Pad 411 - Health Administration

NATIONAL OPEN UNIVERSITY OF NIGERIA
FACULTY OF MANAGEMENT SCIENCES
DEPARTMENT OF ADMINISTRATION
Course Code: PAD 411

Course Title: HEALTH ADMINISTRATION IN NIGERIA
Course Writer: Dr. Joel Adeleke Afolayan

Niger Delta University
Course Editor:
Programme Coordinator: Martha Oruku

(National Open University of Nigeria)
Head of Department: Dr. (Mrs.) Yemisi I. Ogunlela

Dean of Faculty: Dr. Timothy O. Ishola

Course Team
PAD 411 COURSE GUIDE
NATIONALOPENUNIVERSITY OF NIGERIA
©2017 by NOUN Press

National Open University of Nigeria
Headquarters
University Village
Plot 91, Cadastral Zone
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Jabi, Abuja
Lagos Office
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e-mail: centralinfo@noun.edu.ng
URL: www.noun.edu.ng
All rights reserved. No part of this book may be reproduced in any form
or by any means, without permission in writing from the publisher.
Printed 2013, 2017
ISBN:
ii
PAD 411COURSE GUIDE
CONTENTS PAGE
Introduction………………………………………………. iv
Working through the Course…………………………….. iv
Study Units……………………………………………….. iv
Assignment File…………………………………………... v
Textbooks and References……………………………….. v
Tutor-Marked Assignment……………………………….. vi
Final Examination and Grading………………………….. vi
Summary………………………………………………….. vi
iii
INTRODUCTION
PAD 411: Health Administration in Nigeria is a two-credit course for

master's degree programme. Hospitals are the focal point of education
for the health professionals and clinical research necessary for
advancement of health service delivery. It is essential to have a thorough
knowledge not only of the hospital set-up but also of its meaning,
history, classification and peculiar conditions prevailing in hospital
administration before one can undertake the study of its human resource
management.
WORKING THROUGH THE COURSE
You must read through the units and have an in-depth study before
youcan say you are satisfied and that indeed you have completed the
course. Also, you need to read the approved books and any other related
materials prescribed by the university.
Each unit has a tutor-marked assignment which you must do and submit
for continuous assessment. Finally, at the end of the course, you are
expected to write a final examination to test your mastery of the course.
The scores in tutor-marked assignments and final examinations are
added to form your final assessment in the course.
STUDY UNITS
Module 1
Unit 1 Introduction to HEALTH ADMINISTRATION IN

NIGERIA
Unit 2 Hospital Administration
Unit 3 Human Resources Management in Hospitals
Unit 4 Evolution of Human Resources Management and its Role
in Hospitals
Unit 5 Organising the Human Resource Departments in the
Hospitals
Module 2
Unit 1 Manpower Planningin Hospitals

Unit 2 Deciding Workload Ratios and Human Resources Strength
in Various Departments
Unit 3 Training and Management Development I
Unit 4 Training and Management Development II
Unit 5 Wages and Salary Administration
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Module 3
Unit 1 Appraisal of Human Resources

Unit 2 Human Relations and Public Relations in Hospitals
Unit 3 Team Work in Hospitals
ASSIGNMENT FILE
The university will make available your assignment file, which you
must work on; you will submit same to your facilitator for grading.
Remember, the score you make in this assignment is crucial to your
performance in this course so you need to put in your best. This
assignment will attract 30% of the final grade while the final
examination attracts 70% and the total sum is your final grade in the
course.
TEXTBOOKS AND REFERENCES
“A Report of the Commission on University Education for

Administration in Hospitals.” (1954). Washington, DC:American
Council on Education.
Akinyele, D. K. (1999). Principles and Practice of Management in

Healthcare Services. Ibadan: Intec Printers Ltd.
Blaskiston (1956). New Guild Medical Dictionary. New York:

McGraw-Hill.
Dunn, R.T. (2007). Haimann's Healthcare Management. (8th ed.).

Chicago: Health Admin Press.
Ghai, P.N. (1982). "Planned Development in Health in India". Hospital

Administration, Sept. - Dec.
Goyal, R.C. (2006). Hospital Administration and Human Resource

Management. (4th ed.). New Delhi: Prentice-Hall.
Lawrence, A.A. (1990). Management: The Simple Way, American

Management Association. New York.
Leonard, S.R. &Strauss, G. (1985). Managing Human Resources.New

Jersey:Prentice-Hall.
v
Metzger, N. Personnel Administration in the Health Services

Industry.New York:S.P. Medical and Scientific Books.
Peter,D.. (1954). The Practice of Management.New York:Harper and

Bros.
Stoner, J., Edward, F.&Daniel,G. (1966).Management. New Delhi:

Prentice-Hall.
TUTOR-MARKED ASSIGNMENT
There are tutor-marked assignments in this course at the end of each

unit. You are advised to strictly keep to the rules and regulations of the
university in carrying out these assignments. Ensure that your attempts
at answering these tutor-marked assignments are thorough, neat,
readable and concise.
You must read the course guide well so that you understand every bit of
it. Organise your study schedule very well so that you can make
judicious use of your time and materials.
FINAL EXAMINATION AND GRADING
The final examination in this course will be determined by the university

i.e. the time and duration. The examination will be 70% of the course so
it is very important that you study all the units very well as questions
can come out from any unit. It is also important that you find time to
attend the facilitation classes and do your tutor-marked assignments
properly as every area of the course is crucial to your success.
SUMMARY
You must understand that the course is intensive and in order to have
good success, you need to organise your work, study and mind well so
that you are physically, mentally and educationally prepared for the
examination. No doubt, if you heed to these pieces of advice, you will
be confident in approaching the tutor-marked assignments and final
examination.
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MODULE 1
Unit 1 Introduction to Hospital Management
Unit 2 Hospital Administration
Unit 3 Human Resource Management in Hospitals
Unit 4 Evolution of Human Resource Management and its Role in
Hospitals
Unit 5 Organising the Human Resource Department in the Hospital
UNIT 1 INTRODUCTION TO HOSPITAL

MANAGEMENT
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Definition of Hospital
3.2 Nature and Scope of Hospital
3.2.1 Changes in Hospital Organisation
3.3 Classification of Hospital
4.0 Conclusion
5.0 Summary
6.0 Tutor-Marked Assignment
7.0 References/Further Reading
1.0 INTRODUCTION
Hospitals are the focal points of education for the health professionals
and clinical research necessary for advancement of medicine. Thus, the
hospital is one of the most complex of all administrative organisations.
Therefore, it requires a thorough knowledge not only of the hospital set-
up but also of its meaning, history, classification, peculiar conditions
prevailing in hospital administration, etc. before one can undertake to
study its human resource management. It is hoped that the knowledge
acquired in previous courses will be of immediate benefit to you in this
course.
2.0 OBJECTIVES
At the end of this unit, you should be able to:
 define hospital
 discuss the nature of a hospital
 explain the scope of a hospital
 classify hospitals.
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3.0 MAIN CONTENT
3.1 Definition of Hospital
Let us examine a few definitions of the term „hospital‟. The word

„hospital‟ is derived from the Latin word hospitalis which comes from
hospes, meaning a host. The English word „hospital‟ comes from the
French word hospitale, as do the words „hostel‟ and „hotel‟, all
originally derived from Latin. The three words, hospital, hostel and
hotel, although derived from the same source, are used with different
meanings. The term „hospital‟ means an establishment for temporary
occupation by the sick and the injured.
Today, hospital means an institution in which sick or injured persons are

treated.
A hospital is different from a dispensary - a hospital being primarily an

institution where inpatients are received and treated while the main
purpose of a dispensary is distribution of medicine and administration of
outdoor relief.
Dorland’s Illustrated Medical Dictionary defines a hospital as:
an institution suitably located, constructed, organised, staffed to

supply scientifically, economically, efficiently and unhindered,
all or any recognised part of the complex requirements for the
prevention, diagnosis and treatment of physical, mental and the
medical aspects of social ills; with functioning facilities for
training new workers in many special professional, technical and
economical fields, essential to the discharge of its proper
functions and with adequate contacts with physicians, other
hospitals, medical schools and all accredited health agencies
engaged in the better-health programme.
A hospital in Steadman’s Medical Dictionary is defined as:
an institution for the care, cure and treatment of the sick and
wounded, for the study of diseases and for the training of doctors
and nurses.
Blackiston’s New Gould Medical Dictionary (McGraw-Hill, New York,

1959, p. 560) describes a hospital as an institution for medical treatment
facility primarily intended, appropriately staffed and equipped to
provide diagnostic and therapeutic services in general medicine and
surgery or in some circumscribed field or fields of restorative medical
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care, together with bed care, nursing care and dietetic service to patients
requiring such care and treatment.
According to the Directory of Hospitals in India. (1988):
a hospital is an institution which is operated for the medical,

surgical and/or obstetrical care of inpatients and which is treated
as a hospital by the central/state/government/local body/private
and licensed by the appropriate authority.
A close analysis of the above definitions reveals that no single definition

is perfect in defining a modern hospital and its multifarious services.
Dorland‟s definition is comprehensive but fails to visualise rehabilitative
and follow-up aspects. Steadman‟s definition is very simple and to a
great extent, highlights all the essential services. The definition given in
the Directory of Hospitals in India is also very simple but too short to
cover all the aspects of a hospital.
On the basis of the above definitions, we can evolve a comprehensive

definition of a hospital, highlighting all the essential services provided
by a modern hospital:
A modern hospital is an institution which possesses adequate

accommodation and well-qualified and experienced personnel to
provide services of curative, restorative and preventive character
of the highest quality possible to all people regardless of race,
colour, creed or economic status; which conducts educational and
training programmes for the personnel particularly required for
efficacious medical care and hospital service; which conducts
research assisting the advancement of medical service and
hospital services and which conducts programmes in health
education.
Modern hospitals are open 24 hours a day. Their personnel render

services for the cure and comfort of patients. In the operation theatre,
skilled surgeons perform lifesaving surgeries. In the nursery, newborns
receive the tender care of trained nurses. In the laboratory, expert
technicians conduct urine, stool and blood tests, vital to the battle
against disease. In the kitchen, cooks and dieticians prepare balanced
meals that contribute to the patient‟s speedy recovery.
A hospital aims at the speedy recovery of patients. That is why its rooms
are equipped with air-conditioners, call-bells and other devices. Several
hospitals have libraries which provide books for the patients. The
telephone keeps the sick in touch with their friends and relatives. In
most hospitals today, patients have newspaper and barber services in
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their rooms. Many hospitals, keeping in view the recreation needs of

their patients, have provided televisions and radio sets in their
rooms/wards. To save the precious time of the medical staff, secondary
duties, like explaining the diagnosis and line of treatment to the patients
and their attendants, are entrusted to another section of the staff called
„medical social workers‟. In hospitals, therefore, the endeavour is to
provide the best possible facilities to the patients within the hospital‟s
resources.
3.2 Nature and Scope of Hospital
Human beings make a society. Healthy human beings make a healthy

society. However, every society has its share of unhealthy human
beings. Illness disease and invalidity may be a curse for society; but
their victims certainly are not. They are as much a part of society as the
healthiest of individuals.
In the past, an individual afflicted by a wound or disease was

condemned to suffer and fend for himself. In those primitive days, the
healthy never assisted or looked after the afflicted. The practice was to
consider such an afflicted person a spent-force and no longer useful to
society. Thus, complete isolation from society was the tragic lot of one
who fell ill. No attempt was made to ascertain the causes and suggest
cures for ailments. The belief, then, was that illness was caused either by
evil spirits or was a punishment for one‟s misdeeds. Later, the „tribe‟
assumed the responsibility of looking after the sick who were considered
victims of a magic spell, by appeasing or scaring away the evil spirits
with a counter-curse.
As civilisation advanced from the individual to the family, from family

to the tribe and finally to the organised community, society
acknowledged a common responsibility towards the sick. It was only
when civilisation progressed that man sought to provide for the welfare
of his fellow beings (other than his own kith and kin).
Illness creates dependency. The sick need medical treatment, nursing

care and shelter. With the advent of the modern society, the institution
developed to cater to the needs of the sick was the hospital.
3.2.1 Changes in Hospital Organisation
As far as voluntary hospitals are concerned, many religious groups ran

family-style, mission-oriented service centres for the sick. As these grew
into larger and larger modern institutions, the outward and inward
pressures to adapt to the changes in society became evident.
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In spite of various reports submitted by the different committees,

modern hospitals in India have, for the most part, been organised along
British lines with strict hierarchical structure. Government hospitals
have to face increasing bureaucratic difficulties at different levels before
goods and services are received. Traditionally, the Medical Director or
Medical Superintendent is the head of the organisation with the matron
handling the nursing staff, maintenance, house-keeping, linen and other
non-medical departments. There are delays, frustrations and
inefficiencies as revealed by the discussions held with the heads of
various government and semi-government hospitals and in hospital
seminars. The unhealthy growth of trade unions in hospitals has only
added to the difficulties.
During the past three decades, the organisation of hospitals in India has
come in for severe criticism, as is reflected by increasing labour protests
of all kinds and rising public sentiment voiced against existing medical
conditions. Hospitals today are straining under the yoke of a type of
organisation more suited to a previous century. The changing times and
needs of today should be the basis for a suitable system of organisation.
Organisational change is a requisite for organisational improvement and
only a planned change is likely to be effective. Increasing specialisation
is leading to fragmentation. Functional specialisation must give way to
interfunctional integration to maintain organic harmony.
With the increasing complexity of medical care and acceptance of the

hospital as a service, adjunct services to supplement the usual medical
and nursing care are to be developed. These involve medical social
work, linen and laundry management, nutrition, housekeeping, medical
record technology, medical laboratory technology, hospital accounting,
physiotherapy and more complex record and business procedures. As
modern hospitals have to perform more complex functions, employ
highly skilled personnel and provide better facilities, their organisations
have grown increasingly complex and their operations more costly.
These consequences, interacting with or affected by developments
outside the hospital have, in turn, led to new phenomena and situations,
namely, the appearance of hospital administration and human resource
management as professions, the advent of voluntary pre-payment plans
for hospital service and medical care, and a more prominent role of
government, at all levels, in the hospital field, especially in the
construction and financing of hospitals. While similar pressure for social
change has resulted in several industrial concerns in India attempting to
change from the hierarchical organisation to the functional model, there
has been little or no realisation in the hospital organisations of this need
to change.
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3.3 Classification of Hospital
Hospitals have been classified in many ways. The most commonly

accepted criteria for the classification of the modern hospitals are: (a)
length of stay of patients (long-term or short-term), (b) clinical basis,
and (c) ownership control basis.
Classification according to ownership/control
On the basis of ownership or control, hospitals can be divided into four

categories, namely, public hospitals, voluntary hospitals, private nursing
homes and corporate hospitals.
Public hospitals: Public hospitals are those run by the Central

Government, state governments or local bodies on non-commercial
lines. These hospitals may be general hospitals or specialised hospitals
or both. General hospitals are those which provide treatment for
common diseases, whereas specialised hospitals provide treatment for
specific diseases like infectious diseases, cancer, eye diseases,
psychiatric ailments, etc. General hospitals can diagnose patients
suffering from infectious diseases, but refer them to infectious disease
hospitals for hospitalisation, as general hospitals are not licensed to treat
infectious-diseased patients.
Voluntary hospitals: Voluntary hospitals are those which are

established and incorporated under the Societies Registration Act, 1860
or Public Trust Act, 1882 or any other appropriate Act of the Central or
state government. They are run with public or private funds on a non-
commercial basis. No part of the profit of the voluntary hospital goes to
the benefit of any member, trustee or to any other individual. Similarly,
no member, trustee or any individual is entitled to a share in the
distribution of any of the corporate assets on dissolution of the
registered society. A board of trustees, usually comprising prominent
members of the community and retired high officials of the government,
manages such hospitals. The board appoints an administrator and a
medical director to run such voluntary hospitals. These hospitals spend
more on patient care than what they receive from the patients. There is,
of late, a trend among voluntary hospitals to charge reasonably high fees
from rich patients and very little from poor patients. Whatever they earn
from the rich patients of the private wards, spend on the patients of
general wards. However, the main sources of their revenue are public
and private donations and grants-in-aid from the Central Government,
the state government and from philanthropic organisations, both national
and international. Thus, voluntary hospitals run on a „no profit, no loss‟
basis.
xii
Private nursing homes: Private nursing homes are generally owned by

an individual doctor or a group of doctors. They admit patients suffering
from infirmity, advanced age, illness, injury, chronic disability, etc., or
those who are convalescing, but they do not admit patients suffering
from communicable diseases, alcoholism, drug-addiction or mental
illness. There is, however, no uniform definition for nursing homes. The
phrase may refer to out-of-home care facilities that offer a range of
services similar to many found in a hospital. These nursing homes are
run on a commercial basis. Naturally, the ordinary citizen cannot usually
afford to get medical treatment there. However, these nursing homes are
becoming more and more popular due to the shortage of government
and voluntary hospitals. Secondly, wealthy patients do not want to get
treatment at public hospitals due to long queues of patients and the
shortage of medical as well as nursing staff leading to lack of medical
and nursing care.
Corporate hospitals: The latest concept is of corporate hospitals which

are public limited companies formed under the Companies Act. They
are normally run on commercial lines. They can be either general or
specialised or both.
Classification according to length of stay of patients
A patient stays for a short-term in a hospital for treatment of diseases

such as pneumonitis, appendicitis, gastroenteritis, etc. A patient may
stay for a long-term in a hospital for treatment of diseases such as
tuberculosis, cancer, schizophrenia, etc. Therefore, a hospital may fall
either under the category of long-term or short-term (now known as
chronic-care or acute-care hospital respectively) according to the disease
and treatment provided.
Classification according to clinical basis
A clinical classification of hospitals is another basis for classification of

hospitals. Some hospitals are licensed as general hospitals while others
as specialised hospitals. In a general hospital, patients are treated for all
kind of diseases such as pneumonitis, typhoid, fever, etc. but in a
specialised hospital, patients are treated only for those diseases for
which that hospital has been set up, such as heart diseases, tuberculosis,
cancer, maternity, ophthalmic diseases, etc.
Classification according to directory of hospitals
The Directory of Hospitals in Nigeria lists the various types of hospitals

and the types of management.
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Types of hospital
(i) General hospital: All establishments permanently staffed by at

least two or more medical officers, which can offer in-patient
accommodation and provide active medical and nursing care for
more than one category of medical discipline (e.g. general
medicine, general surgery, obstetrics).
(ii) Rural hospital: Hospitals located in rural areas permanently staffed
by at least one or more physicians, which offer in-patient
accommodation and provide medical and nursing care for more
than one category of medical discipline (e.g. general medicine,
general surgery, obstetrics).
(iii) Specialised hospital: Hospitals providing medical and nursing care
primarily for only one discipline or specific diseases (e.g.
tuberculosis, ENT, eyes, leprosy, orthopaedic, paediatrics,
gynaecological, cardiac, mental, cancer, infectious disease and
venereal diseases). The specialised departments, administratively
attached to a general hospital and sometimes located in an annex or
separate ward, may be excluded and their beds should not be
considered in this category of specialised hospitals.
(iv) Teaching hospital: A hospital to which a college is attached for
medical/dental education, nursing education and other allied health
professions.
(v) Isolation hospital: This is a hospital for the care of persons
suffering from infectious diseases requiring isolation of the
patients.
Types of management
(i) Federal government of Nigeria: All hospitals administered by the

government of India, viz. hospitals run by the railways,
military/defence, mining, or public sector undertakings of the
federal government such as teaching/specialist hospital.
(ii) State government: All hospitals administered by the state
government authorities and public sector undertakings operated by
state such as state university teaching hospitals, specialist
hospitals, general hospitals, comprehensive health centres.
(iii) Local bodies: All hospitals administered by local governments, viz.
the rural and basic health centres (primary health care centres),
dispensaries.
(iv) Private: All private hospitals owned by an individual or by a
private organisation.
(v) Voluntary organisation: All hospitals operated by a voluntary
body/a trust/charitable society registered or recognised by the
appropriate authority under federal/state government laws. This
includes hospitals run by missionary bodies and cooperatives.
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(vii) Corporate body: A hospital ran by a public limited company. Its

shares can be purchased by the public and dividend distributed
among its shareholders.
4.0 CONCLUSION
This introductory unit looked at three specific areas to give the

background of the course such as definition of hospital, nature and scope
of a hospital, changes in hospital organisation and different
classifications of hospitals.
5.0 SUMMARY
The hospital is one of the most complex of all administrative

organisations. Therefore, it requires a thorough knowledge not only of
the hospital set-up but also of its meaning, history, classification,
peculiar conditions prevailing in hospital administration, etc. before one
can undertake to study its human resource management.
6.0 TUTOR-MARKED ASSIGNMENT
How can the hospital be classified?
7.0 REFERENCES/FURTHER READING
Akinyele, D.K. (1999). Principles and Practice of Management in

Healthcare Services. Ibadan: Intec Printers Ltd.
Blackiston’s New Guild Medical Dictionary. (1956). New York:

McGraw-Hill.
Dunn, R.T. (2007). Haimann’s Healthcare Management. (8th ed.).


xv
UNIT 2 HOSPITAL ADMINISTRATION
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Distinction between a Hospital and an Industrial Organisation
3.2 Functions of the Hospital
3.3 Hospital Ethics
3.4 Challenges to Hospital Administration
3.5 Conditions Peculiar to Administrative Work in Hospitals
3.6 Role of Hospital Administrators in Legal Matters
3.7 Counselling as a Tool in Hospital Administration
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
This unit will be delving into hospital administration, what it means

distinction between a hospital and an industrial organisation, functions
of the hospital, hospital ethics, challenges to hospital administration,
conditions peculiar to administrative work in hospital, role of hospital
administrators in legal matters and counselling as a tool in hospital
administration. You are getting deeper into the journey of this course, I
am sure your knowledge will increase and it would be an academic
journey of note. Happy reading.
2.0 OBJECTIVES
 differentiate between a hospital and an industrial organisation

 state the functions of the hospital
 explain hospital ethics
 enumerate some conditions peculiar to administrative work in
hospitals
 list the role of hospital administrators in legal matters
 discuss the role of counselling in hospital administration.
xvi
3.0 MAIN CONTENT
3.1 Distinction between a Hospital and an Industrial

