Staff Development in healthcare Industry (The Canberra Hospital)
Contemporary business is an increasingly complex environment, which continues challenging organization by even more multifaceted relationships between various stakeholders. The distinctive characteristic of modern business arena is the growth of the organizations and the interdependencies between for-profit, nonprofit and governmental bodies. The reality shows that in order to succeed and build sustainable and effective organization, companies should place more emphasis on the cost-side and productivity. This productivity comes from the ability of the firms to manage human factor, build on motivation and retention, which will create loyalty and drive performance Armstrong & Baron 2002). With that in mind, Human Resource Management (HRM) provides vital services to any company, including the organizations in the Healthcare sector. It is not a secret that the transformation of the business landscape and more complex organizational structures determined the direction in which the HRM functions itself evolved over the past decades. More specifically, contemporary HRM department plays a strategic role in organizational development, as opposed to supportive function, which it used to be twenty years ago (Millmore 2011). This shift from short-term to long-term role in the company brought numerous elements into daily work of HRM professionals. Today, HRM functions include recruitment and selection, reward and remuneration, training and development and other critical constructs of organizations. While HR department does not generate direct revenue its contribution to the effectiveness of the operations and compliance with the legal environment are critical for organization´s success and profitable operations (Fallon & McConnell 2014). In view of the role, which HR department plays in contemporary, the purpose of this document is to more closely look at the staffing, performance management and motivational strategies in specific healthcare organization – The Canberra Hospital.
An analysis of the organizational needs is a systematic and on-going process, and it is important that HRM department realizes the importance of continuity in the process of recruitment and selection. The reality shows that correct staffing needs assessment is the critical element of the successful HRM practices and human capital management in the company. While the assessment of the organizational needs is based on many variables, three elements build on the critical constructs of this process. The assessment of human capital needs at Canberra Hospital should be based on three elements 1) job-oriented procedures, 2) personal characteristic procedures and 3) employee-oriented procedures. The above three elements allow the HR department to build on the distinctive set of skills and personality traits, which are deemed important for a candidate to be successful at his function. The Canberra Hospital works with two divisions, A Health Promoting Hospital and A Principal University Teaching Hospital. The establishment is also part of the University of Canberra´s School of Nursing. The staffing requirements for the organization, therefore, are based on a threefold strategy: permanent staff members, interns and part-time staff, such as nurses. One of the examples of the staffing process at the Canberra Hospital is the nurse staffing model, utilized by its HR department. The model is based on a percentage ratio between the part and full time employees. The model, utilized for nurses, in contrary to the one used for the doctors is not organized around diseases-specific populations. The staffing need is evaluated with the utilization of the patients’ age, and care intensity needs and, consequently, the skills and working hours, required to provide quality care for these patients (Morehead 2003). The outcome of the staffing needs evaluation at the hospital is the specific and structured framework, which outlines annual requirements for soft and hard elements. Hard elements include such structural measures of care, including a number of employees, number of nurse hours, ratio of nurses to patients, monetary compensation methods and specific qualifications. Soft elements, on the other hand, describe the organizational culture, organization of nursing care delivery, workload, non-monetary motivation and nurse stress management (Hill, Doran, Ross B & Pink 2003). The Canberra Hospital utilizes one of the most common staffing models for nurses and one of the critical elements of this process is re-evaluation and re-assessment of job description and staffing needs in order to meet specific needs, based on the changes in the patient profile, demand and other external factors. Today, Australian Capital territory (ACT) and the Canberra Hospital specifically, present some of the best indicators in terms of staffing and retention in the industry for the country average. Back in 1998 The Hospital implemented a special advertisement and recruitment campaign for the nurses as well as laid the foundation to a strong and well-known today nurse mentorship program through creation of specific positions within the hospital for qualified and experienced mental health nurses to assist new professionals in their roles within the organization (Hansard 1998).
