jurnal tentang hrd

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INTRODUCTIONConsiderable efforts must be made by health careorganizations in developing jobs, work systems,individual knowledge and skills and interpersonal

skills for employees to deliver safe, affordable, andhigh quality patient care (Goldstein, 2003). The hu-

man factor is central to healthcare yet its proper

management has remained beyond most healthcareorganizations. Patients are demanding and opting, wherethere is a choice, for facilities which are patient friendly.

Despite, all the recent medical advancements, health care

employees remain the most vital link for ensuringhealthcare organisations continue to provide patient fo-

cussed health care.

Traditionally the human resource function has been viewedas primarily administrative, focused on the level of the

individual employee, the individual job and the individualpractice (Becker, Huselid and Ulrich, 2001) with the basicpremise that improvements in the individual employee

would automatically enhance organizational performance.

Both researchers and practitioners began to recognize theimpact of aligning HR practices with the organizational

strategy. HR has emerged as a strategic paradigm in whichindividual HR functions, such as recruitment, selection,training compensation and performance appraisal are

aligned with each other and also with the overall strategy

of the organization.

The importance of various stakeholders for delivering carehas been understood. Patients, the consumers of healthcareare recognised to be a very critical part of the overall

healthcare system. From being mere recipients of

healthcare, today, they are in the forefront voicing theiropinion and perceptions of healthcare and demanding for

better quality care. Patient satisfaction is a critical measureof the quality of healthcare from the patient perception.

Employees, who provide the care, their perception of satis-faction with workplace is measured through employee sat-

isfaction. Employee satisfaction is strongly connected tohuman resource practices in place in the organisation. The

employees perception of the human resource practices intheir organisation is a good measure of the reality of actual

implementation of these human resource practices.

This paper attempts to delve into the three concepts: hu-

man resource practices, employee satisfaction and patientsatisfaction and study the relationship between them par-ticularly whether employees satisfaction mediated the rela-

tionship between employee perception of human resource

practices and patient satisfaction.

LITERATURE REVIEWPatients perception of care they receive at a facilityhas a positive correlation with that of employees of thefacility. Organisations with patients who are likely to rec-

ommend it for care have employees who are likely tomake that same recommendation (Lindberg, Kimerlain,

2008). They also found employees who are proud to workat a place provides excellent care that patients want to

receive. Research conducted by Press Gainey shows astrong link between employee satisfaction and patient

satisfaction and that a failure with one is directly related

to a failure with other (Lebbin, 2007). The patient can tellif the employee likes or hates their job. Patients need toknow we care about them and employees need to know

they are cared about as well (Lathren as told to Larson

1999).

Rondeau and Wagar (2002) found that hospitals that had

adopted more progressive

(human resource management) HRM practices reportedimproved efficiency, better fiscal health, increased flexi-bility and greater reputation than did hospitals without

such practices. Khatri et al (2006) argue that traditional

HRM practices adversely affect medical errors and quality

of care by fomenting a culture of blame and demoralisingthe workforce. Strategic HRM on the other hand improvesorganizational learning and employee morale

HUMAN RESOURCES MANAGEMENTManagement in healthXIX/3/2015; pp. 20-25

20

The purpose of this study is to examine the relationship between human

resource practices and employee satisfaction, and to examine the impact of

both on patient satisfaction.

This study examines the mediating role of employee satisfaction on the

indirect relationship between human resource practices and patient

satisfaction.

Data for this study was collected from employees, and patients of

secondary eye hospitals. Hierarchical regression modelling with a two-step

approach was utilized to empirically test the proposed hypotheses and the

relationships between the constructs. Findings suggest that employees

satisfaction fully mediate the relationship between six human resource

practices and patient satisfaction except employee perception of the HR

practice, team orientation.

This result has significant implication for healthcare as it stronglydemonstrates the vital role a well coordinated healthcare human resource has

in ensuring patient satisfaction.