Organisation
Though hospitals have been compared to industries, there is a distinct

difference. The product of a hospital is service to people provided by its
personnel with a variety of skills. The nature of the demand for hospital
services is also distinctive to the hospital - as admission to the hospital
for services is rarely voluntary. The decision is made for the patient; he
is ill and requires services which cannot be provided at home.
The patient leaves home, family, friends, his workplace, his way of life
for a new environment i.e. the hospital. In this new environment, he
becomes one of many. In his home, he has a definite role. In the
hospital, his role is similar to 30 or 40 others in the ward or unit in
which he is a patient. If he is a patient in a multiple-bed unit and
confined to bed, he is housed with strangers and carries out several
intimate functions in the presence of these strangers. He is subjected to a
new set of values and a new way of life. In his environment, he meets
many new people, and he is expected to relate and communicate with
them. On occasions, patients encounter more than 30 different hospital
personnel in the room in one day, each performing different functions.
A hospital deals daily with the life, suffering, recovery and death of
human beings. For the direction and running of such an institution, its
administrative personnel need a particular combination of knowledge,
understanding, traits, abilities and skills.
3.2 Functions of the Hospital
Though there are many functions of a hospital, all of them are

subordinate to its main objective and must never be allowed to detract in
any respect from the care given to the sick and injured. Therefore,
generally, the main functions of a hospital can be classified into four:
1. To provide care for the sick and injured: This can be done by
accommodating them according to their physical condition and
financial status. When we talk of physical condition, we mean that
some patients are seriously ill and require admission in intensive
care unit while others are not seriously ill and can be
accommodated elsewhere (e.g. in deluxe room, single room with
AC and without AC, semi-private room and general ward)
according to their financial status. There may be some patients who
may require isolation. In that case, they should be kept in isolated
rooms, but the building should be kept always in a good state of
xvii
repair, pleasing appearance and providing the patient every mental

and physical comfort. In every hospital, there should be sufficient
diagnostic and treatment facilities available such as medical
laboratory, X-ray, ultrasound, MRI and CT scan for diagnosis and
operation theatre for surgery, labour rooms for delivery, nursery for
children, physical therapy for rehabilitation of patients, so that they
may be properly treated.
2. Training of physicians, nurses and other personnel: They
receive their training in both theory and practice in approved
schools and colleges. Therefore, a hospital being a complex and
specialised organisation must employ highly trained personnel so
that they may train others. Particularly in the branch of medical and
paramedical education, different associations/councils play very
important roles. They make surveys of hospitals and accord their
approval. Only these approved hospitals can provide training in
medicine, nursing, dietetics, pharmacy, physiotherapy,
administration, medical social work, medical record library, X-ray
and medical record technology, etc. Capable boys and girls should
be attracted to such courses as a career which offers them fair
remuneration, opportunities for self-development and reasonable
security.
3. Prevention of disease and promotion of health: It is the duty of
the hospitals to cooperate with the government agencies. They can
treat patients of communicable and non-communicable diseases,
notify to the recognised authorities of any communicable disease of
which it has knowledge, assist in vaccination programmes of the
government, etc.
4. Advancement of research in scientific medicine: In light of the
broad social responsibility for maintaining and restoring the health,
it is an important function, but no hospital is permitted to do direct
experiments on patients. It must resort to necessary tests in
laboratories and on animals. They can do so by making observation
of functions of the body in health and in disease but they will have
to maintain clinical record of patients accurately for which they
have to engage qualified and trained medical record technicians
who will preserve the record in such a manner that it can be made
available for study at any time to physicians and surgeons.
3.3 Hospital Ethics
The code of ethics of hospitals goes hand in hand with the code of ethics
of physicians. Both of them are required to follow their ethics to render
care to the sick and injured. As far as the hospital code of ethics is
concerned, it was developed nearly half century ago, but the code of
ethics of physicians has been in existence since the days of Hippocrates
who lived about B.C. 460-377. Today, the code of medical ethics has
xviii
become the fundamental law of the hospital and is applicable to all its
personnel, including the trustees.
The trustees are required to employ a qualified administrator to keep

accurate records, to provide facilities consistent with community needs,
to determine fair policies, to set professional standards and to provide
protection to the patients during their stay in their hospital. There should
be neither solicitation for patients nor undesired publicity of any kind
whatsoever. Similarly, personnel of the various professions and
avocations are required to maintain the dignity and honour of their
profession by discharging their responsibilities to ensure that all patients
receive the best care without any unnecessary delay; secrecy about their
diseases is maintained and they are not harassed in any way.
The major responsibility of the administrator of a hospital is also to

follow the hospital ethics. His relationship with the trustees should be
respectful, refraining from any violation of their confidence. He should
be courteous in dealing with patients and relatives. No administrator of
any hospital can be successful without having cordial relationship with
the medical staff. It is his responsibility to understand their difficulties,
if any, and solve their problems immediately so that they may render
care to the sick and injured to the best of their ability.
The hospital code of ethics clearly states that to render care to the sick
and injured, to impart scientific knowledge to its personnel, prevention
of disease and promotion of health and advancement of research in
health related fields are primary responsibilities of the hospital. Though
the hospital has many functions, but all are subordinate to its above-
mentioned responsibilities and must never be allowed to detract in any
respect. The very personal information given by a patient and
observations made during examination and treatment by the staff of a
hospital should be held as a sacred trust and should never be revealed
except during academic discussions and in a court of law. Modesty of
the patient is very important. No one including the treating physician
and the nurse has the right to expose the patient unnecessarily. Violation
of this rule means the loss of confidence of a patient in the hospital staff.
Therefore, each and every hospital personnel including the physician,
nurse, laboratory and X-ray technicians, physiotherapists and others
should avoid all those acts which would lead to the loss of trust of the
patient because whatever patient tells, he does so in good faith and
expects that all the information will be kept secret and used only for
treatment purpose. Therefore, it is for practical reasons that sincerity,
reliability, sobriety and calm/balanced temperament are required of
those who are caring for the sick and injured, otherwise, the hospital
may lose its respect not only in the eyes of the patient but also of the
community because each patient belongs to one community or the other.
xix
Thus, the hospital code of ethics acts as a lighthouse and fixes the
responsibility on all those including trustees, administrator, medical
staff, administrative staff and other personnel of the hospital who have
anything whatsoever to do with the care of the patient to make every
effort to ensure that all patients receive the best possible care with
minimum delay, with utmost skill and efficiency and with the greatest of
personal consideration. They should also extend every courtesy and
consideration to any visitor of the hospital. They should maintain
secrecy with regard to information of a personal nature received from
the patient during the course of treatment. They should not ask for any
compensation or reward from any patient.
Thus the human resource development manager should exercise due

care in the selection of personnel who can meet the requirements of the
positions they occupy and should provide salaries and conditions of
service which are commensurate with their qualifications, experience
and status so that they may provide efficient and effective service to the
patients of the hospital where they work and may not violate hospital
ethics by indulging in unethical activities.
3.4 Challenges to Hospital Administration
Challenges to administrative abilities have come from within the health

field as well as from the public: For instance, from (a) business and
professional leaders who were initiated into the hospital scene as
trustees of voluntary hospitals; (b) the large number of physicians who
comprise the medical staff of today‟s hospital and who are especially
concerned about the facilities and services available for the care of their
patients; (c) professional organisations which prescribe various
standards of hospital operation while granting approval to the hospitals;
(d) academicians who are concerned about matching what they teach
with the requirements of the patients and hospital administrations; (e)
labour demanding standards of employment and working conditions at
least equal to if not better than those prevailing in other industries; and
(f) trustees of the trust hospitals, members of Registered Society
Hospitals, shareholders of Corporate Hospitals, and others who have
been their own masters and have been operating with no restraints so far
will have to face increasing professionalism threatening their power and
existence.
These professionals will bring professionalism in running the hospitals,

meaning thereby decentralisation in decision making and strategic
management to survive in the society. No Chief Executive Officer
(CEO) of any hospital will be able to run his hospital without collecting
xx
sufficient funds from his patients rather than from trustees, society
members, shareholders, philanthropists, etc.
Of late, a new challenge is that of being environment friendly. When the

international focus is on a safe environment, hospitals which do not pay
enough attention to this sensitive issue will be eliminated from the
community either through enforcement of legal regulations or
customers‟ boycott. This has already begun in the West and will
certainly happen here too, perhaps within the next five to ten years.
It should be remembers that creditability and effectiveness are mutually

dependent and proportional. The CEO of a hospital must guard his
creditability at all cost. He must be able to provide latest technology and
vision. He should push for change when it is required in the interest of
the patients, employees and the community at large.
The CEO of a hospital will have to serve as a catalyst for relationship

building between patients and employees, government agencies and his
hospital and between hospitals and his own hospital.
It is also important for the hospital‟s CEO to be a business practitioner

first and then a technologist. His responsibilities include executive
communication, budgeting, building relationships, management,
problem solving, etc. In order to take care of these responsibilities, a
successful CEO must develop sharp business acumen.
Above all, as a CEO of a hospital, he is primarily responsible to

facilitate and communicate the hospital‟s philosophy and vision. This
means that he is the key provider of the hospital‟s philosophy and vision
to the patients, employees, government agencies and community at
large.
The administrators of earlier hospitals usually were nurses who

combined their nursing tasks with the performance of supervision of
supply of linen, feeding of patients and housekeeping. As the medical
aspects of hospital service became more complex, physicians became
administrators. Some Christian hospitals place priests, ministers and
particularly sisters in administrative positions.
However, as hospital affairs grew more complicated, some boards of

trustees chose men and women from other related fields as
administrators. Gradually, skilled administration has come to be
recognised as vital for the effective functioning of a hospital in its
efforts to fulfill its greater responsibilities to the community, to the
health field and in its need to adjust to varying social and economic
changes.
xxi
3.5 Conditions Peculiar to Administrative Work in Hospitals
The modern world consists of industrial, commercial, governmental,

educational, health and military organisations of increasing size and
complexity. Moreover, significant changes have taken place in the
social, economic and political institutions, which have made the art of
management so complex as to require a considerable degree of
specialisation. The kind of institution, its size, environment and other
variations create radically different types of situations and problems of
administration. While the science of administration is common to all
institutions, the art of its application requires a wide and varied
knowledge and a varying degree of emphasis on particular
administrative skills.
A hospital obviously has many organisational and operational elements

in common with hotels, industrial organisations and educational
institutions. However, a hospital is a unique institution as it includes all
activities present in each of the above-mentioned groups. The difference
between administrative work in hospitals and in other organisations can
be attributed to the existence of the following conditions peculiar to
hospitals:
1. The consumers of the services provided in a hospital (the patients)

are physically or mentally ill and are rendered services within the
four walls of the hospital. As compared with most other
institutions of business, government and education, this is an
unusual situation and presents quite different problems of
management.
2. The customers of the hospital (the patients) have individual needs
and require highly personalised and custom-made services. The
diagnostic, therapeutic and preventive services provided by
physicians, nurses and technicians, with the aid of expensive and
specialised equipments and medication are tailored to the needs of
each individual customer.
3. In addition to the more common institutional services and
functions such as food preparation, general housekeeping, laundry,
maintenance, purchasing, personnel, credit and collection and
public relations, the hospital also provides a wide range of
scientific and technical services such as nursing, diet therapy,
anesthesiology, pharmacy, radiology, clinical laboratory,
physiotherapy and medical social work. Also, many of its services
are provided continuously, round the clock, every day of the year.
4. All these services involve many individuals-the ill customer
himself, his emotionally tense relatives and friends, physicians,
technologists, clerks and manual labourers. These individuals who
are working, suffering, eating and sleeping within a comparatively
xxii
small space and in an unusual atmosphere, highly charged with

emotion and tension. Only a very capable administrator can
adequately understand and effectively deal with the human
relations problems arising from these constraints.
5. Nurses and certain other personnel must accept direction from both
the matron and the physicians under whom they work closely
every day. The human relations problems in such situations of dual
authority are much more frequent, delicate, varied and complex
than in organisations where this situation does not exists.
6. Handicapped by low wages, rigid discipline and some
apprehension of exposure to disease, hospital personnel are
expected to maintain a very high level of efficiency, as their
functioning affects the lives of patients.
7. Another way in which the responsibilities and activities of the
hospital administrator differ from his counterpart in other fields is
in the amount and variety of training programmes that the hospital
has to provide. Training is provided for medical interns and
residents (six months to one year), nurses (three to four years), X-
ray technicians (two years), medical laboratory technicians (two
years), physiotherapists (four years), pharmacists (two years),
medical social workers (two years), dieticians (two years), nurse
aides and nursing orderlies (one year). Classroom, clinical and
apprenticeship training methods are used in varying combinations.
The administrator is responsible for planning and operating these
various training programmes. Very few other types of institutions
combine such major educational responsibilities with other
operating activities.
8. Just as administration in hospitals differs from that in most other
fields, similarly, public relations aspects and problems of hospitals
are more pervasive, delicate and volatile. The human elements-the
consumers (patients), producers of care and services (doctors,
nurses and other personnel), the variety of community health
agencies, the other competing hospitals, the people in the
community (relatives and friends of the patients) - and the
conditions and environment in which they are brought together
(the hospital), present public relations problems of a sort and
variety vastly different from those of most other institutions.
9. The efficiency and quality of health care services in any hospital is
directly dependent on the use of bio-medical equipments in
diagnosis, surgery and therapeutic process. These equipments
invariably employ sophisticated technology made of complex
systems. Hence, the problem of maintenance and management of
these bio-medical equipments is complex because there is acute
shortage of technical hands who have suitable and adequate
training in the maintenance and repairing of these specialised hi-
tech equipments. At times, spare parts and components are not
xxiii
available because the models of these equipments undergo frequent

change. Next, the local dealers in India by and large do not provide
worthwhile after sales service or repair. The poor hospital
administrator is in a fix whether to go for hi-tech bio-medical
equipments or use conventional methods of treatment. If he opts
for the first, he either discards these equipments one after another
in view of the above mentioned factors or enhances the cost of
treatment. If he does not opt for hi-tech biomedical equipments, he
loses his clientele.
10. The introduction of Consumer Protection Act, 1986 and
subsequently, the Supreme Court judgment bringing doctors under
the purview of this act have evoked diverse reactions. While the
public is happy about what they call a long overdue judgment, but
the doctors and hospital administrators are not happy as at all as it
will worsen the patient-doctor relationship and surely increase the
cost of treatment. The poor hospital administrator will have to
attend consumer courts for no rhyme or reason in most of the cases
as the patients are not only misled by advocates, but the consumer
courts issue notices to doctors and hospitals without understanding
the nature of complaints filed by patients. In other institutions,
such as hotel or industry chief executives can explain to the
advocate, in their office, the line of defence to be taken in the
consumer courts before the trial begins, but in case of hospitals,
their hospital administrators will have to stand by the side of their
advocates to explain each step taken in the treatment of patients by
doctors, as neither the advocates nor the judges of the consumer
courts possess any medical expertise.
11. Hospital waste management is another peculiar condition to
administrative work in hospital and has become a burning issues
these days for hospital administrators, as increased awareness of
health and its related problems amongst the general public has led
to the demand for comprehensive health care facilities which in
turn require frequent visits to hospitals by the patients to undergo
various tests. This results in the escalating amount of hospital
waste generation in the environment. This hospital waste is not like
domestic waste, but a potentially hazardous waste. Its unscientific
disposal can pose serious problems to the public in general and the
hospital administrator in particular, as it results in increased
morbidity due to chemical and radioactive toxicity in the
environment and transmission of various diseases. The
conventional waste disposal method does not work at all. Hence
the hospital administrator faces another peculiar problem what is
not faced by a chief executive of a business organisation or a hotel
in disposing of the waste of their institutions.
xxiv
These peculiarities of hospital administration call for a high degree of

professional competence to do justice to the job. It is, therefore, obvious
that hospital administration should be entrusted to those who have the
necessary training and the right kind of attitude to perform this vital
task.
3.6 Role of Hospital Administrators in Legal Matters
Though all hospital administrators are not qualified legal persons yet
they are supposed to possess sufficient knowledge of the Indian laws to
be able to take decisions on legal matters. For example, if he wants to
terminate a contract with the contractor who is building a particular
portion of the hospital building he needs to have knowledge of the
Nigerian Contract Act. Similarly, if he wants to terminate services of an
employee, he should know the provisions of the Industrial Employment
Standing Orders Act, the Industrial Disputes Act and the principles of
natural justice. No doubt he is briefed by the law officer of his hospital
before he takes decision on any legal matter, but he is still required to
have some knowledge of the laws. Secondly, all hospitals cannot afford
to engage full time law officers or retain part time legal advisors. It is
the hospital administrator who keeps the reign of legal kingdom in his
hand in small and medium size hospitals and decides all matters rightly
or wrongly on the basis of his knowledge and common sense. Thirdly,
the hospitals are no longer immune to legal suits due to reinduction of
the Industrial Disputes Act, 1947 and application of the Consumer
Protection Act, 1986. These acts have made employees as well as
patients more conscious about their rights and privileges and they expect
better working conditions and services from the hospital administrator.
Thus the hospital administrator has crucial role to play in legal matters
these days.
CEO’s vision to improve hospital services
What does a hospital employee want from his job? Money, security and
career development can be high on the list for most of them, but Mike
Rudd, Logistics Director at Bulmers, says that what really motivates
employees is sharing the CEO‟s vision. Though it sounds odd, with the
new world of independent and short stay of personnel, it is true. The
CEO should communicate his vision about the hospitals as well as
involve the employees at every step. They should be invited to give their
views and discuss how they would work towards the vision. It would be
easy to say that such as activity is nothing more than a paper exercise,
but it can be very productive and useful because each individual‟s job
contributes towards achieving the vision. The process should entail
remaining firmly focused on the CEO‟s vision in conversations and
meetings. Thus, one can defuse difficult situations very quickly by
xxv
understanding where the personnel are, why they are there and where
they need to go next so that everyone in the hospital begins to work in a
better way and the vision of the CEO becomes the vision of each and
every employee of the hospital.
The focus should be on people first and always on caring rather than
managing. The following approach works in good as well as bad times:
1. Share the vision with high and low personnel leaving no place for
suspicion.
2. Share even confidential information, personal hopes and fears to
create a common vision and promote trust.
3. Seize every opportunity such as open doors, management by
walking around, networks, etc. to make a point, emphasise values,
disseminate information, share your experience, express interest
and show your care and concern.
4. Recognise performance and contribution of your personnel.
5. Use incentive programmes whose main objective is not
compensation but recognition.
3.7 Counselling as a Tool in Hospital Administration
No institution can be more sensitive than a hospital because it deals with

life and death of its patients. A slightly indifferent attitude on the part of
the employees in a factory can reduce production, which can well be
made-up once they reach an amicable settlement with the management.
But this is not so in a hospital. If a patient dies due to indifference or
work-to-rule attitude on the part of the hospital employees, there can be
no making up thereafter. Therefore, no hospital administrator can afford
to cause resentment amongst his employees; he will have to create a
team of dedicated employees who should serve the patients with smiling
faces directly or indirectly such as employees of nursing service
department or central supply room. To create a team of dedicated
employees, a hospital administrator needs to establish a relationship
with them based upon trust and confidence. While talking to them, he
should not only empathise and be on the same level with them but
sometimes should even communicate something on a very personal
level to understand their problems. Like a counsellor, he not only needs
to deal with their grievances from their stand point but also should listen
to them with genuine and sincere concern. Therefore a hospital
administrator needs to possess the following attitudes:
1. Respect
2. Genuineness
3. Empathy
4. Self-disclosure
xxvi
5. Concreteness
6. Understanding
7. Forgiving
8. Jovial personality
9. Listening
10. Humour
The author strongly advocates that a hospital administrator, like a

counsellor needs to be of a jovial and humorous nature as also forgiving
and religious minded. The aforementioned attitudes will certainly play a
significant role than ever before because health care institutions are
becoming multidimensional and highly specialised day by day. It is
therefore suggested that all hospital administrators should not only be
qualified administrators but they should also be well versed in human
psychology, legal matters and couselling techniques.
4.0 CONCLUSION
We see that special care facilities in hospitals distinguish modern

hospitals from those of the pre-independence era. Today, hospitals are
better known for their specialty and super-specialty services. New
concepts have also been introduced in the management of hospitals, like
day-care services and transfer of specialised diagnostic and therapeutic
services from in-patient to out-patient areas. There is immense scope for
using innovative managerial skill: (a) in running the specialty and super-
specialty services specialty and super-specialty services; (b) to create an
environment for professional excellence for high-quality care; and (c) to
provide services more economically. These functional changes have
necessitated a specific managerial approach. Modern equipment and
facilities call for a specific hospital design and plan. Framing of norms
and standards of programming, designing, equipping and staffing such
special-care services are the need of the day. Special facilities require
professional and managerial skills to optimise the use of available
resources. Hospital administrators have realised now the need for
scientific hospital administration in the running of their hospitals.
5.0 SUMMARY
We have gone through the distinction between a hospital and an

industrial organisation, functions of the hospital, hospital ethics, etc. in
this unit to enrich our learning process. Now, let us attempt answering
these questions.
xxvii
(1) Compare and contrast between a hospital and an industrial

organisation.
(2) Discuss the functions of the hospital.
(3) Why is couselling an important instrument used in the hospital
environment?

Administration in Hospitals.” (1954). Washington, DC: American
Ghai, P.N. (1982). Planned Development in Health in India. Hospital

Administration, Sept.-Dec.

xxviii
UNIT 3 HUMAN RESOURCE MANAGEMENT IN

HOSPITALS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Nature of Human Resource Management
3.2 Assumption of Human Resource Management
3.3 Fundamental Principles of Human Resource Management
3.4 Human Resource Utilisation
3.5 Human Resource Development, Human Resource
Management and Personnel Management
3.6 Characteristics of Human Resource Management
3.7 Functions of Human Resource Management
3.8 Importance of Human Resource Management
3.9 Use of Hi-Tech Machines - An Adjunct to Human Resource
Management
3.10 Human Resource Manager
3.11 Causes for Poor Human Resource Management
3.12 Human Resource Manager‟s Plan
3.13 Human Resource Accounting, Auditing and Research
3.14 Tips for Human Resource Managers in Hospitals
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Over the years, the importance of human factor in the accomplishment

of organisational objectives has increased considerably because of
increasing competition and globalisation of management. Nowadays, the
people at work are considered the most important factor of production in
factories and of service in hospitals from the point of view of
management. There is growing awareness on the part of the
academicians and the professional managers to review management as a
process concerned basically with the management of people because a
tremendous overhaul is under way on the human resource management
front. These days the thrust is on to create a workplace that motivates,
retains and gets the best out of people. Therefore, different organisations
are adopting different strategies. Hewlett Packard India has introduced
new concepts such as flexible time off-an employee can exchange his
weekly off day for any other day to meet his social commitment and or
domestic chores. The Houghes Software Systems has launched an ethics
xxix
programme called „integrity‟ to boost honesty along with productivity.

All employees are encouraged to report any unethical practices they
observe around them. They want everyone to challenge everything that
is wrong in the organisation. Stock options are being increasingly
favoured both as a means of reward and to promote a sense of
ownership that helps organisations in retaining their personnel. In
general electric company, employees are rewarded through shares for
good performance. These shares are usually redeemable after three years
and the employees gain as the value of the shares increases. The
approach seems good but the path to the perfect human resource
management is still slippery. Most organisations encounter teething
troubles because employees sometimes find the new ideas a bit too
radical. Therefore, in the rapidly changing management scenario, human
resource management has an important role to play.
2.0 OBJECTIVES
 briefly discuss the nature of human resource management

 state the assumptions of human resource management
 discuss the fundamental principles of human resource management
 explain what human resource utilisation is
 describe human resource development, human resource
management and personal management
 list the characteristics of human resource management
 enumerate the functions of human resource management.
3.0 MAIN CONTENT
3.1 Nature of Human Resource Management
It is rather difficult to express the true nature of human resource

management. Human resource management is concerned with the
management of people at work. It reflects a new philosophy, a new
approach and a new outlook. The human factor plays such an important
role in the field of management that some people consider human
resource management and management as one and the same thing. As
Appley observes: “Management is the development of people and not
the directions of things.”
3.2 Assumption of Human Resource Management
Human resource management integrates and emphasises on performance

appraisal, career planning, training and development, organisational
xxx
development, systems development, incentives, welfare measures etc.

The important assumptions of the human resource management are that
the members of an organisation are reservoirs of untapped resources, top
management should take the initiative to tap those reservoirs, it should
formulate plans and strategies and create a conducive climate for their
implementation, should develop a culture in which emphasis is mostly
placed on harmonious relationship amongst all members off the
organisation, the thrust should be on self-development of all its
members and finally the members as well as the organisation should be
benefited when the organisation undergoes development. Thus, it
essentially incorporates all those expectations which are not being
fulfilled through the traditional personnel management.
Human resource management openly lays its claim on a fundamentally

different relationship between the organisations‟ employment function
and its strategic role. The assumption lying behind human resource
management is that it is essentially a strategically driven activity which
is not only a major contributor to that process but is a determining part
of it. From this standpoint, the contribution which the management of
the employment relationship makes the overall managerial process is as
vital and informative as that of finance or marketing.
3.3 Fundamental 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. Peter Drucker in his
book, Practice of Management (Heinemann, 1959), wrote. “An effective
management must direct the vision and effort of all managers towards a
common goal.” His concept of a visionary goal-directed leadership is
fundamental to human resource management. While Douglas McGregor
advocated management by integration and self-control. He believed that
a management philosophy needed to be built up, based on attitudes and
beliefs about people and the managerial role of achieving integration.
Thus human resource 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 conducive atmosphere
of working to the employees so that their output is maximum.
xxxi
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.
3.4 Human Resource Utilisation
No organisation can survive for long without proper utilisation of its

human resources. Therefore, it is essential to treat them with dignity as
adults and partners. These fundamental human values can provide a base
for closer ties between management and its personnel. Once both parties
have a clear understanding of each other, industries can have maximum
production and hospitals/hotels can provide best service.
The following steps should be taken to improve the use of human

resources:
1. Improve recruitment, selection and induction programme

2. Increase manpower budget
3. Introduce incentive scheme
4. Start work measurement system
5. Introduce training programmes based on training needs
6. Lay emphasis on new technology
7. Stress on future planning.
Thus, proper human resource utilisation will not only be in the interest
of the organisation but of the nation as well.
3.5 Human Resource Development, Human Resource

Management and Personnel Management
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 primary task for
any organisation. Its survival and growth depend on human resource
development. Organisations have now realised that employees are
xxxii
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 instill 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 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 wholehearted 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 resources. It means that human resource
management includes human resource planning, job analysis, job
design, acquisitions, 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 Flippo, “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.”
Flippo also emphasises that various managerial functions relating to,

procurement and maintenance of people in an organisation comes 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
xxxiii
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, salary
administration, performance appraisal, training, working conditions,
safety, welfare, health services, promotion, transfer, separation,
communication, couselling, 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 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 non-strategic, reactive and preventive.
Human resource management certainly stressed 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 programmes,
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
xxxiv
approach is multidisciplinary from the beginning to the end, is more

comprehensive and deep rooted than training and development.
3.6 Characteristics of Human Resource Management
(i) Human oriented: Human resource management, as the name

suggests, 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. It deals with human
relationship within an organisation. It is the process of bringing
people and organisation together to achieve their goals.
(ii) Development oriented: Human resource management lays stress on
development of employees‟ potential, capacity, interest and their
personality. It helps the employees to get maximum satisfaction
out of their work.
(iii) Pervasive in nature: Human resource management is very wide in
its nature. It is concerned with the management of human resource
of an organisation consisting of all individuals engaged in any of
the organisation‟s activities at any level. Again, human resource
management is pervasive in nature as people are necessary
ingredients in any organisation. The human resource of an
organisation consists of all individuals at all levels. It has wide
coverage. It is not confined to industry alone. It equally applies to
all types of organisations-government, non-government,
educational, social, religious, etc. Moreover, it is not confined to
personnel functions alone but to all the functional areas, i.e.
production, marketing, finance, etc. in factories and nursing,
medical, paramedical, housekeeping, maintenance, etc. in
hospitals.
(iv) Continuous process: Human resource management is a continuing
and never ending process. It flows like a river continuously and is
not stationary like a pool or pond. It cannot be switched on and off
like an electric bulb. It is a constant function of an organisation
whether be it an industry or a hospital.
(v) Multi-disciplinary: Human resource management deals with
human beings which have feelings and emotions too. Therefore, it
is imperative to apply the doctrines of economics, anthropology,
sociology and psychology, etc. to deal with them effectively.
(vi) Developing discipline: Human resource management is a
developing discipline and is of recent origin as compared to the
other specialised functions of management, i.e. productions,
marketing or finances. It made its humble beginning only in the
latter part of the nineteenth century.
(vii) Management oriented: The human resource department operates in
an auxiliary or advisory capacity to other departments in the
xxxv
organisation. It exists to assist and advise the line and operating

managers to do their personnel work effectively.
3.7 Functions of Human Resource Management
Human resource management is a staff function. Human resource

managers advise line managers throughout the organisation.
Furthermore, 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 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
iv. Integration
v. Maintenance
vi. Records and research and
vii. Personnel information system
4. Control
5. Managerial
i. Planning
ii. Organising
iii. Directing and
iv. Controlling.
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.
Staff function: 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
xxxvi
given to them from time to time should be objective and legal; otherwise
it will spoil human relations at work.
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 are other major aspects of human resource
management.
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-à-vis organisational
objectives.”
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
their organisations. They decide in what direction they want their
xxxvii
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 fulfillment 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.
3.8 Importance of Human Resource Management
The importance of human resource management can 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
appraisal.
(iii) Maintaining high morale of workers through incentive schemes,
workers‟ participation in management and proper grievance
handling and redressal policies and procedures.
(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 through various welfare measures.

