Name: MAMTA MARU

Subject: STRATEGIC HUMAN RESOURCE MANAGEMENT &

INERNATONAL HUMAN RESOURE MANAGEMEN

REPORT ON HR PRACTICES IN HEALTH SECTOR AT NATIONAL &

INTERNATIONAL LEVEL

SUBMITTED TO: DR. CHETAN LAD

STRATEGIC HUMAN RESOURCE MANAGEMENT

Strategic human resource management is designed to help companies best meet the needs of
their employees while promoting company goals. Human resource management deals with any
aspects of a business that affects employees, such as hiring and firing, pay, benefits, training and
administration. Human resources may also provide work incentives, safety procedure
information and sick or vacation days.

Strategic human resource management is the proactive management of people. It requires

thinking ahead, and planning ways for a company to better meet the needs of its employees and
for the employees to better meet the needs of the company. This can affect the way things are
done at a business site, improving everything from hiring practices and employee training
programs to assessment techniques and discipline.

Companies who work hard to meet the needs of their employees can cultivate a work
atmosphere conducive to productivity. Human resource management is the best way to achieve
this. Being able to plan for the needs of employees by thinking ahead can help to improve the
rate of skilled employees who chose to remain working for a company. Improving the employee
retention rate can reduce the money companies spend on finding and training new employees.

When creating a human resources plan, it is important to consider employees may want or need
and what the company can reasonably supply. A larger company can usually afford training and
benefit programs that smaller companies cannot afford to offer. This does not mean that a
smaller company should not engage in strategic human resource management. Providing
specialized on-site training, even if provided by senior members of the company and offering
one-on-one assessment and coaching sessions can help employees reach peak performance rates.

An important aspect of strategic human resource management is employee development. This

process begins when a company is recruiting and interviewing prospective employees. Improved
interviewing techniques can help to weed out applicants that may not be a good match for the
company.

After being hired on, a strong training and mentoring program can help a new member of the
staff get up to speed on company policies and any current or ongoing projects they will be
working on. To help employees perform at their best, a company can follow up with continual
training programs, coaching, and regular assessment. Investing in the development of its
employees can allow a company to turn out more consistent products.

Strategic human resource management is essential in both large and small companies. In small
companies, this may be as simple as the owner or manager taking a little time every day to
observe, assist, and assess employees, and provide regular reviews. Larger companies may have
a whole department in charge of human resources and development. By meeting the needs of the
employees in a way that also benefits the company, it is possible to improve the quality of staff
members. Taking the effort to provide employees with the tools they need to thrive is worth the
investment.
WELCOME TO HUMAN RESOURCES FOR HEALTH IN INDIA

The responsibility of delivering health services falls primarily on health workers making them
central to the health systems’ capacity to deliver health services. The health sector in India faces
several challenges in human resources for health. At one level, information on the size,
composition and distribution of the health workforce is limited and fragmented. The lack of
health workers, doctors, female doctors in underserved areas is a cause for concern. Though the
public sector has made serious efforts to place qualified health workers in under-served areas,
institutional constraints in the production and recruitment of health workers pose their own
challenges.

According to a research report by Job science, top talent in the healthcare industry is hard to
come by and even harder to retain in this competitive hiring market. Hospitals cannot afford to
continue operating without giving more serious consideration to recruiting, hiring and retaining
top talent and then addressing it as a primary improvement initiative for the hospital as a whole.
The other key findings include:

• The top concern reported by hospital HR professionals is recruiting quality employees

(80%)

• More than 50 percent of HR professionals are dissatisfied with current recruiting processes

• Best practices in recruiting and staffing are not consistently implemented (less than 50%)

In order to deal with the concerns of hiring and retaining top employees, you must first start by
addressing the HR staff needs such as strategic investments in the technologies and best
practices available. HR professionals must take a practical role in the strategic management of
their institutions proving the value of HR to high-level administrators. Talent is the
differentiator between industry-leading organizations and the rest, and the best practices for
recruiting, hiring and retaining that talent is constantly changing. Once HR professionals
proactively manage that talent and increase staffing effectiveness, they will become valued
members of their hospital.

The hiring market is changing, not only on the availability of qualified staff, but also in how
those staff members apply for positions. Successful HR professionals must be continually aware
of their location and the methods of their search to find the top talent. These methods are
constantly changing and it is up to the HR professionals to educate themselves with the new
processes available. Those who effectively leverage their HR procedures incorporate the
following into their course of action: partnering with an HR provider focused on service,
implementing the latest technology to facilitate hiring and hospital recruiting process and
proactively recruiting and talent pool building.

• Leveraging technology and metrics to support the strategic value of HR

• Positively affecting the economics of the institution by managing HR

• Utilizing search agents and job boards to capture top talent

• Creating an employment brand that attracts top talent

National Rural Health Mission

The National Rural Health Mission (NRHM), launched by the Honourable Prime Minister of
India on 12 April 2005, is an ambitious strategy of the government. It aims to restructure the
delivery mechanism for health towards providing universal access to equitable, affordable and
quality health care that is accountable and responsive to the people’s needs, reducing child and
maternal deaths as well as stabilizing population, and ensuring gender and demographic balance.
Formulation of transparent policies for deployment and career development of human resources
for health, strengthening capacity for data collection, assessment and review for evidence-based
planning, monitoring and supervision and technical support to national, state and district health
missions for public health management are part of the core strategy of the mission. These
strategies have several HRH dimensions and need to be examined as per the model given below:
MANAGING FOR PERFORMANCE

Work Health
HUMAN force system Health
RESOURCE OBJECTI Performanc Outcomes
ACTION VES e
· Numeric adequacy Coverage:
Equitable
· Skill mix Social &
Access
Physical
· Social outreach

