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INTRODUCTION
1.1 STUDY PERSPECTIVE
An attempt has been made in this research study to search the concept of effective utilization of Human Resource Management with reference to some main public and private hospitals of Peshawar in the North-West Frontier Province of Pakistan. The intention in this work is to bring to light the real working of HRM in the said hospitals of the North West Frontier province of Pakistan where establishment of HRM in real sense is still awaited.

The old 'administration', consequently brought into existence the HRM which in strategic and tactical meanings became autonomous. We further extend our study in the light of the concept given by some prominent writers on Human Resource Management. George T 1997: The HRM is "a series of integrated decisions that form the employment relationship, their quality contributes to the ability of the organization and the employees to achieve their objective." De Cenzo Robbins, 1996: In a more specific vein, the HRM is an approach consisting of four functions, viz. staffing, training, development motivation and maintenance. Torrington and Hall (1991): The HRM is "a series of activities which first enables working people and their employing organizations to agree about the objectives and nature of their working relationship and, secondly, ensures that the agreement is fulfilled." Public and private hospitals recruit people for alike objectives. However, as the private organizations generally get the better employees than the public sector does, things happen to be different. Hospitals' HR i.e. doctors, nurses, pharmacists, dentists, para-medi personnel, supervisors, managers and technicians etc., directly or indirectly, provide healthcare. The employees perform professional duties, primarily to improve people's health (WHO 2006). Another WHO report (2000) values HR as "the most important of the health system's inputs". In the new millennium, the role of HRM is further changing, An HR manager should be able to cope with the changing competitive trends and business environment, His role has transformed into that of an active business partner with the management. The new trend can
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ensure success continuity and escalating the organization for a future highly competitive world. An HR management is successful when, besides administrative skills, it can influence people's minds and counsel line management. Such changes are part and parcel of the HR strategy, its organizational policy and its profile. Today, there is greater demand of efficient hospitals' administration and their HR development than ever before. This is so, because trade unions, educational problems and financial professionals are constantly confronted with the administrators. Well-trained, competent administrators and HR managers are in great demand. The same is true for other hospital personnel as well. Human resource management functions have, of course, always been carried out in every organization in one way or the other, but these functions may not have been performed efficiently or economically. Importance of hospital human resource management must be recognized, the workload of the general administrator may be reduced and better service rendered to the patients through the establishment of a separate human resource department. When the administrator of a hospital decides to have human resource departments, he also has to decide whether to recruit a full-time or part-time human resource manager. As a common practice, a hospital with 200 or more employees can use the services of a full-time human resource manager white a hospital employing lesser employees may also use the services of a full-time HR manager. However, in such a case the HR manager should be assigned some additional responsibilities like purchase, public relations, transport management, legal work. In hospitals with more than 300 employees, the HR manager should be assisted. `Hospital' is a simple and familiar word but it is not always understood in its entirety and complexity. It cares for patients of all ages and backgrounds, some happy and others sad. It houses various people inter-acting with each other such as cooks and doctors, cleaners and nurses, technician and therapists, ambulance drivers and administrators of different kinds, plumbers and clerks. It experiences hope and despair, sympathy and indifference, love and hate, It is a place always open to all sort of people.

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1.2 ELUCIDATION OF THE PROBLEM


In the present times, the fast pace socio-economic, scientific and technological progress has influenced every sector of human activity and everywhere there is an increasing want of new approach and adoption of new methods to bring closer the achievement of objectives. As for health sector, which is under increasing pressure due to prominent growth in population and for other reasons, it is all the more obvious. Hospitals as healthcare centers need reform and development not only with regard to facilities, but also in the ways and techniques of providing services to the clients. To great extent, it is the attitudes, skillslevels and qualities of the health care personnel on which factors the reform and development depend. The concept of human resource management is a tool to develop human capital and to manage people at work properly and systematically so that human resource at work could be utilize at maximum level for the achievement of the optimum organizational goals and targets. Like as in many other developing countries, in Pakistan, health care sector has not been managed properly and has consequently failed to provide the necessary services of the desired standard. This is largely due to the lack of proper management of resources which include the personnel i.e. human resources. The resource management levels of both public and private hospital in Pakistan, so as to provide foundations for HRM development in the health care sector in the country.

1.3 AIMS OF THE STUDY


To create awareness among workers about future skills, and to attain a comprehensive understanding of their problems. To analyze effective utilization of Human Resource Management in hospitals. To explore effectiveness, efficiency and productiveness of public and private hospitals. To enable policy-makers in both public and private sectors improve the scientific understanding of individual and group interactions and organizational structure related to employment and productivity. To re-structure planning policy, salary set up, training and development, communication channels, compensation, and motivational techniques. To explore the drawbacks and weaknesses of HRM methods in public and private hospitals.
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1.4 HYPOTHESIS
1. Between effective utilization of HRM and productivity of hospital employees and success of the health care organization, there exists an association. 2. In comparison with public health care sector, there is greater job satisfaction among employees of private healthcare sector because of effective HRM in the latter. 3. There is a link between hospital staffs (doctors and nurses') job satisfaction and quality care provided to patients through client-provider relationship, guided by sound policy of HR management.

1.5 AREA OF STUDY


General area of this study is Pakistan with the city of Peshawar in the province of Khyber Phuktunistan being specific areas. PESHAWAR Peshawar, one of Asia's oldest cities, is a Pakistani city of 3 million people and the capital of Pakistan's North-West Frontier Province, making it a frontier town in more than name. Peshawar is located roughly halfway between Islamabad, the Pakistani capital, and Kabul, the Afghan capital. It is the last city of note in Pakistan before the Khyber Pass on the Pakistan-Afghanistan border. Peshawar through history has been held by Persians, Afghans and Arabs, and has been a Buddhist and Islamic center of learning. The Taliban since the 2000s has attempted to occupy the city in efforts to more decisively control northwest Pakistan. Peshawar has certainly the best health-care services in the country with four medical universities and some of the largest hospitals in the country.

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Hospitals located in the study area

(i) Lady Reading Hospital


Lady Reading Hospital is one of the oldest and largest public Teaching Institutes of the country which provide state of Art, excellent curative and preventive services to the ailing humanity of the Frontier Province.

Vision The vision of the LRH is to be recognized internationally as integral to the center of excellence and an international leader in patient health care through Customer satisfaction, Resource Management, Technological Excellence, Research, Teaching & Training.

Mission The mission of LRH is to provide highest attainable quality curative, preventive and pro motive care, which is compassionate, ethical, accessible, acceptable, and affordable, equitable services. The hospital also provides Training, Teaching, Research opportunities and the working environment to the employees where they attain their highest potentials, improve the professional skills of the staff through continuous education and research in the areas of Medical services, Management of the patients care and Managerial innovation.

AMENITIES (facilities) There are 1450 beds available in the hospital with 26 teaching units, like three surgical, three medical, two pediatric units, two gynecology and obstetric units, and each of cardiology, neurology, neurosurgery, cardiovascular, cardiothoracic, orthopedic unit, urology, dermatology, psychiatry, Eye, ENT, ephrology and pulmonology unit. All inpatients services are supervised by a professor and in charge of that unit.

