Study reveals poor understanding of Human Relations leading to increased job stress in hospitals

In less than a decade the Indian Healthcare Industry has seen unprecedented growth, touted to touch Rs 3,00,000/- crores by 2012¹ and it is expected to continue growing at a faster pace in the next decade. However, given the manpower availability of just 1 doctor for every 10,000 patients², the healthcare reach is far below par when compared to other developing countries. The manpower adequacy in rural India is far worse with a majority of doctors practicing in urban areas. For an industry with unlimited growth potential the biggest hurdle seems to be availability of skilled manpower.

A recent study by PeopleEquity HR consulting, covering several leading hospitals operating in the country, seems to suggest that a renewed focus on human resources development and utilization is critical to sustaining growth of hospitals and the industry as a whole. Aimed at gaining a deeper understanding an industry unique in its demands on staff, the study involved interviewing a cross section of senior  doctors from some of the leading hospitals across the country.

Over 50 doctors from mid to large sized hospitals (bed capacity between 100 – 500) were surveyed through questionnaire based telephonic interviews. Of the sample about 88% of doctors  were seasoned administrators, having played a supervisory role or above for at least 10 years, managing team sizes ranging between 10 to 40 individuals.

The survey focused on  

1. challenges faced by doctors, particularly those involved in administrative roles in hospitals,
2. the most important soft skills needed by them to perform effectively in their administrative capacities; and
3. the role played by focused developmental initiatives in building soft skills in doctors.

The findings seemed to suggest that in most hospitals in India, senior doctors are expected to  take on administrative and supervisory roles as an additional responsibility as they progress in their careers. However most often they are exposed to very little, if any, formal training on administrative or people management skills, forcing them to go through a process of trial and error while shaping themselves into administrators and this often takes its toll on the employee morale and well being of the hospital as a whole.

Interestingly, about 98% of the doctors surveyed have rated communication and teaming skills as being the most important skills in a hospital environment, given the amount of coordination required between diverse sets of professionals to deliver seamless service to patients. Also 58% of them have also stated lack of positive interpersonal relationships as being one of the biggest challenges they face each day in their environments. The respondents noted that issues like inter departmental frictions, cross functional miscommunications routinely resulted in delays and errors affecting the quality of patient care, in some cases with serious consequences. Sadly however interdepartmental communication and teaming are mostly taken for granted and very few hospitals take a concerted effort to address this issue.

Similarly while 86% of the sample believed that some form of managerial training is a must for doctors in administrative roles, only 28% have actually received any such training. This has resulted in a huge amount of stress for doctors who are suddenly required to direct people and outcomes in addition to practicing medicine.  Respondents have also noted that traditional classroom training may not quite be very helpful, but rather a personalized and practical developmental approach is what is needed to help doctors prepare themselves better to handle their new responsibilities. 

Another key issue looming over healthcare institutions is that of rising attrition levels in this industry. According to a news report in The Economic Times⁴, while the IT and ITES sectors saw the highest attrition rate of 23% in the first quarter of 2010-11, healthcare seems to be fast catching up at the number 4 spot. Though the attrition percentage in healthcare is just about half as that of the IT/ ITES industries, given the growth potential and imminent shortage of skilled manpower, the next 5 – 10 years could be very challenging. The industry is already witnessing trends in steep salary hikes with organizations packaging attractive pay and benefits to compete for talent and this is likely to get more aggressive in the coming years.

For management professionals working in the healthcare industry, it is important to acknowledge its uniqueness, the diversity of workforce as well as the criticality of the service offered, frequently handling situations of life and death. What works in other industries might not have much relevance in the typical healthcare set-up, hence Human Resource Development programs have to be well researched and customized to make a real impact.

Training programs on improving communication skills, team bonding, enhancing interpersonal relationships, and time management have come across as the top priority programs for healthcare sector as a whole. A lot of emphasis is certainly needed “Physician Development Program”, akin to Leadership and Mentoring programs practiced in other industries.

External References

1. India Today, April 2010; Cover Story: Healthcare Boom
2. New Delhi, 1^st March 2009; Speech by Her Excellency The President of India, Shrimati PRATIBHA DEVISINGH PATIL, at the concluding function of the Platinum Jubilee Celebrations of the Medical Council of India.
3. The Economic Times, July 19, 2011; IT, ITES sectors witnessing highest attrition rate in India.

Are Employee Performance Management systems actually helping organizations improve performance?

Come April-May it is the season for companies to embark on that dreaded annual rite, the often hated, time-consuming performance review. The process can be bitter for many, as a vast majority or organizations in India evaluate employees based on systems that pit them against their colleagues in the name of healthy competition.