Keywords: patient satisfaction, human resources, India.

HEALTHCARE HUMAN RESOURCE FORHEALTHCARE HUMAN RESOURCE FORHEALTHCARE HUMAN RESOURCE FOR

ENSURING PATIENT FOCUSED CAREENSURING PATIENT FOCUSED CAREENSURING PATIENT FOCUSED CARE

Prof. Preethi PRADHAN1,

V.R. MURALEEDHARAN1,

T.J. KAMALNABHAN1,

R.D. THULASIRAJ1,

1Chitkara Chandigarh University, India


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that in turn boost quality of care and reduce medical errors.

A study of 61 acute care hospitals in England revealed

strong relationships between HR practices and patient mor-

tality.

The study reported that the extent and sophistication ofperformance appraisal in the hospital were strongly related

to patient mortality but also that there were links with the

sophistication of training for staff and with the percentage

of staff working in teams (West et al, 2006).

The role of HR is critical in building an adaptive, learningculture by creating right values and behaviours in

healthcare workers (Anson 2000, Vestal, Fralicxn andSpreier 1997). Empirical studies examining the relation-

ship between HRM and service quality are also proliferat-

ing (Gelade and Ivery 2003; Manring and Brailsford2001). Manring and Brailsford found that encounters of

patients with employees are an important driver of per-ceived service quality and patient satisfaction.

Khatri 2006 in his study found that in the hospital the role

of the HR function was evolving from a hiring and firingmentality to a hiring, training and development point ofview. Khatri also stated that hospitals need to crystallize

their strategic objectives and identify HR practices that

would support those objectives. He also opined that hospi-tals need to articulate values they want to infuse in em-ployees and formulate HR practices that would achieve

those values in their employees. HR can play a critical role

in service organizations and HR in its new role is more

complex than finance or accounting (Khatri 2003).

The lack of advanced job specific skills in HR profession-als in the healthcare industry is one of the major reasons

for limited change or scope of HR in healthcare organiza-tions (Khatri et al 2006; Lawler and Mohrman 2003).

Healthcare organizations must clearly identify what em-

ployee behaviours improve service encounters with theircustomers and then institute HR practices and systems thatencourage and reinforce behaviours enhancing those en-

counters (Goldstein 2003; West et al.2002).

Grindle 1997 characterized high performing health facili-

ties by A strong sense of mission and sense of commitment to

that mission by the staff.

A relatively high level of prestige and social status

accorded to those who work in the organization.

A culture oriented towards results both individually

and organizationally.

All members of the group are evaluated against perfor-

mance objectives regularly and are expected both bymanagers and by co-workers to pull their weight; and

the organization itself constantly evaluated its perfor-

mance against external objectives and benchmarks.

Lines of feedback from the end users are open and

actively used to improve service delivery.


Research journals have linked poor physician satisfactionto higher rates of patient noncompliance (DiMatteo, Sher-

bourne, Hays, et al. 1993) and patient dissatisfaction (Linn

et al. 1985).

On the one hand, doctors and nurses need motivationalenvironment for working with full involvement, and on theother, patients, rich or poor, crave for a more sympathetic

and friendly treatment, reassuring atmosphere, and a cer-tain degree of compassionate and caring attitude from

health care providers (Shah and Dhar 2007). These authors

Shah and Dhar further state that this is particularly so be-

cause health care is basically a service that has 90 percent

human interface on and across the counter and in the pro-cess of delivery, whereas only 10 per cent is equipment-

supported human interface.

This calls for sound grasp and implementation of HRDprinciples and practices (Drake 2002). The need for syn-

chronising the professional approach of health care provid-ers and the humanitarian interests of the recipients is being

increasingly felt (Shah and Dhar 2007). The literature alsostresses that some autonomy in personnel matters is an

essential facilitative condition for developing the organiza-tional performance culture. A review of high performing

public organizations in developing countries found thatthey enjoyed autonomy to identify positions, advertise for

candidates, establish routines for hiring people to fill posi-tions, promote people on the basis of organizationally de-

fined standards and priorities, and punish those who did

not meet these standards (Grindle 1997).