ROLE OF HUMAN RESOURCE AT LRH HOSPITAL Human Resource Department at the LRHH ensures the following aspects: well-planned and quality hiring of personnel
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job description of its employees and proper structure/staffing of departments individual development centered on improving professional skills & performance keeping in view future needs Proper utilization of human resource by motivation to improve the efficiency of organization. Apart from the above, the HRM works on better job satisfaction that reflects in lower absenteeism and higher turnover is achieved. As another important obligation the HRM helps maintain high moral and better human relation to win employee commitment. (ii) REHMAN MEDICAL INSTITUTE Located at the gateway of Khyber, Rehman Medical Institute has revolutionized the concept of medical care in the NWF-P. For the first time ever, the people of this area have access to healthcare facilities of international standards. The founder, Prof. Muhammad Rehman with a vision of providing quality healthcare services to the people of this region, established the RMI which is now catering to all major and minor disciplines of medical sciences.

AIMS & OBJECTIVES

The Rehman Medical Institute is committed to providing: Quality Healthcare Services through state of the art diagnostic facilities and treatment of the highest possible standard in a comfortable, caring and safe environment. Career Opportunities in an environment providing our employees with a purpose and pride in the organization, through personal development and recognition for performance excellence. Education and Training to health professionals while inculcating in them the ethics and values of professional modes of practice.

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(iii) HAYATABAD MEDICAL CENTER The second largest Hospital in Peshawar-a Postgraduate training centre, equipped with all the medical/surical specialities except a few like Cardio-Thoracic Surgery, Psychiatry, burns etc. Serves not only the western part of the city but also caters for patients coming from across the border. Many memories associated with it for those who have done their housejob in it. Mission Through the discovery and dissemination of knowledge and application via service, the HMC is committed to the development of human capacities. AKU seeks to prepare individuals for constructive and exemplary leadership roles, and shaping public and private policies, through strength in research and excellence in education, all dedicated to providing the society with significant offerings.

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1.6 Organization of study


For the purpose of elucidation and elaborations, this study has been divided into the following chapters: Chapter 1: As a prelude to the study the current literature has been revised and only those publications have been considered which are relevant to the topic of the study. Chapter 2: In this chapter, research methodology has been presented. This study was planned as a descriptive comparative study of private and public hospitals. To obtain the required data, questionnaires and interviews were used. These questions were open-ended as well as close-ended. More over, information obtained from the print media is also included, secondary information, too, was collected from the relevant journals and books at various libraries an, Microsoft d also from the intern. Information so collected was statically analyzed using Word, Microsoft Excel software. Chapter 3: This chapter presents and discusses the theory of HRM from a dynamic angle, setting out its mechanics of practically implementation. Chapter 4: Proceeding from the effects of HRM on the quality and accessibility of healthcare services, the functions, planning information system of the HRM in a hospital have been discussed. Next to this is various aspect of HRM have been discussed. These include planning, training and development, compensation, benefits, health and safety of the employees and collaboration between public and private sectors. Chapter 5: This deals with the HRM in Pakistan's hospitals and health care environment. Policy formulation, planning, management, development, and investment skill and potential development aspects of HRM in Pakistani hospitals have been discussed. Chapter 6: Results of the study have been compiled and tabulated in this chapter. Finally, the conclusion driven from this study has been set out and suggestions offered for the improvement of the HRM in Pakistani health-care sectors.

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CHAPTER 2 Literature Review

2.1 Detailed Perspective


For the last around two decades, somewhat late though, Human Resource Management has been systematically introduced in the health system and its importance appropriately recognized in the establishment of human resource policy and management in the 'proper' course. It is found that at present far more information is available on issues of health system, finance and appropriate buyer/supplier structure as compared to Human Resource Management prospects and its scope of influence. Efforts and measures taken to assess the implications of evidence based on the impact of Human Resource Management in the health sector can be referred to as relatively on a low side in spite of growth of this evidence. Factors like mortality rates in various hospitals, re-admission rates, duration of stay and satisfaction of the patients were also probed into, in this study. It revealed that in-hospital death rate increases with the increased number of sick patients in a population. The same phenomenon was observed in the areas with less employment. Education was found to be an important element to influence re-admissions. In areas consisting of people with higher level of education, the hospitals showed lower ratio of re-admissions. The study finally explored into as to what effect on health status did the use of hospital and community nursing services have. It revealed that application of more or less than the average quality of services produced significant effect in terms of statistics, though not quite significance in practical terms.

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2.2 Impact of Education on Health


Patients with older age had lower self-reported health status. In comparison to males, the females were observed less likely to report better health. The same tendency was seen in jobless respondents compared to the employed ones. Respondents dwelling in large cities were more likely to report better health than those living in small cities. As against respondents with lower incomes, those with lower-middle, middle, higher-middle and higher-income were more likely to report better health. However, in the case of lowermiddle income, the difference was not notable. The state of health was observed to be better among the respondents possessing higher level of education.

2.3 Readiness for Disasters


A study by J. Christopher Farmer and colleagues shows that readiness for disasters like the Tsunami that hit South East Asia in 2003, could be greatly improved by better management of the hospital resources and staff. By now, disaster medical response has predominantly on pre-hospital issues such as triage, evacuation, and transport of casualties. It has also largely assumed that hospital management would emerge as planned. Throughout the world, the hospitals short of staff and bed capacity are not in a state of readiness for critical situations, Not only that these hospitals have not been able to cope with such events in the recent past, rather hospital with large facilities, too, have found it hard to overcome conditions caused by such disasters. For instance, following a terrorist bombing in Bali in 2002, as many as 15 patients had to be sent to a hospital in Australia for mechanical ventilation, however, this hospital had a capacity to provide treatment to a maximum of 12 patients. Similarly, ICU beds fell short in the floods of 2001 in Houston, Texas. Numerous examples of like incidents support the view that during a disaster medical response, hospital capacity is the major rate-limiting factor.

2.4 Healthcare Supplies' Demand in Pakistan


Pallas has observed the guidelines for comprehensive health human resource planning (HHRP) developed by TL Hall have been elaborated further (Pallas 1998). In fact the work of Hall, Reid and the SHARP model (developed by Denton, Gafni and Spencer) has been advanced further. Their study has revealed that healthcare supplies' demand is on an
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increase in Pakistan for its large population growth, technology changes in pattern of disease, raised social expectations and the rapid development of health industry. Following issues have been pointed out by them: a. Poorly prepared practitioners b. Unsound linkage among healthcare needs and education c. Surplus physicians d. e. f. g. Lack of female healthcare workers Imbalance between urban and rural healthcare personnel and services Poor linkage between national health policies and implementation Lack of political will to enact policies

h. Unsatisfactory career structure i. j. Insufficient funding for healthcare Limited historical data.