· Satisfactory Efficiency
Motivation: Health of
Remuneration &
Social & the
· Work environment Effectiven
Physical Population
· Systems support ess
Competence Quality &
· Appropriate skills :
· Training and learning Responsivene
Training &
· Leadership & ss
Learning
Entrepreneurship
Building HR Capacity for Health Reform

• It is important to recognize the distinctive features & historical legacy of HR management in

the health sector if reform is to be effective

• HR issues need to be consider at an early stage in health care reform and not to be add on

• Health care reforms have frequently been over optimistic about what can be achieved
without the necessary resources: human or financial to make it happen. The commitment of
senior policy makers to the Hr agenda is vital otherwise it won’t be taken seriously

• The process of health sector reform- who is involved, the sequencing of developments &
the institutional mechanisms to support reform as much consideration as the content of
reform

• Human resource for the health work is frequently focused narrowly on workforce planning
& training , effective HR is characterized by much wider agenda

• Developing an effective HR strategy requires ensuring that ownership, external fit &
internal fit issues are addressed

• The focus on reforming pay systems which has yielded limited results has diverted attention
from the important issues of non-pay rewards, work reorganization & questions of
performance management

The HR Function

• Developing HR capabilities requires investing in the training & development of both HR

specialist & line managers with staff management responsibility

• It is vital that any investment in specialist HR capacity evaluates the different ways to
deliver the HR functions. Even if out-sourcing is rejected the in-house HR function should
be properly audited & monitored
• To be effective HR function must develop both an operational & strategic HR capacity. The
HR function should not try to run before it can walk- robust HR policies & practices should
be developed before attempts at devolution or more radical changes in employment practices
should be pursued.

The Compensation Discipline deals with the various forms of direct compensation i.e.
employees’ pay—that employers use to attract, recognize and retain workers. It includes
designing and administering compensation systems including base pay, differential and
incentive pay, and overtime. It also includes matters that focus on compensation-related careers,
communications, legal and regulatory issues, technology, metrics and outsourcing, as well as
effective compensation practices and global compensation issues. It does not include the various
forms of indirect employee compensation—commonly referred to as “benefits,” which are
encompassed in the Benefits Discipline.

• Variable Pay: How to Manage it Effectively: Variable pay is a significant element of the
direct compensation package of a growing number of organizations.

• The Compensation Scorecard: What Gets Measured Gets Done: Employee compensation,
one of the largest expenses in any organization, is also one of the least managed.

• FAQs on Rewards Strategy

• Implementing Total Rewards Strategies

• CASE STUDY SERIES: Designing a Pay Structure: A Case Study and Integrated Exercises :
Compensation is a critical area of HR that can greatly affect employee behavior. To be
effective, compensation must be perceived by employees as fair, competitive in the market,
accurately based, motivating and easy to understand.

• Employers Assessing Salary Programs for Affordability, Competitiveness: Communication

challenge: Just 51% inform employees of their position's full salary range

• IT, ITES Sectors Lead The Pack In Salary Increments This Year : Although firms are
expected to add more staff, most of the talent especially in the middle to senior management
roles will remain in their current organizations, reveals Kelly Services' Employment Outlook
and Salary Guide 2010-11.
• Attrition woes spark salary increases; focus on pay for performance to intensify: Employees
in India can expect an overall average salary increase of 11.6% in 2010, according to a
recent Mercer India Monitor survey.

• 10 Executive Comp Issues For Aligning Pay Strategy : Understanding these key executive
compensation issues can help HR professionals to better integrate executive compensation
with overall pay strategy throughout the organization.

• Bonuses Are Back, With Emphasis On Hard Measures: More companies globally are
awarding bonuses in 2010, but bonuses are more likely to be strongly tied to the bottom line
with more challenging targets and greater focus on return on investment.

INCENTIVE PAY PLANS

• Firms develop pay-for-performance culture in response to economic recovery in Asia:

According to the Mercer Asia Executive Remuneration Snapshot Survey, approximately 30-
40% of an executive’s total pay package is linked to variable pay regardless of the type of
organization.

• Setting Goals for Executive Incentive Plans: With increased scrutiny of executive
compensation and greater transparency attributable to enhanced disclosure requirements,
having a pay-for-performance compensation philosophy is practically a must for U.S.
companies.

• Executive Comp: Rethink Incentive Plans for Difficult Times : The troubled economy is
causing fundamental shifts in executive compensation bonus and equity-based incentives
plans, according to a November 2008 report by pay consultancy DolmatConnell & Partners.

• Avoid Bonus Blunders as Economy Slows: The end of the year brings bonus and
performance review discussions for many employees.

• Incentive Plans Hit Hard by Economy; Retention Efforts Increase: Decreased earnings and
falling stock prices have shredded the value in some companies’ annual incentive and long-
term incentive plans, according to a survey by Deloitte Consulting LLP.
• Keeping Comp on Track: Some Practical Tips: CHICAGO—It’s the economy, said Sharon
K. Koss, SPHR, consultant and author of Solving the Compensation Puzzle (SHRM, 2007),
during her June 21, 2008 workshop on “Compensation Basics,” held here.

The Bombay Hospital has decided to only hire candidates with strong credentials, after a fake
doctor worked at the hospital for six years undetected until Wednesday, Currently, junior
doctors are hired on the basis of their documentation. “We plan to start getting at least two
cross references for junior doctors as well. We also plan to cross check their SSC & HSC
certificates,” said Dr DP Vyas, medical director at the hospital. “It will help if the medical
degree certificates display the candidates photograph.”

