HUMAN RESOURCES MANAGEMENT AT THE LEVEL OF A SINGLE-SPECIALITY PUBLIC HOSPITAL
VIOLETA FRÂNCU
1, OVIDIU FRÂNCU
21“Lucian Blaga” University of Sibiu, 2Pneumophtsiology Hospital Sibiu
Keywords: human resources,
management, quality medical services
Abstract: Human resources management is essential for increasing the performance of organizations in the public or private medical sector. Improving human resources management at the level of secondary care medical units requires the development of effective strategies from recruitment and selection of personnel from the foreign markets to maintaining the existing staff and their continuous improvement.
Human resources management in the studied organization aims at improving the quality of patient care and thus increasing patients’ satisfaction during hospitalization.
Cuvinte cheie: resurse umane, management, spital, servicii medicale de calitate
Rezumat: Gestiunea resurselor umane reprezintă o condiție esențială pentru creșterea performanțelor unei organizații din sectorul medical public sau privat. Îmbunătățirea managementului resurselor umane la nivelul unei unități medicale din asistența secundară impune dezvoltarea unor strategii eficiente, de la alegerea metodelor de recrutare și selecție a personalului de pe piaţa externă, până la menținerea personalului existent și perfecționarea continuă a acestuia. Managementul resurselor umane în organizația studiată are drept scop îmbunătățirea calității îngrijirii pacienților și implicit creșterea gradului de satisfacție al acestora, pe perioada internării.
1Corresponding author: Violeta Frâncu, Str. Luptei, Nr. 21, 550330, Sibiu, România, E-mail: [email protected], Tel: +40269 212812 Article received on 04.01.2013 and accepted for publication on 18.02.2013
ACTA MEDICA TRANSILVANICA March 2013;2(1):202-206 INTRODUCTION
Human resource is the most important resource within an organization. It is therefore considered, especially in recent years, as a key component to the success of healthcare organizations and the functioning of the health system as a whole.
The importance of human resource management, regarding the increased or decreased level of performance of healthcare organizations has been ignored in the past. Medical sector reforms have focused more on structural changes, on cost control, on the introduction and development of market mechanisms and on increasing patient satisfaction.
In recent years, based on the research in the field and on the experience in other sectors, it has been recognized that promoting a new and progressive human resource management is the best solution to improve the health system performance.
A motivated and well prepared workforce is a key element for providing quality health services that fully meet the expectations of the patients. Human resources management methods used in the health field can be a stimulating factor, or a braking one in achieving the organisation goals. The main objectives of human resources management in the health system aim at mobilizing, motivating and developing staff capacity.
PURPOSE
The purpose of this study is to identify the main strategies of improving human resources management with the final goal to increase the quality of the medical services and implicitly the patients’ satisfaction level.
METHODS
This paper is based on the collection and statistical processing of the data provided by: RUNOS (Romanian acronym for Human Resources, Norming, Organisation, Wages)
financial accounting department and statistical service of the TB Hospital Sibiu, in 2012.
Considering the hospital specific, that is to treat patients with lung diseases, including those with a diagnosis of tuberculosis, there is a constant training concern of all staff regarding the standard rules of hospital hygiene to ensure quality services for the patients admitted and for the safety of the visitors.
The medical staff of the hospital with higher education consists of 12 physicians, namely:
- 4 TB primary physicians with expertise in bronchology;
- 2 TB primary doctors with expertise in general ultrasound;
- 1 TB physician, county coordinator of the National Program for Combating Tuberculosis;
- 1 TB MD, assistant professor at the Faculty of Medicine in Sibiu;
- 1 TB pediatric physician;
- 3 TB primary doctors without other medical competences;
- 1 MD Laboratory;
- 1 specialist laboratory physician.
Within the medical unit, there is other medical staff with higher education, a primary pharmacist who develops the closed circuit pharmacy activity and a chemist within the laboratory of clinical analyses.
The medical staff with secondary education, serving the three wards of the hospital consists of: 47 nurses, of which 29 perform medical care activities of patients in three shifts.
Shift I is represented by the nurses who perform sampling activities, treatment and medical manoeuvres in collaboration with physicians, accompany the patients to the medical examinations and explorations and participate in the medical visit.
Shifts II and III perform supervision and treatment duties, intervene in emergency cases and participate in patient admissions through the emergency service. The rest of the medical staff with secondary education is made up of four medical registrars and a statistician.
In the three wards of the hospital, there also are 18 nurses working in three shifts being responsible for catering, hygiene and helping the admitted patients and 13 domestics working in two shifts being responsible for cleaning the hospital wards. The activity of the medical staff of the hospital wards is developed according to the schedule established by the regulations and laws in force, observing each employee specific job duties detailed in the job description.
PERFORMANCE EVALUATION OF HUMAN RESOURCES MANAGEMENT IN THE TB HOSPITAL OF SIBIU
One of the main objectives of the top management of the medical unit is to improve the quality of human resources.