They point out HRP process in Pakistan being overlooked and stress need of identified issues to be incorporated in future health human resource planning (Pallas 1998).

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CHAPTER 3 RESEARCH METHODOLOGY


This research work has been conducted on open-ended and close-ended questions style. In a survey research, close-ended questions mode is taken to be decisive. As for differences found in the quality of data acquired using close-ended or open-ended questions, a systematic research is still needed, which should aim particularly at differences in averages and division of data.

3.1 Rationale of Study Design


A problem may arise when general open questions are asked at the end of the structured questionnaires; Reasons of this problem could be the quality and quantity of data, unclear analysis and reporting of this data, insufficient time and expertise needed for the purpose. These questions could prove to be of optimum value provided that the researchers are clear about the sort of data to be generated from these questions and study is carried out with a strategic approach. Larger part of closed questionnaires used in the survey contains closed questions asking respondents to make selections from a particular number of options.

3.2 The Advantages of General Open Questions


In designing a questionnaire, general open questions prove of various uses. When a researcher receives responses to the questionnaires, he may become confident to have covered all relevant issues (Moser CA, 1971; Rossi PH, 1983; McColl E, 2001). The responses might also complement answers to closed questions thereby satisfying the researchers about validity of questionnaire, and may highlight specific problems. General open questions may be used by a researcher as a usual exercise. Another reason of these questions may be to enable respondents express their opinion. On the other hand, closed questions, even if prepared from people's verbal views in focus group and detailed interviews,, symbolize researcher's plan of working.

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The open general questions may also reveal some important issues despite how good structure of the questionnaire. Beyond some structured questions, the respondent may wish to give details on particular issues. Some questions may be qualitative only keeping in view a limited number of people or a small group only. In such situation, an open question acts like a safety net and helps the researcher identify issues not contained in closed questions. This may be done by elaborating and explaining some findings of the closed questions.

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3.3 Responses to General Open Question (Quantitative or Qualitative)


Researchers have diversified views about responses to general open questions whether being qualitative, non-qualitative or quasi-qualitative (Steckler A, 1992, Bankankaite, 2003, Boulton 1996, Murphy E, 1998). These questions show some features of qualitative nature viz., they encourage respondents express their views in their own words, output is not figurative but in textual form; techniques associated with qualitative research may be used for analysis. Closed questions may impose constraints on responses as these closed questions may be indicative of the agenda for responses to general open questions. Data on each case may lack conceptual richness. Recipients are asked nondirective questions that bear little capacity for responses, for example, `Any other comments?' or is there anything else you would like to say?'. Data extracted from general open questions is determined by their details/depth, which comes from responses offered to the written instructions for the recipients and what they actually write. With the help of a thorough and quality analysis of data or using shorter responses as safety net for new or complementary issues, the researcher can determine the status of general open questions. This strategy may be helpful in publication process as well.

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3.4 Target Population


It is public and private hospitals that provide a target population. This target population has been selected on the basis of inclusion criteria (see Table below). Before filling the questionnaire, written consent by the respondents was obtained in order to approach the target population primarily via letters. Target Population Name of Hospital Khyber teaching hospital Lady reading hospital Rehman Medical Institute Total Source: Prospectus of above hospitals. S. No. 1 2 3 Target population 1,750 3,500 350 5,600

3.5 Sampling Design


Sampling applied for selecting the study subject was two-stage cluster sampling. Public and private hospitals are split into four strata, with each hospital considered as a cluster.

3.5.1 Sampling Technique


On random basis, in each cluster, employees from various departments of the hospitals were selected. All employees from each department present at the time of visit, satisfying inclusion criteria, were included.

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3.5.2 Sample Size


For effective utilization of human resource management, stratified random sampling was used as sample size, selecting four strata at random. Within the strata, elements are required to be homogenous for the sake of higher precision. Homogeneity in stratum-to-stratum, should be relatively large. Therefore at 5% level of significance with 0.05 bound of error on estimation used to calculate the sample size. A preliminary survey made of three hospitals with population size 1750, 3500 and 350. Population size of stratum Nh hl =LRH, h2=KTH, h3=RMI Proportion of stratum Ph =0,05 Relative weight of stratum Wh , h1=5, h2=10, h3=1 A sample of 362 employees was required. A total relative weight of stratum is (5+10+1=16) LRH=hl =362/16*5=113 (sample size for strata one) KTH=h2=362/16"10=226(sample size for strata two) RMI=h3=362/16*1=22 (sample size for strata three)

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CHAPTER 4 DATA COLLECTION


HUMAN RESOURCE MANAGEMENT IN THE CONTEXT OF HOSPITAL ENVIRONMENT IN PAKISTAN

4.1 POLICY FORMULATION, PLANNING & MANAGEMENT


Health matters pertaining to human resources prove to very important and complex areas that require certain modifications and reforms for the development and improvement of health systems in various countries. In 1999 the issue of human resources development was identified by the Regional Committee ( for the Eastern Mediterranean as a priority area during 2001 and beyond. These issues must be considered at an early stage in health systems reform and not be regarded as an "afterthought". Human resources development is more often than on concentrated narrowly on planning and training only. Developing an effective strategy for human resources is of utmost significance. A workshop for this purpose was organized by the WHO and attended by representatives from the Eastern Mediterranean Region in late 2000. The national potentials of countries to formulate or update their national human resources policy was strengthened through several consultations in the year 2000. In Lebanon, the Ministry of Public Health was supported in projecting human resources for health needs based on WHO models; a new policy is therefore expected as a result of the projection. In Pakistan, a national policy was formulated by a WHO consultant and submitted to the Federal Ministry of Health for discussion as a preparatory stage to draft a national plan for human resourceE, development. In the Republic of Yemen, a mission of two experts conducted an in-depth review on health and human resources for health and prepared a detailed rc port; an updated national policy and plan, based on the results of the review, is being prepared.

Human resources management was supported through developing effective continuing education programs, tailoring of postgraduate course; to fulfill urgent needs for qualified

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professionals in specific specialties, establishment of new centers for human resources development and through introducing new trends in management. Special attention was given to the development of programs in family medicine and general practice. In the area of postgraduate training, evaluation and support was provided to develop and improve training of professionals in a number of specialties on demand. Family medicine and general practice programs attracted support in public health and related topics are increasing in number in the countries of the Region. The Regional Office lent support to these programs in order to encourage students and faculty to join and to help the organizers maintain the high quality and relevance of courses in Pakistan. A comprehensive survey has been initiated, as part of a WHO global project, to study the situation of this important specialty in the countries of the Region to identify further needs of new programs and to provide support to already existing programs. In Pakistan centers were established to organize continuing education. Programs to update and develop skills of the health workforce in different subjects were provided through enhancing continuing education programs focusing on bask: skills programs.

