicians in the diagnosis of
diseases through radiography, ultra sonography, computerised axial
tomography, magnetic resonance imaging, etc.
• Before setting up a radiology department, it is advisable to take into

confidence radiologists and to know fully the mandatory regulations of
the Atomic Energy Regulatory Board (AERB) and the Babha Atomic
Research Centre (BARC) in designing the department, so that the
complex and highly specialised radiological services, equipment and
facilities match with the mandatory requirements laid down by AERB and
BARC.
• While deciding the number of employees in an X-ray department, the

following tasks should be taken into consideration:
1. Reception of a patient
2. Recording the history of a patient, as concerned with X-ray
3. Preparing the necessary papers; the slip to be pasted on the X-ray
request, entry in the register, etc.
4. Taking film from stock, putting the same in the X-ray cassette
5. Explaining to the patient about X-ray procedure and taking the X-ray
6. Processing film
7. Sorting film
8. Reporting to the radiologist
9. Typing of reports
10.Charting report or dispatching report.
! !107
• One senior X-ray supervisor is required for 7 X-ray technicians, to

supervise and execute radiographic work, to maintain efficiency and high
quality of work. Also required are one receptionist-cum-typist to take
care of reception, clerical and typing work and also one X-ray aide to
fetch up to 25 patients from the wards during the day. However, these
figures depend upon working procedures, of different hospitals.
Accordingly, the chief radiographer and the human resource manager can
jointly decide the human resource strength, after anticipating the
number of investigations likely to be referred to the Xray department
every day.
5.8.2 Physiotherapy
• In olden days, physiotherapy was provided by nursing personnel. But

with improved technology, specialised training and sophisticated
equipment, physiotherapy has seen a change to emerge as a specialised
field. A well-developed department provides postoperative and cardio-
respiratory care in various orthopaedic, surgical and cardiac conditions,
re-educational programme to neurologically challenged patients, athletic
and sports physiotherapy and ante and postnatal care to obstetrics
patients.
Thus, the main objectives of physical therapy may be stated as follows:
1. To minimise physical disability through therapeutic exercises and

rehabilitative procedures
2. To assist each patient so that he may reach maximum functional level
3. To contribute to the comfort and well-being of the patient
4. To re-train him in activities of daily living
5. To accelerate the patient's recovery and decrease his length of stay in

the hospital.
The main functions of this department are to rehabilitate or activate

various limbs/ parts of the human body, which might have become inactive
due to accident/disease/ ageing process, etc.
! !108
Therefore, the following are the main functions of the physiotherapy

department:
1. To speed up recovery of patients and shorten their stay in the hospital
2. To prevent and minimise residual physical disabilities
3. To restore physical functions of the body
4. To make an individual return to his optimum way of living
5. To provide assistance to the physicians, orthopedicians, neurologists,

pediatricians, obstetricians, etc. in implementing early ambulatory care.
• Physical therapy is commonly prescribed by physicians, pediatricians,

orthopedic surgeons, etc. but the patient is evaluated and treated by
physiotherapists. Treatment is conducted both in the department and at
the bedside. This situation creates implementation problem for the
physiotherapy department.
• When a patient is brought to the physiotherapy department, the

physiotherapist needs his chart but finds that the chart is being studied
by a panel of doctors, or when a physiotherapist goes to the ward to give
physiotherapy at the bedside, the patient might have gone for an X-ray
to the X-ray department. Thus, coordination is an important factor;
otherwise, the whole schedule of patients goes wrong.
• The department is generally directed and supervised by a Chief

Physiotherapist. He is assisted by a number of physiotherapists
depending upon the work load, one or more receptionists for receiving
patients, their scheduling and clerical duties and sufficient number of
physiotherapy aides to fetch patients from the wards.
• It is advisable to employ educated -and trained physiotherapists. Most of

the physiotherapists used to be diploma holders up to 1990, but now
they are degree holders. Each state has a physiotherapy council, where
physiotherapists are registered and then only can they seek employment
or can set up their own physiotherapy clinic.
! !109
• Physiotherapy aides' Ore mostly matriculates. They receive on the job

training to fetch patients from the wards, to lift and make them sit on the
wheelchair, to check the patient from his in-patient case sheet; to
establish a rapport while bringing the patient from the ward and to hand
over the patient to the assigned physiotherapist after checking from the
receptionist.
• When physiotherapists gain 3-5 years experience and physiotherapy aids

5-10 years experience, they should be promoted as Senior
Physiotherapists and Physiotherapy Assistants, respectively, to boost
their morale and retain them longer.
• In a day, one physiotherapist can attend to 15 diathermies, or 50

ultrasonic therapy cases, or 25 infra-red treatment, or 15 ultra-violet
treatment, or 15 stimulation cases. or 30 cervical traction cases, or 20
hydrotherapy cases, or 10 lumber traction cases, or 25 laser therapy
cases, or 15 microwave therapy cases, or 100 wax-therapy cases, or 15
exercise-therapy cases.
Note: In cases where the physiotherapist has to be with the patient during
the treatment, he can attend 25 patients per day, but in those cases where
he can switch on a machine and leave the patient for 15 to 20 minutes, he
will be able to give 80-100 treatment per day, provided the department has
more than one machine for each treatment. Time spent with each patient
depends on the particular case:
• One Chief Physiotherapist is required for 7 physiotherapists to supervise

their working and to maintain a high standard. Also required are a
receptionist to look after reception and clerical work and two
physiotherapy aide to fetch up to 30 in-patients who cannot walk from
the wards to the physiotherapy department. This, however, depends
upon the working procedures of the hospital. On the basis of these
norms, the Chief Physiotherapist and Human Resource Manager can fix
the human resources strength of the department, keeping in view the
number of cases referred in the past.
! !110
5.8.3 Medical Lab
• In the modern era, clinicians depend more and more on laboratory tests
as they want confirm their clinical diagnosis and at the same time, want
to avoid litigation because of their own inadvertent wrong diagnosis.
Therefore, they prefer to ask patients for laboratory tests which are
absolutely necessary for diagnosis of their disease. Thus, the primary
function of medical laboratory is to perform laboratory tests in the eight
main fields of haematology, parasitology, urinalysis, hematology,
serology, biochemistry, bacteriology, cytology, etc. to assist medical staff
in making or confirming diagnosis.
• In larger hospitals, there are generally two laboratories: One for the
indoor patients and the other for the outdoor and emergency patients.
The laboratory for indoor patients should be in the vicinity of surgery,
intensive care and obstetrics departments and the laboratory for outdoor
patients should by located on the ground floor. Here an important point
to remember is that there should be a well-planned waiting area near the
blood bank where the blood donors can relax. Blood bank officers should
put up some beautiful scenery on the wall of the blood bank, some
literature related to blood donation, and a TV set to keep the donor
occupied when they are waiting for their turn or relaxing after blood
donation. No blood donors should be allowed to go without having some
snacks and cold/hot drinks. Laboratories of big hospitals can keep blood
bank staff on call duty during the night shift.
• In all hospitals, a pathologist is in charge of the laboratory. At the middle

level there is a chief laboratory technician who looks after the section
heads of various sections of the laboratory such as hematology,
biochemistry, histopathology, microbiology, serology, blood bank, etc.
Each section head has a number of laboratory technicians, laboratory
aides and bottle washers, but secretarial staff can be common for all the
section. If the work load is sufficient, secretarial and reception staff can
be separate for each section otherwise not.
• One medical laboratory technician can do approximately 35 tests per day.

If he does less than 35 tests, it means that his performance is below
average. If he does more than 35 tests, the accuracy of his results
should be questioned.
! !111
• In one day, one technician can do: 45 hematology tests; or 50 urine

analysis test or 50 parasitology tests; or 20 blood-bank tests; or 40
serology tests; or 30 biochemistry tests; or 20 histopathology tests.
• Note: These figures are relevant if the technician is asked to do just one
particular type of test. If he has to do a normal mix of tests, he should
perform approximately 35, as mentioned. Where tests are automated,
higher number of tests can be performed. It depends also on the
methodologies practiced in the medical laboratory for various
investigations.
• Also required are one section head over 7 laboratory technicians, clerical
staff and bottle-washers, keeping in view the workload and technology
used in the department. This will also differ from one hospital to another
because it depends to a great extent upon ownership and resources of
the hospital, level of care required, etc.
5.8.4 Pharmacy
• Pharmacy is a specialised area and it is one of the most extensively used

therapeutic facilities of the hospital, from where fairly high revenue can
be generated to meet its expenditure. Therefore, each and every hospital
administrator is required to plan organise, staff, control and evaluate the
pharmacy department scientifically and professionally by employing
qualified and experienced pharmacists.
• To run the pharmacy of a hospital, the head of the hospital requires

qualified pharmacists, sound organisation structure, cooperation of the
medical and nursing staff of the hospital. He should also keep in mind the
modem trend, automation repacking, drug distribution, etc. which are
some of the methods that are being increasingly used in the hospitals.
Hospitals based in the metropolitan cities are using computer based
ordering system, computerised pricing, billing, cash collection, stock
position, etc. Its operation calls for thorough knowledge of drugs, their
salts, market trends, legal complications, etc. Though there is a
therapeutic committee in most of the hospitals, the pharmacy
department of all the hospitals handles their own purchase rather than
leaving it to the purchase department of hospitals. Thus, all purchases
are done as per the formulary prepared by the therapeutic committee of
! !112
the hospitals which makes the job of the chief pharmacist easy and he is
not blamed for not keeping all brands of medicines.
• Each hospital should design its own pharmacy and follow norms and legal
requirements of keeping narcotics and preparing I.V. solutions. Generally,
each hospital has dispensing area, storage area and administrative area,
but these hospitals, which prepare their own I.V. solutions, has also
promotion area. Thus, there are four or more functional areas in the
pharmacy of hospitals.
• Mostly pharmacies keep the essential list of drugs, have their own
formulary, set up policies and procedures, and purchase, receive, store
and dispense drugs to outdoor and indoor patients. And their chief
pharmacist is always a member of the therapeutic committee and
participates in the hospital's educational programme. He acts as a PRO of
the hospital and meets medical representatives and the government
officials such as dung inspectors. He complies with statutory
requirements, carries out quality assurance programmes and initiates
licenses with the government agencies.
• Generally, pharmacies in hospitals function from 7 am to 7 pm without

any break round the year, but in medium size hospitals, one pharmacist
is kept on call to issue emergency medicines if required after 7 pm and in
large size hospitals, pharmacies function round the clock throughout the
year.
• One major responsibility of the chief pharmacist is to make one

therapeutic committee consisting of active and experienced participants
with the help and advice of the medical superintendent of the hospital.
He should revise the formulary of the pharmacy department by
convening meeting of the therapeutic committee at least once in one
year so that new drugs available in the market can be purchased and
also those medicines not being prescribed by doctors may be deleted
from the formulary.
5.8.5 Laundry
• Laundry and linen services play a major role in hospital functioning. A

great deal of space and money is allocated to this department, which is a
major consideration in planning, designing and constructing a hospital.
! !113
Mostly, patients, their family members and visitors think in terms of

doctors and nurses working in the hospital, but they forget the laundry
personnel who provide clean linen to their beds every day.
• This department is also as important as the physician's medication,

tender care of the nurses, accurate reports of X-ray and laboratory tests.
In some hospitals the laundry department not only provides linen to the
patients but also neat and clean uniforms to the employees every day.
• The laundry personnel collect soiled and infected linen separately from
different points such as wards, labor room, operation theatre, nursery,
ICU, and casualty and then process it by sorting, sluicing and
disinfecting, washing, extracting, ironing and folding. Before ironing and
folding linen, they inspect if any bed sheet, pillow cover, napkin, etc. is
damaged. If it is so, they send it to the linen department for mending. If
any article cannot be mended, it is declared obsolete or kept aside and
replaced as per the policy of the hospital by the Laundry and Linen In
charge.
• In some hospitals distribution of washed linen is not done by the laundry

personnel but by the linen personnel. Though the laundry and linen
department is one, its personnel are separate. Therefore, the mending of
the linen and its distribution is done by the linen personnel.
• The laundry supervisor should keep in mind that his slight slackness can
spoil the reputation of the hospital because most of the laundry
personnel are school dropouts who hardly realize their responsibilities.
Therefore, he should always be on his toes to see that his personnel are
following the instructions in word and spirit.
The number of personnel required in the laundry department depends upon

the frequency of changing the linen in the wards, the quality of linen, as
well as upon its laundry equipment - whether it has boilers, washing
machines, hydro-extractors drying tumblers, flat-work ironers, flat bed
presses and allied equipment. However one laundry operator can wash the
linen of 25 to 30 beds and one laundry orderly can assist in washing the
linen of 50 to 60 beds. Thirty per cent of laundry operators and laundry
orderlies should be kept as the leave reserve. The appointment of laundry
supervisor mechanic and clerk, and the number employed depend upon the
size of the hospital However, one shift supervisor, one laundry mechanic
! !114
and one laundry clerk are required in each shift. Some staffing norms
based on the workload being followed at various hospitals are:
One washer man can take care of : 150 to 200 kg linen per day. This includes
collection of linen from different places,
washing, drying, folding, ironing and
returning.
Each operation in O.T. : 7 to 8 kg of soiled linen

Each delivery in L.R. : 7 to 8 kg of soiled linen
Each ward patient : 5 to 6 kg of bed linen
5.8.6 Food Service
• The food-service department of any hospital caters meals to the patients

and plays a significant role. Meals prepared hygienically under the
guidance of qualified dieticians according to the instructions of the
doctors and attractively served to the patients help in their speedy
recovery. If the meals are substandard in any respect, they have the
opposite effect. Today the food-service department ranks as one of the
major departments of a modern hospital.
• It is responsible for planning, organising and directing all phases of the

dietetic operations which include visiting patients, consulting their charts,
menu planning, food preparation, serving, budgeting, cost control, record
keeping, performance appraisal of its personnel, safety, sanitation, etc.
• Therefore, it is desirable to locate the food service department on the

ground floor of the hospital as this department in the basement is likely
to be dingy, dark and poorly ventilated. It is not necessary that it should
be close to the Materials Management department as the purchases of
the Food Service department in most of the hospitals and done by the
department itself. Secondly locating the Food Service department will not
violate the Municipal by-laws also. So far as the employees' cafeteria is
concerned, it is generally close to the Food Service department but the
patient's meals are carried by the diet aids in the electrically heated food
service trolleys to the wards and served to them on their bed side only.
While designing the food service department, it should be kept in mind
that receiving supplies, storing, preparing, serving and washing areas,
! !115
Food service manager's and Dietician's offices should be as close as

possible so that scientific management and logical flow can be ensured.
• These days most of the hospitals employ qualified Food Service

managers with a diploma or degree in hotel and catering management,
and a dietician with a degree in Dietetics after B.Sc. in Home Science or
M.Sc. in Nutrition Science. Some hospitals engage the workers of the
Food Service department through the contractor. It depends upon the
policy of the management, but the Food Service manager and the
Dietician are the employees of the hospital.
• It is difficult to generalize on the size of staff required in the food-service

department of a hospital because some hospitals not only serve
breakfast, lunch, evening tea and supper to the patients but also to their
attendants as well as to the hospital employees. The staff strength
depends upon the number of medicated diets required, the education
programme, research work, and the type of equipment used in the
department. However, one dietary staff member (excluding supervisory
staff) is required for approximately 15 to 20 patients. If the hospital
policy permits the attendants of the patients and hospital employees to
have their meals from the food service department, the same formula
i.e. one dietary staff for 15 to 20 persons will be applicable.
• Generally in the food-service department of a hospital, the dietician, food

storekeeper, cook, cook helpers, bearer and dish washer work in close
co-ordination. One dietician can look after up to 200 beds. If the bed
strength exceeds 200 beds, another dietician should be appointed one
cook, one cook helper, one bearer and one dishwasher are sufficient to
prepare and serve meals for 20 patients/staff members. The food is
served to the patients in their wards and to staff members in the hospital
cafeteria. A thirty per cent leave reserve should be appointed, because
the food service department functions round the year.
5.8.7 Sanitation and Housekeeping
• The hospital may have the best doctors, most dedicated staff nurses,
highly efficient medical laboratory and X-ray technicians and latest
modern equipment, but if its housekeeping is of a poor quality, it
overshadows the effect of all other things and lowers the image of the
hospital.
! !116
• Good housekeeping is very important to patients because they do not

want to be exposed to the hospital acquired infections. It is also
important from the point of maintenance of the hospital building because
a poorly maintained hospital building does not last long and consequently
proves very expensive in the long run. A clean and hygienic environment
has a tremendous psychological impact on the visitors which gives them
an overall impression about the hospital. They go back to their home
after forming an opinion that their patient is admitted in a good hospital.
• The following functions are carried out by the personnel of the

housekeeping department in most of the hospitals.
i. They sweep and mop floors, dust furniture, clean walls, windows and
bathrooms daily.
ii. They scrub and wax floors.
iii. They collect garbage and dump it near the burning site.
iv. They sweep and mop the patient's room as and when he is
transferred or discharged.
v. They prevent spread of infection by exterminating bugs and pests.
vi. They shift furniture from the place of the hospital to another.
vii.They assist the staff nurse in shifting the patients.
viii.They water indoor plants in some hospitals.
ix. They switch off lights and fans of their area.
x. They assist the staff nurse/X-ray technicians/laboratory technicians/
pharmacists/ physiotherapists manually as and when required.
• In some hospitals, housekeeping personnel are the best friends of the

nursing/ Paramedical staff because they are always at their beck and call
to provide any kind of assistance to them. While in some hospitals where
the housekeeping personnel do not maintain harmonious relations
because of their uncooperative attitude, they are considered a nuisance
and a source of interruption in the busy schedule of the departments.
• The key to efficient and effective functioning of the housekeeping

department is good communications, cooperative attitude of its
personnel, understanding the importance of sanitation by its each and
every employee, good interpersonal relations with all the departments.
• Its head of the department must be a qualified and trained officer with a
degree in science and basic knowledge of the health care sanitation,
! !117
including principles of bacteriology for the prevention and control of

infections and communicable diseases.
• The housekeeping department deals with hospital hygiene. The sanitation

in-charge should know the simple facts about bacteriology. He should,
also be able to train his employees in cleaning techniques that prevent
the spread of disease, since all cleaning is meant to remove organic
matter in which bacteria is harbored.
• The time and effort of sanitation employees can be saved and more
efficient cleaning accomplished if set procedures and fundamental
techniques for dusting, sweeping, mopping, scrubbing, polishing and
washing are observed. In all these operations, clean equipment and clean
solution should be used. Cleaning cannot be accomplished with dirty
hands and equipment.
• The allotment of work-area to a sweeper depends upon the degree of

cleanliness required, type of hospital, whether it is a closed or an open
area, the size of the moms, kinds of staircases, kinds of drains (open/
close, etc.) Secondly, it depends upon whether the sweeper is assigned
to the Intensive Care Unit, Coronary Care Unit, Labour Room, Operation
Theatre, Wards, O.P.D., Para-medical departments, etc. Thirdly, it
depends upon whether the sweeper is required to do sweeping, mopping,
scrubbing, polishing and washing as well as cleaning the oil-painted
walls/doors/windows/fans and removing cobwebs as well.
• A sweeper should be allotted a work-area of 1,200 to 1,500 square feet

keeping in view the work policies of the institution, the degree of
cleanliness required, and the electrical cleaning equipment used such as
scrubbing machine, vacuum cleaner, etc. However, for a nursing wilt, one
sweeper over 10 beds is recommended, on the basis of roundthe- clock
services. This ratio is too low in an I.C.U. and C.C.U. because a higher
degree of cleanliness is required. Therefore, more sweepers may be
provided there; but on the whole, sweepers should be employed on the
basis of one for every 10 beds or 1 sweeper for 1,200 to 1,500 square
feet area. Though the sanitation work is done during the day on a full
scale, it continues into the evening and even at night. It is advisable to
keep a 30% leave reserve. This particular work requires strict vigilance.
! !118
• Therefore, one supervisor to supervise 10 sweepers is recommended. For

a 300-bed hospital, there should be one sanitation in-charge, four
supervisors and 40 sweepers (30 sweepers for the daily requirement and
10 sweepers as leave reserve.
5.8.8 Security
• With the passage of time, the security of any organization is becoming

more and more problematic. This is particularly so for a hospital. Visitors
often indulge in pilferage, with or without the connivance of employees of
the hospital. They also try to visit the patients during non-visiting hours,
thereby violating the rules and regulations of the hospital. Similarly,
employees of the hospital try to pilfer hospital property as well as break
hospital discipline. The security personnel of a hospital have a dual role
to play that of watching and controlling both visitors and the staff.
• Therefore, it is advisable to follow physical security regularly by following

physical search of employees and vendors from time to time, keeping
separate entry for employees, vendors, patients and their visitors,
checking vendors and suppliers' vehicles regularly and of the hospital
once in a blue moon, installing electronic gadgets like CCTV for
surveillance in strategic and sensitive areas, issuing visitor passes,
controlling the issue of keys, providing a safe for patients' valuables, etc.
• At the same time, it is necessary to set up a system of procedural

security by keeping procedural manual for each department, establishing
accountability and control over the flow of hospital supplies and
materials, particularly receiving of hospital supplies and sending back
rejected goods to suppliers.
• There are sensitive areas in the hospital which warrant special security,
for example, the cashier cabin, female ward, bank extension counter,
food service store, general store, pharmacy store and changing room in
the operation theatre which are prone to theft and burglary. In the
hospital where psychiatric patients are treated, sometime they become
violent suddenly and immediate help of the security personnel is needed
as they cannot be controlled by the female nursing staff.
• Keeping in view the rising trend of thefts and the tendency of visitors to
violate the rules and regulations, it is necessary to engage sufficient
! !119
security force. The staff strength required depends upon several factors;
the area of the hospital, the location of the hospital (city, town, village),
the construction of the hospital building (compact building, scattered
buildings as a result of mushroom growth with/without proper planning).
However, the norm is that one security guard is required for every 10
beds of a hospital and one security supervisor is required in every shift to
take decisions on the spot in case of any untoward incident such as theft,
fight between the hospital staff and the public or amongst the hospital
employees.
5.8.9 Central Sterilisation and Supply Department
• The central sterilisation and supply department plays a crucial role in the
functioning of a hospital. It not only reduces infection but also prevents it
to a great extent. The infection rate is higher in India than in the
advanced countries like UK, USA, Australia, and Canada because the
equipment used in the central sterilisation and supply department in
India is not of very high quality and secondly, the personnel working in
the department also do not take the work of sterilising the equipment
seriously.
• In most of the Indian hospitals, the central sterilisation and supply

department is a part of the Nursing Service department, and the CSSD
In charge is directly responsible to the Nursing Superintendent because
this department mostly series nursing units operation theatre, ICU, PICU,
labor room, radiology, pharmacy and laboratory of the hospital.
• The primary activities of the department are sterilising, storing and

distributing the dressings, instrument packs, gloves, catheters, sterile
linen packs, treatment trays, etc. Disposable sterile supplies are also
being used in hospitals but a few hospitals can afford to use disposable
items as these are very expensive and increase the maintenance cost.
Hence, it depends upon hospital to hospital in India.
• The main objectives of the central sterilisation and supply department

are:
๏ To prevent infection by sterilising equipment and materials

๏ To sterilise equipments and materials so that reuse of these items can
be possible
! !120
๏ To achieve higher efficiency in the areas where sterilised equipment

and materials are used
๏ To reduce the length of stay of patients by providing proper sterilised
equipment and materials
๏ To reduce the cost of maintenance of the hospital by sterilising the
equipment and materials
• Mostly the functions of the central sterilisation and supply department

are:
๏ Receiving the used equipment and materials

๏ Sorting out the equipment and materials
๏ Deciding whether any of the equipment and materials are required to
be discarded
๏ To disinfect prior to sterilisation
๏ Assembling equipment sets, linen packs and treatment trays
๏ Packing equipment sets, linen packs and treatment trays
๏ Sterilising
๏ Labelling and dating
๏ Storing equipment packs, linen packs and treatment trays
• The central sterilisation and supply department is either located in the

basement or on the ground floor in the Indian hospitals, but it should be
close to the elevators as well as to the departments which use its
services the most such as operation theatre, surgical department,
recovery rooms, and nursing units so that the distance between the user
and the central sterilisation and supply department is minimum.
Generally hospitals make three locations in the central sterilisation and
supply department:
a. Soiled area
b. Clean area
c. Sterile area
• Generally, in the central sterilisation and supply department, there is a

supervisor who may be a nurse and the remaining staff consists of
technicians and aides who are trained on the job. These days, the
manufacturer who supplies the autoclave trains the personnel of the
hospital and does not charge extra. It is a part of the packing deal. The
! !121
supervisor of the central sterilisation and supply department directly

reports to the nursing superintendent.
• The staffing norms of the central sterile supply department of a hospital

depend upon the model of the autoclave, other equipment being used in
the department, the policy for the distribution and collection of articles,
the interpersonal relationships of the staff of this department with the
staff of medicine, surgery, operation theatre, labor room, casualty, etc.
While determining the staffing norms for the central sterile supply
department, several points must be kept in mind:
a. Method of collection and distribution of articles to be autoclaved

b. Number of disposable articles being used in the hospital
c. Repressible articles available for circulation
d. Bed strength of the hospital
e. Size of the autoclave
f. Type of the hospital.
• Since the nature of work is simple and can be learned after a short
training, one person in the central sterile supply department can take
care of 25 to 30 beds. This excludes the supervisory staff but includes a
30 per cent leave reserve.
5.8.10 ECG Department
• The staffing norms for ECG technicians depend upon the type of hospital,
size of the hospital and number of patients visiting the OPD.
• The staffing norms for ECG technicians can be formulated on the basis of
number of ECGs taken in one shift lasting 8 hours. One ECG technician
can take about 20 ECGs in one shift. If the workload is less in the
evening and night shifts, the technicians should be assigned some other
job such as making cotton balls, preparing gloves for obstetric and
gynaecological check-ups making gauze pieces and eye pads, packing of
dressing sets, etc. according to his ability. The technician can thus be
kept occupied.
• The ECG technician's work is not only to take the ECG of the patient, but
also to establish rapport with the patient before taking the ECG, noting
down the requires particulars in the register, setting up the ECG machine
! !122
with ECG graph, tying the cord on different parts of the patient's body,
taking the ECG, cutting the ECG graph, mounting the graph on the ECG
folder, submitting it to the cardiologist, and pasting the ECG request in
the patient's chart for ready reference.
5.9 SUMMARY
Job Analysis is a process which involves collection of information regarding

the knowledge, skill and ability an employee possesses to perform a job
effectively. It is useful for all personnel activities like human resource
planning, hiring, and training of employees, deciding the compensation
and for appraising the performance of employees. For an effective job
analysis, the support of the top management and the whole-hearted
participation of the employees is a must. Job design involves efforts to
organise tasks, duties and responsibilities into a unit of work so as to
achieve certain objectives. A well designed job is the key to a company’s
survival and growth. Job analysis is affected by organisational,
environmental and behavioural factors.
! !123
1. What is Job Analysis? Explain the importance of job analysis in an

organization.
2. What are the various steps that are involved while conducting job
analysis?
3. Explain job description and job specification.
! !124
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !125
RECRUITMENT, SELECTION, INDUCTION IN HOSPITALS
Chapter 6
Recruitment, Selection, Induction in
Hospitals
Objectives:
• What is Recruitment?
• Process of Recruitment in Hospitals
• Various sources of recruitment in Hospitals
• Recruitment Policy in Hospitals
• Selection process in Hospitals
• Induction Process in Hospitals
Structure:
6.1 Recruitment
6.1.1 Job Requisition
6.1.2 Sources of Recruitment
6.1.3 Recruitment Policy
6.2 Selection
6.2.1 Job-application Form
6.2.2 Selection Process -Steps
6.2.2.1 Interview
6.2.2.2 Pre-employment tests-written/oral/practical
6.2.2.3 Interview by department head
6.2.2.4 Decision of administrator to accept or reject
6.2.2.5 Medical examination
6.2.2.6 Check of references
6.2.2.7 Issue of appointment letter
6.3 Induction
6.3.1 Induction by Human Resource Department
6.3.2 Induction by Department Head
6.3.3 Techniques of induction
6.3.4 Advantages of Induction
6.3.5 Confirmation, Extending Probation, Termination
6.4 Summary
6.5 Self Assessment Questions 
! !126
6.1 RECRUITMENT
We have to match the man and the job. Whether it is a new post (a new
job) or a vacancy to be filled, we must review the job and its requirement.
Search the need of the hospital. If it is to fill the vacancy, we must ask
ourselves why the previous incumbent left. There can be a variety of
reasons. Finding out the reason can help in a better choice. Often, enough
thought is not given to the recruitment of personnel. More thought is given
in the purchase of machinery and equipment. We devote a lot of time in
the selection of a monitor-defibrillator costing, say Rs. 40,000/ - and with a
useful life span of 5 years. We do not devote even half the time in the
selection of a Physician (salary, say, Rs. 50,000/- per annum) who is
expected to be with us for the next 10-15 years or more. Getting a wrong
person can be a colossal waste and detrimental to the realisation of the
objectives.
Once manpower requirements have been determined, recruitment is the

next step in the staffing process. This is a difficult job. Hospitals present an
unusually wide range of positions in terms of skill and personality
requirements. This situation is further complicated by the fact that in
smaller hospitals, it is often necessary to combine jobs, so that a human
resource manager may seek a combination of different skills in the same
individual.
6.1.1 JOB REQUISITION
A job requisition is a request to hire someone. Once a department head

knows that there is a vacancy, he fills up a job-requisition slip and submits
it to the human resource department for necessary action. Job requisitions
are intended to give the human resource manager enough information
about the job. A job-requisition form should be designed very carefully.
Form 6.2 is a model job-requisition form.
Department supervisors who want to hire additional staff, or replace

employees who resign or are terminated, generally have to complete a job
requisition. A requisition is forwarded to the human resources department
for handling by the recruiter. The recruiter then places job postings based
on the requisition and discussions with the hiring manager or department
supervisor. Job requisitions, for the most part, are part of the checks-and-
balances procedures that many organisations follow for workforce planning
and staffing actions.
! !127
Fig 6.1 Process of Recruitment
! !128
Fig 6.2 Job Requisition Form
JOB REQUISITION FORM
To,
Human Resource Manager
Please arrange to fill………………………..post/post of …………..For my department

Within days.
Job Specification are given below:
1. Post/ Permeant/Temporary/Leave
Vacancy
2. If Temporary/Leave vacancy, its duration…………………………………………………
3. Age ………………………………………………………………………………………………………
4. Sex ………………………………………………………………………………………………………
5. Qualification …………………………………………………………………………………………
6. Experience ……………………………………………………………………………………………
7. Working schedule ………………………………………………………………………………….
8. Special skill required ……………………………………………………………………………..
9. Budget provision …………………………………………………………………………………..
10.Any special requirement ……………………………………………………………………….
Date: Signature of the Department Head
Instructions:
1. Be sure about the nature of past mentioned at S.No.1