For this purpose, continuously monitoring of the staff performance is made, comparing with the specific indicators achieved by the hospital, with standard average values at national level. The rules of evaluation of hospital managers, the hospital being under the authority of Sibiu County Council, provide performance indicators assumed by the hospital management through the contract management, indicators with mandatory quarterly reporting. Upon the conclusion of the management contract between the hospital manager and the president of Sibiu County Council, a set of values of these performance indicators have been set, following to achieve an annual evaluation of the performance indicators established by the contract.
Table no. 1. Human resources management indicators Name of the indicator Reporting
schedule The average number of patients discharged
per one physician
Quarterly The average number of visits to a physician
in outpatient
Quarterly The average number of visits to a physician
in the emergency room
Quarterly Proportion of physicians from the total staff Quarterly Proportion of the total medical staff from the
hospital staff
Quarterly Proportion of the medical staff with higher
education from the total staff
Quarterly Below, there are highlighted the human resources indicators achieved by the TB Hospital Sibiu in 2012 (figures no. 1-6).
Figure no. 1. The average number of patients discharged per one physician, 2012
Figure no. 2. The average number of visits to a physician in outpatient, 2012
Figure no. 3. The average number of visits to a physician in the emergency room, 2012
Figure no. 4. Proportion of physicians from the total staff in the year 2012 (total staff – 124, of which physicians – 12)
Figure no. 5. Number of the medical staff from total staff, 2012
Figure no. 6. Share of the medical staff with higher and secondary education of the total staff, 2012
Other human resources and performance indicators registered in the TB Hospital Sibiu are represented in the table and figure below (figure no. 7):
Table no. 2. Number of staff per categories registered in 2012
Total staff
Physicians Other medical staff with
higher education
Medical staff with secondary education
Auxiliary medical
staff
Administrative staff
124 12 2 53 35 22
Figure no. 7. Share of staff categories registered in 2012
HUMAN RESOURCES PLANNING PROCESS Human resource planning is an activity of prime importance to human resource management. The disposal of employees in sufficient numbers and with appropriate training in the place and the right time is vital for the success of the organization.
In the establishment of the organization’s goals, one must also determine what human resources are needed in order to accomplish the objectives, otherwise existing complex interactions between the strategic organisational decision making and human resource planning.
Estimating the number of human resources at hospital level was made based on the Order of the Minister no.
1224/2010 on approving the regulations for hospital care personnel and for the amendment of Public Health Ministerial Order no. 1.778/2006 on the approval of the staffing norms and the Order of the Minister no. 514/20.05.2010 on the approval of the organizational structure of TB Hospital Sibiu.
By the application of this law, at the level of the studied organisation, there is a payroll of 217 positions.
The standardization of the staff positions was based on the norming criteria approved per job positions: medical wards departments, laboratories, medical offices etc.
The norming has been made within the RUNOS department, resulting a number of 217 persons. In establishing the norming criteria, the following have been taken into account:
- category of hospital (TB Hospital Sibiu is a single – speciality hospital);
- number of beds (the medical staff is regulated in terms of the number of beds, i.e. 15 beds at 1 doctor, 1 nurse at 12 beds/shift etc.);
- area of the buildings (the cleaning staff is established depending on the square meters, i.e. 1 cleaning nurse at 275 mp);
- number of rooms (the workers are normally established taking into account the number of rooms, strategic points, such as oxygen station, power station, telephone exchange etc.);
- the number of staff serving meals (the personnel from the kitchen);
- the total number of the payroll (the administrative staff is established according to the number of beds approved in the organizational structure of the hospital).
The number of positions determined by personnel norms is minimally mandatory, the manager of the hospital having the responsibility to fit in the staff costs approved in the revenue and expenses budget.
The payroll developed according to the new legislation was submitted to the Sibiu County Council for approval, by analysing the human resources management indicators:
- the average number of patients discharged on a physician;
- share of physicians of the total staff;
- share of the medical staff of the total staff of the hospital;
- share of the medical staff with higher education of the total medical staff;
- average number of visits per one physician in outpatient;
- average number of visits per one physician in the emergency room.
By analysing these indicators, we found that we have a shortage of staff of 93 people, mainly medical staff (figure no.
8), according to the new regulation and in relation to the normalized staff.
Figure no. 8. The existing number of persons in relation to the number of normalized staff
Although healthcare staff is undersized, the number of consultations both in the emergency room and in the ambulatory is high due to the high addressability of the county population to the medical services provided by our hospital.
By performing an analysis of the factors influencing labour, it was found that due to the migration of health professionals with higher and secondary education in other countries in the Western Europe, where they are better paid and benefit from superior working conditions, the number of persons
participating in competitions occupying the free job positions is becoming smaller.
There were also cases when candidates did not show to the competitions for occupying a medical position due to the unattractive salaries and relatively poor working conditions, and this medical unit awards higher increments than other medical units within the public health sector.
Currently, the TB Hospital Sibiu has a large deficit of qualified medical personnel, especially nurses, deficit which increases every year. For example, only in December 2012, four nurses ceased their activity.
Although medical specialised labour migration increased, in 2009, by the Government Emergency Decision no.
34/2009 on the budget rectification for the year 2009 and on the regulation of some financial measures, employments were limited in the public sector, so a new employment was possible only after the release of seven other positions on the payroll.