This change in procedure came after Zuber Qureshi, a medical college drop out, assumed his
old classmate Meraj Shaikh’s identity and used his documents to secure a junior resident
doctor’s post at the hospital. This continued for six years until the police arrested him on
Wednesday after the real Dr Meraj Sheikh, lodged a complaint against him.

The hospital said that at the time of appointment, the original certificates submitted by the
doctor seemed reliable. A statement released by the hospital on Thursday said: “Though we
are very stringent about checking the authenticity of certificates submitted by candidates, this
is a clear case of impersonation and fraud.” The hospital currently has 200 resident doctors.

Qureshi was working under Dr CA Somaya, a cardiothoracic surgeon. His seniors had no
cause to complain about his work.

“We did not receive a single complaint against him. As a junior resident doctor he was not
directly involved with the treatment of the patients and was not authorized to take any
decisions regarding treatment on his own,” added Vyas. Qureshi is currently in police custody
under charges of forgery and impersonation.

RECRUITMENT, SELECTION AND INDUCTION PROCESS IN SAHARA HOSPITAL

CULTURE OF SAHARA HOSPITAL

The organizational culture plays a significant role in making organization gets the best out of
themselves. An optimum level of development climate is essential for facilitating H.R.D. Such a
climate can be observed in “SAHARA INDIA” consisting of following tendencies and
attributes:-

• There is a tendency at all levels and specially the top management to treat people as the most
important resources.
• There is a perception that developing the competencies in the employees is the job of every
manager/supervisor.
• The employee has easy interaction with the seniors in respect to official work and personal
problems.
• There is a general climate of trust.
• The psychological climate in the organization is very conductive to the employees.
• Tendency on the part of the employees to be generally helpful to each other.
• Team spirit and employees are encouraged to take the initiative.
• There are tendency to discourage favoritism and Biases.
• Supportive personnel policies.

RECRUITMENT PROCESS IN SAHARA HOSPITALS

PURPOSE

Human Resource is one of the key resources, which contributes to the success of the hospital. It
is imperative that human resource department will have to identify the right talent to achieve
organizational effectiveness. The success of identification of right talent depends upon finding
the applicants with the most appropriate level of skills, qualifications and experience, who will
identify themselves with the organizational objectives, values and culture and in turn contribute
their best to the organization.

The objectives of the recruitment are,

• To lay down and follow an operating procedure for recruitment function of the HR
Department.
• To identify and select qualified manpower for the various roles as per the job specification
lay down by the management.
 • To follow a systematic procedure to select a right person for the right job at the
right time.
• To recruit people who have a positive attitude towards customers, themselves and other
employees and who are able to contribute towards quality service.
• To follow a recruitment procedure this is applicable to all categories of
employees.

Recruitment Policy

The recruitment process is carried out in alignment with objectives and major organizational
principles. The major policies include:

Appointments in the hospital will adhere to the qualifications and the skill sets as mentioned in
the job description for various job titles.

Wherever experience has been specified, effort will be made to recruit persons with such
number of years and nature of experience.

The recruitment process shall be made transparent and should screen the best talents in the
industry.

• Provide equal employment opportunities irrespective of gender or community.

• Whenever vacancies arise, preferences will be given to applicants within the hospital.
• Recruitment of employee’s relatives will not be encouraged except in certain situations and
categories.
• Selection of unskilled workmen will be restricted for jobs that involve rigorous manual Labor
keeping in mind their capacity to perform.
• Age limit for unskilled / untrained personnel should preferably be below 30 years of age.
• Selection will be strictly on merit taking into consideration the knowledge, skill sets, mindset
of service, attitude and overall personality.

Responsibility

The HR department is responsible for the observance and adherence of the approved recruitment
policy and procedures.

Procedure for Recruitment

Sahara Hospital is now ready to be operational. The requirement of Human Resource has been
determined and the same is approved by Management. Staffing process is now beginning & The
Manager – HR and his team is responsible for the recruitment process.

Sources of Recruitment

Internal Sources

The internal source of recruitment is to provide an avenue for the existing employees within the
organization to perform a new role. This will be based on the suitability of an employee for that
particular vacancy. This may be termed as Promotion (if there is a change in salary / grade) or
Transfer (with or without any effect on Salary / Grade) as stated by the management. The
process starts by sending a note to different departments stating the vacancy. The profiles are
later collected and stored in the data bank followed by the different steps involved in recruiting
the employee.

All internal recruitment will be done through:

• Internal Circular
• Intra – mail

External Sources
The various external sources used for Recruitment are as follows:

• Advertisement
• Recruitment through Job portals such as Jobsahead, Naukri, etc.
• Head Hunters / recruitment consultants
• Campus recruitment
• Walk In interviews

Advertising

When compiling an advertisement, the job profile should be made clear, concise and non
discriminatory. Clear indication should be given regarding the level of competence the position
requires.

Advertisements for recruitment are done in such a manner that it provides the maximum
required reach to the public. There is reliance in more than one source of advertisement.
Advertisement in newspapers magazines / journals shall be considered when the vacancies are
not filled through other sources of recruitment. Identification of the right media for advertising
the jobs has to be made to:

• Attract suitable personnel.

• Discourage unsuitable individuals from applying.
• Project a good image of the hospital.

The HR. Head is responsible for preparing an advertisement based on the current job description
and job specification. The respective Department shall provide all necessary details regarding
the job profile to the Human Resources Department.

