Traditionally, in an effort to make themselves competitive, organisations have opted for strategies which consider the type and price of the product or service, as well as the quality.
This notion of utilising the factors of production as efficiently as possible in an effort to gain a competitive advantage has been well documented, but it is only recently that the human resources (labour) of an organisation have been given the same level of priority as other factors.
The move away from domestic to global production has been a major factor that changed the way in which management interacts with its employees. This is evident in the move away from personnel management to human resource management. Additionally, while in the past the Tayloristic approach seeked to produce increased output and achieve economies of scale, the move away from industrialised business to a more service oriented economy in developed countries, has ensured the elevation of the human resource function as an important factor in creating a competitive advantage. Remarking on this shift Eskildsen and Nussler (2000:581) state that; "the employees have evolved from a resource to be exploited to an asset that needs to be nourished, guarded and developed."
The main driver of this paradigm shift has been globalisation. Although there is no common definition of the concept and phenomenon, globalisation in the 21st century has been characterised by the consistent opening up of labour markets, fewer trade barriers, the rise of economic trading blocs as well as the increased influence of multinational corporations.
CesynienÄ- (2008:41) remarks that "Globalization represents the structural making of the world characterized by the free flow of technology and human resources across national boundaries as well as the spread of information technology and mass media presenting an ever-changing and competitive business environment."
As it relates to the research topic, globalisation has had significant impact on the health care sector in Trinidad and Tobago. Globalisation of health care labour markets has had a profound effect on the national health care system to provide important services to its citizens. As the shortage of health care professionals persists worldwide there is increased pressure for the Ministry of Health which is responsible for leading the health sector, to attract and retain capable staff. The increase and ageing of the population coupled with high levels of emigration has made HR a top priority.
Human resource management, most scholars agree is a concept comprised of practices such as planning, recruitment and selection, compensation, training and development and performance appraisal to name a few. The aim of these practices is to influence employee attitudes, behaviours and performance in an effort to meet the goals of the organisation (Absar et al, 2010).
Greater attention is being paid to the degree to which employees are satisfied with their jobs. While Human resource management is not solely responsible for an employee's overall job satisfaction and may be affected by other factors such as work intensity there is evidence HRM can have a positive effect in the relationship between job satisfaction and organisational performance (Brown et al, 2008).
Locke (1976:1304) defines job satisfaction as "a pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences."
According to Powell (2001:4) there are two sources of job satisfaction… "1) the employees' pride in their craft and 2) the work environment both physical and interpersonal. The ability to produce, the quality of the work, the opportunity to learn and express creativity, the sense of pride in their profession, the recognition for a job well done, the ability to work well in a team, the social satisfaction derived from relationships at work, the opportunity to experience personal growth, and the rewards from a physically supportive work environment are all factors that impact on job satisfaction. Individuals may vary to the degree in which each of these factors contributes more or less to their own job satisfaction. But the end result is that high j o b satisfaction typically leads to career success."
Many researchers have shown interest in trying to understand why some individuals report high job satisfaction while others expresses the opposite. Evidence from research published in journals and case studies indicates specific determinants and correlations between job satisfaction and turnover. It is worth noting that dissatisfaction with one's job may result in tardiness and grievances to more serious matters such as higher employee turnover and absenteeism.(White, 2000)
As the debate rages on concerning the relationship between human resource management and job satisfaction and its impact on employee absenteeism, productivity and turnover, the subject of job satisfaction within health care institutions remains of great interest as it has found to be positively related to patient satisfaction and quality of service (Tzeng, 2002).
The purpose of this study is to answer the main question of "What is the relationship between HRM practices and job satisfaction?" Additionally, answers to the following research questions will be sought after:
Is there any association between HRM practices and job satisfaction?
What is the level of job satisfaction amongst workers at the institution under study?
Which HRM practice has had the greatest impact on job satisfaction amongst employees?
As it relates to methodology, to answer the research questions presented, the focus will be on analysing job satisfaction as it relates to key HRM practices ranging from compensation to supervision using a questionnaire adapted from "Conducting Hospital Employee satisfaction Survey, Linda Powell, MSIPT, 2001". Interviews with key stakeholders as well as policies outlined in organisational documents will also provide data for the study.