In the period following the application of this regulation, it has been registered an annual decrease in the number of employees at the hospital level, as follows (figure no.
9):
Total number of employees at 01.01.2009: 152 Total number of employees at 01.01.2010: 140 Total number of employees at 01.01.2011: 138 Total number of employees at 01.01.2012: 133 Total number of employees at 01.01.2013: 124 Figure no. 9. Hospital employees’ dynamics between 2009 and 2013
One can notice a decrease in the total number of staff on 1 January 2013, compared to the existing number of staff in 2009, with 28 people.
By the Government Decision no. 849/2012 regarding vacancies after January 1, 2012 of medical – sanitary staff, medical and auxiliary personnel in the specialized medical laboratory departments within the health system, the occupation of vacancies was approved after 1 January 2012 on condition not to exceed the personnel expenditures approved in the budget.
The main measure that would limit the departures and would lead to the situation stabilization is the significant increase in wages, which could be achieved by the application of the Law 284/2010 regarding the unitary remuneration of the personnel paid from public funds, followed by the improvement of the working conditions.
CONCLUSIONS
Improving human resources management results in increasing the quality of medical services to beneficiaries. All the efforts of the unit managers to streamline the human resources management and the general management aim mainly at providing patient satisfaction in relation to the care provided.
The dynamics of the quality of the medical services also depends, besides the managerial qualities of the
management team, on the financial and material resources available to the institution.
A rigorous management of human resources requires efficacy in the following management activities:
- the management of the personnel flow relating to recruitment, selection, adaptation to the position, induction and socialization, mentoring, internal promotion, leaving the organization, performance management including performance evaluation, consistent feed-backs regarding the achievement or not of the personal, team or organizational goals, rewards and benefits;
- organizational management, namely: defining the positions, the organizational structure, areas of responsibility, team building or group work and employees’ training;
- communication management, with the employees’
involvement in decision-making activities, developing the upward and downward communication, maintaining procedural fairness and organizational ethics.
All these activities can be successfully accomplished if the management team is able to:
- identify the degree to which the organizational goals are achieved by each employee; to understand and identify the driving internal forces of the employees (volitional, emotional, motivational and their social conditionings that are involved in the activities necessary to achieve the objectives;
- identify the appropriate set of knowledge, skills, aptitudes of the staff, necessary to accomplish the goals and to establish the set of measures for their optimization;
- be able to take advantage of all the qualities of and for the benefit of the organization and to take steps to reduce those behaviours that are at odds with the objectives of the organization.
STRATEGIES TO IMPROVE HUMAN RESOURCES MANAGEMENT
Health human resource management is currently subject to numerous challenges arising from the same type of problems encountered in other health systems around the world, namely: lack of motivation, its inefficient use, low productivity, inadequate training and last but not least, its poor geographical distribution within the healthcare system (from areas overcrowded with medical personnel - e.g. university clinics to the complete lack of medical services in some areas, especially rural).
To meet these challenges and to better meet the health care system requirements, some strategies were proposed to improve human resource management, including the development of the infrastructure management, providing information and conducting studies in human resources, and a better training of the healthcare managers.
In order to continuously improve human resource management in the TB Hospital Sibiu, the following objectives are aimed at:
1. recruitment and selection of well prepared staff;
2. compliance personnel norm according to the Order of the Minister no. 1224/2010 on the approval of the personnel norms for hospital care personnel and for the amendment of the Public Health Ministerial Order no. 1.778/2006 for the approval of personnel regulations, mentioning the number of beds and the number of staff. For example, 1 physician to 15 beds, 1 nurse to 12 beds/shift and 1 nurse to 25 beds/shift;
3. providing stability to the highly skilled staff by awarding incentives in accordance with the law;
4. observing the continuous professional training of the staff;
5. participation in scientific events and continuous training courses of health professionals with higher education;
6. achieving very good hospital indicators so that an advantageous contract should be concluded with the County Health Insurance, this one influencing directly the funds allocated to staff costs. If the total contract value is high, then the fund allocated to staff costs is implicitly high;
7. conducting regular trainings according to a predetermined schedule at the beginning of the year, to focus on issues of hygiene and epidemiology, prevention of nosocomial infections, patient care measures in general and tuberculosis patients in particular.
BIBLIOGRAPHY
1. Analoui F. Strategic Human Resource Management, Thomson Learning, Londra; 2007.
2. Barrystein A, Jick TD, Kanter RM. The Challenge of Organizational Change, Free Press; 2002.
3. Bratton J, Gold J. Human resource management:
Theory and practice, 2nd edition, New Jersey:
Macmillan Press Ltd.; 2000.
4. Currie D. Introducere în managementul resurselor umane, Bucureşti: CODECS; 2009.
5. Ciobanu I. Managementul strategic al resurselor umane, Ed. Polirom Iasi; 2009.
6. Dowling P. Strategic Human Resources Management, PWS Publishing Company, Kent, Massachussets;
2000.
7. Şcoala Naţională de Sănătate Publică şi Management Sanitar – Managementul spitalului – Editura Public HPress Bucureşti; 2006.