An effective advertisement will include:

• Job Title – should match that on the job description

• Department & Location
• Grade and Pay Scale or Range – where ever necessary
• Type of Contract – where ever necessary
• Key responsibilities – the essential elements of the job description
• How to apply – All applications should be sent to the ‘Human Resources Department’ stating,
the post asked for quoting the reference number.
 • Closing Date – normally a minimum of two weeks after publication

INTERVIEWS

Campus Interview

This source has to be used only for entry-level jobs. The directory of relevant educational
institutions may be referred for identifying institutors for conducting campus recruitment.

Process for campus interview…

• Obtain permission from the institutional authorities.

• Communication of the same to the interview panel members.
• Ad display at the college campus (10-15 days in advance stating position, date, time &
venue).
• Presentation of the Hospital.
• Registration.
• Tests (Written/Group discussion).
• Short-listing of candidates.
• Personal Interview.
• Finalization of candidates.

Campus interview kit requirements

• Booking of tickets
• Boarding & Lodging / Vehicle arrangements
• Impressed Cash
• Presentation arrangements at the venue. Requirements include (Slide Projector/Slides,
Laptop/Computer, OHP / Transparencies, OHP markers, Laser pointer, PampWets/Brochures)
• Pay scales and details of other benefits are to be communicated.
• Stationery: requirements include A4 sheets, ball point pens, pencils, erasers, sharpeners,
stapler / pins, gem clips, ball pins, plastic folders, punching machine, flat files, box files,
rubber bands, binder clips, paper weights, ruler, post-it, gum and calculator.)
• Reports of the interviews conducted are to be submitted at the end of every such exercise and
recorded by the concerned authority.

Walk-in Interview
 • Confirmation of date, time and venue
• Permission to be sought if necessary from local authorities
• Communication of the same to the interview panel members
• Preparation of advertisement
• Release of ad (one week in advance & on the day of the interview)
• Travel plan to be decided with the panel members.
• Booking of tickets for interviewers
• Boarding/lodging/vehicle arrangements
• Venue arrangements (Interview & Seating arrangements for the candidates)
• Report of the interviews conducted.

Walk-in interview kit requirements

• Stationery (A4 Sheets, Ball point pens, pencils, erasers, sharpeners, stapler/pins, gem clips,
ball pins, plastic folders, punching machine, flat files, box files, rubber bands, binder clips,
paper weights, ruler, post-it, gum, calculator).
• Application forms.
• Pay scales and details of other benefits.
• Interview rating forms.
• Copy of Ads released

SELECTION PROCEDURE IN SAHARA HOSPITALS

Selection procedure is the most important part of the recruitment process. It should provide
evidence of the required capabilities and should be a completely transparent. It should be a
timely, cost efficient, effective and equitable process.

Scrutiny of applications

Applications received from the candidates are scrutinized and short listed as per the required job
specification. Short listed applicants are called for an interview through an interview call letter
by post or courier / phone call / e-mail /telegram/phonogram. A minimum time frame of 7 to 10
days shall be given to the applicants to make necessary arrangements to appear for the
interview.

Preliminary Screening I Verification

This screening shall be done based on the job requirements and specifications. During the time
of interview, the candidate’s authenticity of the original certificates I testimonials of age,
qualification and experience shall be verified, updated and recorded by the HR personnel. On
completion of verification, the candidates are asked to appear for the written test I group
discussion.

Written technical Test

A standard questionnaire or a practical test shall be held for testing the skill of the candidates.
Based on the marks awarded the candidate will be short-listed for a personal interview.

Personal Interview I Selection

On successful completion of the written I technical test, the short listed candidates will attend
the personal interview. The Interview panel will consist of Director (Medical Health), the
concerned departmental head, representative of Corporate HR and the representative / HR Head
of Sahara Hospital. The panel members will look for the required criteria, based on which the
candidate will be selected or rejected.

The following traits shall be looked upon during the Interview process:

• Willingness to learn
• Willingness to change
• Self-starter
• Ability to concentrate
 • Willingness to learn multiple skills
• Team Player
• Good family background
• Personal grooming & etiquette
• Loyalty to the organization
• Dedication to the profession
• Good communication skills
• Positive attitude towards life
• Caring Nature and helping tendency Decision making ability
• Active & quick to respond to situations

Antecedent check

Due diligence antecedent check shall be carried out for key positions before the offer letter is
sent.

Medical Examination

A pre-employment medical examination shall be done for all employees recruited from the level
of a probationer onwards. The medical fitness of candidate has to be certified by the Staff
Medical Officer for appointment.

Provisional Selection

Provisional selection letter shall be sent / issued to the final short listed candidates subject to
being found medically fit.

Appointment
On receipt of the pre-employment medical fitness certificate and found fit for employment, an
appointment letter will be issued / sent to the candidates enumerating the terms and conditions
discussed during the personal interview. On receipt of the appointment letter, the candidate has
to confirm their acceptance and date of joining by signing and returning the duplicate copy of
the appointment order to the Hospital.

Appointing Authority

The appointing authorities for various categories are as follows:

SR. No. CATEGORY APPOINTING AUTHORITY

Senior Management (Medical and Non
1
– Medical)
Hon’ble Dy. Managing Director
Doctors (Consultants, Registrars,
2 (C. & A.)
Residents, Medical Officers)
3 Managers / Executives
4 Staff / Workers
Placement and joining formalities

A selected candidate has to report a day in advance with the following to complete the joining
formalities and creation of a personal record:

• Proof of age, qualification & experience

• Licenses / Registration Certificates, etc.
• 3-passport size photographs.

The Following forms are to be filled

• Employment form
• Communication form
• Nomination form
• Dependants declaration Form
• PF Form

• Gratuity Form
The Recruiting officer In – charge at Corporate HRD shall verify all the above documents on the
date of joining and complete the check -list formalities. The joining intimation report shall be
prepared and sent to the following areas.