Training and development is a paramount part of internal motivation and productivity building system, applied and controlled by the HRM department in the organizations. For health care sector, training and educational needs are even more critical, given the nature of the job and dynamics of changes in the market and customers´ profiles. To understand the relationships between the organizational strategic and human resource planning, it is critical to realize that the activities within the HRM scope are cyclical, rather than linear. As such, the need for extensive recruitment can be the result of successful strategic development of an organization due to growth and market penetration. The demand for large scale recruitment program, at the same time, can be a sign of unhealthy internal situation, which drive low retention rate and, thus, the need for position replacement. With that in mind, effective recruitment can lead to the right position filling efficient motivation and remuneration program; however, will be required to maintain the advantage, gained by recruitment (Dessler 2007). The reality shows that the staffing process is the initial stage. HR activities, such as staffing, training and development, motivation and other elements of the HR responsibility scope have to become an integral part of the strategic planning with the healthcare industry. The Canberra Hospital has two divisions, which are looking at fulfilling the needs of the education within the establishment, A Principal University Teaching Hospital and the University of Canberra School of Nursing. The work, done with regards to the education of the staff is twofold. First of all the organization is looking at fulfilling its competency gap, based on the formulated growth strategy and quality control. The Canberra Hospital does not look at organic expansion, but its future need for human capital and resource fulfillment is determined by various external influences, such as demographic factor of age and health profile of attended population, governmental regulations and limitations, economic situation in the country and demand for education, influencing overall supply of nurses and doctors and other factors. The need for education, given the above mentioned is adjusted according to the findings of the staffing plan as well as the on-going job analysis, such as Fleishman Job Analysis System (F-JAS) (Brannick, Levine & Morgeson 2007). The School of Nursing is able to provide an independent supply of nurses for full time and part time positions as well as internship for the Hospital, which plays an important role in determining the internal capabilities of the organization with regards to the human capital (Canberra Hospital 2014). Secondly, on job training is part of the market offer, which the Hospital has and the education need in this situation is outlined and linked to a specific job analysis and needs assessment of the establishments and individuals, which go through internship at the Hospital. In this sense, the Canberra Hospital serves as a hub for other institutions´ training needs.
HRM, today, is different from what it was just some decades ago. These differences, surely, are explained by the changes in external environment, and growing pressure of the economic, political and competition factors on organizational costs, effectiveness and productivity. Some of the changes, however, are explained by the internal drivers to improve the relationships between employee and the organization. It is possible to look at the staff supporting mechanisms from various perspectives. The reality, however, is that the triggers of increased attention and organizational focus on this element is the evolving employment market, which starts to behave more like a classic market model. That said; employees today look for an organization, which not only offers good monetary compensation package, but offers a whole package of non-monetary motivation drivers. These drivers generally include the opportunity for personal and professional development and the value, placed on these elements is constantly growing (Brown 2011).
Organizational studies offer various models of supporting, which can benefit both, the employer and the employees. These models include counseling, mentoring, training, ombudsman and other formats. One of the of critical aspects of any supporting program or project is its links with the organizational strategic goals and operational objectives. With that in mind, the companies start to rely more on the performance appraisal systems, which offer an integrated solution for organizations, which seek to align the targets in a way, which will develop people, rather than punish poor performance. Healthcare industry is very specific, and goal setting for medical personnel is different from the commercial organization. Traditional performance management system and the Balanced Scorecard approach, however, can still serve their purpose with some adjustments.
The Canberra Hospital is not an exception. It successfully utilizes the performance management system, based on various measurable indicators, such as working hours, patient attendance rate, error counting and other elements. At the same time, the system is much more focused on individual achievement and development. The objective of the nurse performance appraisal system is to ensure that the personnel receives customized training and development plan, which enables higher productivity and job satisfaction (Dewhurst, Hancock & Ellsworth 2013). As such, over fifty types of face-to-face trainings are available for the staff and can be assigned as a reward for performance, based on individual preferences, as well as a way to improve performance in focus areas. With that in mind, performance appraisal system at the Hospital is a way to focus on strategic goals of operational performance and cost reduction (Canberra Hospital 2014).
As it was previously mentioned performance management in a contemporary business environment and healthcare industry specifically has evolved to address the dynamism and constantly changing external environment. Organizations no longer can afford to pursue “punishing” strategy and eliminate staff, which does not meet the expectations of their work placement. In many situations the only way to achieve high performance among nursing professionals is to provide on job training, which will support the theoretical knowledge and limited practical experience, which these individuals received during their studies (Ashkenas 2012). Contemporary understanding of the performance management in healthcare industry has changed from punishing to “developing”, which follows the general trend of developing and growing potential from within the core of the organization. Hospitals today realize that in order to reach and maintain quality standards, required by the market and the government, there is a need to ensure that the establishments in the sector can provide professional training to improve individual performance and create fit-for-purpose set of skills and expertise.