However, the majority of studies that have explored the

HRMperformance link

(including those in the health sector) do not claim to

demonstrate a causal association

(Guest et al, 2002; West et al, 2002). How and in whatcircumstances HRM is linked to better outcomes has yet to

be elaborated. Research in the field of organisational psy-chology indicates that the link between HRM and perfor-

mance is mediated by employee attitudes and behaviours.That is, HR practices trigger attitudes and responses in

individuals and encourage them to behave in ways that areconsistent with the organisations overall performanceaims (West et al, 2002; Guest et al, 2002; Purcell et al,

2003).

Employee perception is commonly gauged through em-ployee opinion surveys which are widely used for gather-

ing and assimilating HR-related data in companies and

agencies of all sizes across the world (Kraut, 1996).

RESEARCH QUESTIONLiterature had already shown that employee satisfac-tion and patient satisfaction were strongly correlated. Litera-ture also revealed that human resource practices were defi-nitely connected to employee satisfaction. The questions

then remained What is the connection between

21


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(employee satisfaction). It was determined by review ofprevious research that perception of human resource prac-

tices may account for all or some of the relationship be-tween the independent and dependent variables. In addi-

tion, this procedure allowed full and partial mediation tobe tested for this model. These relationships are explained

as the model is explained below.

In an intervening variable model, variable X (human re-source practices) is postulated to exert an effect on an out-

come variable Y (patient satisfaction) through one or moreintervening variables, sometimes called mediators

employee satisfaction (Hayes, 2009). Although there aremany methods available for testing hypotheses about in-

tervening variable effects, the most widely-used method is

the causal steps approach popularized by Baron and Ken-ny (1986). This approach requires the researcher to esti-

mate each of the paths in the model and then ascertainwhether a variable functions as a mediator by seeing if

certain statistical criteria are met (Hayes, 2009). To per-form mediated hierarchical regression, each dependent

variable underwent a series of steps to determine if media-tion existed and if that mediation was partial or full. Re-

search by Hair et al. (1984), Bates and Khasawneh (2005),

and Baron and Kenny (1986) were applied.

In order to do this, the hospital was taken as the sampling

unit. The average score of the

employees within the hospital was taken for each factor in

employee satisfaction and human resource practice. The

number of employees in each hospital varied from 9 - 12.For the patients also the average score of the patients was

taken for each factor of patient satisfaction.

The number of patients varied from 9-11.

Sobel test was also carried out to test the indirect effect ofmediation. Sobel estimates the total, direct, and indirecteffects of causal variable human resource practices on

outcome variable, patient satisfaction through a proposed

mediator variable employee satisfaction. It also calculatesthe Sobel test for the indirect effect as well as a percentile-

based bootstrap confidence interval for estimating the in-

direct effect, as described in Preacher and Hayes (2004).Result of testing the mediation of employee satisfaction on

the relationship between

employee perception of human resource practices and pa-tient satisfaction.

The test of mediation was done as mentioned earlier using

the steps advised by Baron and Kenny.

Medation Analysis

Employee satisfaction mediates the relationship betweenemployee perception of HR practices and patient satisfac-

tion for all factors of HR practices except employee per-ception of the HR practice, team orientation. This has im-

mense significance as a key area to concentrate on in the

eye hospital sector.

human resource practices and patient satisfaction? How does

employee satisfaction fit in this relationship? Is it a mediatingone? To answer these questions a research study was

planned.

The objective of the study was to test the mediation effectof employee satisfaction on employee perception of human

resource practices and patient satisfaction in a cross sec-

tional sample of Indian eye hospitals.

This study focused on finding the relationship between

human resource practices and patient satisfaction and theinfluence of employee satisfaction on this relationship.

