MANAGING PEOPLE IN THE HEALTH AND SOCIAL

CARE

SUBMITTED BY

ANONYMOUS

10TH MAY 2023

WORD COUNT: 3368

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 CHAPTER 1
1.1 INTRODUCTION
Humans are social beings who do not live or work in seclusion but are constantly
interacting with people from different cultures around the world. Resulting from this, it
has become critical for proper planning, development and management of this
relationships both consciously and unconsciously in the work environment in order to
ensure the goals and objectives of the organization are achieved.

Human resource (HR) department in organizations are usually poised with the
function of managing the relations between people in the work environment. Human
Resource Management (HRM) uses theories and ideas from several field of studies
such as Management, Psychology, Sociology and Economics to analyze how people
can be managed effectively (Anon., 2012). Human Resource Management (HRM)
which is responsible for recruiting employees is poised with the task of ensuring that
its employees possess the requisite training and skills needed for the organization.
Managing people is a difficult task and responsibility for the HRM which stems from
the unique nature of individuals who have complex needs and wants.

The Health and Social care sector requires people with requisite knowledge,
compassion and skills, as its primary responsibility involves providing care to people.
However there exist several setbacks with workers of the health and social care
sector in the prompt discharge of their duties due to several factors such as
remuneration, working conditions and health. The HRM is poised with ensuring that
despite these shortcomings the employees are adequately managed. As a result of
this, development of strategic policies which would ensure the employees are
aligned with the objectives of the organization is necessary by the HR. This would
ensure that the workers stay motivated and achieve their job satisfaction.

This essay is focused on Managing people in the Health and Social care with focus
on improving the performance of workers at the Accident and Emergency (A & E)
department of the University Of Uyo, Teaching Hospital (UUTH). This essay would
identify the key challenges facing workers in this sector and its effect on their
performance and also suggest solutions to mitigate this challenges so as to improve
their poor performance. Theories from the Human resource management would be
used to analyze this challenges.

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 CHAPTER TWO

2.1 LITERATURE REVIEW

2.1.1 HUMAN RESOURCE MANAGEMENT

Studies in literature reviewed a wide range of definitions on the concept of Human
Resource Management (HRM) with some referring to it as the process of recruiting,
training, compensating people and further developing effective and strategic policies
for them to relate to (Anon, 2012). Armstrong in (2016) defined HRM as a strategic,
integrated and coherent approach to the work, advancement and welfare of
individual employed in an organization. Boxall and Purcell (2016) also described
Human resource management as the process through which management builds the
workforce and tries to create the human performances that an organization needs.

All these definitions have similar meanings which reflects on people are recruited
and managed in an organization by the Human Resource Manager. Poole in (1990)
described Human Resource Management (HRM) as strategic and which involves
mostly managerial personnel and considers employees as an important asset to any
organization. It enhances the organization performance, employees need and
societal well-being. The HRM maximizes the contribution of employees to an
organization, its productivity and effectiveness whilst also attaining their individual
and societal objectives. (Nishikant, 2014)

Maslow in (1954) developed a theory which identifies the needs, hunger and wants
of an individual, he placed this needs in a hierarchy of increasing and decreasing
order. He classified the lower needs as primary such as food, shelter, sex and
physical security while the greater needs as self-actualization and love for others.
Self-actualization which is the last level of Maslow’s hierarchy translates to
maximizing an individual potential at work.

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 Figure 2.1: Maslow’s hierarchy of needs

Employees often desire to feel they are doing their best in their various positions
which invariably helps them feel motivated and continue in their various career path
to success. The Human resource department are also responsible for developing
policies and strategies that would help employees self-actualize themselves for an
overall job satisfaction.

. Figure 2.2: The role of Human Resource Management (HRM) (Anon., 2012)

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2.1.2 STRATEGIC HUMAN RESOURCE MANAGEMENT (SHRM)

The term HR was commonly used until the 1990s when the word Strategic Human
Resource Management (SHRM) was used to replace it. This was to ensure that the
HR are aligned with strategies and practices that are beneficial to the institution.
(O’riordan, 2017). This resulted from shortcomings across the Human Resources
(HR) roles as the human aspect principally responsible from paying attention and
attending to the needs and concerns of the employees were often neglected as they
were more focused on being strategic (O’riordan, 2017). The primary role of the HR,
is reflecting the benefits of Human Resources practices and how it affects the overall
performance of the organization. Research in this field showed that good HR
practices increases the motivation and commitment of a staff which invariably
impacts positively on their productivity and performance (O’riordan, 2017).

