A Study of Human Resource Management Problems in a Healthcare Organization in India

Priscilla Rejison
Doctoral Student, Manipal Globalnxt, Kualalambur Malaysia
Email: [email protected]

Abstract
In healthcare organization, patient outcome, staff satisfaction, cost savings all can be increased with
organization behavior. Success of any healthcare care organization depends on staff’s behavior. The objective
of this case study is to identify the leadership problems and communication problems in a selected healthcare
organization in India to provide quality care to patients. Organization focus is to provide quality care to the
patients. The case study analyses the issues in the organization related to leadership, communication,
motivation, micromanagement and workplace conflict with observation and incorporated the insights from
internal stakeholders. Outcome of this study is recommended best solution for the analyzed problem. To run
the organization effectively and systematically, the results of the study may be beneficial to the organization.

Introduction:
To deliver a quality service to the patients human resource management (HRM) in healthcare is an important
component. HRM plays a major role to achieve the organisational strategic objectives (Qin et al., 2023, p. 1).
Success of any healthcare organisation depends on effective leadership. High performance and job happiness
can be enhanced by leaders who place a priority on employee engagement, set clear expectations and goals,
and increase the productivity. Effective leadership is mainly focusing on the relationships between leadership
values, culture, capabilities and the organizational context” (Al-Sawai, 2013, p. 287). Inter department and
intradepartmental coordination and effective communication is essential in healthcare organisations.
Organisations that place a high priority on open dialogue can enhance patient safety, lower medical errors, and
increase productivity. Skilled communication is essential for nurses in order to maintain effective and sensitive
relationships with patients, carers, and other members of the medical team (Khodadi et al., 2013, p. 28)
Motivation of working activity is much more complex since different people have different needs and desires
which means they are differently motivated (Rosak-Szyrocka, 2015, p. 21). In healthcare organisation
motivation is a key factor to identify the employee performance and job satisfaction. Recognition of their work,
autonomy, and chances for professional growth are some elements that can inspire workers and enhance
organisational performance. Employee motivation has become a determining factor of organizational success
in recent years. Also understanding employee activity goals and motivation of their economic behaviour is
connected to personnel management and significantly influences the enterprise performance (Rosak-Szyrocka,
2015, p. 21) To deliver high-quality patient care teams are essential in healthcare organisation with clear roles
and duties, open communication, and a shared commitment to patient-centred care. In this study states about
micromanagement as inappropriate method of employing excessive clinical supervision and an excessive level
of control denotes that it goes beyond a generally accepted level of input and culminates in negative
consequences (Lee et al., 2023, p. 2). Due to the demanding nature of their jobs, healthcare professionals
experience high levels of stress and burnout. Organizations that prioritize employee well-being through
strategies such as flexible scheduling, emotional support, and stress management resources can help prevent
burnout. Conflicts may exist between physicians, between physicians and staff, and between the staff or the
health care team and the patient or patient’s family (Ramsay, 2001, p. 138).
Key Issues/ Challenges:

1. Lack of effective Leadership

2. Lack of proper Communication
3. Enhance Motivation
4. Micro management in Teamwork
5. Workplace conflict
Theoretical Analysis with Practical Situation

Kotter’s 8 step change model:

1. Establish a sense of urgency: Sense of urgency for the change of leaders and obtain an individual with
good leadership skills.
Example: Change non-efficient leaders and facilitate skill development of leaders by proper training
and development.
2. Create a guiding coalition: Engaging core stake holders
Example: Incorporate managers and supervisors with good leadership skills and capability to make a
change.
Develop a change vision: Create a vision with purpose and documenting the change
Example: Establishing a vision for initiatives like training and documenting the change management
plan.
3. Communicate the vision for buy-in: Address staffs concern and frustrations openly and honestly about
their team lead.
Example: Establishing effective team to help employees for team work and adjustment.
4. Empower the broad-based action: Hire the managers and supervisors with good leadership skills and
provide proper technical training for them.
Example: Allocating job for right person by proper recruitment and selection process helps to allocate
the right employee in right position.
5. Generate short term wins: Creating short term goals for the managers and supervisors and reward the
people who help to achieve goals.
Example: Performance based compensation and benefits for the efforts and improvements in the
productivity of organisation.
6. Never let up: Analyse what is right
Example: What needs improvement in management and set goals to continue the progress.
7. Incorporate change in to the culture: Talk about progress and remind new employees of the ideals and
values of change.

Example: Positive work place culture enhances the employee job satisfaction, reduces the turn over
and increases the productivity.