The Canberra Hospital widely uses this principle of internal development. It worth mentioning that the structure, which the organization possesses gives clear strategic advantage for the Hospital as it provides an internal source of quality training and educational infrastructure, which, otherwise, would be a significant additional cost for the organization. The Hospital utilizes a classic integrated performance management system, which builds on general and personal goals and looks at the one year horizon. Some of the general goals include quality assurance and productivity, measured on the basis of complaints and errors and number of patients attended per hour respectively. Personal goals are more difficult to measure, as they often include development of some personal characteristics, such as stress management, emergency service and other elements of a medical professional job, which are critical for personal and professional development. Often, to establish SMART goals for such quality measure, supervisors choose to set training and mentorship meeting goals (ADI 2013). A crucial part of the system is a systematic feedback, which is organized in two constructs: formal performance appraisal, conducted bi-annually. Mid-year review aims to evaluate on-going performance against the set targets and make adjustments in personal development plan to achieve better performance in the remaining part of the year. End-of-year appraisal is the final evaluation, which draws conclusions about the quality of one´s job and his or her ability to meet the operational objectives. In a Hospital environment and The Canberra Hospital specifically, the hierarchical structure is very lean and, thus, the relationships between different reporting levels are easier to control. For the performance appraisal system to work, the organization must be able to equip its people management personnel with specific knowledge on how to handle feedback sessions and set personal and general targets in the performance appraisal interface. The objective is to make these targets visible and comprehensive for both, the manager of the division and the employee. Such approach to performance management system allowed the hospital solving one of the major issues – alignment of objectives across professionals and, at the same time, opening the doors for personal development plan and continuing education. Given the size of the organization, supporting almost 540,000 population and offering 600 beds, current performance appraisal system offers a viable solution (Canberra Hospital 2014). There is little evidence to support the arguments statistically, but it is possible to conclude that the integrated performance management system is an efficient model for nurse and doctors turnover in the Hospital, which averages at the level of 13% over the past two years and is significantly lower than the healthcare industry average in the country (Hogan, Moxham & Dwyer 2007). This indicator is the result of the combined efforts of the HRM motivational and remuneration strategy as well as nurse retention program, started as early as in 1998 and which proved to be effective until today.
Previously we already touched upon the retention and remuneration programs, which are currently implemented within the hospital. Before proceeding further down this discussion, it is important to outline the challenges, which all the hospitals in ACT face with regards to personnel retention, especially with nurses on early stages of their carriers. It is not a secret that the past decade is characterized by severe shortage of nursing staff and tough competition within the major players in the sector for qualified and experienced personnel. According to Doiron, Hall and Jones (2008) the reasons for this strategic issues in the sector are twofold. First of all, the enrollment in nursing education, and, secondly, very low retention rate among nurses. The issues, which performance management system and retention policies should address today, are related to the aging population of nurses and potential staffing issues in the near and the long-term future (Doiron, Hall & Jones 2008). One of the major reasons for high turnover in the industry is workload and dissatisfaction with the remuneration. The point that should be made here is that The Canberra Hospital, in spite of its superior position on the employment market, is subject to these external staffing issues, and it is not possible to address them only through internal policies, but a large scale governmental reform and program is required to reduce the impact of enrollment low retention on the quality of nursing services in the hospital.
Finally, the discussion on staff development cannot be considered complete without an analysis of the workplace culture. In view of the discussion of Human resource management strategies and policies in healthcare industry and, specifically, at The Canberra Hospital, two major characteristics of workplace culture come to play, stress and heavy workload and non-standard working hours. Shared values, which The Hospital is trying to bring forward in its internal environment, include culture of care, excellence and internal growth. First of all, the hospital notes that it always strives for excellence and superior service to all the patients, irrespectively of specialty and complexity of their issues. Secondly, the organization promotes a culture of mutual respect and care, not only for the patients, but also in interpersonal relationships within the organization itself. Finally, the discussion on staffing, retention ad performance appraisal system in the company illustrates the third element of the workplace culture, which is internal growth. As the majority of the healthcare organizations in Australia, The Canberra Hospital realizes that one of the primary objectives for the near and the long-term future is the retention of the employees and HRM is concerned with the issues os strategic development. With that in mind, the Hospital promotes internal growth culture through offering career development opportunities, horizontal and vertical development as well as training programs to meet personal expectations of nurses and other medical personnel.