(ii) Enhancing the dignity of labour through workers‟ participation in
management and treating them as human beings.
(iii) Raising workers morale by giving them opportunities for personal
development and job satisfaction.
xxxviii
For the society
(i) Maintaining good industrial relations and thus minimising loss

caused by frequent strikes and lockouts.
(ii) Increasing productivity through workers‟ participation and
motivation.
(iii) Better utilisation of human resource through proper recruitment,
selection, placement and training.
(iv) Maintaining adequate manpower supply through appropriate
manpower planning and training policies and procedures.
3.9 Use of Hi-Tech Machines - An Adjunct to Human

Resource Management
It is high time for management of all kinds of organisations such as

industries, hotels or hospitals, to make full use of hi-tech machines.
Though these machines may seem costly in some of their areas, yet they
can increase efficiency, save time and reduce human bias to a great
extent. So far as industries and hotels are concerned, their management
accepted hi-tech machines in all areas of their work quite some time
back because they had the financial resources. However, management of
hospitals prefer to utilise hi-tech machines in those areas only where
they can increase the output and accuracy of results such as
physiotherapy, medical laboratory, X-ray department, operation theatre,
laundry, etc; but not in a department like human resource department
where they can work manually. But the fact remains that by using hi-
tech machines in this department as well, hospital management will not
only be increasing the efficiency of human resource department, but also
minimise the human bias factor to a greater extent. For example,
frequently, there are disputes over late reporting on duty between the
time office staff and the employees. Installation of computerised
electronic time recorder to record arrival and departure time of
employees will be of immense use and they will feel that their time has
been recorded correctly. Time keeper will have no dispute over the
attendance data of employees and the department heads also can get
daily information about man-hour employed and lost by their
employees. Thus, not only bias factor and differences which arise in the
minds of employees, department heads, time keepers and human
resource manager will get eliminated, but also daily reports of late
arrival and early departure will have a salutary effect on punctuality and
regularity. Proxy punching by employees can be prevented, data
received from the computerised electronic time recorder when processed
further will produce wealth of information for better manpower planning
and management. Departmental summary of attendance will show to
each department head the available manpower for each shift. Not only
this, all the data required for time office for salary calculation will be
xxxix
available in no time from the computerised electronic time recorder.

Thus, installation of just one such machine can avoid misunderstanding
which is generally caused by human bias factor and at the same time
many reports required by the time office staff, human resource
department and concerned departmental heads can be made available
within minutes without loss of time.
3.10 Human Resource Manager
Every one admits that human resource management being one of the
newest of the arts and sciences is yet to be recognised by the hospitals.
They admit further that human resource management is one of the most
important and complex responsibilities of the hospital administration
where more than 65% of the average hospital‟s total budget is allocated
for pay roll alone. However, one close scrutiny of any hospitals‟ board
meeting, one will find that 40% of the time at these meetings is spent by
the board members discussing finances, 20% buildings and equipments,
15% medical, paramedical and nursing problems, 10% services, 10%
public relations and 5% miscellaneous matters including human
resource management. In spite of the hospital management realising the
importance of the people oriented nature of hospital administration, the
human resource management in hospitals has been too often the victim
of the tendency on the part of some hospital administrators to delegate
some responsibility to human resource managers with one hand and take
it back with the other.
There is no denying the fact that hospital administrators more often than
not burden the human resource managers with additional responsibility
of looking after miscellaneous matters such as hospital transport
management, housekeeping, public relations, etc., besides the main
responsibility of recruitment of personnel. However, in practice, they
have neither considered them an important and integral part of the
administrative team not they have given directions to the line managers
to take seriously the counselling of the human resource managers. In the
absence of the above, the line managers are likely to ignore the human
resource manager and may continue to make decisions about the
personnel of their own. However, if the hospital administrator makes it
clear to the line managers that the advice of the human resource
manager is to be taken seriously, its influence on day-to-day decisions
will grow. However, much will depend on the proficiency of the human
resource manager in giving them helpful counsel without trying to usurp
their power and authority. In short, if the hospital administrator gives
due importance to the human resource manager in the hospital
administration, he (human resource manager) can recommend, counsel
and cooperate with the line managers and they in turn can actually
accept his recommendations and act upon effectively to increase their
xl
efficiency. Only then the hospital administrators can expect from the
human resource managers the production of programmes which afford
employees the opportunity for continued self-development and the
possibility of realising their potentialities.
Though there is a human resource development institute in New Delhi,

yet it has not conducted any survey in hospitals according to some
reliable source of knowledge of information. Therefore, it is difficult to
give a profile of human resource managers based on a study, but the
author will like to share his experience on the basis of his knowledge
that human resource managers have not been employed even in 1% of
the health care institutions in India. However, wherever they have been
employed, they are getting salary between fifteen to twenty thousand
rupees per month on an average; they are postgraduates or diploma
holders either in personnel management or in human resource
management; they possess five to fifteen years of experience to their
credit.
Human resource managers are particularly remembered when the

hospital administration is in trouble either due to strike/demonstration
threat given by the employees/their unions, or en masse resignations
received from the medical/paramedical/nursing personnel, or another
legal threat received from any other corner. Generally, they represent the
smallest department in the hospital. Whenever any replacement or extra
person is required in any department, requisition for recruitment of
personnel duly approved by the hospital administrator is forwarded to
the human resource department, which thereafter is primarily
responsible to notify the vacancy on the employment exchange or to
place an advertisement in the newspapers, conduct interviews and
complete necessary formalities with regard to the appointment.
Human resource manager focuses the attention of the hospital

administrator and the medical superintendent upon the social and
psychological needs of the hospital. He does this by giving sound advice
to them. Therefore, he is to serve them as one of the organisation
leaders. He must be an active member of the top administrative team,
should participate in organisational planning by projecting the
organisation into the future, evaluate the present manpower and develop
programme to improve skills by conducting surveys which indicate
staffing patterns in similar organisations in the regions, and compare
them with his own organisation.
3.11 Causes for Poor Human Resource Management
A few services affect the lives of people directly and intimately as these
are offered by health care personnel. Therefore, effectiveness of the
xli
health care organisation depends upon the effective role performed by

the personnel from top to bottom. However, defective communication
system, reluctance to share information, role ambiguity, absence of
accurate job description, wrong selection of employees, lack of
promotional avenues, poor policies, unattractive salary structures,
management action leading to low morale of its personnel, etc. can also
be the factors for poor human resource management.
There can be four major causes. One is indiscipline, second is high

turnover, the third is poor service by the staff and the fourth is low
morale of its personnel. Therefore, human resource manager is to see
that there is check on all these four causes in his organisation. He should
make sincere efforts to discharge human resource management functions
efficiently and systematically. Care has to be taken to ensure that all the
work processes are carried out consistently and correctly. This will
obviate the necessity of checking and repeating the processes which will
ultimately lead to satisfaction of the patients and they will find no reason
to complain against the services received by them from the hospital
personnel. In most of the health care organisations, however, sincere
efforts will have to be made to reduce the genuine grievances with
regard to poor services rendered to the dissatisfied patients and members
of their families. This will not only add to the patient‟s satisfaction, but
will also reduce the high costs involved in treating them. It shall also go
a long way in reducing to a considerable extent mistakes committed by
the personnel. Thus, it will lead to improved human resource
management.
3.12 Human Resource Manager’s Plan
Manpower planning, identifying the appropriate workforce, training

them to perform well, keeping them motivated to put their best and to
give them the organisation‟s best are all a vital part of contemporary
corporate requirements. The responsibility of the human resource
manager begins with manpower planning and the effective identification
of the right people who would prove to be true assets to the organisation.
So far as identification is concerned, it takes place at two levels:
1. Recruitment of fresh employees who are picked up straight from

educational and training institutes. They should be given on the job
training and placed under the supervision of established
supervisors.
2. In recruiting experienced hands, monitoring and analysing are
important so that they follow the established policies and
procedures of the organisation where they had worked earlier.
xlii
Human resource managers must remember the following five points in

the interest of employees as well as the organisation:
1. Begin with a smile: Human resource programmes and giving due

importance to employees are not to be put off for a later stage, but
should begin the day the prospective employee meets the human
resource manager. To begin with, it is, very important to be honest
with the potential staff. Right from the time of recruitment, the
human resource manager should tell all about their working
practices, culture and ethics to the employees.
2. Train the brain: New employees need to be acquainted with the
practices prevalent in the organisation. They should be trained into
this mode of operation and not thrown out with the jerk. Education
and theory do not help an individual develop a perspective to the
process involved, but it is practical training that helps them
perform better. The more an employee trains himself and hones his
skills constantly, the greater will be his ability not only to perform
but also to deal with problems.
3. Lead kindly light: A leader has to be effective. He holds the
responsibility to keep his team motivated and driven to work not
be coercion but through guidance. He should display competence
and ability.
4. The route to develop: Development of the employees is of
paramount importance. If the employees of the organisation
develop, the organisation develops naturally. Every individual
employee has his needs, aspirations and abilities. It is the job of the
human resource manager to identify them and synchronise them
with the broader organisational goals.
5. Retain, do not lock up: Finally, it does not benefit the organisation
to retain employees through coercion or lure them through perks.
Employees who express their desire to leave the organisation
should be taken in good spirit and allowed to go. A better approach
is to seek the reason for their leaving so that others do not follow
suit.
3.13 Human Resource Accounting, Auditing and Research
Human resource accounting is the accounting of investment in personnel

in the form of recruitment, selection, training, development, their
placement and replacement, while human resource auditing is a
systematic assessment of the strengths, weaknesses and developmental
needs of the existing personnel of any organisation and a health care
organisation is no exception.
Human resource accounting accounts for the amount that an

organisation may have invested in the human resource development.
xliii
The process of human resource accounting involves identifying the

human resource accounting objectives and developing human resource
accounting measurements.
So far as human resource auditing is concerned, its need emerges from

increasing demand for high quality patients care to be provided by
personnel of a health care organisation and an increasing demand for
training and development of its personnel as well. Human resource
auditing can point out deficiencies in human resource management and
can forecast needs and priorities of an organisation and can certainly
update human resource development plans keeping in view the
emerging health care needs and technical advancements.
Human resource research is the process of evaluating the effectiveness

of human resource planning, policies and practices. It includes:
1. Conducting various surveys such as those on the morale, attitude

and job satisfaction of employees.
2. Collecting data and information regarding wages, training needs,
employee turnover, fringe benefits, causes of accidents, etc.
3. Tabulating, computing and analysing data and information.
4. Report writing.
5. Finding out shortcomings and their causes in the current policies
and practices.
6. Developing more suitable policies, procedures and programmes.
7. Submitting report to the concerned authorities who are competent
to take decisions by going through the report.
3.14 Tips for Human Resource Managers in Hospitals
Human resource manager should always keep in mind that they are
working in health care organisations which render the highest and
noblest form of service to the society at large through a team of
dedicated and committed personnel. Being entirely people oriented
institutions, people from the axle of health care institutions and their
development become the prime concern of the human resource
managers. Therefore, they should develop team spirit amongst their
personnel who have diverse social, educational, ethnic and economic
backgrounds. By keeping management, philosophy and organisational
goals in their minds, they should frame recruitment policy, salary
structures, appraisal system, training programmes, channels of human
resource development, motivation, communication policy, grievance
redressal procedures, etc. Their aims should be to employ and retain
dedicated and committed personnel procedures not only at top level but
at all levels and at all costs. They should see to it that there is proper
distribution of personnel in all departments of the hospital. There should
xliv
neither be shortage of skilled and managerial personnel in one

department nor surplus in another. No decision should be taken which
would lower the morale of personnel because health care organisations
in particular, cannot afford to do that. They should leave no stone
unturned to motivate their employees by adopting a fair and suitable
salary structure, employees welfare schemes, incentive schemes,
promotion policies, effective communication system, and effective
supervision. Human resource managers often have to deal with
employees who may be creative as well as trouble shooters. They should
try to provide an environment in which creative employees can flourish
and show their creativity, e.g. surgeons of high caliber or skilled
workers of maintenance and food service departments. However,
troublesome employees should be handled rather tactfully and carefully.
The goal should be to clarify and firmly warn them of their unbecoming
and unwanted behaviour and lay down clearly what is expected of them.
The sooner they fall in line with, the better it would be for the
employees and the organisation. Human resource managers should
remember that employees whether of industries or of health care
institutions are progressive in their outlook besides being well organised
through their trade unions. Thus, human resource managers are not only
required to have a thorough knowledge of the human resource
management but also of psychology of human behaviour and prevalent
labour laws of the land because at times they may have to take a tough
stand and advise their management accordingly. Before advising the
management to take strict disciplinary action they should ensure fairness
and the erring employees should be provided sufficient opportunities to
mend themselves. It is because the ultimate aim of human resource
managers is to build team morale by taking good care of their employees
at all levels so that the organisations keep going and continues to serve
the sick persons.
Human resource management gives more emphasis on human aspect

and believes in providing them as much amenities as it can be adopting
human approach towards them. It develops among its employees a sense
of commitment to achieve the overall goals and objectives of the
organisation. It considers personnel as resources rather than as costs.
Recently dynamic and enlightened management have started conducting
value-based training workshops cherishing Indian culture, tradition and
ethos because values of India. It is heartening to note that there is an
increasing appreciation and recognition of this fact.
4.0 CONCLUSION
Human resource management is a staff function through which

managers recruit, select, train and develop their employees and develop
the organisation as well. It can assure the organisation of an adequate,
xlv
timely and constant supply of skilled as well as unskilled employees.

The success of human resource department is largely dependent on the
way they treat their employees, formulate policies and recruit personnel.
If they formulate just and fair policies, their success will be 33 %. If
they fit round pegs into round holes and square pegs into square holes,
their success rate will be 66 %. It would be better if they treat their
employees well with the assurance that they are hiring them to retire in
the normal course rather than to fire, their success rate would be 100 %.
What a wonderful proposition!
5.0 SUMMARY
Human resource management is both a science as well as an art. It is a

science because it consists of well-recognised body of knowledge,
principles and techniques. It is an art because it deals with human
beings, popularly called social animals who have feelings and emotions.
It requires knowledge, tact, and presence of mind to effectively deal
with human beings, i.e. the people at work. Your understanding of
human resource management will assist you greatly in dealing with
different people in the hospital.
Discuss why it is always difficult to manage human beings in the

hospital environment (both clients/patients and workers).
Lawrence, A.A. (1990). Management: The Simple Way, American

Management Association. New York.
Leonard, S.R. & Strauss, G. (1985). Managing Human Resources.
Englewood Cliffs, New Jersey: Prentice-Hall,.
Metzger, N. Personnel Administration in the Health Services Industry.

New York: S. P. Medical and Scientific Books.
Peter, D. (1954). The Practice of Management. New York: Harper and

Bros.
Stoner, J., Edward, F. & Daniel, G. (1996). Management. New Delhi:

Prentice-Hall of India.
xlvi
UNIT 4 EVOLUTION OF HUMAN RESOURCE

MANAGEMENT AND ITS ROLE IN
HOSPITALS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Need for Change from Personnel Management to Human
Resource Management
3.2 Nature, Scope and Definition of Human Resource
Management
3.3 Objectives of Human Resource Management
3.4 Objectives of Human Resource Development
3.5 Human Resource Systems (Components)
3.6 Human Resource Management as a Profession in Hospitals
3.7 Role of Human Resource Management in Hospitals
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Human resource management is a comparatively new and rapidly

growing profession in India. It deals with the management of people and
is based upon very old and well-established disciplines such as
economics, psychology, anthropology, sociology, political science, etc.
Most decisions made in health-service institutions involve people and
therefore, human resource management plays a very important role in
achieving the primary aim of hospitals of rendering the highest quality
of care to the patients.
Human resource management relies on the experiences of developed

countries, especially on aspects of human relations. However,
indigenous experiments in human resource management practices in
various settings have provided valuable results which can be applied in
similar settings elsewhere. Although we have been basically relying on
the theoretical framework developed in the West, but our own efforts
can prove more suitable and acceptable.
The Indian constitutional objective of achieving a welfare state and

ensuring social justice through the socialistic pattern of society is being
achieved through state intervention by enacting various legislations.
xlvii
Nevertheless, a healthy human resource management policy can

supplement governmental endeavours.
2.0 OBJECTIVES
 explain why it is necessary to change from personnel

management to human resource management
 describe the nature and scope of human resource management
 list the objectives of human resource management
 enumerate the components of human resource management
 describe human resource management as a profession in hospitals
 list the role of human resource management in hospitals.
3.0 MAIN CONTENT
3.1 Need for Change from Personnel Management to Human

Resource Management
Human resource management has replaced the traditional concept of

labour welfare and personnel management. There are many factors
which led to the change. The search for competitive advantage, modes
of excellence, personnel management‟s failure to promote potential
benefit of effective management of people, change of nature of work,
etc. Technology increased requirements of skill and knowledge,
restructuring of production, new quality system requirements and
demand of better educated new generation of workmen who had higher
expectations from their organisations. These trends led to the change
from personnel management of human resource management.
3.2 Nature, Scope and Definition of Human Resource

Management
Human resource management activities have probably been performed

since time immemorial but it is very surprising that only in recent years
it has received tremendous attention. Its role in organisations is being
gradually accepted. In fact, many organisations have already oriented
themselves towards a human resource management approach from the
traditional personnel management approach because its emphasis is not
only on production and productivity but also on the quality of life of its
personnel. Therefore, the basic approach of human resource
management is to perceive the organisation in its totality. It seeks to
achieve the fullest development of human resources.
xlviii
Human resource management is a specialised field that attempts to

develop programmes, policies and activities to promote the satisfaction
of both individual and organisational needs, goals and objectives. It
shapes culture of the organisation and introduces programmes which
support its core values and ensure its success. Human resource
management is pro-active rather than reactive, i.e. it is always ready to
do what needs to be done rather than waiting to be told to do, e.g.
recruiting, selecting, inducting, training, performance appraisal, etc. The
techniques for the application of human resources management will
certainly be the same as many familiar functions of personnel
management such as manpower planning, selection, performance
appraisal, salary administration, training and management development.
However, besides these, human resource management also includes
special programmes designed to improve communication systems,
involvement, commitment and productivity. In its essence, human
resource management is a qualitative improvement of human resources
which are considered the most valuable assets of an organisation.
Human resource management is comprehensive and deep-rooted than

training and development. Its approach is multi-disciplinary from the
beginning to the end. It is a scientific process of continuously enabling
the employees to improve their competence and capability to perform
their duties so that the goals of the organisation are achieved faster and
at the same time the needs of the employees are also met adequately.
Human resource management can be defined as:
“From the national point of view, the knowledge, skills, creative

abilities, talents and aptitudes obtained in the populations; whereas from
the viewpoint of individual enterprise, they represent the total of the
inherent abilities, acquired knowledge and skills as exemplified in the
talents and aptitudes of its employees.” Michael Jucious calls these
resources „human factors‟ which refer to a whole consisting of inter-
related, inter-dependent and inter-acting physiological, psychological,
sociological and ethical components.
Thus, human resources are multidimensional in nature. People at work

constituting the human resource in an organisation comprise all
individuals engaged in any of the organisational activities, regardless of
age, socio-cultural backgrounds, etc. They differ from one another in so
many ways, including their intelligence, personality, physical make-up,
etc.
Every individual also differs from the other in his behaviour, habits,
needs, goals, future expectations and past experiences. No two human
beings are alike in mental abilities, traditions, sentiments, etc. This fact
xlix
of individual differences is something of which we are all so aware that

we generally tend to take it for granted. Moreover, human resource
management is also concerned with these various types of individuals
who may be changed to meet the requirements of an organisation. Thus
it can safely be stated that human resource management is essentially
concerned with any activity relating to human beings in the
organisation.
In simple words, when individuals come to work place, they come not
only with technical skill, knowledge, ability, intelligence, etc. but also
with their personal feelings, perceptions, desires, motives, values,
problems, etc. In such a situation, human resource manager employs
them, compensates them, utilise them and develop them in tune with
their jobs and organisational requirements. Thus, a dynamic human
resource manager can provide skilled, well disciplined and dedicated
workforce to the organisation and at the same time can solve personal
problems of his employees as well.
3.3 Objectives of Human Resource Management
Human resource management is concerned with the management of

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 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 can 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.
Briefly, the following are the objectives of human resource

management:
1. Obtaining and developing the right personnel.

2. Providing effective motivation and leadership.
3. Paying attractive remuneration and treating them like brothers and
sisters.
4. Effective utilisation of human resources in the achievement of
organisational goals.
l
5. Establishment and maintenance of an adequate organisational

structure and desirable working relationships among all members
of the organisation.
6. Securing integration of the individual and informal groups with the
organisation and thereby ensuring their commitment, involvement
and loyalty.
7. Recognition and satisfaction of individual needs and group goals.
8. Provision of maximum opportunities for individual development
and advancement.
9. Maintenance of high morale in the organisation.
10. 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, mutual confidence, etc. These are the lifeblood of human
resource management.
These objectives can be achieved by conducting the following human

resource management functions:
1. Anticipating and providing personnel for future openings from

time to time.
2. Seeking and attracting qualified applicants to fill vacancies.
3. Determining the organisational structure and manpower needs to
effectively meet the organisational objectives.
4. Analysing the applicants‟ qualifications for determining their
suitability.
5. Officially assigning each employee an appropriate position which
clearly defines his responsibilities.
6. Ensuring that new recruits are provided with appropriate training
and information to enable them to perform their duties effectively.
7. Further providing for increasing the utilisation of the employee‟s
capabilities.
8. Providing for the individual employee‟s development.
9. Arranging programmes as required for developing existing
personnel.
10. Providing facilities for the employee‟s enjoyment of the job and
making the workplace more attractive and satisfying.
11. Providing the needed exchange of information throughout the
organisation.
12. Building up rapport with the officially-recognised and legally
established employees‟ organisations in the best interests of both
the organisation and its employees.
li
13. Developing effective work regulations and harmonious working

relationships.
14. Objectively appraising each employee‟s performance in relation to
the duties and responsibilities assigned.
15. Helping employees solve their personal problems.
16. Developing facilities and procedures for the prevention of on-the-
job accidents.
17. Preventing diseases and physical ailments and at the same time
caring for diseases, ailments and injuries suffered by employees
on-the-job.
18. Providing precautionary measures for safeguarding the
organisation and its property from fire, theft, etc.
19. Developing improved employees‟ attitudes and conditions of work.
20. Doing a human resource audit.
By no means can all the above-mentioned functions be found in every

human resource department; but they do cover the range of tasks seen in
many commercial organisations, industries and hospitals where human
resource management has been established as a specialty. The jobs that
the human resource department is called upon to perform are too
numerous and too varied to admit any concise presentation. But the
objectives of human resource management can be achieved only by the
performance of these functions.
3.4 Objectives of Human Resource Development
Human Resource Development (HRD) is a process that helps employees

of an organisation to improve their functional capabilities for their
present and future roles, to develop their general capabilities to harness
their inner potentialities, both for their self and organisational
development and for developing organisational culture in order to
sustain harmonious superior and subordinate relationship, teamwork,
motivation, sense of belonging, etc.
Human resource development makes efforts in training and development

of employees in the form of education and development programmes.
This is also known as organisation development (OD). The objectives
of OD are to develop:
1. capabilities of all individuals working in an organisation in relation

to their present role
2. capabilities of all such individuals in relation to their future roles
3. better interpersonal and employer-employee relationships in an
organisation
4. team spirit
5. coordination among different units of an organisation
lii
6. organisational health (by continuous renewal of individual

capabilities and keeping pace with the technological changes).
3.5 Human Resource Systems (Components)
There are several components of human resource management such as

human resource organisation, human resource planning, human resource
relationship, and human resource utilisation. One component is human
resource system in which the human resource manager is required to do
the following main key programmes:
1. Recruitment management is a process of obtaining the required

number of human resources for an organisation. They should
clearly fit in the organisation like a square peg in a square hole and
round peg in a round hole.
2. Information management is a method of ensuring that all policies
and practices are to be soundly communicated to each and every
person in the organisation from the lowest employee to the CEO.
3. Training management is a system of identification of training
needs to develop employees. According to training needs, training
programmes are suitably prepared and appropriately arranged.
4. Performance management is a technique of appraising human
resources objectively and scientifically against defined criteria,
reviewing the present position and assessing further growth of
employees. There are various appraisal systems.
5. Career management is a technique for charting career path of the
individual employees for advancement in the organisation.
6. Health and safety management is a system of maintaining healthy
and safe working conditions so that each and every employee may
work freely and safely in an organisation by following the
necessary precautions.
7. Discipline management is a system of administering discipline
amongst employees to foster positive behaviour which is
conducive to both organisational and employee growth.
8. Culture management is a system of inculcating a particular culture
among employees by the management so that they think and
behave according to the values, sanctions and attitudes of the
organisation.
Human resource systems are the essential programmes needed for any
organisation for its growth and prosperity by adopting some, if not all,
systems of human resource management as mentioned above.
3.6 Human Resource Management as a Profession in

Hospitals
liii
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 was developed into 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 embodied 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
possesses all the characteristics of any other profession which can be
summarised as follows. Human resource management:
 requires special knowledge for the uniform performance of

standard practices and procedures
 requires special competence achieved through intellectual
training which develops skills and requires the use of
independent and objective judgment
 assumes a sharing of information among all members of the
profession
 maintains a continuous flow of professional literature
 has a code of conduct; it requires the provision of specialised
education and the use of specialised knowledge and skills
 requires a high degree of personal responsibility and
accountability from its members
 demands primary allegiance to the profession from its members
 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 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.
3.7 Role of Human Resource Management in Hospitals
liv
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 „labour‟ in trade
union terms. They should be, in fact, considered as essential to hospital
functioning as a physician or a staff nurse.
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 labour laws of the
land.
Governing boards and administrators of industries as well as of hospitals

in advanced countries like the USA, Canada, the UK, Germany and
Japan became conscious of the importance of human resource
management long ago. But in India, the governing boards and
administrators in industries alone have realised its importance. The time
has now come for the governing board 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.
lv
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
hospital.
3. One of the problems confronting health-care institutions is 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 hospital services in India.
4. India is facing the problem of brain drain of its personnel.
Previously, the United States of America, Australia, Canada and
Germany were literally „snatching away‟ our trained personnel and
scientists. Now the Arabian countries too have started attracting
them by offering 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 labour legislations,
imposing legal restrictions on employment in hospitals, have been
passed. It is, therefore, essential that a human resource manager
well versed in the labour laws can be of immense service.
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 cost of hospital care has an implication for hospitals
similar to that of rising production costs in industry. It is essential
that unit costs of operation be re-examined 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 skill in selection,
training, planning workloads, motivation and supervision.
8. There is a belief that hospital employees are not usually unionised
because they are working, in most of the cases, with missionaries
and charitable bodies. They too become dedicated and do not
charter their demands like the employees of industries through
their union leaders. But this is not wholly true as most 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.
lvi
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 (Fig. 1). Their dealings with each of these
four groups involve a wide range of interpersonal relationships. Unless
these relationships are of a positive nature, it is likely to affect the
functioning of a hospital.
No doubt the human factor is significant in the industrial field also, but
it assumes to priority in the working of a hospital employee. Figure 1
shows how a hospital employee is surrounded by human beings on all
four sides, while an industrial employee is surrounded by human beings
from two sides and by machines and products from the remaining two
sides. Thus, the significance of employee contact with human beings in
the hospital is greater than in other occupational areas. This is
particularly so because a considerable number of the individuals with
whom the hospital employees have to deal, are under more than average
stress. A patient‟s reaction to his physical and mental conditions may
not be the same as that of a healthy person. Visitors may be worried
because of the condition of the patient in whom they are interested.
Members of the medical staff may be working under stress due to the
serious conditions of their patients. These are conditions little known to
professionals in industrial organisations. Not only must hospital
employees be given adequate training in the professional skills
necessary to perform their daily tasks, but they must also be trained in
the art of getting along with people who are sick and worried. It is
evident, therefore, that human resource management in hospitals
involves more complexities that that in the average industrial situation.
lvii
Machines
Supervisors Industria Management

l
Employe
Products
Patients
Medical and Industria

Paramedical Staff Management
l
Employe
Visitors
Fig. 1: Environmental Factors Surrounding a Hospital

Employee and an Industrial Employee
4.0 CONCLUSION
Human resource management functions have always been performed in

hospitals too. Employees have been recruited. They might have worked
happily or unhappily. They might have left the employment of the
hospital in a friendly mood or with resentment. But 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‟. This is
possible by pursuing a course aimed at establishing the best possible
lviii
human relations. Good personnel practices can produce much better

results through employees who are well selected, thoroughly trained and
who work under satisfactory working conditions.
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.
5.0 SUMMARY
In this unit, we looked at the evolution of human resource management,

especially the nature, scope, objectives, components of human resource
management. We also looked at human resource management as a
profession in hospitals and the role of human resource management in
our hospitals today.
Describe the relevance of human resource management in achieving the

goals of hospitals as a social institution.
Adepoju, A. (2006). Management Concepts and Applications. (2nd ed.).

