Training: A Vital Aspect of HR Management

Training, Development and Education is the fourth key area of human resource management.

It is unfair to blame an under-performing employee if he/she has not been trained. Health workers need continuous training to keep them abreast of current trends in patient management. A properly trained and competent workforce is essentially to any successful healthcare system. Training, development and education is also an important motivational factor for employees.

Training is usually short-term and practical-oriented. It helps workers adapt to their present job needs e.g. customer care training, training workers to use new equipment. e.t.c

Training may include in-house seminars, lectures or conferences. Training could also be done outside the hospital e.g. short courses of 1 week, 3 months e.t.c. or even longer courses of 12 months, 24 months etc. Training could be “on-the-job” training or “off-the-job” training.

Development on the other hand, is more long term in approach. Its emphasis is on continuous learning and growth. Development is more broad –based and prepares employees for the future. It ensures rapid career growth. For example, management training for medical staff prepares employees for future management positions.

Education is training that is more specific to the employees’ chosen profession. It keeps employees informed of recent trends and practices. It prevents employees from being obsolete. For example, the treatment of malaria has evolved from the use of chloroquine monotheraphy to ACT combination therapy. Medical workers therefore cannot rely entirely on the knowledge received from school; there has to be continuous medical education.

Education, training and development must have a focus for it to be effective. Effective training must also be planned and budgeted for. It is necessary to develop a short, medium and long-term training schedule for employees. This must also include a financial plan that should be strictly adhered to. Unplanned and haphazard training could become counter-productive and ultimately expensive.

Lack of training means:

·        Your hospital cannot grow beyond its present level.

·        Your hospital cannot compete with others.

·        Your hospital cannot adapt to the constantly changing world of medical science.

·        Your hospital is not a learning Organization.

In training employees, it is imperative to reconcile the needs of the hospital with the needs of the individual. If the employee does not see the relevance of a particular training, then training will lead to wastage of hospital resources.

Performance appraisal helps in assessing employee performance and creates awareness of opportunities for training and development.

Finally, employees who require training exhibit certain signs and symptoms. It is important that they are identified promptly to prevent shoddy performance.

See you soon….

How to Evaluate Employee Performance in a Small/Medium Sized Hospital

Small and medium scale enterprises are the bedrock of any vibrant economy. In 2005, the Central Bank of Nigeria classified industries thus:

Enterprise	No of Employees	Asset Base (Naira)
Micro	</= 10	< 1.5 Million
Small Scale	11-100	</= 50 Million
Medium Scale	101-300	50-200 Million
Large	>300	>200 Million

Using the classification above, many hospitals in Nigeria and the developing world can be categorized as small or medium scale hospitals. Such hospitals usually don’t have a formal method of evaluating employees’ performance neither do they have a structure in place to do that.

It must be noted however that many hospital owners do not evaluate employee performance not because they don’t want to but because they don’t know how to.

This post will teach you how to evaluate your employees using simple criteria. After studying the example below, you can develop criteria that will fit your hospital and expectations.

The first step to performance evaluation is answering the following questions:

What will I evaluate?
The three most important criteria to evaluate include:
• Personal Qualities
• Professional Qualities
• On-the-Job Qualities

Who will do the evaluation?
Evaluation can be conducted by employee (self rating), peers, immediate supervisor, and management. The use of multiple evaluations (i.e. combination of all four) helps to reduce problems of validity and reliability. The ratings from each level of evaluation can be averaged to get the employees final score.

How will it be done?
Methods to use may include written tests, rating system, oral interviews or a combination of all three.

How often will it be done?
Depending on your peculiar needs, performance evaluation may occur biannually, annually, biennially or every 3 years.

What will I do with the outcome?
This may include setting performance improvement goals for employees as well as plans of action to implement them.

What are the consequences for employees who do not meet standards?
Consequences may include placing employees on probation (then reviewing employee performance at the end of the probationary period), training and development, transfer of employee to another unit, demotion of employee or outright termination of appointments for those who refuse to improve.