4.2

INVESTMENT

FOR

HUMAN

RESOURCE

DEVELOPMENT

&

INVESTMENT
Investments in the development of nursing and midwifery resource in the region, as a vital component of the health system and health services development keep on being made. As in the past, the process of collaboration with countries in taking corrective measures to improve basic nursing and midwifery education and reorient the curricula towards primary health care continued. Nursing and midwifery education has been fortified in Pakistan where one nurse is available for eight doctors and only one doctor is available to treat 2,300 patients. Federal and provincial governments still to plan to produce a sufficient number of nurses and paramedical staff. Besides Pakistan, shortages of nurses and midwives in many countries of the Region requires a critical review of the nursing human resources situation in the Region for the purposes of planning, development the management in order to meet the increased demand of relevant services both quantitatively and qualitatively. Pakistan was provided with support in the form of fellowships, rational training, supplies and equipment to strengthen the teaching and training capabilities of the national allied health institutes and to meet the continuing education and training needs of allied health
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personnel (Annual Report of Regional Director, 2006).

Some NGOs too have become actively involved in this field. HRSW 3-International is such an NGO operating from the NWFP, Pakistan. It was established in the year 2000 and registered with the Government of Pakistan under the Societies Act 1860. In the field of social work, human resource and public health services, the HRSWS has made a good reputation for itself,

4.2.1 Aims and Objectives of HRSWS


For a long time, the problems of inequity, scarcity of resources, inefficient and untrained human resources, gender insensitivity and structural mismanagement confront the healthcare system in Pakistan. With the precarious health status of the people and poor indicators of health in the region, health care reforms were finally launched by the government in 2001, which envisaged decentralization. There are, however, numerous challenges and constraints in the system. The future health of the nation depends on this decentralization initiative. Hopefully, this new system shall result in the institutionalization of the health services at the district level. Most importantly, it will help in strengthening the primary health care se vices catering to the major fraction of the population. Besides political commit rent, attitudinal, behavioral and cultural conditions conducive to this system should be maintained (Sheikh BT, Rabbani F., 2004).

Though surprising but true that most of the developing countries are not spending more than 2% of their gross national product (GNP) on health, resulting in poor coverage of public health services. The Government of Pakistan spends about 0.8% of GNP on health care, which is lower than some neighbouring countries such as Bangladesh (1.2%) and Sri Lanka (1.4%) (World Bank, 1999),

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Pakistan spends 80% of its meager health budget on tertiary care, services, which are utilized by only 15% of the population. In contrast, only 15% is spent on primary health care services, used by 80% of the population (Pakistan - Towards a Health Sector Strategy, 1998).

Looking at the above data, however, Pakistan seems way behind fulfilling its commitment. Though the country has achieved a very healthy economic growth rate, but it has not been pro-poor. This is evident from high unemployment and poverty levels. Health expenditure in Pakistan is about US$ 17 per head per year, out of which $13 is out-of-pocket private expenditure {World health report 2000). As for determining the poverty factor, measured by the international standard of earning less than $1 a day, at least one-third of the population is poor. On the other hand, countries having a much smaller GDP size than that of Pakistan are far ahead of it in literacy and other HD-related indicators As for economic growth, it is a necessary element, though not sufficient for human development. No doubt, owing to resource constraint, it is difficult. for a developing country like Pakistan to allocate sufficient funds for human development. Therefore, by way of enhancing the pace of growth, sufficient resources can be generated for raising the standard of living of the people. However, for this purpose a pro-people growth: higher investment in labor intensive sectors like SMEs and agriculture are needed so as to create greater employment opportunities. It may be argued that without developing its human resources country cannot sustain a high growth rate. Poor, illiterate, unskilled, sick and disgruntled' people are a serious obstacle to development. The development of human resources is an important issue in the current development policies of Pakistan, which this policy focuses on health-and education as well as poverty alleviation as essential elements for sustained economic revival and growth in Pakistan. Under this policy, in the health sector, the Government has taken steps to awareness. Vocational education at sub-District and District levels includes health awareness programs.

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It reveals from the report that the mortality rate is high, hepatitis B vaccinations are unavailable for the whole country, pregnancy complications have increased, there is no national health policy, drug policy and an accountability procedure to motivate doctors. According to the report, it might be claimed that more morey was spent on healthcare but a majority of people still have no access to primary healthcare, emergency obstetrical care or emergency healthcare in Pakistan.

4.3 MAGNITUDE OF THE TRAINING & DEVELOPMENT PROGRAMS IN PAKISTAN

With a view to consolidating its position in the world markets and achieving internal economic balance and growth, the government has now taken up major economic restructuring. Liberalization in terms of major changes in the industrial policy, as a part of the economic restructuring programs, has brought in a lot of competition for the overprotected industrial organizations in general. Foreign capital and direct participation of multinational organizations in the corporate sector rave exposed the industrial organizations to intense competition. The effect of such liberalization on the industrial organizations has given rise to certain international developments in the form of global trade restrictions. Certification as per the quality system standards (developed by the international organization for standardization) o" the products of the industrial organizations are now almost essential for going global. Total Quality Management (TQM) is now a widely discussed issue in the corporate world, but it is absent in the health care sector, not only in state hospitals but also in a number of private hospitals. (Dipak Kumar Bhattacharyya, 2002)

4.4 ENHANCING CAPABILITY OF HOSPITAL EMPLOYEES


At present times, a trend has come that that health care is provide to the indigent and uninsured. Because of industry-wide consolidation pressures, it is unlikely that 10 years from now governments will find it strategically desirable to directly operate their own public hospitals and clinics 3 or 4 more cost-effective choices are becoming available. Apart from bringing a decrease in the public resources, the main force driving this change is vigorous competition for treating the poor from private for-profit and nonprofit hospitals.
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In most communities, even those on public assistance now have a choice of providers. The advent of HMOs is leading to a fundamental restructuring of the whole health care system. One of'shoot of this is a declining need for hospital beds. In the development of a nation, health plays a fundamental role

4.5 WORKERS SKILL DEVELOPMENT: A TRUE SOURCE OF NATIONAL WEALTH


The key to a strong economy, as usually argued, is money in the lands of factory owners and rich investors. The appropriate view is that redistribution of money from the rich to programs for the poor and the middle class is important. Neither opinion is adequate to the economy of the 1990s and beyond - a world economy in which the true source of national wealth is the accrued skills of the workforce coupled with the quality of the social and the material infrastructure supporting them. Available data gives us to know that the success of economy in Pakistan no longer depends on the private investments of highly motivated capabilities. Rather, our nation's future economic success depends instead on the skills anti insights of our Workforce, and how well we link those skills and insights to the economy of the United Nations. The role of government in Pakistan is to build our human capital and public resource base and to bargain with global capital on our behalf, Our economic policy must be adapted to the new realities of the world economy for the sake of survival and growth in
the 215` century.

Rich Pakistanis whose savings remain usually unknown, tend to decline to help the rest of our population. But the saving of the foreigners are appearing on the scene to found promising projects. and ever more valuable connections between particular ideas and particular practices.