Contingency Theory: Effective management practices depend on the specific circumstances including
the organization's structure, the nature of tasks, and external environment. This theory brings the
significance of adapting management approaches to fit the unique needs and challenges of each situation.
Organisation can use
the contingent approach as this gives many conclusions regarding identifying key personality factors of
different employees, which shows how to cope with various situations based their leadership style.
Leadership styles are influenced by certain factors. These factors have to be analysed by organisation, to
create the possibility of intervention through work programs and action plans to increase the level of
recognition as a factor of organizational success at work (Shala et al., 2021, p.19).

Elaborating Major Problems with Discussion

Lack of effective leadership:
To run the organization smoothly effective leadership is essential. Any healthcare organisation’s success is
depending on effective leadership. Due to Lack of effective leadership delay in discharge process is happening
in organization. The organization is taking 7 to 8 hrs to complete discharge process. Patients are complaining
about the delay in discharge process and getting irritated. As per NABH standards duration for the completion
of discharge process is 180 min. High performance and job happiness can be enhanced by leaders who place
a priority on employee engagement. Effective leadership mainly focusing on the relationships between
leadership values, culture, capabilities and the organizational context (Al-Sawai, 2013, p. 287). Effective and
constant leadership is important for any organisation to enhance employees’ capabilities. Employee’s
Performance depends on their knowledge and their skills. Organisation has delay in discharge process due to
lack of effective leadership. The time taken to complete discharge process is more and this results in patient
dissatisfaction. Organization needs to focus on this problem because this can be affecting the brand image,
productivity of organization and decreases the patient satisfaction. A leader is effective when he/ she can

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motivate the subordinates to achieve their work-related goals.Interventions related to leadership are important
for improving health care delivery. Healthcare organization leaders have a significant role in achieving
healthcare goals and capable leaders are essential to achieve the service delivery goals. To improve the health
care service delivery in hospital, an integrated leadership approach is critically important while considering
the factors like economic, social, psychological and cultural diversities population (Govender et al., 2018, p.
165). In terms of effectiveness and efficiency in healthcare deliver, leadership approaches are very important
be to run the diverse workforce smoothly. Organisation should have the right kind of leadership to cope up
with complex healthcare environment. Leadership skills are essential for managers to handle the healthcare
organisation problem such as personal conflict, lack of skills and experience of the employees.

Lack of proper communication:

Communication plays a significant role in the healthcare organization. Communication plays a major role to
increase patient satisfaction and for good health outcomes, physician- patient communication is important.
Communication problems like between staffs, between inter and intra department, between physician and
nurse, between patient and healthcare professionals are happening in organisation. All these leads to decrease
in quality of care provided by the organisation. Communication problems with patients leads to the drug
related preventable adverse events, patient safety and life- threatening events (Bartlett et al., 2008, p.1561).
Inter department and intradepartmental coordination and effective communication is essential in healthcare
organisations. High priority on open dialogue can enhance patient safety, lower medical errors, and increase
productivity. Skilled communication is necessary for nurses in order to maintain effective and sensitive
relationships with patients, carers, and other members of the medical team (Khodadi et al., 2013, p. 28).
Ineffective communication affects the patient satisfaction, treatment outcome and resource utilization. Quality
of work life and service quality are depending on effective communication. Also, poor communication leads
to the economic impact on health care organisation.
Evaluation of patient healthcare experience with and with-out communication problem should be conducted
to improve patient safety ((Bartlett et al., 2008, p.1561). If right information is not available from the right
person at right time, the patient safety may be compromised. Improper utilization of resources and wasted cost
are the other problems of improper communication (Vermeir et al., 2015, p. 1262). Poor communication results
in additional work load on the health care professionals. Effective utilization of resources is crucially important
for an organisation to reduce the cost. Healthcare organisation have an economic impact with poor
communication such as reduced hospital admission and unnecessary healthcare expenditures (Vermeir et al.,
2015, p. 1263). The main reason for the improper or lack of communication is inadequate communication
skills of healthcare professionals.

Enhance Motivation:
Motivation of employees are very important. In an organization, if employee feels and complains that their
work is not valued or that they are not getting opportunities to learn and grow, they may become dissatisfied
and seek employment elsewhere. Motivation of working is much more complex, people are differently
motivated because different people have different needs and desires (Rosak-Szyrocka, 2015, p. 21). In
healthcare organisations motivation is a key factor to identify the employee performance and job satisfaction,
recognition of their work, autonomy, and chances for professional growth. Effectiveness of healthcare
organization is linked with employee performance. Employee performance should be improved by the hospital
management and it is essential to reward their efforts. To provide quality service to the patients, these factors
are necessary for the healthcare workers such as clear expectation of their work and work environment, proper
knowledge and skills required for their work, necessary equipment, feedback for the performance and team
leader to motivate them. (Kitsios & Kamariotou, 2021, p. e06857). Enhancing employee motivation helps to
gain patient satisfaction and organization success. Power tool to motivate healthcare workers is the provision
of incentives. This can be used to motivate them and helps to increase their productivity. Their job satisfaction
can be increased by providing reward for their efforts in work and acknowledgement and appreciation of their
work by management, colleagues and patients. (Kitsios & Kamariotou, 2021, p. e06857). Significance of work
motivation is important among medical professionals compared to other professions because they work with
real life patients who needs special care and attention to provide quality service and treatment. The ability to
deal with mental burden of difficult patient management needs more commitment and dedication towards their
work, (Chmielewska et al., 2020, p. 2). Supervision and performance feedback from the management is another
factor for employee motivation. Healthcare workers performance is related with patient satisfaction by the
quality and efficiency of the service. Motivating healthcare workers ensures their commitment towards work.
There is a difference between the motivating factors for men and women in healthcare organisation.

