Improvement of the Quality of Service in a Hospital - Case Study Example

?Introduction: Human resource is considered as the most significant factor in any firm, because only with human resource a firm can perform its responsibilities. The achievements of any organization depend on the skill of its human resources.” Services are defined as “social act(s) which take place in direct contact between the customer and the representatives of the service company. Service Quality is more difficult to measure objectively than product quality, because service characteristics include intangibility, heterogeneity, and inseparability of the production and consumption of services. These characteristics render service quality a more abstract and elusive construct than product quality” (Sower et al. 2001). Public services in London based hospitals provide urgent concern to the public with acute ill health or harm. The hospitals provide emergency ambulance services, blood courier services and other voluntary services. English National Health Services has largely benefited by the recent introduction of Service delivery targets under a more meticulous management regime. But proper use of HR tools can ensure less staff turnover, better organizational productivity and corporate financial performance. Even in developed countries like the United Kingdom where there are sufficient number of nurses, they are often utilized inefficiently, because they do not possess adequate skills or are more focused on urban areas than rural areas. This case study includes the following: Public services and its comparison with private service. SERVQUAL and dimensions of service quality. Measures to improve the SERVQUAL Emotions and work Organizational climate Service climate Ways to measure the service climate. Creation of service climate and its relation with the human resource tools. Conclusion “Public sector productivity and service quality is often held to be dependent, at least in part, on beliefs, values and attitudes that go beyond self interest to include concerns for the needs of others and the greater common good (Have NHS Regulatory Reforms Undermined Altruism in the Health Workforce? 2012)” “Public ambulance services across the UK are required by law to respond to four types of requests for care, which are: Emergency calls Doctor's urgent admission requests High dependency and urgent inter-hospital transfers Major incidents” (Emergency Medical Services in the United Kingdom 2012, para. 1). The private service generally includes organizations that are in private ownership, and not owned by government. These generally include partnerships, corporation, and charities. The organizations are not own or operated by the government, for example, local businesses, retail stores, credit unions, are run by the private sector. The public sector includes organizations that are owned and operated by the government. This includes provincial, state, federal, or municipal governments. Some examples of public services in the United Kingdom are health care bodies, educational bodies, police and prison services, and local and central government bodies and their department. “Public employment services exist to compensate for market failure and inefficiency in the labour market. This does not make them a panacea for the problem of unemployment; indeed, when they were introduced in the UK a century ago, the rate of unemployment was approaching 8% – very similar to the one we see today” (The UK Public Employment Service 100 Years On 2010). The hospitals need to adopt the following techniques to improve the quality of services. SERVQUAL: “SERVQUAL represents service quality as the discrepancy between a customer's expectations for a service offering and the customer's perceptions of the service received, requiring respondents to answer questions about their expectations and their perceptions” (Theories Used in I S Research: SERVQUAL 2006). The purpose of this case study is to improve the quality of service in a hospital. The development in service quality helps to create a clean environment, and develop practical competency among the workforce, which is of prime importance to patients. Public service is meant for providing quality service to the customers. The hospital has to deliver quality service to their patients. This is possible only through the employment of right nurses for the right jobs. The Management can use the following Dimensions to Increase the Service Quality: Responsiveness-It indicates the willingness on the part of the nurses to deliver quality service to the patients. Courtesy-The nurses and the authorities should give respect, care and consideration and should have a friendly approach in handling the patients. Credibility-Honesty and trust are is essential for the functioning of hospitals. Reliability-It shows the capability of the staff to perform their service more efficiently. Tangibles-It indicates that, in order to improve the services, the hospital authorities have to provide adequate facilities and equipments to the nurses. Security- The patients should feel that the hospital is able to cure their illnesses and that they can afford the treatment course without any problem. Competence-It means that the staff nurse should possess the required knowledge and skill to perform the duty effectively. Communication- Proper communication should be there between higher authorities and nurses, between the patient and nurses. Access-It shows the ease of contact and access on the part of nurses. They should treat the patients with a broad smile. Understanding the expectations of customers-The reason behind the failure of many organizations in delivering service quality pertains to their negligence in responding to the needs of the patients, yet focuses more on profit maximization. Improve the Quality of Services: . The customers have different perception about the treatment offered by the hospitals. Service quality can be improved by reducing the gap between the customers’ expectations and perceptions. This gap can be reduced by delivering quality services at the right time and for the right cost. The following are the causes of the gap: 1) “Not knowing what customers expect. 