Adopted mostly as a means to motivate employee to their highest levels of performance, rewarding the best and acting tough with the low performers logically seems to be the right way to go. But the practice increasingly is coming under fire as it and hinders positive collaboration and teaming and risk-taking. 

Daniel H. Pink in his paradigm shattering book Drive (The New York Times Top 10 Bestseller) explains that “the secret to high performance and satisfaction in today’s world is the deep human need to direct our own lives to learn and create new things, and to do better by ourselves and the world”. He suggests that it is about time that organizations evolve their people management tools to cater to the new motivational needs of professionals.

In this context the research team at Medallion decided to study the issue of employee performance management through a firsthand interaction with HR practitioners, the implementers of these systems, and line managers and employees, the users of the systems. The aim was to gain a greater understanding of modern trends in performance management, the techniques that work and practices that are questionable and need a serious relook.

The research included a random poll on Linkedin, one of the most trusted professional networking sites, which received over 300 responses as well as in depth discussions with over 20 industry leaders from across multiple industries. Both the surveys elicited responses from HR professionals, non-HR professionals, who have used or have experienced performance management systems in their work environments.  

The Linkedin poll through a single question “What do you hate most about performance management system?” brought out some interesting results. A third of the respondents believed that performance management systems they have encountered actually fail to meet their primary objective of helping and motivating employees improve their performance. The second most commonly cited issue is the inability of the immediate supervisor and/or the HR to take accountability or provide adequate explanation for the ratings given, as one of the participants put it “If you are fortunate, you will have a manager who provides (you) more specific information on how each category relates to your work”

(For the poll results click here)

The comments on poll and the detailed discussions with industry professionals helped us analyze and understand the poll outcomes. Most organizations introduce performance management as a tool to track and thereby encourage higher performance among staff, however more often than not, the emphasis remains on “measuring past performance” than “motivating higher future performance”. One of our survey participants comments that Performance management “is seldom used to improve overall efficiency and motivation levels of employees.  Often mistakes and errors are highlighted without suggesting how to avoid/reduce such mistakes. It has hence become a chore or a routine activity and has lost its purpose.”

A lot of time is spent of grading and rating staff, often pitting team members one against the other, creating a negative impact on teaming and as a result jeopardizing the overall team performance. Often concepts like the forced ranking, bell curve or “bottom 10” push line managers or HR to manipulate rating, which they are then unable to explain or justify to staff.

These issues and many more weaken the credibility of performance management systems among employees and end up encouraging employees to compete with each other when they should be collaborating, putting organizational performance at great risk. Dissatisfaction with ratings invariably results in loss of talent to competitors and some managers compound the problem by pretending that employees are easily replaceable by new hires. So while these techniques may seem to work in short run, the benefits are likely to dissipate over the long term.

Having identified the drawbacks of grading system, is not an easy task to replace the existing system and yet find ways to foster merit-driven cultures that motivate standouts while staying tough on low performers. What then should organizations do to do away with some of the drawbacks, while still retaining the core purpose of performance management?

1. Shift focus from the past to the future – It does not help employees to be only told that they performed poorly, unless it is followed up with specific feedback on what and how they need to improve things.  
2. Make feedback a continuous process – How does it help the employee to be told that he had performed below par on a project 10 months back, when an immediate feedback with action items for improvement would have actually helped him in his subsequent works. Periodic informal feedbacks upon completion of tasks and assignments are a must to ensure effectiveness of the formal cycles..
3. Avoid Surprises – Inefficient managers, in order to avoid the discomfort of giving critical feedback time and again, bottle it all up till the formal appraisals and shock the employee with the ratings. This can be very frustrating for employees, especially to receive a poor rating, while otherwise have been expecting a good rating.
4. Work through positive reinforcements – It is a well accepted theory that positive reinforcements have a far more powerful and lasting impact that negative reinforcements, hence the systems should enable encouragement of even the low performers through positive stokes.
5. Make it less number based – People and their performance are more than what can be signified by a grade or rank. While it is easier to deal with grading scales and rankings, especially while dealing with a larger workforce, it may not be the best approach, as it tends to leave a huge gap on developmental front. A survey participant comments “The challenge for managers is to make the performance management outcomes more actionable rather than just numbers/charts on a page. The critical part of successful performance management is in the coaching & development of employees and that is where the most organizations (fail).”

People Equity helps organizations remodel and upgrade their performance management systems, to cater to the changing needs of current day professionals, through introduction of techniques of goal setting, positive reinforcements, continuous constructive feedback and many more etc.