Finally, you must discuss areas of the performance review including the employee's feedback. Then record the evaluation in the personnel files.

Let’s see how the actual performance evaluation is done using the Rating Method. The criteria I will use are
• Personal Qualities
• Professional Qualities
• On-the-Job Qualities

These are further divided into several sub-criteria and rated on a scale of 1-5 as indicated below.
• 5 = Consistently exceeds expectations
• 4 = Frequently exceeds expectations
• 3 = Achieves/meets expectations
• 2 = Inconsistently meets expectations
• 1 = Performs below expectations

Example
John Ebele is a laboratory scientist working at Demy Hospital. He is due for his annual performance appraisal and the owner of the hospital, Dr. Yahaya rates him on the three criteria of personal qualities, professional qualities and on-the-job qualities as shown below. He scores 10.7 out of a possible 15 points.

NAME	CRITERIA	RATING (1-5)	AVERAGE RATING (max score:5)	TOTAL SCORE(15)
JOHN EBELE	PERSONAL QUALITIES ·        Integrity ·        Diversity ·        Initiative ·        Innovation ·        Respect ·        Growth	·        3 ·        4 ·        5 ·        5 ·        1 ·        4	3.7	10.7
	PROFESSIONAL QUALITIES ·        Interpersonal skills ·        Quality of work ·        Stewardship ·        Reliability ·        Productivity ·        Knowledge	·        2 ·        4 ·        3 ·        3 ·        4 ·        3	3.2
	ON-THE-JOB QUALITIES ·        Duties and Responsibilities ·        Health and Safety ·        Professionalism ·        Efficiency and Effectiveness ·        Continuous Development	·        3 ·        4 ·        4 ·        4 ·        4	3.8

The next step after the evaluation will be to review the rating with the employee.

Using our example, Dr Yahaya will discuss with Mr. Ebele on areas that need improvement. For example, he got a score of 1 in the respect criteria. This obviously has to be improved. The steps to be taken for improvement are discussed and a time frame for the next evaluation is agreed upon by both Dr Yahaya and Mr. Ebele. He may also require training to boost his performance in other areas. This should be determined and implemented as well.

Regular performance evaluation is a must for every serious minded hospital. It is important that you have a thorough knowledge of how to perform evaluations.Kindly go through the example again so you will fully grasp the steps involved.

 I will write on another aspect of HR management in a subsequent post.

See you soon….

7 Reasons Why You Must Evaluate Employee Performance

Evaluating employee performance is the assessment of the employee’s effectiveness in doing the job. Though seemingly tedious, it is a task that you must undertake at regular intervals.

Here are some reasons why you must do a regular performance evaluation or appraisal:

Reason #1: To recognize the training and development needs of employees

Performance appraisal helps you to identify the shortcomings of employees and to recognize the need for their training and development. This knowledge will help you plan development and training programs that will be beneficial to your employees. Without regular appraisals, training will be largely haphazard and add little or no value to your employees.

Reason #2: To determine the extent to which employees contribute to    organizational success

When employees do not reach the standards of performance set, organizational success cannot be achieved. Employee evaluation therefore helps you determine the extent to which each employee meets standards and how much they contribute to your success.

Reason #3: To motivate employees to perform better

When an employee is evaluated and commended for doing well, he/she is motivated to perform better. Those rated poorly during evaluation are also inspired to improve their performance before the next evaluation.

Reason #4: To keep employees on their toes

Another reason why you must evaluate employees’ performance is to keep them on their toes. When employees know that they will be appraised and that their promotion depends on the outcome of their appraisal, they become more committed to their duty.

Reason #5: To develop acceptable behavior in employees

Regular appraisals are one way of identifying deviant behavior. Appraisals help you to not only identify deviant behavior but also to correct such behavior. Thus, employees develop patterns of behavior that are acceptable to your organization.