2. While filling particulars form S.No.2 to, & please go through the job
description of the concerned job.
3. Before submitting this form to the Human resource Department,please take
the approval of the head of the institution.
! !129
6.1.2 SOURCES OF RECRUITMENT
The moment human resource department gets a job requisition slip from
any department, it starts looking for prospective candidates using various
sources of recruitment. The following sources are well established but their
effectiveness varies in different situations and different parts of the
country.
Fig 6.3 Source of recruitment in hospitals
1. Existing employees
2. Door applicants
3. Government employment exchange
4. Private employment exchange
5. Newspapers
6. Professional journals
7. From other hospitals
8. Unsolicited applications
9. Campus interviews in teaching institutions
10.Internal circulars for vacancies
11.Referral front
i. employees;
ii. ex-employees;
iii. political leaders;
iv. government officials; and
v. religious bodies.
12.Re-employment
13.Through contacts
14.Walking interviews
15.Job websites/Job portals 
! !130
• Though the Human Resource department of a hospital generally tries to

utilise one or more sources of recruitment as mentioned above, a few
Human Resource managers give some weightage to the referred
candidates of their own hospital's employees.
• Employees, if given the opportunity to make referrals, will only

recommend those candidates who suit the hospital where they are
themselves serving. A talented employee will always refer an equally
talented candidate. Through referrals, an employee restores the pride he
has in being associated with the hospital. The existing employee will
provide the referred candidate with information about the job, the
employer and the boss's behaviour. These references also provide social
and moral support to those who are newly recruited. They can be
mentors to the new recruits.
• Referral programmes play a major role in bringing faster cultural

bonding. The most noteworthy characteristic of a referral system is that
it provides an effective screening process in terms of employee
background checking. Referral candidates have a shorter recruitment
cycle. In this way, the filtering phase is already over. It is generally found
that employees who refer friends usually belong to the same social circle,
same locality and have same qualifications. One may perceive the
employee referral programme as an extension of the buddy system.
• The employee referral system can be effective only when they are
recruited properly. If employees are unclear about the structure of the
programme, it can impede successful implementation. Therefore, a
written brief will enable employees utilise their programme better. In
addition, the entire process should be employee-friendly. A cumbersome
and lengthy process can be a deterrent to the programme's success.
• The latest source of recruitment which is catching up the market these

days is social networking. The very concept of social networking for the
purpose of recruitment is that everyone knows someone. Though social
networking might not exactly be the next frontier of recruiting, yet it is
certainly being seen as a strategy to complement more traditional hiring
tools. In this way, one can also hire candidates across geographical
distances and evaluate them online itself. Since the process of
conventional recruitment is expensive, networking, definitely being a
cheaper source of recruitment, is becoming an excellent choice. Some
! !131
management gurus also feel that social networking can be a great

resource for finding candidates to fill senior level positions in the
organisation.
• It is a usual practice to rely on more than one source. The specifications

of the vacancy should be circulated in writing to all the recruitment
sources and particularly to the government Employment Exchange.
6.1.3 RECRUITMENT POLICY
The hospital authorities should frame a recruitment policy for the guidance
of the human resource department. The management should clearly spell
out the objectives and major principles they intend to pursue while
recruiting employees. They should also lay down a promotion policy.
• Recruitment Policy Considerations:
The following points should be kept in mind for the recruitment and
selection of employees:
a. Internal vs. external recruitment. Recruitments can be classified

into two main types: (i) internal, and (ii) external.
i. Internal recruitment implies the promotion and transfer of

employees within an organisation to fill a vacancy.
ii. External recruitment implies recruitment of an employee from

outside the organisation.
Both these methods have their merits and demerits. In practice, both these
sources are used in varying degrees depending upon the recruitment policy
of the management.
Promotion within the hospital is a widely accepted policy because this has
the advantage of building loyalty, ensuring stability, and creating a sense of
security among the employees. The hospital authorities should use external
sources of recruitment for such jobs whose specifications cannot be met by
the present personnel.
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b. Appointment of relatives of employees.The relatives or friends

recommended by employees are accepted as a reliable source of
recruitment. Where there is confidence and respect between an
employer and his staff, it is unlikely that employees will put forward
the names of such persons who would let them down. However, it is
not a safe practice as it sometimes leads to groupism among
employees. They form an informal group which is difficult to break
and can create all sorts of problems for the management. In any
case, no two relations should be employed in the same department.
c. Over- and under-qualified staff. The candidate to be selected

should neither be under-qualified nor over-qualified. If he is under-
qualified, he will not be able to do his work efficiently. On the other
hand, if he is over-qualified, he would soon become frustrated and
ultimately leave the hospital. Hence the candidate to be selected
should be suitably and adequately qualified.
d. Exit interview.Exit interviews are considered essential to get a

feedback regarding the hospital's policies. In fact, the exit-interview is
a very useful tool to study labour turnover. Weak spots in the
organization's policy are revealed which help in reducing turnover and
building the morale of the remaining employees in the hospital.
• Advertising the post/vacancy. Where it is not possible to fill the

vacancy through other sources of recruitment such as employment
exchange, teaching institutions, etc., vacancies hare to be advertised in
newspapers and professional journals. Since advertising vacancies in
newspapers and journals is a very costly affair, the advertisement has to
be carefully drafted.
• Objects of advertising a post. A post is advertised to (a) attract

suitable persons (b)get adequate number of applicants; (c) discourage
unsuitable persons from applying, and (d) project a good image of the
hospital.
• Advertising Considerations.While advertising, the following points

should be kept in mind:
i. The advertisement should be designed in such a way that it arouses

the interest of potential candidates. It should state the job title,
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briefly outline the duties, qualifications, previous experience, if

necessary, salary and perks payable, conditions of service and any
particular features about the job which distinguish it from similar jobs
elsewhere.
ii. The media of advertisement should be selected carefully. It should be

inserted in a prominent newspaper.
iii. As far as possible the advertisement should be a display

advertisement. A classified advertisement usually fails to attract the
right persons.
iv. Repeated advertisement for the same post should be avoided

because it gives the impression that the hospital is one where
employees do not wish to stay long.
v. Give background information about your hospital in a couple of

sentences such as a mission hospital, private hospital, public hospital,
charitable hospital, etc.
6.2 SELECTION
• Selection of the right person is one of the most important activities on

which depends the future of the hospital. Our task is to search and find
the right person.
• Selection may be made by promotion (wherever possible, higher level

jobs should be given to current hospital employees; a promotion is to be
considered in the same manner as new employment), or by
advertisement or other methods, (such as invitation of a person whose
name has been suggested by knowledgeable person). The advertisement
must give factual information. In such cases, give details in an
information sheet to be attached to the application form. People would
like to know about your hospital. This will help people with similar
objectives to apply and stop others from applying. Mismatches will be
reduced. The information sheet would give the salary and other benefits,
if any, and also describe the job. It must indicate what we expect and
what the candidate can expect.
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• Selecting Applications- The selection process starts when applications

are received and screened in the human resource department. The
Human Resource Manager goes through the applications to identify
potential candidates for interview. Yet surprisingly, not all organizations
place quite so much faith in the applications since many applicants mould
their particulars according to the requirement of the advertisement.
Generally, human resource managers do not take applications at their
face value as they know that some candidates say that they have such
and such qualifications, experience, skills, etc. while in fact they don't
have them. An applicant for the post of receptionist might say that she
can cope with a particular type of telephone exchange while she might
have never used one such before. Such applicants believe that they can
tell a few lies to get an interview call, and thereafter they might get the
job as well. These days, cases of lying by applicants are on the increase
because of intense competition. Therefore, the dealing personnel in the
human resource department should be quite vigilant while screening the
applications. Those applications which are neat, carefully planned, and
well expressed create a favorable impression while the others which
appear untidy, incomplete and full of mistakes find their way to the
wastepaper basket. The attempt is to find 'a round peg for a round hole'.
This is the first stage at which unsuitable candidates are weeded out.
Those applicants who seem to meet the job requirements are sent blank
job-application forms and are directed to fill them up and return the
same for further action.
• Background Check- HR managers need to be wary when they employ

people on the basis of their impressive resumes. The reason, one in four
applicants lies about his/her curriculum vitae. As these job seekers seek
desperate means to reach their ultimate goal, resumes are becoming
more attractive and impressive overnight. Therefore, hospital consultants
advise the verification of all documents at the time of hiring as it may
save the recruiter from a lot of unforeseen troubles in future.
Interestingly, different hospitals use different methods of verifying
credentials of the candidates. Some HR Managers use telephone
verification, some send verification letters and some like to have
a meeting with the candidate’s previous employers, but the HR
Managers should take written permission from the candidate for
checking his credentials from his previous employers.
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• The job-application form is one of the most important tools in the

selection process. When drafted properly, it can supply enough
information about a candidate. The information received through the job-
application form again helps in weeding out some more candidates who
do not meet the exact requirements of the job. In this way, the number
of persons who have applied can be reduced to a manageable size for
interview. The selection process is a negative mechanism, i.e.
unsuitable candidates are eliminated until two or three suitable
candidates are finally left in the field.
6.2.1 Job-application Form
• Generally, all employers seek almost the same information through job
application forms. They need to know the applicant's name, father's
name, present and permanent address, sex, age, religion, weight,
height, physical deformity, if any, educational qualification, experience
and participation in extra-curricular activities.
• However, hospital authorities have not paid enough attention to its

design. It is unfortunate that some hospitals have not even introduced
the job-application form in their hospitals. While preparing the job-
application form, the following points should be kept in mind:
1. The form should be large enough to provide enough space for writing
the desired information.
2. The application form should be printed on good paper so that ink

does not spread on it.
3. The wording used on the form should not be ambiguous.
4. Items included in the form should be designed to elicit only the

required information.
5. It is desirable to include some questions about the previous

employers of the candidate to find out his stability at work.
6. One blank page should be attached with every job-application form

and the candidate should be asked to write why he is applying for the
post. It is not an easy task for a candidate to set out these reasons
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and offer an analysis of personal attributes which qualify him as a

suitable candidate. Including this question in the form will eliminate
unsuitable candidate's right at the outset.
7. At the end of the form, there should be a place for his signature. The
signature should follow two statements:
i. I have no objection if any enquiry is made from my past or present

employer(s).
ii. I hereby certify that all the information given by me in the form is
correct and complete to the best of my knowledge and belief. I
have not concealed any information which might impair my fitness
for employment in this hospital. I also understand that any
misrepresentation in the job-application form will make my
services liable to summary termination without any notice or
compensation.
• In some organisations, different job-application forms are prepared for

different categories of employees. Similarly, in hospitals also, 6 different
job-application forms can be prepared for (a) senior medical staff; (b)
junior medical staff, (c) para-medical staff, (d) nursing staff; (e) general
staff; (f) skilled/semi-skilled/ unskilled employees. The reasons for
suggesting different job-application forms for different categories of
employees are obvious. Different information is needed for different
categories of posts. The question, 'What type of nursing do you prefer? is
valid only for nursing candidates. The questions, 'In which area do you
want to do your house-job? is valid only for junior medical staff.
A job-application form serves three main purposes:
1. It enables the hospital authorities to weed out unsuitable candidates. It

acts as a frame of reference for the interview.
2. It forms the basis for the personal record file of the successful
candidates.
3. One model job-application form has been given for guidance (Form 6.4) 
! !137
Fig 6.4 Job Application Form
HUMAN RESOURCE DEPARTMENT — PERSONAL INFORMATION
Post applied for ……………………………………………………………….

Please paste your
Name …………………………………………………………………………….
latest passport
Address …………………………………………………………………………. size photograph
here
Present …………………………………………………………………………..
……………………………………………………………………………………….
Permanent ………………………………………………………………………
Father’s/Husband’s Name ………………. His Occupation …………………………
Citizenship ……………………… Religion ……………….. Sex ……………………
Age ……… Date of Birth …………… Physical Deficiency, if any ………………….
Marital Status: Single Married Divorced Separated/widows
Hobbies …………………………………………………………………………………………….
Name and address of reliant to be satisfied in case of emergency …………………..

………………………………………………………………………………………………………………..
Educations:( Including technical/professional qualification,if any)
Degree/certificate Institution
Year Division Subjects
Diploma Board/University
Do you know typing ? Yes/No. If Yes,What is your typing speed
Do you have working knowledge of computer? Yes/No.
Reference (Not relations and employers)
1. Name 2. Name
Designation Designation
Address Address
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Are any of your relatives employed in this Hospital? Yes/No. If Yes,
Name …………………………………….. Relationship ………………………………………….
Have you had any major illness,Operation or accident in the past . If Yes, Give
details ……………………………………………………………………………………………………..
Service Experience ( Star with the last employment)
1.Name and address of the employer
From ……………………….. To …………………Year Position …………… Description of

duties ……………………………………………………………………… Salary and grade
……………………Fringe benefits, If any …………………………………………………………..
Reason for leaving …………………………Refer to whom? …………………………………..
2.Name and address of the employer

3. Name and address of the employer

what type of nursing do you prefer most? OT/Public Health/OPD/Medical/

Surgical/Paediatrics/Orthopaedics &
Gyn.
(For nurse only)
Are you member of any professional organisation? Yes / No.

If Yes, Name: ……………………………………………………………………………………………
Have you any objection to our making enquiries from your

(a) Past employers: Yes/No
(b) Present employers: Yes/No
Minimum salary expected …………………………………………………………………………
Minimum time required for joining …………………………………………………………….
Have you ever applied earlier? If so,with what result ………………………………….

………………………………………………………………………………………………………………
! !139
Have you ever been evacuated by court of Law …………………………………………….

………………………………………………………………………………………………………………..
I here by certified that the statement made by me in answer to the following

questions is true,Complete and correct to the best of my knowledge and belief.
I understand that any mis-representation or material mention made in the
personal information form or any other document required by the hospital
authorities readers a staff member /work man of (name of the hospital liable to
termination or dismissal)
Date ………………….. Signature of the Applicant
6.2.2 Selection Process -Steps
The steps which constitute the employee selection process are the
following :
1. Interview by human resource department

2. Pre-employment tests-written/oral/practical
3. Interview by department head
4. Decision of administrator to accept or reject
5. Medical examination
6. Check of references
7. Issue of appointment letter.
6.2.2.1 Interview
• Selection is carried out usually after an interview. From the applications

received, a short list is prepared. In some cases written and practical
tests are given (these are ideal in the case of technicians, radiographers,
stenographers and others where the number of applicants is sizeable and
skills are important). Other methods of assessment like group
discussions can be held.
• The interview must be utilised more to bring out the potential. The
application form would have given most of the information regarding
what the candidate has done. Clarifications can be obtained during the
interview. But maximum use must be made to bring out the ability of the
candidate to perform the job well.
๏ It is important to provide the proper environment for the inter-

view. It must be friendly. The interview must be such as to have
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the candidate in a relaxed mood, to bring out the strengths and

potential. The seating must be comfortable.
๏ The number of interviewers must not be too many. If there is a

large number, it overawes the candidate. Try to restrict the
number to three or four. If there are more, perhaps it may be
better to split the committee, with each group probing into
specific, predetermined areas.
๏ Hold the interview at the appointed time. It is not correct to make

the candidates wait for an unreasonably long time. If there are
many candidates, it may be good to give different timings. It is
also necessary to give sufficient time for each candidate. Do not
hurry through. If you have done your homework of short listing,
every candidate deserves to be given sufficiently long time. How
much is sufficient? It depends on the job.
๏ Introduce the members of the board to the candidate. This would

help the candidate to answer pointedly to the person who puts the
question -to the professional expert in a professional manner and
to the social scientist in the way relevant. Avoid disturbances, as
far as possible, during the interview. Instruct the Secretary not to
put through telephone calls, unless they are emergent and cannot
wait.
• Interviewing is the main method of appraising an applicant's suitability

for a post. This is the most intricate and difficult part of the selection
process. Interviews are often conducted to assess the suitability of
candidates. The interviewer must have of the dynamics of human
behaviour and familiarity with the kinds of abilities, interests a thorough
knowledge of the requirements for successful hospital work, an
understanding and personality patterns best suited to specific work
situations. The key to a successful interview is the interviewer himself.
The employment interview can be divided into four parts; the warm-up
stage, the drawing-out stage, the information stage and finally the
forming-an-opinion stage.
• The employment interview is aimed at obtaining certain basic

information. It is normally conducted by the human resource manager
and the concerned department head. The candidate is asked about his
! !141
education, job experience, minimum salary acceptable, etc. Sometimes,

he is asked why he is applying for a job in that hospital or why he is
leaving his present job. As the human resource manager screens
applicants, he must constantly think of the degree to which the applicant
will fit into the overall set-up of the hospital, such as in dealings with
patients, in its public relations, in its requirement of unusual working
hours and working conditions in certain employment areas. For example,
a telephone operator or a nurse who lives far away from the hospital
cannot report for duty early in the morning or late at night. In the case
of lower positions, there is no need to call a candidate for final interview
with the administrator, as the final selection is made by the head of the
department and human resource manager jointly. After completing
selection formalities, they can inform a candidate about his selection. At
this stage, the human resource manager can also disclose the terms and
conditions of appointment to the candidate who has been selected. This
procedure may vary slightly from hospital to hospital.
• In the case of senior posts, where the selection of a candidate is

decided by a selection board, all the candidates who are found eligible
during screening are referred to the board for interview. These
candidates are interviewed and a list is made of the first three
candidates found suitable by the board. The human resource manager
implements the decision of the board by sending an offer letter to the
first candidate. In case the offer is turned down by the first candidate,
it is sent to the second candidate and so on.
A. Phone Interview
• These days, Human Resource Managers interview outstation and out of

country applicants on phone. The interviewer and the interviewee do not
meet face to face. Instead, they talk on telephone and the interviewer
interviews the interviewee, the result of which determines whether the
candidate can be invited to meet the Human Resource Manager or not.
• Many leading organizations use phone interviews as an initial

employment screening technique because the interviews are brief, saving
time and also serving as a more realistic screening alternative. Though
Human Resource Managers of the Indian hospital are not using the phone
interview technique, Human Resource Managers of the advanced
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countries use it quite frequently in interviewing Indian staff nurses,

physiotherapists. Xray technicians, doctors, etc.
• So, Human Resource Managers and the Department Heads concerned

should treat the phone interview seriously just as they would a face-to-
face interview. Before they telephone a candidate, preferably on land line
so that both parties can hear each other clearly and the phone is not
disconnected off and on causing disruption, they should keep the resume
of the candidate, the questions to be asked and the points to be clarified
ready.
B. Main objectives of an interview. The main objectives of an interview

are:
• for the employer to obtain all the information about the candidate to
decide about his suitability for the post;
• to give the candidate a complete picture of the job as well as of the

organization; and
• to demonstrate fairness to all candidates.
C. The Interview Letter. When calling a candidate for an interview, the

time, date and place must be specifically mentioned. Other conditions
such as requirements of passport size photograph, certificates, and
testimonials, and payment of travelling allowance_ etc. should also be
mentioned.
D. Preparation before the interview.There are several points to be

taken care of before the interview.
1. Plan carefully before the interview.
2. Inform the receptionist so that candidates called for the interview are
correctly directed to the place of interview.
3. Make sure that the waiting arrangements are satisfactory.
4. Ensure that there are no interruptions during the interview.
! !143
5. Anticipate questions about conditions of service
6. Decide in advance the information to be provided to all the

candidates.
7. Stagger timings, i.e. different timings for different candidates so that

rounding up of a lot of candidates at the same time and at the same
spot can be avoided.
8. Ensure that all waiting candidates are served refreshment in the

waiting area.
9. Show a video about the history, philosophy and present set-up of the
hospital.
10.Ensure that adequate reading material about the hospital, its HR

policies, etc. are kept in the waiting area to keep the candidates
occupied as well as apprise them in advance about the hospital and
its policies.
11.Explain the process of selection to the candidates about the hospital

and its policies.
12.Ensure that all candidates feel at ease before and during interview.
13.Have a plan of questions so that assessment is comprehensive.

Prepare a list of characteristics you want to observe and evaluate.
a. General appearance; b. attainments; c. general intelligence; d.

special aptitude; e. nearest; f. disposition; g. use of language; h.
ease in conversation; i. general habits of courtesy, j. facial
expression.
! !144
Fig 6.5 Interview Latter
INTERVIEW LATTER
Date:………………….
Address
…………………………………..
…………………………………..
…………………………………..
…………………………………..
Dear ……………………
With reference to you application dated …………….. for the post of ………………….
I am pleased call you for an interview at …………… on……………….. in the human
resource department.
You are required to fill up the enclosed job - application form and bring it with
you at the time of the interview .
You will be will not be paid traveling allowance to report here for the interview.
Please bring your original certificates and testimonials with you. We look
forward to seeing you.
Your sincerely ,
(Human Resource Manager)
E. During the interview.  

 
Encourage the candidates to talk frankly. Privacy during the interview is
essential. The discussion must be confined to relevant topics. Rapport
be established with the applicants. A written appraisal of the candidates
should be made by the interviewer(s) after the interview.
F. Interviewing Functions of the Human Resource Manager
• There is always some confusion about the responsibilities of the

department head and of the human resource manager. It can be
clarified by stating that the human resource manager helps the
department head in the selection of the candidates who meet the job
requirements. He thinks of the applicant as a potential member of the
! !145
whole hospital family, one who meets most of the requirements set
forth for the position. The department head, on the contrary, is able to
visualise the applicant as a part of his own department and will
question him more specifically as to his adaptability to the position to
be filled.
• There should be clear understanding between the department head and

the human resource manager as to what areas of information are to be
covered by each in their interviews. A workable division of
responsibilities is outlined below.
• The responsibilities of the Human Resource Manager are:
1. to screen the application of the candidate;

2. to give information about:
i. general nature of work,

ii. hours of work,
iii. pay-scale, allowances and starting total salary,
iv. fringe benefits,
v. leave policy, and
vi. 'brief' information about the background of the hospital;
3. to discover any differences in the expectations of the hospital and the

candidate
• The responsibilities of the Department Head are:
i. to review the job-application form to check pertinent data on

experience;
ii. to assess the professional competence of the candidate;
iii. to give a detailed picture of the job requirement to the applicant;
iv. to advise the human resource manager if he thinks that the previous
training or experience or both of the applicant justifies a higher
starting salary.
G. Concluding the Interview. Once the interviewer has secured a clear

idea of the applicant's basic strengths and limitations, he should bring
the interview to a close with a brief summary of what has been
discussed and give indications to the applicant of the next step. At the
! !146
end of the interview, the interviewer should fill up his evaluation form/
recommendation sheet.
6.2.2.2 Pre-employment tests-written/oral/practical
To ensure selection of the most suitable candidates for various posts,

interviews should be conducted carefully and pre-employment tests should
be held in a systematic manner wherever necessary and possible.
For certain categories of posts, there is a need for testing the professional
competence of the candidates because there are several characteristics
which cannot be properly assessed either during the interview or by
investigating the background of the candidate` from their exemployer(s).
In such cases, various kinds of tests are used for assessing the professional
competence of the candidates. These tests can broadly be divided into four
types:
1. Tests of general ability - intelligence tests

2. Tests of specific abilities - aptitude tests
3. Tests of achievement - trade tests
4. Personality tests - Tests of emotional stability, interest, values, traits,
etc.
A. Tests Of General Ability. Intelligence tests are regarded as tests of

general ability. There are several intelligence tests available for use.
These tests can give a useful indication of a candidate's mental caliber.
It has been observed that for various professions, there is an optimum
level of I.Q. While selecting individuals for a particular job, the human
resource manager should ensure that he selects individuals who have
I.Q.s within the required optimum range -not higher or lower.
B. Tests Of Aptitude. Aptitude tests measure whether an individual has

the capacity or latent ability to learn a new job, if given adequate
training. These tests measure skills and abilities that have the potential
for later development in the person tested.
C. Tests Of Achievement. Tests of achievement measure the present

level of proficiency that a person has achieved. In hospitals, these tests
can be used for typists, stenographers, laboratory technicians,
radiographers, etc. These tests can also be used at the end of training
programmes to assess the level of proficiency achieved.
! !147
D. Personality Tests. Personality tests are used to assess certain

personality characteristics. These tests are used in selecting candidates
for sales jobs, supervisory jobs, management trainees, etc., because
certain personality characteristics are essential to succeed in such jobs.
E. Psychometric Tests. A psychometric testing is usually conducted by

experts of the subject to measure the knowledge, abilities and
personality traits of a person seeking job for a position. It is an attempt
to measure human intelligence. A combination of personality and
aptitude tests used to measure attitude, values and habits of the
person. In some cases, these tests are incorporated in the organisation
employment form and in some cases; it may be done as part of the
interview process, while aptitude tests are aimed to measure the
comprehensive and analytical skills of a person. Questions of these tests
have marks and a candidate has to score above the cut-off level. These
tests are based on reasoning as well as logic. By this process, the
person's qualities and abilities can be assessed comparing to the job
requirement for which he has applied. This process also helps
management to place the right person at the right job based on his
psychological bent of mind.
Utility and Administration of Tests:
• Selection process assesses a candidate in order to predict his

performance. Systematic and objective measurements are required to
make these predictions accurate. Psychological tests can be very useful
aids in the selection process but one cannot wholly rely on the results of
these tests alone. However, these tests can be used as screening
devices.
• For positions which require considerable manual dexterity and rapid

finger movements, one of the several available tests of manual dexterity
may be used successfully. Some of the jobs for which this test should be
administered are: 
 
(a) Filing, and card sorting, (b) washing of glassware; and (c) handling of
delicate equipment.
Similarly, for positions which require color perception, a simple color test
may be used. Such a test should be applied for the following jobs: 
! !148
1. Laboratory jobs where colour tests are done
2. Linen sorting where different colours are used for different floors/
departments
3. Clerical jobs where coloured cards are used to indicate classification by

year, such as OPD or IPD charts.
• Oral, written and practical tests can be administered while interviewing

candidates for the following posts. The followings are sample questions
for specific jobs:
Nursing orderly- How do you transfer a patient from a stretcher to a bed?

Nurse aide- In what ways can a child's temperature be taken? (Mouth
Joints/Rectum)
Laboratory assistant- Which needle will you use for taking blood from a
blood donor?
Cook- What do you put on fried sweet potatoes to make them brown?
The following is the list of tests recommended for specific jobs.
Billing clerk- Written test to check aptitude for figure work.

Statistical clerk- Written test to check handwriting.
Medical record clerk- Written test to check handwriting and spelling.
Laboratory technician- Practical test to evaluate the procedure used by
the candidate.
X-ray technician- Practical test to evaluate the quality of X-ray taken by
the candidate.
Physiotherapist- Practical test to evaluate the technique used by the
candidate in doing an exercise.
Pharmacist- Practical test by showing some prescriptions to judge the
knowledge of the candidate whether he can read prescriptions, know the
dose of the medicines, explain to the patients as to how to take particular
medicines, etc.
! !149
Telephone operator- Practical test to evaluate telephone etiquettes and

skills as telephone manners are very important. Her voice over the phone
is often the first or the only impression a person receives of her and of the
organisation that she represents.
Psychometric Tests
Though multinational industrial organisations and all the three forces of