Lagos: Concept Publications Ltd.
Dressler, G. (1998). Human Resource Management. New Delhi:

Prentice-Hall of India.
Dunn, R.T. (2007). Haimann’s Healthcare Management. (8th ed.).


Jucious, M.J. (1973). Personnel Management. Homewood Illinois:

Richard D. Irwin.
lix
UNIT 5 ORGANISING THE HUMAN RESOURCE

DEPARTMENT IN THE HOSPITAL
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Introduction
3.2 Internal Organisation of the Human Resource Department
3.3 Human Resource Policies
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
This unit will expose you to how the human resource department in the
hospital can be created and organised to be effective and relevant to the
organisation at large since the hospital enlarges on daily basis due to
increased population in the society leading to increased social demands.
2.0 OBJECTIVES
 explain the need for human resource department in our hospitals

 describe how human resource department can be organised
 list the human resource inventory
 discuss human resource policies.
3.0 MAIN CONTENT
3.1 Introduction
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
lx
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.
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, increase in absenteeism and frequent employee
grievances, differences in total hours of work required for similar tasks
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 full-
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
in figure 1.
lxi
Hospital Administrator
Department Department Department Department Department

Head Head Head and Head Head
Human
Resource
Manager
Fig. 1: Hospital Organisational Chart. (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 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, anesthetists, 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 all staff officers. A physician, whose objective is to
provide the best medical care to his patients, 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 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.
lxii
3.2 Internal Organisation of the Human Resource

Department
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 hi own department is always that of a line specialist.
Within the human resource department, there is a chain of command
from top to bottom, just as in line departments. A good human resource
department should possess 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 manager must shoulder the responsibility of all the
human resource functions, including those of his own department, he
must be a man of high caliber who can lead his department, guide others
and report in various matters with confidence to the administrator.
Human resource plan
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.
Human resource philosophy
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, staffing,
directing and controlling employees at work. Organising means
arranging the work for the effective accomplishment of objectives.
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 projects. Controlling ensures progress toward objectives
lxiii
according to plans. The human resource philosophy should be flexible

so that it may be amended as conditions alter with the passage of time.
Human resource objectives
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.
Tools of the human resource department
Good tolls are essential for god 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.
The human resource office
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 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 desk 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.
Office equipment
Filing cabinets, typewriters, computer, printer, electronic clock,

cyclostyling/photocopying machine, etc. should be provided in
lxiv
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.
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:
1. Name
2. Designation
3. Department
4. Immediate supervisor
5. Location of job
6. Dependents
7. Present address with telephone number, if any
8. Permanent address with telephone number, if any
9. Date of joining
10. Date of promotion, if any
11. Total salary and pay-scale at the time of joining
12. Total salary and pay-scale at present
13. Date of last salary increase
14. Hobbies
15. Background of family members
16. Any other information.
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:
1. An overall picture of the personnel situation

2. Data for making a rough analysis of the turnover of personnel
3. Information as to the number and types of jobs in existence
4. The number of employees reporting to each supervisor
5. Data for making a rough study of salary schedules
6. Seniority list of personnel
7. 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:
lxv
1. Determining the areas where short-term employment is needed

2. Studying the effects of transport facilities on employment
3. Assessing the ratio of supervisors to employees.
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 requires. There are several reasons for
keeping human resource records:
1. 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.
2. Government agencies frequently ask for various kind of
information from time to time. This can easily be supplied on the
basis of such records.
3. Payroll is prepared from these records.
4. Training needs are determined from these records.
5. 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:
1. Permanent records concerned with employees‟ positions.

2. Forms which may become part of the permanent records once their
immediate use is over.
3. Temporary forms which are destroyed once their immediate
purpose has been served.
Permanent records concerned with employees
lxvi
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 organisation.
It has been found useful to record the following particulars:
1. Name
2. Father‟s name
3. Present address (sufficient space should be provided to record
changes in address)
4. Permanent address
5. Telephone number, if any
6. Birth place
7. Date of birth
8. Marital status
9. Dependent(s) name, sex, age, relationship
10. Person to notify in case of emergency, with address and telephone
number, if any
11. Hobbies
12. Education
13. Experience
14. Test record if pre-employment and promotional tests are used
15. References
16. 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
17. Unauthorised absence record
18. Misconduct record, date-wise
19. Punishment record, date-wise
20. Commendation record
21. Special notes, if any, e.g. special health report, repeated loans
taken.
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
lxvii
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.
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.
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:
1. Requisition for new employee(s) and authorisation for employment

2. Job application form
3. Medical fitness report
4. Employee probationary rating form
5. Employee annual rating form.
Temporary forms
These are to be destroyed after use. They consist of the following:
1. Introduction slips
2. Meal passes
3. Leave record (should be maintained for three years)
4. Attendance record (should be maintained for three years)
5. Permission to visit health clinic.
3.3 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
lxviii
executives, whether thy are in the fields of industry, hotel, business or

hospital. The change in their attitude has been due to: (a) the increasing
power of labour 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. The
human resource policies should be founded on three social policies:
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 cooperation of
employees.
The human resource policies of a hospital should be clear-cut statements

of its aims and objectives, setting out clearly what is 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 principles 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. These policies should fulfill 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.
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
lxix
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
7. maximising utilisation of existing human resources.
There are various advantages of having human resource policies:
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
lxx
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
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 condition
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.
4.0 CONCLUSION
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
lxxi
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.
2. Good employees understand the financial position of the
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.
5.0 SUMMARY
The emphasis of this unit is that every human resource manager should
think of forming a team of such employees who can deliver better goals
and really serve the customers i.e. clients and patients plus their relatives
and organisation to the best of their abilities.
Discuss the procedure available to human resource manager to make

human resource inventory.

lxxii
Akinwale, E.J.A. (1999). Human Resources Management: An Overview.

Akinleye, T.A. (1976). Management by Objectives. Ibadan: Government

Printers.
Amitai, E. (1964). Modern Organisations. New Jersey: Prentice-Hall.
Flippo, E.B. (1988). Personnel Management. New York City: McGraw-

Hill Book Comp.
Ikemefuna, C.O. (2005). Management Theory and Practice. Lagos:

Concept Publications Ltd.
Massie, J.L. (1987). Essentials of Management. (4th ed.). New Delhi:

Prentice-Hall.
lxxiii
MODULE 2
Unit 1 Manpower Power in Hospitals

Unit 2 Deciding Workload Ratios and Human Resource Strength in
various Departments
Unit 3 Training and Management Development I
Unit 4 Training and Management Development II
Unit 5 Wage and Salary Administration
UNIT 1 MANPOWER PLANNING IN HOSPITALS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Introduction
3.2 Nature and Scope of Manpower Planning
3.3 Need for Manpower Planning
3.4 Benefits of Manpower Planning
3.5 Objectives of Manpower Planning
3.6 Manpower Planning Steps
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
This unit is looking at manpower planning in the hospitals as the nature

of hospital manpower determines the qualitative and quantitative
services that will be delivered by that hospital hence the significance of
hospital manpower planning cannot be underscored.
2.0 OBJECTIVES
 discuss the nature and scope of hospital manpower planning in

Indian hospitals
 list the need for manpower planning
 explain the benefits of manpower planning
 state the objectives of manpower planning
 discuss the steps of manpower planning.
lxxiv
3.0 MAIN CONTENT
3.1 Introduction
Manpower planning is the prime function of the hospital human

resource manager but before he starts individual jobs, he should
consider the overall management problem of making the best use of
available human resources. Just as the controller of finance budgets for
the best use of financial resources, the human resource manager is
basically concerned with budgeting for the best use of human resources.
Manpower planning calls for the integration of information, formulation
of policies, 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 years or so ahead-is promotion planning. But
the really important planning is the long-term planning - five to ten
years ahead. In manpower planning, the basic questions of objectives,
organisation structure and age-structure of personnel have to be
considered. Hence, the direction of a hospital‟s development efforts will
be determined by short-term as well as long-range manpower planning.
3.2 Nature and Scope of Manpower Planning
Manpower planning may be defined as a technique for the procurement,

development, allocation and utilisation of human resources in
organisation. It views employees as scare and costly resources, whose
contribution must be developed to the fullest by the management. It is
also concerned with the interaction between an organisation and its total
environment.
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
lxxv
emergence of more hospitals in the vicinity and better opportunities

offered by hospitals coming up in developed, developing and
underdeveloped countries aboard can result in high employee turnover
and a source of potential loss.
3.3 Need for 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, paramedical personnel in USA, UK, Ireland, the Gulf
countries, etc.
7. Introduction of computers.
3.4 Benefits of Manpower Planning
Manpower planning anticipates not only the required kind and number
of employees but also the action plan for all the functions of human
resource management. The major benefits of manpower planning are
that it:
1. enables an organisation to have the right person at the right place

and at the right time
2. provides scope for advancement and development of employees
through training, development, etc.
3. helps in anticipating advertisement and salary budgets
4. foresees the need for redundancy and plan to eliminate it
5. plans for better working conditions, fringe benefits, training needs
6. gives an idea of the type of tests to be used and interview
techniques in selection based on the level of skills, qualifications,
intelligence, values, etc. of future manpower
7. helps improve service to patients and contributions of working
personnel.
3.5 Objectives of Manpower Planning
The objectives of manpower planning are very wide and varied. The
most important ones are:
lxxvi
1. ensuring maximum utilisation of personnel

2. assessing future requirements of the organisation
3. determining recruitment sources
4. anticipating from past records:
i. resignations
ii. discharge simpliciter (simple discharge)
iii. dismissals
iv. retirement
5. determining training requirements for management development
and organisation development.
3.6 Manpower Planning Steps
Manpower planning covers the total activity of the personnel functions

such as recruitment, selections, 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. Investigation of turnover of personnel
4. Planning job requirements and job descriptions.
Scrutiny of the present strength of personnel

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.
Anticipation of manpower needs

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. Its 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, discharge simpliciter, dismissals, retirements, etc.
Ultimately, the net requirements of the hospital are indicated.
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 labour turnover is
helpful in manpower planning. A high turnover is a warning to the
hospital authorities that something is wrong with the personnel policies
lxxvii
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
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 labour turnover. When an

employee is leaving, he is generally willing to be candid and may share
his better 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 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.

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.
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
lxxviii
observations and recommendations to the head of the hospital so that

corrective measures may be taken to reduce the turnover.
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.
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.
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
lxxix
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.
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.
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.
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.
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.
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.
The requirements vary from job to job. Due importance should be given
to each requirement depending upon the circumstance of each job.
However, undue importance should not be given to any one requirement
at the cost of the other. A well-laid-out job specification will enable the
management to identify the right man needed to do the required job
efficiently. It should not be noted that if a man is not found fit for a
lxxx
particular job, he need not be necessarily unfit for all other jobs. At the
same time of selection, due care and caution should not be taken to
avoid selection of the wrong person.
Human resource requirements in hospitals: Before the recruitment

and selection of personnel can be undertaken, the requirements for
human resources must be analysed in terms of number of personnel
needed for each type of job. According to a report of the Commission on
University Education in Hospital Administration, a ratio of two
employees per bed has been prescribed. This ratio is applicable to
general hospitals where patients with all types of diseases are treated.
The term „employee‟ means any person who works in any capacity in a
hospital, e.g. doctors, nurses, pharmacists, medical laboratory
technicians, X-ray technicians, physiotherapists, dieticians, medical
social workers, supervisors, skilled/semi-skilled/unskilled employees,
etc.
This ratio of two 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, semi-automatic or
manually operated), etc. Under prevailing conditions, to manage every
bed, whether in a small or big hospital, it requires three to five
personnel.
Doctor-to-beds ratio
According to the Indian Medical Council, 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 one doctor to 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.
Nurse-to-beds ratio
The nurse-to-bed 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 four ward sisters and 30 staff
nurses and for fractions of 100, the staff should increase in the
proportion of one ward sister to 25 beds and one staff nurse to three
beds. When the bed strength is between 150 and 400, in addition to the
nursing superintendent, there should be an assistant nursing
lxxxi
superintendent, and when the bed strength is 401 to 700 and for every
300 beds in excess of 700, there should be an additional assistant
nursing superintendent. There should be separate staff for special
departments with a sister-in-charge 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.
The nurse-to-beds ratio also depends upon the kind of ward. The
recommended nurse-to-beds ratios for the various kinds of wards in a
hospital are given in Table 1. However, needs may vary from one
hospital to another, depending on the size of the hospital and services
rendered. Thirty percent leave reserve personnel should also be
provided.
The nurse-to-beds ratio given in Table 1 according to the kind of ward,

has been found to be ideal, keeping in view the high quality of nursing
care must 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.
Table 1: Recommended Nurse-to-Beds Ratios

Ward Nurse Beds Remarks
Medicine 1 3
Surgery 1 3
Casualty 1 1
I.C.U 1 1
C.C.U 1 1
Paediatric 1 4 If mothers are allowed to stay
with the patients
1 2 If mothers are not allowed to
stay with the patients
Obstetrics and 1 3
gynaecology
Labour room 1 3
Operation theatre 2 1 (Per table, day shift)
Orthopaedic 1 3
Well-baby nursery 1 3
Special nursery 1 1
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,
lxxxii
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, 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 day-shift 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 medicines, makes the round with the
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.
Afternoon care of the patient: This care is given to a patient by the

day-shift nurse after he has 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 tea
and for receiving his visitors, etc.
Evening care of the patient: This care is 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, wishes the patient a peaceful and comfortable night‟s
sleep, switches off the lights 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
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 time 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 hospitalisation is to try to help an individual
lxxxiii
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 relatives 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.
These ratios as shown in Table 1 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.
4.0 CONCLUSION
Manpower planning being the major function of the hospital human

resource manager, he has to consider the overall management problem
of making the best use of available human resources and a systematic
manpower planning is a must for any dynamic organisation because the
success or failure of any hospital rest squarely on the human resource
management of that hospital.
5.0 SUMMARY
In this unit, we have looked at manpower planning: nature and scope,

need for manpower planning, benefits and objectives of manpower
planning, etc. No doubt your knowledge has increased by this exposure
so we can consider the tutor-marked assignment.
Explain the relevance of manpower planning in meeting the demands of

both the hospital and its consumers of service.
lxxxiv
Beach, D.S. (1970). Personnel: The Management of People at Work.

(3rd ed.). New York: Macmillan Publishing Co. Ltd.
Blackburn, R. & Rosen, B. (1993). Total Quality Resources

Management: Lessons Learned from Baldridge. Award-Winning
Companies. Academy of Management Journal. 7:49-65.
Burns, T. & Stalker, G. M. (1966). The Management of Innovation.

London: Tavistock.
Drucker, P.F. (1964). Managing for Results. London: Heinemann.
Drucker, P.F. (1976). The Effective Executive. London: Pan Book.
lxxxv
UNIT 2 DECIDING WORKLOAD RATIOS AND

HUMAN RESOURCE STRENGTH IN VARIOUS
DEPARTMENTS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
This unit is a continuation of the previous unit. We will be looking into

how human resource management decides the workload ratios and
human resource strength in various departments of the hospital in order
to avoid over and under staffing or under and over utilisation of the
personnel in various departments. The departments itemised in this unit
cannot be said to be exhausted so you can add more departments but
basic ones are mentioned here.
2.0 OBJECTIVES
 list some basic departments in the hospital

 explain how the resource management department arrives at the
employees in each department
 discuss the relationship between equipment, personnel and
productivity.
3.0 MAIN CONTENT
Deciding workload ratios and human resource strength in various

departments in hospitals
X-ray department
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
lxxxvi
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.
Keeping in view the quality of work required, one X-ray technician

cannot be asked to do more than 30 X-ray investigations per day. There
are certain X-rays such as carotidangiography, myelography which take
very long and only two can be done in a day. It can be recommended
that in one day one X-ray technician can do five I.V.Ps; or five O.C.G.s;
or two myelographies; or three hysterosalpingiographies; or 10 Barium
investigations; or two cartidangiographies; or 30 one-view X-rays or 20
ultrasound investigations or five C.T. scans.
One senior X-ray supervisor is required for seven 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 X-ray department
every day.
Physiotherapy
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. One physiotherapist
can treat about 25 patients in a day (eight hours duty). Before giving
treatment to the patients, he has to do some preparatory work:
1. Examination of the patient

2. Entry into register
i. Name
ii. Age
iii. Sex
iv. Present history of illness
v. Past history of illness
lxxxvii
vi. Family history, if any

vii. Diagnosis
3. Aim of treatment
4. Planning of treatment
5. Result of treatment
6. Progress reports.
In a day, one physiotherapist can attend to 15 diathermies; or 50

ultrasonictherapy cases; or 25 infra-red treatment; or 15 ultra-violet
treatments, or 15 stimulation cases; or 30 cervical traction cases; or 20
hydrotherapy cases; or 10 lumber traction cases; or 25 lasertherapy
cases; or 15 microwavetherapy 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 to 100 treatments per day, provided
the department has more than one machine for each treatment.
If the physiotherapist is required to attend to more than 25 patients in a

day, the quality of service will certainly suffer.
One senior physiotherapist is required for seven physiotherapists, to

supervise their working and to maintain a high standard. Also required
are a receptionist to look after reception and clerical work and one
physiotherapy aide to fetch up to 25 in-patients who cannot walk from
the wards to the physiotherapy department. This, however, depends
upon working procedures of the hospital.
On the basis of these norms, the chief physiotherapist and human

resource manager can fix the human resource strength of the department
keeping in view the number of cases referred in the past.
Medical Laboratory
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 tests should
be questioned.
In one day, one technician can do: 45 hematology tests; or 50 urine

analysis tests; or 50 parasitology tests; or 20 blood-tank 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
lxxxviii
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 requires are one section head over seven laboratory technicians, e-
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.
Pharmacy
The number of pharmacists to be employed in a hospital depends upon
the policy of the hospital. Some hospitals expect out-patients as well as
in-patients to purchase only costly medicines from outside because of
their own pharmacy not stocking them due to financial constraints. On
the other hand, there are some hospitals which manufacture I.V. solution
themselves, because they do not want to risk purchasing contaminated
I.V. solution from outside.
The pharmacy department of any hospital is a major source of

administrative concern in term of cost control, quality of medicines,
pilferage, wastage, legal obligations, etc. Over and above these, it is
essential to stock the right quality of vital and essential drugs all the
time. Hence, hospital pharmacy operations are fairly complex.
It has been observed that one pharmacist can dispense medicines to 150
patients per day. This excludes placing the order with the supplier,
receiving supplies and making entries in the ledger but includes reading
prescriptions, dispensing medicines and explaining how to take
medicines to the patients. As far as the dispensing of medicines to in-
patients is concerned, it depends upon the policy of the hospital, because
some hospitals send medicine trolleys to the wards once a day or on
alternate days, while some others expect the nurses to collect medicines
for their in-patients from the pharmacy counter. Whatever the policy,
one pharmacist can dispose of one prescription of a patient, whether an
out-or an in-patient in approximately two minutes. Thus, one pharmacist
who works eight hours a day can take care of 100 out-patients as well as
50 in-patients, but for every two pharmacists, one pharmacy aid will
have to be provided to assist them.
If the number of pharmacists in a hospital exceeds seven, the chief

pharmacist should employ one senior pharmacist to assist him in
supervision so that the efficiency of the department may be maintained.
lxxxix
Laundry
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 percent 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 and one laundry clerk are required in
each shift. Some staffing norms based on the workload being followed
at various hospitals are:
One washerman 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
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.
It is difficult to generalise 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
xc
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 coordination. One dietician can look after up to 200 words. 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 30 % leave reserve should be appointed, because the food
service department functions round the year.
Sanitation and housekeeping

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 harboured. Some organisms are too
small to be readily seen by the naked eye. Some viruses are so small that
they cannot be seen even under a microscope. A number of infections
are caused by bacteria. Under certain conditions where there is moisture,
heat and accumulation of dirt, these bacteria multiply rapidly.
Cleanliness is the cardinal method of attacking them.
It is not essential for the sanitation in-charge and his workers to know
about every kind of bacteria and the diseases they produce, but it is
necessary for them to understand that bacteria enters the body through
the mouth, nose, mucous membranes or through broken skin. The
hospital patient who is already ill has lowered-resistance and is,
therefore, subject to secondary infection. A surgical patient who
develops an infected wound may pay dearly in many ways, e.g. a higher
hospital bill, longer stay in hospital, catching some other diseases, etc.
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 rooms, kinds of staircases, kinds of drains
xci
(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., paramedical 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 unit,
one sweeper over 10 beds is recommended, on the basis of round-the-
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 one 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. 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).
Security
With the passage of time, the security of any organisation 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.
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
security force. The staff strength required depends upon several factors:
the area of the hospital, the location of the hospital (city, town and
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.
xcii
Sterile supply department

The staffing norms of the central sterile supply department of a hospital
depend upon the model of the autoclave, other equipments 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, labour room, casualty, etc.
While determining the staffing norms for the central sterile supply
department, several points must be kept in mind:
1. Method of collection and distribution of articles to be autoclaved

2. Number of disposable articles being used in the hospital
3. Reprocessible articles available for circulation
4. Bed strength of the hospital
5. Size of the autoclave
6. 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 percent leave reserve.
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 eight 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 foe 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 required particulars in the register, setting up the ECG
machine with ECG graph, tying the cord on different parts of the
patient‟s body, taking the ECG, cutting the ECG graph, mounting the
ECG graph on the ECG folder, submitting it to the cardiologist and
pasting the ECG request in the patient‟s chart for ready reference.
xciii
4.0 CONCLUSION
Modern equipment and newly-discovered techniques in the day-to-day

operations of a hospital call for specific hospital designs and planning
approaches. The setting up of norms and standards of programming,
designing, equipping and especially staffing are the need of the day. The
core determinants of staffing the hospital organisation are quality,
quantum of work, round-the-clock service, professional and technical
skill required in the job and optimum utilisation of its personnel. The
variables determining the quality of personnel are appropriate
recruitment, selection, induction, training on the job, continuing
education, promotional avenues, decent salary with attractive
perquisites, etc. The staffing norms should aim at matching the
individual aspirations to the aims and objectives of the hospital. Hence
the norms recommended for the number of personnel in different
departments of the hospital are only general guidelines to determine the
manpower. Each hospital has to consider various factors which
influence its staffing before arriving at its staffing quarters.
5.0 SUMMARY
In this unit, we have looked at basic departments in the hospitals vis-à-

vis personnel management so that at the end, the clients/patients and
relations would have been satisfied with the kind of quality service
rendered.
(1) List the basic departments in hospitals.

(2) How can the human resource manager determine the allocation of
personnel to those departments?