Reason #6: To foster employee-management relationship

Appraisals usually occur in the form of an interaction between an employee and management (management-oriented appraisal), an employee and supervisor (supervisor-oriented appraisal) or an employee and co-worker (peer-oriented appraisal). The aim of these interactions is to determine performance. Good interactions however, have an additional benefit. They help you to know who the employee really is, understand his/her needs, shortcomings and strengths; thus creating a relationship between you and employees. Regular appraisals strengthen this relationship and foster unity in the workplace.

Reason #7: To identify employees that deserves promotion

Employees deserve to move from one level to another as they progress in their careers. The tendency is to promote employees every 3 years or so. But promoting a redundant employee just because he/she has worked for a certain period of time may be counterproductive. Appraisals will help you identify employees that actually deserve promotion and reduce the chances of promoting redundant employees.

From the reasons above, it is clear that you must regularly evaluate the performance of your employees to achieve business success.

When evaluating performance, the three most important criteria to use are:

• ·        Personal Qualities
• ·        Professional Qualities
• ·        On-the-Job Qualities

In my next post, I will show you how to carry outperformance appraisal using these criteria.

See you soon…..

Do You Praise Good Efforts?

My Dad was a no-nonsense Army Officer who ruled his household with a firm hand. He was not abusive but expected high standards from all his children.  Despite his instructions and acts of discipline, one thing I loved about my Dad was the fact that he always rewarded good behavior. The highlights of my childhood were those times when he praised me for excelling in school or for doing a particular task well. His words of praise made me forget all the pain of discipline and motivated me to always strive to do better.

I have since discovered that praise is a critical but often overlooked aspect of motivation. Praise as a motivator comes under the third aspect of HR management - performance appraisal and motivation.

 Performance appraisal involves the assessment of employees to determine their current knowledge, attitude and skills. Assessing employee performance will also provide awareness of opportunities for training and development. Evaluations lead to efforts to improve performance problems.

Motivation describes the reasons why your employees do the things they do or refrain from doing what they ought to do. The motivation of your employees is a major factor that determines the quality and consistency of service delivery to your patients. A poorly motivated employee may not give his/her best to the patients and this may result in the loss of lives.  

There are many theories of motivation in the literature but without praise or commendation, these theories are largely useless.

Praise as a motivator

Praise is an expression of admiration or approval for somebody's achievements or for something's good qualities. We often forget to praise good efforts but always remember to blame bad mistakes. Praise is a potent but often overlooked motivator. A hospital employee who is well paid but seldom appreciated will not remain motivated for long. A combination of good salaries and merited praise is necessary to sustain motivation. You should realize that you have an obligation to not just to pay salaries but also to commend the positive efforts of their employees. Doing this will produce several effects.

Effects of Praise

Courtesy: Ohi Ohioze

Adapted from: Hospital Management Made Easy © 2012HospitalmgtNigeria

Praise creates a feeling of importance in employees. When employees feel important, they develop a positive attitude. This positive attitude is reflected in their behavior towards the job, the patients, and fellow colleagues and even towards management. A positively minded employee will be willing to do more work. More work coupled with efficiency and effectiveness increases productivity and profit. The praise cycle begins again when management commends the increased productivity (see the diagram above).

Psychologists claim that for praise to be effective, it should be done in public. Praise must also be earned. It is important that you do not make praise continuous but occasional so that its effect is not lost. Another thing worthy of note is that praise should be timely. It should be done as and when due (not many days after the incidence).

In addition, praise is better done informally because calling formal meetings where you heap praises on a particular employee could be counter-productive (the exception being during annual award ceremonies for diligent employees). 

Praise should be based on specific things and results. You should be consistent in praise and recognition. This means that you should avoid the mistake of praising an employee for something and not praising another for the same thing.

In contrast, blame is the direct opposite of praise. It should always be done privately so as not to dampen employee morale. As with praise, blame should be timely. You must immediately recognize substandard work and correct it before the end of the day. This is to ensure that employees can connect the blame received with the work done.

