Human Resource Mechanisms in Healthcare

 

Health care workers are people, who often work in hospital, healthcare centers and other service delivery points, but also in academic training, research and administration; some provide care and treatment services for patients in private homes. Human resources are really important to a health care system’s effectiveness. From an economics viewpoint, health workers’ salaries make up a great share of health budgets in most countries. The health worker can be considered as the gatekeeper of the health system. However, caregivers are getting low-paid in spite of the fact that they are the people perform the most intimate, most personal tasks for our frail, elderly parents and grandparents. According to NZ Herald, they do almost everything for a medium pay rate of around $15/hour – only $1.25 more than adult minimum wage. Dr Judy McGregor, Equal Employment, Opportunities Commissioner, called this is “a form of modern-day slavery”. Healthcare workers and other formals carer told that they love the work in spite of the low pay, but others said they had little time to care properly or that they often weren’t paid for some of their work, for example  writing daily progress notes on residents after the end of their shifts (Collins, 2013). Therefore, what’s health care workers motivation to continue working in this sector? In New Zealand there are 20,000 people; most of them are women and many of them new immigrants, work as caregivers in nearly 700 rest homes and geriatric hospitals. According to Maslow’s Hierarchy of Needs, there are 5 basic things of human needs: Self-actualization, Esteem, Love/Belonging, Safety and Physiological. As shown in this theory, a person’s basic need must be met before self-actualization can be achieved. There is a way of thinking about the different needs of individual employees. In lower-order needs of physical and emotional well-being are basic all; once satisfied, these no longer serve as motivators. Therefore, a lot of people have to take this job for their whole life to meet their own needs. Such as Rouru Kiria, a 55 years old woman has been a caregiver for 15 years at the now renamed Meadowbank Lifestyle and Care Village. As the facility moved more towards the retirement village model in 2010, at the same time her husband had a kidney transplant, her job became redundant. They have to live in a rented home and both unemployed. However, she was still looking for work in aged care despite the low pay. She said she will take whatever is given since it’s better than the dole (Collins, 2013). Generally, if a health worker feel that they are effective at their jobs and having well performance they can be motivated and express their job satisfaction. Factors contributing to motivation and job satisfaction also include an adequate compensation, strong career development, adequate working and living conditions. Despite of the fact that health care workers get a low salary, having strong human resources mechanisms within a health system can also help to ensure what motivational factors are in place at adequate levels to keep health workers satisfied.

According to the ‘Inside our Rest Homes’ series by NZ Herald in 2012, one in four  caregivers left their job in aged care homes and hospitals. The series also showed that there is high turnover that affect quality of care, as well as discouraging staff development and training which adversely impact stress levels. Therefore, we all come up with the question that what is major source of stress. According to some research, stress usually comes from 4 factors: Environmental factors, Organisational factors, Job factors and Personal factors. According to some research, many caregivers have to work under pressure because lack  of staff. Some which work in a high dependency hospital fear that their needs are not always being met. This also leads to high mental and physical stress. Some said stress comes from surrounding environment, physically tough; their pay rate doesn’t reflect the responsibility that they carry, having to constantly train and orientate new staff due to high attrition rate. “An estimated 30,000 women working in aged care have been underpaid and undervalued for too long” (Herald, 2013). While others think that the worst thing about their job are low pay, stress and physical strain on body. Some of them even being yelled at, hit and being called names by resident (Katherine Ravenswood). Based on the research of NZ Aged care workforce survey, the most common causes of injury or illness which relate to work were lifting, pushing, pulling and bending movement (43.7%); hitting, being hit or cut by person. Non-specified  causes accounted for 20.7% of injuries which is a small number cited falls but long term exposure. Therefore, to reduce staff turnover and improve organizational outcomes we need to come up with some appropriate solutions. Hiring more staff and using an objective pre-screening tool to identify those likely to succeed can be one of the ways to manage this problem. There is about 46% of the healthcare staff that have no qualification – said in Dr. McGregor’s report, which may leads to lower quality of caregiving (Simon & Martin, 2013). There is a large proportion of participant had completed some of the National certification in health, disability and aged support but there is number of people that hadn’t completed it yet. Caregivers should be trained both skills and knowledge in order to work more effective. On the other hand, caregivers also need to be respected and supported from everyone around, especially from their boss. Getting exhausted and having no actual support make the staff easily quit the job, which means aged care organisations need to get more people and at the same time give them proper training. Some trainees said they want to be supported by their boss while they are studying and also the responsibilities my boss trusts them with. Also match the caregiver with the right client can be one appropriate solution to reduce their stress. By discovering which role applicants are best and suit for in order to help them not to work under pressure (Talintel, 2013).

