Human Resource Management in Selected District Hospitals of Bangladesh-A Cross Sectional Study

Human resource management (HRM) is fundamental of any organization because of its utility. A cross-sectional was conducted from January to December, 2016 in two district hospitals named General Hospital, Munshiganj and 100 Bedded District Hospital, Narsingdi with the objective to assess the status of HRM. Purposively 144 hospital staffs were selected and interviewed by using semi-structured questionnaire and record review. The collected data were processed and analyzed meticulously with the help of SPSS (Version 21) software on the basis of different variables. The study revealed that the mean age was 36.6 ± 1.8 years, 71.5 % were clinical and nursing personnel, other category of respondents were support services and other personnel (22.2%), administrative personnel (6.3 %).Most (96.5 %) of the respondents were recruited by Government, after recruitment 52.1% hospital staffs mentioned scope of training facilities either work-based or instruction based exists in workplace, 63.9 % needed to be trained, 80.6% wished further career plan. Working environment found friendly by 39.6 % hospital staffs, where as average found by 50.0%. The recommendations for further improvement of HRM of their workplace was to increase training facilities by 31.9%, other recommendations were to increase manpower, improvement of monitoring and supervision. From this study some effort in the training, increase of manpower , performance appraisal can ensure better quality of service at district hospitals.


Introduction:
Human resource management (HRM) is a system, a philosophy, policy and practices that can influence individuals working in an organization [1] .An effective and competitive human resource is the key strength of organizations in facing the challenges of business today.Successful organizations recognize the significance of human element in the organizational success and emphasize on their development, satisfaction, commitment and motivation in order to attain desired objectives [2] .The importance of HRM in healthcare lies in the fact that a well-managed human resource department is vital for the delivery of efficient and quality healthcare services.In developed countries the human resource managers have identified the challenges they face and have developed different strategies to overcome these challenges [3] .But developing countries like Bangladesh, India and Pakistan are still facing many challenges in implementing human resource management practices in healthcare sector [4] .Despite rising attention to delivery of healthcare services in Bangladesh, little attention has been paid to the role of human resource management which can transform health workers into a productive, motivated, and supported workforce capable of improving healthcare services and saving lives.Lack of attention towards the role human resource management in the health sector is a key factor standing between success and failure in Bangladesh [5] .District hospitals are very important place for health facilities to care and cure of the patients; it is the place where secondary health care is given.The skillful use of human resources, proper methods of selection training and motivation, division of responsibilities; distribution of roles, incentives for better works, opportunities for promotion and professional advancement, effective design of "Health team" could contribute to efficiency of health service delivery.The major components of HRM covers job design, recruitment and selection, capacity building, job facilities and environment.The aim of the study was to assess the status of human resource management in selected district hospitals of Bangladesh which includes the overall recruitment process, capacity building opportunities of hospital staffs, the working environment and the organizational activities for retaining employees.This study was conducted with a hope and expectation to know the problems and constraints in the field of HRM practices in the selected district hospitals so as to facilitate health activities of selected areas by upgrading the quality of services.

Materials and methods:
The descriptive type of cross sectional study was conducted in two District Level Govt.Hospitals of Bangladesh, one was General Hospital, Munshiganj and the other one was 100 Bedded District Hospital, Narsingdi for the duration of one year from January to December, 2016.Data were collected from 144 hospital staffs (administrative, clinical and nursing personnel, support services and other personnel) by face to face interview administered questionnaire and record review.The study was approved by the Institutional Review Board of National Institute of Preventive & Social Medicine (NIPSOM) and official permission for data collection was obtained from the Civil Surgeons of District Hospitals.After developing the questionnaire was pre tested for necessary modification and finalization.Then the master tabulation sheet was prepared after proper checking, verifying and editing as per specific objectives and key variables.Analysis of data was finally done with Statistical Package for Social Science (SPSS) software (version 21) of computer on the basis of difference variables.Then the data presentation was perfectly done by MS Word and MS Excel.Verbal consent was taken from the respondents.Confidentiality and anonymity of the respondents was maintained.Figure 1 shows that out of 144 respondents 72 (50.0%) gave their opinion about working environment is average, 57 (39.6%) and 15 (10.4%) mentioned friendly and unsatisfactory respectively.

