Madinah Cardiac Centre - Research Proposal Example

Harnessing the Cultural Metaphor through a Social System Approach to Promote Employee Engagement as a means of solving the Problem of Employee Turnover: A focused study of the Saudi health sector Harnessing the Cultural Metaphor through a Social System Approach to Promote Employee Engagement as a means of solving the Problem of Employee Turnover: A focused study of the Saudi health sector Introduction Research Problem The World Bank indicates that the doctor–patient ratio of Saudi Arabia as of the end of 2013 was 0.9. The implication here is that one doctor is assigned to every 399 patients (Arab News, 2013). Even though this value is better than the global average of 600 patients for 1 doctor, the situation remains alarming as the recommended doctor-patient ratio by the World Health Organization (WHO) is 1 doctor to every 200 patients (Jacobs, 2014). In the opinion of Arab News (2013), the situation of a lower doctor-patient ratio in Saudi Arabia also translates into the overall ratio of healthcare workers to patients. By implication, Saudi Arabia can be said to be faced with an alarming healthcare workers to patient ratio. There are several factors that have been attributed to the current trend in literature. One such factor that the researcher found to be particularly striking was high employee turnover in the healthcare sector (Bunton & Macdonald, 2002). This means that the rate at which healthcare facilities in the country lose employees, particularly to other professions, is high. Even in situations where change of work is within the same profession, Tones and Tilford (2001) posit that this could have its associated problems of inconsistency with professional practice. Sadly, the most health institutions in Saudi Arabia are no exception in the problem of high employee turnover. Aim and Objectives Having identified the problem of high employee turnover at the health institutions, the researcher aims to use the proposed study to find the best management approaches and interventions that can be used in solving the problem. The aim of the study will be pursued through some specific objectives which have been listed below. 1. To find the best cultural theories and models that can be used to harness the cultural metaphor of health facilities 2. To investigate the role of the social system approach in harnessing the cultural metaphor of health facilities 3. To identify ways in which a harnessed cultural metaphor through cross-functional team can lead to employee engagement 4. To find the impact of employee engagement on employee retention Justification of Objectives The achievement of the individual specific objectives will lead to the overall achievement of the research aim. The objectives set help to build both theoretical and practical significance for the study. By achieving the first two objectives, the researcher will use the research as a conceptual and theoretical basis on the concepts and phenomena of cultural metaphor and social system approach. As noted by Bunton and Macdonald (2002), the modern healthcare organization is one that is multicultural from the perspective of both service providers and service users. In the light of this, it is very important that theories and conceptual frameworks on culture such as cultural metaphor and social system approach will be well understood by healthcare managers in the context of their individual organizations. The third and four objectives also offer very practical ways in which health facilities can be guaranteed of solving its problem of employee turnover. The practical intervention to be used will be cross-functional teams by which employee engagement will be expected to be promoted. Research Questions In order to achieve the objectives of the study, the researcher will be asking the following questions and attempting to answer them through both secondary data and primary data. 1. What cultural theories and models can be used to harness the cultural metaphor of health facilities? 2. What is the role of the social system approach in harnessing the cultural metaphor of health facilities? 3. How can cross-functional team lead to employee engagement? 4. What is the impact of employee engagement on employee retention? Background Literature Use of Cultural Metaphors in Management Practice Harrison and Huntington (2000) defined cultural metaphor as a phenomenon or activity that members of a given culture are identified with either emotionally or cognitively. Some common examples of cultural metaphor that are globally identified are American football and Japanese garden (E. Hall & M. Hall, 1990). Within the organizational setting, Huntington (2006) explained that there are two different ways in which culture may be identified and used in relation to building a cultural metaphor. These are the culture of the individual employees and the organizational culture of the institution in which the employees work. In order to use cultural metaphor as a management practice therefore, it is expected that leaders of organizations will be abreast with ways of managing the individual cultures of employees and the organizational culture in a way that aligns with all identified diversities (Gannon, 2001). Huntington (2006) opined that once this form of integration is done, it will be possible to easily identify particular organizations with some cultural metaphors such as punctuality, customer satisfaction and employee engagement. From a