Research Background
The Republic of Trinidad and Tobago, located at the southern end of the archipelago that forms the Caribbean islands, is a twin-island nation and former British colony which gained independence in 1962 and Republic status in 1976. It is a member of the British Commonwealth and has a multi ethnic and multicultural population of approximately 1.3 million people (PAHO, 2006).
Reflecting on the colonial period up to the 1970's, Walt et al (2002: 87) explain that "…there was considerable exchange of professionals between the colonial countries and the Caribbean territories. Midwives, nurses and sanitary inspectors were trained locally by expatriate teachers and supervisors from the governing country, although training for doctors, specialist nurses and some allied health professionals was carried out abroad, usually in the governing countries." This resulted in an increase of health care professionals in the 70's and 80's, however it was a collection of factors such as a lack of employment opportunities, economic slowdown and the inefficiency of administrative institutions such as the Public Service Commission that facilitated their migration in hopes of better career opportunities.
An interesting statistic to consider shows that over the past two decades there has been a noticeable aging of the population with the proportion of those under 15 years decreasing and those over 60 years increasing while expenditure on health care which is financed by taxation revenues has fallen from 12% of the national budget in the 1970s to approximately 7% in 2003. Additional funding as well as technical assistance comes from regional and global bodies such as the UNDP, UNAIDS, PAHO and the WHO. There are eight hospitals and a network of one hundred and seven primary health care and community clinics in operation (PAHO: 2006).
It could be said that the national health care system suffers from weaknesses other than staffing shortages. These include the lack of adequate information systems which would be used to monitor and evaluate the quality of care delivered and performance of both private and public institutions. There is progress being made in terms of policy making at the national level but implementation at the institutional level is a slow and ongoing process. Facilities at the public hospitals remain in a poor state which is often characterised by outdated equipment and lack of space. At the private level, the rising cost of health care may prevent many lower income individuals from accessing services outside of the public system unless referred by the Ministry of Health.
At the top of the agenda is the goal of training and recruiting health care professionals from the local population. Unfortunately, this has not been able to materialise as the local labour market is not able to fill all the vacancies. The government therefore has employed a short to medium term strategy that entails the outsourcing of doctors as well as nurses from other parts of the world, most notably from Cuba to fill the vacancies in the public sector. (Trinidad Guardian: 2012).
The government has tried to boost its ability to provide sufficient healthcare to its population by entering into partnerships with private enterprise namely private hospitals and labs to supply its services at a cost to the state as well as through collaboration with international health organisations in formulating regulations which promote accountability and efficiency.
The private sector which is substantially smaller than the public apparatus provides a complimentary and supporting role and is comprised of nursing home, private hospitals, laboratories etc. The Private Hospitals Act 2 of 1960 Chapter 29:03 is the legislation that forms the regulatory framework under which our organisation of study operates. All private hospitals are required to apply for a licence to operate. A criticism of the regulatory landscape is that once in operation there is little or no mechanism to monitor and regulate the services of the facilities. To solve this , the Ministry of Health has been working to establish an accreditation system to apply to both public and private providers to ensure that quality health care is provided.(PAHO:2006). This has yet to be implemented.
Having described the environmental landscape of the health care industry, the study is focused on Gulf View Medical Centre, a well known provider of medical services.
Company Background
Gulf View Medical Centre is a registered private hospital located in the south of Trinidad that has been in existence since 1993. As a privately owned business the main goal of the organisation is to be profitable but also to provide a high quality of medical services to the people of Gulf View and its surrounding areas. The organisation employs one hundred and twenty individuals.
The organisations vision statement as outlined in its employee handbook is "To be the premier health care provider of choice for patients, physicians and employees in Southern Trinidad". (Gulf View Medical Centre: 2012)
The main revenue source is the sale of laboratory, ultrasound, CT scan, X- ray, operating theatre and other hospital services which is supplemented by income derived through the rental of office space to practicing doctors.