Specifically it sought to test whether employee satisfactionmediates the relationship between employee perception of

human resource practices and patient satisfaction.

RESEARCH DESIGNA cross-sectional survey of eye hospital staff namelyophthalmologists, ophthalmic assistants, and support staff

using a self-administered questionnaire was carried out inIndia to measure employee satisfaction as well as employ-ee perception of human resource practices. Patient satisfac-

tion was also measured by a questionnaire from the cata-

ract patients when they had been discharged from the hos-pital. The study was carried out in 33 secondary eye hos-

pitals located within India.

Reliable and validated questionnaire was used.

MEDIATION ANALYSISMediation analysis was used to test the mediationeffect of employee satisfaction in

determining the relation between human resource practices

and patient satisfaction. The

history of mediation analysis is quite long and significantin the area of behavioral research (Alwin and Hauser,1975; West and Wicklund, 1980). For this study, media-

tion analysis followed the guidelines proposed by the rele-

vant literature in this area (Baron and Kenny, 1986;

MacKinnon, Warsi, and Dwyer, 1995). With the aim ofplacing employee satisfaction as the mediator variable, thefollowing two conditions were taken into account:

(i) Whether the direct path from the antecedent (human

resource practices) to the consequents (patient satisfaction)were greater than the paths under the condition of media-

tion

(ii) Whether the direct path from the predictors to the crite-

ria under the mediated condition was significant?

Mediated regression was selected in particular because it

was hypothesized that the

relationship between the independent (human resource

practices) and dependent (patient satisfaction) variables inthis study may be mediated by a third variable


22


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The result of Sobel test offered further evidence for the full

mediating effect of employee satisfaction to the employeeperception of HR practices patient satisfaction association

for six factors of employee perception of HR practices.However the result of the Sobel test established there was

no mediating effect of employee satisfaction to the con-genial working environment patient satisfaction associa-

tion.

Discussion of results of employee satisfaction mediating

the relationship between

employee perception of HR practices and patient satis-

faction

The above results highlight that employee satisfaction fully

mediates the relationship between HR practices such ascareer development practices, supervisory consideration,

pay and benefits, leadership management, job design andstaffing and patient satisfaction. The results also bring out

that team orientation is not mediated by employee satisfac-tion to influence patient satisfaction. Conversely, it means

that team orientation will directly influence patient satis-

faction.

When one reflects on this result, it is apparent that the six

HR practices considered: career development practices,supervisory consideration, pay and benefits, leadership

management, job design and staffing all relate to aspectswhich the patient cannot visibly experience or understand.

Whereas team orientation is an HR practice which

even the patients can make a judgement on based on theirindividual experience of interaction with the different staff

as well as experience of the coordination between them.

The communication between different health care profes-sionals providing care to the patients is one that patientscan interpret to be good and well-co-ordinated or with ab-

sence of coordination between staff.

This is a very significant finding as it brings to the fore-front the high value for staff in healthcare to work togethercollaboratively as a team to provide better patient care.

The six other factors are related directly to the employees

well being and these six HR practices are seen to impactthe employees like behaviour of their supervisors and lead-ership, factors related to fairness in the policies like their

entry into the system, pay and benefits, and their involve-

ment in job design as well their growth within the organi-sation. It is not possible for patients to gauge during the

patient care experience how the employees perceive thesesix factors. Whether there is a team orientation is some-

thing that even the patients can perceive as they interactwith different staff for their patient care. This result is

aligned to the WHO report 2006 Working Together for

Health. Two of the four recommendations in the reportfor bringing out the best in the existing health workforcerelate to ensuring they have a congenial work environ-

ment. The point related to critical support systems and

ensure lifelong learning are related to making their work

environment more conducive to do work. Research hasshown that supportive aspects of the work environmenthave a positive influence on job satisfaction (Boles and

Babin, 1996).