India, viz. Military, Naval and Air Force have been using psychometric tests
in their recruitment processes, the health care industry is still largely
ignorant about their benefits. Fortes and Reliance Health care have
implemented psychometric tools like Thomas profiling, FIRO-B and Myers
Briggs type indicators in key areas of senior management and patient care
to hire and harness the right personnel. Psychometric tests are objectively
and scientifically designed questionnaires which test one's ability in general
and/or in specific areas. Psychometric analysis is the interpretation of
psychological data to predict an individual's success in a given role, hence
considered a major help in recruiting the right individuals with the right
attitude for a particular job.
Health care is a service industry, with a lot of stress and strain on human
resources owing to high expectations from patients, fast-changing
technology and competition. In such a scenario, psychometric tests can be
used for fresher's to judge their adaptability and attitude to learn, whereas
for the middle level, strategic leadership and ability to take key decisions.
For the senior level, skills like leadership, outlook and ability to look beyond
the horizon are essential. Psychometric tests can bring out the
temperament, care_ consideration, and the softer aspects of an individual
like empathy, concern and compassion.
Note: Psychological tests can also help in identifying areas of strength

and development of hospital employees. This will help the hospital to
customise its training programmes to meet specific development needs,
behavioural training programme, etc. There is a considerable potential
for using psychometric testing in the health care industry. As hospitals
become more professionally managed and want to provide the best
possible treatment and care to their patients, they will require staff with
right competencies and psychometric tests can contribute in the
selection and development of such employees.Therefore, there is a
significant use for psychometric tests in health care industry.
! !150
6.2.2.3 Interview by Department Head
After the initial screening based on the application history and experience,
an interview with the concerned department is taken. This is usually taken
before the HR round where salary etc is discussed. The department head
usually assesses the candidate on the basis of the knowledge and work
experience in the required field so as to test whether he/she is fit for
selection. After the selection of the candidate by the department head the
decision lies with the head of the hospital to approve the appointment /
sanction the candidate for the said profile.
6.2.2.4 Administrator's Decision
In some hospitals, the selection committee consists of one person each

from the human resource department, the department head/supervisor of
the concerned department and representative of the head of the hospital.
After interviewing all the candidates, the selection committee submits its
recommendations for approval to the head of the hospital, who is generally
the hiring and firing authority.
In other hospitals, the head of the hospital may prefer to interview all the
candidates himself for the key jobs and leave it to the selection committee
for the less vital jobs. In case of appointment of a department head, one
expert is also usually included in the selection committee. Different
hospitals adopt different policies according to their main convenience for
the selection of their employees. However, final approval of selection or
rejection of the candidates rests with the head of the institution. Generally
this authority lies with the Medical Superintendent or Administrator or
Business Manager or Chief Executive.
6.2.2.5 Medical examination
The medical examination of a prospective employee is an aid both to the

employee and to the management. The selection of the right type of
employee who can give his best and be most happy requires a thorough
knowledge of his physical capacities and handicaps. This necessitates a
complete medical examination by a doctor who understands the job
requirements. Therefore, no employee should be placed on the job unless
he has been declared medically fit by a competent medical officer. The
purpose of the medical examination is threefold:
! !151
1. It is for the protection of the applicant himself to know whether that

job will suit him or not from the medical point of view.
2. It is for the protection of the other employees so that they are not at
risk of any communicable or other disease which the prospective
employee may have.
3. It is for the protection of the employer as well, so that he may avoid
selecting a medically unfit person.
The medical examination will eliminate an applicant whose health is below

the standard or one who is medically unfit. If at all such an applicant is
selected, he will prove a liability to the hospital because job performance
will be below average. His abnormal behaviour towards his colleagues, the
public and patients may reflect his poor physical condition. In some cases,
he may be a health hazard to the patients, visitors and his fellow
employees. Therefore, the pre-employment medical examination should be
done for all selected candidates before they are placed on the job.
6.2.2.6 Check of references
• The references provided by the applicant should be cross-checked to

ascertain his past performance and to obtain relevant information from
his past employer and others who have knowledge of his professional
competence.
• Reference forms are generally checked by the employees of the human
resource department who have comparatively little knowledge about the
applicant. It is desirable to obtain the requisite information directly from
the applicant's former department head.
• The reference letters should be brief and should require as little writing
as possible by the person to whom it is sent. If it is directed to a former
employer, it should ask for the following data:
1. Date of joining
2. Date of leaving
3. Job title
4. Last salary drawn
5. Promotion/ demotion, if any
6. Unauthorised absentee record
7. Reason for termination/leaving
8. Ability to work with others
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9. Dependability
10.Emotional stability
11.Health conditions
12.Does the employee habitually borrow money?
13.Would you re-employ?
14.Any other information.
6.2.2.7 Issue Of Offer Letter And Appointment Letter
At first, an Offer Letter sent to the candidate. On the basis of this he

prepares for joining the particular hospital/ healthcare organisation.
When a new employee reports for joining, he should be given an
Appointment Letter, his job description and a handbook of the hospital. He
should be asked to submit his Joining Report.
Fig 6.6 Offer latter
OFFER LATTER
Date:……………
Address
……………………………
……………………………
……………………………
Dear………………….
With reference to your application dated ………….. and the subsequent

interview held on …………………., I have been directed by the Administrator/
Medical superintendent of our hospital to offer you the post of ………………. in
the pay scale of Rs………………….. at its P.M. as basic pay, Rs………………P.M. as
dearness allowance, Rs……………….P.M. as house rent allowance and Rs…………
P.M. as city Compensatory allowance.(Mention any other allowance,If any).
Total Rs……………P.M.
You will be on probation for……………………..month/year. This offer is subject to

your medical fitness declared by the medical officer of our hospital.
If this offer is acceptable to you, please report for the medical examination at
………a.m.on ……………..in our hospital.
Your sincerely,
(Personal Manager)
! !153
6.3 INDUCTION
Generally, in all organisations, employees give farewell party on the

departure of a colleague, but they do not give welcome party on the joining
of a new employee. And this is probably one of the reasons why newly
recruited employees who are already carrying with them an anxiety and
bewilderment end up with a feeling of isolation. Apart from everything else,
they get strong signals that the hospital they have just joined does not
care for them. And this could cause a lot of damage unless effective steps
are taken to ensure that the employees' first experience at the workplace
is pleasurable.
Therefore, some hospitals do organise induction programme for new

employees. They hand out exhaustive brochures that give the hospital's
history, past achievements and future goals while others do the same by
enlisting similar data in power point slides. Additionally, the newcomer is
gifted with the employee manual which informs the individual of his rights
and directs him as to what he cannot do.
He is introduced to the existing employees so that he may develop a sense

of belonging. This process is also part of the training, as it involves an
introduction to the organisation's objectives, policies and practices. The
induction sequences must aim at helping the new employee visualise his
place in the overall hospital picture.
As hiring costs have gone very high, hospitals have to ensure that once an
employee is recruited, he stays. Induction enables the new employee to
understand the culture, systems and processes and what the new
employee expects from the hospital and vice versa. The generic objectives
of most induction programmes include:
1. to develop realistic job expectations, positive attitudes and job

satisfaction,
2. to reduce anxiety and employee turnover,
3. to reduce time of supervision of the supervisor,
4. to develop a sense of belongingness, and
5. to adapt oneself according to the culture of the organisation. 
! !154
6.3.1 Induction by Human Resource Department
This should cover (a) a brief history of the institution; (b) its aims and
objectives; (c) the terms and conditions of the appointment letter, (d)
personnel policies; (e) an explanation of services available to the employee
in the hospital, such as bank, canteen, fair-price shop, library, social club,
etc.; (f) the attitudes expected of him with regard to patients and visitors;
(g) promotion policy; (h) the names of the key officials; (i) a tour of the
hospital; O) fire precautions and safety regulations; and (k) general
discussion.
6.3.2 Induction by Department Head
This should cover (a) an introduction to the department; (b) the location of
the changing mom, rest room, toilet etc.; (c) the use of lifts, telephones;
(d) an explanation of the job descriptions of others; (e) an explanation of
his own job description; (0 an introduction to all the supervisors in the
department; (g) a tour of the department; and (h) general discussion.
6.3.3 Techniques of induction
The following techniques may be adopted to orient new employees:
i. The general orientation lecture. In those hospitals where the

number of new employees is more than ten per month, it is advisable to
hold a group orientation session. It should be compulsory for all new
employees to attend this session. Such a meeting should be held in a
comfortable room. Devices such as charts, slides, handbook, etc. should
be used to make it interesting.
ii. General tour. A tour of the hospital can prove very informative for new
employees. It should be arranged to show to the new employees: (a)
how patients, arrive; (b) where patients are cared for, (c) how patients
are fed; (d) where different tests are conducted; (e) where patients'
linen is washed; (0 where the hospital's payroll is made; and (g) any
other place of major interest.
iii. Employee handbook. A well-prepared employee handbook is an

important document. It can set out a wide range of useful information
for new employees. It can be read at leisure. It is prepared for the use
! !155
of employees but is also read by his friends and family members as

well. This booklet should cover a brief history of the hospital, its aims
and objectives, conditions of employment, employees' health
programme. grievance procedure, safety precautions, etc.
iv. Buddy system. Under this plan, the new employee is introduced to an
old employee-a specially chosen 'buddy'. This buddy assumes the
responsibility of sharing the general information about the department
and the hospital such as locker, uniform, toilet, daily routine duties,
canteen, leave procedure, bus routes, etc. The buddy should be
carefully selected, lest the new employee receives wrong information. If
possible, some training should be given to some good employees in
each department so that their services may be utilized under this buddy
system. Thus a new employee will not fall into the wrong hands and not
collect false information about the hospital in general and the
department in particular.
6.3.4 Advantages of Induction
For employees:
• A chance to get a clearer picture of the organisation with a

comprehensive introduction to its philosophy, objectives, culture, policies,
etc.
• Introduction to relevant people, which makes easier for new employees

to approach them at the time of need in future.
• Time to settle into a new environment with new people.
• A valuable opportunity to gather all sorts of information according to

one's needs, likes and taste.
For the organisation:
• A chance to watch closely new employees in order to know them better.
• Helps the new employees to shape up according to the requirement of

the organisation.
• A system that ensures all new employees are well settled.
• An opportunity to inject fresh blood into the DNA of an organisation.
! !156
6.3.5 Confirmation, Extending Probation, Termination
During the probation period, a close watch should be kept on the

employee. If a new employee is properly groomed by his immediate
supervisor and the department head, he will prove to be an asset for the
organisation.
The probationary report on an employee should be obtained from his

department head 15 days before the completion of his probation period.
The human resource department should send a probationary rating form to
the concerned department head under a forwarding slip at least 30 days
before from the date of confirmation. A model probationary rating form has
been provided for guidance (Form 6.7). It can be suitably amended by the
hospital authorities according to their requirements.
Fig 6.7 Probationary rating Form
EMPLOYEES PROBATIONARY RATING FORM
Name……………………………… Date Employed ……………………………

Conformation due on ………………………
Designation ……………………… Department ………………………
Please choose the rating which best describe the employee’s

performance in each factor and choice
Factor Description
1. Quality of Work Generally careless, excessive errors ………..( )
Quality meets requirements of the job ………..( )
Careful worker, good quality of work ………..( )
Seldom makes errors, excellent quality of work ………..( )
2.Attendance Has never been absent or tardy ………..( )

punctuality,
dependability
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Seldom absent or tardy ………..( )
Occasionally absent or tardy ………..( )
Frequently absent or tardy ………..( )
Unacceptable absence or tardiness ………..( )
3. Quantity of work Exceptionally fast worker ………..( )
Fast worker ………..( )
Meets volume requirement of the job ………..( )
Slow worker, occasionally falls behind in work ………..( )
Very slow worker, often falls behind in work ………..( )
4. Initiative Exceptional ability in initiating action, follow-up ………..( )
Works well with minimum supervision and ………..( )

direction
Shows qualities of leadership and originality ………..( )
Performs routine assignments needing some ………..( )

supervision
Does not take initiative ………..( )
5. Ability to work with Very co-operative, seeks ways to help ………..( )

others, graciousness
Actively co-operative ………..( )
Good attitude, follows instructions willingly ………..( )
Not readily co-operative ………..( )
Antagonistic and/or trouble maker ………..( )
6. Appearance Exceptionally well groomed, good taste in dress ………..( )
Carefully groomed, appropriately attired for ………..( )

work
Meets grooming and dress requirement for job ………..( )
Somewhat careless, occasional disregard for ………..( )

appearance
Generally careless in grooming, solvently attired ………..( )
7. Interpersonal Relations With superiors ......(very good/

good/so-so/
bad)
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With peers ......(very good/

good/so-so/
bad)
With subordinates ......(very good/

good/so-so/
bad)
With patients ......(very good/

good/so-so/
bad)
With visitors ......(very good/

good/so-so/
bad)
Department Head’s Comments, If any
6.4 SUMMARY
Recruitment, selection and induction are crucial, complex and continuing

functions of the human resource department. This process begins with the
determination of manpower requirements, both in terms of quality as well
as the number of persons to be engaged. Once the requirement has been
determined, the department head sends the requisition of his personal
requirements to the human resource department. The human resource
department discovers the sources of potential employees and attracts them
through its recruitment activities. It then helps the concerned department
head in the selection process by providing its expertise and skill in
interviewing, psychological testing, verifying the antecedents etc. The
potential candidates who successfully cross all the selection hurdles are
finally selected. Each hospital should pay close attention to evolving
effective policies and procedures of recruitment, selection and induction,
because the hospital's success depends to a great extent on the quality of
its human resources.
 
! !159
1. Describe the various sources of recruitment in a hospital.
2. Explain induction process in hospitals.
3. How a candidate is selected in a hospital?
! !160
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !161
TRAINING AND DEVELOPMENT
Chapter 7
Training and Development
Objectives:
• Training Guidelines, Purpose and advantages of training for an

organisation
• What needs to be fulfilled in a training
• Types of training
• Management Development Programs and methods
• Counselling, its types, techniques, functions, duties of an employee
counsellor
Structure:
7.1 Definition of Training, Training Guidelines

7.2 Purpose of Training
7.2.1 Advantages of Training

7.2.2 Determining Training needs
7.2.3 Types of Training
7.3 Management Development Programs
7.3.1 Management Development Methods
7.4 Counseling
7.4.1 Nature and scope

7.4.2 Types of Counselling
7.4.3 Techniques of Counselling
7.4.4 Functions of Counselling
7.4.5 Duties of an Employee Counsellor
7.4.6 Summary
7.4.7 Self Assessment Questions
! !162
7.1 DEFINITION OF TRAINING, TRAINING GUIDELINES
• Training has been around for a long time. With the pressure on
productivity, it is now being perceived as a means of boosting
performance. There are many, however, who still harbour doubts about
the effectiveness of training. The most common reaction is: What you
hire is what you get, so what is the point of training? Or "Don't get me
wrong but I have a problem accepting the fact that people can change
and become more effective because of training”.
• Much of this skepticism stems from a lack of complete understanding

on what training is all about and what it can deliver. What training can
do is change behaviour. No good sales training programme tries to
change personalities. It cannot. Trainers start with the premise that
better selling, managerial skills and better teamwork can be imparted
or improved upon, they are not inborn.
• People who deliver results are those who consistently use effective
skills or behaviours. Post-training, the personality of the person
remains the same but the behaviour changes for the better. The
changes that any training programme brings about are broadly at four
levels:
1. Increase of effective behaviour

2. Decrease of ineffective behaviour
3. Use of additional behaviour for enhancing effectiveness
4. Improving existing behaviour for enhanced effectiveness
TRAINING GUIDELINES:
While designing any training programme, the following guidelines should

be kept in mind:
i. Training opportunities should be given to all employees irrespective of

their age, sex, rank, etc.
ii. Training programmes should be based on job analysis.
iii. Training opportunities should be provided throughout the employees'

stay in the organisation in order to meet technological changes.
! !163
iv. Apart from meeting immediate demands, all employees should be

encouraged to take courses which are likely to improve their respects
for more highly skilled employment.
v. A systematic means of assessment should be used while selecting

employees for training
DEFINITION OF TRAINING:
• Training may be defined as systematised tailor-made exercise to suit the

needs of a particular organisation for developing certain attitudes, skills
and abilities in employees irrespective of their functional levels.
• Training, therefore, serves not only one but many important purposes for
an organisation. If the hospital authorities provide training to new
employees to attract them and to old employees to retain them, they will
certainly notice change in the service of their hospital.
• Training may be defined as systematised tailor-made exercise to suit the

needs of a particular organisation for developing certain attitudes, skills
and abilities in employees irrespective of their functional levels.
• Training, therefore, serves not only one but many important purposes for
an organisation. If the hospital authorities provide training to new
employees to attract them and to old employees to retain them, they will
certainly notice change in the service of their hospital.
! !164
Fig 7.1 Process of Training
Activity A
What is training and development? What are the benefits of training?

Explain the process of training and development.
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………. 
! !165
7.2 PURPOSE OF TRAINING
Training should be based on the needs of the organisation. In hospitals,

training is needed for
1. rendering better service to patients;

2. reducing waste;
3. filling higher posts;
4. promoting safety measures;
5. teaching employees to efficiently operate new machines which are
installed or are likely to be installed in X-Ray/Laboratory/CSR/Laundry
departments;
6. constantly developing manpower to meet the current as well as future

needs of the organisation;
7. ensuring effective utilisation of human resources;
8. increasing the performance level of employees and developing them in

such a manner that they can rise to the positions of higher
responsibilities;
9. integrating individual goals with the organisational goals for creating a

climate so that an individual employee can best achieve his goals by
attaining the goals of the organisation;
10.updating knowledge of employees;
11.developing human skills of employees for overall better performance;

and
12.stabilising workforce.
7.2.1 Advantages of Training
Just as education improves the knowledge of a person, training enhances

the aptitude, skill and abilities of the employees to perform specific jobs
better. The advantages of a training programme are numerous.
! !166
1. Training brings about an improvement in the quality and quantity of

output, by increasing the skill of the employees.
2. Trained personnel can make better use of material and equipment.
3. Training helps to spot promising employees.
4. Training also helps in locating mistakes in the selection process.
5. Training creates a feeling of security among the employees that they are
properly looked after by the management
7.2.2 Determining Training needs
It is the duty of the human resource department to determine the training

needs of a hospital. The first step in determining training needs is to obtain
evidence of needs. This evidence may be gathered from various sources
such as exit interviews, complaints from supervisors and managers, staff
turnover rate, complaints from patients and visitors, etc. William McGhee
and Paul W. Thayer recommended the following three-step approach to
determine training needs:
1. Organisation analysis to determine where training emphasis should be

placed within the organisation.
2. Operations analysis to decide as to what the training programme should
consist of including a study of what a person should be taught, if he is
to perform his task with maximum effectiveness.
3. Man analysis to determine who needs to be trained and what skills,
knowledge or attitudes should be augmented or improved.' As soon as
the training needs are identified, a suitable training programme should
be developed for the concerned employees.
7.2.3 Types of Training
The type of employee training depends upon a number of factors such as

skills called for in jobs to be filled, qualifications of candidates applying for
jobs and the kinds of operating problems confronted by the organisation.
Although it is important that the training programme be developed to meet
specific needs, the human resource manager should also be familiar with
the whole range of training practised in other hospitals and organisations
so that he can advise managers on training methods best suited to their
needs. 
! !167
The most important type of training has always been and will always be
training on the job. The experience of actually doing something on the job
makes a lasting impression that other types of training cannot provide.
Training on the job to train new employees can be successful when it is
done in an effective manner. It is, therefore, necessary to ensure that
supervisors are themselves trained and motivated to be good trainers.
The following outline can help in giving on-the-job training effectively:
Step 1. Prepare the employee for training on the job. State the job and
find out what he already knows about it.
Step 2. Illustrate and show one important step at a time. Instruct clearly
and patiently.
Step 3. Let him do the job. Correct his errors. Make sure he understands.
Continue correcting his errors until he can do the job confidently.
Step 4. Choose a 'buddy' to whom he can go for help.
Step 5. Check frequently. Let him feel free to ask questions.
For training on the job to be effective, the trainer must take time to see
that learning really occurs and is in the best interest of the trainees,
patients and hospital. There are four main types of training. These are
provided by the management according to their requirements.
1. Entry training. It refers to the initial training provided to employees

at the time of joining the hospital.
2. Job training. It is provided to the employees with the object of

increasing their knowledge about their jobs, and also to enhance
their efficiency. It enables employees to know the correct method of
handling the machines and materials at their jobs.
Skills are taught through a mixture of demonstration, explanation and

practice. The teaching must be geared to the job. There must be a
continual process of correction of errors made, and checking that the
trainee understands what is taking place.
! !168
3. Training for promotion. It is provided in some organisations to fill

higher posts from among the existing employees. This gives
encouragement to employees to work harder.
4. Refresher training. It is arranged through short-term courses for

the old employees to keep abreast of the latest development in their
fields.
All jobs, whether in industries or hospitals, call for the use of certain skills
and the application of different forms of knowledge. These jobs cannot be
carried out effectively unless the skills and knowledge are properly
imparted. In considering the methods of training, hospital authorities
should remember that methods which are useful in large hospitals may or
may not be useful in small hospitals. Methods must be chosen to meet
specific situations.
7.3 MANAGEMENT DEVELOPMENT PROGRAMS
Recently, a leading surgeon and proprietor of a nursing home in New Delhi

asked a renowned industrialist of India, to give him an executive to take
care of the administration of his newly established nursing home. The
industrialist replied: "I can give you money, machinery and factory but I
cannot give my executive".In a developing economy such as ours,
managerial resources are scarce. If an organisation has the policy of
recruiting managers as and when the need arises, it is like digging a well
when fire breaks out. Such a policy is wrong, because managers cannot be
developed overnight.
If an organisation has a band of effective and efficient managers, it

possesses a most valuable asset, though it does not appear on the balance
sheet of the organisation. Without this asset, the organisation's very
survival is at stake, as no organisation can exist without managerial talent.
Management development occurs in every organisation in some way, as
subordinates learn from and respond to the example of their superiors.
Training and development activities within an organisation are geared to its
future as well as present requirements. For better results, it is necessary
that systematic and planned procedures for management development are
introduced on a wider basis and followed.
! !169
Management Development Programmes
The management development programmes aim at making available

managers and executives with requisite knowledge and skill to meet the
present and anticipated future needs of the organisation. They encourage
managers to develop their full potential for handling greater
responsibilities. The functional competence of the managers is improved by
the management development programmes, making them more
transparent and responsive to the changing needs of the organisation.
Besides developing managers for higher assignments by duly replacing the
retiring executives, the management development programmes help
sustain good performance of the managers throughout their career and not
allow them to develop managerial obsolescence.
The management development programme:
1. is a continuous process;
2. is a vehicle for attitudinal change;
3. is stimulant to higher competence;
4. provides feedback mechanism;
5. eliminates functional deficiencies;
6. is a self-development process as managers learn many things through
sharing the experience of each other in a stimulated classroom.
Principles of Management Development
The following principles of management development should be kept in

mind:
1. The first principle for determining a long-term strategy for

management training is that it must be comprehensive, extending to all
health-care personnel with managerial responsibilities.
2. The integration of management training with work is the second

principle , as the real meaning of management can only be learnt for
actually managing. The task of management development training
cannot be fully discharged by conducting external courses. The process
begins and continues at the workplace rather than in the classroom. The
gap between the two can be bridged by focusing training on the
practical problems of management.
! !170
3. The third principle is that training should be designed to be

progressive. Supervisory training should comprise the basic technical
instructions in the concerned occupation, and in turn should constitute a
foundation for subsequent middle-management training and thereafter
training at senior levels. A good employer will see that training for a
career should be the main objective.
4. The fourth principle is that management-developing training should

be collaborative. This means that experts from outside are called in to
undertake relevant fieldwork, to co-operate in follow-up and evaluation
efforts, and to develop health oriented case studies.
5. The fifth principle is that training must take full account of an

organisation’s objectives and be directly related to its need. It must
contribute to an understanding of actual situations and must not be
allowed to take place in vacuum. In short, it should be tailor-made
rather than ready-made.
6. The sixth principle is that training for management development

should be related to individual needs and be adapted to the varying
strengths, personal interests and pace of learning of each individual
manager. Only in this way can the hospital take the best advantage of
the opportunity to develop skills and potential. Substantial teaching time
and tutorial support are necessary to achieve this objective. Some of
the recognized techniques of individual teaching, such as programmed
learning, have yet to be fully developed for use in management
education.
7. The seventh and the final principle is that training must be monitored
and evaluated. The investment of resources in management
development training it so high that there must be a systematic and
comprehensive evaluation to assess its effectiveness and to modify and
improve training programmes as required.
! !171
Fig 7.2 Management development Method
7.3.1 Management Development Methods
Generally, the aim of all management training techniques is to generate in

department heads a deeper understanding of themselves and of others so
that their decisions may take better account of the needs of the hospital.
Many methods are used, but all of them seek to develop managerial styles
that are likely to build morale and motivate personnel for more effective
work, to attain the objectives of a hospital. A brief description of these
methods follows.
! !172
• Formal Management Education  

 
There are full-time programmes at Universities and other institutions of
higher learning designed especially for middle and top-level executives
who leave their jobs for short periods and are exposed to new ideas and
new people from other organisations.Some institutions of higher learning
conduct off-campus training programmes as well as 4 specialised training
on particular aspects of management for managers. In India there are 30
health-care institutions which impart hospital administration training. The
All India Institute of Medical Sciences, New Delhi is one of them.
• Management Seminars 
 
Working managers, who want a speedy orientation in various
management areas, may get it by attending seminars. There are a
number of associations such as the National Institute of Health & Family
Welfare, Voluntary Health Association of India, the Indian Hospital
Association, etc., which conduct such seminars from time to time. These
seminars are useful for middle management managers and top-level
executives.
• Job Rotation 
 
Managers may be rotated among positions to test their ability and to
meet new situations and challenges. Some organizations give middle-
management managers little opportunity to consider whether or not they
are interested in job rotation. Others consult them in detail before taking
any action. Job rotation is a very useful method for developing people's
careers, but it may not be good at senior levels. This method can be
used in the case of management trainees as well as existing managers.
It provides actual experience to both categories of trainees. A word of
caution is necessary here. When job rotation is used for management
trainees, great care must be taken in handling the relationship between
the management trainee and the staff.
• Lectures 
 
Lectures are generally preferred for disseminating information and
communicating new methods and policies to a large number of trainees
at a time. The lecturer presents material orally. He hands out prepared
! !173
notes to the trainees before or after his lecture. If he does not hand out
his notes, the trainees make their own notes during his lecture. The main
disadvantage of a lecture is that participation of the trainees is minimal.
This can, however, be overcome by having a panel of speakers and
encouraging the listeners to ask questions.This can bridge the gap
between the one-way communication of a lecture and the needed
exchange of ideas between the lecturer and the listeners.
• Role Playing 
 
Role playing is a useful technique in developing skills. It may be used
where human relations skills are required to be developed. Ward in-
charges, senior X-ray or laboratory technician, senior pharmacists or
physiotherapists, who are required to get work from their subordinates,
can benefit from role-playing. In this method, an individual puts himself
in another person’s shoes and acts as that person would act This gives
practical experience free from theoretical and academic restraints. The
great advantage of role-playing it practice in a reality situation. The first
step is to get the trainees to suggest problems which they experience
while performing their duty. The scenario is then prepared and the
trainees are asked to volunteer themselves to play different roles. This
provides each individual with an opportunity to develop insights. Thus,
persons who work in supervisory capacities can learn to supervise their
subordinates better.
• Sensitivity Training 
 
Sensitivity training is designed to make the trainee employees more
aware of themselves. Its agenda is open, and is determined by the group
itself. Sensitivity training develops situations which induce the individual
to examine his compartmentalisation's, incongruities and discrepancies
and endeavour to integrate his behaviour, value, needs and feelings,
which constitute his inner world with the expectations of the social
environment. 
 
There is no role-playing in sensitivity training, because participants are
playing their own, actual roles. In sensitivity training, it is assumed that
the essential sources of personal growth and development lie within the
participants themselves. It provides ample opportunity to the participants
to expose their behaviour as well as their thinking, receive feedback
! !174
about their behaviour and give feedback about the behaviour of others.
It has been found that stress on participants as they undergo sensitivity
training is so high that they risk nervous breakdown. Sensitivity training
is, therefore, the most controversial training method. Some proponents
of laboratory education denounce it while others strongly support it.
• Delegation 
 
Indian managers are generally scared of delegating their powers to their
subordinates. They wrongly believe that no one can excel them. They
forget that without delegation of authority and giving additional
responsibility, no subordinate can gain confidence in him. Asking the
subordinate to study problems and take decisions by themselves can
infuse them with confidence and develop decision-making and leadership
skills which are so essential for a good manager.
• Promotion 
 
The possibility of promotion can encourage a manager to acquire skills
required for the higher job, so that he may take proper decisions and
discharge his duties efficiently. Deserving candidates who have potentials
should be promoted and in no case be left to stagnate at one place. If
management does not follow this policy, it will soon start losing its good
employees, with dire consequences to the organisation.
7.4 COUNSELING
• Employee counselling is a comparatively-recent phenomenon, although

the functions performed by counsellors are not new. Some enlightened
managements, like that of Western Electric Company, USA, introduced
counselling programmes long back. In western countries, most of the
hospitals engage counsellors for employees counselling and Chaplin for
pastoral care of patients in mission hospitals. However, hospital
managements have yet to make a beginning in this field in India.
Counselling helps in reviewing training needs, establishing proper
relationships and solving the personal and official problems of
employees. Health, family responsibilities, lack of training temporary
difficulties on the job, etc. are all tackled under employee counselling.
! !175
• Sitting in front of an employee or a patient and listening to the

complexity of story, one may wonder, what do I have to offer in this
situation? Often we may find ourselves in a position where there is not
much that can be done. Some health care professionals experience a lack
of confidence and discomfort since many of them are neither trained nor
exposed to dealing with psycho-social and spiritual matters. Just as
medical and nursing skills are crucial for the physical care of the patient,
counselling skills are important to deal with the non-physical issues.
• Our country is lagging far behind. Many hospitals do not have the
advantage of employing counsellors or social workers as their
administrators have not felt the need of their employment. Secondly, we
do not have also many trained counsellors and social workers. There are
a number of schools of social work where social workers a -- trained, but
they go abroad after training and join there. So far as counselling
training centres are concerned, those are very few and therefore make
the feel of shortage of the counsellors.
7.4.1 Nature and scope of Counselling
• The word 'counselling' is commonly misunderstood as a process where

counsellors give solutions and suggestions to people's problems by telling
them what to do and what not to do. Rather, counselling has more to do
with listening, empathising, accepting and understanding. It is a process
where the counsellor is able to identify the issues related to the person's
problems to give clarity of thought which leads to understanding oneself
better and to handle situations in a better way. Counselling is to help
people gain confidence to understand their inner conflict and pressing
problems.
• Counselling aims at helping people, whether they are employees or

patients, discover or rediscover the meaning of their life and help them
live fully in the available time. It is therefore a process by which one
could help people find a new direction in life and to experience and
witness a purposeful and meaningful new life rather than leading a
disputed life at his workplace or at home.
• Counselling is defined as the discussion of an emotional problem of an

individual (employee) with a counsellor with the general objective of
decreasing it. This definition has several implications:
! !176
1. Counselling deals with emotional problems. It does not include job

inconveniences J which have no emotional involvement. Nor does it
include legal advice, advice on technical aspects of one's job and
similar matters which are primarily non-emotional in content.
2. Counselling involves discussion, meaning thereby an act of

communication. Proper counselling depends on communication skills.
3. The general objective of counselling is to understand and decrease an

employee's emotional disorder.
4. This definition in no way implies that counselling can be given only by

professionally-trained people)
7.4.2 Types of Counselling
There are generally two types of counselling, i.e. directive counselling and
non-directive counselling: Keith Davis has suggested one more type of
counselling which has been named co-operative counselling’.
A. Directive Counselling 
 
Directive counselling rests on the philosophy that the manager can best
understand both the situation and the individual problems arising there
from. In this type of counselling the counsellor gives advice, warns,
praises or gives reassurance, etc. All these actions emphasise the
superior position of the counsellor. Hence he is said to be directing i.e.
providing directive counselling.
B. Non -directive Counselling 

 
Non-active counselling rests on the belief that the individual can best
understand his own emotional problems and work out an effective
solution to himself. This requires a congenial and friendly atmosphere
with the counsellor exhibiting continuing interest but making no
judgment. This results in a release of tension, the development of
insight and the formation of new plans and choices. In non-directive
counselling, the function of the counsellor is to listen carefully and
encourage the individual to explain his problems. This is the type of
counselling generally practised by professional counsellors. No doubt
! !177
non-directive counselling emphasises deeper feelings, equates

counsellor and counsel, and holds the counsel responsible for solving his
problems himself, etc. but it is very time-consuming and therefore
costly.
C. Cooperative Counselling 
 