The Canberra Hospital is one of the largest healthcare organizations in the country. Management of such a large scale operation and Human Resource Management is a complex task, which requires time and efforts for total adjustment. In spite of the fact that staffing and retention policies in the organizations are developed at least a decade ago, the success factor of strategic HRM efforts at the hospital is dependent on the ability of the HR and operational management flexibilize and revise its policies, job descriptions and perform on-going job analysis for all the positions. The reality shows that as much as the organization can do, healthcare sector links with the governmental policies and other sectors of economy, such as education are extremely strong, and these connection makes healthcare organizations extremely vulnerable to the external influences. As such, the downfall in the number of enrollments to the nursing courses has significant influence on the activities and quality of the skills and expertise in the organization. With that in mind, staffing should be focused on retention and internal growth and current strategies with regards to these to constructs should be further enhanced to increase the level of independence of this institution from the industry trends.
ADI. Performance Management. Understand the True Meaning and Origin of Performance Management. Aubrey Daniels International[Online], 2013, viewed 19 May 2014, retrieved from http://aubreydaniels.com/Performance-Management-1
Armstrong M and Baron A (2002) Strategic HRM . The Key to Improved Business Performance. London: Chartered Inst. of Personnel and Development. Print.
Ashkenas R (2012). Firing Someone the Right Way. Harvard Business Review, March, 2012, viewed 18 May 2014, retrieved from http://blogs.hbr.org/2012/03/firing-someone-the-right-way/
Brannick M.T., Levine E.L., and Morgeson F.P. (2007). Job and Work Analysis: Methods, Research, and Applications for Human Resource Management. 2nd Edition. London, UK: Sage Publications. Print.
Brown J N (2011). The Complete Guide to Recruitment. A Step-by-Step Approach to Selecting, Assessing and Hiring the Right People. Philadelphia, PA: Kogan Page Publishing. Print.
Canberra Hospital (2014). About Us. Canberra Hospital Foundation Corporate Website, viewed 18 May 2014, retrieved from http://canberrahospitalfoundation.org.au/
Dessler G (2010). Fundamentals of Human Resource Management: Content, Competencies and Application. New York: Pearson Education. Print.
Dewhurst M., Hancock B., and Ellsworth D. (2013). Redesigning Knowledge Work. How to Free Up High-End Experts to Do What They Do Best. Harvard Business Review, viewed, 19 May 2014, retrieved from http://www.qualimet.ca/pdfs/HBR-Article.pdf
Doiron D, Hall J and Jones G (2008). Is There a Crisis in Nursing Retention in New South Wales? Australia and New Zealand health Policy 2008, 5:19. Print.
Fallon F and McConnell (2014). Human Resource Management in Healthcare. Principles and Practice. Jones and Barlett Learning. Print.
Hansard (1998). Nurses. Legislative Assembly for the ACT: 1998 Week 11 Hansard (10 December), viewed 19 May 2014, retrieved from http://www.hansard.act.gov.au/hansard/1998/week11/3478.htm
Hill M and Doran D, Ross B and Pink G (2003). Nurse Staffing Models as Predictors of Patient Outcomes. Medical care, volume 41, Issue 9: 1096-1109.
Hogan P, Moxham L and Dwyer T (2007). Human Resource Management Strategies For the Retention of nurses in acute care settings in Hospitals in Australia. Nurse Recruitment and Regtention. Volume 24, Issue 1. Print.
Millmore M (2007). Strategic Human Resource Management. Contemporary Issues. New York: Financial Times Prentice Hall. Print.
Morehead A (2003). Managing Flexible Working Time Arrangements: Negotiations Between Mothers and Managers in a Canberra Hospital. Labour & Industry: A Journal of the Social and Economic Relations of Work, Volume 14, Issue 1.
SHRM (2012). Job Analysis: How do I conduct a job analysis to ensure the job description actually matches the duties performed by the employee in the job? Strategic Human Resource Management, viewed 20 May 2014, retrieved from http://www.shrm.org/TemplatesTools/hrqa/Pages/conductjobanalysis.aspx