Introduction
The health care delivery system is one of the vital components of the public welfare schemes of the government. The healthcare components like accessibility to good medical care, quality and cost are increasingly moving beyond the grasp of the general public. The downtrend of the national healthcare delivery system has become a major issue which, if not tackled soon, may return on the government with serious consequences. The needed reforms, therefore, require not only comprehensive feedback of the delivery system as a whole but careful consideration of all the pros and cons of the developing situations in the concerned areas of public health care. Healthcare organizations are facing several problems and need to introduce some radical organizational changes to improve the health delivery systems. Human resources in the health organizations of the UK have therefore become essential in improving and improvising the quality of healthcare delivery. So the question, ‘Is NHS implementing job evaluation to assist pay equity?’ becomes highly relevant. Pay equity broadly defines the same wage across people belonging to different gender, race, culture or disability the same job description. (Anderson & Black, 1997)The study is designed to evaluate the job criteria of people employed in healthcare organizations and would enable these organizations to determine whether or not pay equity is being implemented properly.
Statement of the problem
The National Health Service is the largest healthcare organization of the government of the United Kingdom and Nationwide; the NHS employs more than 1.5 million people. There are only three other organizations globally employing more staff than the NHS (www.nhs.uk, 24-3-2005). The way of providing better healthcare in hospitals is aimed at ensuring different professions work well together in teams, are dedicated to patient care, and provide the best quality care the facility is capable of. (Lowe, 2003) The deteriorating quality in NHS hospitals has increasingly become a major concern. In the emerging challenges of the changing business equations, the healthcare industry needs highly skilled persons who can work under stressful conditions.
Purpose of the study
The purpose of the study is to gauge the extent of the influence of the job criteria and job skills on the quality of the healthcare services and the safety of the patients in the hospital. The private equity in the hospital seems to have significantly increased the cost of healthcare, without promising quality and safety for the patients. Various constituents of safety measures like right diagnosis of the illness, efficient and timely delivery of healthcare services, clean and hygienic conditions of the hospitals etc. are important criteria of healthcare. It is a fact that even though the state spends a huge amount on the healthcare system, the complexities that encompass the inter-related processes of the various elements of the system, are seemingly contributing to its falling standard of effective delivery.
The hospitals are plagued with increasingly low staff presence which is adversely affecting the quality of their health delivery system resulting in long waiting lists and low quality of healthcare services. The study would primarily be evaluating the job description against the existing job profiles of the staff, to find if pay equity has been implemented across different gender, race, and culture and how it reflects in their performance outcome.
Significance of the study
The study would help to understand the various factors which are seriously affecting the quality of the healthcare services in the United Kingdom. The study would help to make more simple the processes of HR strategy and evolve a restructured healthcare system ‘that would be more efficient (and less costly), more manageable and safer… and development and application of national practice guidelines would simultaneously reduce complexity and variability and improve the quality of care for millions of patients’ (NCHC, p. 21, 2004).
With the advances of technology, collective production has become more complex. There is a significant paradigm shift in the technical division of labor from direct to indirect model that is focused on regulation, administration, improvement and innovation to meet the challenges of the changing time that is increasingly relying on information technology (Lowe, 2003).
Hypotheses
The long waiting list and low quality of healthcare services in the hospitals run under NHS have become major causes of concern. In healthcare area, innovative approach is the key to successfully disseminating information and implementing new schemes and better resources that meet the challenges of the time. (National Coalition on Health Care, 2004) The methodology of the delivery system of healthcare and the administrative inputs are important ingredients that make it a success. It is a fact that despite huge spending by the state on the healthcare system, the complexities that encompass the inter-related processes of the various elements of the system, are apparently contributing to its falling standard of effective delivery. It is imperative that issues and factors, that promote the concept of safest hospital at affordable cost, be addressed urgently to meet the challenges of the deteriorating healthcare services. The study is seen as an effort to gauge the performance outcome of the workforce in NHS through evaluation of their job and looking at factors like pay equity.
Research Questions
Is NHS implementing job evaluation to assist pay equity?
Research questions
- Does the NHS implement job evaluation to assist pay equity in its hospitals?
- Does NHS promote job equity in projects which it forms under public-private partnership?
- Will job equity improve better working conditions?