In an effort to realise its vision and to improve competitiveness the organisation has implemented a digital hospital management records system which covers all aspects of the organisation from accounts to inventory, to databases of its clients. This system is still being tested and staff trained to utilise the software based on their specific job descriptions. The organisation has renovated all patient rooms and added a new floor which has additional rooms as well as administrative offices to improve the facilities for their customers and employees.
As its services are all administered by people, the management of staff is an issue of great importance to any hospital. In terms of recruitment and selection, there are three types of employees: full time, part time and contract employees. Full time workers are permanent employees who enjoy all fringe benefits offered by the facility and/or defined by law, while the other two categories are employed for a stated, limited period of time and receive only those benefits defined by the administrator.
The organisation states that it is "committed to providing all employees with fair and reasonable conditions of employment. In return it expects that all employees will perform the duties assigned diligently, effectively and loyally" (Gulf View Medical Centre: 2012). The role HRM plays in the organisation and its effects on job satisfaction will be explored in the research findings.
Chapter 4 : Methodology
The methodology section of this dissertation describes the design of the study, the sampling procedures and guidelines that were used; as well as the instruments that were involved in data collection. The way in which data is analysed is also discussed.
Design
As the primary research tool, a cross-sectional survey adapted from "Conducting Hospital Employee satisfaction Survey, Linda Powell, MSIPT, 2001"was used to determine overall satisfaction as well as the factors influencing job satisfaction among the employees of the organization under study. The design was chosen in order to establish a relationship between independent variables such as motivation and hygiene factors discussed at length in the literature review and the dependant variable of general job satisfaction. Additionally a secondary research tool was employed in the form of additional data provided by the organization to provide a background to the findings.
Study Site
The study was conducted at Gulf View Medical Centre (also referred to as GVMC) in the south of Trinidad. As mentioned in the company background, the organization is a privately owned institution with 45 beds which plays the role of supporting primary healthcare as well as providing an avenue for individuals to receive specialized care.
Study Population
For the primary research tool, the study population consisted of all employees at GVMC from every department and ward at the time the research was conducted. This includes those who work on a contractual basis and those that are employed permanently. The study did not include medical doctors who are not considered employees, but are tenants of the offices they occupy and customers of the services offered to them by the institution. The secondary research considered the perceptions and experiences of patients where documented by the admissions clerk in a log book.
Sampling and Size
The entire working population amounted to one hundred and twenty individuals. As a result, one hundred and twenty self administered questionnaires were distributed with employee pay slips in separately enclosed envelopes. Information concerning the identity of the respondents or the specific department was not asked for. The survey was kept anonymous in order to prevent any bias on the part of the surveyor or respondents. As the questionnaire was voluntary employees had no obligation to answer and return the questionnaire which ensured that each response was not tainted or manipulated by the researcher. All employees made up the inclusion criteria while the exclusion criteria were limited to those who may have been on leave or those who chose not to participate. Out of the one hundred and twenty questionnaires distributed, the researcher received sixty- six complete responses which indicated a fifty-five percent response rate. Having more than fifty percent of the population reply is an indication that the topic under study i.e. job satisfaction is of interest and relevance.
Data Collection Instruments
A structured self administered questionnaire was employed as the primary instrument for collecting data from the participants. The questionnaire has two sections of which the first consists of a list detailing thirty seven job satisfaction statements measured on a five point scale which asks the individual how strongly they agree or disagree. This applies to all but one statement of this section. The first statement requires the respondent to indentify how satisfied or dissatisfied they are as it relates to overall job satisfaction. The value of one is given to statements that have the highest agreement or satisfaction while at the other end of the spectrum the number five is used to convey the highest level of disagreement or satisfaction. These statements cover eight variables which include overall satisfaction, understanding of mission and goals, general attitudes towards work, performance issues, management issues, supervisory issues and satisfaction with training and benefits. (Appendix A).
The second part of the questionnaire seeks to gather demographic information concerning four dimensions. These are age, experience, sex and income. Another question included in this survey asks employees how long to they intend to continue employment at the organization. They are given six options to choose from. Also included in the second part of the questionnaire is a narrative question which asks what benefits the respondent would like to see added to the current lineup of benefits.