Organizations with a culture of praise and commendation usually place emphasis on finding loopholes in the system (that leads to errors and mistakes) rather than blaming the individual worker. Hence, to enhance a culture of reporting errors and learning from mistakes, individuals should seldom be blamed. Your emphasis should always be to help the worker improve rather than make him/her feel small.

Remember, you can get the best out of your employees by imbibing a culture of praise in your hospital..

See you soon….

7 Staffing Mistakes You Should Avoid

Most people probably think of staffing as mere interviewing of applicants. However, staffing is much more than job interviews. It begins with recruitment, continues with selection, includes placement and ends with induction. A mistake at any stage of the process could result in filling your hospital with misfits. 

The foundation for a successful staffing must be laid during manpower planning where the job description and specification is decided. The job description highlights the work activities to be carried out by the position advertised while the job specification describes the qualifications, skills and characteristics that that position requires.

Staffing does not just involve filling the positions provided for by the manpower plan but goes beyond that to ensure that the positions remain filled. Failure to successfully employ the right personnel could be expensive to the organization.

Hence, you should avoid these staffing mistakes. But first, let’s get a basic understanding of the different stages of the staffing process.

Recruitment is informing job seekers that vacancies exist in the hospital as well as receiving their applications. It involves attracting a pool of potential applicants that the hospital can choose from. Internal recruitment is the filling of vacancies using in-house employees. External recruiting is the filling of vacancies with candidates outside the hospital.

Selection is the sorting out of application forms, short listing candidates and the actual interview of suitably qualified candidates. During interviews, you should endeavor to strike a balance between certificate and competence, charisma and character, expertise and experience, skill and stamina, independence and interdependence (teamwork), and finally imitation and innovation.

Placement or employment is the appointment of the employee into various positions. Medical and physical evaluation of the employee is also done at this stage.

Induction is the series of activities aimed at integrating the new employee into the hospital. This is the period when new employees are taught about the hospital’s vision and core values as well as their role in achieving it. It actually begins at recruitment when key information about the organization is passed across to prospective employees through adverts. It continues all through to the final induction stage. The aim of induction is to help the employee adjust to the new job with its policies, procedures, environment and colleagues.

Mistake #1

Poorly Designed Job Description and Specification: This will attract the wrong candidates and lead to employing the wrong people. To avoid this mistake, the work done during the manpower planning phase of human resource management must be thorough and comprehensive.

Mistake #2

Halo Effect: This is a common mistake whereby the interviewer likes the candidate because (s)he possesses a certain trait that appeals to the interviewer. This perception distorts the interviewer’s perception of other traits and reduces objectivity. For example, the interviewer may select a less qualified candidate because they share similar hobbies or attended same school.

How to Manage Hospital Employees

Have you ever watched the Nigerian Medical Sitcom titled “Clinic Matters”? If you have, I’m sure you will remember Nurses Titi and Abigail. They are two troublesome nurses who are always trying to outdo each other. Their frequent bickering sometimes affects the quality of service received by their patients. And then there is Nurse Theresa who is the umpire and who tries hard to keep the peace of the clinic. Add Biliki the Ward Attendant to the mix and the Doctor has a turbulent situation on his hands.




In reality, the sitcom is not much different from many everyday clinics. Sometimes, despite your best efforts, you still fall short of achieving the goals of your hospital. This is because human beings are unpredictable and managing them is one of the most difficult jobs on earth.

Right from the start, it is worthwhile to note the following:
• No two individuals are alike in their behavior, attitude, skill, discipline, work ethics etc.
• Every employee comes into your Organization with his/her skills and personal problems. You get the good and the bad.

Most large hospitals already have a functional Human Resource (HR) department. However, smaller hospitals (like the ones in most developing countries) do not have a clearly defined HR unit. Either way, you may have to do some or most of the HR functions yourself, so it is necessary for you to know a little bit of how HR works.