theoretical perspective, Harrison and Huntington (2000) indicated that using Hofstede’s cultural dimensions is one way in which managers and leaders can easily integrate the individual cultures of employees with the organizational culture to ensure effective management practice based on the creation of cultural metaphor. Based on the Hofstede’s cultural model, leaders must always understand whether individual employees have high or low power/distance, individualism, masculinity, uncertainty/avoidance index, and long term orientation (E. Hall & M. Hall, 1990). Based on the majority consensus among the employees from the Hofstede’s cultural dimensions, the organizational cultural is also formed in a way that guarantees a common ground. Gannon (2001) noted that in organizations where the organizational culture is contrasting with the overall cultural dimension of employees, it is always difficult to have a common ground that will be used as a basis for building a cultural metaphor for the organization. Meanwhile where there is no such cultural metaphor, it will be difficult to distinctly have a basis on which management practice can be promoted. The Role of Cross-functional Teams in Promoting Employee Engagement According to Hofstede, Hofstede, and Minkov (2010), a cross-functional team is a group of experts working together as a team for the accomplishment of a common goal. Several researchers have identified the use of cross functional teams as an important approach to promoting cultural diversity in an organization (Minkov, 2007). This is because Petrakis (2014) observed that once experts from different expert backgrounds come together in a cross-functional team, they are expected to work together in a more synchronized manner rather than promoting the achievement of their individual objectives. On the part of Hofstede, Hofstede, and Minkov (2010), however, cross-functional teams do not necessarily promote cultural integration but that cultural integration is expected before cross-functional teams can successfully be used within the organizational context. Emphasizing on this point, Petrakis (2014) stressed that in the absence of cultural integration, members of cross-functional teams find difficult in coexisting to accomplish their set goals. Throughout literature, one common characteristic that was attributed to the use of cross-functional teams is the fact that they help in promoting and enhancing employee engagement. Minkov (2007) stressed for example that as a principle of using cross-functional teams, decision making and innovative approaches to getting problems solved within the workplace is left to the care of the team. This way, instead of taking direct instructions from management or receiving interferences in the execution of their daily duties, employees are assured that they will be the fulcrum around which all decisions will be made (Hofstede, Hofstede, & Minkov, 2010). Minkov (2007), on the other hand, argued that even though the use of cross-functional teams put employees at the center of decision making, it could fail in guaranteeing employee engagement at the individual level. This is because the employees are always expected to function as a group instead of doing so as individuals. In a related study, Petrakis (2014) noted that employees who feel well engaged in the work process are more likely to retain their positions because they feel well utilized. Social System Approach to Healthcare Intervention Largely attributed to Vilfredo Pareto, the social system approach to management argues that organizations such as the healthcare setting is made up of a cultural system that comprise people working together in cooperation (Tones & Tilford, 2001). The social system approach can therefore be seen as having a lot of relationship between cultural metaphor and cross functional teams, all of which have direct cultural bearing on how people are managed in the organization (Wise & Signal, 2000). Writing on the use of the social system approach as a healthcare intervention, Bunton and Macdonald (2002) indicated that when management and leadership of health facilities understand that the organization is a cultural system, they are made to develop cooperative systems of management that is based on the understanding of different cultural behavior of people. Tones and Tilford (2001) also related the use of social system approach to employee engagement by stressing that with the understanding that the organization is a social system, management are forced to approach decision making and overall execution of work in a manner that satisfies the different social dimensions of workers. Meanwhile to achieve such satisfaction, it is eminent to allow each employee to bring on board their unique qualities and expertise. Methodology Research Design The proposed study is expected to be performed as a mixed research design that makes use of both the quantitative research method and the qualitative research method (Sapsford & Jupp, 2006). The quantitative method will make use of statistical and numerical indices where data will be collected and analyzed from employees of as many hospitals and other health institutions in Saudi Arabia as possible through the use of a survey questionnaire. The qualitative method on the other hand will involve a face-to-face interaction with the management of the hospitals and other health institutions in the form of an interview. Due to the numerical nature of quantitative method, it will be used by