Cooperative counselling starts by using the listening techniques of non-
directive counselling but as the interview progresses, the counsellor
plays a more positive role than the non directive counselor. The
counsellor may offer bits of knowledge and insights which he has, thus
giving the counsel a different and broader perspective for comparison.
Except for severe cases and special situations, co-operative counselling
seems to be the best type for managers to practise. The most important
contribution that non-directive counselling has made to management
practices is to pull managers away from directive counselling toward a
more non-directive approach called co-operative counselling.
7.4.3 Techniques of Counselling
Counselling is not a modem phenomenon. It has been practiced since the

evolution of mankind. Lord Krishna counselled Arjun in the battlefield when
the latter was not agreeing to fight against injustice. Effective, counselling
can be given by a skilled and experienced counselor. There are certain
techniques of counselling which can be followed and adopted according the
requirements from time to time.
1. Releasing Emotional Tensions
Releasing emotional tensions is a process of getting out of one's heart and

mind. This helps gain power of understanding the things in their proper
perspective. Coming under the influence of emotions is a human weakness
present in almost all the human beings. When such an emotionally ridden
person, after being counselled, overcomes this weakness, he realises that
he was unnecessarily caught up in the emotional grip which was
impractical and far away from the facts. Thus, the counselor is to take the
counsel into confidence and listen to him carefully as if he is the only
caretaker of the counsel. 
! !178
2. Effective Communication
Effective communication helps subordinate employees to narrate their

difficulties to their superiors, through which many problems get
automatically resolved. Here, supervisors/ managers can perform the job
of counsellors. They can remove the fear from the minds of their
subordinates by talking freely so that they open up their minds to them.
Through effective communication, the supervisor can understand his
subordinate's point of view on what he means to say. Thus communication
is an effective technique in counselling.
3. Positive Thinking
One should think positively and shun negative thinking. Negative thinking
needs to be removed from the mind of a subordinate. Such thinking only
helps in developing °al misunderstanding and distrust. The counselor
should develop a new pattern of positive thinking in the counsel - he
should be motivated and encouraged to think positively.
7.4.4 Functions of Counselling
Employee counselling is a process of adjustment of establishing a new

emotional equilibrium for an employee. An employee's feelings cannot be
ignored or argued about. They are situational facts which need to be
accepted, understood and dealt with because modern management
supervises the whole man, not just his work. The functions which
counselling undertakes are advice, reassurance, and communication,
release of emotions, clarified thinking and reorientation.
I. Advice: Counselling is primarily an advice-giving activity. The giving of

advice requires a counselor to sometimes make judgments about the
individual's emotional problems and to lay down a course of action.
II. Reassurance: Counselling provides reassurance. It is a way of giving

courage to an employee to face his problem. However, if he faces the
same problem again, counselling may not provide the required
reassurance once again. Reassurance is useful in some situations.
III.Communication: Counselling is one of the sophisticated

communication forms to maintain a constructive employee attitude.
! !179
Communication between counselor and counsel should be extremely

open. Counselling helps a lot in upward communication as the counselor
discovers emotional problems related to the policies of the organisation
and A interprets those problems to top management.
IV. Release of emotions: Counselling releases emotional tensions. The

counsel gets emotional release from his frustration when he gets the
opportunity to ventilate his pent-up feelings. It is a fact that as soon as
a person begins to explain his problems A to a sympathetic listener, his
tensions begin to subside. Though this does not mean that his
emotional problems are solved, it certainly helps remove the mental
block and enables him to face his problem.
V. Clarified thinking. Clarified thinking is a result of the release of

tensions. A skilled 3 counselor acts as a catalyst to quickly bring about
clear thinking. The net result of clarified thinking is that a person is
encouraged to accept responsibility for his emotional problems and to
behave rationally in solving them.
VI.Reorientation. Reorientation involves a change in the employee’s

psychic-self through a change in his basic goals and values. It requires a
revision of the employee's level of aspiration to bring it more in line with
his level of attainment. It helps the individual to recognise and accept
his limitations. This last function is usually performed only by
professional counsellors, but managers practice the other five functions.
Activity B
Explain the different methods of training and development. Which method

would most useful in training doctors and nurses in a hospital?
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………….
7.4.5 Duties of an Employee Counselor
• In most organisations, counsellors play an important part in the induction

of new employees. The first few days at the place of work are always
bewildering. At this stage, counsellors can do much to help new
! !180
employees. They take new employees round the hospital, show them
different departments and explain their functioning. issue lockers and
uniforms, explain rules and regulations of cafeteria and hostel, introduce
them to the administrator and medical superintendent, etc.
• The employee counselor usually finds out if the new employee has any
personal problems such as housing, transportation, admission of children
in school, etc. The most difficult duty of the counselor is to tactfully listen
to problems of the employees. This function is to some extent an
indivisible part of the job of supervision, but supervisors are likely to
have little time to listen to employees' grievances and personal problems
as they are more engrossed in the problems directly related to the
patients. In any case, many employees hesitate to thrust their personal
difficulties upon an immediate supervisor. Where employee counsellors
are provided and not burdened with too many other responsibilities, the
employees are encouraged to approach them as they will not misuse the
information in any way that will endanger the employee's self-respect or
his status in the hospital.
• The employee counselor is and should always remain just a friend who is
well informed about the hospital, hospital rules and regulations and
stands ready to give any help and advice needed, but who has no
supervisory authority of any kind. Such a counselor can be of great help
to employees, to supervisors and to top management.
• It will thus be worthwhile to appoint one employee counselor for every

100 employees in a hospital. The appointment of an employee counselor
will not only help employees solve their personal and official problems
but will also boost their morale resulting in a high standard of service,
less grievances, better public relations, etc. An employee counselor can
look into the following problems of employees: leave of absence; job
transfer; problem with immediate supervisor, complaint about co-
employees: shift duty; duty on holiday; illness of employee; job
promotion; raise in salary; uniform/locker; financial problem/debts;
property dispute; death in family; marital problems; children’s admission
in school; children's personal problems; gas/ration card; transport;
housing problem; illness in family electric connection, etc.
• If the hospital is too small to warrant appointing a separate employee

counselor, the work of medical social worker and employee counselor can
! !181
be combined. The administration should appoint one employee

counselor-cum-medical social worker for every 50 in-patients and 50
employees. These employee counsellors or employee counselor-cum-
medical social workers should be at least graduates in social work and
diploma in counselling preferably, so that they are mature enough to deal
with the patients, doctors and nurses. When they deal with a patient,
they can play the role of liaison officer between doctor, nurse and
patient, as doctors and nurses are generally hard-pressed for time to
explain to the patient in layman's language what he is suffering from.
Similarly, when an employee counselor deals with an employee, he can
again play the role of a liaison officer between the management and
employee.
• Counsellors should be appointed in the human resource department

because of the availability of the service records of all employees. Before
employee counsellors or employee counselor-cum-medical social workers
are assigned jobs in the hospital, they could be sent to a school of social
work for a short orientation programme. The course contents can be
framed in consultation with the hospital management, medical staff and
faculty of the school of social work.
7.4.6 Summary
Training ensures the future of any organisation. It helps to ease the

transition into an organisation and facilitates movement within an
organisation. Training takes many forms. New-employee orientation,
mentoring, on-the-job and off-site training are common examples.
Managers often provide training in formal or informal settings. Cross-
training of employees with similar types of jobs provides organisational
flexibility. Giving developmental opportunities to potential leaders
facilitates succession planning.
! !182
7.4.7 Self Assessment Questions
1. What is training and development? Why should training be imparted to

staff in a hospital?
2. Explain the barriers to training medical and non-medical staff.
3. Explain why counselling should be practiced as a policy in hospital

management. 
! !183
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !184
WAGE AND SALARY ADMINISTRATION
Chapter 8
Wage and Salary Administration
Objectives:
• Nature and importance of compensation in HR dept.

• Various components of compensation
• Difference between Wage and Salary
• How compensation is determined, and importance of Payment of Wages
Act, 1936
Structure:
8.1 Role of Human Resources Department in compensation

8.2 Difference between Wage and Salary
8.3 How compensation is determined?
8.4 Payment of Wages Act 1936
8.5 Summary
! !185
8.1 ROLE OF HUMAN RESOURCES DEPARTMENT IN

COMPENSATION
• Wage and salary administration is a pivotal function of human resource

management. Its importance is evident from the fact that a majority of
union-management problems and disputes relate to the question of wage
payment. According to the hierarchy of needs proposed by Abraham
Maslow, money, food and shelter are the first needs of a person. It is
therefore of utmost importance to develop a sound wage and salary
scheme to attract capable employees, motivate them toward better
performance and retain them.
• Fair and equitable compensation for each hospital employee should be

the objective of the wage and salary administration programme. The way
in which this function is discharged varies depending upon policies, size
and other characteristics of the hospital.
• Hospital authorities, particularly those of charitable hospitals, have

recently realised that the salaries paid to employees in hospitals are less
than those paid for similar occupations in industries. In an increasing
number of hospitals, this recognition has resulted in reconstitution of pay
scales and allowances, improvement of working conditions, fringe
benefits, etc. The bread-winning motivation need not replace the service
ideal in hospital employment; but in an analysis of the motives which
determine an individual's choice of a job, the wages paid is an important,
if not the most important factor involved.
Purpose of Compensation:
The wage and salary administration programme has a variety of purposes.

These are as follows:
1. To define the duties and responsibilities involved in each position in the

hospital and determining the qualifications and training requirements of
the employee occupying the position.
2. To compare positions according to mental and physical requirements,

skill, responsibility and working conditions.
! !186
3. To establish common titles for jobs which have similar duties and
responsibilities, so facilitate dependable salary comparison.
4. To establish within the hospital wage levels comparable to that

prevailing in the community for similar work.
5. To establish a periodic salary review system so that adjustments may be

effected whenever indicated.
8.2 DIFFERENCE BETWEEN WAGE AND SALARY
Wage and salary administration means different to everyone involved in

hospital business:
To employers it means:
i. Fair and equitable wages and salaries for all employees

ii. A basis for establishing, developing and maintaining good employee
relations
iii. Development and maintenance of good employee morale

iv. A guide for administrative action concerning wages and salaries
v. A basis for facilitating control over expenditure on wages and salaries.
To the employees it means:
i. A basis for understanding the hospital's policies concerning wage levels,

structures and ranges.
ii. A means for clarifying opportunities for development and channels for
promotion.
iii. Greater job satisfaction and feeling of security, helping the individual
attain his occupational objectives.
To the patients it means:
i. Better service to patients and their families by hospital employees, who

enjoy their job and are happy with their work.
! !187
ii. Lower hospitalisation costs, resulting from a higher degree of employee

efficiency.
Payment made to compensate labour for the work done is generally termed
as wages. Money paid periodically to persons whose output cannot easily
be measured, such as clerical staff supervisory and managerial staff is
termed as salaries. Salaries are generally paid on a monthly basis.
8.3 HOW COMPENSATION IS DETERMINED?
The following FACTORS determine compensation:
• Demand and supply. If enough candidates are available, they will offer
themselves for work at low salaries. However, if they are in short supply,
they will work only if they are paid well.
• Capacity to bargain. Candidates are usually not in a position to

bargain, but they acquire some powers through their unions.
• Government regulations. Since employees do not have the bargaining

power to ask for fair wages, the government intervenes and fixes
minimum wages.
• Hospital's ability to pay. The ability of the hospital to pay the rates
prevalent in comparable hospitals is an important consideration. If a
hospital pays less, it will find it difficult to attract and hold employees. If
a hospital can pay more, it can attract,retain and motivate its employees.
• Cost of living index. In many industries, wages are linked to the cost of
living index which ensures fair wages to the employees. As prices of
commodities go up, wages too go up and when the index goes down, as
a result of fall in prices, wages also come down but it is not so practically
because employers can increase wages but cannot decrease.
Any job may be arbitrarily assigned in hospitals to any particular pay scale,
but a more satisfactory result may be achieved if a job-evaluation
programme is completed before hand. Job evaluation is a technique of
human resource management concerned with assessing the value of one
job in relation to another. Its objective is to determine relative value of
each job in the institution. 
! !188
The process of job evaluation involves the fallowing steps:
1. Selection of a representative committee

2. Agreement on the objectives to be attained and jobs to be covered
3. Conduction of job analysis- an analysis of the factors necessary for its
successful performance
4. Comparison of one job with others

5. Arrangement of jobs in their proper sequence
6. Salary survey in the industry and the region
7. Assignment of rates to each job.
Note 8.1 Wage and Salary Distinction
Wages is best associated with employee compensation based on the number of

hours worked multiplied by an hourly rate of pay. For example,an employee
working in an assembly plant might work 40 hours during the work week. If
the person’s hourly rate of pay is $ 15,the employee will receive a pay check
showing gross wages of $ 600 (40 x $15). If the employee had worked only 30
hours during the week, her or his pay check will show gross wages of $ 450 (30
x $ 15). Because the pay check needs to be computed based on the actual hours
worked ,the employee earning wages will likely receive her or his pay check
five days after the worked period.
Salary is best associated with employee compensation quoted an annual basis.

For example the manager of the assembly plan might earn a salary of
$ 120,000 per year. If the salaried manager is paid semi - monthly (perhaps on
the 15th and last day of each month) her or his pay check will show gross
salary of $5,000 for the half month. Since the salary is the same amount for
each pay period,the salaried employee’s pay check will likely cover the work
period through the date of the pay check.
Generally,the hourly paid employees will earn wages at the rate of time and
one half for the hours in excess of 40 per week. The salaried employees in high
pay positions are not likely to receive additional pay for the hours in excess of
40 per week. However, employees with low salaries are entitled to overtime
pay.
! !189
• Before a job-evaluation plan is launched, it is important to identify which

jobs are to be evaluated because job evaluation is as applicable to high
paid jobs as to low paid jobs. It is equally necessary to decide a
representative committee which can ensure the programme's success.
The committee should consist of human resource manager, nursing
director, head of the department of any paramedical department,
maintenance engineer of the maintenance & repairing department and,
one of the medical personnel.They should be liberal, objective and
analytical in their approach. In this way, they cannot only eliminate to a
great extent grievances about salary but will also give the satisfaction to
the management and employees that justice has been done. Job
evaluation can provide a sound foundation for framing an incentive
scheme, selection,placement of employees, etc.
• Depending on the job-evaluation plan, similar jobs can be grouped into

categories by total points assigned in the evaluation programme. There is
generally a positive correlation between pay scales and points. However,
there may be deviations due to the following reasons:
1. Certain categories of employees are in great demand (such as

nurses)
2. Department Head exerting undue influence
3. When certain jobs carry extra responsibilities and are, therefore,
compensated in proportion to the extra responsibilities assigned.
Wage and salary administration program may be divided into four

interrelated steps:
a. Developing fundamental policies;

b. Building the wage and salary structure;
c. Job assignment; and
d. Developing compensation procedures.
A. Developing Fundamental Policies
Policies must establish the average level of wages and salaries within the
hospital. These policies are influenced by the following factors.
! !190
1. Existing labor legislation.
India is a fast developing country. Through the Five Year Plans, beginning
with the First Five Year Plan, the country has aimed at achieving rapid
economic and industrial growth, price stability, equitable distribution of
income, etc. In the light of these goals, state regulation of wages has
become the principal characteristic of Indian wage policy. Our government
in the post-independence period has always felt the need for protection of
the large segment of the population-the working class.
i. Article 39 of the Constitution of India provides the principle of equal

pay for equal work for both men and women as a directive principle
of state policy.
ii. Similarly, Article 43 of the Constitution provides that the State must
endeavour to secure for all workers a living wage and conditions of
work which ensure a decent standard of life as well as full enjoyment
of leisure and social and cultural opportunities.
iii. The Minimum Wages Act, 1948, is a direct state measure for the
regulation of wages in the country. The act empowers the
government to fix minimum rates of wages. It also provides for the
review of these wages at intervals not exceeding 5 years.
iv. The Payment of Wages Act, 1936, was a step in the direction of wage
regulation. It tries to ensure regular and prompt payment of wages to
prevent exploitation of employees by arbitrary fines and deductions
from wages.
2. Wages and salaries paid for similar work in the community.
This is one of the most important factors influencing wages and salaries
policy formulation. The hospitals compete with other employers for the
available labour force. If the supply and demand for labor are in balance
and if a competent staff is to be retained, it is necessary that hospitals pay
wages which are comparable to those being paid for work of a similar
nature elsewhere in the community. Paying adequate competitive wages
can result in actual monetary saving to the hospital, if an efficient worker
who is able to do more and better work in less time with less supervision is
! !191
employed. Payment of salaries that are lower than those prevailing in the
area might result in a higher total payroll, since more employees and more
supervisors will be required due to low efficiency. The quality of work will
also be substandard.
3. Regulations established by employees and their unions/

associations through negotiations.
Regulations established by the unions through negotiations with the

management affect the wage and salary bill of the hospital. Subject such
as leave, pay scales, allowances, fringe benefits, working conditions,
overtime rate, etc. are frequently included in the agreements with the
unions and professional associations.
4. The hospital's financial position.
The hospital's financial position is a major factor in the establishment of a

wage and salary plan. It obviously imposes a limit on the payroll costs
which the institutions can incur. The following factors should be considered
in connection with this problem.
i. One of the major objectives of a wage and salary study is to create

the proper relationships among the positions in the hospital.
ii. A study of duties performed in various positions may enable the

hospital to spend the money available for wages and salaries more
wisely.
iii. If the wage and salary plan indicates a need for overall increase in
wage and salary, this fact should be clearly understood and a basis
for budget revision be firmly established.
iv. In no case should the study of wage and salary be stopped on

account of non-availability of funds. In the absence of such study, the
hospital might start losing its most valuable asset-its personnel. On
the contrary, the completion of a study covering such matters for the
institution as a whole will provide the basis upon which more
consistent and intelligent decisions can be taken.
! !192
5. Availability of qualified hospital personnel.
This is an important factor. A hospital may sometimes be forced to pay to a

person a salary which is above the market value. This type of problem
exists mainly in positions filled by highly skilled employees. If the study
indicates a pay rate for a given job classification, and if this rate is not
adequate to attract suitable employees, it is advisable to make a
temporary adjustment in the rate which will enable the hospital to fill the
necessary positions. The rate can later be reduced to the level indicated by
the study, as and when a competitive situation arises.
B. Building the Wage and Salary Structure
It is very important to build a wage and salary structure for the hospital.
The matters of primary importance in developing such a structure for a
hospital are:
a. Establishing the jobs to be performed, describing their content and

the duties and responsibilities of employees assigned to them.
b. Studying and analysing each job to determine the standard of

performance necessary for its successful completion and the qualities
which the person should possess.
c. Evaluating each job to determine the relative value in relation to all

other jobs performed in the hospital.
d. Classifying the jobs into groups which possess similar characteristics

and establishing a wage level for each group.
Although the development of a study of the type proposed is time

consuming, the procedure is a valuable tool in encouraging administrative
and supervisory personnel to think through the problems involved and
arrive at logical conclusions. This involves the following tasks:
1) Establishing the jobs to be performed, describing their contents

and defining the duties and responsibilities of employees
assigned to them.
! !193
There are three fundamental steps in the investigation of the work

performed in the hospital:
i. The positions involved must be listed.
ii. The contents of each position must be described including the duties
and responsibilities of the employees assigned to it.
iii. Positions with essentially the same content must be grouped under
the same job title.
The work undertaken should be so organised and directed that answers to

the following questions, will be completely and clearly indicated:
i. How many persons are employed by the hospital?
ii. What tasks does each person perform?
iii. In which positions are the same tasks performed?
iv. What job title can be assigned to each position which will be
indicative of the tasks performed and most universally accepted and
understood by others in the health service profession and related
organisations?
There are four methods generally used in collecting the above information.
It is advisable to use all of them in order to secure complete and valid
information.
a) A review of payroll record to identify each position and each employee.
b) A work questionnaire completed by each employee in which he lists all

the duties he performs.
c) An interview with each employee and his supervisor to clarify and

supplement the information received from them through the
questionnaires.
d) Direct observation of work performance, to check the accuracy of the

data collected.
! !194
After this information has been collected and correlated, positions involving
essentially the same duties should be grouped into job classifications. The
job title for the job classification should be meaningful and as widely
accepted as the circumstances permit.
2) Studying and analysing each job to determine the requirements

necessary for its successful performance and the qualities which
the person assigned to it should possess.
Each of the job classifications must be studied in terms of its demands. The
procedure presupposes complete knowledge of content for each job
classification upon which judgment can be based concerning the minimum
performance requirements. The resulting analysis describes the qualities of
the worker who should be selected to fill the job. A complete analysis of
jobs has many practical uses for members of the hospital at all levels.
i. Agreement upon terminology so that job names, titles, etc. have

specific and uniform meaning to all those who use them.
ii. A definition of performance requirements so that employees can be

more carefully and intelligently selected, more realistically inducted
and, wherever necessary, trained on the job.
iii. Understanding of job relationships to encourage better co-operation

among employees and to establish promotional lines and transfer
opportunities.
iv. Awareness of job-environment factors which may involve health

hazards.
v. Provision of relevant facts to serve as the basis for method's

improvement.
vi. Development of information essential for a system of job evaluation

which will support and defend wage and salary differentials between
jobs.
vii.Helping workers and supervisors to formulate a better common

understanding al job standards and of rating procedure.
! !195
viii.Prevision of accurate job facts for use in negotiating with

professional associations.
An analysis of jobs should include a great many facts about each job
classification. The following is a list of items generally necessary:
i. Job title
ii. The number of positions commonly carried on the payroll in each job
classification
iii. The departments in which positions in this job classification are found
iv. Work performed
v. Supervision given and received. The number and titles of individuals
reporting to each supervisor in this classification and the type and
degree of this classification given to them.
vi. The level of difficulty involved in the job, such as: (i) degree of
responsibility, (ii) degree of knowledge, (iii) value of judgment
affecting the welfare of patients and successful operation of the
hospital, (iv) amount of resourcefulness needed to meet new
situations without specific instructions, (v) manual strength and
dexterity, (vi) degree of accuracy, and (vii) training required.
vii.Hours and shifts

viii.Standard of performance
ix. Job combinations
x. Working conditions
xi. Mechanical requirements
xii.Special performance demands, if any
xiii.The date of completion of analysis
xiv.The signature of the supervisor responsible for the job described.
3) Evaluating each job to determine its relative value in relation to

all other jobs performed in the hospital.
! !196
This is meant to find out the relative worth of all jobs. Many other elements
may influence the relative wage rate for a given job such as economic
conditions, availability of capable workers, the cost of living and collective
bargaining by the unions and associations. A job evaluation system does
not determine the wage rate for any given position but provides a logical
and uniform basis for decisions concerning the relative level of wages and
salaries between jobs in the hospital. The bm. thus collected may be useful
in selecting, training and supervising employees. There are four common
methods of job evaluation - the ranking method, the classification method,
the factor comparison method and the point systems. The method to be
used in a given hospital should be determined on the basis of its
applicability, its usefulness and the success with which it can probably be
completed.
A. Ranking method.
All the jobs in the hospital are arranged in the, order of importance
accepted by the common agreement among those responsible for the
evaluation system on the basis of job titles and job content. The least
important position is placed at the bottom of the list, the most important at
the top and the remaining others are properly arranged between them.
Although this procedure is sound and simple, its value is largely
dependent upon the judgment of the persons applying the method.
This method considers each job as a whole and measures each job against
every other. It attempts to establish an order of relative worth right from
the post of sweeper/dishwasher/ chowkidar to the post of chief executive/
medical superintendent. It is helpful to begin with a small group of key jobs
with which the committee is familiar. It requires only a short time to do the
actual rating of the job and it is quite flexible. The ranking method can be
effective in a small hospital where a limited number of jobs are being
rated.
B. Classification method.
This method involves the establishment of certain grades or classifications

of employees, each of which is carefully defined by describing the types of
duties performed, the degree of responsibilities involved, etc. The jobs are
then reviewed and assigned to a grade or classification, for example,
clerical, technical, nursing, etc. Tentative grade descriptions of these areas
! !197
are written. It is assumed that positions which can be classified under the
general title 'clerical' will have some common elements. A decision as to
the applicable job level is reached through discussions of the job-
evaluation committee. Jobs are then assigned to this level. It may be
necessary to rewrite the tentative descriptions several times.
The evaluation is accomplished by preparing a set of job grades and

classifying individual jobs in relation to how well they match the grade
definitions. There are three steps in this method:
i. Job grades are established.

ii. Each grade is carefully defined.
iii. Individual jobs are classified in relation to the grade descriptions.
Since the grade descriptions are the foundations on which the plan is built.
The descriptions should be general enough to include the various jobs and
yet specific enough to distinguish clearly the type of jobs to be included.
Within the general grade descriptions will be included the several levels of
jobs which fall in each category and these levels of jobs can be limited
from ten to fifteen. Too few job levels limit the accuracy of classifications;
too many levels call for unnecessary and artificial separations. There may,
of course, be several positions at any one job level.
The grade level should be clearly defined in terms of the general grade
description. In writing the grade level descriptions, the degree to which any
or all of the following conditions are presented must be watched, because
on these considerations will be based the decision on the importance of
each job:
a) Supervision and leadership of subordinates

b) Co-operation with associations who are not in the line of authority
c) Probability and consequences of errors
d) Initiative and resourcefulness
e) Minimum experience requirements
f) Minimum education requirements.
In such a plan, clerical staff might be divided into nine or ten categories:
! !198
While the duties of Typist-Clerk I were less arduous and less demanding
than those of Clerk III, the distinction made seems wise because of the
recruitment problem for any position requiring typing.
Once the grade levels have been established and the general descriptions
within the various
Clerk I Typist - Clerk I Stenographer I
Clerk II Typist - Clerk II Stenographer II

Clerk III Typist - Clerk III Stenographer III
clerical positions arrived at, positions in the organisation can be assigned

to a grade level by the evaluation committee.
C. Factor comparison method.
The factor comparison method is a comparatively easy method to evaluate

unlike jobs. One can use the same scale for appraising laboratory
technician, X-ray technician, pharmacist, physiotherapist, staff nurse,
medical record technician, accountant and executive jobs because this
method does not employ specific scales for job measurement as does the
point method. Instead, one job is compared with another. There are four
steps to the factor comparison method.
The first step is the selection of certain factors common to all the jobs
involved. It is assumed that a factor may differ in the degree to which it is
important from one job to the other. The second step is the selection of
certain key jobs which appear to be properly rated at present in terms of
relative status and pay status as compared to other jobs. Enough key jobs
should be selected to provide some guidance from the bottom to the top of
the total list under consideration. The third step is the arrangement of
key jobs on the basis of each of the factors previously chosen. A rank
should then be assigned to these key jobs for each of the other factors to
be used. When this step is complete, a scale of key jobs will be completed
based on which all other jobs can be ranked on each of the factors to be
considered. The fourth step is the comparison of all other jobs with the
key jobs and the assignment of a degree to each of them under each factor
used and the consideration of these ranks in establishing an overall
evaluation of each job as compared to all others.
! !199
There are five standard factors in the construction of the factor comparison
method. The first factor is mental effort which includes intelligence,
general education, specialised information, creativity, etc. The second
factor is skill which is required in operating machines in X-ray, laboratory,
physiotherapy departments. The third factor is the physical requirement
of a job such as standing during an operation for operation-theatre nurse,
lifting patients for nursing orderly, etc. The fourth factor is responsibility for
hospital property, money and negotiating contracts on behalf of the
hospital. The fifth and last factor is working conditions, such as
congestion, humidity, accident hazards, noise and radiation.
This method is more reliable than the ranking and classification methods. A
change in general employment or economic conditions may affect some
jobs more than others which will necessitate the re-evaluation of all
positions.
D. Point systems.
The point systems have the widest application. They have been used for
both clerical and manual skill positions. A number of factors, each
considered to be pertinent to success on the jobs are selected for study. It
involves the following steps:
i. Under the point systems, a few jobs are selected by the point
decision of job analyst and the department head. These jobs should
be representative of the various levels of employment found in the
department.
ii. A temporary organisation chart for the department should be

prepared. This should show the organisational pattern as it actually
exists. Only those lines of relationship which actually function should
be included. The chart will help in determining the relationships
between positions.
iii. Once agreement has been reached upon key jobs, it is possible to
proceed with evaluation of the other jobs in the department. The job
analyst should bear in mind the following points:
a. The job under consideration is to be compared with similar jobs

in other departments.
! !200
b. The job, and not the worker in the job, is under study. It is
essential that the requirements considered relate to those which
will assure the necessary job productivity. The fact that the
worker on the job has abilities in excess of the job requirements
does not mean that the job can be given a higher assignment of
points.
When the job analyst completes his study, the assigned points can be
reviewed by a committee consisting of the department head, human
resource manger and the thief executive. Their decision should be
considered final. This programme must be looked upon as a guide to the
development of the wage and salary structure.
iv. Classifying the jobs into groups that possess similar characteristics
should establish a wage level for each group. In many cases no
significant differences can be established between two or more
classifications. Then the various classifications can be grouped into
grades. The number of grades will vary depending upon the
dissimilarity of the job classifications considered. If all the job
classifications in a hospital of 100 beds are evaluated, they can be
arranged into 10 to 20 grades. Decisions concerning the number of
grades to be established should be governed by the following
considerations:
a. There should be enough grades to avoid placing job classifications

into the same grade when the evaluation process has shown their
different values.
b. The number of grades should be sufficiently small to avoid minor
differentials in grades which may lead to minor differences in pay
rates.
c. There should be a minimum overlap between the pay rate for two
adjacent rates.
d. A defensible basis for establishing differentials should be

established and applied to all the grades used. It is usually
assumed that the difference between the minimum rates for
successive grades will increase as the grades ascend. This may be
done by adding a fixed percentage to the base rate of the
preceding grade in order to determine the base rate for the next
grade. This percentage can be between 5 and 15 per cent to avoid
excessive overlapping.
! !201
• If the ranking or classification or factor-comparison method of evaluation

has been used job classifications should be assigned grades on the basis
of their relative positions. If the point systems has been used, a
numerical point should be determined for each job classification which
will serve as a guide to grouping classifications into grades. The
establishing of grades and the assignment of a salary range to each
grade Sire numerous considerations beyond the evaluation of jobs by
classification and the mathematical computation of setting up a
defensible grading system. These often include the following.
1. The prevailing rates in the region where the hospital is situated
2. Custom within the hospital as evidenced by existing wage and

salary levels
3. Assignment of higher responsibility to a particular job in the

interest of the hospital
4. Raising the salary level in a given position to attract prospective

candidates.
• The programme must be looked upon as a long-term guide to the

development of the wage and salary structure.
• Each of the above, four job-evaluation methods, has its own advantages
and disadvantages which should be weighed by the hospital. The
objective, regardless of the method adopted, should be to develop a
logical relationship among jobs to be used as the basis for a salary and
wage schedule, because good compensation plans have a salutary effect
on the entire organisation. In the absence of such plans, pay scales for
each category of jobs are determined subjectively on the basis of
haphazard and arbitrary decisions. This creates unrest in the organisation
resulting in low morale of its personnel. Therefore, compensation plans
should keep a balance between the needs of the organisation and those
of its personnel.
C. Job assignment
After a satisfactory salary and wage structure has been developed, it

should be applied to the individuals employed by the hospital. Assigning
! !202
each hospital employee to his job, appraising his performance and

compensating him involve:
1. Procedures for recruitment, selection and induction
2. Procedures for transferring, promoting and separating employees
3. Setting standards of performance and the evaluation of the

performance of each employee
4. Establishing a salary range for each job and paying each employee
according to this range is possible through the process of merit
rating because it is easy to compare the performance of any given
person in a job with all other in the same grade. This comparison
will indicate the approximate position with the salary range which
should determine the compensation for the individual employee.
Fig 8.2 Wage and salary Distinction
! !203
• These functions are all carried on in all hospitals. Some of them are
carried out to some degree every day. There is a possibility that their
importance may be overlooked and their relationship to the salary and
wage administration programme forgotten because they are such familiar
parts of the hospital operation. The following points are intended to bring
out the importance of such matters in developing a complete plan for the
administration of salaries.
• Unfortunately, it is not easy to assign the salary range for a given

employee. When introducing a system, the existing rate must be
considered. Length of service must be taken into account. There may be
other matters which influence the decision. Ideally, merit ratings should
be the major factor in determining the salary paid to an employee within
the grade to which his position has been assigned. The new employee in
a classification will ordinarily be started at or near the bottom of the
range, unless his training and experience justify a higher rate.
D. Developing compensation procedures.
The development of the hospital's compensating methods and procedures

requires a decision as to what payment methods the hospital should adopt.
The nature of work in hospitals is such that employees have commonly
been paid only on a monthly basis. This situation has largely eliminated the
possibility of using incentive wage plans for hospital employees.
• Compensation includes all benefits given to the employees in cash as well

as in kind. It is, therefore, important for the hospital to adopt a well-
defined and uniform policy. Items to be considered include: (a) basic pay,
(b) dearness allowance; (c) house rent allowance; (d) city compensatory
allowance; (e) uniform allowance; (f) mess allowance; (g) night
allowance; (h) provident fund; (i) gratuity; (j) free medical care; (k)
casual leave; (1) festival leave; (m) sick leave; (n) annual leave; (o) any
other benefit given by the hospital, such as overtime, etc.
• These are all a part of the wage and salary cost of the institution and
must be considered in arriving at total compensation. There has been a
marked growth in cash as well as non-cash compensation during the past
several years, affecting the salary budget of the hospital. Non-cash items
should be converted into their cash equivalent and the employees should
be informed of the value of these items. It is doubtful whether the
! !204
average employee places as great a value upon non-cash items as he

does on hard cash. The hospital will probably be in a better bargaining
position if it pays the maximum proportion of its compensation package
in cash and the minimum in non-cash items.
• A clear understanding must be reached with each employee, preferably

before his joining, concerning the total compensation which he will
receive in cash as well as in kind. This objective can be implemented
through the use of the employees' handbook which can be distributed to
the employees.
• The mode of disbursement of salaries to employees differs from hospital

to hospital.Some hospitals pay in cash through their cashier on a working
day during working hours; others by crediting in the bank accounts of all
the employees.
• In most of the hospitals, the length of the pay period is usually a month.
Definite procedure must be established and followed for several
functions:
i. Putting the employee on the payroll. When a new employee joins, a

copy of his appointment letter with a copy of his joining report should
go to the accounts department. Similarly, when there is a change in
salary of any employee onaccount of his promotion. a copy of the letter
indicating this change must be given to the accounts department.
ii. Reporting absence for salaried employees. This should be done for
each absence and an indication as to whether the time lost is to be: (a)
deducted from the employee’s salary; or charged to (b) casual leave;
(c) festival leave; (d) sick leave; (e) annual leave; (0 maternity leave;
(g) study leave; (h) administrative leave; or (i) any other source should
be sent to the accounts office before the salary clerk starts preparing
salary bills.
iii. Reporting changes in salaries. This can be done by informing the

accounts department in writing. The change in salary may be due to:
(a) increase in dearness allowance; (b) release of annual increments;
and (c) any other reason.
! !205
iv. Removing an employee from the payroll. The human resource

manager should communicate the effective date and reason of
termination to the employee in writing and a copy of this should be sent
to the accounts department immediately, to avoid any excess payment
being made.
Copies of each document with this information as well as other data having
to do with the compensation of the employee should also be filed in the
employee's personal file.
8.4 PAYMENT OF WAGES ACT 1936
• Countries like India have a plenty of labor laws at the central level as
well as at the state levels. Some of the central laws which have a bearing
on employee remuneration are the Payment of Wages Act, 1936; the
Minimum Wages Act, 1948; the Payment of Bonus Act. 1965; Equal
Remuneration Act, 1976; and the Payment of Gratuity Act,1972.
• The Payment of Wages Act was passed to regulate payment of wages to

certain classes of persons employed in the industry. It also seeks to
protect workers against irregularities in payment of wages and
unauthorised deductions by the employers. In addition, the Act ensures
payment of wages in a particular form and at regular intervals.
• The Minimum Wages Act enables the central and the state governments
to fix minimum rates of wages payable to employees in sweated
industries. The Payment of Bonus Act provides for payment of a specified
rate of bonus to employees in certain establishments. The Gratuity Act
provides for payment of gratuity to employees after they attain
superannuation. The Equal Remuneration Act provides for payment of
equal remuneration to men and women workers for same or similar
work. The Act stipulated stringent punishments for contravention of its
provisions.
• The payment of Wages Act, 1936, has imposed a number of obligations

on employers. Basically, the management has obligations regarding the
payment of wages and salaries to its employees:
1. The management must fix a time to pay wages and salaries.
! !206
2. This period must not be longer than one month.
3. The management must pay within seven days of the wage period if
the number of employees is less than 1,000. In case the number of
employees is more than 1,000 wages must be paid within 10 days of
the wage period.
4. The payment should be made on the working day and within working
hours.
5. The payment should be made in cash or be cheque if the employee

consents to it.
6. The payment should be made in full without any deductions except

those authorised by law.
• The following deductions can be made under the Payment of Wages Act,
1936:
1. Fines
2. For absence from duty
3. For damage or loss of goods
4. For house accommodation
5. For amenities and services provided
6. For the recovery of advances and adjustment of overpayments
7. For the recovery of loans taken from provident fund, or from thrift
and credit society
8. For income tax
9. By order of the Court
10.For life insurance scheme
8.5 SUMMARY
Compensation and benefits are two significant human resources (HR)

activities. All employees expect their compensation to be fair and expect
HR to collect information related to compensation in a regular and
systematic manner. Managers should be familiar with compensation scales
for their employees. Exchanging pay scale information with professional
colleagues in different organisations is essentially illegal.
! !207
1. Describe the role of human resource department in compensation in

hospitals.
2. How do you differentiate between wage and salary?
3. How does Payment of Wages Act regulate compensation in healthcare

organisations?
! !208
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !209
WORKING CONDITIONS IN HOSPITALS
Chapter 9
Working Conditions in Hospitals
Objectives:
After reading this chapter, you will be able to:
• Working conditions in Hospitals