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Mediation Analysis

Independent Variables MediatorDependent

Variables

of the

Mediat-

ed Model

Sobel

TestResult

Career Development

Employee

Satisfac-

tion

Patient Sat-

isfaction

-0.237 3.150**Supported

(Full Mediation)

Leadership Practices -0.344 3.474**Supported

(Full Mediation)

Staffing 0.043 2.893**Supported

(Full Mediation)

Job Design -0.005 2.970**Supported

(Full Mediation)

Supervisory Considera-tion

0.264 2.053** Supported(Full Mediation)

Pay and Benefits 0.139 2.372*Partially Supported

(Partial Mediation)

Team orientation 0.7930.037

(NS)

Not Supported

(No Mediation)

**p


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seen as the means for ensuring that patients receive quality

care (Hornblow, 1997). Such a mindset sets in motion animportant organizational and psychological dynamic that

inhibits system change and creates a dysfunctional rela-

tionship between management and clinical staff.Partly as a result of strong professional cultures, the health

care industry has lagged behind other industries in man-agement innovations. In the last ten to fifteen years, pro-

gressive human resource practices have become common-place in several industries. However, because of the man-

agement deficit or vacuum, there has been little progressmade in implementing strategic human resource manage-

ment practices in health care organizations.

RECOMMENDATION

As an outcome of the findings from this study it isimperative that one steps back and analyses how key HRpractice like teamwork which can influence patient satis-

faction so much can be fostered. Teamwork can be

strengthened first by changing the curriculum to incorpo-rate principles of teamwork into the curriculum.

A study of the Veterans Administration hospitals found

that the teamwork culture was positively associated with

inpatient satisfaction and the rule-based, bureaucratic cul-ture was negatively associated with it. The positive rela-

tionship between teamwork and inpatient satisfaction wasmediated by more effective coordination and greater cohe-

sion among employees working towards the same goal.Similarly, a study of 283 Canadian nursing homes found

that nursing homes that had implemented moreprogressive HR practices, and that reported a workplace

climate that strongly valued employee participation andaccountability, performed better on a number of clinical

outcomes. (Rondeau and Wagar, 2001).

Recent research from Press Gainey which provides healthcare satisfaction measurement and improvement servicesshows that the area of work experience with which health

care employees are most dissatisfied is participation. Par-ticipation is defined by employees as feelings of connectiv-ity to the decision making process and the solicitation of

their opinion before the changes are made. Involving em-ployees in service and quality improvement is an excellent

way to improve patient and employee satisfaction(Lindberg, Kimerlain, 2008). This again highlighted the

important role that team orientation can play.

Khatri opined that one of the reasons for the slow develop-ment of HR in healthcare organisations maybe the clinical

culture prevalent. While clinical culture enhances patientcare by enhancing the commitment of health professional,

an unintended but powerful effect of strong clinical cultureis the perpetuation of the old industrial model resulting in

management deficit in the health care organizations.

Khatri 2006 has observed that the management approach

affects HR management practices. In the second level, HR

management practices affect employee behaviors that inturn determine clinical outcomes. The basic management

philosophy imposing control on employees or elicitingcommitment from them affects clinical outcomes signifi-

cantly. It does so in two ways: by affecting the detectionand reporting of errors (the learning effect); and by affect-

ing the motivation, satisfaction, morale, and effort put

forth by employees (the motivational effect). In the past,health care organizations lacked management practices andsystems and relied predominantly on the clinical culture

for delivering patient care. Most of them are moving to-ward more standardization, systematization, and formaliza-

tion in their management systems and processes. In otherwords, they are making a transition from a craft system to

the industrial model.

A professional culture enables sustained action by provid-ing members with a similarity of approach, outlook, and

priorities. Yet these shared values, norms, and assumptionsin health care organizations have blinded health care pro-

fessionals to vital management issues affecting their per-formance because they lie outside the bounds of their per-

ceptions (Weick and Sutcliffe 2003). Great doctors and

nurses, not great organization or management, have been

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