Boxall in (1996) described Strategic human resource management as an interface

between Human Resource Management (HRM) and strategic management. It
proposed that having employees who are skilled, motivated and capable are
advantageous and SHRM is poised towards ensuring the recruitment, support and
development of employees to yield a suitable outcome (O’riordan, 2017). Armstrong
and Taylor (2015) argued that HR strategies helps to emphasize the ideology that
‘except you know your destination, you would not know how and when you get
there’.

2.2 MANAGING PEOPLE PROBLEM- PERFORMANCE MANAGEMENT

Human Resource Management (HRM) ensures that an employee’s performance

commensurate with the expectations of the organizations. This often requires the
Human resource department to develop strategies and policies for checking the
performance of employees in organizations through a performance management
systems (PMS) (Basaza, 2016).

Performance management as defined by (Anon, 2006) is what and how an

organization does to realize its goals against performance targets, in order to deliver
effective and efficient services. The HRM develops performance management

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systems to achieve the best of people in the workplace and to deliver excellent
services to its customers.

Aguinis in (2009) further described performance management as a continuous

process of identifying, measuring and developing the performance of individuals and
aligning their performance with the strategic goals of the organization. This is a
critical aspect in the area of Human resource management, often times the concept
of performance management is often muddled with performance appraisals, however
performance appraisal is a component of the performance management system.

Figure 2.2: Impact of HRM on organization performance

Studies by (Norton, 2004) tried to propose ways of measuring an employee’s

performance both in the private and public health sector. Performance is referred to
as a dependent variable which is often measured in terms of efficiency,
effectiveness, and timeliness. It has been observed that employees perform better
when they are aware they are been appraised based on their performance at work.
(Radnor & David, 2007) Indicated that performance management is management
based on performance, it measures and reports an employee’s performance which
often results in an improvement in their behavior, motivation whilst also making them
creative.

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Potter and Richard in (2004) showed that the work environment plays an important
role in improving the performance amongst staff, this often entails addressing system
issues such as the decision making process, information exchange processes, and
capacity issues such as workload, infrastructure and support services. An
employee’s performance are the job related activities an employee is expected to do
and how well those activities were executed. This performance are usually assessed
either annually or quarterly so as to help employees identify the shortcomings in their
performance.

Studies conducted by (Pulakos, 2004: Armstrong, 2012) suggests that an

employee’s performance improves when the management are concerned and
support their activities. Also when an employee perceives that the organization
management support their job related effort, they are more likely to improve their
performance so they can be noticed. Frederick Herzberg (1959) proposed a two
factor theory on motivation, he implied that certain factors results in satisfaction while
there are some job factors that prevent dissatisfaction. Herzberg’s two factor theory
of motivation, proposed that employee motivators give positive satisfaction while
hygiene factors such as (status, job security, salary, fringe benefit, work conditions)
that do not give positive satisfaction results in job satisfaction. This also implies that
self-motivated employees tend to exhibit good performance even if they are not
given enough external motivation but an increase in their performance is observed
when they are motivated.

Celtek in (2004) proposed that employers should pay close attention to their
employees and ensure they stay motivated for the purpose of the organization. This
is based on the fact that employees are affected by events happening in their
environment to a large extent. Mabey et al in (1999) prescribed a model in the form
of a performance management cycle, which suggest how the performance
management system should be implemented in an organization. The cycle requires
that the employees set achievable goals which they are expected to achieve in order
to be assessed adequately. The cycle contains 5 major elements which includes:
setting of objectives, measurement of performance in reference to the set objectives,
the managers provide feedback on performance results to employees, rewards are
given with regards to the employee’s performance, and further adjustments to the
objectives and activities for future improvements (Mabey, et al., 1999).