• Sahara Hospital HR
• Time – office
• Security office
• Pay – roll Section

ID cards and uniforms shall be provided on the date of joining

Procedure for New recruitment / filling vacancies

The department in need of manpower will send in a properly completed personnel requisition
form to the HRD Development..

The HRD Development will have to process the requisition and will have to place a person
within 30 days of receipt of the requisition.

The HRD Development may place a position on hold if it is not justifiable. In such case the user
department, which has made the requisition, will have a suitable alternative for ensuring service
delivery.

The HRD Development will do an internal search before starting the external recruitment
process. However if the position demands and need is urgent the HRD Development will
embark on the external recruitment process.

Recruitment Process for Nurses

The deployments of nurses are being done in two stages depending on the occupancy projected.
In the initial phase of operations, nurses are required in two cadres; staff and supervisory.
Initially the number of supervisory nurses will be limited and allocated according to the
functional areas of operation in the hospital.

The Nursing Head would also have to simultaneously arrange for meetings with the Principal of
Nursing colleges for Campus Recruitment.
Recruitment Process for Paramedical Personnel

The recruitment of paramedical staff has been conducted as per approved man power planning
under the direction of Director (Medical Health).

Recruitment Process for Administrative Personnel

The staff requirement during the years will be constant since it is not dependent on the variation
in the occupancy of the hospital. The following points have been considered while drawing up
the recruitment plan.

1. The heads of most administrative departments have been recruited in advance owing to the
fact that many of them will have to be deputed for orientation program.
2. The HRD Development Team have been identified and recruited in the very beginning so
that they can oversee the entire recruitment process of staff at various levels.
3. The clerical level staff will be recruited just before the soft commissioning of the hospital.
However adequate training period has to be accounted for while drawing up the recruitment
plan.

The recruitment process for all heads of departments will follow similar schedule. The only
exception to the general rule is in the case of the HRD Development who has been to be
recruited earlier than most administrative heads.

The Executive and clerical level staff can be placed in the hospital just before operations
commence. The schedule however accounts for their training period before the date of soft
commissioning.

Recruitment Process for Support Service Personnel

The following departments will constitute support services in the hospital:

1. Engineering and Maintenance

2. Biomedical Engineering
3. Information Technology
4. Medical Records
5. Front Office
6. Food and Beverages
 7. Security
8. House keeping

The recruitment of all the above departments has been be conducted in the following staff
categories:

1. Heads of Departments
2. Executive staff / Clerical staff
3. Contract staff

The pattern of recruitment will be uniform in all cases with the exception of the following:

1. HOD- Engineering and Maintenance

2. HOD-Biomedical Engineering,
3. HOD-Information technology

The above departmental heads will have to be in place by the time the installation of
Engineering equipment, biomedical equipment and LT hardware and networking takes place.
They would be placed in the hospital prior to the date of soft commissioning.

INDUCTION & ORIENTATION IN SAHARA HOSPITALS

All new incumbents shall undergo a comprehensive induction program for familiarization of the
organization’s process, structure and people.

The induction period sows the seeds for bringing out the best in the employee and enables
employees to settle down quickly to perform their duties well.

During this process the employee gets to know the mission and goals of the organization, its
values and norms and his expected behavior pattern.

During this process, the new employee is provided with Induction Kit comprising the induction
manual, service rulebook, all forms related to joining formalities of an employee.
It is mandatory that all the employees should attend the Induction program before they start
reporting to their respective departments. After the successful completion of this program an
Orientation form is filled up and attached in the personal file of that employee.

INDUCTION PROGRAM

Induction Program is a 3-4 days program, which is given to the newly employed staff (doctors,
nurses, technicians, administrative staff etc.) and would include a series of lectures on various
topics. The induction program introduces the employee to the Hospital about the general
functioning of the Hospital and would also include hospital rounds. Manager – HR is
responsible to organize this in the Hospital with timely integration with the commencement of
operations and in relation to the joining dates of batches of employees.

The Induction Program provided by the Hospital would include:

• Introduction to the Hospital

• Organization structure
• Role of various departments
• Importance of infection control
• Communication and team work
• Psychology of patient.
• Human values etc.

Need Based Training Program

The training is general to all departments and at all levels except for a few topics, which are
specific to executive and managerial cadre. These program are mainly aimed at developing the
behavioral aspects of individuals and will be more focused toward employees who interact
directly with the patient.

Technical Training Program

Technical training program consist of on-the-job training and would be given to the technical
employees of the hospital. The technical training program is aimed at updating the technical
skills and knowledge of the employees according to the latest development in the fields.
Technical training is generally given to the employees of the medical, nursing and paramedical
departments.

What to avoid in Induction

• Providing too much, too soon; the inductee must not be overwhelmed
by a mass of information on the first day. Keep it simple and relevant.
•HR rather than local personnel providing all the information – it should be a shared process.
• Creating an induction program which generates unreasonable
expectations by overselling the job.
• Having to repeat the unproductive learning curve of the leaver
damage to the company’s reputation.

New HR Tactics for New Challenges

Increasing rates of attrition are compelling HR departments in hospitals to rethink their

strategies. Rita Dutta reports

It was an entertaining and competitive evening with scintillating dancing and singing
competitions and games at the Mumbai-based Dr LH Hiranandani Hospital. Winners were
gifted with TVs, DVD players, microwave ovens and so on. Surprised?

It was a part of the well-crafted HR strategy to scale up the happiness and satisfaction quotient
of employees. Whether it is cheering employees by celebrating their birthdays, weekend cricket,
creating a sense of empowerment by making them stakeholders, weaving a cocoon of safety and
security, extending medical benefits after superannuation, or emphasizing training and
development, the Human Resource Developments (HRD) in major hospitals are rolling out
innovative plans to woo employees.