Administration in Hospitals.” (1954). Washington, D.C: American
Indian Nursing Council. Syllabi and Regulations for the Courses in

General Nursing and Midwifery.
Medical Council of India. Minimum Standard Requirement for a

Medical College for 100 Admissions Annually.
xciv
UNIT 3 TRAINING AND MANAGEMENT

DEVELOPMENT I
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Development of Training and Development
3.2 The Need for Training and Development Programmes
3.3 Symptoms Requiring Training and Development
3.4 Advantages of Training and Development
3.5 Techniques Used to Determine Training Needs
3.6 Training Principles
3.7 Phases in Training Process
3.8 Training and Development Techniques
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Training and Development (T & D) is an important phase in human

resources management. Employees may become obsolete or rustic if
they do not update themselves with new work methods, skills and
knowledge about their work, the organisation and the environment. The
entire organisation may also become rustic and obsolete if it lacks a
systematic means of continually developing and renewing organisational
capabilities. Klatt and his colleagues (1985) reported that it has been
estimated that “an engineer‟s knowledge of his or her filed is cut in half
every 10 years because of the advancement of the field-unless he or she
continues to work”. Training and development activities are planned
programmes of both individual and organisational improvement. But
what is training? What is development? Are they different or the same?
2.0 OBJECTIVES
 define training and development

 state the need for training and development
 list the advantages of training and development
 discuss the techniques used to determine training needs of an
organisation
xcv
 state the training principles

 enumerate the phases in training process.
3.0 MAIN CONTENT
3.1 Definition of Training and Development
Training is planned organisational efforts or activities concerned with

helping an employee acquire specific and immediately usable skills,
knowledge, concepts, attitudes and behaviour to enable him or her
perform efficiently and effectively on his present job. Training,
therefore, is related to improving upon the present job experience. It is
concerned with technical/manual skills to non-managerial staff.
Development, on the other hand, are planned activities which focus on

increasing and enlarging the capabilities of employees so that they can
successfully handle greater and/or assume higher positions in the
organisation‟s hierarchy to better handle current responsibilities.
Development usually focuses on improving the conceptual skills-the
intellectual and abilities needed to handle complex situations and do a
better job (Mathis and Jackson, 1982; Klatt et al. 1985). Development is
therefore, not only “person-oriented”, but it also focuses on supervisory
and managerial personnel. This does not imply that these higher-level
personnel do not involve themselves in training activities. For example,
Klatt and his associates have made the point that “a manager may be
trained in public speaking so that the speeches he or she gives for the
company will be better, just as a stenographer may receive training to
increase the rate of dictation that he or she can take”. Training and
development, however, are geared toward improving upon workers‟
performance with the ultimate aim of achieving set organisational goals.
3.2 The Need for Training and Development Programmes
Training and development has become an accepted phenomenon in

organisations. The need for employees to improve their knowledge,
skills, attitudes and behaviour while on the job is rarely questioned.
There are several reasons providing an impetus for the need to develop
employees while on the job. These are:
 Academic programmes rarely adequately prepare candidates for

their future positions and their accompanying responsibilities.
Consequently, many persons enter their career with no practice and
with no experience in using the tools of their profession (Heiss,
1970).
 The declining rate of employee mobility and high tenure density
coupled with less hiring of new blood.
xcvi
 The presence of aging employees and the explosion of knowledge.

Georgiades (1980) pointed out that with age, human beings suffer
from diminished vitality, creativity and flexibility. Aging
employees can be assisted to remain or once again become vibrant,
vital, productive and pertinent through employee renewal
activities.
 The increasing heterogeneity of employees in organisations. This
includes very young graduates, some from economically, culturally
and educationally disadvantaged background.
 The public and organisation‟s disenchantment with the quality of
the Indian educational products. The rapidly changing society,
continually expanding and developing technology and sometime
restive community youths.
3.3 Symptoms Requiring Training and Development
There are usually certain signs in an organisation, that serve as pointers

to management that training and development activities should be
engaged in so as to improve individual and organisational performance.
Some of these symptoms have been highlighted by Nwachukwu (1988)
to include:
 Lack of interest in one‟s job

 Negative attitude to work
 Low productivity
 Tardiness
 Excessive absenteeism rate
 Excessive complaints (and excuses)
 High rejects or low quality output
 High incidence of accidents
 Insubordination.
3.4 Advantages of Training and Development
The advantages of employee training and development can be

summarised thus:
 Increased knowledge, skills and the development of positive

behaviour and attitude to work
 Increased organisational productivity and quality products
 Improved worker‟s morale
 Reduced turnover rate among workers
 Brings about sense of belongingness among employees and
reduces the rate of absenteeism
xcvii
 Brings about better coordination of both human and non-human

resources within the organisation as it helps to save supervisor‟s
time of supervision
 Enhances employee‟s chance for promotion.
3.5 Techniques Used to Determine Training Needs
An effective training programme must be one planned to improve or

correct identified areas of weaknesses among employees. Several
techniques are available in determining training needs. Gilbert (1967)
developed a common sense approach to identify areas of training needs
of employees. He summed up his approach in a formula thus:
D= M – I
Where,
D = Deficiency in the employee
M = Complete list of behaviour necessary for mastery of the job
I = Knowledge of behaviour necessary for the job which the
employee already possesses.
According to Nwachukwu (1988), by identifying the behaviour required

to perform a job and finding out what an employee lacks, training can
then be concentrated in areas of difficulty.
Klatt, Murdic and Schuster (1985) have suggested 10 techniques for

identifying training needs of workers. These have been summarised as
follows:
i. Interview with potential participants by the manager or career

counsellor in order to identify areas of training needs.
ii. Questionnaire survey conducted on employees and manager.
iii. Analysis of personal inventory files.
iv. Management (managers) request.
v. Observation of on-the-job behaviour communications, workflow
and relationships on the job.
vi. Job analysis and job competencies, which lead to the development
of job specifications and reveal that a worker does not meet the job
specifications, set for the job.
vii. Tests.
viii. Outside consultations may be invited to review the T and D
programme and make recommendations.
ix. Group problem analysis. Here managers concerned with problems
meet to identify the specific problems and causes. Often, training
of employees is a major part of any solution.
xcviii
x. Assessment centres used for evaluating employees for promotion,

placement and further T and D.
xi. Others include discussion with immediate boss.
3.6 Training Principles
We have stated earlier on that training and development is intended to

bring about certain relatively permanent changes in the employee or
trainee‟s behaviour, skills, knowledge and attitudes in order to improve
performance on his or her current job or future job. In psychology, this
is called learning. For any training and development programme to be
successful, the trainees must learn. Personnel training effort must
therefore be guided by learning principles that have been developed
principally by psychologists. In summary, some of these principles are:
i. Readiness to learn: the trainee must want to, or have the intention
to learn.
ii. Reinforcement: provide positive rewards for certain acceptable
behaviours because trainees are most likely to repeat response
patterns, which give them some type of positive reward.
iii. Immediate confirmation: trainees learn best if reinforcement is
given as soon as possible after the training response. For example,
a promotion or an increment at the conclusion of training
processes.
iv. Feedback: provide feedback on learning results as to whether the
results of a learning process are correct or not.
v. Active practice: learning by doing is more effective than by
reading or passive listening.
vi. Spaced practice: learning task spaced over a period of hours or
days are more effective than being concentrated into one period.
vii. Whole learning: learning is better when an overall view of what
the trainee will be doing is given to him than just go immediately
into the specifics.
viii. Sequence: materials to be learned should be developed or
presented in stages; moving from the known to the unknown,
simple to the complex, and part to the whole.
ix. Instructional materials: use audio-visual aids as they help
learner/trainee to learn more effectively and retain materials learnt
longer than reading and/or listening.
x. Recognise plateaus: that is, during the training process, employees
reach a stage where they make very little or no progress. At this
point, the trainer should take a break and/or encourage trainees to
prevent a feeling of despair or a desire to give up (Mathis and
Jackson, 1985; Pigors and Myres, 1981).
xcix
3.7 Phases in Training Process
An effective training system must involve a number of phases and steps.

(Mathis and Jackson, 1985) have developed a model of training system
based on the training model developed by Godstein (1974). The former
model has been adopted here because of its simplicity and
comprehensiveness. This model is made up of three major phases with
specific steps. They are:
Phase 1: The assessment phase

This phase involves the following steps:
 Determine training needs, i.e. identify areas of weaknesses.
 Identify and specify training objectives.
 Develop and set the criteria against which training success is to be
measured.
 Pre-test trainees to determine their competence and areas of
deficiencies.
Phase 2: The implementation phase

 Select training methods specifically aimed at weak areas.
 Conduct training.
** Monitor training
Phase 3: Evaluation phase

It focuses on measuring how well the training accomplishes the desired
objective(s). You compare training outcome against criteria.
** Monitoring of training services as a bridge between the
implementation phase and the evaluation phase.
3.8 Training and Development Techniques
After the employee training and development needs have been

identified, actual training must be engaged in. This involves choosing a
particular training and development method. There are several training
methods to choose from. These methods have been variously classified
into different categories. Campbell and his associates (1970) developed
one of such taxonomies wherein training and development techniques
have been classified as:
 Information presentation techniques

 Simulation methods
 On-the-job training.
This selection has been based on the Campbell‟s modified taxonomy by

Cascio (1993), as:
c
Information presentation techniques
These techniques include the following methods:
i. Lectures: Lecture is a method of teaching. It is an organised talk,

giving formation about a specific subject matter to an audience or a
class. It can be used for a small or a large group of trainees.
ii. Conference: This is an organised meeting for the discussion or an
exchange of views about an issue or problem.
iii. Correspondence courses.
iv. Motion pictures: This refers to cinema films.
v. Reading lists.
vi. Closed-circuit television (and videotape).
vii. Systematic observation (closely akin to modeling).
viii. Programmed Instruction (PI). It is a method of guided self-learning
which provides trainees immediate feedback and step-by-step
learning. According to Mathis and Jackson (1982), the total
information to be learned is divided up into meaningful segments
using either a “teaching machine” or a book. An employee is
presented small segments of information, which progressively
increase in difficulty. Trainees‟ respond to each segment of
information by answering a question or responding on a machine.
The trainee receives an answer or looks up the answer. Correct
response allows the trainee to proceed to other material. If an
incorrect response is given, the trainee is guided back to previous
material for review. Programmed instruction is a recent method for
training employees.
ix. Computer Assisted Instruction (CAI): As the name implies, CAI
involves the trainees‟ learning by interacting with a computer.
x. T-group training: T-group is also called sensitivity training,
encounter group and laboratory training. It is a technique for
learning about one‟s self and others. It is done by observing and
participating in a group situation. The individuals usually meet in
groups over a certain period of time, during which they attempt to
enhance their awareness both of themselves and of social
processes.
xi. Laboratory education: This involves more complete programmes
of training experiences, which may include, in addition to the basic
t-group, short lectures, role playing, group exercises designed to
illustrate problems in inter-personal or inter-group behaviour, and
the likes.
xii. Organisational development: This involves systematic long-range
programmes of organisational improvement through action
research. Action research includes: (a) preliminary diagnosis, (b)
data gathering from client group, (c) data feedback to the client
ci
group, (d) data exploration by the client group, (e) action planning,
and (f) action. The cycle then is repeated continuously.
Simulation methods: These include:
The case study method: This is a widely used oriented development

technique in medicine, law and business schools. The case study method
involves the examination of an organisational event or series of events
or problems, actual or hypothetical. These situations usually involve
statements that reveal problems or opportunities that must be
recognised, identified and solved through strategic decision. The case
study approach adds realism to the classroom and offers the trainee the
opportunity to apply concept, principles and theories of management. It
therefore helps to improve the analytical thinking, problem solving and
decision-making ability of the trainee. As Casio rightly pointed out:
In the case method, representative organisational problems are

presented on paper, usually to groups of trainees who then are
required to identify problems and offer solutions. Individuals
learn from each other and also receive feedback on their own
performance.
The incident method: This technique is similar to the case study

method, except that trainee is given only a sketchy outline of a particular
incident. They have no question the trainer and when they think they
have enough information, they attempt a solution. At the end of the
session, the trainer reveals all the information he or she as and trainees
compare their solution to the solution based on complete information.
Role playing: Role-playing is a developmental technique that requires

the trainee to assume a role, character or function of another in a given
situation and act out behaviour associated with that role, it is thus as
appreciation of the factors in a certain situation.
Programmed group exercises: This is a hybrid technique that

incorporates many of the elements of the case study, multiple role
playing, programmed instruction and sensitivity training. Trainees
examine their responses first as individuals, then with members of their
own groups and finally with larger group and with the trainer.
The task mode: This involves the construction of a complex but easily
built physically object and a group of trainees is assigned the task of
duplicating the model, given the proper materials. Certain trainees are
then allowed to view the object. Common problems are then discussed
as they arise and solutions are reached through group discussion.
cii
The in-basket technique: This is a behaviourally experienced learning

method. It involves short work assignments for trainees.
Business games: These are computer-based business games that often

have to do with labour/management negotiations. In such games, a
player takes the role of either management or union and the computer
takes the other role. The trainee and the computer bargain on such items
as wages and benefits (Mathis and Jackson, 1982).
Assessment centres: The assessment centre is not a physical location.

Rather, it is a set of individual and group activities in which a number of
candidates participate. It is a multiple method group selection technique.
They help identify areas in employees that need development and are
useful for selecting managers. Mathis and Jackson (1982) provides a
vivid description of what assessment centres are as one off-the-job
development methods:
Candidates may participate in a wide variety of exercises that are

work samples of managerial situations that require the use of
managerial skills and behaviours. These standardised exercises
could be management games, leaderless discussion groups, and
an in-baskets over a several-day period. Trained observers watch
the candidates‟ behaviour in detail and record impressions. Each
assessor writes a report on each candidate, which is given to the
candidate‟s superior to use in selection and promotion decisions.
The reports often identify guidelines for further development of
the assessed employee.
At the end of the procedure, the assessors or judges have to come to

agreement on a cumulative rating for each individual, related to job
requirements, taking into account all the selection activities (Torrington
and Hall, 1998).
Managerial modelling: There is an old truism in personnel

management development that says managers tend to manage as they
were managed. That is, modelling the behaviour of other managers just
as children learn by modelling parents and older children makes much
of management to be learned; they are quite comfortable with the
process by the time they grow up. Modelling is a very natural way of
managers to develop since it will likely occur regardless of design,
intent or desire. Management development efforts can take advantage of
the natural human behaviour by matching young or developing
managers with appropriate models and then reinforcing the desirable
behaviour that are exhibited.
ciii
On-the-job training methods

These methods, as the name implies, are used with organisations and are
directly job related. They are the most common training and
development methods used by organisations. They are used both in
skills training and in management training and development. The
advantages of this method are:
 The employee is using the same machine, equipment or

materials, which he will be using after the training.
 He is being subjected to the same environmental constraints
under which he will have to operate.
 What he produces while learning is a contribution to the day‟s
effort (Nwachukwu, 1988).
Mathis and Jackson (1982) have identified five common advantages of

on-the-job methods as follows:
 Effective training can be tailored to fit each trainee‟s background,

attitudes, needs, expectations, goals and future assignment. Off-
the-job training cannot usually be tailored as well as to the exact
measurement of each trainee.
 The importance of learning by doing is well recognised in on-the-
job training.
 On-the-job training is not as time consuming.
 The employee‟s development is influenced to a large extent by
the immediate supervisor and is likely to go along with the
supervisor‟s expectations in an on-the-job training situation.
 When an organisation relies mostly on off-the-job training,
supervisors do not feel that their obligation to develop their
subordinates is a primary one. They tend to neglect it. On-the-job
training focuses a supervisor‟s attention on subordinates‟
development.
On-the-job training methods include:
Orientation training
Apprenticeships: Apprenticeship training is best used in training

manual skills as in welding, carpentry, auto-mechanic, plumbing,
typesetting, etc. An apprentice programme involves on-the-job
experience by an employee under the guidance of a skilled and certified
worker. During this time, the apprentice receives lower wages than the
certified individuals (Mathis and Jackson, 1982).
Internships: This is one type of cooperative job-experience training. It

is a form of on-the-job training, which usually combines job training
civ
with classroom instruction in technical schools or universities. In a

typical internship, students receive educational credit for the on-the-job
experience. For example, an engineering or business administration
student in a university, after two sessions of academic work, goes and
works for a company for six weeks or a semester. The objective of the
internship called Industrial Training (I.T.) programme, is for the student
to acquire knowledge and skill (ibid).
On-the-job coaching: This is one of the on-the-job development

techniques. It involves the daily instruction of subordinates by their
immediate superior. It is a continuous process of learning by doing. For
coaching to be effective the trainers should provide trainees with
frequent and immediate feedback and a healthy and honest relationship
must exist between subordinates and their supervision or managers
(ibid: 262).
Special projects: They take various forms. For example, conference

leadership. This requires that the trainee organises and chairs problem-
solving conferences. A typical example of this is the Junior Executive
Board. This allows promising middle-level managers to experience, first
hand, the problems and responsibilities faced by high-level executives in
their organisation. Ordinarily, the board is allowed to study any problem
faced by the organisation and to make recommendations to the Senior
Board of Directors.
Continuous understudy assignments: It is a recognised fact that

organisations need to have trained people ready to assume key high-
level positions. This is because necessary understudy and assignments
are used for this purpose, and to promote „home grown top executives‟.
An understudy relieves senior executives of selected responsibilities,
thereby allowing the understudy to learn certain aspects of the job and
the executive‟s style of handling it (Cascio, 1995). Similarly, Mathis and
Jackson (1982) has observed that assignments of a promising employee
to important committees can be very broadening experience. Employees
who participate in committees which make important decisions and
plans may gain a real grasp of personalities, issues and processes of
governing the way the organisation functions.
Vestibule-training: This is exclusively a training method. It involves

duplicating exactly the materials and equipment used on the job, but
takes place in an area off the production line or away from the actual job
situation.
Job rotation: It involves shifting employees from one position to

another similar one within the organisation. The objective is to give the
trainee an appreciation of the problems in the different departments and
cv
also the opportunity to learn from the different superiors. When properly
handled, job rotation encourages a deeper and more general view of the
organisation.
Assistant-to-positions: This is closely related to the junior executive

board, coaching and job rotation methods. The assistant-to-position is a
staff position immediately under a manager. Through this job, trainees
can work with outstanding managers they may not otherwise meet.
As earlier pointed out, the above tripartite categorisation of T & D

methods is not exhaustive. One employee development technique not
covered in that taxonomy is the off-the-job technique called sabbaticals
and leave of absence. Sabbaticals, as Mathis and Jackson (1982) noted,
are a very useful development tool. Sabbaticals have been popular for
many years in the academic world, where professors take a leave to
sharpen their skills and advance their education and research. Similar
sorts of plans have been adopted in the business community. However,
paid sabbaticals can be an expensive proposition.
4.0 CONCLUSION
Any approach to training and management development programmes

must start with the identification of training needs. Its policies,
objectives and techniques must be clarified. This is bound to improve
service to patients and will, in the long run, improve the image of the
hospital and its employees. The objective of training is increasing the
efficiency of employees and their development for future promotion and
better service to patients. The training programmes must be well planed
and evaluated periodically.
5.0 SUMMARY
This unit has exposed you to the uncompromising necessity of training

and development of the employee. It is what makes an organisation not
to do extinct as will remain relevant always. Now let us attempt the
following questions.
(1) Explain why it is necessary for top management to support

training and development activities for employees.
(2) How do you identify the training needs of employees in a
hospital?
cvi
Campbell, R. F. (1970). Introduction to Education Administration. (4th

ed.). Boston: Ally and Bacon Inc.
Cascio, W. F. (1987). Applied Psychology in Personnel Management.

(4th ed.). New Jersey: Prentice Hall.
Goyal, R. C. (2006). Hospital Administration and Human Resource

Heiss, A. (1970). Challenges to Graduate Schools. New York: Jossey-

Bass.
Klatt, L. A., Murdick, R.G., & Schuster, F. E. (1985). Human Resource

Management. Columbus: Charles E. Merril Publishing Company.
Mathis, L. & Jackson. J. H. (1982). Personnel: Contemporary

Perspectives and Applications. (3rd ed.). St. Paul: West Publishing
Company.
Nwachukwu, C. (1988). Personnel Administration in Nigeria. Port

Harcourt: University of Port Harcourt Press.
Pigors, P. & Myres, C. A. (1981). Personnel Administration: A Point of

View and a Method. (9th ed.). New York: McGraw-Hill Book
Company.
cvii
UNIT 4 TRAINING AND MANAGEMENT

DEVELOPMENT II
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Introduction
3.2 Management Development Programmes
3.3 Principles of Management Development
3.4 Grooming Leaders
3.5 Management Development Methods
3.6 Line and Staff Responsibilities in Management Development
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
In the last unit, we looked at the definition of training and development,

need for training and development, advantages, techniques, principles
and phases in training process. This unit will build on these areas and
focus in management development in the hospital organisation.
2.0 OBJECTIVES
 describe management development programmes

 state the principles of management development
 explain how leaders are grouped
 discuss management development methods
 state the responsibilities of line and staff in management
development.
3.0 MAIN CONTENT
3.1 Introduction
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
cviii
but I cannot give my executive.” In a developing economy like India,

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
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.
3.2 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:
 is a continuous process
 is a vehicle for attitudinal change
 is stimulant to higher competence
 provides feedback mechanism
 eliminates functional deficiencies
 is a self-development process as managers learn many things
through sharing the experience of each other in a stimulated
classroom.
cix
3.3 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.
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 field-work, to cooperate 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 recognised 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 is so high that there must be a
systematic and comprehensive evaluation to assess its
effectiveness and to modify and improve training programmes as
required.
cx
3.4 Grooming Leaders
No organisation can do without a super-leader someone who can

recognise the „skill set‟ of every employee, hone these skills and mould
him into the next rung leader. A super-leader‟s brief is to spot and
liberate the leader in every employee. And, this liberation cannot happen
overnight. It is often the result of a continuous effort at developing
individual capacity of every employee till they realise their optimum
potential to act in a responsible manner.
Effective leaders invest in developing people‟s skills and competencies.

Surveys have shown that organisations, which spend more that average
amount of money on employee training, achieve higher levels of
commitment, better customer service and employee alignment with
company vision and values.
Another responsibility of a super-leader is to create an effective learning

environment. This is characterised by a climate of trust and openness
which leads to greater willingness to communicate about feelings and
problems and a positive inclination for change.
Learning is also about making mistakes. In any work environment, there

is learning curve. Performance generally goes down before it goes up.
Super-leaders are thus great learners who regard all mistakes as learning
opportunities. They foster this attitude among their associates also by
encouraging them to break old patterns of thinking, come out of their
boxes, question routines and challenge assumptions.
One leading company introduced a suggestion system that rewarded

thinkers of original ideas. The response from the employees was prompt
and instantaneous. The system began to change established mindsets.
Employees began to think more in terms of how to improve their
productivity rather than remain disturbed by others‟ mistakes. In less
than five years, inventories went down by 60%, output shot up to 90%,
timely deliveries increased from 65% to 95% and sales increased by
over 30%.
The president of a well-known company pursues a very open-ended

communication strategy with his subordinates. Instead of interacting
only with a small coterie of key executives, he routinely summons big
employee groups to his office and openly shares his vision for the
company with them. Sometimes, the employees come up with their own
suggestions on better alternatives. Needless to add, there is better
understanding in this company than anywhere else. The employees are
more committed to the company plan than even the boss himself.
cxi
3.5 Management Development Methods
Generally, the aim of all management training techniques is to generate

in department heads a better 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.
3.5.1 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 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.
3.5.2 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 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.
3.5.3 Job Rotation
Managers may be rotated among positions to test their ability and to

meet new situations and challenges. Some organisations give middle-
management managers little opportunity to consider whether or not they
are interested in job rotation. Others consult them in detail before taking
into 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.
cxii
3.5.4 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 prepare
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.
3.5.5 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 technicians, 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 is practice in a reality situation. The first
step is to get the trainees to suggest common 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.
3.5.6 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, 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 behavior as well as their thinking, receive
feedback about their behaviour and give feedback about the behaviour
cxiii
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.
3.5.7 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 himself. Asking
the subordinates to study problems and take decisions by themselves can
infuse then with confidence and develop decision-making and leadership
skills which are essential for a good manager.
3.5.8 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.
3.6 Line and Staff Responsibilities in Management

Development
The prime responsibility for management development is that of each

and every line manager. The responsibility for planning and
implementing the management development programme would,
however, rest with the training officer, who is part of the human
resource department.
The success of a formal management-development programme depends

largely on the sustained interest of all management personnel. Each
manager should feel that he is required to assist in the development of
his subordinate. It is only then that the management-development
programme will succeed in a real sense.
Dr. P.N. Ghei in his paper presented on 22 March, 1992 at Bangalore on

“Hospital Management Training in India” stated that hospitals operate
365 days a year. Although they are looked upon as humanitarian
institutions, yet they encounter the same economic problems that the
modern industry does. Therefore, modern business techniques should
now readily be adopted in most hospitals. As necessity and requirements
cxiv
of new items are unending, it is more than difficult to restrict or limit the
activities of a hospital. In order to keep it updated, hospitals should
maintain suitable pace with the day to day advancement in the field of
medical science. He further stated that the first programme of training
leading to Master in Hospital Administration was started in the All India
Institute of Medical Sciences, New Delhi in 1963. At present there are
30 different training programmes spread in different parts of the
country.
4.0 CONCLUSION
Management development activities must meet the needs of the

employees to further develop techniques and abilities, to keep abreast of
the latest technology available in the field of radiology, medical
laboratory and medical record technology, physiotherapy, nursing,
surgery, administration, etc. There are, of course, many variations in
training and management-development programmes. Each hospital uses
some combination of types of training, which fits its situation best.
5.0 SUMMARY
We have seen that management development is crucial to the progress

and existence of any organisation especially hospital. I am sure you will
agree with me that the knowledge acquired in these last two units is
quite insightful.
Discuss the various methods used in management development.
Ghei, P.N. “Hospital Management Training in India.” Journal of the

Indian Hospital Association. September-December 1992.
Lyton, R.P. & Pareek, U. (1978). Training for Development.