4.5.1 Obstacles in Human Resource Development in Pakistan The greatest barrier to human development initiative is provided by the Establishment Division and the Finance Ministry where the preexistent policy of maintaining status-quo and sustaining the inflexible, unscientific and illogical rules, quite a few of which are ultravirus to the constitution of Pakistan.

The skills needed for human development initiative are of several types. First, among the
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core skills are the problem solving skills required to put things together in unique ways. Identifying problems is yet another important issue as, without this, it is hard to understand people's needs and the ways to meet these wants. Third are the skills needed to link problem solver and problem identifiers. Problem solvers, problem identifiers, and brokers are now called upon to join hands in stimulating and uncovering the discoveries. . The work force possessing good basic education can easily bring the fruits of its labor to the global economy, and can attract global capital for the performance of its complex task. The experience acquired by performing these tasks promotes additional on-the job training and experience. It, in turn, serves to hire global capital for more complex pursuits. If Pakistan is strongly committed to economic development, it would be more convenient for it to establish a virtuous relationship with global capital.Lacking educated workers and highly qualified members of public service, many of our policy makers would not be able to resolve the problem of unemployment and low wages. Even if Pakistan bargains for global capital, it would still be challenging for it to attract good jobs unless it could offer an educated workforce and effective communication systems.

4.5.2.1 Promotion of Female Education The ability of mothers to provide adequate care for their families can be greatly improved by uplifting female education. Female primary school enrolment of 26% (in 1990) is extremely low and almost half that of their mall; counterparts. 80% women in Pakistan are illiterate (compared to 50% men) - .a situation that has persisted throughout the 1980s. Apart from the high reproductive burden, this poor educational level has negative consequences for labour force participation: official female rates are only 6% overall (Horwitz A., 1993).

4.5.2.2 WHO Collaboration for Health The collaboration of WHO with the Government of Pakistan has existed ever since the foundation of the organization, and has been faithful to the first article of its constitution devoted to the attainment by all peoples of the highest possible level of health. This collaboration was further strengthened with the establishment of the WHO country of ice in Pakistan in January 1960. Through this close partnership, WHO has been contributing to health sector development in Pakistan, while the experience gathered from this and
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other countries has played a positive role in shaping the strategic policies of the organization. WHO has always designed its strategic interventions in a country on the basis of the national priorities, using the "Health for All" approach as one of the critical guiding principles for health sector development.

4.5.2.3 Lady Health Workers In the later part of the same year (1993), the initiative of the Lady Health Workers (LHWs) was jointly launched in Union Council Tamman of district Chakwal in the Punjab as a pilot intervention. Young rural females with a high school certificate were inducted in an intensive community based PHC training programme to subsequently deliver essential PHC services to the households of their residential catchment areas, and bridge the existing ga,.J between the community and first level care facilities. The programme was scaled-up in early 1994 throughout the country. The strength of the LHWs cadre hays now reached 70,000, and the government is working to further raise this force :o 100,000 with recognized success in delivering essential PHC interventions. We strongly hope that the current devolution process will seriously take advantage of this expanded district health system network with added financial and human resources allowing it to operate effectively.

4.5.2.4 Diseases Control Childhood Communicable Diseases Control Through this network of PHC-based district health system, Pakistan has every opportunity to avert the havoc caused by the few childhood communicable diseases and surmount reproductive health problems that presently account for most of the 280,000 infant and 16,000 maternal deaths every year. In the area of disease control, a remarkable partnership in the eradication of Small Pox, helped Pakistan get finally declared free of this disease in 1974. The last case of small pox occurred on 14 October 1974 in a 6-year old girl of district Muitan and the country was certified or 17 December 1976. Through this joint intervention, Pakistan and WHO were able to make a permanent impact on the public health sector .of Pakistan by completely wiping out a disease that entailed a very high morbidity and mortality over the centuries.
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Small-pox Control The experience of small pox was followed by the gigantic task of eradicating guineaworm disease. Pakistan enthusiastically worked together with WHO to eradicate the disease, thus obviatiig its negative impact on the working capacity of farmers and the less arivileged rural population. The eradication campaign was launched in 19136 and the last case being detected from Dera Ismail Khan in the NWFP during 1993, absolute success came after six years.

Tuberculosis Control The next work we undertook was Tuberculosis control. Pakistan ranks sixth amongst the 22 high burden countries. WHO has introduced the strategy of Directly Observed Treatment Short Course (DDTS), a viable and cost-effective methodology for TB control, endorsed already by 155 countries. The program is able to curtail the infectivity of T13 patients after only two months in the majority of cases, and after a further 6 months, 85%90% of patients using the DOTS strategy are cured at an average treatment cost of US$15. As we commemorate the World TB Day today, we salute the Government of Pakistan for having declared Tuberculosis as a national emergency several years ago and the momentous strides taken since then resulting in around 60% DOTS coverage throughout the country.

Malaria Control Malaria is quite old communicable contagious disease in Pakistan. In the year 1998 the traditional control strategy was replaced in this country through the Roll Back Malaria initiative, where several landmark strategies entailing early diagnosis, prompt treatment, the promotion of insecticide treated nets or ITNs, the use of residual spraying, promotion of health education, early detection and response to epidemics, building of local partnership for and promoting operational research to imprcve the efficacy of these interventions were introduced. IThe public health community and the government need to work extensively to ensure that tits disease is effectively controlled through inter-sectoral action and sound implementation of RBM strategies. Blood Transfusion
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In the area of Safe Blood Transfusion, WHO and the MoH are striving together to avert the escalation of Hepatitis B, Hepatitis C and HIV/AIDS in Pakistan. These efforts have resulted in the promulgation of a national ordinance on the subject in October 2002. Today the 650 hospitals offering blood transfusion services are morally required to ensure comprehensive screening.

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CHAPTER 5

RESULTS
5.1 DATA ANALYSIS AND INTERPRETATION
Data has been analyzed by both the descriptive and inferential statistical methods, and interpreted through frequency tables and graphs. The utilization of HRM in public and private hospitals has been tested and compared using chi-square.

5.2 DATA MANAGEMENT


Database was developed in SPSS version 13.0. Questionnaires were edited simultaneously during the study and all the completed questionnaires thoroughly scrutinized. Data was double entered and then validated and corrected for any disparity. Finally, 10% of the questionnaires were checked randomly to look for any error in the data entry.

5.3 DESCRITIVE STATISTICS


Questionnaire was divided into qualitative and quantitative parts. Both types of questions have been separately analyzed and interpreted. The questionnaire comprised of three sections: Section 'A' pertains to information relating to personal opinion on human resource management. Section '2' is based on effective utilization of human resource management in the hospital. While section '3' is based on the suggestions and recommendations for improvement.

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5.4 SECTION 1
Personal Opinion on Human Resource Management.
Subject: Study is based on two criteria i.e. Public and private hospitals. Out of 362 respondents, 35.4% were from public hospitals and 64.6% from Private hospitals. Table 1: Type of Hospital (n=362) Type Public Hospital Private Hospital n 128 234 % 35.4 64.6

Hospitals 29% samples were taken from the KTH,58.6% from the LRH , and 6.1% from RMI Table 2: Hospital Status (n=362) Hospital KTH LRH RMI n 106 212 22 % 29.3 58.6 6.1

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Q-1 what is the purpose and objectives of HR department in your hospital?