The difficulties involved in dealing with humans have already been highlighted. Managing them is a skill that every hospital manager/hospital entrepreneur should possess. The efficient and effective management of people will ensure organizational goals are met. Management involves getting things done through people. People however are the most complex elements in any organization. How do you then manage your staff to achieve your Organizational goals?

There are 5 key areas of human resources management:

• Manpower planning
• Staffing
• Performance and Motivation
• Training, Development and Education
• Discipline and Grievance

In this post, I will write briefly on manpower planning.

 Manpower Planning
Managing your employees and getting the best from them actually begins with manpower planning. Failing to plan is actually planning to fail. Before you employ the ‘Nurse Titis’ and ‘Attendant Bilikis’, it is wise to determine your staff needs well in advance. Manpower planning should be a carefully thought-out line of action rather than a knee-jerk reaction.

You must get the right balance between staff levels and workload. Over-staffing will lead to lose of man-hours, laziness, reduced productivity, and reduced profit. Conversely, under-staffing will lead to work exhaustion, stress, frequent illnesses, bad attitude, frequent mistakes, reduced productivity, and reduced profit. The right balance is needed to succeed.

In planning for your workforce, the following steps will guide you.
 Determine the activities of your organization
 Group activities into roles and positions
 Determine job description(activities) and job specification(qualifications & skills)
 Decide on remuneration you can afford
 Determine the number of people to fill each position
 Draw organizational chart
 Document job specification & description

Having followed the steps above, you can then move on to the next area of human resource management- Staffing. I will discuss staffing in a future post. Keep visiting this blog in this month of July to learn more about human resource management.

See you soon…

How to Determine the Optimal Target Manpower for Your Hospital

There are many methods used by Operation Management Experts to determine the number of employees needed by an organization. The two common ones are the Full Time Equivalent (FTE) method and the Takt time Method. In my Training Sessions with Hospital Entrepreneurs, Doctors and Managers, I tend to favor the Takt time method. Though slightly more technical, it can be used in combination with deductive reasoning. This makes it suitable for use in the hospital setting. Physicians are generally not fans of calculations, so I will explain it as clearly as I can.

 Firstly, I will define the following terms-Labor Content, Demand, Takt Time and Target Manpower.

Labor content is the total amount of time that a flow unit (e.g. a patient) spends within a process. It is determined by calculating the sum of the individual time each resource/employee spent with the patient. For example, if a patient spends 5 mins at registration, 30 mins at consultation and 30 mins at the pharmacy before leaving the hospital, the labor content will be (5 mins+30 mins+30 mins) 65 mins.

The demand is the total number of flow units per given period. E.g. we can speak of a demand of 10 patients/hour.

The takt time defines the ideal amount of time that a flow unit should spend with each resource/employee/work station. Takt is a German word that means “the beat of the music”. Literally, it signifies that workers should dance to the beat of the music of demand. That is, if the demand increases, the pace of the work should also increase. If the demand reduces, then the work pace should equally drop. The formula for Takt time is:

Takt Time= 1/Demand

           Or

Takt Time/hour= 60 mins/Demand per hour

 The target manpower is the approximate number of resources you need to employ in order to achieve the takt time. It is calculated as follows:

Target Manpower = Labor Content/Takt time

For better understanding, let’s consider the problem below:

Dr. Johnson is a Hospital Entrepreneur who owns a modest hospital, New-life Hospital (a general practice facility) located in a small town. He runs consultation services Mon-Fri (8 am-4 pm) and also admits the occasional patient into the ward. Thus the hospital is open 24 hours a day, 365 days a year.

He has on his payroll, 1 resident doctor, 9 nurses who rotate on an 8 hourly basis. (3 nurses on morning shift, 2 on afternoon, and 2 on night duty and 2 off duty). He also employs 1 pharmacist-technician, 1 laboratory scientist, and 1 receptionist/records staff to help him during clinic hours (8 am-4 pm). His total number of employees is 13.