Connecticut: Kumarian Press.
McGhee, W. & Thayer, P.W. (1961). Training in Business and Industry.

John Wiley & Sons. New York.
cxv
UNIT 5 WAGE AND SALARY ADMINISTRATION
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Purposes of Wage and Salary Administration Programme
3.2 Meaning of Wage and Salary Administration
3.3 Wages versus Salaries
3.4 What Determines Wages and Salaries?
3.5 Obligations of the Management
3.6 Authorised Deductions used the Payment of Wages Act, 1936
3.7 What is Involved in Wage and Salary Programme?
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
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 involved.
cxvi
2.0 OBJECTIVES
 state the meanings of wage and salary

 differentiate between wage and salary
 state the purposes of wage and salary administration programme
 discuss what determines wages and salaries
 describe the obligations of the management to the staff
 explain why authorised deductions are made from the wages of the
workers.
3.0 MAIN CONTENT
3.1 Purposes of Wage and Salary Administration Programme
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 ad training
requirements of the employee occupying the position
2. To compare positions according to mental and physical
requirements, skill, responsibility and working conditions
3. To establish common titles for jobs which have similar duties and
responsibilities, to 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.
3.2 Meaning of Wage and Salary Administration
To the hospital, wage and salary administration means:
1. Fair and equitable wages and salaries for all employees

2. A basis for establishing, developing and maintaining good
employee relations
3. Development and maintenance of good employee morale
4. A guide for administrative action concerning wages and salaries
5. A basis for facilitating control over expenditure on wages and
salaries.
To the employees it means:
cxvii
1. A basis for understanding the hospital‟s policies concerning wage

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

who enjoy their job and are happy with their work
2. Lower hospitalisation costs, resulting from a higher degree of
employee efficiency.
3.3 Wages versus Salaries
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. However, in practice, these two words are used
interchangeably for employees in the lower strata.
3.4 What Determines Wages and Salaries?
Demands 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.
cxviii
3.5 Obligations of the Management
The Payment of Wages Act, 1936, has imposed a number of obligations

on employers. Basically, the management has six obligations regarding
the payment of wages and salaries to its employees:
1. The management must fix a time to pay wages and salaries

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 the case of 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 by cheque if the employee
consents to it
6. The payment should be made in full without any deductions except
those authorised by law.
Authorised deductions used the payment of Wages Act, 1936
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
These deductions can be made in the manner and to the extent provided
in the Act. No other deductions are permissible.
3.7 What is involved in Wage and Salary Programme?
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.
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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 the relative value of each job in the institution. The process
of job evaluation involves the following 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.
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, one head of the department of any paramedical department,
maintenance engineer of the maintenance and 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 programme 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.
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3.7.1 Developing Fundamental Policies
Policies must establish the average level of wages and salaries within
the hospital. These policies are influenced by the following factors:
Existing labour 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. The Indian government in the post-independence
period has always felt the need for protection of the large segment of the
population-the working class.
1. 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.
2. Similarly, Article 39 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 employment of leisure and social and cultural opportunities.
3. 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.
4. 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.
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 labour is 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 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 sub-standard.
Regulations established by employees and their unions/associations

through negotiations: Regulations established by the unions through
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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.
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:
1. One of the major objectives of a wage and salary study is to create

the proper relationships among the positions in the hospital.
2. A study of duties performed in various positions may enable the
hospital to spend the money available for wages and salaries more
wisely.
3. 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.
4. 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.
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 give 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.
3.7.2 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:
1. Establishing the jobs to be performed, describing their content and

the duties and responsibilities of employees assigned to them.
2. Studying and analysing each job to determine the standard of
performance necessary for its successful completion and the
qualities which the person should possess.
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3. Evaluating each job to determine the relative value in relation to all

other jobs performed in the hospital.
4. 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:
Establishing the jobs to be performed, describing their contents and

defining the duties and responsibilities of employees assigned to
them: There are three fundamental steps in the investigation of the work
performed in the hospital:
1. The positions involved must be listed.

2. The contents of each position must be described including the
duties and responsibilities of the employees assigned to it.
3. 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:
1. How many persons are employed by the hospital?

2. What tasks does each person perform?
3. In which positions are the same tasks performed?
4. 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:
1. A review of payroll record to identify each position and each

employee.
2. A work questionnaire completed by each employee in which he
lists all the duties he performs.
3. An interview with each employee and his supervisors to clarify and
supplement the information received from them through the
questionnaires.
4. Direct observation of work performance, to check the accuracy of
the data collected.
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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.
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 classification
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.
1. Agreement upon terminology so that job names, titles, etc. have

specific and uniform meaning to all those who use them.
2. 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.
3. An understanding of job relationships to encourage better
cooperation among employees and to establish promotional lines
and transfer opportunities.
4. Awareness of job-environment factors which may involve health
hazards.
5. Provision of relevant facts to serve as the basis for method‟s
improvement.
6. Development of information essential for a system of job
evaluation which will support and defend wage and salary
differentials between jobs.
7. Helping workers and supervisors to formulate a better common
understanding of job standards and of rating procedure.
8. Provision 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:
1. Job title.
2. The number of positions commonly carried on the payroll in each
job classification.
3. The departments in which positions in this job classification are
found.
4. Work performed.
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5. 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.
6. 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.
7. Hours and shifts
8. Standard of performance
9. Job combinations
10. Working conditions
11. Mechanical requirements
12. Special performance demands, if any
13. The date of completion of analysis
14. The signature of the supervisor responsible for the job described.
Evaluating each job to determine its relative value in relation to all

other jobs performed in the hospital: 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 logical
and uniform basis for decisions concerning the relative level of wages
and salaries between jobs in the hospital. The fact 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.
1. 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
cxxv
worth right from the post of sweeper/dishwasher 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.
2. 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
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 ad 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 10 to 15. 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
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(b) Cooperation 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 10 categories:
Clerk I Typist-Clerk I Stenographer I

Clerk II Typist-Clerk II Stenographer II
Clerk III Typist-Clerk III Stenographer III
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 clerical positions arrived at, positions in the
organisation can be assigned to a grade level by the evaluation
committee.
3. 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
consideration of these ranks in establishing an overall evaluation of
each job as compared to all others.
cxxvii
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.
4. 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 shows 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 relationship 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.
(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
cxxviii
head, human resource manager and the chief 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 five and 15 percent to avoid
excessive overlapping.
If the ranking or classification or factor-comparison method of

evaluation has been used, job classifications should be assigned to
grades on the basis of their relative positions. If the point systems
have 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 involve numerous considerations beyond the evaluation
of jobs by classification and the mathematical computation of
cxxix
setting up a defensible grading system. These often include the

following:
(a) The prevailing rates in the region where the hospital is
situated
(b) Custom within the hospital as evidenced by existing wage
and salary levels
(c) Assignment of higher responsibility to a particular job in the
interest of the hospital
(d) 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.
Job assignment: After a satisfactory salary and wage structure has been
developed, it should be applied to the individuals employed by the
hospital. Assigning each hospital employee to his job, appraising his
performance and compensating him involves:
i. Procedures for recruitment, selection and induction

ii. Procedures for transferring, promoting and separating employees
iii. Setting standards of performance and the evaluation of the
performance of each employee
iv. 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.
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
performance may be overlooked and their relationship to the salary and
wage administration programme forgotten because they are such
cxxx
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.
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; (l) 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
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.
cxxxi
The mode of disbursement of salaries to employees differs from hospital

to hospital. Some hospitals pay in cash through their cashier in a
working day during working hours; others by crediting on 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 on account 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; (f)
maternity leave; (g) study leave; (h) administrative leave; or (l) 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.
(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.
4.0 CONCLUSION
A plan for the administration of wages and salaries is always a changing

process which requires continuous study and frequent revision. It is
important that the hospital should provide for: (a) frequent checks on job
description to make sure that they are essentially correct; (b) periodic
wage surveys to determine the prevailing wages paid in the
neighbouring hospitals; (c) a means of explaining the procedure in use
to new employees; (d) periodic reviews if the wage and salary structure
to eliminate inconsistencies and strengthen the programme in general.
cxxxii
Responsibility for the development and administration of a fair and

equitable wage and salary administration system rests with the line
managers. The human resource department has an important role to play
in this area, as wage and salary administration has significant human
relations implications. The human resource manager renders expert
advice to line management in the development of a suitable system of
job evaluation. A very large hospital may have a separate wage and
salary administration department. Smaller hospitals, which cannot afford
such a specialist department, assign the responsibility to someone in the
human resource department.
5.0 SUMMARY
Wage and salary administration is not only a science but is also an art,
whatever data is available, a proper selection has to be made, and this
requires the highest skill in the human resource manager so that
effective policy decisions may be evolved.
Describe how the wage and salary structure of hospital workers be built
in order to bring peace or reduce the unhealthy rivalries within the
system.

Patchen, M. (1961). The Choice of Wage Comparisons. Englewood

Cliffs. N.J: Prentice-Hall.
Peretomode, V.F. & Peretomode, O. (2001). Human Resources

Management Principles, Policies and Practices. Lagos: Obaroh &
Ogbinaka Publishers Ltd.
Salschneider, J. (1981). “Developing Pat Strategies for Diversified

Companies.” Compensation Review 2nd Quarter; 15-24.
cxxxiii
MODULE 3
Unit 1 Appraisal of Human Resources

Unit 2 Human Relations and Public Relations in Hospitals
Unit 3 Teamwork in Hospitals
UNIT 1 APPRAISAL OF HUMAN RESOURCES
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 History of Performance Appraisal
3.2 Definition
3.3 Components of Performance Appraisal
3.4 Appraisal from Employee‟s Point of View
3.5 The Purpose of Appraisal
3.6 Preparing for the Discussion
3.7 Process of Performance Appraisal
3.8 Advantages of Employee Performance Appraisal
3.9 Limitations of Appraisal
3.10 Requisites of a Good Appraisal System
3.11 By whom should Appraisal be Done?
3.12 Precautions to be taken while Introducing Appraisal Scheme
3.13 Behaviourally Anchored Rating Scales
3.14 Executive Appraisal
3.15 The 360 Degree Appraisal
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Recognition and advancement are some of the basic human aspirations.

A proper system which caters for those aspirations motivates a person to
provide better output. On the other hand, the absence of such a system
leads to frustration, disappointment and lethargy, which result in the
deterioration of performance. The success and efficiency of an
organisation depend to a large extent on how these basic requirements
are taken care of.
It is an unfortunate fact that the more deserving a person is, the more is
his desire for unmerited advancement. He is prepared to use both fair
cxxxiv
and foul means and is often able to attract the favourable attention of his
superiors simply by being more visible though working less that he
should, or though he is capable than many of his colleagues. It is this
phenomenon which lowers the standard of conduct and behaviour
resulting in frustration and inefficiency. The administrator has,
therefore, to constantly struggle to make employee assessment objective
and keep any vicious trend under check.
A system in which a job is properly defined and some yardsticks laid

down for judging the employee‟s performance makes the appraisal more
accurate and objective. This system also gives the conscientious
employee a good opportunity for self-appraisal. The whole process
paves the way for continued betterment of the employee‟s performance
and development of confidence and pride in his work.
In any system of performance appraisal it is necessary to adopt

nomenclatures which have uniform and universal application, so that
one description would convey to all persons at all times and at all places
the same meaning and eliminate any misunderstanding.
Terms commonly applied to the management and evaluation of

performance of employees are efficiently rating, service rating, annual
rating, merit rating and performance appraisal. As applied to human
resource management, they are practically synonymous. The last two are
most frequently used. More recently, emphasis has been given on
increasing the results of the employee‟s performance rather than his
merits.
If managers accept that one of their responsibilities is to develop their

subordinates, they should also accept that appraisal and discussion about
job performance are their duties too. But the truth is that most of the
senior officers holding medical, nursing, paramedical and administrative
posts in hospital have never held discussions with their superiors and
subordinates on how they were fairing in their jobs, with a view to
developing their potential or correcting their weaknesses.
Central to the concept of employee-performance appraisal is the mutual

advantage of employer and employee so that in practice the phrase
„career development‟ establishes an identity of interest between them.
The employer benefits by identifying individuals with the ability to take
on more responsible and senior jobs and the employees are helped to
develop their personal capacities further. Performance, capacity and
potential are the main qualities under review and in recent years the
emphasis is being placed more and more on performance. Measuring
result against previously agreed objectives is now seen as the main
purpose of appraisal. This is contrary to the earlier, traditional type of
cxxxv
assessment which was largely based on assessing a subordinate‟s

personality and which was kept absolutely secret from him.
Another sign of the traditional approach being swept away is that the
written confidential report has been replaced by the appraisal interview
where the senior officer neither dominates the interview nor announces
his opinion. Rather, an appraisal interview has come to mean a joint
interview in which the subordinate is expected to make a constructive
contribution including self-assessment of his performance and career
aspirations. Recently some organisations have introduced 360 degree
appraisal system for their employees, which will be explained in a later
section.
2.0 OBJECTIVES
 define performance appraisal

 state the components of performance appraisal
 list the purpose of appraisal
 describe the process of performance appraisal
 enumerate the advantages and disadvantages of employee
performance appraisal
 mention the requisites of a good appraisal system
 discuss the precautions necessary while introducing employees‟
appraisal scheme.
3.0 MAIN CONTENT
3.1 History of Performance Appraisal
Employees‟ performance appraisal technique is said to have been used

for the first time during World War I, when Walter D. Scott of the U.S.
Army adopted the man-to-man rating system for evaluating military
personnel. Now, merit rating is largely restricted to the rating of hourly
paid employees and is used for developing criteria for wage
adjustments, promotions, transfers, etc. Performance appraisal places
emphasis on the development of the individual and is used for
evaluation of technical, professional and management personnel. Some
authorities use terms such as performance appraisal, merit rating,
employee evaluation, annual rating, etc. interchangeably while others
interpret some of these terms differently. However, the term
performance appraisal is most widely used in the human resource
management vocabulary.
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3.2 Definition
Performance appraisal is the process of evaluating the ability of an

individual employee against predetermined standards usually set in the
job description. It replaces casual assessment with formal, systematic,
scientific, objective and professional procedures. Employees know they
are being evaluated and they are told the criteria that will be used in the
course of the appraisal. Nothing is kept secret. The appraiser and the
appraisee should carry out this task jointly in a cordial atmosphere
stressing on the plus points and finding out ways and means of
overcoming drawbacks, if any, of the appraisee.
3.3 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.
Therefore, it is necessary to understand clearly the objectives of the
performance appraisal. While doing the performance appraisal, the
appraiser should address the question in respect of the five Ws, viz.
who, what, why, when, where, as also the how of performance appraisal.
These five Ws will not only help the appraiser but the appraisee as well.
Who: All employees work under the supervision of one supervisor.

Therefore, the supervisor is the best person to do performance appraisal
of his subordinate.
What: This includes appraisal of current performance and future

potential. It also includes evaluation of human traits.
Why: It is concerned with creating and maintaining a satisfactory level

of performance of employee in his present job, highlighting his needs
and potentials for personal growth and promoting understanding
between the supervisor and his subordinate.
When: Informal performance appraisal continues throughout the year.

The supervisor should use good work as an opportunity to provide
positive thrust and use poor work as a basis for training. But formal
performance appraisal should be done once a year.
Where: Performance appraisal should be done in the office of the

supervisor in a cordial atmosphere without any interruption. At that
time, the appraiser, the supervisor, and the appraisee, the subordinate
should not be disturbed.
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How: The method of performance appraisal must be decided. All

supervisors must be trained in it. Certain ethical norms should be
followed.
3.4 Appraisal from Employee’s Point of View
An appraisal discussion, for some, is a nightmare. For others, it is a

much awaited opportunity. How does an employee react to his
appraisal? Does it cause him to feel anxious or does he see it as a
positive event - an opportunity to learn about oneself so that he can
grow and develop.
An appraisal discussion can be very positive experience, depending

upon the attitude and mindset one brings to it. Some managers are more
skilled in preparing and delivering appraisals than others but there are
many things one can do to help make it a good experience.
3.5 The Purpose of Appraisal
The first thing to do is to remind oneself of the purpose of the appraisal.

The boss has no desire to slap at one‟s face and tell what one has done
wrong. A good appraisal reviews past performance that shows how one
met one‟s goal and objectives. It gives an insight into one‟s strengths
and reveals weaknesses and areas one needs to improve, with a plan to
perform better in future.
3.6 Preparing for the Discussion
An employee should remember the purpose of the appraisal system so

that he can go in with the right mindset. He should reflect on his
performance over the past year and what he perceives to be his strengths
and weaknesses. It is better if the employee keeps a written document of
his past performance and what he intends doing in future for the
organisation. He should imagine how he wishes to behave during the
discussion.
Get a good night‟s sleep the evening before so that he will be alert and
fully present during the appraisal discussion.
Lastly, he should be rest assured that his boss is like his father who is
there for his growth and development.
The following points needs to be taken into consideration during the

discussion on appraisal:
cxxxviii
(a) Make sure that the employee understands the basis of his appraisal
system from the beginning.
(b) Sit up straight in the chair and look at the appraiser in his eyes.
(c) Listen carefully without interrupting.
(d) Be open, flexible and willing to admit you short comings.
(e) If the employee does not understand how his superior arrived at a
particular evaluation, he can request him to give specific example
of that event.
(f) If the employee does not agree with his comments/evaluation, try
to respond as objectively as possible.
(g) Before the appraisal is over, the employee should be clear in his
mind of areas where he has been required to improve his
performance.
(h) The employee should give assurance to his superior that he would
certainly perform better in future.
3.7 Process of Performance Appraisal
Performance appraisal is a process of various human resource functions.

It begins with the job analysis, job description and job specialisation.
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. The figure below 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.
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Job Analysis, Job Description &

Job Specification
Establishing Standards of
Performance
Communicating Performance
Standards to Employees
Measuring Actual Performance
Comparing Actual Performance with

Standards and Discussing with
Employees
Initiating Corrective Action, if

Necessary
Fig. 1: Steps Involved in Employee Performance Appraisal
Now the step in order is to measure the actual performance. It can be

effected 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.
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.
3.8 Advantages of Employee Performance Appraisal
The principal advantages of employee performance appraisal are:
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i. 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.
ii. It gives evidence of management‟s interest in the individual
employee.
iii. It induces supervisors and department heads to think more
seriously and objectively about the performance of their
employees.
iv. It gives an opportunity to an employee to know his plus and minus
points and to improve his performance.
v. It provides an objective basis for many types of personnel
decisions including pay increase, training, promotion, etc.
vi. 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.
Time interval between two performance appraisals

Performance appraisal is a regular and continuous activity. It should be
conducted at regular intervals. Some experts are of the opinion that it
should be conducted every six months while others opine that it should
be conducted once every two years, but the author firmly suggests that it
should be conducted every year for all those employees who are
permanent, at any time for those employees who are being considered
for promotion, or being sent for higher training, etc. It may be part of a
strategic decision to the manager, which he has to take. It is surprising
that in many organisations performance appraisal is not undertaken
regularly, which is not a good practice. Periodic performance appraisal
of the employees enables them to improve their performance.
3.9 Limitations of Appraisal
There are also certain limitations of employee performance appraisal:
a. There is a tendency among supervisors to rate an employee as well

as his job. Therefore, a personal bias cannot really be eliminated
while appraising an employee.
b. There is a tendency to rate the individual on the basis of an overall
impression.
c. In similar institutions, there is close personal association between
the rater and the rate. With such close contact, the rating tends to
become subjective.
d. The efficiency of an employee may be measured in terms of the
quality of the work accomplished and the quality of work done, but
there is a serious lack of quantitative standards on which rating can
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be based. It is regrettable but true that in many cases, hospitals do

not know what production standards at various levels should do.
3.10 Requisites of a Good Appraisal System
The following are the requirements of a good employee performance

appraisal system:
1. The most important conditions for the success of any rating system
is that the supervisors fully understand the plan, have faith in its
effectiveness and carry out their part conscientiously.
The original rating is made by the employee‟s immediate
supervisor. If this rating is made carelessly, no amount of care and
intelligence elsewhere will be able to save the programme.
2. It is important that the employee performance appraisal system has
the active support of the top executive who makes the final
decisions on promotion, training, increment, transfer, etc.
3. An appraisal form that has been thoughtfully and skillfully
designed should be used. A well designed form is of great help in
securing accuracy and uniformity in doing the appraisal.
4. An important part of any employee‟s performance appraisal plan is
the statement of standards of performance. The statement of
standards will enable both the employee and the rater to have some
basis for judgment as to how satisfactory the employee‟s
performance has been. These standards should be stated in writing
and in as specific terms as possible.
5. It must have the support of all the line managers who administer it;
otherwise they will not take interest in its operation.
6. It must be easily understandable. If the system is too complex or
too time consuming, it may be a non-starter and ultimately be
rejected by those who are to use it.
7. It must identify persons of proven competence and leadership.
8. There should be very close collaboration between line managers
and the human resource manager, because the line managers are
primarily concerned with the subordinate and his job and the
human resource manager focuses on the man and his career.
9. As much notice is possible should be given to the employee
regarding the performance appraisal interview, so that the
employee may be mentally prepared.
10. Adequate time should be allowed for the performance-appraisal
interview. This may vary according to circumstances and the
persons taking part in it.
11. Complete privacy and freedom from telephone and other
interruptions should be ensured.
12. Finally, it is a must to establish rapport before commencing the
employee performance appraisal interview.
cxlii
3.11 By Whom Should Appraisal be Done?
It is essential to carefully select and train the appraiser. It is important

that those who are to appraise other employees:
a. Recognise the need for an objective attitude while appraising an

employee. An employee should never be appraised when the
appraiser is displeased with the employee, because his displeasure
will be reflected in the performance appraisal. In such cases, the
work should be assigned to a second person.
b. Avoid rating an employee high or low because of any personal
liking or disliking about him.
c. Understand the danger of rating consistently high, consistently low
or grouping all employees at the centre of the scale.
d. Understand the objectives of the appraisal programme.
e. Are familiar with the job of the concerned employee, its
requirements in quantity and quality of work, its difficulties, etc.
f. Are aware of any public relations problems involved. This point is
especially important in the hospital field, where each employee
somehow or the other come into contact with patients and the
public.
In selecting an appraiser who can meet these requirements, the first

choice should be the department head, or in larger institutions, the
immediate supervisor of the concerned employee. It is also important
that the employees know about and understand the programmes before it
is undertaken. The plan should be discussed and advantages to the
employees stressed before the appraisal programme is introduced in the
hospital.
3.12 Precautions to be Taken while Introducing Appraisal