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Motivating women is more difficult process. In healthcare field main factors that can motivates the employees
are safety of their work environment, reward and recognition of their work, possibility of development within
work and provision of incentives (Shah et al., 2016, p. 471).

Micromanagement:

Micromanagement is a supervisory style of excessive supervision. Employees are complaining that team lead
is constantly checking in on a team member's work and provide unnecessary feedback, leading to frustration
and demotivation. In health care organisations, clinical supervision is important to provide high quality
medical care to the patient and patient safety, however excessive supervision can have a negative effect on
organisational culture. To deliver high-quality, excellent patient care, good teams and team work is essential
in healthcare organisation with clear roles and duties, open communication, and a shared commitment to
patient-centred care. Inappropriate method of employing excessive clinical supervision and an excessive level
of control, culminates in negative consequences like reduced productivity and increased turn over. (Lee et al.,
2023, p. 2). Micromanagement can be a threat to the individual growth, autonomy and engagement (Mookerjee
et al., 2022, p.3). Alignment of important work and including them in decision making results in employees
job satisfaction in healthcare workers (Kitsios & Kamariotou, 2021, p. e06857). It is necessary to have a focus
on micromanagement.
Micromanagement is the inappropriate method of applying excessive supervision, excessive control and
attention which may result in negative impact on organisational culture. Micromanagement have negative
impact on patient care and medical training. (Lee et al., 2023, p. 2). Due to the criticality of patient care, the
perception of micromanagement in healthcare profession is controversial. Improper and excess supervision
does not improve the patient safety and outcome (Finn et al., 2018, p.958). Adverse effects of
micromanagement in clinical supervision of trainees’ lead to loss of their physical health and psychological
health, efficiency of patient care and organisation dysfunction ((Lee et al., 2023, p. 12). For a good and positive
work environment the team member should feel a sense of autonomy. Effective clinical supervision is essential
to prevent the micromanagement in organisation. Supervisors should understand the difference between
support and micromanagement and should change gradually to make a productive and positive work
environment for employees.

Work place conflict:

Healthcare professionals experience high levels of stress and burnout due to the nature of their job. The
implementation national accreditation of this hospital made documentation and paperwork manifold. This
results in conflicts between nurses and technicians. Organizations that prioritize employee well-being through
strategies such as flexible scheduling, emotional support, and stress management resources can help prevent
burnout. Healthcare conflict management is time consuming. Conflict may arise between physicians, between
physician and healthcare staffs, between healthcare staffs, between patient and patient family. Conflicts have
a negative effect on productivity as well as patient care. Results in stressful work environment lead to employee
turnover and in efficiency (Ramsay, 2001, p.138). The organisation should ensure the well- being of staffs and
proper management of work place conflicts and avoid violence in workplace environment. Organisation should
establish the professional code of conduct to prevent the work place conflict. Everyone should be treated
equally and respectfully in work place.
Workplace conflict among healthcare professions are very common due to the nature of work. From employee
perspectives the trigger of conflicts is lack of proper communication, unfair criticism, sexual inequality,
unreasonable expectations and personal and professional work interference (Ramsay, 2001, p.139). While
handling a conflict situation the leaders should be calm, controlled, clear and respectful. The common
consequence of work place conflict in health care organisation is insufficient quality of patient care. Provision
of safe patient care not only depends on good clinical knowledge but also on good communication and
collaboration skills (Cullati et al., 2019, p. 49). It is difficulty to choose
the method of managing conflicts. The organisation can provide conflict management training to reduce the
work place conflicts. Each people working in organisation is different, their perception is different hence the
disagreement can occur in any situation. Providing high quality patient care is the primary goal of healthcare
organisation. Resolving conflict in healthcare organisation need the changes in labor organisation and
management. Reviewing existing job description, rights and responsibilities and provide an opportunity to
express employee’s opinion and feelings to maintain a healthy work place environment (Biduchak &
Chornenka, 2022, p. 733).

