A Comparative Study of Human Resource Practices and Job Satisfaction in Public Healthcare Organisations in United Kingdom and Pakistan
Identification of important issues that determine job satisfaction of nurse may allow managers to develop strategies to increase job satisfaction nursing staff. The problem of the current quantitative research was to examine and compare the nurses’ job satisfaction at public healthcare organisations in U.K.
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The purpose of the current study was to determine whether there were differences between factors and level of job satisfaction among nurses at two hospitals. The current quantitative research data were collected by using the Index Work Satisfaction (IWS) questionnaires (Stamps 1997). The sample for the current research was nurses who were employed in NHS and PIMS hospitals.
For this study, a survey will be utilised as the primary method of acquiring the research data. The questionnaire will be comprised of closed-ended questions to get an accurate and complete data.
The sample will consist of 53 employees from public healthcare service providers in United Kingdom and Pakistan. The sample of employees will be chosen randomly, however, the research will attempt to get a wide range of individuals.
The findings revealed that nurses are dissatisfied with the amount of paper work required, lack of time to deliver quality care, administration who are perceived to be out of touch with daily problems, and lack of involvement in policy decision making. Different components that influence job satisfaction between NHS and PIMS nurses were also reported.
NHS nurses reported twice as many dissatisfiers than PIMS nurses. The overall job satisfaction indicated that work satisfaction on both the NHS and PIMS hospitals is fairly low, according to Index of Work Satisfaction. However, PIMS has a higher level of job satisfaction than NHS.
There is no better time than the present to analyse job satisfaction among professional nurses, especially those working in specialised units in hospitals, because of the changes and chaos occurring in the current environment.
Numerous factors have affected the profession of nursing over the last five years. The driving force behind these factors is the economics of health care. The rising cost of health care has caused hospitals and other healthcare agencies to restructure their nursing care delivery systems.
Simultaneously, technological advances have necessitated more sophisticated and complex care, acuity of patients has risen, and the length of stay in acute care facilities has dramatically been reduced (Murphy, Roch, Pepicello, & Murphy 1997).
Past studies of job satisfaction among professional nurses have demonstrated relationships among satisfaction and positive and negative behaviours. High satisfaction is associated with positive behaviours such as high productivity, teamwork, and high morale, while low satisfaction is associated with negative behaviours such as absenteeism, high turnover rates, and conflict among employees (Boumans & Landerweerd 1994).
Job satisfaction encompasses not only the workers’ adaptation to the organisation, but also what their work means to them and ways in which they and the organisation might adapt to their needs. Nurse managers need to assess the satisfaction of their employees, not to gain a sense of work satisfaction, but to gain knowledge that can be used to assist them and the organisation to create more meaningful and more satisfying jobs (Stamps 1997).
The issue of job satisfaction has become more important to both employers of nurses and nurse employees since the beginning of health care reform and changes in the delivery of nursing care that have caused frustration and chaos among the staff nurses who are delivering the care to the patients.
Managed care has changed the health care environment by putting economic constraints on hospitals. This has affected the nursing profession because the third party payers are dictating how nurses deliver care (Moore 1997).
With the restructuring of nursing care delivery systems, nurses are working with different staff mixes and different staffing levels. With the increased use of unlicensed personnel, nurses have greater supervisory requirements to ensure quality care (Moore 1997).
Many professional nurses have not been well prepared to manage their increasing supervisory responsibilities in the current healthcare environment. When employees are ill equipped for their jobs, dissatisfaction and ultimately negative behaviours result (Murphy et al. 1997).
A study conducted by Shindul-Rothschild and Duffy, (1996) looked at nurses’ views on health care reform and the practice of nursing. She found that nurses who experienced restructuring, downsizing, and the increased use of unlicensed personnel express concerns with decreased quality of nursing care. These nurses are required to do more with fewer resources so they cannot accomplish all the tasks and supervision that they are required to do.
The nurses report they are taking care of more complex patients due to the seriousness of their illnesses, but they have less time to practice nursing due the increased supervisory responsibilities. Thus, they report it has become difficult to provide high quality care to patients with the resources available and this is decreasing their job satisfaction (Corey-Lisle, Tarzian, Cohen, & Trinkoff 1999).
The supply and demand of professional nurses has frequently been out of balance. According to Brewer (1997) when there is a nursing shortage, nurses are required to work long hours with an insufficient number of staff, ultimately leading to burnout and job dissatisfaction.
She predicted that with the turmoil of the health care environment, another nursing shortage would occur in the near future (Brewer 1997). Critical care units have a particularly difficult time recruiting and retaining nurses in such times to fill their positions.