To, know more or talk to our experts please feel free to email us at reach@people-equity.com 

Culture Shock: Why Cultivating Organizational Culture is Critical for Success

Just like every person is unique, every organization too has its own distinct “personality.” The set of behavioral norms, traditions, styles, and ways of working all create an organization’s culture. Organizational culture is important in promoting a cohesive, supportive, and productive work environment.

                                                  

What is organizational culture?

Generally, organizational culture is described as the combination of norms, values, and behaviors that employees at an organization share. In common terms, it is “the way things work around here.”

Organizations develop a culture based on their size, their history, their mission, their leadership, and other things. An investment banking company may develop a highly rigorous, hierarchical, and aggressive culture due to the nature of its competitive, profit-seeking work. A new art museum might be a much more ‘flat,’ or less hierarchical in terms of authority and supervision, and much more laid-back. Call centers tend to be more individualistic, with each individual focusing on his or her work, while an environmental action organization aiming to clean up a river more team-oriented.

Even seemingly similar institutions may have vastly different cultures. Take two hospitals in India. One is newly built, modern and highly technically advanced, well-resourced, in the middle of one of the fastest growing cities in the world. The other is a 90-year-old health facility in one of the poorest states of India, run by Christian missionaries. Both provide similar healthcare services, but the atmosphere, style, type of employees, and methods will be entirely different. Neither is ‘right’ or ‘wrong,’ both of have just developed unique cultures based on the resources, history, and needs of the community.

Culture and its Role in a Healthy Organization

Organizational culture plays a very important role in building a strong, cohesive, productive institution. Consider the following analogies:

An organization is like a…

Family: Parents signal to their children norms and values. So too does organizational culture inform employees what they value. Rural development organizations may cultivate a sense of service, humility, and giving of owns time and money. Religious groups may have a strong sense of purpose, devotion, and piety in its work. Developing strong organizational values will help ensure employees display those values important to you and your organization.

Nation: Just as a country develops, national holidays, cuisine, anthem, flag, and other customs, an organization develops its own tradition. These serve as important signals to the citizens, or in our case, employees, its own unique aspects and history. This helps people involved feel included, that they belong, and thus loyal to the organization they are serving.

Peer Group: Like a secondary school class, an organization signals to its employees appropriate work behavior. A potential client arriving for a meeting at a bank with a strong sense of professionalism mayimmediately notice that staff are well-dressed, serious, and focused. Similarly, a new teacher arriving for her first day at a school may quickly realize that her fellow colleagues are all extremely engaged and interactive with their classes, sending her the message of how that school expects her to interact with her class as well. Like a peer group, an organization with a clear sense of norms and acceptable behavior will send a straightforward message to new employees and potential clients of “this is who we are.”

In short, organizations with strong organizer cultures:

• Attract more likeminded talent who will thrive at their work. (“This organization may pay less, but their values match with mine, which is important to me”)
• Increase retention because employees feel they are a part of something. (“This place feels like family to me, I could never leave.”)
• Improve their effectiveness, due to a stronger sense of cohesion among employees. (“This project is tough, but I know with my teammates we can accomplish our goal.”)
• Display to their clients, donors, and the community the values it holds important, such as caring, giving back, dedication, or high quality of work. (“I definitely want to make my donation to this organization- they put thoughts into action with how dedicated their employees are!”)
• Endure hardships and ‘bounce back’ from difficult times more effectively, due to higher morale and group cohesion. (“Come on, guys, we know we can do this, let’s get back on our feet!”)

Okay, I get it. Culture is improves morale, productivity, and overall success. How do I develop one?

Developing an organizational culture is not a one-step process. It requires multiple facets to truly create an entire way of thinking and behaving. Some of these can include:

• The highest levels of leadership demonstrating the norms and behaviors desired in employees.
• Including ‘orientation’ components to new employee training, including sharing with them appropriate behavior,
• Developing traditions, such as an annual picnic, prayer each morning, or employee-of-the-month awards, which match the kind of organization you want to be.
• Ensuring policies reflect with values. For example, if your organization provides healthcare services to poor expectant mothers in your community, does your organization have a good maternity leave policy for its employees?
• Check for how well a potential new employee will fit in with the organization. Ask him or her questions about their values and ways of working. Are they a team player? Are they motivated by a strong sense of giving back to the community? Pick questions which make sense given your own organization’s unique culture.

People Equity provides consulting services to organizations and companies seeking to promote organizational culture in their institutions. Email us at reach@people-equity.com for more information.