• Safety issues/ risks in hospitals
• Welfare Policy in Hospitals
Structure:
9.1 Working Conditions in Hospitals

9.2 Safety
9.3 Welfare
9.4 Summary
! !210
9.1 WORKING CONDITIONS IN HOSPITALS
• The necessity of good working conditions in hospitals cannot be over-

emphasized. Hospital employees are exposed to various diseases as they
have to work with patients. Providing good working conditions in
hospitals will go a long way in improving the efficiency of the hospital
employees, which in turn will improve the level of patient care. The
environment in hospitals should be made as congenial as possible by
providing good lightning using bright colors to lend cheer to the
appearance of buildings, controlling the temperature, providing proper
ventilation and hygienic conditions. In office buildings and wards, high
physical standards can be ensured by providing good furniture,
equipment and proper maintenance of the workplace.
• The control of noise is another important consideration in improving

working conditions. It is all the more necessary for the well-being of the
patients. The prevention of noise depends largely on the proper
maintenance of all movable equipment such as doors, ward screens,
trolleys, coolers, oxygen cylinders, kitchen equipment, wheel-chairs,
stretchers, etc. in the hospitals. Continuous education and periodic
reminders to employees about noise control are necessary to control
noise.
• Some jobs in hospitals have the problem of monotony and boredom

associated with repetitive work being performed. A careful selection in
the first place of the right type of employees for such work is the best
safeguard. Ideally, they should be trained to perform several different
tasks so that they can easily adjust to alternate jobs from time to time.
• The anatomical aspect is very essential in hospitals. An obvious example

is teaching a light-weight nurse how to lift heavy patients. Time and
motion studies can help to evolve easier methods of work by devising
mechanical aids to make heavy jobs easier.
• Working hours and shifts should be regularised in such a way so that the
maximum work may be taken from the employees without causing
fatigue and endangering their health. The aim of the hospital authorities
should be to make the physical environment at work as congenial as
possible.
! !211
• Ergonomic studies are becoming more and more relevant with the
introduction of highly sophisticated instruments in hospitals. Design
engineers of these instruments have to take human limitations into
account and consult departmental supervisors and managers for their
advice to know that causes strain to the users.
Dr. K G. Desai in his book Human Problems in Indian Industries states:
'I believe that our workers are capable of doing the work at a much higher
level of efficiency but our managements have failed to create the
conditions whereby we get the best out of our workers. I believe that it is
the responsibility of the management to create conditions so that the
workers would give their best to the organisations.’
If the hospital authorities take note of the following points, they can
certainly get the best out of their employees and the statement of Dr.
Desai can be proved true.
• The physical surroundings in which employees do their jobs must be as

pleasant and comfortable as the circumstances of the work permit.
• Adequate welfare services such as housing, transport, canteen, fair-

price shop, counselling, etc. should be provided.
• The number of working hours should be restricted to 48 in a week, so

that basic social needs at home and in the community can be taken
care of.
• Security of employment in all respects must be provided by the

hospital authorities.
• The employees' safety and their health should be ensured.
• Policy and procedures dealing with most of these topics are not covered
by the provisions of the Factories Act, 1948, the Shops and
Establishment Act, 1954, the Payment of Wages Act, 1936, the
Employees State Insurance Act, 1948, the Workmen Compensation Act,
1923, the Minimum Wages Act, 1948, and the Industrial Employment
Standing Orders Act, 1946, as these Acts are not wholly applicable to
hospitals. Some of the states in India have covered hospitals under the
Minimum Wages Act, 1948. The Act empowers the government to fix the
! !212
minimum rates of wages and overtime for employees. It also provides for
the review of wages at intervals not exceeding 5 years. It is unfortunate
that none of these Acts, except the Minimum Wages Act, 1948, is fully
applicable to hospitals and it is entirely upto the hospital authorities to
provide all the security and conditions which have been provided in these
Acts. Recently some of the states have included hospitals under the
Shops and Establishments Act, 1954.
• India is an underdeveloped country. Through its Five Year Plans, it has

aimed at achieving rapid economic growth, price stability, industrial
peace, equitable distribution of income (including reduction in income
disparity), enlargement of employment opportunities and a progressive
raising of the standard of living of every Indian, especially the working
class. In the light of these goals, state regulations of wages and security
measures have become the principal characteristic of Indian wage policy
and social security. Our government in the post-independence period has
always felt the need for the protection of large segments of the working
population. This particular segment of the population is either living at
the subsistence level or is working in the unorganised sectors. It has
been realised that the wages of these workers cannot be left to be
determined on the basis of market forces of supply and demand in the
labour market. It is the realisation which found expression in Article 43 of
the Constitution which enjoins on the government the responsibility to
secure for all employees a living wage and good conditions for work
resulting in a decent standard of living.
• Administrators are generally concerned about working conditions of

medical, par-medical and clerical employees; but there is one more
category of employees consisting of skilled, semi-skilled and unskilled
employees. They hardly pay attention to the working conditions of the
last category of employees, who also work in hospitals, day and night.
They also deserve to be provided good working conditions, as are
provided to doctors, nurses, etc., like clean, comfortably cooled, light and
airy workplaces where physical fatigue is minimised. An alert supervisor
can often relate observations of employees' behaviour and the
sentiments they express about physical conditions of work, such as heat,
noise, temperature, humidity, odour, posture required to do the job,
working hours, rest interval, etc. The supervisor can make slight
modifications by changing the length of the cycle, by providing the
opportunity for social relationships and so on.
! !213
• Good working conditions keep employees cheerful and thus contribute

towards greater efficiency. They also have a psychological impact on
employees, considerably influencing their attitudes towards their job.
Thus it has been alleged that as much as 30 per cent of all absence from
work is caused by illness stemming from anxiety neurosis which develop
as a reaction to the type and conditions of work. This is the essence of
the practice of occupational medicine-how far a patient's condition can be
attributed to his or her work.
9.2 SAFETY
Safety provisions in hospitals have not received due attention, perhaps,

because the rate of accidents in hospitals is negligible. However, it is
important to introduce a system of accident prevention rather than make
safety provisions compulsory for hospitals because at any given time there
is a large number of people inside the hospital and thus the number at risk
in case of an accident is higher. Also, hospital inmates are less capable of
looking after themselves in case of accident than others are.
The hospital situation involves three groups of people: (a) hospital

employees, (b) patients, and (c) visitors.
The natural resentment by any of the three groups of people towards

restrictions and checks imposed to enforce safety must be dealt with
tactfully. The best approach is to point out that the restrictions are for the
protection of the individual as well as the institutions. It is essential that
restrictions be complied with strictly. It has often been pointed out that
accidents do not just happen, they are caused. Therefore, they can be
prevented.
A. Causes of accidents:
Accidents may be caused by one or more of the following factors
1. Fatigue
2. Disturbed mental state
3. Faulty building and equipment
4. Poor lighting
5. Unsafe practices associated with the job
6. Lack of concentration on work in hand
! !214
7. Poor discipline among employees

8. Lack of rigid and continuous safety inspection
9. Lack of training of supervisors in the basic principles of safety
10.Retention of accident-prone employees
11.Employment of retired persons in whom signs of infirmities have
become evident
12.Failure to keep a record of accidents and to eliminate their causes.
In the early 1980s, employees at the Idaho State School and Hospital
(ISSH) made up a disproportionate percentage of workers’ compensation
claims. Although the employees comprised of only 5% of the state
workforce, they were responsible for 20% of the state insurance costs.
From 1980 to 1986, workers’ compensation claims and medical
payments for ISSH habilitation therapists totaled nearly $1.6 million.
When further studies showed that in most organisations, 10% of the
workforce accounts for 90% of medically related absences, finding a way
to reduce the number of injured employees at ISSH became paramount.
An in - depth analysis included reviews of training manuals and job
descriptions; day-to-day observation of the employees; interviews and
panel discussions, and a job questionnaire covering all aspects of the
employment situation. The analysis revealed that the physically
demanding nature of the job was a prime reason for the large number of
injuries. The results yielded that the best employees were well adjusted,
conscientious, empathic and mindful of their physical limitations with
regard to the physical demands of the job. “There are so many different
ways that people can have accidents within a healthcare facility,” says
Ross. “You need compliant people who are trainable, who know how to
do these tasks without getting hurt or putting other people at risk.”
• Factories Act- As far as factories are concerned, the Factories Act has
laid down detailed safety requirements for fencing all moving parts and
prime movers, especially dangerous machines, hoists, revolving
machinery, etc. In addition, it has laid down restrictions on the
employment of young persons on certain machines, but no such law is
applicable to hospitals. In such circumstances, the hospital management,
on its own, should be concerned with providing safety measures to its
employees at work. It should be the duty of the Security Officer or the
! !215
Human Resource Manager to see that the provisions in this regard are
properly observed. Compliance with such provisions is likely to check
accidents and promote good employer-employee relations resulting in
greater employee efficiency, higher morale and loyalty.
• Training- Civil defence needs have led us to realise that disasters may
come without warning. Employees must be trained how to behave in the
event of those disasters. There should be a manual of instructions which
should be used as a basis for the training of the employees. This manual
should cover the duties of the personnel not only in the case of fire but
also in the event of a large-scale disaster either in the hospital or in the
community. Planned fire drills may be organised at frequent intervals.
These should be scheduled at varying hours in order to include all
personnel and to train employees for all emergencies under both the
ideal and the most difficult conditions. This work can be assigned to a
safety committee which will work in an advisory capacity to the hospital
fire official who can probably be the security officer or human resource
manager. This committee should maintain close liaison with the local fire
department Officials of the fire department can study the actual situation
and assess from personal observation the needs and hazards of the
situation.
• Mental State- It has been found that a common cause of accident is a

disturbed mental state. It may be caused by a personal problem. While
investigating accidents, it is not enough to simply classify an act as
carelessness. The investigator must search for the cause of the
carelessness. It may not be of much help to the injured employee to
know the cause of the accident, but it can serve as a warning and a
guide to supervisors. The supervisor can remove the fear of a new
employee, can give a worried employee a chance to relieve himself or
move the man to a place where he may be required to perform light
jobs.
! !216
Four significant reasons explain why the most skilled employees

may lack proper
safety skills, all related to the long hours many healthcare
workers face:
✴ OVERWORKED AND OVERTIRED EMPLOYEES – Working

long shifts makes employees prone to mistakes.
✴ POOR HANDOFFS AND TRANSITIONS – A lack of

communication between shifts, units, and/or hospitals
compromises the safety of the patient.
✴ HIGH TURNOVER RATE – To keep up with a high turnover

rate, some newer employees may be rushed into their
positions without having been properly trained in safety skills.
✴ HIGH BURNOUT RATE – Because of the stress and hours

associated with their positions, many healthcare employees
don’t stay at the same job for a significant length of time.
A recent study published in The Journal of the American Medical

Association showed that lack of sleep for physicians leads to
issues with patient safety. The study found an increased rate of
complications for surgical procedures performed by physicians
with less than six hours of sleep following an overnight shift. ( The
study found no significant increase in complication rates for
attending physicians.)Handoffs and transitions from one unit to
the next are also problematic. In fact, in the AHRQ Hospital
Survey on Patient Safety Culture 2010, handoffs and transitions a
cross hospital units and during shift changes had the lowest
average percent positive response, with only 44 percent of those
surveyed agreeing that their organisation did a good job in this
area.
!
Requisites of a good safety programme. A careful analysis of

successful safety programmes in different institutions indicates that for the
best results, the programme should include the following points:
i. Personal involvement of top management in safety programmes.

The safety of the employees is an important responsibility and unless
top management accepts that responsibility and becomes actively
interested in the reduction of accidents, there is Sale little chance of
success of the safety programme. When the medical director or hospital
! !217
administrator makes a round of the hospital, he should talk about safety

matters as well as the concerned jobs of the department. If he comes
across any case of carelessness, he should immediately bring the matter
to the attention of the concerned supervisor.
ii. Assign responsibility of implementing safety programme to one
official only. The responsibility of carrying out the safety programme
should be assigned to one person only. He could be the human resource
manager, security officer or maintenance engineer. If the hospital cannot
afford to engage a full-time safety officer, this work can be assigned to
any one person as suggested. The feasibility of employing one officer
exclusively for the safety programme will depend upon the size of the
hospital. Therefore, it is up to the hospital authorities to decide this
issue 45
iii. Safety committee. There should be a safety committee to ensure the

following functions:
a. to demand from the hospital the maintenance of safe working

conditions;
b. to formulate a manual of instructions;
c. to conduct fire drills;
d. to review all accident reports and make recommendations for the
prevention of future accidents;
e. to train employees in safety maintenance; and
f. to inspect fire extinguishers/water hydrants.
iv. Fire-safety training films. A large number of fire-safety films for

training supervisors and employees are available from the National
Safety Council. It is a good practice to show the films to the supervisors
in advance and ask their advice as to what points should be stressed in
a talk given during or after the film show.
The aim of any safety programme should be to ensure built-in safety. It
should be seen that employees take reasonable care while at work to avoid
injuries, not only to themselves but also to others. The willing co-operation
of all employees should be obtained in meeting statutory requirements in
letter and spirit. Similarly, the hospital authorities must ensure the safety
of the employees at work by providing safe systems of work, good working
conditions and safe premises, and also by ensuring adequate training,
instructions and supervision. In accident prevention, as in every other
! !218
sphere of hospital human resource management, the active co-operation of

each and every employee is essential.
9.3 WELFARE
Any sincere attempt to give real service to patients can bear fruit, only if
the employees are given the right type of work environment and are
provided with those basic amenities of life which have direct bearing on
their efficiency. Employee-welfare plans should form an integral part of the
overall scheme for raising efficiency of the employees. Simply stated,
welfare services are concerned with the improvement of working conditions
and environment at the workplace. Some of the facilities and services
which come within the purview of welfare plans and schemes are canteens,
recreation rooms, rest rooms, transport, etc.
A) Principles of a Good Welfare Policy
Employee benefits and welfare services should be provided with good

intention and in all sincerity. Employees very often feel that management is
providing these welfare services with ulterior motives, i.e. to escape its
responsibility for providing better working conditions, and that such
amenities provided unilaterally, could be withdrawn at any time without
breach of agreement. Therefore, welfare policy must be based on sound
principles.
1. Management should never intrude into the private lives of

employees through welfare schemes.
2. Amenities should be provided only when desired by employees. The

sincerity of this desire should be judged by their willingness to
administer the activities.
3. The amenities provided should be beneficial to both management

and employees in the long run.
B) Amenities to be provided under welfare schemes.
Administration of welfare facilities varies enormously from organisation to

organisation, as also the extent to which the hospital human resource
department directly involves itself in the administration of welfare services.
Broadly speaking, however, the following services and amenities are
normally considered to be within the ambit of welfare plans:
! !219
i. Accommodation. 
 
All hospitals, whether big or small, should provide accommodation to
their employees. Those employees who are unmarried may be
accommodated in hostels and those who are married should be provided
staff quarters. As far as possible, housing facility should be provided on
the hospital campus because the hospitals work round the clock. This
facility helps the employees considerably in attending to their duties at
odd hours. Those employees who are required to attend their duty in
the day shift only should be assisted in finding accommodation in
nearby colonies. The human resource department can help in many
ways; for example, by maintaining lists of property dealers who provide
to-let services, by maintaining contact with working-girls hostels and
agencies dealing with advancing loans for building houses. The more
smoothly this facility can be provided, the more favourable will be the
impression on new recruits. However, the provision of such assistance
needs the most careful control, especially as regards the legal position
of employees who leave the hospital but continue to occupy hospital
accommodation or accommodation occupied through hospital assistance
in the nearby colonies.
ii. Serving of food during working hour  

 
Hospital authorities should provide catering facilities for employees-both
resident and nonresident.It encourages team-spirit and fosters economy
as well. To provide better food and to decide upon the menu to be
served, it is advisable to form food-service committee to help the food
service manager with constructive suggestions.
iii. Transport service  

 
The problem of transport from the employee's home to the hospital and
vice versa can be eased by providing hospital transport or by
maintaining dose contact with the local transport authorities.
Arrangements can also be made by hiring buses from private transport
companies. If the hospital is situated at a far-off ? place. the employees
may be given conveyance allowance or transport costs may be
subsidised
! !220
iv. Counselling service 

 
Each and every one of us has personal problems. These problems cause
inefficiency in job performance, particularly in hospitals where the
employees deal with physically or mentallyill patients. Their supervisors
should be able to spot symptoms of personal problems and be willing to
offer assistance, whether tliE is asked for or not by referring to the
counsellor.
v. Festivals 
 
Festivals are all about celebrations and an opportunity to spend quality
time with the family members. But hospitals cannot afford to give
festival off to all their employees on the festival day as they work round
the clock and throughout tbe year. However, hospital authorities know
that their employees miss being with dreir family on such occasions. So,
they bring the festival to the hospital with the help lfightecl lamps, floral
decoration, ballons, colourful wall hangings, and a lot of fun. Some
festivals like Diwali among Hindus, X-mas among Christians, Eid among
Muslims, Guru Parv among Sikhs and Budha Purnima among Buddhists
are occasions for exchanging sweets and gifts among friends and
relatives but in hospital where people from diverse background come
together to celebrate the festival of each other, it is an opportunity to
enhance team building and team spirit.
vi. Sports and social activities 

 
The Indian Factories Act, 1948, makes it obligatory for a factory to
provide certain welfare activities, but there is no such Act for hospitals.
The extent to which the hospital authorities should not lag behind in
providing recreational and welfare facilities to their employees. Such
facilities provided by the hospital make the employees loyal to the
institution and increases their efficiency. The extent to which
management should organize and finance sports and social activities
( for employees depends upon many factors such as financial resources
of the management and resident or non-resident status of the
employees. If the employees express a 4 genuine desire for sports and
social activities, the hospital authorities should come 4 forward to
finance these activities. However, the hospital authorities must plan and
supervise lunch-hour recreation. The right type of rest rooms and
! !221
recreation facilities are provided will certainly improve the efficiency of

the employees. 
 
Advantages- Recreation facilities have the following advantages:
• he employees' efficiency is constantly improved

• The employees' identification with the organisation increases
• Staff turnover and absenteeism rates decline
• They promote understanding among the employees and also between
employees and management
• They help iron out anti-hospital attitudes of employees.
vii.Crèche 
 
Female employees work in majority in hospitals. They take extra leave
when their infant is not well. This hampers the services of hospitals.
Extended maternity leave policy beyond the statutory three months or
part-time working option 1 does not solve their problem. Providing a
crèche on-campus by the management can 1 be a big facility for them.
On-campus creche is a godsend facility for today's nuclear families since
parents are then in a position to prioritise their needs and give special 1
attention to their kids. Unlike private creches, the advantage of
hospitals running, crèche is that grievances, if any, can easily be
resolved by the hospital management and mothers of the crèche going
children can visit them during their tea and lunch breaks. Hence female
employee's interests are highly respected. It is up to them management
to provide a balanced and nutritional diet at the crèche. This creche4
facility can certainly reduce absenteeism among female employees since
they can not only visit their ailing children but can show them also to a
paediatrician during duty hours.
• Hogan Assessment Systems, a global personality assessment provider

that has studied unsafe work behaviour for more than 30 years, offers
five best practices to help improve safety within healthcare organisations.
1) RAISE AWARENESS AND CREATE A CULTURE OF SAFETY - In a

healthcare organisation, administrators, medical staff and non-medical
personnel must understand the role of a safety culture and how it plays
into patient safety.
! !222
2) UNDERSTAND THE IMPORTANCE OF COMPLIANCE VS. COMMITMENT -

Healthcare employees must feel that their organisation supports a
culture of patient safety and that mistakes can be reported without fear
of reprisal.
3) REALISE SAFETY AND PATIENT CARE ARE NOT MUTUALLY EXCLUSIVE-

If employees are focused on safety, patient care will improve.
4) A C K N O W L E D G E T E C H N I C A L L Y S K I L L E D E M P L O Y E E S A R E N ' T
NECESSARILY SAFE EMPLOYEES - The jobs of most healthcare
employees involve more than just skills and qualifications. Even the best
can make mistakes if the situation isn't right.
5) RECOGNISE SAFETY AND REVENUE ARE RELATED - A healthcare

organisation that does not emphasise safety can incur steep financial
penalties and lose customers, caregivers and ultimately, the company
itself.
9.4 SUMMARY
It is unfortunate that the working conditions in India are poor compared to

those in western countries. In the West, multifunctional mechanical
instruments are used for lifting, conveying, depositing and storing raw or
finished material. The use of such machines increases the efficiency of the
workers, helps them do monotonous jobs cheerfully. Also, the workers do
not fall sick again and again. In India, where the climate is warm and
process of lifting, conveying and depositing material is done mostly
through manual labour, the provision and maintenance of proper working
conditions become very important. Also, the provision of drinking water,
canteen, toilets, etc. needs much improvement. Very few hospitals
maintain these in adequate number and in good condition. No doubt, it
needs the co-operation of employees to maintain these amenities.
! !223
1. Discuss "safety of workers in hospital is as important as safety of

patients.
2. What can be done for the welfare of the employees in a hospital?
! !224
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !225
PERFORMANCE APPRAISAL:TECHNIQUES & PRACTICES
Chapter 10
Performance Appraisal:Techniques &
Practices
Objectives:
• The need and purpose of performance appraisal in a hospital setting

• How performance appraisal is conducted?
• Components of performance appraisal like self appraisal, team appraisal
etc.
Structure:
10.1 Meaning of Performance Appraisal

10.2 Purpose of Performance Appraisal
10.3 Process of Performance Appraisal
10.4 Self Appraisal
10.5 Team Appraisal
10.6 Appraisal Interview
10.7 Techniques of Performance Appraisal
10.8 Advantages and Limitations
10.9 Summary
10.10 Self Assessment
! !226
10.1. MEANING OF PERFORMANCE APPRAISAL
• Performance appraisal is a structured event. It involves a periodic

examination of performance to ascertain how well a particular employee
is performing relative to what is expected. Performance appraisal is
based on two documents, a position or job description and a performance
appraisal form. A permanent record is usually created and retained in an
employee's personnel file.
• Different organisations may use different names for the performance

appraisal process.The more common titles are performance evaluation,
performance review and performance assessment. A newer term is
performance management. Performance management purports to
encompass not only evaluation but also the overall development and
improvement of an employee as a producer. When completed correctly,
however, performance appraisals include everything that performance
management claims to include.
• According to Edwin Flippo, "Performance Appraisal is the systematic,

periodic and impartial rating of an employee's excellence, in matters
pertaining to his present job and his potential for a better job."
• According to Dale Beach, "Performance Appraisal is the systematic

evaluation of the individual with regards to his or her performance on
the job and his potential for development."
• How do we manage performance within the organisation? The most

common part of the process, and the one with which we are most
familiar, is the process of the performance appraisal, or evaluation. In
this chapter, we will use the phrases performance evaluation,
performance appraisal, and appraisal interchangeably. However, the
performance appraisal process is not the only thing that's done in
performance management.
• Performance management is the process of identifying, measuring,

managing, and developing the performance of the human resources in
an organisation. Basically we are trying to figure out how well employees
perform and then to ultimately improve that performance level. When
used correctly, performance management is a systematic analysis and
measurement of worker performance (including communication of that
! !227
assessment to the individual) that we use to improve performance over

time.
• Performance appraisal, on the other hand, is the ongoing process of

evaluating employee performance. Performance appraisals are reviews
of employee performance over time3, so appraisal is just one piece of
performance management. Although we will spend most of this chapter
discussing performance appraisal, there are several other significant
pieces of performance management that we already covered in past
chapters and will cover in future chapters. We discussed "strategic
planning," which provides inputs into what we want to evaluate in our
performance management system.
10.2. PURPOSE OF PERFORMANCE APPRAISAL
Performance appraisal is used to facilitate improvement in employee

performance, provide formal or official feedback to employees concerning
their job performance and collect information for decisions concerning
compensation and other personnel transactions such as promotions and
transfers.
The primary purpose of an appraisal is to improve employee performance

in the present job. A secondary purpose is to maintain the performance at
an acceptable level. The process contributes to two developmental
objectives for an employee. It delineates an employee’s progress toward
advancement and assuming greater responsibilities.It helps senior
managers to identify employees who are capable of advancement.
Performance appraisals periodically remind employees about what their
employers expect from them.
From the perspective of individual employees, performance appraisals

should enable them to know how they are performing. It also helps them
to know what is needed to improve their performance.
Performance appraisal in health care is mandated by organisations and

agencies that accredit and regulate healthcare facilities. In some instances,
mandated evaluation has led to the development of performance appraisal
systems that are little more than a formality. Such evaluation systems
have minimal value. 
! !228
PURPOSE OF PERFORMANCE APPRAISAL
• Identify employees who are eligible for salary increase.
• Generate data to take personal decisions such as promotion,transfer

and lay-off or termination decision.
• Determine the training and development needs of the employees.
• Validate the selection process
• To measure whether standard laid down has been achieved by the

employees or not.
• Estimate the future requirement of work force.
• Helps to recognise potential of promising employees.
• Last but not the least, performance appraisal also helps in motivating
employees by providing feedback about their level of performance.
• The Five Key Elements of a Performance Appraisal:
1) Measurement: Assessing performance against agreed targets and

objectives.
2) Feedback: Providing information to the individual on their performance

and progress.
3) Positive Reinforcement: Emphasising what has been done well and

making only constructive criticism about what might be improved.
4) Exchange of Views: A frank exchange of views about what has

happened, how appraisees can improve their performance, the support
they need from their managers to achieve this and their aspirations for
their future career .
5) Agreement: Jointly coming to an understanding by all parties about

what needs to be done to improve performance generally and overcome
any issues raised in the course of the discussion.
! !229
When to do Appraisal:
Many hospitals do not appraise their employees annually. They give annual
increment to all the employees without appraising them because they are
of the opinion that annual increment is the birth right of every employee.
So, what is the use of wasting valuable time in appraising them? Thus,
annual increment is added in the salary of each and every employee
provided he has completed one year of service in the month of January
every year.
Those hospitals where appraisal of the employee is done, they do it either

in the month of January or in the month of April every year. It depends
upon their financial depending upon their financial year.
Accurate Performance Measures
Performance should be accurately measured so employees will know where

they can improve. Knowing where to improve should lead to training
employees to develop new skills to improve. To be an accurate measure of
performance, our measure must be valid and reliable, acceptable and
feasible, specific, and based on the mission and objectives.
1) Valid and reliable- As with all areas of our people management

process, we must make sure that all of our performance management
tools are valid and reliable. If our method of measurement is not valid
and reliable, then it makes no sense to use it. When a measure has
validity, it is a factual measure that measures the process that you
wanted to measure. A reliable measure is consistent; it works in
generally the same way each time we use it.
2) Acceptable and feasible- In addition to validity and reliability, we

need to look at a couple of other characteristics of our performance
measures. We need to analyze acceptability and feasibility. Acceptability
means that the use of the measure is satisfactory or appropriate to the
people who must use it. However, in performance appraisal, this isn't
enough. Acceptability must include whether or not the evaluation tool is
feasible. Is it possible to reasonably apply the evaluation tool in a
particular case? As an example, if the performance evaluation form is
two or three pages long and covers the major aspects of the job that is
being evaluated, and both managers and employees believe that the
! !230
form truly evaluates performance measures that identify success in the

job, then they are likely to feel that the tool is acceptable and feasible.
If, however, the manager must fill out a 25-page form that has very
little to do with the job being evaluated, the manager may not feel that
the form is acceptable or feasible, at least partially due to its length,
even if the employee does.
3) Specific- Next, we want any evaluation measure to be specific enough

to identify what is going well and what is not. The word specific means
that something is explicitly identified, or defined well enough that all
involved understand the issue completely. In performance appraisal,
specific means that the form provides enough information for everyone
to understand what level of performance has been achieved by a
particular employee within a well-identified job.
4) Based on the mission and objectives- Finally, you want to make

sure that your performance management system leads to
accomplishment of your organisational mission and objectives. As with
everything else we do in HR, we need to ensure that the performance
management process guides our employees toward achievement of the
company's mission and objectives over time. As managers in the
organisation, making sure of this connection will allow us to reinforce
employee behaviours that aim at achieving organisational goals and to
identify for our employees things that they may be doing that actively or
unintentionally harm our ability to reach those goals.Thus, stating
specific objectives of exactly what each person in each job should
achieve or his or her performance outcomes leads to accurate
assessment that can increase performance.
Components of Performance Appraisal:
There are a number of reasons for performance appraisal of employees

such as counselling, promotion, training, or a combination of them. While
doing the performance appraisal, the appraiser should address the
question in respect of the five w's viz. who, what, why, when, where, as
also the how of performance appraisal. These five w's will not only help the
appraiser but the appraise as well.
! !231
10. 3 PROCESS OF PERFORMANCE APPRAISAL