His workers are idle most of the time except on Wednesdays (ANC days) when the demand is overwhelming (40 patients on average). During ANC days, the workers usually work overtime. The ANC process is as follows: 5 mins (registration), 10 mins (vital signs), 15 mins (doctor) 30 mins (laboratory) and 20 mins (pharmacy).

On other days, New-life hospital attends to an average of 16 patients in the Out-Patient Clinic.

What should be his optimal target manpower for Non-ANC days and for ANC days? (Assume a labor content of 40mins during non-ANC days.)

Solution:-

To calculate the target manpower for non-ANC days ,

Labor content =40 mins (given above)

Demand/hour = 16 patients/8 hours

                         = 2 patients/hour

 (Note that there are 8 working hours every clinic day and a total of 16 patients every clinic day)

Takt Time/hour = 60/Demand per hour

= 60/2= 30 mins (i.e. a patient should spend 30 minutes at each work station)

Target Manpower = Labor Content/Takt Time

                                 =40/30= 1.3   (approx. 2 workers)

N.B: In practice, a patient will not spend an equal amount of time at each work station. The 30 minutes above is therefore a theoretical guide that gives the maximum duration a patient should spend with each resource at New-Life Hospital.

Let’s calculate these same values for ANC days

Labor Content = 5 mins+10 mins+15 mins+30 mins+20 mins

                          = 80 minutes

Demand/hour = 40/8

                          = 5patients/hour

Takt Time/hour = 60/5

= 12 mins (i.e. a patient can spend 12 minutes at each work station)

Target Manpower = 80/12

                                = 6.7 (approx. 7 workers)

Deductions:

1.     For non-ANC days, the target manpower is actually 1.3 workers. However, we rounded it up to 2 workers because we can’t have 0.3 of a person. But having only 2 workers in a clinic is hardly practicable (unless, Dr. Johnson wants to run a village health outpost).

Dr Johnson feels that to effectively run a clinic, there must be a minimum of a doctor, a nurse, a pharmacist-technician and a laboratory scientist. That makes a total of at least 4 workers. Dr. Johnson currently has 9 nurses, 1 doctor, 1 pharmacist-technician, 1 laboratory scientist and 1 record staff making a total of 13 workers.

To determine his optimal target manpower for Non-ANC days, I will assume here that the number of patients visiting the OPD daily determines the number of patients on admission. If only 2 patients come every hour, the chances are that the admission rate will be low, therefore the nurses on afternoon and night shifts will not have much to do.

With that in mind, Dr. Johnson doesn’t need a resident doctor on non-ANC days. He alone can cope with the work load until his clientele increases. He also doesn’t need a records staff, 1 of his nurses can perform that role currently. Also, he doesn’t need 9 nurses. 5 nurses should suffice i.e. 2 on morning shift, 1 on afternoon, 1 at night and 1 on off duty per time.

 The optimal target manpower for non-ANC days will now consist of 5 nurses, 1 laboratory scientist, and 1 pharmacist-technician = 7 workers.

(We arrived at this number through a combination of scientific calculations and deductive reasoning.)

2.     On ANC days, the demand increases to 5 patients/hour and the calculated target manpower is 7 workers (not 6.7 because you can’t have 0.7 of a person). This corresponds with the optimal target manpower for non-ANC days.

However, because of the increased work load on ANC days, Dr Johnson may need to employ a Doctor on a part time basis and also bring in an extra nurse. This will bring the optimal target manpower on ANC days to 9.

3.       Finally, from calculations and deductive reasoning, Dr Johnson should employ 7 full time employees and 2 part-time employees. This brings his total number of employees to 9 instead of 12.  This 9 should consist of 5 full-time nurses, 1 full-time laboratory scientist, 1 full-time pharmacist-technician, 1 part-time nurse and 1 part-time doctor.