Dynamics Are Changing

Why this sudden awakening of hospital HRDs? The change is

fuelled by an attrition rate of 15 to 20 per cent in hospital
administrators and managers in the last six months, a result of
the burgeoning USD 23 billion Indian healthcare industry,
growing at an annual rate of 13 per cent. New hospitals in Having weekend cricket with
Mumbai, Delhi and Bangalore are poaching employees from employees is an HR strategy at
established hospitals by upping their salaries by 30 to 40 Dr LH Hiranandani Hospital
percent, say analysts. (See box for an estimate of salary hike
in new hospitals)

Gone are the days when an employee stuck to an organization for decades together working for
a modest salary, while a few years back, a fresher with MHA received a salary of Rs 12,000 to
Rs 15,000, today he commands a salary of Rs 20,000 in corporate or upcoming hospitals. A
manager with three years experience, who used to earlier receive Rs 35,000 to Rs 40,000, today
pockets Rs 1lakh and above says unofficial estimates.

An opportunity for better career growth, stagnation and lack of job enrichment at the present
organization are also driving employees to new hospitals"
Ankush Gupta
Senior Manager,
HR and Administration,
Hiranandani Hospital

The flip side of the boom is faced by the hospitals losing their top guns. In the last six months,
Hiranandani Hospital lost eight key people, while Wockhardt Hospitals, Mumbai and PD
Hinduja Hospital, Mumbai lost eight and four people, respectively to the upcoming hospitals.
Rockland Hospitals, Delhi has lost four key people. The sudden exits sometimes have HRDs at
their wit’s end scouting for immediate replacements within 24 to 48 hours. “I had to replace my
materials manager within 24 hours. Sometimes, it becomes quite challenging,” says a harried
Gupta. Coping with the crisis has made most hospitals realize that their HR policies needs to be
better defined. Opines Gurushant Phatate, General Manager, HRD, Jaslok Hospital and
Mumbai, who worked in the steel industry earlier, “Hospital HR is definitely less well-defined
when compared to other industries.”

And why is it sketchy? S Patnaik, Senior General Manager, HR, Apollo Indraprastha Hospital,
New Delhi explains, “Hospitals have always accorded more importance to doctors than their
internal customers—administrators, nurses or ward boys. Hence, HR for other employees never
took concrete shape, until recently.” Additionally, there is lack of trained HR personnel in
healthcare. “Most of the HR personnel in healthcare come from the FMCG and pharma sector,
without any training in hospitals and thus fail to address the finer nuances,” avers Dr Alok Roy,
Vice President, Operations, Fortis Hospital and Noida.

Where the Problem Lies

It’s only a handful of hospitals which chart out a career graph for their employees while
recruiting them, convey the group’s vision, train them or take steps to appreciate their work.
Asian Heart Institute (AHI) learnt the importance of communicating with its employees the hard
way. A host of people left the organization in its first year of operations. Dr Bhaskar Shah,
Director, AHI reveals, “Employees were unsure of their growth and future in the organization as
we did not clearly define our group’s vision to them. But, now we have learnt from our mistake.
We hold regular training sessions with employees.”

According to Tufan Ghosh, CEO, Columbia Asia Hospital and Bangalore, “HR in hospitals is
hierarchy-driven, which does not necessarily translate into career growth. There is no unified
chain of command as the medical and the administration departments are mostly at loggerheads,
preventing one from taking the right decision.” He feels that the recruitment process in hospitals
is heavily skewed towards people with the right technical knowledge than those with the right
behavioral approach.

Different hospitals are beset with different HR problems. Mumbai-based Jaslok Hospital, like
many other hospitals, has to cope with high degree of absenteeism and indebtedness in class III
and class IV employees. Every year, around 30 people are suspended from Jaslok Hospital
because of absenteeism. This is after they are served innumerable warnings and show cause
notices. “We also have a hard time trying to pay cheques of people with high debts,” says a
distressed Phatate. To avoid such problems, most hospitals have started outsourcing Class IV
staff.

"Hospital HR is definitely less well-defined when compared to other industries"

- Gurushant Phatate,
General Manager,
HRD, Jaslok Hospital

Unions Matter

The dynamics of hospital HR are different in a unionized hospital, which often prevents the
authorities from taking immediate and stringent punitive measure against an errant employee.
For instance, when an employee was found to be inebriated during duty in a major Mumbai
hospital, the hospital authorities could not take any immediate action against him. Only after the
enquiry committee filed its report after one and a half years, the employee was suspended for
three days. “Does such punishment hold any meaning?” asks an HR person.

Lack of proper appraisal system can also lead to disgruntled employees and thus poor
performance. Most unionized hospitals do not have performance-based appraisal, except for
managers. The yearly hike is decided during the time of appointment, which is a demotivating
factor.
According to Dr SK Biswas, VP, Duncan Group, Kolkata, “Often employees grudge the hikes
given to them, without knowing the dynamics behind that hike. A hospital needs to explain its
Key Result Areas (KRAs) to the employees, monitor their progress during the course of the
financial year and then make them understand why a particular salary hike was given. This is
the KRA for the HR Department of a well-administered hospital.” The concept of ‘Balanced
Score Card Approach’, a management tool introduced by Kaplan and Norton of Harvard
University thus assumes significance in HR. In this frame-work, the approach is to ensure better
focus, accountability, alignment and communication at all levels, with the objective of four
inter-dependent perspectives of training and development, well-defined internal process,
customer satisfaction, therefore more patients inflow and hence revenue viability.