• Performance appraisal is a process of various human resource functions.
It begins with the job analysis, job description and job specification.
These help in establishing the standard performance. The standard set
for performance must be clearly defined and unambiguous. It should be
attainable by the average employees. Figure 10.1 shows the various
steps involved in employee performance appraisal.
• The next step in the process is to communicate the set standards of

performance to the employees. The feedback should also be taken to
eliminate any confusion or misunderstanding. The feedback assures the
management that the information has reached the employees.
• Now the step in order is to measure the actual performance. It can be

affected through personal observation, and written and oral reports from
the supervisors.
• The next step is to compare the actual performance with the set
standards. Deviations, if any, from the standards are noted and
discussed with the employee. Weaknesses are also discussed so that the
employee takes interest in improving his performance.
! !232
• The last step in the process is to initiate corrective action to improve the
performance of the employee. Before this, the reason for low
performance should be probed by taking the employee into confidence.
He should be motivated for better performance. Counselling and training
can do the magic to a great extent.
10.4 SELF APPRAISAL
• Self-appraisal can be a productive component of a performance appraisal

system. However, self-appraisal is not appropriate for everyone. Some
employees are intimidated by it. Others are apprehensive, fearing the
possible consequences of rating themselves too high or too low. Self-
appraisal is most appropriate for higher-level technical employees,
professionals, supervisors, and managers. While self appraisal has the
potential for success, many hourly employees are suspicious of the
process and management's intent when using it
• While some people rate themselves higher or lower than may be

appropriate, research has repeatedly shown that the majority of
employees Idle themselves no higher, and frequently lower, than their
supervisors rate i hem. When it is used, an employee should complete a
self-appraisal while a manager completes an evaluation. These tasks
should be completed separately. Neither appraisal should bias the other.
• The forms should be similar and should address the same major job
description criteria. The forms should be exchanged for the first time
during an appraisal interview. The items on both appraisals should be
compared one at a time. Both participants should note items on which
they appreciably differ. Areas of divergence highlight an important aspect
of self-appraisal and focus discussion where it is most likely to be
needed.
• Self-appraisal is not appropriate for every situation. However, when

appraising employees who are required to exercise some degree of
independent discretion and judgment, self-appraisal can be a
constructive adjunct to a performance appraisal system. Self-appraisal
draws employees more deeply into the appraisal process and transforms
it into more of a participative activity. 
! !233
10. 5 TEAM APPRAISAL
• Organisations have been assembling and using teams during recent

decades. While team building is useful for organisations, it must be
periodically evaluated. Teams present evaluation challenges to managers.
Individual evaluations rendered in a team environment can be
troublesome because they tend to undermine teamwork and cooperation
by stressing individual competitiveness. They can encourage competitive
individuals to circumvent team requirements for individual gain and to
fail to nurture an open, problem-solving environment. Individual
performance appraisals do not support team-building because they lack a
means of identifying the effects of individuals on the group or the group
on individuals. Individual appraisals can impede effective team building.
• Teams can be appraised as groups. However, a glaring weakness is the

inevitable differences that exist among individuals. People always
perform in different ways. A properly managed team should be able to
use the different strengths of all its members. Likewise, it should be clear
to groups who function well that a team is no place for either single stars
or individual slackers.
• As with individual performance appraisals, team evaluations require

criteria and standards. These must be constructed specifically in terms of
team performance. In many organisations, group or team appraisals
supplement rather than replace individual performance appraisals. Thus,
although the emphasis on groups and team performance continues to
increase, most reward and recognition systems are focused on this
reinforces the need to appraise both team and individual performances.
10.6 APPRAISAL INTERVIEW
• Most performance appraisal systems stipulate that each employee

receive a personal interview. An appraisal interview is a requirement; a
manager's appraisals are not considered complete until all employees
have had an opportunity to discuss their appraisals in detail. Managers
should be certain that each appraisal interview occurs on time. Few
events of a work-place can raise apprehensions and uncertainties faster
than appraisal interviews that are late.
! !234
• Managers should schedule sufficient time for the meeting. Although an

appraisal interview may seem routine to a manager, it is one of the most
important annual events for many employees, so it should never seem
rushed. Privacy and freedom from interruptions are important
considerations. Employees should have several days of advance notice so
that they can be prepared.
• If the review involves objectives as well as ratings, then supervisors

should review the objectives before the interview and be prepared to
discuss them. Managers should come to the interview with ideas or
suggestions concerning objectives for the next cycle. If improvement or
correction is needed, managers-and employees should agree on
appropriate steps to achieve both.
• As with any other kind of interview from a manager's perspective, the

most important parts of an appraisal interview occur while the evaluator
is listening, not speaking. Whenever delivering praise or criticism, man-
agers should be certain to address specifics. Generalisations are not use-
(and should be avoided in any element of an appraisal. Before concluding
an interview, supervisors should ask their employees to sign the
appraisal form to acknowledge receipt. This does not indicate agreement
with the findings or conclusions. If an employee declines to sign the
form, this should be noted before the form is filed. Be sure to supply
signed copies of all evaluation documents to employees.
• Employees occasionally report to more than one supervisor. This occurs

with overlapping shift assignments or split-shift responsibilities of man-
agers. When this occurs, the primary input must come from the manager
who provides the most direct supervision. This is supplemented with
input from other involved supervisors. The manager who provides the
majority of direct supervision should be the one who conducts the
appraisal interview.
• Neither the written performance appraisal nor the appraisal interview

should contain surprises loran employee. Employees should have a good
idea of their standing with their manager at all times. It is a manager's
responsibility to ensure that this is the case. 
! !235
Figure 10.1 Performance Appraisal Process
! !236
MODEL POLICY AND PROCEDURE: PERFORMANCE APPRAISAL
It is the policy of the Hospital to provide a formal performance appraisal for

each employee at least once each year. The purposes of the appraisal
program are to:
• Maintain or improve performance in the job an employee presently holds

• Assist in employee development by providing learning and growth
opportunities for those wishing to advance
• Assist the Hospital in identifying individuals with advancement potential.
Performance appraisal applies to designated employees as follows:
1. Newly hired employees:
• The first appraisal will occur at the end of the initial three (3) month
probationary period.
• The second appraisal will occur three (3) months following the
probationary appraisal.
• The following appraisal will occur six (6) months later, or on

approximately the employee’s first anniversary of employment.
2. Employees promoted or transferred:
• The initial appraisal conducted in an employee's new position will occur

at either three (3) months or six (6) months, depending on the
learning period established for the particular position.
• Following successful completion of the learning period, the employee

will revert to the normal appraisal scheduled per 3, below.
3. All employees:
• Once having successfully completed the first year of employment or the

learning period following promotion or transfer, all employees will be
subject to appraisal on approximately the anniversary of their
employment.
! !237
General Provisions of the Performance Appraisal Program:
• Appraisals in addition to those indicated in the foregoing may be

instituted by the department manager when either a significant
deterioration or a marked improvement in performance is evident.
• Regular communication with employees concerning performance is

essential. Continuing positive communication can assist in motivating and
reinforcing outstanding performance, which is the objective of the
appraisal process. Regular communication may also call attention to
specific needs for improvement in performance and immediately
addressing areas of need will help prevent them from emerging as major
problems at formal appraisal time.
• An appropriate performance appraisal should:
1. Provide an employee with guidance in growing and developing as a

performer
2. Provide a manager with a means for personalising management

guidance to individual employees
3. Provide an employee with direction consistent with that appropriate

fur pursuing the objectives of the department and organisation
4. Provide a manager with a moans to assess an employee's

performance and place a value on the effectiveness of this
performance
5. Result in a more effective work force, as individuals tend to perform

more appropriately when they know what is expected of them arid
they are able to gauge their performance against periodic
measurement.
The following procedure applies to the performance appraisal process:
1. Approximately 30 days in advance of an employee's scheduled appraisal

date, human resources will send the department man-ager an appraisal
form for the employee with the heading ino formation completed.
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2. The employee's job description provides the basis for the appraisal.
Before attempting the appraisal, a manager should as-certain that the
job description is complete and accurate. If necessary, the job
description should be updated at this time, before the appraisal is
begun.
3. In addressing the appraisal, for exempt (salaried) professional,

technical, and supervisory employees the manager should assess
performance primarily against the actual accomplishment of duties and
responsibilities as delineated in the lob description. Nonexempt (hourly)
employees should be assessed primarily on the timely and accurate
completion of assigned duties.
4. As appropriate, and provided that plans and objectives were delineated

when the previous appraisal was discussed, consideration should also be
given to employee growth and development and improvements in
performance that might have occurred since the previous appraisal.
5. Objective, quantifiable measures of performance should be applied

whenever possible. For example the Hospital's standards for attendance
and punctuality may be applied, as may the output standards available
in some departments. For duties for which no objectives measure of
performance is available managers should be able to reasonably
describe normal expectation and indicate why, in their judgment the
employee did or did not meet or exceed the expectation.
6. Once completed, each appraisal must be submitted for review and

approval by the next highest level of management
7. When higher management approval of an appraisal has been secured,

the manager may schedule the employee for an appraisal conference.
Every effort should be made to accomplish this conference no more than
five (5) working days before or after the employee's anniversary date.
8. The manager is urged to follow good interviewing practices in

conducting the appraisal conference by providing adequate time,
privacy, reasonable comfort and freedom from interruptions.
9. As appropriate (primarily for technical, professional and supervisory

employees), the manager and employee will jointly determine goals,
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objectives, and development plans to be pursued during the period

preceding the next appraisal. As necessary, they should achieve
agreement on interim dates on which to examine progress between
appraisals.
10.As the completion of the appraisal conference, the employee should be

asked to sign the appraisal document to acknowledge having discussed
it and received a copy. If necessary the employee may be reminded that
signing the appraisal is simply acknowledgment and does not
necessarily mean agreement with all that it says. The employee may
add comments of disagreement or agreement in the appropriate space
on the appraisal form.
11.Should employees refuse to sign their appraisal, a manager should so

note the fact on the form: II; in the manager's judgment, the employee
is in strong disagreement with the appraisal and may appeal or take
ether action, the manager should two vintner party witness the refusal
to sign and so indicate on the form.
12.Following the conference the completed appraisal is distributed as

follows:
a. Original to Human Resources

b. Copy to employee
c. Copy retained by manager
10.7. TECHNIQUES OF PERFORMANCE APPRAISAL
The formal performance appraisal usually involves the use of a standard

form developed by the HR department to measure employee performance.
Again, "If you can't measure it, you can't manage it."20 But you must be
careful how you measure success, as the assessment should be as
objective as possible, not subjective.22 Employees need to know the
standards and understand what good performance looks like, and they
need to be able to measure their own performance. If you are stuck with a
form that has subjective sections, work with your employees to develop
clear accurate standards. There are some commonly used performance
appraisal measurement methods and forms and displayed on a continuum
based on their use in administrative evaluative and developmental
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decisions. In the following section, we discuss each of them, starting with

the developmental methods and working toward the evaluative.
Performance Appraisal Measurement Methods and Forms
1) CRITICAL INCIDENTS METHOD
The critical incidents method is a performance appraisal method in which

a manager keeps a written record of positive and negative performance
of employees throughout the performance period. There is no standard
form used, so it is a method.
Why and when do we use the critical incidents method?
Most formal reviews take place only once or twice a year. Do you want to
wait for formal reviews to talk to employees about what they are doing well
and when they are not performing up to expectations? Of course you want
to let them know how they are doing on an ongoing basis. Also, let's say
we are a manager with 12 employees. Can we remember everything each
of them did well, and when they messed up, and on what dates, so we can
evaluate their total performance for the past 6-12 months? Very few, if
any, of us can say yes. However, many managers don't keep a record of
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critical incidents, which leads to problems of accurate measures during the

formal review meeting. -2 Performance Appraisal Measurement Methods
Why and when do we use the critical incidents method?
Most formal reviews take place only once or twice a year. Do you want to
wait for formal reviews to talk to employees about what they are doing well
and when they are not performing up to expectations? Of course you want
to let them know how they are doing on an ongoing basis. Also, let's say
we are a manager with 12 employees. Can we remember everything each
of them did well, and when they messed up, and on what dates, so we can
evaluate their total performance for the past 6-12 months? Very few, if
any, of us can say yes. However, many managers don't keep a record of
critical incidents, which leads to problems of accurate measures during the
formal review meeting.
We use critical incidents to do a good assessment of the entire review

period, and we coach when needed during the entire review period for
developmental decisions. We need to continually conduct informal coaching
and disciplining when needed as we make notes of critical incidents to use
during the formal review. With clear standards and coaching, you can
minimize disagreements over performance during the formal performance
appraisal because there are no surprises, because employees know what is
coming.
Although critical incidents are commonly used for developmental decisions,

they are also used for evaluative decisions. For legal purposes, a list of
documented critical incidents is especially important to have leading up the
evaluative decision of firing employees.
How to use critical incidents?
Managers commonly simply have a file folder for each employee, which can
be hard copy or electronic. Critical incidents are important employee
actions, not minor ones, which help or hurt performance. Every time
employees do something very well, such as beat a tough deadline or save
angry customers from terminating their business relationship with the firm,
a note goes in the employees' file. Notes also go into the file every time
the employees’ behaviour hurts performance, such as coming to work late
or the quality of work not meeting standards.
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The note is usually written by the manager and/or is in the form of

documentation, such as a warning that is given, performance reports, or a
letter from a happy customer thanking the employee for doing a great job.
Coaching is part of this ongoing process, and it involves helping employees
succeed by monitoring performance through giving feedback to praise
progress and to redirect inappropriate behaviour as often as needed. One
error managers tend to make is to focus on the negative actions of
employees. Remember that a good balanced evaluation includes both
positive and negative, so look for good performance, not just poor, and
praise it when you see it.
2) MANAGEMENT BY OBJECTIVES (MBO) METHOD
The Management by Objectives (MBO) method is a process in which

managers and employees jointly set objectives for the employees,
periodically evaluate performance, and reward according to the results.
Although it is a three-step process, no standard form is used with MBO, so
it is a method. MBO is also referred to as work planning and review, goals
management, goals and controls, and management by results.
Why and when do we use the MBO method?
The MBO method is one of the best methods of developing employees. Like
critical incidents, employees get ongoing feedback on how they are doing,
usually at scheduled interval meetings. We can use the MBO method
successfully with our employees if we commit to the process and truly
involve employees rather than trying to make them believe that our
objectives are theirs-accurate measures.
On an organization-wide basis, MBO is not too commonly used as the sole

assessment method. It is more commonly used based on the evaluative
assessment during the development part of the performance appraisal.
One difficult part of MBO is that in many situations, most, if not all,
employees will have different goals, making MBO more difficult and time-
consuming than using a standard assessment form.
How do we use the MBO method? MBO is a three-step process:
Step 1: Set individual objectives and plans.

The manager sets objectives jointly with each individual employee. The
objectives are the heart of the MBO process and should be accurate
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measures of performance results. To be accurate, objectives should be

SMART. They need to be Specific, Measurable, Attainable, Relevant, and
Time-based. Being specific, measurable, and time-based is fairly easy to
determine in a written goal, but being attainable and relevant is more
difficult.
Step 2' Give feedback and evaluate performance.

Communication is the key factor in determining MBO's success or failure,
and employees should continually critique their own performance.28 Thus,
the manager and employee must communicate often to review progress.
The frequency of evaluations depends on the individual and the job
performed. However, most managers do not conduct enough review
sessions.
Step 3' Reward according to performance.

Employees' performance should be measured against their objectives.
Employees who meet their objectives should be rewarded through
recognition, praise, pay raises, promotions, and so on.30 Employees who
do not meet their goals, so long as the reason is not out of their control,
usually have rewards withheld and even punishment when necessary.
3) NARRATIVE METHOD OR FORM
The narrative method or form requires a manager to write a statement

about the employee's performance. There often is no actual standard form
used, but there can be a form, so narrative can be a method or a form.
Why and when do we use the narrative method or form?
A narrative gives managers the opportunity to give their evaluative

assessment in a written form that can go beyond a simple "check of a box"
to describe an assessment item. Managers can also write up a
developmental plan of how the employee will improve performance in the
future. Narratives can be used alone, but are often combined with another
method or form.Although the narrative is ongoing, it is commonly used
during the formal review. BARS.
How do we use the narrative method or form?

The system can vary. Managers may be allowed to write whatever they
want (method), or they may be required to answer questions with a
written narrative about the employee’s performance (form).
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The no-form narrative method can be the only assessment method used
during the formal review process. But the narrative method, when used
alone, is more commonly used with professionals and executives, not
operative employees. How we write the formal narrative assessment
varies, as writing content and styles are different. A narrative based on
critical incidents and MBO results is clearly the best basis for the written
assessment.
The narrative is also often used as part of a form. For example, you have
most likely seen an assessment form (such as a recommendation) that has
a list of items to be checked off. Following the checklist, the form may ask
one or more questions requiring a narrative written statement.
4) GRAPHIC RATING SCALE FORM
The graphic rating scale form is a performance appraisal checklist on

which a manager sim-ply rates performance on a continuum such as
excellent, good, average, fair, and poor. The continuum often includes a
numerical scale, for example from 1 (lowest performance level) to 5
(highest performance level).
Why and when do we use the graphic rating scale form?

Graphic rating scales are probably the most commonly used form during
the formal performance appraisal (primarily for evaluative decisions), but
they should lead to development decisions as well. Why the popularity?
Because graphic rating scales can be used for many different types of jobs,
they are a kind of "one form fits all" form that requires minimal time,
effort, cost, and training. If we walk into an office supply store, we can find
pads of them. But on the negative side, graphic rating scales are not very
accurate measures of performance because the selection of one rating over
another, such as an excellent versus good rating, is very subjective. For
example, think about professors and how they measure performance with
grades. Some give lots of work and few As, while others give less work and
almost all As.
How do we use the graphic rating scale form?

It is very simple, and we have most likely all used one. For example, many
colleges have student assessments of professors at the end of the course.
All we do is check off, or usually fill in a circle for, our rating. One problem
is that some of us don't bother to actually read the questions. Based on our
biases, some of us just go down the list checking the same rating
! !245
regardless of actual performance on the item. To be fair, this problem is not

common with managers formally evaluating their employees. However, it
does tend to occur when customers evaluate products and services,
including student assessments of professors.
To overcome this problem, which is unfortunately not commonly done, we

can reverse the scale from good to poor on different questions. Why isn't
this done all the time? Some HR, or other, managers who make the scales
do not know they should do this. Some who do know they should reverse
the scales don't because they don't want to end up with overall ratings
being pushed to the middle because people don't read the questions.
5) BEHAVIOURALLY ANCHORED RATING SCALE (BARS) FORM
The Behaviourally Anchored Rating Scale (BARS) form is a performance

appraisal that provides a description of each assessment along a
continuum. Like with rating scales, the con-tinuum often includes a
numerical scale from low to high.
Behaviourally anchored rating scales belong to a recently developed

method of performance appraisal. The exponents of this method claim that
it is a more reliable and advantageous method.
The method is designed to identify critical areas of performance of a job.

The evaluator is required to observe the behaviour of the employee while
performing the job and at the same time prepare the behaviourally
anchored rating scale to recognise the critical areas of effective and
ineffective performance behaviour. He then compares these behavioural
observations with the behaviourally anchored rating scales. Generally, the
following seven performance criteria have been established:
1. Knowledge and judgment

2. Human relation skills
3. Conscientiousness
4. Skill in operation
5. Organisational ability
6. Skill in monetary transactions
7. Observational ability.
This method is more valid and expected to give more reliable results as it
minimises the errors in performance appraisal.
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Why and when do we use the BARS form?

The answer to why and when is the same as for graphic rating scales. So
let's focus on the differences between graphic rating scale and BARS forms.
BARS forms overcome the problem of subjectivity by providing an actual
description of the performance for each rating along the continuum, rather
than one simple word (excellent, good, etc.) like graphic rating scales. A
description of each level of performance makes the assessment a more
objective accurate measure. So if BARS forms are more accurate, why
aren't they more commonly used than graphic rating scale forms?
It's partly economics and partly expertise. Again, the graphic rating scale
can be used for many different jobs, but BARS forms have to be
customised to every different type of job. And developing potentially
hundreds of different BARS forms takes a lot of time (which costs money)
and expertise. Even when a firm has an HR staff, the question becomes
whether developing BARS forms is the most effective use of staff members'
time. Obviously, it depends on the types of jobs being evaluated and the
resources available to complete the evaluation process.
How do we use BARS forms?

Like graphic rating scales, we simply select a level of performance along
the continuum. College accreditation associations are requiring more
measures of student outcomes as assurance of learning, and as part of the
process they want more BARS rubrics as evidence. So in college courses,
especially for written assignments, professors give out rubrics that describe
in some detail the difference between excellent (A), good (B), average (C),
poor (D), and not acceptable (F) grades for multiple criteria put together to
provide a final grade. Here is a very simple example of making a graphic
rating scale item into the more objective BARS form.
Attendance-excellent, good, average, fair, poor
Attendance-number of days missed 1, 2, 3-4, 5, 6 or more
6) RANKING METHOD
The ranking method is a performance appraisal method that is used to

evaluate employee performance from best to worst. There often is no
actual standard form used, and we don't always have to rank all
employees.
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Why and when do we use the ranking method?

Managers have to make evaluative decisions, such as who is the employee
of the month, who gets a raise or promotion, and who gets laid off. So
when we have to make evaluative decisions, we generally have to use
ranking. However, our ranking can, and when possible should, be based on
other methods and forms.
Ranking can also be used for developmental purposes by letting employees

know where they stand in comparison to their peers-they can be motivated
to improve performance. For example, when one of the authors passes
back exams, he places the grade distribution on the board. It does not in
any way affect the current grades-but it lets students know where they
stand, and he does it to motivate improvement.
How do we use the ranking method?

Under the ranking method, the manager compares an employee to other
similar employees, rather than to a standard measurement. An offshoot of
ranking is the forced distribution method, which is similar to grading on a
curve. Predetermined percentages of employees are placed in various
performance categories, for example, excellent, 5%; above average, 15%;
average, 60%; below average, 15%; and poor, 5%. The employees ranked
in the top group usually get the rewards (raise, bonus, promotion), those
not at the top tend to have the reward withheld, and those at the bottom
sometimes get punished. In Self-Assessment and Skill Builder 8-1, you are
asked to rank the performance of your peers.
While this section does not contain an exhaustive list, it provides examples
of each major method of performance appraisal. Determining the best
appraisal method or form to use depends on the objectives of the
organisation. A combination of the methods and forms is usually superior
to any one used by itself. For developmental objectives, the critical
incidents,MBO, and narrative methods work well. For administrative
decisions, a ranking method based on the evaluative methods and
especially graphic rating scale or BARS forms works
well.
Remember that the success of the performance appraisal process does not
just lie in the formal method or form used once or twice a year. It depends
on the manager's human relations skills in ongoing critical incidents
coaching, and on effective measures of performance that are accurate so
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that everyone knows why they are rated at a given level (evaluative), as
well as how to improve (develop) for the next assessment.
Activity A
Some management experts have recommended that performance appraisal

be abolished. Provide three reasons why performance appraisals should be
retained in modern healthcare organisations.
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Common Problems with the Performance Appraisal Process
Let's briefly discuss each of the common problems during the performance
appraisal process listed here.
I. BIAS. Bias is simply a personality-based tendency, either toward or

against something. In the case of performance assessment, bias is
toward or against an individual employee. All human beings have
biases, but supervisors especially cannot afford to allow their biases to
enter into their evaluation of subordinates in the firm. This is very easy
to say, but very difficult to do. Biases make the evaluation process
subjective rather than objective, and certainly provide the opportunity
for a lack of consistency in effect on different groups of employees. So
to overcome the bias problem, we need to be objective and not let our
feelings of liking or disliking the individual influence our assessment.
II. STEREOTYPING. Stereotyping is mentally classifying a person into an

affinity group, and then identifying the person as having the same
assumed characteristics as the group. Though stereotyping is almost
always assumed to be negative, there are many incidents of positive
stereotypes. However, regardless of whether the stereotype is positive
or negative, making membership in a group, rather than explicitly
identifying the characteristics of the individuals, creates the potential for
significant error in evaluations. So we can avoid stereotyping by getting
to know each employee as an individual and objectively evaluating
individual employees based on their actual performance.
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III.HALO ERROR. This error occurs when the evaluator has a generally
positive or negative (negative halo error is sometimes called "horns
error") impression of an individual, and the evaluator then artificially
extends that general impression to many individual categories of
performance to create an overall evaluation of the individual that is
either positive or negative.46 In other words, if employees are judged
by their supervisor to be generally "good" employees, and the
supervisor then evaluates each of the areas of their performance as
good, regardless of any behaviours or results to the contrary, the
supervisor is guilty of halo error. We can avoid halo error by
remembering that employees are often strong in some areas and
weaker in others, and we need to objectively evaluate individual
employees based on their actual performance for each and every item of
assessment.
IV. DISTRIBUTIONAL ERRORS. These errors occur in three forms:

severity or strictness, central tendency, and leniency. They are based on
a standard normal distribution, or the bell curve that we are all so
familiar with. In severity or strictness error, the rater evaluates
everyone, or nearly everyone, as below average. Central tendency error
occurs when raters evaluate everyone under their control as average-
nobody is either really good or really bad. Finally, leniency error occurs
when the rater evaluates all others as above average. Leniency error,
therefore, is basically a form of grade inflation. We can avoid
distributional errors by giving a range of evaluations. The distribution is
often based on the ranking method of evaluation and forced distribution.
V. SIMILARITY ERROR. This error occurs when raters evaluate

subordinates that they consider more similar to themselves as better
employees, and subordinates that they consider different from
themselves as poorer employees. We all have a tendency to feel more
comfortable with people who we feel are more similar to ourselves,47
and if we are not careful, we can allow this feeling of comfort with
similar individuals to be reflected in the performance appraisal process.
We can avoid similarity error by embracing diversity and objectively
evaluating individual employees based on their actual performance,
even if they are different from us and don't do things the same way that
we do.
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VI.PROXIMITY ERROR. This error states that similar marks may be given
to items that are near (proximate to) each other on the performance
appraisal form, regardless of differences in performance on those
measures. We can avoid proximity error by objectively evaluating
employees' actual performance on each and every item on the
assessment form.
VII.RECENCY ERROR. This error occurs when raters use only the last few
weeks or month of a rating period as evidence of their ratings of others.
For instance, if a warehouse worker has been a strong performer for
most of the appraisal period, but right before his annual evaluation he
knocks over a stack of high-cost electronic equipment while driving a
forklift, he may be rated poorly due to recency error. We can avoid the
recency error by evaluating the employee based on the entire
assessment period, commonly 6-12 months. Using the critical incidents
method really helps our recall and assessment of the entire period more
objectively.
VIII.CONTRAST ERROR. In contrast error, the rater compares and

contrasts performance between two employees, rather than using
absolute measures of performance to measure each employee. For
example, the rater may contrast a good performer with an outstanding
performer, and as a result of the significant contrast, the good
performer may seem to be "below average." This would be a contrast
error. We can avoid contrast error by objectively evaluating individual
employees based on their actual performance. We must use the ranking
method correctly; first we assess each individual based on the items on
the assessment form-then we rank the individuals based on their
assessments.
IX.ATTRIBUTION ERROR. In simplified terms, attribution is a process

where an individual assumes reasons or motivations (such as attitudes,
values, or beliefs) for an observed behaviour. So, attribution error in
performance appraisal might occur when the rater observes an
employee action-such as an argumentative answer to a question-and
assumes that the individual has a negative attitude toward the job and
is a poor performer. This may not be true, and in such a case the rater
would be guilty of an attribution error. We need to avoid attribution
error because it is based on our subjective conclusion. When in doubt,
we shouldn't assume we know why the employee did or didn't do
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something. We should talk to employees to find out so that we can

objectively evaluate employees based on their actual performance.
10.8 ADVANTAGES AND LIMITATIONS
The principal advantages of employee performance appraisal are:
1. It provides a regularly scheduled uniform system of reviewing the

employee’s performance and an opportunity for exchanging views about
each other, i.e. the department and the employee.
2. It gives evidence of management's interest in the individual employee.
3. It induces supervisors and department heads to think more seriously

and objectively about the performance of their employees.
4. It gives an opportunity to an employee to know his plus and minus

points and to improve his performance.
5. It provides an objective basis for many types of personnel decisions

including pay increase, training, promotion, etc.
6. Employee performance appraisal indicates whether the present job

makes full use of an employee's abilities and if any change is desirable
in his duties, what kind of training is required to improve his
performance.
10.9 SUMMARY
The importance of regular, structured employee appraisal cannot be over-

stated. Supervisors must be well-trained and diligent about completing
employee evaluations on time. Forms and procedures mist be current. The
personal interview that follows a written appraisal is often dreaded by
employees. Successful managers use the interview as a positive experience
to review and motivate their employees. Human resources supervises the
appraisal process and collects and files completed appraisal forms.
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10.10 SELF ASSESSMENT
1. Why do experts recommend that three to five point rating scales be

used for appraisals?
2. What is the primary shortcoming of team appraisal?
3. Which method would you use for the appraisal of doctors working in a
hospital and why?
Activity A
List down stages in the development of HRM.