In response, 33.4% employees were in favor of Human Resource Management to increase the efficiency and effectiveness of work; 19.3% said that they have no HR management in their hospitals; 28.7% agreed that Human Resource Management maintains and manages resources; 9.1% said that it managed employees and their records, and 3.6% were of the opinion that HR fulfilled the needs of internal and external customers.

Table 3: Purpose and objectives of HR department in hospitals (n=362) Objective of HR department in hospitals To increase the effectiveness and efficiency No HR department exists but one is needed To manage employees and their records To fulfill the needs of internal and external customers To maintain and manage the resource system To make the organization work more smoothly n 121 70 33 13 104 21 % 33.4 19.3 _ 9.1 3.6 28.7 5.8

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Q-2 Why is human resource planning necessary in a hospital?

Out of 362 respondents, 34.3% agreed that HR planning makes the services system more effective, 24.6% employees said that the HR planning increases proper utilization of services to community and 14.6% said HR planning makes working atmosphere better and more harmonious.

Table 4: Why HR planning necessary in a hospital (n=362)

Variable To make working atmosphere better and more harmonious To make maximum used of resources To create better relationship between employees and bosses bosses it is necessary in patient care services system To keep proper person at proper place For management and improvement For proper utilization of their services in relation to community To provide an environment that builds leadership To achieve the organizational goals

n 53 36 21

% 15 9.9 5.8

124 6 9 89 11 13

34 1.7 2.5
24.6

3 3.6 I

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Q-3 Are you satisfied with the supervision system of your hospital?

75% employees were satisfied with their supervision system, while 25% were not and wanted to improve the hospital supervision system.

Table 5: Are you satisfied with the supervision system (n=362)

Variable Yes No

n 272 90

% 75.1 24.9

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Q-4 What methods do hospitals use to assess their training methods?


46% respondents said that evaluation is the best method to assess their training, while 14.4% wanted to assess training through supervision observation and survey. 21% said that there was no method available in their hospitals.

Table 6: Method to assess the training (n=362)

Variable At present there is no method Appreciation, meeting and punishment To check the output after training sessions Through practical procedure Evaluation Monitoring through supervisor observation and survey

n 76 24 31 13 166 52

% 21 6.6 8.6 3.6 45.9 14.4

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Q-5 What motivation techniques are used for employees in your organization?
105 employees (29%) said that there was no such technique applied in their hospitals, while 21.5% intimated that performance appraisal was a good motivation technique. 12.7% said that they were satisfied with their incomes and that was the technique for motivation, while 15.2% believed in training being a useful motivation technique.

Table 7: Motivation techniques used for employees (n=362)

Variable No such techniques at present Letter of appreciation and constant reward Training Positive attitudes Employees are satisfied with their income Performance appraisal

'n 105 45 55 33 46 78

% 29 12.4 15.2 9.1 12.7 21.5

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Q-6 what are the drawbacks and weaknesses in your administration system of hospital?
166 employees did not know about the weaknesses of the administration system, while 19.6% said that political influence weakened the administration system and 18.2% said too much hierarchy is a big drawback.

Table 8: Drawbacks and weaknesses in your organization (n=362)

Variable Don't know Outside influence and politically grouping Administrative interference by the high authorities No systematic approach Lack of proper supervision Lack of communication Too much hierarchy 66

n 166 71 15 11 11 22 66

% 46 20 4.1 3.1
3.1

6.1 18

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Q-7 What would be your recommendations for improving the quality of human resource?
362 employees 117 (23.3%) recommended that proper selection of employees and proper utilization according to their ability, improved the quality of human resources, while 13% said that giving better incentives to employees would improve the work and 20% said that regular promotion and encouragement would improve the quality of work.

Table 9: Recommendation for improving quality of HR (n=362)

Variable Better incentives for hard workers Regular promotion and encouragement of staff Training at HR level with frequent interval, rewards Hire and fire power without outside interference Merit and only merit Proper selection and utilization according to ability There should be HRM in every organization Increase communication and interest

n 47 73 40 10 12 117 25 38

% 13,0 ~ 20.2 11 2.8 3.3 32.3 6.9 10.5

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6.5 SECTION 2
Effective Utilization of Human Resource Management in the Hospital

1. Can the effective utilization of HRM in hospitals be analyzed?


48.9% said that HRM was effectively used in their hospital, 31.8% said it was sometime used effectively and 19.3% response said that HR was not used in their hospital. Table 13: Effective utilization of HR in your hospital (n=362)

Variable Always Sometimes Never

n 177 115 70

% 48.9 31.8 19.3

Effective utilization if HRVI is your hospotal.

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2. Does HRM explore the importance of efficiency and effectiveness in hospitals?


239 (66%) employees believed that HRM was important for the hospital and 34% said that it was not necessary.

Table 15: HR explore the importance of efficiency in hospital (n=362) Variable Always Sometimes Never n 239 123 % 66 34 -

HRM explore the importance of efficiency in hospital

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3. Are the employees motivated by adopting fair promotion policies in hospitals?


A total of 105 employees (29%) said that they were always motivated by fair promotion policies, 59% said that sometimes they were so motivated and 11.9% were of the view that promotion system of the hospital was not satisfactory. Table 18: Employees motivated by the promotion policies (n=362) Variable ' Always Sometimes Never n 105 214 43 % 29 59.1 11.9

Employees motivated by the promotion policies.

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4. Is employees' criticism encouraged by the hospital management?


49 employees (13.5%) said that employees' criticism was always encouraged by their hospital, 68.8% said that sometimes their criticism was encouraged by the management, and 17.7% said that employees' criticism was never allowed in hospital. Table 20 Employees criticism is encourage by hospital management (n=362) Variable Always Sometimes Never n 49 249 64 % 13.5 68.8 17.7

Employees' criticism is encouraged by hospital management

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5. Do hospitals provide beneficial incentive schemes to their employees?

72 (19.9%) employees said that the hospital always provided incentives to their workers, 59.7% said that the hospital provided incentives sometimes and 20.4% said that no incentive was provided in their hospital. Table 21: Hospital provides benefits (n=362) Variable Always Sometimes Never n 72 216 74 % 19. 9 59.7 20.4

Hospital provides benefits.

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6. Are hospital employees encouraged by restructuring their salary structure? 21.5% said that the hospital always encouraged the employees by restructuring their salaries, 60.5% said that their salaries were restructured sometimes and 18% said that the hospital never restructured, their salaries.

Table 22: Employees are encouraged by restructuring their salary (n362) Variable Always Sometimes Never n 78 219 65 % 21.5 60.5 18

are re encouraged by restructuring uring their salary

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6.6 SECTION 3
Q-1 Is HRM effectively utilized in hospitals to increase effectiveness and efficiency?
305 employees (84.3%) said that the HRM increased hospital work effectively while 15.7% said that it sometimes increased efficiency.