Job satisfaction may vary depending on work settings. There has been no research comparing job satisfaction between developed and undeveloped countries public healthcare providers.
UK nurses have lower patient to staff ratios, fewer unlicensed personnel, no licensed practical nurses, and rely on modern technology like hemodynamic monitoring to help monitor patients. Pakistani nurses must supervise more licensed practical nurses and unlicensed personnel, lack hemodynamic monitoring assistance, and have a larger number of patients per staff member.
Job satisfaction has incredible significance to the health care system. When employees are satisfied, productivity and morale increase. When employees are dissatisfied, employers encounter negative behaviours. Employees may decide to leave, morale and productivity decrease, absenteeism and tardiness increase, and conflict is more prevalent (Williams 1990).
All of these factors have considerable implication for organisations. Low quality, absenteeism and the need to retrain and orient new employees add significant issues to organisations. Even more important are the effects these behaviours can have on patient outcomes. If the morale and productivity levels are low and stress levels are high, an increase in patient and staff injuries is likely (Wunderlich et al., 1996).
Nurse administrators and managers need to be aware of job satisfaction because of its impact on morale, budget, productivity, and staff and patient injuries. Nurse administrators and managers can be proactive and develop strategies to assist in increasing job satisfaction among nurses. Nurse managers on specialty units need to assess job satisfaction closely because of the added difficulty recruiting and retaining qualified professional nurses for these units.
Public Healthcare Organisations within UK and Pakistan
The government organisations namely as National Health Service in UK and Pakistan Institute of Medical Sciences in Pakistan, are the subjects of this dissertation. The part of study was based in the PIMS, which is one of the largest health public organisations in Pakistan. There were three main reasons for selecting this organisation for the study:
1) Like several other large health public organisations (in Pakistan), PIMS has a well defined organisational structure comprised of a voluntary advisory board, paid employees and community based volunteers. Also, its general vision about the health care delivery, staffing pattern and range of salary, benefits and employee development activities are similar to other health public organisations. Hence, the lessons learnt from this organisation could be applied to other health public organisations.
2) PIMS started providing community based primary health care services from mid 1980s. In a short period, it showed a significant improvement in health indicators in northern areas and its strategy of community participation in program planning and implementation became a model for other public organisations as well as private.
Several public organisations adapted PIMS’ strategy either fully or in part. Based on the lessons learnt from PIMS, the government decided to include its philosophy of community involvement in health care delivery in its national health policy and also invited PIMS to help the government health department in replicating its strategy in the government setting (PIMS, 2007).
PIMS’ strategic direction and operational approaches have become a model for many other organisations working in the health sector in Pakistan. Thus, it was expected that the lessons learnt from this study in the PIMS would receive due attention by other public organisations as well as the government sector, resulting in wider acceptability and benefit.
3) PIMS’ keen interest in improving its performance further by conducting organisational research was also one of the reasons for selecting it as a study site. In this regard, a research agenda developed in consultation with the PIMS senior staff members was shared with the investigator before conceptualisation of this study.
Based on the mutual need and the interest of PIMS and the investigator, the research topic was finalised. Considering PIMS’ serious interest in the topic it was expected that the research findings will be utilised by the organisation to develop better human resource management policies resulting in more efficient use of their resources and effective health care delivery to the communities in its program areas.
Health Sector in Pakistan
Pakistan a low-income country (http://www.worldbank.org.pk). The rural-urban division is sharp, as are the disparities between the rich and poor. According to the National Human Development Report (http://www.un.org.pk), almost one third of the people of Pakistan, mainly in rural areas, live below the official poverty line (income of less than US dollar a day per household).
Inadequate social services and the high rate of population growth perpetuate poverty and the unequal distribution of wealth (http://www.oxfam.org.uk). The socio-economic indicators are worse than most of the countries in South Asia. United Nation’s Human Development Index (http://www.unfpa.org) puts Pakistan at number 142 (out of 177).
Each year the Pakistani government (federal and provincial combined) spends around GBP 5.0 per capita on education and GBP 2,5 per capita on health (2001 figures based on average exchange rate for GBP).
Compared to this, the national expenditure on health per capita is around GBP 9.0, indicating a huge role of private and other health care providers (mainly NGOs), which cover around 76% of the total per capita health care expenditure (http://www.emro.who.int).
There are not enough schools, health facilities or houses. The average number of people living in a house is seven; and half the population live in one-room housing units, with inadequate basic utilities, such as water, sanitation and electricity. Access to education and health services is limited, especially in the rural areas, and women and girls are at a particular disadvantage (http://www.oxfam.org.uk).