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REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !254
INDUSTRIAL RELATIONS
Chapter 11
Industrial Relations
Objectives:
• Industrial Relations and its history in India

• Objectives of Industrial relations in hospitals
• Unions and their role in healthcare
• Settlement of disputes and Industrial Dispute Act
• Collective Bargaining and Conflict Management in healthcare
Structure:
11.1 Unions and their role

11.2 Settlement of disputes
11.3 Collective Bargaining
11.4 Industrial Dispute Act
11.5 Conflict Management
11.6 Summary
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Day to day operations of hospitals require human, technical and conceptual

skills, like any other organization. Hospital Administration is responsible
and accountable for its functioning to the owners of hospitals, employees,
patients, visitors and the public at large. Hospitals also enter into various
contractual obligations for employment, business activities and safety
operations. All these activities have to be in a prescribed manner and are
liable to legal scrutiny. Hospital is an industry and thus falls under the
purview of various acts related to maintenance of industrial relations.
Besides the Health Laws, other laws like Industrial Dispute Act 1947,
Maternity Benefits Act 1926, The Contract Labour (Regulation and
Abolition) Act 1970, The Trade Union Act 1926, Payment of Wages Act
1936, Minimum Wages Act 1948 etc are also applicable to hospitals.
The law relating to labor and employment in India is primarily known under
the broad category of "Industrial Law". Industrial law in this country is of
recent vintage and has developed in respect of the vastly increased
awakening of the workers of their rights, particularly after the advent of
Independence. Industrial relations embrace a complex of relationships
between the workers, employers and government, basically concerned with
the determination of the terms of employment and conditions of labor of
the workers. Escalating expectations of the workers, the hopes extended
by Welfare State, uncertainties caused by tremendous structural
developments in industry, the decline of authority, the waning attraction of
the work ethics and political activism in the industrial field, all seem to
have played some role.
INDUSTRIAL RELATIONS:
Industrial relations define relationships between employers and employees

toward each other in terms of supervision, direction, planning and
coordination of organisational activities, with minimal human effort and
functions; all this done with an enthusiastic spirit taking into consideration
the safety of all employees. Industrial relations may also be defined as
relations between employees and management. The concept of Industrial
relations has been defined using various terminologies, but in the strictest
sense, it is essentially the relationship between management and labor.
The full concept of industrial relations is the organisation and practice of
multi-pronged relationships between labor and management, unions and
labor, unions and management in an industry. Dale Yoder defines it as a
“whole field of relationships that exists because of the necessary
! !256
collaboration of men and women in the employment process of an

industry.”
A. EVOLUTION:
The evolution of industrial relations in India began a long time ago. The
caste system greatly influenced the ancient industries and their
development. Due to successive foreign invasions in India, the living
conditions of slave and artesian couldn't be differentiated. Furthermore,
under the autocratic regime of Muslim rulers, the conditions of employees
worsened. Wages were not guaranteed, the living conditions of workers
were harsh, and there was no proper management. The coming of the
British didn't improve the working conditions. After some time, however,
most Indian industries were modelled after the British system of business,
and this led to growth in various sectors.
I. Industrial Relations under British Rule: 

 
During British rule, India was expected to be a colonial market for
British goods up until a cotton mill was established in Mumbai in 1853
and a jute mill was established in Kolkatta in 1955. The working
conditions of workers, however, were still very harsh with low pay, and
this gave rise to various disputes involving the management and
employees. On the other hand, Tata Iron and Steel industry was also
established in Jamshedpur in 1911. While there was great demand of
iron and steel before and during the First World War, the working
conditions of workers hadn't improved. Hence, the Factories Act of
1881 was established, and it granted workers certain rights.
II.Industrial Relations in First World War: 

 
The First World War was an opportunity in disguise for local factories in
India. Prices of virtually all products went up and profits soared,
however, wages of lower employees were still the same. There were
various strikes and disputes between management and employees.
During this time, the Workmen's Compensation Act (1923), the Trade
Union Act (1926), and the Trade Disputes Act (1917) were established.
While the wages of employees remained the same, they were given a
certain share of profits made by their hiring industry. Strikes, however,
were sometimes prohibited under the Emergency Rules. The years
! !257
following World War II involved the most workers' upheaval, and saw
the establishment of Industrial Employment Act (1946) and Industrial
Disputes Act (1947).
III.Post-Independence Industrial Relations: 

 
The post-independence era saw a developing relation between industry
and labor. A conference called the Industrial Truce Resolution took
place in 1947, and foresaw the establishment of the Minimum Wages
Act, Factories Act, and Employees State Insurance Act in 1948. This
ensured peace between labor and industry. While industrial relations in
India have evolved a long way, some features of the early system still
exist today. Modern industrial relations are dynamic, and may
integrate industrial policies of American and British businesses.
B. ROLE:
Industrial relations are associated with labor, management, labor unions,

and the state. The scene of industrial relations has grown tremendously,
and cannot be represented merely by relations between management and
labor. It has become a comprehensive and total concept embracing the
sum total of relationship that exists at various levels of the organisational
structure. Additionally, it connotes relationships between workers
themselves within the labor class, and relations among the management
within the managerial class. In an open sense, industrial relations denote
all types of relations within a group and outside a group - both formal and
informal relations.
C. OBJECTIVES:
1. Protect management and labor interests by securing mutual relations

between the two groups.
2. Avoid disputes between management and labor, and create a

harmonising relationship between the groups so productivity can be
increased.
3. Ensure full employment and reduce absenteeism, hence, increasing

productivity and profits.
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4. Emphasize labor employer partnership to establish and maintain

industrial democracy. This is done to ensure the sharing of profit
gains, and personal developmental of all all employees.
5. P r ov i d e b e t t e r wa g e s a n d l i v i n g c o n d i t i o n s t o l a b o r, s o
misunderstandings between management and labor are reduced to a
minimum.
6. To bring about government control over plants where losses are

running high, or where products are produced in the public interest.
7. To bridge a gap between various public factions and reshape the

complex social relationships emerging out of technological advances
by controlling and disciplining members, and adjusting their conflicts
of interests.
11.1 UNIONS AND THEIR ROLE
Unions have considerable allure for workers who are dissatisfied with
aspects of their jobs. Employees join unions when they believe that their
personal situations will be improved. Employers usually resist unionisation
because they will have to share control over their workers. Interactions
with employees are governed by a contract, also known as a collective
bargaining agreement. Unions and managers are bound by law.
A. Reasons for Workers to Join Unions:
• When unions are organising or when they are striking or threatening to

strike, the public hears a great deal about monetary demands being
made of employees. While economic issues are important, insecurity is
usually a dominant factor in causing employees to seek union
representation. Mounting health care costs, layoffs resulting from
mergers and acquisitions, and fiscal belt-tightening all have caused many
workers to seek protection from a union because they perceive that their
job security is threatened.
• Many factors compel employees to seek affiliation with a union. Often,

senior managers make erroneous assumptions about their employees. A
common error is to assume that the main goal of employees is economic.
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Another error is to believe that employees are inherently lazy and must
be constantly supervised to get them to produce.
• If the basis of employee dissatisfaction is lack of trust, giving them more

money will not resolve the underlying problem. Insecurity and lack of
communications are significant drivers of employee unrest. Employees
want someone to listen to them. This need is strongest when conditions
are unsettled and they are threatened. If workers perceive that no one in
their organisation is willing to listen to them, they will turn elsewhere,
seeking persons that demonstrate a willingness to listen and promise to
help them.Union organisers are all too willing to be the ones who will
listen.
• Another classic error of top management is to assume that because they

hear few negative comments, everything is fine among the ranks of
employees. Information does not readily travel upward in an
organisational structure. Numerous organisational obstacles block the
upward flow of information. If relationships are weakened by distrust or
uncertainty, little of relevance will reach senior managers. Most senior
managers know little about what is on the minds of the people at the
bottom of the structure.
• Another mistake that top managers make is to assume that all first-line
supervisors and middle managers are, by virtue of their positions,
automatically on the side of management when a union beckons. Many
lower-level managers started as rank and file employees, and some of
them have never felt fully accepted by higher management. Senior
managers may not realise that they have ignored or mistreated their
supervisors and middle managers until they are threatened by
unionisation.
• Another significant error is to ignore lower levels of management when

union organising occurs. Top managers fear the possibility of supervisors
inadvertently committing unfair labor practices or making other legal
errors. However, first-line supervisors are in positions to provide the
strongest, most direct communication links between workers and higher
management. Union organising campaign depends upon on
communications. If first-line supervisors are isolated, then management
may be stifling its best communication channels.
! !260
• Economics are usually involved in union campaigns. However, if all other

factors are satisfactory, economics alone will promote interest in a union
only if the economic disparity is dramatic. Otherwise, employees may
seek unionisation if they feel insecure about their employment and their
future prospects. Major changes in organisational structure,
management, operating requirements, job content, and equipment
changes that are made without notice or explanation invite unionisation.
If significant changes in upper management alter the prevailing style of
organisational culture from being open to authoritarian or autocratic,
then unions often follow. When employees are given little or no
information about their organisation's financial status or its plans and key
decisions affecting jobs and careers are made in isolation, they often
seek help from unions. Ignoring employee dissatisfaction promotes
unionisation. If employees rarely receive feedback from management in
response to their questions, complaints or concerns, and the comments
they hear are negative, then they will seek unions that will listen to
them.
B. Reasons Organisations Avoid Unions?
• Management generally wants the organisation to remain union-free. A

primary reason is to preserve greater latitude in operations and
managing employees. When a union is in place, the terms of a contract
must be followed. Specifying procedures imposes limitations on many
management prerogatives and operational processes.
• Unions usually increase the costs of doing business and thus increase the
costs that must ultimately be borne by consumers. Increase in wages
and benefits gained through negotiations are not the only costs
attributable to union. The costs of paying for a labor counsel and
maintaining a labor relations department or staff can be considerable.
From the perspective of management, a union adds cost and effort to
running an organisation without providing many tangible or revenue-
producing benefits.
• A union can significantly realign communication relationships within an

organisation. Without a union, communications can flow directly between
managers and employees. With a union, some of that information must
flow through the union. This has the effect of interjecting a third party
into an existing two-party relationship. Additionally, unions often have
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their own agendas that are not consistent with an organisation’s goals.
Once established, a major objective of a union is remaining in place. A
union can remain and continue to collect its dues and assessments for a
long period only by providing value to its members (employees). One
way in which some unions attempt to establish value is by encouraging
distrust between employees and management. If relations between
employees and management are completely open, cordial and
satisfactory in all respects, then the union is not needed. From the
perspective of management, there-fore, a union is an extraneous
element that increases expenses and aggravation. Unions also make
operations more difficult because they are self perpetuating entities with
their own agendas.
• Management is often late in learning the value of positive labor relations.

Senior executives understood some basic truths only after a union has
become established. If employees are treated fairly, spoken to openly
and honestly, and provided with salaries and benefits that are
comparable to local competitors, then employees are unlikely to turn to a
union to seek equality.
C. THE DEPARTMENT MANAGER'S ROLE IN UNIONS
If a union is not present and there is no immediate prospect of one being

formed, most department managers will have little concern for them.
However, employees can seek union representation at any time. Supervisor
should have basic knowledge about how unions form and operate.
1. BEFORE UNION FORMATION: The most effective way to prevent

union organising is to create and maintain a work environment in
which employees do not feel that a union is needed. Such a work
environment includes caring managers who believe that satisfied
employees are the best producers, that thorough and open
communications are essential, and that one of the most important
attributes of supervisors is a willingness to listen to employees.
Astute department managers are aware of one fact organisational life
upon which every union organiser counts. If no one in an
organisational is listening to them, then employees will turn to
someone else that will listen.
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2. EARLY ORGANISING: Organising drives are costly for unions.

Unions deciding to organise the employees of a particular
organisation may undertake their activities without fanfare. Unions
commonly test their appeal and potential to organise by talking with
employees. They quietly estimate their chances of success before
becoming a visible presence. Unions sometimes plan to organise
employees in a particular geographic area. They may undertake
unionisation because a number of employees have asked the union to
do so. However, before seeking a representation election, a union will
still analyse a facility in an attempt to assess whether the overall
climate is favourable. First-line managers are the first line of defence
in union organising situations. They are in the best position to be the
eyes and ears of management before and during an organising
campaign. They are best positioned to serve as effective liaisons
between employees and upper management. In general, employees
typically view an entire organisation in a way similar to how they
view their own managers. If a supervisor, the member of
management that employees know personally, is seen as cold,
indifferent, or uncaring, this is how an entire organisation is likely to
be viewed.
For years, people who worked in healthcare thought that the health care
industry was invulnerable to recession or layoffs. These assumptions have
proven to be false. Financial pressures, mergers and other affiliations, and
the proliferation of health care systems have transformed health care from
an arena in which employment could be considered relatively secure to one
in which job security is as elusive as it is in other industries. When faced
with insecurity and uncertainty in an environment traditionally regarded to
be stable, some employees have turned toward labor unions.
CASE STUDY
Radhika Sharma was in a meeting with her supervisor, Mayank Rathi. "I
wanted to share some observations with you," said Radhika. She
continued, "Some of the employees in my section have become distant.
Over the past six months, they have had progressively less to say to me.”
"Do the employees have any problems that you're aware off?" asked
Mayank.
! !263
"No," came the reply, "but they've become jumpier since the hospital
merger rumours started.”
"I'll bet the two events are related," thought Mayank. He continued, "See
what you can find out. Try meeting with a couple of groups of employees.”
"Do you think the employees might be thinking about forming a union?"
asked Radhika.
"Maybe. That's one of the things that I want you to find out," replied
Mayank.
What advice would you offer to Radhika and Mayank? Does the possibility
of a union change your advice? Why?
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11.2 SETTLEMENT OF DISPUTES
The hospital is a place where a lot of human minds are at work to save the
lives of patients. Still they think in different ways. The clash of their
personal interests leads to disputes. It takes seconds for eruptions but
requires months and years to resolve them. Peace is important to provide
better services to patients in hospitals. It can be achieved through cordial
relations between the employees and the management. When the relations
between management and employees are not smooth, there is bound to be
a confrontation leading to industrial disputes. It may lead to gherao, strike,
demonstrations, boycott, etc. any kind of dispute leads to hampering
efficient service to the patients. Thus, it becomes necessary to resolve an
industrial dispute as early as possible.
A. FORMS OF DISPUTES:
Industrial disputes may take any form, like strike, lockout, gherao,
picketing and boycott. They may be violent at times, leading to loss of life
of employees and hospital property. Industrial disputes disturb the public
! !264
life instantly as the admitted patients are to be discharged and OPD and
emergency departments do not render service to those patients who report
there.
• Strike- Non-acceptance of employees' demand leads them to stop the

work and proceed on strike. It is the last resort and an important weapon
in the hands of the employees, which is used when all hopes of fulfilment
of their demand fail and there is no way left to the employee. Then only
they resort to strike to pressurise the management to accept their
demand. The recent strike by AIIMS resident doctors has opened
alternatives for fighting for justice. The fight for justice was well
described in the Vedic times. Mahatma Gandhi fought a long battle
against the British regime using the nonviolence concept of satyagraha.
• Gherao- Ghearo means to surround. The active members of the union

surround the chief executive officer of the hospital and do not allow him
to leave the place. They form a human chain restricting him to move. It
may take violent form also.
• Picketing- It is a method resorted to by the union leaders to attract the

attention of the common man to the fact that there exists a dispute
between the management and employees. Picketing is done to dissuade
employees from reporting to work by some union members at the gate of
the hospital.
• Boycott- Employee may boycott use of service of their hospital. They

may request the general public also to do so. This adversely affects the
reputation of the hospital.
• Lockout- Lockout is resorted to by the management of the hospital to

put pressure on employee. It is undertaken by the management to force
the employees to resume work on the terms and conditions of the
management. At times, it becomes a trial of strength between employers
and employees.
All forms of agitations whether strike, gherao, picketing, boycott and

lockout adversely affect not only the cordial relations of employers and
employees but also the services to patients. Employees and management
should settle disputes amicably without resorting to any of the above
stated forms of agitations. As far as possible, maximum care should be
! !265
taken to avoid the ugly situation. If employees of industrial proceed on any

kind of strike, they can compensate the loss once they resume work, but
employees of hospitals cannot. If a patient dies due to non-availability of
medical services during the strike period, he cannot be revived when the
strike is over. If he is dead, he is dead forever.
B. CAUSES OF DISPUTES:
There are many causes of industrial disputes. Some of them are

enumerated below:
• Salary - The steep rise in the prices of essential commodities to bring

down the value of money. Thus, it becomes very difficult for employees
to meet both ends meet. They get dissatisfied with the salary they get
from the hospital. This forces them to demand for higher salary.
• Retrenchment - If the management resorts to retrenchment of its

employees for any reason whatsoever, the union takes up the issues and
asks for reinstatement of its members. This is a solid reason for a
dispute.
• Working conditions and hours of work- In many hospitals, working

conditions are not congenial. The basic amenities like drinking water,
changing rooms, rest rooms, and lavatories are not available to the
employees. No safety provisions are made. Hours of work are long.
These small things lead to industrial disputes.
• Partial treatment by supervisors- Some supervisors are partial in

their treatment to their employees. They treat them partially by putting
them on night duty or on duty on holidays and Sundays.
• Absence of grievance procedures-The absence of grievance redressal

procedure leads to dissatisfaction and creates disputes.
Thus it is sensible for employers to ensure equitable treatment of

employees for some of the reasons mentioned above. Timely preventive
action by the management can save its reputation. Once employees resort
to any kind of agitation such as slow down, pen down, picketing,
demonstration, gherao, and strike, they are not likely to resume normal
working until and unless their demands are accepted. We strictly believe
! !266
the management should behave like a wise mother and should give
something to their employees from time to time without waiting for their
employees to come up with their demands.
11.3 COLLECTIVE BARGAINING
• An individual is free to bargain for himself and safeguard his own

interest. If an individual workman seeks employment, his prospective
employer, from his position of power, usually stands in better position to
dictate his own terms. The individual often has to accept even a very
poor offer when he is under pressure to feed his family. However the
position becomes different if a bargain is made a body or association of
workmen. They can negotiate and settle their terms with the employer
more effectively and secure better wages, better terms of employment
and greater security. The object of collective bargaining is to harmonise
labour relations and promote industrial peace by creating equality of
bargaining power between the labor and the management.
• Collective bargaining can exist only in an atmosphere of political

freedom. Any conditions of service, for example wages, hours of
employment, leave, gratuity, bonus, allowances and similar privileges can
be settled by consultation between the body of workmen and the
employer. Thus 'collective bargaining' is that arrangement whereby the
wages and conditions of employment of workmen are settled through a
bargain between the employer and the workmen collectively, whether
represented through their union or by some of them on behalf of all of
them.
• In the present day, collective bargaining has become a common feature

in all industries. 
 
Any agreement collectively arrived at is generally observed by both the
employers and workmen who are at a party to it. Though the trade union
movement in India has not been able to reach the standard which its
counterparts in other developed countries have, yet it has done much.
The object of any labour movement at all times is to ‘seek and ever-
rising standard of living, which means not only more money but more
leisure and a richer cultural life'. Collective bargaining is not a means of
seeking a voice in management. It is a method adopted by trade unions
to champion the cause of their members.
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Collective bargaining is defined as an agreement under which the

organisation of workers and employers collectively undertake to resolve
their existing or future differences with or without the assistance of a
third party.
A. PREREQUISITES OF COLLECTIVE BARGAINIONG:
There are six prerequisites to collective bargaining:
I. Existence if a truly representative and strong trade union

II. Existence of a progressive management
III.Absence of any external pressure either on the employer or on the
worker to come to the kind of agreement desired by the authority
exerting the pressure
IV. Existence of a measure of parity of strength or bargaining power

between the trade union and the management
V. Delegation of authority to an officer involved in negotiations
VI.Acceptance of a fact-finding approach by the management as well as
the union
B. NEGOTIATING A SETTLEMENT
Before the management proceeds to negotiate a settlement with the union,

it must analyze the basic factors and specific issues on which an agreement
must be reached to avoid a conflict in future. The next step should be to
draft a comprehensive document incorporating all the points such as:
a) Purpose and scope of the settlement

b) Rights and responsibilities of the management and the union
c) Issues settled
d) Interpretation clause and
e) Termination clause.
Both the groups involved in arriving at the settlement should consist of

persons who have job knowledge, negotiation skills and the full authority to
negotiate. During negotiation they must maintain continuity of the dialogue
and should not reach a deadlock. Negotiations will be easier if the
concerned parties develop a problem-solving attitude. At the same time,
! !268
they should remember that nothing must be said or done which, instead of
creating a congenial atmosphere, aggravated the situation. Careless words
may lead to a violent explosion which would take the situation out of
control.
C. FUNCTIONS OF COLLECTIVE BARGAINING
In the industrial world, collective bargaining serves a number of important

functions.
I. It is a rule-making or legislative process in the sense that it

formulates terms and conditions under which labour and management
will cooperate and work together over a certain stated period.
II. It is also a judicial process, for in every collective agreement there is

a provision or clause regarding the interpretation of the agreement
and how any difference of opinion about the intention or scope of a
particular clause is to be resolved. Such interpretation can be left to a
joint committee of worker's and management's representatives or to
the top level management or to a third party jointly selected by the
trade union and the management.
III.It is also an executive process, for both the management and the
trade unions undertake to implement the agreement signed, each
accepting a series of obligations under the agreement.
D. CHARACTERISTICS OF COLLECTIVE BARGAINING
I. It is a group action as opposed to individual action and is initiated

through the representatives of workers.
II. It is flexible and dynamic, and not fixed or static. It has fluidity and
ample scope for compromise, for a mutual give and take, before the
final agreement is reached or the final settlement is arrived at.
III.It is a two-party process. It is a mutual give and take rather than a

‘take-it-or-leave-it' method of arriving at the settlement of a dispute.
Both parties are involved in it.
! !269
IV. It is a continuous process which provides a mechanism for continuing

and organised relationships between management and trade unions.
V. It is dynamic and not static because it is relatively new concept, and

is growing, expanding and changing. In the past, it used to be
emotional, turbulent and sentimental; but it is scientific, factual and
systematic.
VI.It is industrial democracy at work; the government of labour with the

consent of the governed-the workers.
E. PRINCIPLES OF COLLECTIVE BARGAINING
Several management experts have put forth more or less similar principles
of collective bargaining:
For the management:
I. The management must develop and consistently follow a realistic

labour policy, which should be accepted and carried out be its
representatives.
II. The management must grant recognition to the trade union without
any reservations and accept it as a constructive force in the
organisation.
III.The management should not assume that employee goodwill will

always exist. It should periodically examine the rules and regulations
to determine the attitudes and degree of comfort of its employees and
gain their goodwill and co-operation.
IV. The management should extend fair treatment to the trade union in
order to make it a responsible and conservative body.
V. The management should not wait for the trade union to bring
employee grievances to its notice but should rather create the
conditions in which employees can approach the management
themselves, without involving the trade union.
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For the trade union:
I. In view of the rights granted to organised labour, the trade union

should eliminate racketeering and other undemocratic practices within
their own organisation.
II. Trade union leaders should appreciate the economic implications of

collective bargaining, for their demands are generally met from the
income and resources of the organisation in which their members are
employed.
III.Trade union leaders should not imagine that their only function is to
secure higher wages, shorter hours of work and better working
conditions for their members. They and their members have an
obligation to assist the management in the elimination of waste and in
improving the quality and quantity of production.
IV. Trade union leaders should assist in the removal of such restrictive
rules and regulations that are likely to increase costs and prices and
reduce the amount that can be paid out as wages.
V. Trade unions should resort to strikes only when all other methods of
the settlement of a dispute have failed.
For the union and management:
I. Collective Bargaining should be made an education as well as a

bargaining process. It should offer trade union leaders as opportunity
to present to the management the wants, desires, grievances and
attitudes of its employees and make it possible for the management
to explain to union leaders and through them, to its employees the
economic problems which it is confronted with.
II. The management and trade union must look upon collective
bargaining as a means of finding the best possible solution, and not
as a means of acquiring as much of finding the best possible solution,
and not as a means of acquiring as much as one can while conceding
the minimum. There must be an honest attempt at solving problems.
! !271
III.Both parties to a dispute should command the respect of each other

and should have enough bargaining power to enforce the terms of the
agreement that they may arrive at.
IV. There must be mutual confidence and good faith, and a desire to
make collective bargaining effective in practice.
V. There should be an honest, able and responsible leadership, for only

this kind of leadership will make collective bargaining effective and
meaningful.
VI.The two parties should meticulously observe and abide by all the
national and state laws which are applicable to collective bargaining.
VII.Both parties must bear in mind that fact that collective bargaining is,
in a sense, a form of price fixation and that the success of any
collective bargaining depends, in the final analysis, on whether the
management and the trade union do a good job of ensuring that the
price of labour is properly adjusted to other prices.
11.4 INDUSTRIAL DISPUTE ACT
A. INTRODUCTION:
The main purpose of the Industrial Disputes Act, 1947 is to ensure fair
terms between employers and employees, workmen and workmen as well
as workmen and employers. It helps not only in preventing disputes
between employers and employees but also help in finding the measures to
settle such disputes so that the production of the organisation is not
hampered. It is important to understand the different authorities and their
duties in the settlement of disputes.
The objective of the Industrial Disputes Act is to secure industrial peace

and harmony by providing machinery and procedure for the investigation
and settlement of industrial disputes by negotiations. This act deals with
the retrenchment process of the employees, procedure for layoff,
procedure and rules for strikes and lockouts of the company.
Industrial Disputes have adverse effects on industrial production, efficiency,

costs, quality, human satisfaction, discipline, technological and economic
! !272
progress and finally on the welfare of the society. A discontent labour force,
nursing in its heart mute grievances and resentments, cannot be efficient
and will not possess a high degree of industrial morale. Hence, the
Industrial Dispute Act of 1947, was passed as a preventive and curative
measure.
B. HISTORY:
The World War I (1914 -1919) brought a new awakening among the
working class people who were dominated by the employers regarding the
terms and conditions of service and wages. The workers resorted to strikes
to fulfill their demands and the employers retaliated by declaring lockouts.
During the period 1928-29 the numerous strikes and lock-outs forced the
Government to enact the Trade Disputes Act, 1929.
The Trade Dispute Act, 1929 was introduced for the settlement of industrial
disputes. This Trade Union Act gave the trade unions a legal status. The
main object of the Act was to make provision for the establishment of
Courts of Enquiry and Boards of Conciliation with a view to investigating
and settling trade disputes. But, this Act failed to create favourable
atmosphere in the industry and settle the disputes. The rule provide
speedy remedies for industrial disputes by compulsory reference of
disputes to conciliation or adjudication, by making the awards of
adjudicators legally binding on the parties, by prohibiting strikes and lock-
outs during the pendency of conciliation or arbitration proceeding.
With the termination of the Second World War, Rule 81-A was about to
lapse on 1st October, 1946, but it was kept alive by recourse to
Government's Emergency Powers. The main provision was retained in the
Industrial Disputes Act, 1947.
C. SCOPE AND OBJECT
The Industrial Dispute Act of 1947, came into force on the first day of April,
1947. Its aim is to protect the workmen against victimisation by the
employers and to ensure social justice to both employers and employees.
The unique object of the Act is to promote collective bargaining and to
maintain a peaceful atmosphere in industries by avoiding illegal strikes and
lock outs. The Act also provides for regulation of lay off and retrenchment.
The objective of the Industrial Disputes Act is to secure industrial peace
! !273
and harmony by providing machinery and procedure for the investigation

and settlement of industrial disputes by negotiations.
D. OBJECTIVES:
The Industrial Dispute Act of 1947 has been described as the latest
milestone in the industrial development in India. The Act has seen new
additions in the past few years. However, the principal objectives of the
Industrial Dispute Act of 1947 are:
1. To encourage good relations between labor and industries, and

provide a medium of settling disputes through adjudicator authorities.
2. To provide a committee for dispute settlement between industry and

labor with the right of representation by a registered trade union or
by an association of employers.
3. Prevent unauthorised strikes and lockouts.
4. Reach out to labor that has been laid-off, unrightfully dismissed, etc.
5. Provide labor the right to collective bargaining and promote

conciliation
E. DEFINITIONS:
1. Appropriate Government [Sec. 2(a)]: Appropriate Government

means the Central Government in relation to any industrial dispute
concerning any industry carried on by or under the authority of the
Central Government, any industry carried on by a Railway Company,
any controlled industry specified by the Central Government, The Unit
Trust of India. Corporations under the Central Statutes, Banking
company, Insurance company. Mines. Oil field, Cantonment board, Major
ports, etc. In relation to any other industrial dispute, the appropriate
Government is the State Government.
2. Award [Sec 2 (b)] means an interim or a final determination of any

industrial dispute or of any question relating thereto by any Labour
Court, Industrial Tribunal or National Industrial Tribunal and includes an
arbitration award made under section 10A;
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3. Industry [Sec. 2(j)]: Industry means any business, trade,

undertaking, manufacture or calling of employers and includes any
calling, service, employment, handicraft or industrial occupation or
avocation of workmen.
4. Industrial Dispute [Sec. 2(k)]: means any dispute or difference

between employers and employers, or between employers and
workmen, or between workmen and workmen, which is connected with
the employment or non-employment or the terms of employment or
with the conditions of labour, of any person.
F. FIRST SCHEDULE:
INDUSTRIES WHICH MAY BE DECLARED TO BE PUBLIC UTILITY SERVICES