Table 23: Utilization of HRM increase effectiveness and efficiency Variable Yes No Never n 305 57 65 % 84.3 15,7 18

Utilization of HRM increases effectiveness and efficiency

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Q-2 Do all workers want their pay to be based on their performance?

In total, 84% employees said that workers wanted their pay to be based on their performance and 16% was of the view that pay should not be based on employees' performance.

Table 25: Employees wants their pays to be based on their performance Variable Yes No Never n 304 58 65 % 84 16 18

want their pay to be based on their performance

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Q-3 Do bonuses tend to be more effective motivational tool than increased salary?
49.4% said that bonuses were good motivation tools, while 50.6% responded that it was not an effective tool of motivation.

Table 26:Bonus is more effective motivation tool than salary Variable Yes No n 179 183 % 49.4 50.6

Bonus is more effective motivation tool then salary.

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Q-4 Has safety often been managed as effectively as some other business functions?
Only 48.9% employees said that safety has always been managed effectively in their hospital, while 51.1% said that it was not managed effectively.

Table 28: Safety not managed effectively Variable Yes No n 177 185 48.9 51.1

Safety not managed effectively

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Q-5. Do the hospital's health and safety rules provide quality services to employees?
69.1% employees' response was that hospital health and safety rules provide quality services to their employees, while 30.9% did not agree to this version.

Table 29: Health and safety rule provide quality services Variable Yes No Never n 250 112 65 % 69.1 30.9 18

Hospitals provide quality services to employees

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Q-6 Does the communication system work effectively in hospitals?

Out of 326 employees, 71.3% said that communication system worked effectively in their hospital, and 28.7% said that there was lack of communication in their hospital system.

Table 30: Communication system worked effectively in hospitals Variable Yes No Never n 258 104 65 % 71.3 28.7 18

Communication works effectively in Hospital

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Q-7 Does the implementation of new technology reduce the number of jobs?
In response, 41.2% said that implementation of new technology reduced the jobs, but 58.8% did not think that new technology reduced the number of jobs.

Table 32: implementation of new technology reduced the number of jobs Variable Yes No Never n 149 213 65 % 41.2 58.8 18

Implementation of new technology reduced the number of jobs

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6.7 SECTION 3
Suggestions and Recommendations for Improvement.

Q-1 Is HRM effectively utilized in hospitals to increase effectiveness and efficiency?


Variable Yes No Public hospital 76 (24.9%) 52 (91.2%) Private Hospital 229 (75.1%) 5 (8.8%) Total 305 57 362

75% private hospital employees' opinion was that HRM increased efficiency and effectiveness, while 24.9% public hospital employees agreed that HRM increased efficiency.

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Q-2 Has safety often been managed as effectively as some other business functions?
Variable Yes No Public hospital 73 (41.2%) 55 (29.7%) Private Hospital 104 (58.8%) 130 (70.3%) Total 177 185 362

Out of 104 private employees (58.8%) said that safety had often been managed effectively, 70.3% said that safety was not managed effectively, while 41.2% public hospital employees said that safety was often managed effectively.

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Q-3 Do the hospital's health and safety rules provide quality services to Employees?
Variable Yes No Public hospital 53 (21.2%) 75 (67.0%) Private Hospital 197 (78.8%) 37 (33.0%) Total ~ 250 112 362

Private hospital management provides better health and safety rules as compared to that of the public hospitals.

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Q-4 Does the communication system work effectively in hospitals?


Variable Yes No Public hospital 96 (37.2%) 32 (30.8%) Private Hospital 162 (62.8%) 72 (69.2%) Total 258 104 362

In private hospitals, the communication system works effectively as compared to that in the public hospitals.

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Q-5 Does the implementation of new technology reduce the number of jobs?
Variable Yes No . Private hospital employees (74.5%) said that implementation of new technology reduced the number of jobs, while 25.5% public hospital employees said that it not reduce the number of jobs. Public hospital 38 (25.5%) 90 (42.3%) Private Hospital 111 (74.5%) 123 (57.7%) Total 149 213 362

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CONCLUSION
In the context of present-day exercise and tradition in the developed states of the world, 'administration' techniques have given rise to Human resource management. This is so because the said techniques did not have the potential to change the conditions of the old customary industry, business, services and certain governance aspects in the perspective of the Second World War where-after a large growth in the industries and business was seen in many countries world over. It is worth acknowledging that previous studies pertaining to job analysis and testing helped development of certain staffing procedures for the present era. The human resource managers today have very different responsibilities and obligations as compared to those of their predecessors. Presently, the personnel management is assigned prominent emphasis and respect in the overall corporate hierarchy. Consequently, there is a constant rise in the demand for these professionals and the compensations they are paid. It will be observed that human resource management has yet to make its presence felt in Pakistan like many other practices and techniques of the present time. Although to some extent in the private sector, HR management has been introduced, however, for the purpose of becoming integrated into country's system, it has to become an inseparable part of the governance policy. The required kind of manager and the specific managerial skill market are not still adequately available at the critical mass level in the country. Subject of the subject is as to how far the new trend has made it headway in Pakistan's health-care sector. To cover the objective of the study, the following three hospitals (two public i.e. state-run, and one private) were selected: 1. The Lady Reading Hospital, Peshawar 2. The Khyber Teaching Hospital, Peshawar 3. The Rehman Medical Institute, Peshawar.

The Rehman Medical Institute is private while the rest of the two (Lady Reading Hospital and Khyber Teaching Hospital) are public sector hospitals. The study reveals that only
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one hospital, the RMI, enjoys a well established and functional HR department integrated into its setup. In the two public-sector hospitals, on the other hand, no human resource management exists, and they operate through the obsolete government administration policies and procedures.

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A. Functions of RMI, HR Department


The HR department of NTH carries out the following functions : 1. Integration of HRM with policy and decision making 2. Suitable staffing 3. Formulation of job-descriptions 4. Motivation of personnel in order to improve individual as well as organizational efficiency. 5. Provision of individual development of the personnel focuses on performanceenhancement, and failure to current as well as anticipated future needs. 6. Improving employer-employee relationship for achievement of objectives 7. Redesigning work processes and jobs in accordance with changing needs formulating sound policies of recruitment, training services condition, discipline retirement records leading to creation of a versatile work-force 8. Promoting job-satisfaction as evinced by low absenteeism and higher turn-over. 9. Helping to maintain high moral and better human relationships for the sake of employee-commitment 10. Creating self-respect in the hospital employees. 11. Training and development

Effectiveness of this methodology is evident from the responses of the employees to our questionnaires and interviews. Compared to the performance of the private Hospitals, the position of state hospitals leaves much to be desired. The following summarize data will support this opinion.