“The impact of behavior of employees on the revenue and the importance of balanced
score card needs to be explained to them,” says Dr Biswas, a firm believer in this innovative
concept.

Even as HR policies are taking shape, are all HR personnel given the power to execute policies?
Dr Shreedhar V Sherigar, Chief Manager, Personnel & Human Resources, Breach Candy
Hospital, Mumbai fumes, “Most hospital managements twist HR for their own benefits. HR
personnel end up being lackeys of the management.”

Ways to Curb Attrition Rate

To curb the high attrition rate, the success mantra for a hospital is not just offering a fat pay
packet, but chalking out long-term development and career growth for employees, along with
giving them a sense of empowerment. “A hospital should always innovate, keep their
employees busy with various projects,” suggests Dr Roy.

So that the functioning of a hospital is not plagued by somebody’s sudden exit, it is important to
keep a databank of apt substitutes ready. “I always chat with my employees trying to
understand who is not happy and may leave the organization. I try to address their
problems and grievances and always keep the replacements ready,” says Gupta. Anupam
Verma, Director, Administration, PD Hinduja Hospital agrees, “We always keep a second line
of people ready so as to avert a sudden crisis.”
Multi-tasking also comes handy in times of crisis. “It is the job of HR to identify the right talent,
encourage and train them for multi-tasking,” says Dr Biswas.

Winds of Change

According to Dr Bidhan Das, Director, Administration, Rockland Hospital, “It is the role of
HR to analyze behavioral patterns whether it is a high-skilled surgeon or a low-skilled
security guard, chart their behavior for months together and then use targeted
intervention, which is accomplished through behavioral and motivational training.”
Manipal Hospital, Bangalore, like some of its counterparts, is consciously creating a working
environment that facilitates a performance-driven culture. “Performers are motivated with ample
opportunities to take up challenging assignments. We empower employees to take decisions and
thus instill self-confidence and sense of pride in working for us,” says R Basil, CEO and
Manipal Hospital. The hospital also conducts sports and cultural activities for a span of three
months in parallel with regular work every year, which culminates in the annual Manipal
festival called Manifest. “All these go a long way to instill a sense of loyalty not only among our
employees but also among the consultants, who are not on our direct payroll,” says Basil. The
importance of well-defined HR is slowly taking root. With a spate of new hospitals, there is
renewed emphasis on training and development. “From focusing on Industrial Rules (IR) or
union-related activity, hospital HR is now making a paradigm shift towards training &
development and customer satisfaction (both internal and external),” says Patnaik.

“Listen to the winds of Change.” Welcome to the employees’ world!!

‘HR Should Never Cave In To Any Favoritism’

The Chairperson for Mumbai Hospital HR Forum and Head of HRD with Reliance’s (ADAG
GROUP) Kokilaben Dhirubhai Ambani Hospital (previously Mandke Heart Hospital), Sunil
Karanjikar, is a busy man these days crafting HR strategies for the upcoming hospital. In a
career spanning 12 years, Karanjikar has worked with Tata SSL (Wire Division), a subsidiary
company of Tata Iron & Steel Company, Voltas, Norwegian conglomerate Norsk Hydro and
Saint Gobain Sekurit India. Dabbling in the healthcare industry for the last two years, he is
respected in the industry for setting the HRD standards in PD Hinduja National Hospital and
Medical Research Centre, when he was the Deputy Director, Personnel & HR. An Executive
Committee member and treasurer of National Institute of Personal Management, Mumbai
Chapter and HR Committee member of Bombay Management Association, he discusses the
paradigm shift needed in HR related to healthcare, in an interview with Rita Dutta

HR in healthcare is sketchy. Do we need to overhaul the present HR systems in hospitals?

A doctor’s role in treating patients is important, but the time he spends with patients is very less
compared to others. Yet, it is always the doctor who is treated as demi-god both by patients and
management, forgetting others who are also serving the patient. We need a 360-degree change
in HR approach, so that the support staff is also given the equal importance they deserve. A
hospital needs to have such HR standards, which act as a magnet to attract talent.

What changes did you bring in at Hinduja Hospital’s HR?

During the two years of my tenure, I have helped the hospital not only to attract the right talent
but also successfully implemented various HR initiatives to make the workplace people-centric.
‘Team HR’, which we used to call ourselves, started by designing an HR mission, based on
which various initiatives were taken.

In one year, almost 20 innovative HR practices were successfully implemented, including

celebration of birthdays of all employees by the department heads, presentations by employees
after attending external training programs for knowledge of other employees and union leader-
employee discussions. We also introduced dance classes for doctors and administrative staff,
training programs and HR survey to understand the needs of employees.

What are the main challenges faced by HR personnel?

To begin with, we have to maintain quality of service, which we attain by inculcating the right
philosophy and principles in our staff. Training programs are thus very important. It is a
challenge to create passion for work in people and that applies for HR people too. Secondly, we
have to battle with attrition, which is highest in nurses. Besides a good salary, we need to give
people fancy designations, career paths, and empower them, which will lead to better
productivity. We should also have a succession plan for at least the top two levels.
We have to attract the right talent, because there is a dearth of trained personnel. The parameters
of judging talent are different for various roles; soft skills have assumed immense significance
today. People are in a sensitive state of mind when they visit a hospital and one small mistake or
slip in service can be blown out of proportion. Even doctors cannot afford to be rude with
patients. Additionally, we have to increase the level of transparency and trust in employees and
make the hospital people-centric.

However, the most important challenge lies in not caving in to the demands made by doctors
and management to hike salaries or promote certain people, whom they think are good
performers.