Residential  care is more applicable for the old aged people due to the lack of capability of taking care of themselves. Based on my study of changes that affect employee behavior in organisations, employee behaviour basically relies on number of factors which resulting quality fluctuation of the care services among its stakeholders and their residents. In other words, there are 4 main factors that affect employee’s behaviour in organisation: Political factor, Economic factor, Socio-cultural factors and Technological factor. According to the article which was published by  Ministry of health, asset threshold has become one of the prime factors to measure the amount spent by the older people in enjoying the residential care services (Changes to the Residential Care Subsidy asset threshold, 2016). On 1 July every year, the asset threshold is set at a new level which will be determined and set by the government with cost residential care. According to the instruction of the government, the person with equal possession or below the specific asset threshold would be accounted for government funding. There was an increase of the asset in the cost of care services on consumer price index, in other word they don’t have to depend on a lump sum amount every year from 1st July, 2012 onwards. This change means that it will takes you longer for the value of your assets to reduce to the threshold and for you to become eligible for the Residential Care Subsidy if you have been assessed as having assets with a value above the current threshold. On other hand, it is clear that the rest home staffs have unsustainable paid in proportion to the value of service provision. In the Equal Pay  Case, the union has talked about raising the hourly caregiver rate to $26.00 from the current average of $15.30. According to their calculations, the sector would need to find an additional $500 million annually in order  to increase caregiver pay rates. In that case, the staffs have switched option to the other care and rest home institute against satisfactory pay scale, some even change into another job. Staffs in the residential care also have to with deal more with emotion than the rational knowledge and skills. The New Zealand aged care association has claimed that the residential care homes under the association is capable  to pay higher to the staffs based on the value of the area they work on. However, even when some employers want to give their workers a raise, they still can’t do it since they stuck to the contract with government, which funds homes for the care they deliver (Equal Pay Case, 2012). Thus, the organisations should develop the benefit package on residential care on long term service provision in order to attract potential care staffs in the company. The association would also enter into a contract with the government to improve the care services against better pay scale and security on future residential care provision.

According to my interview and my opinion of the respondents it is clear that the care home staffs have faced more difficulties in the service provision than the benefits from the organisation. Salary is the key issue among all the respondents where no one is happy with the current pay scale of the care home staffs in proportion to the effort and labour contributed. On the other hand, payment, workplace relationship, clients’ complaints after service or some caregivers be bothered about the organisational behaviour and treatment of the co-workers which can create the state of stress. Based on the responses obtained and my study of the relevant theories, I have made some practical suggestions to management. Provide meaningful feedback in a constructive manner on a regular basis. Helpful feedback in manner to employees which will encourage them is a cornerstone of effective management. However, feedback is not always positive but that the communication is done thoughtfully. Another suggestion is respect employees as individuals, in addition to the job they do. According to Allieli and most of health care student that I have interviewed with, they all want to be respected by their residents, their colleagues, especially their family. Furthermore, they also want to be given credit or some specific feedback for what they do. “Management support in times of need won’t be forgotten; it builds employee goodwill and loyalty” (Lipman, 2013). Moreover, non-financial rewards in terms of achievement recognition and disclosure of contribution of the care home staffs would overwhelm the staffs to stay back in the association for better service provision to the older people. Maria also mentioned above the interview that the pay scale is major factor to reduce morale of the care home staffs. In that case, the salary package of the staffs needs a little upliftment to motivate the staffs under greater scope of financial benefits. Salary and wage are considered as the most common motivation for caregivers. Moreover, be sure management at all levels of an organization receives adequate training. There’s a tendency for companies to put so much effort in “training leader ” while focusing far less on supervisors and middle managers. Mrs Kiria, who was a senior union delegate with the Nurses Organisation, said she received adequate training, but some colleagues had difficulties she attributed to lack of training (Simon & Martin, 2013). Therefore, providing fairly training is really important, especially when it can minimize employee turnover rate.

Changes to the Residential Care Subsidy asset threshold. (2016). Ministry of Health.

CIPD. (2007). Annual survey report. Recruitment, retention and turnover, 36.

Collins, S. (2013, 11 27). NZ Herald. Inside our rest homes: Aged care’s low-paid workforce.

Equal Pay Case. (2012).

Herald, N. (2013). Rest home chains face legal battle over pay.

Katherine Ravenswood, J. D. (n.d.). THE NEW ZEALAND AGED CARE WORKFORCE SURVEY 2014. A FUTURE OF WORK PROGRAMME REPORT, 22.

Lipman, V. (2013). 7 Management Practices That Can Improve Employee Productivity. Forbes.

Simon, & Martin. (2013). NZ Herald. Inside our rest home.

Talintel. (2013). The 5 Key Ways To Reduce Caregiver Turnover, 4.