presenting some interventions on ways in which cross-functional teams can be used at the health facilities from a cultural perspective. Views will then be collected from employees to know the number of employees accepting particular interventions. The qualitative research on the other hand will be used for the fact that it allows in-depth understanding of phenomena (Yin, 2009). The will therefore involve an interaction with the management on the best ways they can use the social system approach in implementing the preferred interventions by the employees. Research Strategy Ridley (2012) identified six major research strategies, among which focused research will be used for the proposed study. Focused research has been explained to be a research strategy in which the researcher identifies a unique problem or phenomenon within a large research setting and critically studies the phenomenon through the collection of data from the research setting (Riley, Wood, Clark, Wilkie, & Szivas, 2000). The rationale for selecting focused research for the study is that it will give the researcher the opportunity of giving practical contributions of employee engagement impacts on employee turnover without having to limit the researcher to just a single organization or health facility. By extension, the focused research will ensure a wider coverage for the concepts and variables selected for the study. O’Leary (2006) saw that one major advantage of a focused research is the fact that it allows the researcher to modify the data collection processes until the most preferred goals of the study are achieved. This will be done for the proposed study by using an inductive research approach where the researcher will modify the research emphasis between the use of quantitative research method and qualitative research method until all objectives of the study can be deemed as being achieved and the research questions being answered. Population and Sample As part of the mixed research design, there will be two major research populations that will be considered for the study. These are staff of hospitals and medical centers to be drawn from as many as 40 health facilities, and the management members of the facilities. More specially, staff of the Case Management Department of the 40 health facilities and the management of the department will be used. This specification will be done so as to ensure that the focused research is broad and wide instead of being limited and specific to a single organization. A preliminary desk research conducted has showed that the Case Management Department of the 40 facilities has an average of 12 employees and 4 management members per head. The researcher will however not have direct encounters with all these people due to time constraints. Rather, a sample size made up of 120 employees and 10 management members will be set. In both instances the researcher will make use of random sampling technique, where all the people within the populations will have an equal opportunity of becoming part of the sample size. As far as the employees are concerned, the random sampling will be done for each facility via a fish-bowl method, where 3 respondents will be selected from each of the 40 facilities. The names of all people within the population will be written on pieces of papers and put in a bowl and the preferred number among these selected without looking into the bowl (Hardy & Bryman, 2004). For the management members, names of the 40 facilities will also go through the fish-bowl method where 10 of them will be selected. For the 10 selected hospitals, the head of management shall be included as a respondent for the study. Random sampling is preferred as it allows fairness and avoids bias in the selection process (Bender, 2003). Research Instrument The research instrument is a tool the researcher will use in collecting data from the respondents (Collis & Hussey, 2013). There will be two major research instruments in line with the different data collection methods that will take place as part of the mixed research design. As far as the quantitative research is concerned, the researcher will make use of a questionnaire. The questionnaire will be a piece of paper containing close ended questions which will be answered by the respondents by ticking their preferred answers from the options that come with the questions. The questions on the questionnaire will mainly be an extension of the third and fourth research questions as those are the practical work related questions. The qualitative research on the other hand will involve the use of an interview guide where questions will be set based on the first two research questions and presented to each of the respondents in an oral, one-on-one format. The first two research questions will be expanded for the management of the health facilities because those questions are related to management approaches. Through the data to be collected from staff and management, it will be possible to identify trends among the staff and management on ways in which they each see the best means of retaining employees at their facilities through employee engagement. Ethical Consideration The researcher will observe maximum ethical considerations while collecting data from the respondents involved in the study. One of the first approaches to ethical consideration will be to present an official introductory letter from the awarding university to all 40 facilities. After the permission has been secured, a