Linking to the case study there has been a number of attempts to evaluate the relationship between departmental strategy and the management of human resources. The models used include the Business Strategy model, life cycle model and Whittigton’s model of generic perspectives on strategy. The Accident and Emergency department of the South Warwickshire Hospital is an ‘Analyser’ according to The Business strategy Model of (Miles and Snow; 1984) and is in the ‘Growth stage’ of (Kochan and Barocci ; 1985) and is in the ‘Systemic (pluralistic, deliberate)’ Quadrant of (Whittington’s model; 1993).
Miles and Snow identify three effective types of strategic behaviour, associated organisational characteristics and supportive HRM strategies, which they term defender: to ‘build’ human resources, prospectors: to ‘acquire’ human resources, and analyser: to ‘allocate’ human resources. In the case study, the planning for the staff available in the Accident and Emergency department is extensive and formal as everything is defined and laid properly. For example the three shifts with the frameworks within those shifts and their timings are given; again the nurses are allocated for weekdays and weekends.
This means the department has process oriented procedures. In the analyser strategy, the growth of the organisation (here department) is through market development. Since 1990 the A&E department has been growing with the growth of the hospital (technology) as well as with the development in its cultural web (Johnson and Scholes; 2002). There is continuing modernisation of A&E. (Appendix-4)) and the new technology replaces the old one (X-ray films).
Though the training and development needs are identified and carried out through various performance appraisal schemes like comparing, monitoring and analysing the problem and treatment given twice, but the quality is seen as being ‘built in’ to the system by the dedication of the staff and acquiring skills with experience. The departmental structure is Functional and Matrix for example either the receptionist or the ambulance driver can notify the medical staff of the arrival of a patient. Also some of the A&E Department’s facilities are used by patients referred from other parts of the hospital.
On the other hand the department is in the growth stage of the Life Cycle model. Kochan and Barocci identify four stages (Start-up, Growth, Maturity and Decline) in the product or departmental life cycle, in an effort to explain why employers adopt different policies in different situations. As the organisation grows beyond a certain size, formal policies and procedures probably begin to emerge in order to ensure that it builds upon earlier successes. There is a need to retain expertise and ensure that earlier levels of commitment are maintained, so more systematic HR procedures and systems are introduced.
For example, in the recruitment of staff, Warwickshire had the best record for nurse recruitment of any county in England in 1999-2000. Also new consultant appointments have been made to ensure that service provision is maintained. Again there is an ongoing and continuous development in Administration, Improving working lives, training and development, investors in people etc. (Appendicex-4)). Whittington suggests that theories of strategy may be typologised in terms of four generic perspectives based on their position on two axes, relating to continua of outcomes (profit maximisation – pluralistic) and of process (deliberate – emergent).
(Whittington 1993). The A;E department is in the forth quadrant of Systemic (pluralistic, deliberate) perspective, which emphasises how strategic goals and processes are shaped by the social systems in which they are embedded. From this perspective the norms that guide strategy derive not so much from individuals’ cognitive limitations as from the cultural rules of the local society; the processes of strategy formulation (of a hospital) reflect not just organisational micro-politics but the institutional interests of broader society.
(Marchington and Wilkinson; 2002). According to Schuler and Jackson’s model of employee role behaviour and HRM policies associated (innovation, quality enhancement and cost reduction), the strategy of A;E department is ‘Quality Enhancement’ as the behaviour of the staff (receptionist, nurses and driver) is relatively repetitive and predictable because of fixed and explicit job descriptions. Also the department use a mix of individual and group criteria for performance appraisal (through comparison of reports/outcomes) that is short-term and result oriented.
Also as said above that there is continuous training and development of the staff. The focus is on customer satisfaction through high concern on quality, though the quality of treatment given is ranked 1st, but the Waiting time has to be reduced especially for the patients who require immediate treatment. Multiple admissions in the same room at the same time are a factor of concern as it affects both staff and the patients. In a hospital the efforts should be made to motivate staff and boost the morale of patients.
Thus hygiene factors (Herzberg 2 factor Theory of Motivation; 1960) associated with bad feelings-included cleanliness, which has been ranked 8th by the patients, refreshment facilities, TV, toys etc are also a factor of concern which holds important implications for the HR. Another implication and problem that is derived from the case study is guarantee of employment security and the reward system. It is mentioned in the case study that ‘if an unexpectedly busy period occurs, staff can be called out (without pay)’.
But people work in the expectation of something in return which may be in the form of intrinsic or extrinsic rewards (Psychological Contract; Shein 1965). And if their promises have not been kept by the employer then they might get dissatisfied with the job and can act as a de-motivational factor, hence loss of employees. Another HRM implication is to continuously improve quality in service through decentralisation by customer and staff involvement in decision making not directly but through the feedback and information received from the patients in the form of questionnaire.
Department and HR managers should keep under review the staffing, facilities, equipment and inter-departmental and inter-agency operational policies necessary to ensure that: obstacles to the provision of high quality care are identified and tackled by; minimising delays in A;E; adequate facilities available to make patients feel welcome in A;E, e. g. food, drink, appropriate chairs/beds available for the elderly; reducing time to a minimum.
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