UNDER SUB-CLAUSE (VI) OF CLAUSE (N) OF SECTION 2
1. Transport (other than railways) for the carriage of passengers or goods

by land or water.
2. Banking.
3. Cement.
4. Coal.
5. Cotton textiles.
6. Foodstuffs.
7. Iron and steel.
8. Defence establishments.
9. Service in hospitals and dispensaries.
10.Fire brigade service.
11.India Government Mints.
12.India Security Press.
13.Copper Mining.
14.Lead Mining.
15.Zinc Mining.
16.Iron Ore Mining.
17.Service in any oil field.
18.Omitted
19.Service in uranium industry.
20.Pyrites mining industry.
21.Security Paper Mill, Hoshangabad.
22.Services in Bank Note Press, Dewas.
23.Phosphorite mining.
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24.Magnesite Mining.
25.Currency Note Press.
26.Manufacture or production of mineral oil (crude oil), motor and aviation
spirit, diesel oil, kerosene oil, fuel oil, diverse hydrocarbon oils and their
blends including synthetic fuels, lubricating oils and the like.
27.Service in the International Airports Authority of India.
28.Industrial establishments manufacturing or producing Nuclear Fuel and
Components, Heavy Water and Allied Chemicals & Atomic Energy.
2(k)"industrial dispute"means any dispute or difference between

employers and employers,or between employers and workmen, or between
workmen and workmen, which is connected with the employment or non-
employment or the terms of employment or with the conditions of labour,
of any person;
Settlement [Sec. 2(p)]: Settlement means a settlement arrived at in the

course of conciliation proceeding and includes a written agreement
between an employer and a workman arrived at otherwise than in the
course of conciliation proceeding where such agreement has been signed
by the parties thereto in such manner as may be prescribed and a copy
thereof has been sent to an officer authorised by the Appropriate
Government and the Conciliation Officer.
Wages [Sec. 2(rr)]: Wages mean all remuneration capable of being

expressed in terms of money, which would, if the terms of employment,
express or implied were fulfilled, be payable to a workman in respect of his
employment or of the work done in such an employment and includes:
i. such allowances (including dearness allowance) as the workman is for

the time being entitled to;
ii. the value of any house accommodation, or of supply of light, water,
medical attendance or other amenity or of any service or of any
concessional supply of food grains or other articles;
iii. Any travelling concession. But the following are excluded:
a. Any bonus.
b. Any contribution paid or payable to any pension fund or provident
fund, or for the benefit of the workman under any law for the time
being in force.
c. Any gratuity payable on the termination of his service.
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2(n) "Public utility service" means -
i. any railway service or any transport service for the carriage of

passengers or goods by air;
a. any service in, or in connection with the working of, any major
port or dock;
ii. any section of an industrial establishment, on the working of which
the safety of the establishment or the workmen employed therein
depends;
iii. any postal, telegraph or telephone service;
iv. any industry which supplies power, light or water to the public;
v. any system of public conservancy or sanitation;
vi. any industry specified in the First Schedule which the appropriate
Government may, if satisfied that public emergency or public interest
so requires, by notification in the Official Gazette, declare to be a
public utility service for the purposes of this Act, for such period as
may be specified in the notification
G. PRINCIPLES:
The principles under the act are:
1. A permanent conciliation committee for the speedy settlement of

industrial disputes.
2. Compulsory arbitration in public utility services and enforcement of

arbitration awards.
3. Strikes during proceedings of conciliation and arbitration meetings are

prohibited.
4. Set aside specific times for conciliation and arbitration meetings.
5. Employers have to be obliged to communicate with labor unions.
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6. Mutual consultation has to be set up between industry and labor by

the Works Committee.
7. Disputes between labor and industry have to be forwarded to an

Industrial Tribunal. If the Industrial tribunal fails to handle the case,
the case should be forwarded to the appropriate government.
H. DISPUTE SETTLEMENT AUTHORITIES UNDER THE ACT:
The I.D. Act provides elaborate and effective machinery for the
investigation and amicable settlement of industrial disputes by setting up
the various authorities. These are:
a) Works Committee;
b) Conciliation Officer;
c) Conciliation Board;
d) Court of Enquiry;
e) Labour Court;
f) Industrial Tribunal;
g) National Tribunal;
Let us discuss these authorities in detail:
1) WORKS COMMITTEE (Section 3):
The works committee is a committee consisting of representatives of

employers and workmen (section3). The works committee is a forum for
explaining the difficulties of all the parties. The main objective of the works
committee is to solve the problems arising in the day-to-day working of a
concern and to secure industrial harmony. The function of the working
committee is to ascertain the grievances of the employees and to arrive at
some agreement. The committee is formed by general or special order by
the appropriate Government in an industrial establishment in which 100 or
more workmen are employed or have been employed on any day in the
preceding 12 months. It consists of the representatives of employers and
workmen engaged in the establishment. It shall be the duty of the working
committee to promote measures for securing and preserving amity and
good relations between the employers and workmen and, to that end, to
comment upon matters of their common interest or concern and to
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endeavor to compose any material difference of opinion in respect of such

matters and decision of the works committees are not binding.
2) CONCILIATION OFFICER (Section 4):
For promoting and settlement of industrial disputes the appropriate

Government may by notification in the Official Gazette, appoint such
number of conciliation officer as it thinks fit. The main objective of
appointing conciliation officer is to create congenial atmosphere within the
industry and reconcile the disputes of the workers and the employers. He
may be appointed for a specified area or for specified industries in a
specified area or for one or more specified industries and either
permanently or for a limited period.
The duty of the conciliation officer is not judicial but administrative. He has
to hold conciliation proceedings, investigate the disputes and do all such
things as he thinks fit for the purpose of inducing the parties to arrive at a
fair settlement of the disputes. The conciliation officer is entitled to enter
an establishment to which the dispute relates, after reasonable notice and
also to call for and inspect any document which he consider relevant. He
has to send a report and memorandum of settlement to appropriate
Government. The report by the conciliation officer has to be submitted
within 14 days of the commencement of the conciliation proceeding or
shorter period as may be prescribed by the appropriate Government. The
conciliation officer has the power to enter the premises as well can call for
and inspect documents.
3) BOARDS OF CONCILIATION (Section 5):
The appropriate Government may by notification in the Official Gazette,

constitute a Board of Conciliation for the settlement of industrial disputes.
The Board shall consist of a chairman and 2 or 4 other members in equal
numbers representing the parties to the disputes as the appropriate
Government thinks fit. The Chairman shall be an independent person. A
person is "independent" for the purpose of appointment to a Board, Court
or Tribunal if he is uncommitted with the dispute or with any industry
directly affected by such dispute. He may be a shareholder of a company
connected with or likely to be affected by such disputes. But in such a case
he must disclose to the Government the nature and intent of his share
[Section 2(i)]. Where the appropriate Government is of the opinion that
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any industrial disputes exist in an industry, it may refer by order in writing

to the Board of Conciliation for settling industrial disputes.
The Board of Conciliation has to bring about a settlement of the dispute.

He has to send a report and memorandum of settlement to appropriate
Government. He has to send a full report to the Appropriate Government
setting for the steps taken by the Board in case no settlement is arrived at.
The Board of Conciliation has to communicate the reasons to the parties if
no further reference is made. The Board has to submit its report within 2
months of the date on which the dispute was referred to it within the
period what the appropriate Government may think fit. The report of the
Board shall be in writing and shall be signed by all the members of the
Board.
4) COURT OF INQUIRY (Section 6):

constitute a court of inquiry into any matter appearing to be connected
with or relevant to settlement of industrial disputes having an independent
person or of such independent persons as the appropriate Government
may think fit. The court consists of two or more members one of whom
shall be appointed by the Chairman. Within a period of 6 months, the court
has to send a report thereon to the appropriate Government from the
commencement of its any inquiry. This period is not mandatory and it may
be extend. It has the same powers as are vested in a Civil Court under the
Code of Civil Procedure 1908, in the following mattersa.
a. enforcing the attendance of any person and examining him on oath,

b. compelling the production of documents and material objects,
c. issuing commissions for the examination of witnesses,
d. in respect of such other matters as may be prescribed.
The report of the Court must be signed by all the members. A member can
submit a note of dissent. The Report together with the dissenting note
must be published by the appropriate Government within 30 days from its
report. A court of enquiry has no power to improve any settlement upon
the parties.
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5) LABOUR COURT (Section 7):

constitute one or more labor court for adjudication of industrial disputes
relating to any matters specified in the Second Schedule. A labor court
consists of one person only to be appointed by the appropriate
Government. The main function of the labor court is to hold its proceedings
expeditiously and submit its award as the proceeding concludes.
A person shall be presiding officer of a labor court unlessa.
a. he is or has been, a Judge of the High court,
b. he has for a period of not less than three years, been a District Judge
or an Additional District Judge or
c. he has held any judicial office in India for not less than seven years;
or
d. he has been the presiding officer of a Labour Court constituted under

any provincial Act or State Act for not less than five years.
e. He must be an " independent" person and must not have attained the
age of 65 years.
6) LABOUR TRIBUNALS (Section 7- A):

constitute one or more Industrial Tribunals for adjudication of industrial
disputes. A Tribunal shall consist of one person to be appointed by the
appropriate Government. The Appropriate Government may appoint two
persons as assessors to advise the Tribunel. The person shall be not
qualified unlessa.
a. he is, a Judge of the High court,

b. he has for a period of not less than three years, been a District Judge
or an Additional District Judge.
c. The appropriate Government may, if it so thinks fit, may appoint two
persons as assessors to advise the Tribunal in the proceeding before
it.
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The functions of the Tribunals are very much like those of a body
discharging judicial functions, although it is not a Court. Its power is
different from that of a Civil Court. The proceedings before an Industrial
Tribunal are quasi-judicial in nature with all the attributes of a Court of
Justice. The Government is empowered under Section 7-A of the Act to
constitute for a limited time which comes to an end automatically on the
expiry of the said period for any particular case. The duties of Industrial
Tribunal are identical with the duties of Labour Court, i.e. on reference of
any industrial disputes; the Tribunal shall hold its proceedings expeditiously
and submit its award to the appropriate Government.
7) NATIONAL TRIBUNALS (Section 7-B):
The Central Government may, by notification in the Official Gazette,

constitute one or more National Industrial Tribunals for the adjudication of
industrial disputes. National Industrial Tribunals are involve only in case of
the questions of national importance or if they are of such a nature that
industrial establishments situated in more than one State are likely to be
interested in, or affected by, such industrial disputes. It consists of one
person only to be appointed by the Central Government. The person shall
not be qualified for appointment as the presiding officer unless he is, or
has been, a Judge of a High Court. Beside these, the Central Government
may, if it thinks fit, appoint two persons as assessors to advise the National
Tribunal in the proceedings before it.
HEALTHCARE PROFESSIONALS AS WORKMEN
The question whether activity of running a hospital would fall within ambit
of definition of an industry, came for consideration for the first time before
High Court of Bombay in Hospital Mazdoor Sabha v. State of Bombay the
High Court took a view that 'undertaking' used in the definition of industry
in 2(j) would cover activities which have no commercial implications, such
as hospital carried on with philanthropic motives. Mere fact that
government is running such activity is not of any consequence. This
decision was confirmed by the court in Bangalore water supply case where
the court held that hospital services, research products and training
services are 'services', hence they are within the purview of industry.
The point of discussion is- Whether Healthcare Professionals are

'workmen'? The judiciary has taken divergent views in this regard. For this
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first one should seek to answer the question that is the work done by
doctors is manual unskilled, skilled, technical, operational, clerical or
supervisory in nature. Healthcare professionals includes physicians,
dentists, nurses, pharmacists, therapists, psychologists, physical
therapists, optometrists, paramedics, and a wide variety of other
individuals regulated and/or licensed to provide some type of health care.
In Bengal United Tea Co. v. Ram Labhaya the court held that a medical
officer and his work is of technical nature and is therefore a workman. The
dictionary meaning of “technical" means a person skilled or conversant
with some particular art or applied science (medical science being one of
them). However, in this case there was no dispute as to the purpose of
which the appointment of doctor was made or the functions which he
performed. The case proceeded on the assumption that doctor performed
functions of a medical attendant.
In Dr. Surendra Kumar v. UOI , the question was whether Assistant Medical
Officer Class appointed in Railways was workman. The court observed that
the duties of Assistant Medical Officer was not only to treat persons but to
meet other administrative requirements where he is in charge of hospital
or health unit and was responsible for its establishment and administration.
The duties of the doctor required him to perform supervisory functions in
addition to treating patients, which means he was employed in a
supervisory capacity and by virtue of him earning more than Rs 1200/- per
month he cannot be a workman.
Heavy Engineering Corp. Ltd. v. Presiding Officer, Labour Court - here

Heavy Engineering Corp. Ltd. appointed a doctor on ad hoc basis for a
period of 6 months which was later extended for 3 months. 3 more doctors
were appointed along with him. They were given a notice stating
termination of their service after one month. This was challenged. The
Supreme Court observed that when he was on shift he was the sole person
in charge of the first aid post and he had people working under him (male
nurse, nursing attendants, sweepers etc.)to whom he used to give
directions. Court held that when a doctor discharges his duty attending the
patients and in addition supervises the work of persons subordinate to him
he cannot be held a workman.
In Wadia Charitable Hospital v. Umakant, a Charitable hospital (a part of

the money received was given in charity), employed doctors who were
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even allowed to have their own private practice. The hospital terminated
services of one of the doctor. Prior to this, there existed a dispute with
regard to better facilities for the doctor. After the termination, doctors
announced an indefinite strike, therefore the hospital terminated services
of all. The question before the court was doctors who are employed in
hospitals and who are allowed private practice, are workmen? It was
argued before the court that the doctors were providing "service" (under
Sec 2(1)(o) of I.D Act) to the patients and are therefore workmen. The
court held that when patients are allowed to come to the hospital, it cannot
be said that the doctor is rendering services only to an employer who owns
an industry or an undertaking. He renders service to the Society at large.
Court, observed that in the cases cited by the counsels, the Medical Officer
has been appointed for treating the workmen employed in Industries and
were doing the work of the Industry for which they were paid salary and
such a situation cannot be equated to the facts of the present case. Here
the doctors are rendering only professional service to various institutions.
Therefore the doctors cannot be held to be workmen. It also added that
there cannot be a strait jacket test or formula in these matters. It will
ultimately depend on the fact of each case.
Ahmedabad Municipal Corporation v. Virendra Kumar Jayantibai the court

held that a doctor being paid for visits for visiting the dental clinic of the
corporation which provided medical service to the residents of the
Corporation, was held not to be a workman.
A chemist-in-charge of performing, the work essentially of technical nature,

having power to recommend leave but no power to grant leave or take
disciplinary action was held to be a workman.- Sudhirkumar v. Ferro Alloys
Corporation Ltd
In Bombay Hospital Trust v. Shailesh Hathi the question was whether

physiotherapist is workman? The court observed that the job of
Physiotherapist is not `perennial in nature of work. It is highly specialized
skilled job and is in nature of job of Doctor. It was held that the person
holding a degree of physiotherapist is not a workman because of his
carrying work of helping a patient to exercise. In fact a treatment given by
the physiotherapist is not a perennial nature of work. Therefore, a
physiotherapist is not a workman under S 2(s) of I.D Act. The payments
which were made by the Hospital was from the fees recovered from the
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various patients moreover, there was no material whatsoever produced by

the petitioners to show any direct master servant relationship
Recently, a Division Bench of the Kerala High Court comprising Justice C.N.
Ramachandran Nair and Justice V.K. Mohanan ruled that a consultant
physician employed by the hospital did not come within the meaning of the
term workman as defined in the Industrial Disputes Act, 1947.The Bench
observed that there was a categorical finding by the Supreme Court on the
issue. The apex court had held that a medical officer, being a professional,
could not be termed as a workman under any law. The court observed that
an employee engaged in supervisory work was outside the scope of
workman. The claimant-doctor who was one of the senior doctors in the
hospital was engaged in supervisory and technical work.
From the above cited cases it is evident that there is no straight jacketed
formula adopted by the judiciary for determining if a person is a workman
or not. The decision varies with facts and circumstances of each and every
case. The Supreme Court has not given a concrete reason as to why
doctors are not workman. In most cases the issue of doctors being
engaged in supervisory work is raised and the court without applying the
predominant nature of the work test and looking into the fact if a doctor is
engaged in technical work or not, holds him not to be a workman. This
approach of the court is highly erroneous as the Court is digressing from
the main function of the doctor and holding him not to fall under the
definition of the workman because of the ancillary function of supervision
being carried out by him.
CONCLUSION
A single uniform definition for 'workman' is the need of the hour,

considering all the confusion of the courts on the subject as to who is
workman and who is not, under the various legislations.The First National
Commission on labour (1969) had observed that in order to bring a feasible
degree of simplification and uniformity in definitions it should be possible to
integrate those enactments which cover subjects having common objects.
Report of the Second National Commission on Labour (2002) had also

considered this issue and recommended that the coverage as well as
definition of the term 'worker' should be the same in all groups of laws,
subject to the stipulation that social security benefits must be available to
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all to all employees including administrative, managerial, supervisory and

others excluded from the category of workmen and others not treated as
workmen. The Commission proposed that instead of having separate, it
maybe advantageous to incorporate all provisions relating to employment
relations, wages, social security, safety and working conditions etc. into a
single law.
It is high time to implement the recommendations of both the

Commissions by integrating and amending labour legislations to bring
uniformity in the definitions of various terms so it can avoid confusion so
that there is no conflict or inconsistency in their interpretation by the
courts.
11.5 CONFLICT MANAGEMENT
Wherever there are people, there always will be conflict. Managers have to
deal with conflict in the work place every day. Conflict management is the
ability to be able to identify and handle conflicts sensibly, fairly, and
efficiently.
A. DEFINITION:
Conflict management is the practice of being able to identify and handle

conflicts sensibly, fairly, and efficiently. Since conflicts in a business are a
natural part of the workplace, it is important that there are people who
understand conflicts and know how to resolve them. This is important in
today's market more than ever. Everyone is striving to show how valuable
they are to the company they work for and, at times, this can lead to
disputes with other members of the team.
Webster's Dictionary defines conflict as "a battle, contest of

opposing forces, discord, and antagonism existing between
primitive desires, instincts and moral, religious, or ethical ideals.”
Conflict occurs when two or more people or organisations disagree because

their needs, wants, goals, or values are different. Hurt feelings, anger,
bruised egos, and poor communication are all the precursors to conflict.
However, conflict is NOT the end of the world, or your team or group. Some
tools have been developed that will help us all recognize conflict and deal
with it so that our group or team can move on, stronger than before.
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Do not confuse conflict with:
• Indecision
• Disagreement
• Stress
These are not conflict and they cannot be best handled by conflict
management tools. However they can be the possible reasons for conflict
to take place.
Red Flags of Conflict
• Body language
• Disagreement regardless of issue
• Withholding bad news or too surprises
• Strong public statements
• Airing disagreement through media
• Conflicts in value systems
• Desire for power
• Increasing lack of support
• Open disagreement
• Lack of condor on budget problems or other sensitive issues
• Lack of clear goals
• No discussion of progress, failed goals, and inability to evaluate leaders
fairly or at all
Many people think of conflict as negative. But conflict can be both negative
AND positive.
Conflict is negative when it….
• Takes attention away from other activities

• Damages the spirit of the team or an individual
• Divides people and groups, and makes cooperation difficult
• Makes people or group focus on their differences
• Leads to harmful behaviour, like fighting or name-calling
But it can be positive or constructive when it…
• Clears up important problems or issues
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• Brings about solutions to problems

• Gets everyone involved in solving issues
• Causes real communication
• Releases emotion, anxiety, and stress in a positive way
• Helps people learn more about each other and cooperate
• Develops understanding and skills
B. UNDERSTANDING CAUSES OF CONFLICT:
1) Power distance
i. High Power distance 

 
A high power distance society/culture (such as the Philippines, Hong
Kong, Singapore or India) is one in which the supervisor takes all the
decisions. Subordinates do not expect to, are not in which supervisor
takes all the decisions. 
 
People in these cultures/societies accept that inequalities in power
and status as natural. In the same way they accept that some people
are smarter than others, people accept that some will have more
power and influence than others. Those with power tend to
emphasizes it, to hold it close and not delegate or share it, and to
distinguish themselves as much as possible from those who not have
power. They are however, expected to accept the responsibilities that
go with power, to look after those beneath them and subordinate are
closely supervised.
ii. Low Power distance 

 
A low power distance society/ culture (the US, Canada, Israel, or the
Scandinavian countries) is one in which responsibility for decisions
are more evenly distributed. Though the manager is still primarily
responsible, subordinates do expect to, are often trained for, paid for,
and are resentful and motivated if they are not given the opportunity
to participate in decisions. 
 
Those with power, therefore, tend to deemphasize it, to minimize the
differences between themselves and subordinates and to delegate
and share power to the extent possible. Subordinate are rewarded for
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initiative and do not like close supervision. 

 
Again, each value arguably works fine in its own context. Problems
occur when the two come together. The US manager bringing his
participatory style to Singapore may be met with both resentful
and loss of respect as a manager, the Mexican manager in a newly
opened Canadian branch may find authoritarian style openly
rebelled against. 
 
And of course the skills to do each are different. The skill to elicit
effective participation from a work team in problem solving are very
different than those required by the high-power distance boss to
accurately read and respond to the needs of both the company and
the workers.
2) Context of communication:
Context refers to the amount of innate and largely unconscious

understanding a person can be expected to bring to a particular
communicating setting.
i. Low Context Communication 

 
Low context cultures, like the United States, tend to be more
heterogeneous and individualist and accordingly have evolved a more
direct communication, with lots of documentation. People from low
context societies must rely more on words, an on those words being
interpreted literally. Getting or giving information is the goal of most
communication exchanges. 
 
Example: reporting on an assignment to our boss would involve an
elaborated description of assignment objective, what we did to meet
those objectives, difficulties we had along the way, the outcome, and
perhaps our feelings about it. It would be a rather detailed affair
whether oral or written.
ii. High Context Communication 

 
High context communication, on the other hand, relies heavily on the
context in which an interaction takes place to convey meaning. The
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words only serve as cues to the important aspects of the context-the

status, age, gender, or role relationship between the participants,
their shared past experiences, or their shared cultural experience.
The meaning of the words cannot be fully understand without
understanding that context or background. People carry within them
highly developed and refined notions of how most interactions will
unfold, of how they and the other person will behave in a particular
situation. Because people in high context cultures already know and
understood each other quire well, they have evolved a more indirect
style of communication. They have less need to explicit and rely less
on words to convey meaning and especially on the literal meaning of
the spoken word and more on nonverbal communication.
Example:
Making a report to the boss in this case, might consist solely of a wide
smile and a sketchy overview of the assignment done. This is because high
context people would think in the following way- "great!". We know our
boss is aware of the objectives, that he has been such assignments,
himself, and can guess much of what we did and our difficulties. He would
know without us getting into the details.
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C. CONFLICT MANAGEMENT STYLES:
Conflict happens and how an employee responds and resolves conflict will
limit or enable that employee's success. Here are five conflict styles that a
manager will follow according:
• ACCOMMODATING: An accommodating manager is one who cooperates

to a high degree. This may be at the manager's own expense and
actually work against that manager's own goals, objectives, and desired
outcomes. This approach is effective when the other person is the expert
or has a better solution.
• AVOIDING: Avoiding an issue is one way a manager might attempt to

resolve conflict. This type of conflict style does not help the other staff
members reach their goals, and does not help the manager who is
avoiding the issue assertively pursue his or her own goals. However, this
works well when the issue is trivial or when the manager has no chance
of winning.
• COLLABORATING: Managers become partners or pair up with the each

other to achieve both of their goals in this style. This is how managers
break free of the ‘winlose' paradigm and seek the 'win-win.' This can be
effective for complex scenarios where managers need to find a novel
solution.
• COMPETING: This is the 'win-lose' approach. A manager is acting in a

very assertive way to achieve his or her goals, without seeking to
cooperate with other employees, and it may be at the expense of those
other employees. This approach may be appropriate for emergencies
when time is of the essence.
• COMPROMISING: This is the 'lose-lose' scenario where neither person

or manager really achieves what they want. This requires a moderate
level of assertiveness and cooperation. It may be appropriate for
scenarios where you need a temporary solution, or where both sides
have equally important goals.
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D. CONFLICT MANAGEMENT STYLES:
Resolving Conflict Situations:

To manage conflict effectively you must be a skilled communicator. That
includes creating an open communication environment in your unit by
encouraging employees to talk about work issues. Listening to employee
concerns will foster an open environment. Make sure you really understand
what employees are saying by asking questions and focusing on their
perception of the problem.
Whether you have two employees who are fighting for the desk next to the
window or one employee who wants the heat on and another who doesn't,
your immediate response to conflict situations is essential. Here are some
tips you can use when faced with employees who can't resolve their own
conflicts.
• Acknowledge that a difficult situation exists. Honesty and clear

communication play an important role in the resolution process. Acquaint
yourself with what's happening and be open about the problem.
• Let individuals express their feelings. Some feelings of anger and/or

hurt usually accompany conflict situations. Before any kind of problem-
solving can take place, these emotions should be expressed and
acknowledged.
• Define the problem. What is the stated problem? What is the negative
impact on the work or relationships? Are differing personality styles part
of the problem? Meet with employees separately at first and question
them about the situation.
• Determine underlying need. The goal of conflict resolution is not to

decide which person is right or wrong; the goal is to reach a solution that
everyone can live with. Looking first for needs, rather than solutions, is a
powerful tool for generating win/win options. To discover needs, you
must try to find out why people want the solutions they initially
proposed. Once you understand the advantages their solutions have for
them, you have discovered their needs.
• Find common areas of agreement, no matter how small:

• Agree on the problem
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• Agree on the procedure to follow

• Agree on worst fears
• Agree on some small change to give an experience of success
• Find solutions to satisfy needs:
• Problem-solve by generating multiple alternatives
• Determine which actions will be taken
• Make sure involved parties buy into actions. (Total silence may be a sign
of passive resistance.) Be sure you get real agreement from everyone.
• Determine follow-up you will take to monitor actions. You may
want to schedule a follow-up meeting in about two weeks to determine
how the parties are doing.
• Determine what you'll do if the conflict goes unresolved. If the
conflict is causing a disruption in the department and it remains
unresolved, you may need to explore other avenues. An outside
facilitator (such as the Staff Ombuds Office) may be able to offer other
insights on solving the problem. In some cases the conflict becomes a
performance issue, and may become a topic for coaching sessions,
performance appraisals, or disciplinary action.
E. CONFLICT RESOLUTION IN HOSPITALS AND HEALTHCARE

FACILITIES
Conflict resolution is a dynamic process. Conflict does not always appear

in the same form or from the same people. One essential element of
effective conflict resolution is the recognition that there are stages of
conflict, with appropriate interventions at different stages.
The stages of conflict can range from robust argument within a single
meeting to longstanding opposing, entrenched positions of medical staff,
administration, and the governing body. Depending upon the culture or
needs of the organisation and the type of conflict, an administrator or
leader can use various communication skills and negotiation techniques to
manage a conflict.
The goal in hospitals and healthcare facilities is to develop and implement

a conflict management process so that conflict does not adversely affect
patient safety or quality of care.
! !293
Foundational principles necessary to support conflict management

in healthcare include:
• A willingness to acknowledge existence of conflict;

• Open communication;
• Dealing with conflict within an environment of mutual respect;
• Acceptance and tolerance of different perspectives through the process;
• Commitment to fundamental fairness;
• Educating all stakeholders about conflict management in healthcare;
• Developing a conflict management process with policies and procedures
with input from the stakeholders; and
• Holding stakeholders accountable to use the conflict management
process.
The opportunities inherent in a conflict management system include: (1)

recognition of conflict as an indicator to allow early identification of
problems, (2) promotion of a proactive response to problems and conflict,
(3) encouragement of a culture of mutual respect, open communication,
and problem solving during inquiry or intervention relating to conflict, and
(4) a means of working towards potential resolution.
11.6 SUMMARY
Unionisation is attractive to workers who are frustrated. Historically, unions

have offered what they claim to be a more attractive option to workers.
Employers and employees have different opinions about unions. The former
feel that unions lead to loss of autonomy. The latter feel that they have an
additional entity that works for them. Collectively bargained contracts
govern the interactions between unionised workers and their employers.
Managers must give union organisers reasonable courtesy and ensure that
they are treated in a fair manner.
! !294
1. Explain origin and growth of Industrial Relations.
2. It has been felt by many that growing incidents of unionism among

medical and paramedical staff stands in the way of providing quality
medical services in India. Do you agree? Give reasons.
3. Collective bargaining is an effective tool for grievance redressal. Explain

the process of collective bargaining.
a. Define the term "Industrial Dispute". State powers and duties of

Authorities appointed under Industrial Disputes Act. [10]
b. Explain the provisions for "Strikes and Lock-outs" under Industrial

Disputes Act.
4. Explain role of Trade Union in view of globalisation of Indian Healthcare

Industry.
5. Define conflict. Why and how constructive and destructive conflicts arise
in the organisation? Make the concepts clear by illustrations.
6. Explain the different remedies to solve trade union problems.
! !295
REFERENCE MATERIAL
chapter
Summary
PPT
MCQ
! !296

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HR in Hospitals

Sub Code - 376

Program Design and Advisory Team

Prof. B.N. Chatterjee Mr. Manish Pitke

Prof. Kanu Doshi Prof. B.N. Chatterjee

Prof. Dr. V.H. Iyer Mr. Smitesh Bhosale

Prof. B.N. Chatterjee Prof. Vineel Bhurke

Prof. Venkat lyer Dr. Pravin Kumar Agrawal

Prof. Dr. Pradeep Pendse Mrs. Margaret Vas

Prof. Sandeep Kelkar Mr. Anuj Pandey

Prof. Dr. Swapna Pradhan Course Editor

Prof. Bijoy B. Bhattacharyya Prof. B.N. Chatterjee

Mr. P.M. Bendre Course Coordinators

Mr. Ajay Prabhu Ms. Kirti Sampat

Mr. A.S. Pillai Mr. Kishor Tamhankar

COPYRIGHT © by Prin. L.N. Welingkar Institute of Management Development & Research.

NOT FOR SALE. FOR PRIVATE CIRCULATION ONLY.

1st Edition (Jan,2015) 2nd Edition (Nov,2015)

Chapter No. Chapter Name Page No.

1 Human Resource Management 3-20

6 Recruitment, Selection, Induction in Hospitals 125-160

After reading this chapter, you should be able to understand:

• Principles of HRM, Functions of HRM

Human Resource management is the strategic and coherent approach to

The goal of human resource management is to help an organisation to

Human resource management comprises several processes. Together they

1. Manpower Planning or Workforce Planning

• In a globally competitive and challenging business scenario, success in

• In terms of the growth rate, the healthcare industry in India is moving

• Existing healthcare organisations are expanding by opening hospitals in

• The providers in turn need to be more innovative in their approach and

1.2 PRINCIPLES OF HUMAN RESOURCE MANAGEMENT

• Human resource management of an organisation represents one of its

management is an approach to the management of people based on the

1. Human resource management is concerned with integration by

2. Human resource policies of the organisation should be fair to all.

4. The culture and values of an organisation exert enormous influence

• If the aforesaid fundamental principles are followed in letter and spirit,

• Human resources management evolved from the task-oriented nature of

Figure 1.1 Principles of Human Resource Management

responsibility to ensure that their employees are skilled to do their

need that employees have to demonstrate their commitment to the

1.3 DIFFERENCE BETWEEN HUMAN RESOURCE

Human resource development is the main function of human resource

Human resource management is a process of bringing an organisation and

resources. It means that human resource management includes human

Personnel management is concerned with the manpower planning,

In its essence, human resource management is a strategic approach to the

1.4 FUNCTIONS OF HUMAN RESOURCE MANAGEMENT

Human resource management is a staff function. Human resource

1. Policy formulations. One of the important functions of the human

2. Staff functions. Line managers come across various problems in their

3. Line functions. Line functions consist of procurement, development,

their organisations they decide in what direction they want their

List down stages in the development of HRM.

1.5 SIGNIFICANCE OF HUMAN RESOURCE MANAGEMENT

Importance of human factor, the only animate resource in the

Philosophy of management is also changing in tune with the growing

The importance of human resource management can also be judged from

For the Organisation

(i) Maintaining adequate manpower supply through recruitment, selection,

(ii)Developing right attitudes and required skills among employees through

(iii)Maintaining high morale of workers through incentive schemes,

Video Lecture - Part 4 