Discussion:
Within many healthcare systems worldwide, increased attention is being focused on human resources management (HRM).Specifically, human resources are one of three principle health system inputs, with the other two major inputs being physical capital and consumables.In the present study 144 human resources were selected from two different district hospitals in Bangladesh to assess the status of human resource management and the study result revealed that the mean age was 36.6 ± 1.8 years ; more than half (54.2%) of the respondents age were in between 36-45 years, which was consistent with the study conducted by Barman N, 2014 [9] .Majorities (51.40%) of the respondents were male; among the 144 human resources participated in the study majority (71.9%) were clinical and nursing personnel, only (6.3%) were administrative personnel, which was not consistent with the study [6] which found most (74.20%) of the respondents were female and the majority (67.0%) were from management background.This study found only 3.5% of respondents were recruited on contractual basis which is not consistent with the study [7] which found in district hospital 30.0 % of respondents were recruited on the basis of contract.In the selection process Cadre, Non-Cadre, Adhoc and others were 30.6%, 16.0%,18.1%and 35.4% respectively.Though all the hospital staffs are recruited through Ministry of Health and Family Welfare 42.4 % respondents were recruited by Directorate General of Health Services (DGHS), 33.3% recruited by Directorate General of Nursing and Midwifery Services (DGNMS), only 4.9 % were placed locally either by Civil Surgeon or by Ministry of Social Welfare (MSW).Regarding capacity building facilities in workplace present study found more than half (52.10%) mentioned the scope of training facilities exists in their workplace which was inconsistent with study conducted by Aftabuzzaman M.2012 [7] , which found most of the respondents (82.3%) were dissatisfied about their scope of training.Majority (63.90%) mentioned that they need training which was consistent with the study conducted by Montesinos JL.2013 [8] , where 58.40% need further training.The study conducted by Jardali F [6] found 54.

Conclusion:
Based on the findings of the present study, it can be concluded that majorities of the respondents were satisfied in scopes of training, received training, asked for training and were interested for career plan which is a positive sign in capacity building facilities of an organization.There was average working environment for the employee.A congenial working environment was present between colleagues.On the other hand various type of punishment process was observed like verbal reprimand, suspension, penalty etc. Performance appraisals of the employees are done annually by ACR.Some employees participate in decision making but the percentage was poor.
Various motivational activities like bonus, special leave, training, good working environment exists to maintain the effective workforce of hospital.Due to the vacant post the organizational activities can hamper, which has been reflected in the recommendation of the hospital staffs.The study suggests effective and efficient human resource management practice in district hospital to ensure optimum and quality healthcare delivery service.However specific problems identified by different stakeholders need to be critically appraised by the authority to improve the HRM further.

Figure 1 :
Figure 1 : Distribution of the respondents (hospital staffs) by their opinion about working environment.

Figure 2 :Figure 2
Figure 2 : Distribution of the respondents (hospital staffs) by their recommendations to improve HRM of the workplace.[n=144]

Table 1 :
Socio demographic characteristics of the respondents (hospital staffs).

demographic characteristics Frequency Percentage Age group (in years ) Category of the respondents
services and other personnel 22.2% and 6.3 % was administrative personnel, 74 (51.4 %) were male and 70 (48.6%) were female.

Table 2 :
Distribution of the respondents (hospital staffs) by their recruitment procedure related information.

Table 3 :
Distribution of the respondents (hospital staffs) by their capacity building facilities related information.

Table 4 :
Distribution of the respondents (hospital staffs) by their organizational activities for HRM related information.[n=144]

Table 5 :
Status of human resource in district hospitals