2) Not selecting the right service designs and standards. 3) Not delivering to service standards. 4) Not match in performance and promise” (Weitz & Wensley 2002, p. 339). Emotions and Work: Emotions play an important role in delivering service quality. In hospitals, the nurses have different emotions and it affects their work negatively.” Emotional labor can be defined as the degree of manipulation of one’s inner feelings or outward behavior to display the appropriate emotion in response to display rules or occupational norms” (Chu 2002, p. 2). The emotional labour is of two types: Self-focussed emotional labour-This type focuses on one’s own feelings. The job of nurses is a difficult one. Other-focused emotional labour-This emotional labour focuses on others’ feelings. Nurses should accept other person’s feelings as their own, and work in a satisfied manner. Emotional labour affects the service quality in the following ways: Negative emotions seldom guide to patterns of physiological problems that signify illness. Create job dissatisfaction among nurses, and thus results in poor quality of service. Gives depression, bad self-esteem, self-alienation, cynicism and role alienation. Emotive dissonances reflect a break among expressed emotions and felt emotions.For example, the nurse treats the patient in a happy and wholehearted way, but really, the individual is dull and sad. Organizational: “Organizational climate clearly influences the success of an organization. Many organizations, however, struggle to cultivate the climate they need to succeed and retain their most highly effective employees” (What is Organizational Climate and Why Should You Warm Up to it? 2009). As far as the hospital sector is concerned, they should give attention to the service climate. “Service climate is a specific application of organization climate, a term that refers to employee’s shared perception of what is important in their organization” (Dietz et al. 2004). Service Climate can be Measured in the Following Ways: Meaningful interviews are conducted between the managers and nurses to solve work related problems. Questionnaire should be supplied to find out whether the nurse and other supportive staff are satisfied with the service climate. Service rewards should be distributed on the basis of merit so that the employees will deliver quality services. Service standards need to be explained to the nurses, to find out their faults, and to improve their performances. Linking customer perceptions with service climate. It is necessary to know what kind of services the customers expect from the hospitals. Creating a Service Climate: In hospitals, service climate can be created by adopting different human resource tools to measure the performance of employees which will develop their personality, as well as help in achieving the objectives of the hospitals. Performance Appraisal System: It is a process of measuring the performance and progress of the employees. Different performance appraisal techniques will be adopted to improve their performances. Recognition: The staff requires proper attention. They should feel that their conditions and status are being recognized by the hospital authorities. Total Quality Management: It should be initiated by the management, to take advantage of the contribution of manager, nurses, and customers. It helps the organization to rise above the expectations of customers. Quality Circles: It is a group of workers under the direction of their superior educated to recognize, examine and work out job-related problems and provide their solutions to managers, to improve the work quality of the organization, and to inspire and improve the job of employees. Employee Relations: There should be a sound relationship between the management and the workers. Provide Continuous Training: Job security is a major characteristic feature in the effective performance of an employee. Provide extensive training to the new nurses and the existing ones on the latest methods of treatment, so that patients do not have to suffer in the absence of skilled force. If possible, education and development opportunities should be provided to enhance professional competencies. Retention of Good Employees: An effective retention programme consists of providing a good working environment and professional development. “Most of the time, if nurses feel challenged and have the opportunity to grow in their career, they will be happy,” says Stacey Brull, R.N., director of magnet/professional development at Good Samaritan Hospital in Baltimore” (Runy 2012). Giving flexible schedules based on individual lifestyles, keep the nurses