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B. Statistical Results & Findings


(i) Hypothesis Test Results This comparison of the public and private hospitals has been carried out. According to our hypothesis, effective utilization of human resource management brings about efficiency and effectiveness among employees as well as organization, and an element of association emerges between the two groups. The alternative hypothesis is that the said two groups do not have association. On the basis of our hypothesis, which is sufficiently supported with evidence, we conclude that there is no association between the two groups. In private hospitals 95.5% employees reported HRM to have been effectively utilized. The lack of potentiality and capability in employees creates mismanagement in hospital; we have significant evidence to prove our hypothesis and conclude that in private hospitals, 46.1% employees reported that lack of capability in employees created mismanagement in the hospital while, 77.3% private employees concluded this aspects happen sometimes. (ii) HRM and Efficiency & Effectiveness HRM works on exploring the importance of efficiency and effectiveness in hospitals. In this regard, too, on the basis of significant evidence to prove ourhypothesis, we conclude that there is no association between the two groups, and 59% private hospital employees said that HRM is important for efficient and effective working of a hospital.

(iii) Understanding of Employees The hospitals are engaged in efforts to improve the understanding of employees so as to enhance their productivity. However, there is no association between the employees of public and private hospitals. Private hospitals employees (66.7%) relate that hospital tries to improve understanding of employees to increase productivity. (iv) Employees' motivation & promotion policies There is a difference between two organizations. Private hospitals adopted fair promotion policies, while public hospital employees were not satisfied with the promotion policies of their hospitals.

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(v) Incentive schemes for Employees Private hospitals always provided beneficial incentive schemes to their employees, while public hospitals did not do so.Hospital employees get encouraged by restructuring of their salary set up. Private management have restructured the employees' salaries, but public hospitals have not. (vi) HRM Utilization for increased Effectiveness & Efficiency As per study, 75% private hospital employees' opinion was that HRM increased efficiency and effectiveness, while 24.9% public hospital employees agreed that HRM increased efficiency. Today's organizations and employees are becoming more empowered so hospitals redesign its practices to meet their needs. Private hospitals gave more empowerment to their employees as compared to public health hospitals. 200 private hospital employees (65.8%) said that workers wanted their pay on the basis of their performance, while 34.2% public hospital employees responded that it was not necessary. According to 52. 5% public hospital employees bonuses were more effective motivation tool than increased salaries, while 47,5% private hospitals employees agreed with this opinion.

(vii) Participative management in hospitals Participative management has not succeeded in hospitals. Private hospital employees (63.3%) said that participitative management succeeded in hospitals while 36.7% public hospitals respondents said that participitative management was good for success. Out of 104 private employees (58.8%) said that safety had often been managed effectively, 70.3% said that safety was not managed effectively, while 41.2% public hospital employees said that safety was often managed effectively.

(viii)Communication System in Hospitals The communication system performs effectively in hospitals. In private hospitals, communication system works effectively as compared to public hospitals.

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(x) Use of New Technology The implementation of new technology reduces the number of jobs. Private hospital employees (74.5%) said that the implementation of new technology has reduced the number of jobs, while 25.5% public hospital employees said that it has not reduced the number of jobs. The two state hospitals, the LRH,KTH In both there is no human resource management to speak of. Both are run by the government rules and regulations in all matters and are not autonomous. To be more exact, these hospitals are run like some ministerial office or department. As far human resources are concerned, the personnel are governed by the various government rules e.g.. Establishment Rules, Efficiency and Discipline Rules, etc. These rules and regulations do specify punishments for misdemeanors. But as for rewards, which encourage workers to do better and better, these rules offer no encouragement. The only rewards, if they can be so lubricated, are the annual increment and, the occasionally promotions. There are no fiscal awards save very occasional advance increments or an allowance, furthermore jobs-descriptions are sketchy and procedures are neither uniform nor efficient. Human relations are, by and large, a matter of individual choice or whim; the organization takes practically no measures to support such relations.

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C. Measures Proposed
All the facts and observations give us to reach the following conclusion: 1. There is an immediate need of the governance shift from the traditional administration to modern management, incorporating human resource management, in the interest of better governance and greater public good. 2. The state (or public) hospitals should have greater autonomy in decision and policy making and the administrative over-burden which means that various ministries, secretariats and directorates should be lessened of this burden to a feasible and practical level. 3. The public and the private health-care intuitions ought to have a closer cooperation between themselves. An assessment need to be carried out of the feasibility of local' governing bodies for state hospitals for the healthcare services point of view instead of from the economy point of view alone. There should be a revision of the services rules and conditions in state hospitals in order to incorporate HRM practices. In this regard, depending upon its size, there should be a human resource department or section in each state hospital and only an HRM professional should head such departmental section. 4. At the highest level, particularly in the healthcare sector, human resource management should form an integral part of national planning. It is believed that performance of the healthcare sector of Pakistan can be greatly improved and enhanced through a proper implementation of the proposed measures.

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Health Human Resources Planning: An Examination of Relationships among Nursing


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Appendix-1

Questionnaire Section No 1 -Answer the following questions: 1 What is the purpose and objectives of HR department in your hospital? ____________________________________________________________________ ___________________________________ 2 Why human resource planning is necessary in a hospital? ____________________________________________________________________ ___________________________________ 3 Are you satisfied with the supervision system of your hospital? ____________________________________________________________________ ___________________________________ 4 What methods do hospitals use to assess their training methods? ____________________________________________________________________ ___________________________________ 5 What motivation techniques are used for employees in your organization? ____________________________________________________________________ ___________________________________ 6 What types of incentives are provided by the hospital to motivate employees to increase profits? ____________________________________________________________________ ___________________________________ 7 What are the drawbacks and weaknesses in your administration system of hospitals? ____________________________________________________________________ ____________________________________ 8 What would be your recommendations for improving quality of human Resource? ____________________________________________________________________ _____________________________________

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Appendix-2

Questionnaire Section No 2 - (Tick the suitable one)

Is the effective utilization of HRM in hospitals can be analyzed? (Always, Sometimes, Never) Does HRM explore the importance of efficiency and effectiveness in hospitals? (Always, Sometimes, Never) Are Employees motivated by adopting fair promotion policies in hospitals? (Always, Sometimes, Never) Employees criticism is encouraged by the hospital management? (Always, Sometimes, Never) Does hospitals provide beneficial incentive schemes to their employees? (Always, Sometimes, Never) Does Hospital employees are encouraged by restructuring their salary structure? (Always, Sometimes, Never)

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Appendix-3

Questionnaire

Section No 3 - (Tick the correct one)

1 2

HRM is effectively utilized in hospitals to increase effectiveness and efficiency. (yes/ no) Do all workers want their pay to be based on their performance? (yes/ no)

3 4 5 6

Do bonuses tend to be more effective motivational tool than increased salary. (yes/ no) Safety has often not been managed as effectively as some other business functions. (Yes/ No) The hospital's health and safety rules provide quality services to employees. (Yes/ no). Does the communication system work effectively in hospitals? (yes/ no)

Does the implementation of new technology reduce the number of jobs. (Yes/ no).

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