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 Figure 2.4: Performance Management Cycle

In (Salaman, et al., 2005) two theories were proposed under the concept of
performance management which were the Goal setting theory and the Expectancy
theory. In the goal setting theory by Edwin Locke, it was suggested that individual
goals set by an employee’s helps to motivate them into performing optimally while
Victor Vroom who proposed the Expectancy theory suggested that employees would
naturally adjust themselves based on their expected satisfaction of goals set by
themselves (Salaman, et al., 2005). This is imperative to the benefit of achieving set
goals, assessing the performance of an employee and the attainment of these goals
help an individual to stay focused.

2.3: PROBLEM STATEMENT- POOR PERFORMANCE

This essay would address the poor performance of Healthcare workers employed at
the Accident and Emergency (A&E) Department of the University of Uyo, Teaching
Hospital. The Emergency department of any healthcare provider is usually a high
pressured environment where the medical staff are often poised with many
challenges. The key responsibilities of the first responders (Nurses) in this are to
attend to emergency situations and promptly administer first aid to patients so as to
stabilize the patients before further attention is done by the Medical Doctors (JPS
medical, 2012). Ambulances oscillates with casualties in and out of the emergency

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room, also people from the streets often work in with all sorts of minor/major injuries
or medical conditions for treatment. This is always a busy time in this department
which often requires the right skills and competence of staff to be a successful
worker in this department. It is also necessary that this role offers its workers lots of
job satisfaction which is often reflected in their performance at work.

However, since the Covid-19 pandemic there has been a negative decline and
output in the performance of staffs in this department. Many suggests this may be
due to the non-payment of Hazard allowance which affected most health care
workers who lost their lives during the period of the Covid-19 pandemic. This
resulted in the staff thereby causing the remaining health workers to work extensive
hours with more excessive workload. NHS also reported Workforce burnout amongst
the NHS staff leading to resignation from staff, medical blunders on the increase
thereby putting the safety of patients at risk which a committee of MP disclosed
(NHS society,2021 ). This problem which was worsened by the Covid-19 pandemic
has greatly affected both the Health and Social care services thereby exposing it to
the danger of not working effectively. Staff are constantly requesting for sick-leave
and even resigning due to the effect of this, their performances at work has grossly
been affected by this excessive workload which has been identified as a key driver of
this problem.

It has however been observed on several occasions and reported that most nurses
in the public sectors of the Health care system are not prompt at attending to
patients with emergency issues despite the urgency for care and most times
relatives of patients have to keep demanding for their prompt attention. This often
results in more complications and eventually high casualty and death rate. Surveys
conducted by health workers suggested that the motivation of the employees have
declined as a result of the working conditions they experience while at work. This
working condition as demonstrated in Figure 2.5 below play a crucial role in the
performance of the employees.

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 Figure 2.5: Factors affecting the performance of employees

2.5 SOLUTION TO HUMAN RESOURCE PROBLEM

Poor performance by workers does not necessarily stem from them being lazy or not
skilled, it often requires managers to investigate why their workers are performing
below their expectations. There are several reasons workers behave poorly at work,
such as lack of training or adequate skills, health, poor welfare etc. (McGregor,
1985) it is however important that organizations provide employees and managers
the criteria that makes for an acceptable level of performance. This requires
adequate planning for performance reviews by the Human Resources department
(O’riordan, 2017). The use of a performance management system would help the
organization effectively address this issues of poor performance amongst
employees. If employees are aware their performances are assessed, it would curb
poor performance as employees would strive to impress their employers in order to
have an excellent appraisal.

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Maslow hierarchy of needs shows that when employees are highly motivated, they
perform highly and vice versa. This shows that it is important that employers take
cognizance of its staff welfare in other for them to perform optimally (Swanepoel, et
al., 2014). If the organization has records or reports of poor performance, it will
tarnish the image of the organization. In the case of the problem stated above which
resulted from the Covid-19 pandemic, poor welfare of the workers could have led to
the demotivation.

The Causal model of working conditions has been shown to influence an employee’s
performance in the workplace. This has showed that a Strategic Human Resource
Management leads to an excellent human resource management system which has
the ability to increase an employee skill, motivation and job design. This involves all
the necessary steps taken by a business to ensure they are getting the best
performance from their employees. This often involves the review of employees’
performance as well as developing procedures for addressing underperformance. In
other to improve the service delivery of workers in the healthcare sector there has
been many reforms which believes that incentives could play a role in improving
performance (Basaza, 2016).