We must put our foot down, because if we agree to their demands every time, we end up not
only upsetting the salary level of everybody else in the same category, but also the financial
goals at the end of the year. Rules and regulations apply to all and favoritism cannot be allowed
under any circumstances. Such situations mostly arise when the organization is dictated by one
person.

A renowned CEO of a prominent Mumbai-based hospital left the organization some years back
as the management were not ready to listen to his suggestions for improvement. What is the role
of HR in such situations?

It is very sad that sometime people at the helm don’t understand professionalism. It is the top
management which should support all strategic plans of its CEO. Nobody appoints a CEO
without understanding his professional status, credentials and the work he has done in the past.
What we need is more transparency while recruiting top people. There is a need to decentralize
power.

There is a sudden hike in salaries in healthcare. What impact will it have on employees’
mindsets?

The hike is well-deserved and expected considering the boom in the healthcare industry. Most
hospitals don’t pay heed to rewarding their own employees. They fail to understand that the
ranking they have is not only because of their technology or medical practitioners, but also due
to hard work put in by the employees working in Para-medical, nursing and administrative
areas.
Salary in healthcare has never been competitive, be it for marketing, finance, HR, administration
or technicians. I want people to feel cheerful while coming for work and not have Monday
morning blues. Rectifying salary is the one of the steps towards achieving that goal.

is lack of skilled HR professional in healthcare. Please comment.

Yes, that is true. HR is not seen as a lucrative career option in hospitals as students opting for
professional healthcare courses believe that they only go for administration in a hospital. There
are only a few institutes, like TISS, Mumbai, ASCI and IIHMR which have HR courses related
to healthcare. While we need more such institutes, keeping in synch with times, most of these
institutes need to modify their syllabus.

INTERNAIONAL HUMAN RESOURCE MANAGEMENT

The shortage of health human resources (HHR) has been identified as one of the major
challenges facing Trinidad and Tobago and the region of the Caribbean and the Americas for a
number of years. WHO estimates that a total of 4 250 000 health workers, are needed to fill the
human resources gap that exists in fifty-seven countries, and that without prompt action, the
shortage will worsen.

The health human resource shortage in Trinidad and Tobago has been exacerbated by the
migration of health care professionals from the country. This migration is not unidirectional,
however; statistics for 2008 show that there was a net inflow of medical doctors to Trinidad and
Tobago. There were 501 Trinbagonian doctors resident abroad, and 1180 foreign doctors
registered with the Medical Board of Trinidad and Tobago.
International Factors

The ability of the health system to effectively respond to the changing needs and health profile
of the population has been constrained by the shortage of health personnel and the absence of a
comprehensive approach to HR planning for health that adequately incorporates the
international factors. Some of these international factors include:

• the international composition of the health workforce in Trinidad and Tobago;

• the impact of the international labor market for health on the domestic health labor market;

• the migration of health professionals into and out of Trinidad and Tobago;
• national and regional codes of practice on recruiting of health care workers;

• existing bi-lateral arrangements between Trinidad and other countries for the supply of
health workers;

• the opportunities that exist to strategically pursue internal cooperation arrangements with
other countries;

• the impact of international training institutions on the supply of health care workers to
Trinidad and Tobago;

• the capability and capacity of local training institutions

Health System Labour Pool

National Health Labor Market Inflows: National Health Labor Market Outflows

local and regional and international training institutions Migration

Effective recruitment and retention strategies
Migration
International health labor market
Government’s policies and plans
Foreign policy and international cooperation
Social and economic conditions
Bilateral treaties and arrangements on Recruitment
of health personnel
International health labor market
Ineffective national retention strategies
International recruitment agencies
Foreign policy and international cooperation
Internationally relative social and economic conditions
International and bilateral treaties
Absence of an international Code of Practice on Recruitment
of health personnel

Factors impacting on the national labor market determine the size and composition of the pool
of health care workers for the country. This pool comprises all persons that are willing to work
in the health sector in Trinidad and Tobago and possess the necessary qualifications and means
to do so. It is important to note that the labor pool is not limited to a geographic area or a
specific nationality. The health labor pool will comprise mainly nationals and residents,
however, eligible non-residents and non-nationals would also be a part of that pool.
 The size of the health labor pool is determined by the national health labor market inflows and
outflows, which are themselves influenced by both national and international factors. Where the
labor market inflows exceeds the outflows an increase in the size of the labor pool results, and
when the labor outflows exceed the inflows, the labor pool decreases in size.

The health labor market inflows are in turn influenced by: inward migration; training program
available at local, regional and international training institutions and the throughput of health
graduates; the employment of effective recruitment and retention strategies; bilateral treaties and
arrangements on the recruitment of health workers; government’s policies and plans; and the
country’s foreign policy and international cooperation.

Labor market outflows are influenced by: the level of migration of health workers from the
country; demand and supply conditions in the international labor market; ineffective and poorly
instituted retention strategies; recruitment practices of international recruitment agencies;
superior living standards in countries that are competing for health workers; and foreign policy
and international cooperation; and the absence of an international code of practice on the
recruitment of health workers.
The challenge that nation states face is how to increase its health labor pool given the globalized
nature of human resources for health and the fact that there is an international shortage of health
human resources. Any manpower plan and strategy to increase the size of a country’s health
labor pool must therefore be international in scope
At the national level, these include:

1. The health needs of the population;

2. The health profile of the population;
3. The social determinants of health; and
4. Government’s policies and plans.

At the international level, these include:

1. The country’s commitment to regional and international health goals;
2. The growing numbers of multinational fast food establishments;
3. The multinational tobacco companies;
4. International marketing that induces health impacting behavior;
5. International trade; and
6. US deportation policies with respect to Trinidad and Tobago and the CARICOM region.