Scheme
It is important that an appraisal scheme be introduced at a time when

employee-management relations are not strained on account of incidents
such as pressure for salary increase, the dismissal of a senior employee,
withdrawal of any facility, etc.
An appraiser might best start by getting his subordinate to talk about the
job and problem areas. This is the time to discuss those parts of the job
that are done well. The superior should then move on to ask about any
difficulties encountered. Questions must be asked in a subtle manner to
bring out personal shortcomings. When these are known to exist but the
subordinate is unwilling to admit them, the superior must have on hand
evidence of inadequate performance during the period under review.
The interviewer must carefully set the tone throughout the interview by
cxliii
listening attentively, helping the subordinate to express his feelings and

never permitting the exchange to become heated.
The conclusion of the interview should take the form of a confirmation

of agreed action so that both are perfectly clear about what is to follow
in the immediate future. A „development action plan‟ - a written
statement of objectives agreed upon between the superior and
subordinate for the development of the latter should be instituted. It
should include training and career needs as well as indicate the areas in
which improvement in the present job are called for from the appraised.
It should be practical and the agreement should signify a commitment to
the plan by both superior and subordinate. If this is done, the
subordinate will believe that his boss is genuinely interested in his job
performance and career aspirations.
Participation in employee performance appraisal means giving the

initiative to the subordinate. He should be allowed to write his own
report on the main tasks he has dealt with during the year under review
and how he has carried them out. He should be encouraged to analyse
the problems that arose and how he tackled them.
With this approach as a basis, the nature of the conventional type of

appraisal interview changes. It becomes primarily a joint problem-
solving event. However, the programme does not achieve a maximum
usefulness until several appraisals have been completed. It is, therefore,
important that the operation of the programme be maintained
continuously. When several appraisals are compared, a pattern of
behaviour can usually be established for the individual employee.
All appraisals should be kept confidential between the employee

appraised and members of the supervisory staff responsible for the
operation of the programme. This information should never be discussed
with other employees or publicised in any form. Appraisal reports
should be retained centrally in the human resource department for a
minimum period of five years or for a longer period, if possible.
3.13 Behaviourally Anchored Rating Scales
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
cxliv
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.
3.14 Executive Appraisal
The work of appraising the performance of employees does not stop

with the appraisal of workers and supervisors of the hospital. Executive
appraisal is equally necessary to strengthen administrative performance
by developing a clear-cut mutual agreement on work objectives, plans,
personal and institutional goals. Some leading hospitals in the United
States of America have developed a system of appraisal which
incorporates three phase directed toward the final goal of sharing total
objectives: (a) the personal appraisal by the executive himself; (b) the
appraisal of the executive by his peers; and (c) the appraisal of the
executive by his boss or chief executive.
A personal appraisal form is given to the executive whose performance

is to be evaluated. The executive is asked to outline his job, describing
the objectives, responsibilities and duties of his job. He is then asked to
list the phase of his work that he performs well and those he performs
just adequately. He is also asked to make specific suggestions as to how
he can improve. The narrative form of appraisal includes obtaining a
statement on what points he needs improvement from: (a) workers such
as nurse/pharmacy/X-ray/physiotherapy/laboratory aides; (b)
supervisors such as in nursing/pharmacy/X-ray/ physiotherapy/
laboratory/medical record/accounts, etc.; (c) his fellow executives; (d)
the organisation; and (e) himself. The executive is then asked to look
back on the past year and describe what he considers were his main
achievements, to look to the future and describe the areas he intends to
develop from the viewpoint of his personal goals and the needs of the
hospital. Concurrent with the self-evaluation of the executive, the chief
executive of the hospital selects one or two peers of the appraised
executive and asks them to measure the effectiveness of his performance
by frankly stating how well he functions to fulfill the needs of their
cxlv
departments and how he strengthened or weakened their own efforts to

perform effectively. Thus, they are asked to outline the fellow
executive‟s principal strengths and weaknesses. Finally, upon receiving
the self-appraisal of an executive as well as the appraisal of his peers,
the chief executive completes a two part executive appraisal by having a
free and frank discussion about his performance, based on the
assumption that the performance will improve further by training and by
meeting his requirements. Here the chief executive measures the
executive‟s problem-solving abilities, report writing, meeting of
deadlines, his organisational ability and communications with
subordinates and superiors. On the basis of the information required,
each hospital can design s form for the performance appraisal of the
executives.
3.15 The 360 Degree Appraisal
Recently, a new appraisal system is coming into vogue where chief

executives have started following the 360 degree appraisal of their
employees in their organisations. The 360 degree appraisal is a
development oriented appraisal system of employees, which gives due
recognition and importance to all entities that influence the performance
of employees in an organisation and attempts to gather all the vital
inputs from these entities with an objective and attempts to gather all the
vital inputs from these entities with an objective of performance
enhancement and overall employee development.
As depicted in the figure 2, the employee is at the core of this system

because different entities such as superior, subordinates and peers of
one‟s own department as well as of other departments of the
organisation play important role in his work. Thus, the 360 degree
appraisal can be classified into: self-appraisal, superior appraisal,
subordinates‟ appraisal and peers‟ appraisal.
cxlvi
900 900
Supervisor
Peer Employee Peer
Subordinate
900 900
Fig. 2: The 360 Degree Appraisal: Illustration of 360 Degree
Appraisal
Self-appraisal
In the 360 degree appraisal system, self-appraisal gives to an employee
absolute freedom to objectively look at his strong points and areas of
development along with an opportunity to assess his performance. Some
executives have found that employees are their own critiques and
display very high degree of objectivity. Secondly, they share their
development areas with their superiors based on their self-appraisal and
then they work out a development plan, keeping in view the
organisational requirements and resources. Thirdly, self-appraisal
provides an opportunity to the employees to express their future career
plan in which the organisation may or may not be helpful to them
because of its constraints and resources.
Superiors’ appraisal
In the 360 degree appraisal, superior‟s appraisal places career
aspirations of the employees in proper perspective. The superior must
communicate to the employees in clear words, what the organisational
plans are for them. Apparently, the superior provides constructive
feedback on the employees‟ performances in the review period. Here,
the superior and the employees set goals manually for the next year.
Subordinates’ appraisal
Appraisal by subordinates of their superior encourages openness and
brings them closer. Besides, it is a systematic recognition of the fact that
subordinates do play a vital role in the performance of their superiors.
So the purpose of subordinates‟ appraisal is to get first-hand assessment
cxlvii
of how they view their superiors in terms of the style of their

functioning. It provides an opportunity to the subordinates to give
feedback to their superiors on the kind of things the former would like
the latter to continue doing and what they should stop doing.
Peers’ appraisal
Peer‟s appraisal is significant because they play a critical role in the life
of any employee in the organisation. First thing about peers appraisal is
to select the right peers for getting the appraisal done from within the
department as well as from the other departments who are directly
connected with the working of the peers‟ department. Thus, these four
components complete the 360 degree appraisal system, each one
representing 90 degree of the overall appraisal. The factors to keep in
mind before attempting to introduce the 360 degree appraisal system are
that it requires the level of maturity in one‟s organisation‟s history of
appraisal, current stage of appraisal, organisational climate and culture,
top management‟s willingness to accept openness and feedback, and
implementing inputs received from the 360 degree appraisal system. A
word of caution for those who want to adopt this appraisal system:
whether or not their organisation is ready to accept this new system;
otherwise, a step taken in hurry to adopt this appraisal system can prove
fatal because of its ill consequences.
Performance counselling
As the name suggests, performance counselling relates to the
performance of employees. If the employee is not keeping up his
performance and it is going down day by day, then counselling is
required to maintain the standard level of performance. Performance
gets affected by many reasons. Those reasons must be spotted by the
supervisor of that employee. If he fails to spot them, he should refer
such an employee to the counsellor as the employee may be having
family problems, financial problem, marital problem, difference with his
peers or supervisor, etc. All these problems have a negative impact on
his job. The urgent need is to remove the problem and help the
individual regain his or her self confidence. Here counselling can do the
magic and help an employee to overcome his lost confidence.
4.0 CONCLUSION
Ideally, every appraisal should end in three easy steps. Setting

measurable goals for each employee, measuring part performance and
recommending remedial action for the future. All this can be handled in
a usual interview format, but the interview should centre on specific
goals, targets and rewards. So far as performance is concerned, it can be
reviewed in many ways. Whatever mode one chooses for one‟s
cxlviii
organisation, make sure it meets the approval of all concerned,

otherwise, it might end up as one more futile experience.
5.0 SUMMARY
Employee‟s performance appraisal in a hospital is necessary to ensure

understanding and to obtain the most favourable agreement between an
employee and his supervisor on the goals of the institution and the
progress of the employee in reaching institutional and personal goals.
The employee‟s plus points should be appreciated and the minus points
should be minimised by counselling instead of criticising them. It is
hoped that you enjoyed your reading and your knowledge enhanced as
well.
Discuss the remedial programmes that human resource management

department should put in place for employees that could not meet the
standard of the organisation in performance of their duties.

Ferris, G.R. & Buckley, M.R. (1995). “Human Resources Management:

Perspectives.” In: Context, Functions and Outcomes. New Jersey:
Prentice-Hall.
Mathis, L. & Jackson, J.H. (1982). Personnel: Contemporary

Perspectives and Applications. (3rd ed.). St. Paul: West Publishing
Company.

Thompson, P.H. & Dalton, G.W. (1970). “Performance Appraisal:

Managers Beware.” Harvard Business Review. 48: 149-157.
cxlix
UNIT 2 HUMAN RELATIONS AND PUBLIC

RELATIONS IN HOSPITALS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Ways and Means of Maintaining Cordial Human Relations
3.2 Importance of Human Relations in Hospitals
3.3 Motivation
3.3.1 What is Motivation?
3.3.2 Motivated Workforce - the Only Survival Game
3.3.3 Types of Motives
3.3.4 Objective of Motivation for Human Resource
Manager
3.3.5 Praise as a Strong Motivational Tool
3.3.6 Steps in Motivation
3.3.7 Theories of Motivation
3.3.8 Public Relations
3.3.9 Roles of Public Relations
3.3.10 Methods of Public Relations
3.3.11 Main Methods of Communicating with the Public
3.3.12 The Publics
3.3.13 Tips on Relationship with Publics
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
Hospitals provide medical care to the sick and needy. They are not in the
business of manufacturing goods but for rendering service and are far
more dependent than other organisations upon their employees‟ morale
and commitment. Employees in such institutions are constantly facing
the public. Institutions which provide medical care are generally
criticised more for the attitudes of their personnel than for the quality of
the care. Patients and visitors are more impressed and concerned with
the attentiveness, empathy and responsiveness of the healthcare
personnel than with the architecture of the hospital building,
sophisticated machines or ward facilities like televisions, refrigerator,
telephone, newspaper, barber, music, etc.
Human behaviour of two persons is not the same. It differs from person
to person. The manager should try to understand what causes this
cl
difference and how to cope with certain problems caused by their

different behaviour. A manager with an understanding of human
relations and human behaviour can still make use of their differing
behaviour to the advantage of an organisation.
Good human behaviour creates cordial human relationship and bad

behaviour creates bitter relationship. For understanding his
subordinates/peers/superiors and maintaining cordial relationship with
them, a manager may have to acquire knowledge in such disciplines as
psychology and sociology. The managers must understand that the good
of the individuals is also good for organisation for maintaining good
human relations.
2.0 OBJECTIVES
 describe ways and means of maintaining cordial human relations

 state the importance of human relations in hospitals
 define motivation
 discuss why workers need to be motivated
 list the theories of motivation.
3.0 MAIN CONTENT
3.1 Ways and Means of Maintaining Cordial Human

Relations
When all functions of human resource management are performed

effectively and efficiently, there will be definite improvement in human
relations. The following are the ways and means to maintain and
promote cordial human relations:
1. By promoting honesty among the individuals.

2. Openness clears misunderstanding and restores good relations.
Therefore, one should be free and frank. At the same time, one
should appreciate frankness of others.
3. By helping and respecting employees of other departments when
they visit other‟s department.
4. By treating the subordinates with dignity and respect.
5. By winning those people who acknowledge his appreciation for
their ideas.
6. By speaking about his own mistakes before criticising others.
7. By providing himself to be a good leader, a manager can bring
cohesion in the group and thereby contributes to the improvement
of human relations.
cli
8. Effective communication in a way improves human relations.

9. By requesting the others instead of issuing direct or indirect order.
3.2 Importance of Human Relations in Hospitals
In his book Hospital Organisation and Management, Mac Eacheren

comments that hospitals were slow to follow the lead of industries
which had long ago realised the necessity for good human relations and
had set up human resource departments to perform human resource
functions. Human resource management has been a victim of
administration. In conducting a survey of hospital board meetings, it was
found that 40% of the time at these meetings was spent by the governing
board members talking about money, 20% about building improvement
and equipment, 15% about medical staff problems, 10% about patient
services, 10% about public relations and five percent about
miscellaneous subjects including human resource.
In modern health care institutions, the personnel functions should be

given due importance and the human resource manager should be
considered an integral part of the administrative team so that he may
arrange organisational conditions in such a way that people can achieve
their goals. This is one of the most important and complex
responsibilities of the human resource manager. This will go a long way
in establishing cordial human relations which will reflect in patient care.
The primary aim of hospitals is to provide patient care of the highest

quality. An often overlooked truth is that efficient patient care develops
not from modern medical equipment and drugs alone but from the work
force, a group of well rewarded and motivated medical, paramedical,
skilled and unskilled personnel. The assembly of these personnel, who
are committed to institutional goals and their fulfillment, is not just a
matter of chance. It is the result of sound professional administration
and cordial human relations.
The role of human relations in health organisations is concerned with

the integration of people into a work situation. It is also concerned with
motivating personnel to work together cooperatively and productively.
In understanding the behaviour of human beings, some knowledge of
basic needs and human behaviour is necessary. It should therefore be the
first duty of health care administrators and human resource managers to
see that most of the basic needs of their personnel are met so that their
behaviour is of cooperation and not of aggression at their workplace.
The following is a list of dos and don‟ts in the interest of good human
relations:
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a. Do not injure the pride and sense of dignity of your employees in

any manner.
b. Set the target of their work in consultation with them and place
your confidence and trust in them.
c. Allow your employees to represent any current grievance and pay
due heed and give priority to such representations. As the saying
goes, „A stitch in time saves nine‟.
d. Maintain contact with employees, either directly or through
supervisors and foster an environment of empathy and good human
relations.
e. Make every effort to solve the problems - both official and
personal - of your employees to their satisfaction.
f. Ensure the training, better placement and promotional opportunity
of each individual employee, if possible.
g. Welcome constructive suggestions from patients and visitors in
general and from employees in particular.
h. Suppress tendencies towards luxurious working environment for
senior officers but do not spare any effort in improving the
working environment for lower categories of employees.
i. Fill higher posts by promoting your personnel rather than
recruiting people from outside. This will boost morale of your
existing employees.
j. Reassure your employees regarding your responsibility for their
future security.
k. It is a good idea to give to employees a small gift on the occasion
of their festival - not a box of sweets which will be eaten and
forgotten, but something durable for the house.
l. During the festival days, employees are suddenly faced with
expenses which they often cannot meet out of their normal salary.
It is a good idea to give your employees a loan at that time, which
can be recovered in a few installments.
m. When an employee gives a very good performance, supervisors
and managers should not hesitate in giving recognition to his work.
This act of the management will not only boost morale of that
employee but of others also.
n. If the hospital can afford to, it should provide a proper canteen and
subsidised meals to the employees.
o. Where the distance from the nearest railway station or major bus
stop is considerable, hospital authorities should persuade local
transport officials to provide transport facilities.
Human behaviour cannot be fully understood and accurately predicted,

and as such, all basic needs of the employees cannot possibly be fully
met. Nevertheless, hospital authorities should make sincere efforts to
ensure that all laws which are applicable to hospital are adhered to in
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letter and spirit and, if possible, should provide more than what is
prescribed in the Statues.
Human wants and problems are multitudinous and diverse. As Dr. Peter
Drucker has wisely stated: “When you employ a man, you employ the
whole man.” In other worlds, all problems whether official or personal
which an employee is facing, have to be viewed by hospital authorities
as their own problems. They must fully accept their responsibility for
the education, training, development of their employees, and for
providing solutions to their problems.
In hospitals, the lower rungs of employees are usually not taken into
confidence by the hospital authorities at any stage. They are absolutely
ignored. The present day‟s employees expect to be treated with dignity.
Therefore, all the concerned hospital executives must stop working from
above or pushing from behind. They should, instead, start leading from
the front and must work together with all categories of employees and
gain their genuine and wholehearted contribution to achieve the hospital
goals by providing them opportunities for participation even at the
planning stage.
These do‟s and don‟ts of human relations in hospitals may appear rather
simple and petty; yet they can act as powerful agents in building bridges
of understanding between management and employees. The more
affection and concern hospital authorities have for their employees, the
more cooperative will be the employees‟ attitude towards work. This
will result in very cordial human relations.
3.3 Motivation
Motivation plays a crucial role in maintaining cordial human relations,

particularly in service-oriented organisations like hospitals. Attractive
architecture, modern equipment and costly medicines alone are not
enough to run a hospital efficiently and effectively; what is essential to a
greater degree, is a well motivated, dedicated and disciplined work
force. Therefore, it should be the earnest endeavour of every human
resource manager to keep his employees highly motivated so that they
may give better service to patients and do not invite undesired litigation
of medical negligence under the Consumer Protection Act, 1986.
3.3.1 What is Motivation?
Every human action is the result of a need. One experiences a sort of

mental discomfort as long as that need remains unfulfilled. The moment
the action is initiated, he makes an attempt to get over the discomfort.
So what causes an action is the need. What causes a need is called the
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stimulus. Therefore, it is the duty of every human resource manager to

create the stimulus creating a need that initiates an action which leads to
satisfaction.
The word „motivation‟ has been derived from the word „motive‟. A
motive is an inner state that energises, activates and directs behaviour
towards a goal.
3.3.2 Motivated Workforce - The Only Survival Game
In this highly competitive work environment, large corporations are

looking for motivated workforce to see the cash registers booming.
Accelerated growth, vibrancy in the organisation, and a high level of
pep among its employees are the dreams of every organisation.
In the age of globalised economy and acute shortage of trained

personnel, hospital administrators can raise physical (property) and
financial resources with some efforts, but the key factor for any hospital
aiming to give superlative performance hinges on its human capital.
Therefore, hospital administrators must invest this human capital to
produce more motivated employees who may rise to any given
challenge if they want to expand.
Many enlightened industrialists have started doing this for their

existence in this highly competitive work environment and in the age of
globalisation. An employee is now a key asset who can play a crucial
role in further expansion of the organisation. They have started realising
that to retain an employee, they must first treat him on a human level,
understand him and make him feel wanted. Companies are aware that
superlative performance can be achieved provided the corporate goals
are linked to the individual goals, needs and aspirations of the
employees.
For this, every individual needs to be trained to formulate his life goal.
He needs assistance to find out where he is vis-à-vis his goal and how he
can fill the gap between the two.
There are five key ingredients which the hospital administrators need to
inculcate in their employees:
1. High value system - It consists of personality and character ethics

2. Time management - The art of prioritisation of work according to
time schedule
3. Emotional bank balance - Investment in personal relationships
4. Interdependence - Working in team and with team spirit
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5. Role of meditation - To develop positive attitude toward life and

work.
Thus, hospital administrators can not only motivate their employees but
can provide better service to patients.
3.3.3 Types of Motives
Motives are divided into three categories:
1. Primary motives
2. Secondary motives
3. General motives.
Primary motives: These motives are unlearned and physiologically

based. They include hunger, sleep, sex, and avoidance of pain.
Secondary motives: Secondary motives are closely tied to the learning

concept. A motive may be learned to be included in the secondary
classification. Important among them are: achievement, affiliation,
power, security and status.
General motives: These motives are unlearned and physiologically

based. These general motives include curiosity, manipulation and
affection.
3.3.4 Objective of Motivation for Human Resource Manager
It is generally known that most of us use only a small portion of our

mental and physical abilities. To tap the unused potential in employees,
they need to be motivated. Such tapping by the human resource manager
results in greater efficiency, better service and better standard of living
of the employees.
There are two ways by which people can be motivated. One is the
positive approach, e.g. appreciation and recognition of a work of an
employee and the other is the negative approach, e.g. finding fault and
criticising an employee.
3.3.5 Praise as a Strong Motivational Tool
Usually, giving something involves costs money, but giving praise

costs nothing. In fact, it is the failure to praise that can cost a lot because
there is no motivational tool as powerful as praise. Its presence is keenly
felt and so is its absence.
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There are five rules for using praise effectively to motivate employees:
1. Look for points to praise: Do not give empty praise but do praise
absolutely everything that deserves it. One should go out of the
way to identify praiseworthy events and then praise the person.
2. Praise is positive reinforcement: If you want your subordinates to
be more attentive, then praise them when they perform well in any
area.
3. Give timely praise: It is important to associate positive
reinforcement as closely as possible with a desired behaviour and
the reinforcement greatly reduces its effectiveness.
4. Give praise as publicly as possible: There is certainly some value
in taking an employee aside and then praise him privately but the
value is multiplied many times if you praise the person in front of
his colleagues.
5. Praise specific things: There is nothing wrong in telling someone
that he is doing a great job but the praise becomes much more
powerful if it is tied to specific events.
Positive motivation: Employees are said to be motivated positively

when they are shown a reward and the way to achieve it. Such reward
may be financial or non-financial. Monetary motivation may include
special increment, promotion, bonus, incentive scheme, etc. Non-
monetary motivation may include praise for work, social recognition,
etc. Thus, positive motivation seeks to create an optimistic atmosphere
in the organisation.
Negative motivation: Employees can be negatively motivated by

creating fear in their minds, e.g. employees will not get raise in their
salaries if they do not achieve the target. Thus a manager can get the
desired work done. This method has several limitations because fear
creates frustration, a hostile state of mind and an apathetic attitude
towards the job, which hinders efficiency and productivity. So the use of
this method is undesirable.
3.3.6 Steps in Motivation
A human resource manager should adopt the following steps in

motivation:
1. Sizing up: This step mainly involves understanding of the different

needs of employees. Having assessed their needs, one can
determine what motivates them.
2. List of motivators: The list of motivators should be prepared based
on the revealed needs of the employees.
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3. Selecting and applying motivators: Out of the list of motivators, a

few should be selected and applied wherever and whenever they
are needed.
4. Feedback: Having applied the motivators, it is important to find
out how effective has a particular motivator been.
3.3.7 Theories of Motivation
There are several theories of motivation. The significant among them

are Maslow‟s hierarchy of needs, Herzberg‟s two-factor theory,
Vroom‟s expectancy theory, Alderfer‟s ERG theory, Porter and
Lawler‟s model expectancy theory and equity theory.
Maslow’s theory of hierarchy of needs: According to Maslow,

humans needs form a hierarchy, starting at the bottom with the
physiological needs and ascending to the highest need of self-
actualisation. He says when one set of needs are satisfied, they no longer
work as motivators as a person seeks to satisfy the next higher level
needs.
1. Physiological needs: These are basic needs of human beings such

as food, clothes, shelter, sleep and sexual satisfaction. Maslow says
that until these needs are satisfied, a person does not aim for the
satisfaction of the next higher level of needs. As far as work
organisations are concerned, these needs include pay, allowances
and incentives.
2. Safety needs: When the physiological needs are satisfied, a person

starts thinking of the way by which he can continue to satisfy the
physiological needs. Thus, security needs spring up the moment he
makes an effort in the direction of providing himself the source of
continuity of physiological needs. This is exactly the reason why
attitude towards security is an important consideration in choosing
the job. These needs include stability of the job, financial position
of the organisation and union membership.
3. Affiliation needs: When the physiological and safety needs are

satisfied, the affiliation needs begin to occupy the mind of a
person. This is exactly why he looks for the association of other
human beings and strives hard to be accepted by its group. Social
needs at work place under membership of formal and informal
groups such as canteen committee, welfare committee and so on.
4. Esteem needs: Every person has a feeling of importance and he

wants others to regard him highly. These needs make a person aim
high and make him achieve something great. These needs in the
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case of employees include status symbol such as promotion and

better organisation.
5. Self-actualisation needs: This is the highest need in the hierarchy.

This refers to the desire to become what one is capable of
becoming. A person tries to maximise his potential and accomplish
something in society.
Herzberg’s two-factor theory: Herzberg modified Maslow‟s theory of

hierarchy and called it two-factor theory of motivation. According to
him, the first group of needs is such things as organisation policy,
supervision, working conditions, salary, status, personal life. Herzberg
called these factors as dissatisfaction and not motivators. By this, he
means that their presence does not motivate in the sense of yielding
satisfaction but their absence would result in dissatisfaction.
Table 1: Herzberg’s Two-Factor Theory

Maintenance factors or Motivational factors or
dissatisfaction factors satisfiers
Job context Job content
Extrinsic factor Intrinsic factors
Organisational policy Achievement
Supervision Recognition
Relationship with supervisors Advancement
Peer relations Possibility of growth
Relationship with subordinates Responsibility
Pay
Job security
Status
Vroom’s expectancy theory of motivation: Victor Vroom felt that

content models were inadequate explanations of the complex process of
work motivation. Therefore, he developed a relatively new theory of
motivation. According to his theory, motivation of any individual
depends on the desired goal and the strength of his expectation of
achieving the goal. His model is built mainly on three concepts, viz.
valence, instrumentality and expectancy.
1. Valence: Vroom says that valence is the strength of an individual‟s

preference for a particular outcome. It can be taken as equivalent
of value, incentive, attitude and expected utility. The valence to be
positive, a person must prefer attaining the outcome to not
attaining. A valence of zero occurs when the individual is
indifferent towards the outcome. The valence is negative when the
individual prefers not attaining outcome to attaining it.
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2. Instrumentality: Another major input into the valence is the

instrumentality of the first level outcome in obtaining desired
second level outcome. For example, assume that an individual
desires promotion and feels that superior, average or poor
performance. His second level outcome is promotion. The first
level outcome of high performance thus acquired a positive
valence by virtue of its expected relationship to the preferred
outcome of second level promotion. In this case, the person is
motivated to achieve superior performance because he has desire
to be promoted. The superior performance (first level outcome) is
seen as being instrumental in obtaining promotion (second level
promotion).
3. Expectancy: The third major variable in the Vroom‟s theory is
expectancy. Though expectancy and instrumentality appear to be
the same at the first stage but they are different. Expectancy is a
probability ranging from 0 to one or strength of a belief that a
particular action of effort will leave to a particular first level
outcome. Instrumentality refers to the degree in which a first level
outcome will lead to the second level outcome. According to
Vroom, the sum total of these variables is motivation.
Alderfer’s ERG theory: Alderfer also feels that needs should be

categorised and that there is basic distinction between lower order needs
and higher order needs. Alderfer identifies three groups of needs, viz.
existence, relatedness and growth. The existence needs are concerned
with survival or physiological well-being. The relatedness needs talk of
the importance of interpersonal and social relationships. The growth
needs consist of the individual‟s intrinsic desire for personal
development. This theory is somewhat similar to that of Maslow‟s and
Herzberg‟s models, but unlike Maslow and Herzberg, he does not assert
that a lower level need has to be satisfied before a higher level need; nor
does he say that deprivation is the only way to activate a need. So a
person‟s background and cultural environment may make him think of
relatedness needs or growth needs though his existence needs are
unfulfilled.
The Porter and Lawler’s model expectancy theory: All the content
theories assume that satisfaction leads to improved performance.
However, it was later found that there is a very low positive relationship
between satisfaction and performance. Porter and Lawler explored the
complex relationship between motivation, satisfaction and performance.
According to them, performance is a function of two important factors:
1. Reward: A person gets intrinsic reward by performing a task well.