consent form will be prepared, spelling out the aim of the study, the role of participants, any possible risk of participation, how the researcher intends to minimize risk of participation, including risk of exposure of participant identity. Ways in which the researcher will use data collected from the respondents will also be made known in the consent form. As part of ethical consideration, the researcher will ensure that all data collected from respondents will be done anonymously where respondents will not be identified by names or specific positions. The overall description that will be given to respondents will be the fact that they are employees and management members of the Case Management Department of the health facilities. What is more, even though the facilities and the department will agree for the researcher to undertake the research at their premises, the researcher will ensure that participation by employees and management members is strictly voluntary. Data Analysis Plan As expected from the mixed research method, data collected will be analyzed through the use of both quantitative data analysis and qualitative data analysis procedures. Quantitatively, the researcher will emphasize the use of percentages, mean table and charts in presenting the findings collected from respondents. From a qualitative perspective also, the researcher will build themes from the interview questions, based on which responses from the interviewees will be presented in a coded format. The coded format means that instead of presenting raw and direct answers, only excerpts will be presented with an analysis of these excerpts. Timeline The chart below shows how the research will be carried out within a period of 6 months, which will be divided into bi-weekly activity of 12 main bi-weeks. Time Activity 1st bi-week 2nd bi-week 3rd bi-week 4th bi-week 5th bi-week 6th bi-week 7th bi-week 8th bi-week 9th bi-week 10th bi-week 11th bi-week 12th bi-week Permission from research setting Collection of secondary data Writing the literature review Formation of sample size Conducting quantitative research Conducting qualitative research Writing introduction chapter Analyzing primary data Writing findings chapter Writing discussion chapter Writing conclusion chapter Presentation and defense Summary The retention of health workers has been noted to be a very important requirement for ensuring quality delivery of healthcare. Meanwhile, most health facilities in Saudi Arabia go through very difficult times trying to achieve employee retention due to high incidence of employee turnover. This is the problem that has informed the proposed study, seeking to find ways in which the existing problem of high employee turnover can be solved. Based on literature reviewed, it has been established that when employees have sufficient control at the workplace to bring to bear their experiences, dynamism and innovation, they feel part of the overall management of the organisation. This situation is no different for health workers also. Meanwhile, in order for employees at the health sector to be given the room to operate in the manner described, it is important that the concept of employee engagement will be institutionalised at the health facilities. Because the need to undertake employee engagement has been noted to work best when institutionalised, the study seeks to use the concept of cultural metaphor through a social system approach to investigate the best modalities that can be used in making employee engagement a permanent part of the health facilities. Once this is achieved, it will be expected that instead of the health facilities to engage their employees once a while, employee engagement will actually become a permanent part of their organisational culture, where they will be practiced on a permanent basis. To get all these achieved, a focused research involving 40 health facilities in the locality of the researcher shall be used in the study. Through a mixed research method, questionnaire will be given to 120 employees whiles 10 management members will be interviewed on the best ways in which employee engagement can be institutionalised to ensure employee retention. References Arab News. (2013). One doctor for every 399 patients in Kingdom. Retrieved March 9, 2015 from http://www.arabnews.com/news/466352?quicktabs_stat2=0. Bender, S. (2003). Producing the capstone project. Kendall Hunt Publishing. Bunton, R., & Macdonald, G. (2002). Health promotion: Disciplines, diversity, and developments (2nd ed.). London: Routledge. 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Sofia, Bulgaria: Klasika y Stil Publishing House. O’Leary, Z. (2006). Researching real-world problems – A guide to methods of inquiry. Thousand Oaks: SAGE. Petrakis, P.E. (2014). Culture, growth and economic policy. New York and Heidelberg: Springer Ridley, D. (2012). The literature review (2nd ed.). London: SAGE. Riley, M., Wood, R. Clark, M., Wilkie, E., & Szivas, E. (2000). Researching and writing dissertations in business and management. London: Thomson Learning. Sapsford, R., & Jupp, V. (2006). Data collection and analysis (2nd ed.). London: SAGE. Tones, K., & Tilford, S. (2001). Health promotion: Effectiveness, efficiency and equity (3rd ed.). Cheltenham UK: Nelson Thornes. Wise, M., & Signal, L. (2000). Health promotion development in Australia and New Zealand. Health Promot Int, 15(3), 237–248. Yin, R. K. (2009). Case study research design and methods. London: SAGE. Read More