Review of the literature
In the United States of America, the healthcare system is increasingly becoming market-driven by various modules, which can be identified through such aspects as insurance and accessibility, being treated as commodities. Anderson’s theory arranges the healthcare system as per the contribution of government and private agencies in healthcare delivery (Anderson, 1997). It also explains the deteriorating status of healthcare delivery in the UK and the increasing disparity in the care provided to the people, at large. In the market-driven health system, consumers or people decide what goods (health module) to buy and at what cost. Therefore, the prices and the level of services become the crucial factor in the exchange of goods or healthcare services.
In the era of globalization, it becomes important that HR leaders look beyond the criteria of race, nationality and color of their employees. HR leaders need to be aware that the traditional process of labor deployment is undergoing a fast transformation, both in terms of quality and quantity. (Freeman and Perez 1988, Best 1990) ‘It is widely acknowledged that over the past decade and a half, radical new forms of production have emerged with the pervasive expansion of information and communication technology (ICT)’(Freeman and Perez 1988, Best, 1990). The rapidly changing models of the work environment have made it imperative for the employees and the job aspirants alike, to keep themselves updated with the knowledge and use of all the latest gadgets and processes which are increasingly replacing the older model of office efficiencies.
According to Ginsburg, the migration of healthcare delivery towards a more market-determined system has had major effects on the social and economic outcomes of the society (Nichols, Ginsburg et al., 2004). In the last few decades, UK has seen a marked shift in healthcare which has moved from public-driven policies to market-funded paradigms. Healthcare is funded by private agencies and insurers, some of which may have forged partnerships with the NHS. The NHS has specifically taken initiative in involving the PFI (private finance initiatives) in the ‘non-clinical’ support services like portering, catering, laundry etc. Such secondary services form important part of NHS administration which not only stretch the NHS budget but are also observed to reduce the efficient execution of core competency of the NHS in emergency and critical hours (Amicus Union Guidelines, pg. 3).
NHS has stressed the need for participation from local bodies as it provides an opportunity “to overhaul an inappropriate system of governance characterized by a high level of centralization and a low level of accountability” (Hughes et al.,p. 231). Thus, opting for private participation ensures that high quality of such services are maintained at comparatively low cost and NHS can carry on with its main aims and objectives of providing quality healthcare services to the people. This has led to the huge disparity in the quality of services rendered by the so-called outsourced agencies, ultimately leading to deteriorating healthcare delivery.
Quality healthcare and the safest hospital have remained inaccessible and not so safe primarily because of lack of accountability. According to a World Bank report ‘social accountability is defined as an approach toward building accountability that relies on civic engagement, i.e., in which it is ordinary citizens and/or civil society organizations that participate directly or indirectly in exacting accountability’ (WB, 2005). Concept of accountability is an extremely important factor in the healthcare industry because of various interacting elements which have significant influence on the overall development processes of society.
Institutions are “often neither responsive nor accountable to the poor” and “not accountable to anyone or accountable only to the rich and powerful” (Narayan et al. 2000, pp.172,177). Singh says, ‘poor people are most reliant on government services and least equipped to hold government officials to account, they have the most to gain from social accountability initiatives’ (Singh & Shah, 2003). Strategies and policies must incorporate the changing nature of the society that is increasingly becoming multicultural. Hence job evaluation becomes imperative part of management to assist pay equity for the delivery of quality healthcare services.
Research Plan
Framework of the Study
The proposed research study would be based on Healthcare system analysis in nature and would involve a comprehensive literature review. Profound critical analysis is a very important tool for evaluating trends and behavioral patterns of the people who are in a position to influence a set of defined parameters or vice versa. It helps to analyze the changing paradigms of the evolving social values and the factors that affect the decisions for adopting the changes (Lofland, J. & Lofland, L., 1995).
The study would take into account the conceptual model as well as the theoretical one. Secondary information sources such as libraries, commercial bibliographic databases for peer review, internet resources and e-journals would be used for literature review. The wider conceptual model of the research would be used to analyze the data.
Some aspects of the research paper would be covered through descriptive model concentrating on major points of Healthcare system peculiarities.
Data collection and Sample
Since literature review survey methodology was adopted focusing on literature analysis, the sampling primarily comprised of reading works of wide-ranging authors on the topic concerned, who had compared different approaches to the same issue but with different perspectives.