Intrinsic reward is the feeling of accomplishment and existrinsic
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rewards like pay, promotions and status, which are offered by the
organisation.
2. Satisfaction: Satisfaction depends on the perceived rewards and the
actual rewards. If an individual feels that he should have received
more for what he had done, it results in dissatisfaction and vice
versa.
Thus, motivation and achievement result in satisfaction and
dissatisfaction of an employee about the job, organisation and the
like.
Equity theory: According to this theory, a major input into job

performance and satisfaction is the degree of equity that people perceive
in their work situation. In equity occurs when a person perceives that the
ratio of his outcome to input and the ratio of other‟s outcome to input
are unequal. Thus, equity theory is based on the assumption that a major
factor in job motivation is the individual‟s evaluation of the equity and
fairness of the reward received.
Thus there are many motivation theories. Each of these theories attempt
to describe what human beings are and how they can be changed
provided they are properly motivated. Therefore, managers keep on
trying to motivate their employees by giving them financial and non-
financial incentives so that they can extract maximum out of them to
reach the organisational goals which are not so easy to attain without the
enduring commitment of their employees.
3.3.8 Public Relations
Public relations is an extrapolation or extension of human relations. I

have dealt with human relations with peers, superiors and subordinates,
the next is human relations with the public.
In any organisational set-up, apart from people within it, there are
people who are external to it. People within an organisation should be
ready to get along with the outsiders.
The World Book Encyclopedia (1982) defines public relations as „an

activity concerned with winning public approval and understanding for
an organisation or individual‟. „These organisations seek to have
themselves viewed favourably by people and thus gain the goodwill of
the public‟.
In Osho (1999), Nigerian Institute of Public Relations (NIPR) and the

Institute of Public Relations, London define public relations as “the
deliberate, planned and sustained effort to establish and maintain mutual
understanding between an organisation and its public(s).” Miller et al.
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(1983) defines public relations as “the methods and activities employed

by an individual, organisation, corporation or institute to promote a
favourable relationship with the public.”
Just as we have many authors of different backgrounds and disciplines

so we have many different definitions of public relations.
Bello (1998) also cited the definition of public relations by the Public
Relations Society of America as „a distinctive management function
which helps to establish and maintain mutual lines of communication,
understanding, acceptance and cooperation between an organisation and
its publics‟.
Salu (1994) cited International Public Relations Association of 1978

Mexican statement which defines public relations as “the art and social
science of analysing trends, predicting their consequences, counselling
organisation leaders and implementing planned programmes of action
which serve both the organisation‟s and the public interest.”
A comprehensive definition of public relations by Rex Harlow of San

Francisco, USA as cited by Salu (1994) is that:
Public relations is a distinctive management function which helps

to establish and maintain mutual lines of communication,
understanding, acceptance and cooperation between an
organisation and its publics. It involves the management of
problems or issues, helps management to keep informed on and
responsive to public opinion.
Public relations defines and emphasis the responsibility of

management to serve the public interest; helps management keep
abreast of and effectively utilise change, serving as an early
warning system to help anticipate trends; and uses research and
sound and ethical communication techniques as its principal
tools.
Finally, Engel et al. (1979) cited Canfield and More (1973) who defines
public relations as “the communication function which evaluates public
attitudes, identifies the policies and procedures of an individual or an
organisation with the public interest and executes a programme of action
to earn public understanding and acceptance.” The essence of public
relations is to ensure that the publics which the organisation serves
support it. What the public relations experts or practitioners do is to
ensure that the organisation knows what the publics want and then
formulate policies which will satisfy the publics.
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Since the organisation deals with many publics, the organisation must
ascertain the interest of each public and design the programme which
will satisfy the needs of each public.
Another reason for the importance of public relations is that there is no

organisation which is independent of the society in which it is
established. In order to survive within the society, it needs public
relations.
3.3.9 Roles of Public Relations
The following roles of public relations of an organisation are:
 Researching into public opinion, attitude and expectations

 Preventing conflicts and misunderstandings
 Promoting mutual respect and social responsibility
 Harmonising the private and public interest
 Promoting goodwill with staff, suppliers and customers
 Promoting products and services
 Maximising profitability
 Projecting a corporate identity and
 Promoting good employees relations
3.3.10 Methods of Public Relations
The two methods which public relations employs in achieving its goals
are research and communication.
1. Research method is required in order to elicit information from the

publics with regard to their needs or wants. All forms of research
e.g. opinion polls, surveys, interviews and the use of questionnaire
may be employed in order to gather useful data and information for
the purpose of public relations.
2. Communication method is employed for contact between the
organisation and the public. The nature of the organisation or
message will determine the type of communication and its media.
3.3.11 Main Methods of Communicating with the Public
The World Book Encyclopedia (1982) identifies four main methods of

communicating with the public which are advertising, lobbying,
publicity and press agency.
Advertising is defined as the non-personal communication through such

media as billboards, posters, handbills, mails, newspapers, journals,
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magazines and other forms of print media and electronic media such as
radio, television, cassettes, cinema, megaphone, public address systems,
etc. Lobbying is a term used by politicians when legislators are expected
to vote in support of an organisation‟s interest. Publicity and press
agency are ways of promoting an organisation through the use of the
media.
3.3.12 The Publics
The publics referred to in the definitions above and the concept of public
relations are divided into two, to wit; internal and external publics.
1. The internal public comprises organisational sections, units,

departments, governing council, board of directors, board of
governors, etc.
The internal public media of communication are seminars,
workshops, newsletters, bulletins, in-service training, joint
consultation, end-of-year party.
2. The external public comprises the shareholders, clients, customers,
communities, societies, clubs, suppliers, governments at all levels,
parastatals, mass media, etc.
The external public media of communication are the various print
and electronic media such as newspapers and radio respectively.
Salu (1994), identifies four services of public relations as the 4Cs
i.e. counselling, coordination, communication and corporate
commitment.
Salu (1994) in explaining the 4Cs showed that management should be

counseled on organisation‟s policy and social responsibility to the
publics. There is need to coordinate all other departments with regard to
implementation of the policy. Having done this, there is need to
communicate with the public using appropriate communication media
such as oral, written, graphic or non-verbal communication. Corporate
commitment requires cooperation between the Public Relations Officer
(PRO) and the management in order to attain good corporate image.
3.3.13 Tips on Relationship with Publics
a. Admit your mistakes and do not give excuses

b. Form the habit of saying „please‟ and „thank you‟
c. Always look pleasant
d. Differentiate between „order‟ and „request‟
e. Learn to listen and talk less
f. Do not boast about your progress especially in the front of failures
g. Have a confidant
h. Keep secrets secret
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i. Avoid gossiping about people or spread rumours

j. Do not make promises which you cannot fulfill
k. Keep an arm‟s length with dangerous people
l. Help those who need you.
4.0 CONCLUSION
The objective of human relations is to ensure positive relationship

among workers within an organisation and between the organisation and
the public.
It is a truism that conflict is inevitable occasionally between humans but

it should be minimised. Unresolved conflict among workers in an
organisation will certainly affect public relations adversely and the
ultimate effect on the organisation will kill the existence of the
organisation completely.
5.0 SUMMARY
In this unit, we have gone through what human relations is in hospitals,

ways and means of maintaining cordial human relations, importance of
human relations in hospitals, motivation and its theories. Hopefully you
enjoyed your reading.
(1) What are the roles of human relations?

(2) List the ingredients of human relations.


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UNIT 3 TEAMWORK IN HOSPITALS
CONTENTS
1.0 Introduction
2.0 Objectives
3.0 Main Content
3.1 Nature and Scope of Teamwork
3.2 Mcgregor‟s X and Y Theories
3.3 Mcgregor‟s Characteristics of Effective Teams
3.4 Team-Building
4.0 Conclusion
5.0 Summary
1.0 INTRODUCTION
“United we stand, divided we fall.” All over the world, the most
successful managements always develop a team for efficient
organisation of their work. The large companies in Germany have
always had team management. One member customarily presides over
the team, but all are equal. Similarly, those marvels of efficient
management organisation - the “Big Five‟ of British banking have
always been managed not by one, but by two chief executive teams: the
chairman and the deputy chairman concerned with basic objective and
the joint general managers concerned with policies, practices and
personnel.
2.0 OBJECTIVES
 define teamwork
 describe the nature and scope of teamwork in hospitals
 discuss the McGregor‟s X and Y theories
 list the McGregor‟s characteristics of effective teams
 explain team-building and its ingredients
 enumerate how to build trust
 discuss the test of good teamwork.
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3.0 MAIN CONTENT
3.1 Nature and Scope of Teamwork
Teamwork is coordinated action by a cooperative group whose members

contribute responsibly and enthusiastically towards task achievement. It
works best in a supportive environment. The essentials of teamwork are:
(a) a small group; (b) a leader; (c) a common goal; (d) regular
interaction; (e) each member contributing responsibly; (f) coordination;
and (g) team spirit.
During and after World War II, there was an acute shortage of nurses.
Therefore, nursing administrators introduced the functional method of
nursing. Professional nurses were assigned strictly professional duties
such as giving medicines, taking blood pressure, writing notes, making
rounds with physicians and surgeons, etc., and nurse aides and orderlies
were assigned tasks such as making beds, escorting patients to the X-ray
department, carrying stool and urine specimens to the laboratory,
handing over the patient chart for billing, etc. Professional nurses now
had more time for skilled services. But this system did not work out as
planned because non-professional personnel found their work dull. At
this point, far-sighted senior nursing executives noticed the need for and
possibility of developing genuine teamwork. Professionals were
assigned to guide non-professionals in nursing care; each one functioned
according to his ability, but was made to participate in making the plans
which were expected to be implemented. This was teamwork at a lower
level.
In a hospital set-up, there is no other job that needs to be organised as

carefully and as systematically as that of the chief executive of a
hospital. The priorities of the assignments of the chief executive should
be arranged systematically. Even then, the job of the chief executive of
the hospital cannot properly be organised as the job of one man. It must
be the job of a team of several persons working together. Teamwork is
essential at all levels of management in a hospital.
3.2 McGregor’s X and Y Theories
According to Douglas McGregor, the management guru, traditional

managers believe that by nature people dislike work, are not ambitious
and tend to shun responsibility. Thus, in order to get the work done,
people need to be pushed by applying the carrot and stick policy. He
named the traditional approach to management as theory X. however, he
feels that this approach is not correct and in his theory Y, he propounded
that normally “People want to work and work is as natural as play or
rest.” The theory adds that every human being wants self development.
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According to theory X, the four assumptions held by traditional

managers are as follows:
1. Generally employees dislike work by nature and, whenever

possible, will attempt to avoid it.
2. Since employees dislike work, they may be coerced, controlled or
threatened with punishment to achieve organisational goals.
3. Employees avoid responsibilities and seek formal direction
whenever possible.
4. Most workers place security above all other factors and will
display little ambition.
In contrast to these negative views about the nature of human beings,

McGregor listed four positive assumptions, which he called theory Y.
1. Employees can view work as being as natural as rest or play.

2. People will exercise self-direction and self-control if they are
committed to the objectives.
3. The average person can learn to accept, even seek, responsibility.
4. The ability to make innovative decisions is widely dispersed
throughout the population and is not necessarily the sole province
of those in management positions.
When both the theories are analysed, one will notice that theory X
assumes that lower order needs dominate individuals while theory Y
assumes that higher order needs dominate individuals. McGregor
himself held to the belief that theory Y assumptions were more valid
than theory X. Therefore, he proposed such ideas as team-building,
participative decision making and good human relations as approaches
that would maximise an employee‟s job motivation.
3.3 McGregor’s Characteristics of Effective Teams
Douglas McGregor, in his book, The Human Side of Enterprise, has

spelt out some characteristics of effective teams:
1. The working atmosphere is informal, comfortable and relaxed.

There are no obvious tensions. People are involved and interested.
2. There is a lot of discussion in which virtually everyone
participates, but it remains pertinent to the task of the group. If the
discussion gets off the subject, someone will bring it back on track
shortly.
3. The task of the objective of the group is well understood and
accepted by the members after free discussion of the objectives,
followed by commitment of the members.
clxviii
4. The members listen to each other. Every idea is given a hearing.

Members are not afraid to offer extreme views.
5. There is disagreement. The group is comfortable with this and
doesn‟t have to avoid conflict or keep everything on the plane of
“sweetness and light.” Disagreements are not suppressed or
overridden. Options are carefully examined and the group works
for resolution.
6. Most decisions are reached by a kind of consensus in which
everybody is in general agreement and willing to go along.
Members are honest concerning their position. Voting is kept to a
minimum.
7. Criticism is healthy, frank and relatively comfortable. There is
little evidence of personal attack, either openly or in a hidden
fashion. The criticism is constructive and directed toward problem
solving.
8. People are free in expressing „feelings‟ and „thoughts‟. There is
little pussy-footing, and there are few hidden agendas. Everybody
seems to know how everybody else feels about any matter being
discussed.
9. When action is taken, clear assignments are made and accepted.
10. The chairperson of the group does not dominate, nor does the
group show undue deference to him or her. Leadership shifts as
circumstances dictate. There is little evidence of a struggle for
power; the issue is not who controls, but how to get the job done.
11. The group is aware of its own operation and examines how well it
is doing. Maintenance of the group is a priority that gets regular
attention.
3.4 Team-Building
Team-building is essential to improve organisational effectiveness by

diagnosing barriers to team performance and improving inter-team
relationships and task accomplishment. Team-building analyses the
activities and relationships of the team members.
The purposes of team-building are to 1. Analyse the way work is

performed; 2. Examine the way a group is working; 3. Examine the
relationships among team members; 4. Improve relationships of
members; 5. Improve service; and 6. Set goals.
3.4.1 Essential Conditions of Team-Building
Teamwork needs collaboration among its members. It is said that one

plus one is two in mathematics but eleven in team-building. Moreover,
the synergetic effect is evident in teamwork; each team is a linking pin
to another team and to the total organisation. Teams do wonders. They
clxix
make the impossible things possible. Japan gives a prime example of

teamwork.
The essential conditions for team building are: 1. Every member must
have a clearly assigned role; 2. The team must take collective
responsibility for the action of each of its members; 3. The team must
speak with one voice; 4. Each member should be able to handle
responsibilities of other members of his team, if the need arises.
3.4.2 Ingredients of Team-Building
Team-building aims at diagnosing barriers to effective team

performance, improving task accomplishment and improving
relationships among members. The major ingredients of team-building
are 1. Get the right people together. 2. Have a large block of
uninterrupted time. 3. Deal with high priority problem first. 4. Study the
problems in depth and not superficially. 5. Develop realistic solutions. 6.
Implement the solutions wholeheartedly and not half heartedly. 7.
Follow up to assess results.
3.4.3 Hints for Team-Building Managers
Team-building is not everybody‟s job. It is a job of capable persons who

are dynamic, have clear vision, clean hearted, are objective and
committed to organisational goals. The essential hints to the manager
whose job is to build the team successfully are: (a) hold small and
informal meetings for minor problems and longer meetings for major
problem; (b) create cooperative atmosphere; (c) pick up easy problem to
be solved first; (d) have an open mind; (e) compliment the participants
to encourage their morale; (f) encourage the subordinates to formulate
the goals; (g) provide the members all necessary material, finance, etc;
(h) remember honesty and democracy are best policies in team-building.
3.4.4 Trust
In teamwork, trust plays the main role. Trust is (a) a central issue in all
human relationships; (b) at the heart of collaboration; and (c) essential to
organisational effectiveness.
Trusts exist when we make ourselves vulnerable to others whose

subsequent behaviour we cannot control. By trusting another person we
become dependent upon them. The level of trust governs subsequent
behaviour
High trust leads to openness about feelings, self disclosure, greater

clarity about goals, problems, etc. more searching for alternatives
clxx
instead of jumping to conclusions, greater levels of mutual influence,

increased motivation, closeness, increased comfort with each other,
tolerance of differing viewpoints and better utilisation of expertise and
abilities.
Low trust leads to the following conditions controlling environment,

self-protective behaviour, facts, ideas, conclusions and feelings ignored,
disguised and distorted, people becoming suspicious, unreceptive and
perceive manipulation, attempts to be truly open being rejected, effort to
build trust being sabotaged, misinterpretation and misunderstandings.
Deepening a relationship requires taking the first step in trusting another

person despite uncertainty about the consequences. If neither person
takes the risk of trusting, at least a little, the relationship remains stalled
at a low level of caution and suspicion. Trusting another‟s competence,
judgment, helpfulness or concern, results in a greater willingness to be
open. Feeling trusted also makes it easier to be open. The foundation of
a trusting relationship is in believing that the other person has integrity.
3.4.5 How to Build Trust
1. Do what you say you are going to do. When you create
predictability, you are seen as trustworthy, which promotes trusting
behaviour from others.
2. Trust develops when people feel safe and secure so that they can
risk being vulnerable.
Reduce defensiveness by:
(i) providing descriptive rather evaluative feedback
(ii) avoiding game-playing and secrecy
(iii) expressing genuine feelings of caring and involvement
(iv) being sensitive to the needs and interests of others
(v) seeking out, listening to and understanding the perspectives
of others
(vi) utilising and recognising the contributions of others.
3. Be a trust risk-taker. Let people know where you stand even if it
differs from their view. Acknowledge your own mistakes and
vulnerability. Be human.
Most development activity is centred upon the improvement of

individual skills, knowledge and experience, but organisations are
increasingly finding that this is not enough; that the real key to success
is the way in which individuals behave towards each other and the way
in which groups of people relate to and work with each other.
clxxi
3.4.6 Test of Good Teamwork
How do we recognise good and bad teamwork? Let us first look at some
of the symptoms of bad teamwork.
First, there is the symptom of frustration. As an organisation gets larger,

the opportunities for personal expression and satisfaction often become
less. Too frequently, people who work in organisations become
frustrated because they can no longer see a clear way of meeting their
own needs and aspirations. People lose inspiration and lack the
commitment and motivation which are essential ingredients of effective
teamwork.
In many organisations, the symptoms of grumbling and retaliation are

evident. If people cannot express themselves through the system, they
do it privately through discussion in the corridors, lavatories and car
parks. Often bar room chat is a better indicator of organisational health
than the most elaborate attitude surveys. The organisations that have a
poor output of work also spend a lot of time on retaliation. They do not
use mistakes as opportunities for increased learning and improvement
but as excuses for punishing those who made the mistakes, leading to ill
will.
Unhealthy competition is another indicator of poor teamwork.

Competition is the life-blood of many organisations but there is a great
difference between the healthy competition where people can enjoy the
just reward of their work and others can accept that the best man, system
or policy succeeded and the kind of organisation where backbiting,
„dirty tricks‟ and politics are the everyday pastimes of the managers.
Similarly, many organisations owe much of their success to the natural
competitive spirit which exists between departments and to the pride of
team membership which departmentalisation often brings; but many
others have departments which are at constant war with each other, each
jockeying for superior organisational position, influence or perks. One
particular organisation was for many years plagued by the constant
bickering and „dirty tricks‟ of its department heads, each one striving for
advantage over the others whenever possible. Not only did that lead to
the organisation as a whole missing opportunities, but many junior
employees found that, although they wanted to work with others,
barriers had been erected between them and their counterparts in other
departments.
Another sure indicator of poor teamwork is the expression employees

wear on their faces. Effective teamwork breeds happiness and a visitor
gets an immediate impression of whether the workplace is a happy one,
or whether he is likely to be „killed in the rush‟ if he is around at
clxxii
„clocking-off‟ time. The workplace does not have to be a dull and

unenjoyable place; it can so easily be a rewarding place where people
love to be.
Openness and honesty are the key indicators of organisational health.

Unfortunately, some people seem to try honesty only when everything
else has failed. Many mangers particularly seem to go to enormous
lengths to avoid telling the truth. There are, of course, occasions in
every organisation where total openness is not feasible, but where good
teamwork exists, there is generally no need for locks on drawers,
dishonest statements to employees and the taking of false bargaining
stances.
Meetings are another key indicator of teamwork. The main reason for
having meetings is to utilise the collective skills of a group of people
whilst working on common problems or opportunities. Too often,
however, we experience meetings which in no way use these skills;
meetings where only one or few people contribute and meetings used by
managers simply as an opportunity to lay down the rules rather than
utilise the resources of the team. The quality of meetings can usually be
determined by the way in which individuals either look forward or to
dread the normal weekly or monthly get-together.
In many organisations, the quality of the relationships between

managers and those they manage is low that effective teamwork cannot
get off the ground. Where people cannot confide in or trust their
manager, where they are fearful of him or where they can converse with
him only on a superficial or trivial level, real teamwork is unlikely to
exist. Another sign of low quality relationships is that the leader
becomes increasingly isolated from his team. He does not represent their
views and they do not subscribe to his. The effective team leader needs
to be very much a part of his team.
People not developing, is another sure sign of ineffective teamwork. If a

team is to be effective, it needs to be continually developing itself and
this in part means constantly facilitating individual as well as team
development. Often development does not happen because: (a) there are
perceived or real pressures; (b) it is seen as the job of the human
resource department or training officer; (c) conflict exists between the
team‟s culture and that of the organisation; (d) team leaders lack the
skills or willingness to make it happen; and (e) there is fear of the
consequences of development.
Sometimes poor teamwork results in jobs getting done twice or not at

all, because no clear understanding of rules within and between teams
clxxiii
exists. Sometimes, although common problems exist, people are not

willing or get together and work on them.
Then there is the attitude which teams and individual members have to
the possibility of external help. The ineffective team usually either
rejects offers of help because it fears the consequences of outsiders
finding out what the team is really like or seizes all offers of help
because it lacks any coherent view of how to proceed and is content to
handover its problems to someone else. The effective team uses external
help constructively by recognising the new contribution and viewpoint
which it can bring, but it always maintains response of its own problems
and its own destiny.
Creativity is a delicate flower which flourishes only in the right

conditions; namely conditions of personal freedom and support, freedom
to experiment, to try out new ideas and concepts, with the support from
those who listen, evaluate and offer help. A dearth of new ideas
generally goes with poor teamwork, because it is within a team that the
conditions for creativity can most easily be created.
The degree to which people help and use each other is another indicator.
Where effective teamwork does not exist, people tend to work in
isolation and they neither offer nor receive the help of their colleagues.
All of us need help in order to perform at our optimum level.
The conditions described are indicative of an unhealthy organisation and
all of them can be significantly improved by effective teamwork.
In an organisation where good teamwork exists, people can and do

express themselves honestly and openly. Conversation about work is the
same both inside and outside the organisation. Mistakes are faced
openly and used as vehicles for learning and difficult situations are
confronted.
Competition and the conflict of ideas are used constructively and team
members have a pride in the success of their team. Unhelpful
competition and conflict have been eliminated.
Good relationships exist with other teams and departments. Each

individual values and respects the other and their respective leaders
themselves comprise an effective team.
Personal relationships are characterised by support and trust, with
people helping each other whenever possible.
Meetings are productive and stimulating, with all participating and

feeling a sense of ownership of the actions which result from the
clxxiv
decisions made. New ideas abound and their use enables the team to
stay ahead.
Boss-subordinate relationships are sound, each helping the other to
perform his role better and the team feeling that it is being led in an
appropriate way.
Personal and individual developments are highly rated and opportunities

are constantly sought for making development plans.
There is clear agreement about and understanding of objectives and of

the roles which the team and its individual members will play in
achieving them.
External help will be welcome and used where appropriate.
Finally, the team regularly reviews where it is going, why it needs to go

there, and how it is getting there. If necessary, it alters its practices in
the light of that review.
All these means that „work‟ is a happy place to be; people enjoy
themselves wherever possible but this enjoyment is conducive to
achievement, nor a barrier to it. People get satisfaction from their
working lives and work is one of the places where they meet their needs
and aspirations.
4.0 CONCLUSION
In an organisation where good teamwork exists, people can and do

express themselves honestly and openly. Conversation about work is the
same both inside and outside the organisation. Mistakes are faced
openly and used as vehicles for learning and difficult situations are
confronted.
5.0 SUMMARY
Hospital is a team approach institution, every member/worker is

interrelated and interdependent hence the significance of teamwork
cannot be overstressed. No doubt you must have learnt greatly in this
course as you are well prepared to meet the societal demands from you
as a hospital worker.
(1) Discuss the relevance of teamwork in the effective health service

delivery in the hospital.
(2) List and explain barriers to effective teamwork in the hospital.
clxxv
clxxvi
Goyal, R. C. (2006). Hospital Administration and Human Resource

McGregor, D. (1960). The Human Side of Enterprise. McGraw-Hill,

New York.
clxxvii

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NATIONAL OPEN UNIVERSITY OF NIGERIA

FACULTY OF MANAGEMENT SCIENCES

Course Code: PAD 411

Course Writer: Dr. Joel Adeleke Afolayan

Programme Coordinator: Martha Oruku

Head of Department: Dr. (Mrs.) Yemisi I. Ogunlela

Dean of Faculty: Dr. Timothy O. Ishola

©2017 by NOUN Press

Printed 2013, 2017

PAD 411: Health Administration in Nigeria is a two-credit course for

WORKING THROUGH THE COURSE

Unit 1 Introduction to HEALTH ADMINISTRATION IN

Unit 1 Manpower Planningin Hospitals

Unit 1 Appraisal of Human Resources

TEXTBOOKS AND REFERENCES

“A Report of the Commission on University Education for

Akinyele, D. K. (1999). Principles and Practice of Management in

Blaskiston (1956). New Guild Medical Dictionary. New York:

Dunn, R.T. (2007). Haimann's Healthcare Management. (8th ed.).

Ghai, P.N. (1982). "Planned Development in Health in India". Hospital

Goyal, R.C. (2006). Hospital Administration and Human Resource

Lawrence, A.A. (1990). Management: The Simple Way, American

Leonard, S.R. &Strauss, G. (1985). Managing Human Resources.New

Metzger, N. Personnel Administration in the Health Services

Peter,D.. (1954). The Practice of Management.New York:Harper and

Stoner, J., Edward, F.&Daniel,G. (1966).Management. New Delhi:

There are tutor-marked assignments in this course at the end of each

FINAL EXAMINATION AND GRADING

The final examination in this course will be determined by the university

UNIT 1 INTRODUCTION TO HOSPITAL

3.0 MAIN CONTENT

3.1 Definition of Hospital

Let us examine a few definitions of the term „hospital‟. The word

Today, hospital means an institution in which sick or injured persons are

A hospital is different from a dispensary - a hospital being primarily an

Dorland’s Illustrated Medical Dictionary defines a hospital as:

an institution suitably located, constructed, organised, staffed to

A hospital in Steadman’s Medical Dictionary is defined as:

Blackiston’s New Gould Medical Dictionary (McGraw-Hill, New York,

According to the Directory of Hospitals in India. (1988):

a hospital is an institution which is operated for the medical,

A close analysis of the above definitions reveals that no single definition

On the basis of the above definitions, we can evolve a comprehensive

A modern hospital is an institution which possesses adequate

Modern hospitals are open 24 hours a day. Their personnel render

their rooms. Many hospitals, keeping in view the recreation needs of

3.2 Nature and Scope of Hospital

Human beings make a society. Healthy human beings make a healthy

In the past, an individual afflicted by a wound or disease was

As civilisation advanced from the individual to the family, from family

Illness creates dependency. The sick need medical treatment, nursing

3.2.1 Changes in Hospital Organisation

As far as voluntary hospitals are concerned, many religious groups ran

In spite of various reports submitted by the different committees,

With the increasing complexity of medical care and acceptance of the

3.3 Classification of Hospital

Hospitals have been classified in many ways. The most commonly

Classification according to ownership/control

On the basis of ownership or control, hospitals can be divided into four