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Solutions for the Problems
Lack of effective leadership skills
 Hiring employees with good leadership skills
 Provide training to enhance leadership skills
Lack of proper communications
 Provide communication tools to employees
 Develop communication skills and facilitate frequent feedback from employees.
Enhance Motivation
 Recognition for good performance
 Prioritize employee- well being
Micromanagement
 Set clear goals and guidance to follow employees
 Provide real time feedback
Work place conflict
 Identify root cause and encourage open communication
 Implement conflict resolution training
Best Recommendation to be Implemented:
 Training and Development: Lack of effective leadership can be overcome by providing more training
to managers to deal with hospital environment and also encouraging managers to develop leadership
skills and capabilities. Performance management system of managers should be strengthened by
proper assessment of individual performance. Organization can ensure the development of leadership
capabilities by an ongoing process (Govender et al., 2018, p. 159).

 Effective Communication Practices: Need to improve the better communication practices and
communication skills of healthcare professions by training (Tiwary et al., 2019, p. 4). Also, evaluate
the communication skills of healthcare professionals

 Reward and Recognition: It is necessary to enhance the employee motivation by providing reward and
recognition for their work, safe work environment and proper incentives (Shah et al., 2016, p. 471).

 Mutually Agreed Purpose of Clinical Supervision: Micromanagement in healthcare organisation may

lead to negative effect on organisational culture and patient safety. Mutually agreed purpose of clinical
supervision decreases the ambiguity in healthcare professions. (Lee et al., 2023, p. 12).

 Professional Code of Conduct: Conflicts in work place: To prevent this a protocol should be set to
handle the violent work place situation and good professional code of conduct should be maintained.
Organisation should ensure the safety of staffs (Ramsay, 2001, p. 139).

Relevance and Applicability of Proposed Recommendation:

The above-mentioned problems can make a negative impact to the organisational culture, employee
productivity and organisational success. Hence the organisation should focus on above mentioned
recommendations to solve problems and create positive workplace environment to increase productivity of
employee, to deliver high quality health care services for patients and organisation success.

Action Plan:
 Step 1
Develop Smart goals: By setting clear objectives based on organisational strategic goals and available
resources.

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  Step 2
Budgeting and resource allocation: Determine the financial and team members needed to implement
solution.

 Step 3
Identifying and Prioritising task: By identifying important and less important task.

 Step 4
Timeliness: By defining deadlines and milestones.

 Step 5
Implementing actions for existing problems.

 Step 6
Monitoring and reviewing: By tracking changing priorities and deadlines.

Conclusion:
The conclusion derived from the case study analysis is that the organisation has to focus and implement
solution for existing problems for more productivity and positive workplace environment. Good leadership
skills are essential to provide optimum healthcare service to the patients. Leadership approach is critically
important to provide proper healthcare service delivery (Govender et al., 2018, p.165). Constant and effective
leadership is essential to enhance employee capabilities. Performance of employees always depends on their
knowledge and skills. To ensure this the organisation can develop ongoing leadership training to improve the
leadership capabilities.
Clear communication is necessary to provide proper treatment for patients. Poor communication may result in
life- threatening complications (Tiwary et al., 2019, p. 4). Improper communication result in negative outcome
for the organisation such as patient safety compromise, inefficient usage of valuable resources, poor employee
work life balance, patient dissatisfaction and over work load. The information is not properly communicated
between departments or individuals and this may result in medical error. Hence, develop proper
communication practices and skills in healthcare staffs.
To provide efficient and quality treatment to the patients, it is necessary to receive feedback for healthcare
workers performance and to have a superior who motivates them. (Kitsios & Kamariotou, 2021, p. e06857).
Stress and burnout are expressed by staff due to nature of their job which results in decreased productivity,
increased absenteeism, and finally leads to high turnover. Lack of employee motivation in organisation results
in negative impact on organisation’s employee performance and organisation productivity. It is important to
ensure that the employees are motivated to do their work. It is essential to create a positive work environment
by identifying their efforts and reward and recognition for their work.
Micromanagement is a supervisory style which can lead to an impaired trainee autonomy (Mookerjee et al.,
2022, p.7). Team leads who closely monitor and control the work of their team members have a negative
impact on organisational culture and patient safety. This can result in low morale and decreased productivity
among healthcare workers.
Conflicts in healthcare organisation affects the quality of care, which is timely, patient centered and efficient
care (Cullati et al., 2019, p. 48). Conflicts in the healthcare organisation is common due to complex nature of
healthcare work and professional work pressure. Conflicts can create a negative impact on work place
environment. It is necessary to have a focus on conflicts in work place. Try to understand the conflicts, how it
occurs. The organisation should prevent the work place conflicts with proper conflict management strategies
and ensure a positive work place environment for employee wellbeing.

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