happy at their jobs. Given Adequate Wages: When compared to other sectors, nurses are the least paid of all. Better wages can improve job satisfaction, and also boost the motivation of the employee. “Given a total NHS nursing workforce of 453,366 in 1994 (OHE, 1999), and assuming that our sample is representative of the whole profession, this is equivalent to retaining 36,838 (49,118) nurses who would have left the NHS otherwise. A more ‘optimistic’ scenario, where all nurses would report to be satisfied with their job, would reduce nurse turnover by 82,171 (109,561) which is equal to 18.1% (24.2%) of the total NHS nursing workforce. Given the ?5000, it costs a NHS hospital trust to replace a core staff nurse (Audit Commission, 1997), improved job satisfaction will reduce total turnover costs by between ?184 and ?548 million” (Shields & Ward n.d., p. 23). Selective Hiring Based on Requirement: The right candidate should be selected for the right job. A proper analysis has to be made to determine if the nurses have adequate knowledge and experience to do the job assigned to them. Even if employee base is overfilled but skilled professionals are not available based on requirement. Decentralization of Decision Making and Encouraging Individual Decision Making: Decentralization of work helps in more effective decision making, as less time is wasted. Decisions are made in consultation with employees, hence making it easy to implement the rules. Establish Appropriate Employee Relations Policy: No communication barrier should exist between the employer and the employee, so that grievances on either side can be properly conveyed without any difficulty. Team leaders should be designated at each level, so that problems can be solved at lower level itself. Reduced Status Distinctions and Barriers: Irrespective of origin or language, equal opportunities should be given to all employees. Promotion Based on Merit: Employees should be properly rewarded for their performance. Irrespective of their monthly wages, additional incentives in the form of bonus, or promotion should be given to deserving employees. Using Nursing Unit Staff Projections for Forecasting Demands: Adequate current records help the management to determine the current strength of the existing skilled workforce, so that future requirements can be predicted beforehand. There should be adequate staff to provide proper care and support to patients. “In 2000, the National supply of FTE registered nurses was estimated at 1.89 million while the demand was estimated at 2 million, a shortage of 110,000 or 6 percent. Based on what is known about trends in the supply of RNs and their anticipated demand, the shortage is expected to grow relatively slowly until 2010, by which time it will have reached 12 percent. At that point, demand will begin to exceed supply at an accelerated rate, and by 2015 the shortage, (a relatively modest 6 percent in the year 2000), will have almost quadrupled to 20 percent. If not addressed, and if current trends continue, the shortage is projected to grow to 29 percent by 2020” (Nursing Supply and Demand: A National Perspective 2003, p. 1). Maintain Proper Skill Mix: A proper mix of experienced and new employees should make up a team so that the nurses don’t feel over stressed or burnt out by working more. “All of this guidance is well summarised by the International Council of Nurses: ‘There is no optimum skill mix, and attempts to reach the best possible standard must be an on-going and creative process’. In the NHS Plan, the government develops its ideas on the nursing workforce in some detail. As well as promising 20,000 new nurses, it states that there will be 1,000 nurse consultants by 2004 (#9.22). There are to be‘modern matrons’ – senior sisters and charge nurses who are easily identifiable to patients, and who will be accountable for a group of wards and who will have the resources ‘to sort out the fundamentals of care’ (# 9.21).The Chief Nursing Officer sets out ten ‘key roles for nurses’, stating that employers must empower ‘suitably qualified nurses’ to undertake a wider range of clinical tasks, including the right to receive and make referrals, admit and discharge patients, order investigations and diagnostic tests, run clinics and prescribe drugs (#9.5)” (Scott 2003, p. 22). Conclusion: Service quality is unique and prejudiced. The majority of the customers wish for good services, and they will go to some other place if they don’t obtain it. Therefore the hospitals need an extensive atmosphere for customers; the numerous staff should get training in the latest methods, and also high, in technological machines and equipments. “Of course when trying to bring in change, the HR department should have perceived benefits, a deadline for execution, and also the realized gains in relation to the change in culture. There should also be continuous integration. Through this, the HR department should be able to change the culture in the organization and add value to it” (Harold, 2003)” (Roles and Functions of the Human Resource Department 2010). Reference List Chu, KH 2002. The Effects of Emotional Labor on Employee Work Outcomes. Hospitality and Tourism Management. Available at [Accessed on 09 March 2012] Dietz et al. 2004. Service Climate Effects on Customer Attitudes: An Examination of Boundary Conditions. The Academy of Management Journal. 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