Validity and Reliability
To ensure that erroneous statements or questions did not permeate the study and instrument, a draft of the questionnaire was submitted to the administrative manager to ascertain the relevance of each item. Four statements regarding satisfaction with benefits were thus removed as they pertained to benefits which did not exist at the organization under study.
Data Collection Method
The period designated for data collection was eight weeks between the 16th July 2012 and 17th September 2012. Owing to the nature of the shift system at the organization under study the researcher who was solely responsible for the collection of questionnaires was only able to collect an average of two per day.
Ethical Considerations
Ethical considerations for this study were submitted to the University of Leicester as part of the required dissertation proposal uploaded via Blackboard. Permission to conduct the study was given by the managing director of the organization in written form which was also emailed to the university via the course administrator.
As far as respondents were concerned prior to administering the questionnaires, the aims of objectives were clearly explained to the participants. Verbal and not written informed consent was sought as the latter had the potential to compromise the anonymity of the respondents. Participants were verbally reminded that their involvement was voluntary and that they were not obligated to complete the questionnaire if they deemed so.
Data Analysis
One hundred and twenty questionnaires were distributed and seventy three were collected. Seven were incomplete, thus the total number of responses was sixty six (55% response rate). Quantitative data in the form of descriptive statistics were coded according to frequency or percentages and entered into Microsoft Excel 2007 to be analyzed and summarized. All percentages were rounded off and therefore approximated to whole numbers to ensure ease of interpretation. Qualitative data extracted from questionnaires and organizational log books were also listed and analyzed. Tables are used to present the data.
Limitations of the Study
All studies would be incomplete without discussing the limitations of the research undertaken. Firstly it should be noted that this type of research mainly derived from a self administered questionnaire cannot be said to be objective. As it measures the individual's perception the research can be said to be subjective. Further, if the data is subjective and therefore unique to the particular environment and circumstances, the findings cannot be used to develop generalized assumptions of other organizations within the same industry.
Another important point is as a result of assuring confidentiality it is possible that levels of satisfaction were under or over reported. The study is limited to descriptive statistical data, narrative data and other qualitative data; therefore a cruder presentation may be the outcome as inferential statistical modeling was not possible. Finally the study does not take into consideration local culture , external environmental , political and economic factors which may have a major effect on an organization and its workforce
Discussion
This study provided information that is important to staff, management and the organization as a whole. With regard to overall job satisfaction the employees can be said to be minimally to moderately satisfied with their jobs. Employees' perceptions were affected by the motivation and hygiene factors.
The first research question asked if there was any association between HRM practices and job satisfaction. What was discovered was that there was a link between HRM practices and individuals' perceptions concerning satisfaction but a concrete causal or correlated link proved elusive. It is traditionally accepted that employees who have higher levels of satisfaction provide better experiences for patients. In this instance, while many employees were highly dissatisfied with their pay, their level of recognition, management and supervisors, a review of the complaints log of the organization from the period June 1st to September 1st revealed that customers had more problems with the cost of their medical services as opposed to the delivery of those services by employees. Another interesting point is that the HR Supervisor indicated in an informal interview that there were more interdepartmental conflicts than there were customer patient conflicts for the same period. This may say something about the complexity of the concept of job satisfaction and its relationship with motivation. The study reported low levels of teamwork but respondents were positive about the amount of pride they had for the organisation and the extent to which they liked their job.
In addition to the overall measure of employee job satisfaction being slight to moderate; of the eight dimensions of HRM activities and practices investigated, those which provoked the most dissatisfaction amongst respondents were those statements which dealt with general attitudes towards work, management issues, supervisory issues, training and pay as well as benefits. This addresses the research question concerning the levels of satisfaction amongst the workers.
The third research question asked which HRM practice had the greatest impact on employee satisfaction. Of all the activities listed in the survey, the one which had the highest level of associated dissatisfaction was that of pay and benefits.
The implications of this research to management are substantial. With a better idea of the factors influencing and acting on employees, management given they have the resources can attempt to make adjustments to existing policies and implement new ones in an effort to foster
satisfaction.
Conclusion
Given the importance of healthcare especially in aging societies and the impact of its professionals on health systems worldwide, the topic of job satisfaction within hospitals is still very contemporary and requires additional research as there are still many issues and causal relationships to be explored.