The literature review would be based on primary sources analysis comprising healthcare researches and scientific works related to the topic.
Data Analysis
The ‘typology method’ of data analysis would be adopted. ‘It is a classification system, taken from patterns, themes or other kind of group data’ (Patton, p. 393, 398) John Lofland & Lyn H. Lofland. In this case, the literature contents would be segmented according to pre-defined criteria of theme, pattern and issues to develop and predict pattern that best reflects the sentiments of the people. The thematic analysis would allow evaluating systems typology and peculiarities of their functioning.
Strengths and Limitations
Comprehensive sampling with wide-ranging factors which are significantly influencing the quality and cost of healthcare would be identified in the literature review, so that the scope of study is large enough to ensure success of the research’s aims and objectives. Another strong point of the study is the wide diversity in the sample selected which would ensure wide scope of accurately measuring the performance index and criteria for quality healthcare.
The literature review approach is highly relevant as it deals primarily with the feelings of the target subjects and hence requires something more than numbers to evaluate the emotional impact of their feelings on the issues and factors which are under study. The literature analysis methods are comprehensive in their understanding of the social relationships and try to evaluate behavioral patterns of the people or target subjects so as to evolve new theories that can correctly interpret the social changes. They are, at the same time, designed to consolidate the perspectives and experiences of the subjects to portray and reflect the behavioral pattern that may determine the aims and objectives of the research.
The limitation of the study would be that we would be taking into account only the impact of the evaluation and pay equity on the healthcare delivery within a predefined sample that does not focus on the diversity of the demography.
Ethical Considerations in Literature Review
Rapid globalization has brought in the era of a pluralistic society and an increasingly large segment of the population comprised of people from different races, colors, cultures and nationalities. (Narayan, Patel, Schafft, Rademacher & Koch-Schulte, 2000) The changing values necessitate development of a new social order, which would not only embrace multicultural values but help forge a universal bond that would transcend race and religious boundaries. Managing diversity, thus, has become a crucial issue with the businesses which needs to be addressed urgently, if they want to maintain a competitive edge over their rivals. Therefore, one often comes across moral and ethical dilemmas while dealing with people with cross-cultural values in the healthcare industry. The research study would be particularly looking at the topic from the perspective of the inclusion of people from diverse backgrounds and ensure that the literature reviewed has diversity issues within its content and scope.
Tentative time frame
References
Anderson, G. and Black, C. (1997). Willingness to pay to shorten waiting time for cataract surgery. Health Affairs, 16(5): 181-190.
Amicus union Guidelines. Guide to NHS PFI Schemes and the TUPE Regulations.
BBC news. (2005). Labour hails fall in MRSA cases.
Best, M. (1990). The New Competition: Institutions of Industrial Restructuring. Cambridge. MA: Harvard University Press.
M. Lowe, W.G. Lowe, (2003) Issues in the Development of Inter-professional Working in the NHS: HR interventions to bring about greater efficiency and co-operation, International Journal of Applied Quality Management (1) 1 1-4
Freeman, C. and Perez, C. Chapter Four in Dosi. G et al. (1988). Technical Change and Economic Theory. Pinter. London. pp. 38-66.
Hughes, J., Knox, C., Murray, M., and Greer, J. (1998). Partnership Governance in Northern Ireland: The Path to Peace, Oak Tree Press. Dublin.
Lofland, John & Lofland, Lyn H. (1995). Typological Systems: Analyzing social settings, 3rd ed. Belmont, Cal.: Wadsworth.
Narayan, Deepa, Raj Patel, Kai Schafft, Anne Rademacher and Sarah Koch-Schulte (2000). Voices of the Poor: Crying Out for Change. Washington: World Bank.
National Coalition on Health Care. 2004. Building a Better Health Care System: specifications for reform.
National Health Services website. Web.
Nichols, L. M., Ginsburg, P. B. (2004). Are market forces strong enough to deliver efficient health care systems? Confidence is waning. Health Affairs, 23, (2), 8-21.
Singh, Janmejay and Parmesh Shah (2003). Making Services Work for the Poor: The Role of Participatory Public Expenditure Management. World Bank, Social Development Note No. 81.
World Bank. (2005). World Bank operations and evaluation department report(2005) ‘The Effectiveness of World Bank Support for Community-Based and -Driven Development’