Research shows that employees working in the public sector work less and are paid
more. In the (Brief, 2005) it was suggested that this has a high possibility of affecting
their performance as there are no motivations to make them perform optimally if they
are paid excessively. It is imperative that Performance management system which
measures an employee’s performance against his set objectives and rewards their
performance based on the achievement of their set goals be implemented. This
would go a long way in ensuring that employees stay motivated in order to improve
their performance.

For instance if the Nurses at the Accident and Emergency Unit understand their
rewards are dependent on their performance they would be willing to work extensive
hours and put in their best since they will be rewarded for their performance. There
has been evidences demonstrating the success of the application of these principle.
Byrnes in (2006) showed how the Nucor’s steel system adopted a performance
based compensation for its employees and how this helped to improve the
motivation of the employers thus leading to their improved performance. Although

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Nucor steel is a private organization but it is expected that this would yield greater
result in the public sector. It has been observed and reported that the public sector
often provides job security and this contributes greatly to its staff underperformance.
The public sector have been reported as providing job security which has invariably
contributed to underperformance

Over the years, remuneration has been shown to be one of the most effective tool for
motivating employees and this has impacted actively on their performance. Using the
pay for performance approach it would also help employers distinguish between the
effective and less effective employees. It has also increased their productivity and
reduce cost which results in improved performance (Brief OECD, 2005).

In (Buchner, 2007) it was proposed that most employees are not comfortable with
performance management system, as it is believed that the process manipulates
employees to work optimally without rewarding their efforts but it is believed that if
the system is adopted it will increase productivity amongst employees. In most
organization, the Human Resource Department are more focused on other functions
such as recruitment, training and ensuring employees are fully equipped with the
needed tools for carrying out their duties (Blain 2009). It is also crucial that the HR
also develop methods for assessing the performance of this staff in other to put in
place policies that will motivate employees into performing optimally.

The HRM should use the Personnel Performance system (PPS) which evaluates the
actual performance of employees against their set targets and rewards them
adequately, and areas where improvement is required should be taken into
consideration. In Fig 2.5 below is a Performance management system, Simon (2000)
proposed that an efficient Performance Management system is human dependent
and the successful implementation of the PMS is dependent on the organization
understanding of the behavioral factors of Performance management (Holloway et
al, 1995). Sole in (2009) further explained that the performance management system
in a public organizations can be influenced by two factors. This factors are either
internal or external. Armstrong and Baron in (2004) stressed that for managers to
effectively manage, a good knowledge of the PMS is required, which ensures that
people are informed of what their expected to do with regards to the organization
objective and also the skills required for delivery on these expectations is provided, a

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feedback process to enable employees meet their performance and having the
opportunity for the employees to contribute to their individual and team target.

Fig 2.6: Performance Management System

The performance management process works firstly by the organization identifying

its goals and developing its strategies on achieving its goals. The HRM would further
decide on ways of ensuring the organization performs optimally at the performance
planning stage and communicate with its individual employees on their individual role
in achieving the overall objectives of the organization. The Employee would further
confirm their ability to achieve their individual set targets to their Managers through
the Employee input, who would in turn assess their performance based on the
achievement of their set goals. The Employee are further assessed and rewarded
where applicable, while review of their performance is given to ensure their future
improvement.

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 CHAPTER 3

3.1 CONCLUSION

Performance Management Systems plays a crucial role in Human Resource

Management. It is a significant tool which would help organizations achieve its core
goals and objectives. With an effective PMS, employees are certain of been
rewarded for their hard-work based on the achievement of their objectives.
Organizations can easily identify the training needs of their employees, strength or
weaknesses and develop policies to strengthen them. The Performance
management system is an effective tool for both the employers and the employees
for ensuring sustained motivation for the staff. This would ensure excellent quality
service delivery and improved performance to de-motivational factors. The Nurses at
the University of Uyo, Teaching Hospital would behave appropriately towards
patients as a result of the pay-based-on-performance structure, as it is evident that
their performance would be appraised which will eventually contribute to the overall
improvement of their performances. The PMS system would not only aid employers
identify high performing workers but will help the organization to achieve its
sustainable growth and development.

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