HRM Innovations in Rapid Growth Contexts: The Healthcare Sector in India

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HRM innovations in rapid growth contexts: The healthcare sector in India
Article in The International Journal of Human Resource Management · May 2014

DOI: 10.1080/09585192.2013.870308
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HRM innovations in rapid growth contexts: the

healthcare sector in India
Vasanthi Srinivasan & Rajesh Chandwani
To cite this article: Vasanthi Srinivasan & Rajesh Chandwani (2014) HRM innovations in rapid
growth contexts: the healthcare sector in India, The International Journal of Human Resource
Management, 25:10, 1505-1525, DOI: 10.1080/09585192.2013.870308
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Download by: [Indian Institute of Management Ahmedabad] Date: 03 March 2016, At: 10:54
The International Journal of Human Resource Management, 2014
Vol. 25, No. 10, 1505–1525, http://dx.doi.org/10.1080/09585192.2013.870308
HRM innovations in rapid growth contexts: the healthcare sector in

India
Vasanthi Srinivasan* and Rajesh Chandwani
Organizational Behavior and Human Resource Management, Indian Institute of Management,

Bangalore
Downloaded by [Indian Institute of Management Ahmedabad] at 10:54 03 March 2016
Human resource management (HRM) researchers have shown that rapid-growth

organizations face HR challenges that vastly differ from their low-growth counterparts.
These include acquiring and retaining key talent, and adapting the mind-set of the
employees as the organization expands in size and scope. However, there is a paucity of
research that examines the HRM challenges faced by rapidly growing organizations in
dynamically growing sectors in emerging economies, particularly healthcare. In this
study, we attempt to fill this gap by examining the HR challenges faced by rapid-
growth organizations in the healthcare sector in India. Through interviews with 23 key
top managers in healthcare organizations, the study identifies the specific challenges
arising out of the privatization and corporatization of healthcare facilities, and the new
emerging business models being used in healthcare delivery. Some of the challenges
are at the sectoral level requiring policy interventions by government, such as stepping
up educational curriculums to keep pace with the rapid growth in the need for
healthcare workers. Others are at the firm level demanding hybridized approaches to
HR both as a function and as a strategy, specifically encouraging companies to innovate
to fill the voids rather than waiting for crisis to appear.
Keywords: evolving environment; healthcare in India; healthcare sector; human
resource issues; rapid-growth organizations
Introduction
Rapid-growth organizations – i.e. those that perform significantly better than their peer
group and the industry average – have long intrigued academicians, policy makers and
practitioners (Barringer, Jones and Lewis 1998; Mason and Brown 2011). Kotter and Sathe
(1978) defined rapid-growth organizations as those which have grown at more than a 20%
compounded annual growth rate (CAGR) over four to five years. Researchers have identified
that the human resource management (HRM) challenges in such rapid-growth organizations
differ from their low-growth counterparts (Rich 1999; Barringer and Jones 2004), especially
in acquiring and retaining key talent, enhancing performance and evolving the mind-set of
employees as the organization increases in size and scope (Kotter and Sathe 1978; Barringer,
Jones and Neubaum 2005; Budhwar, Varma, Singh and Dhar 2006).
The healthcare industry in India is a living example of these HRM challenges. Over the
past few years, the Indian economy witnessed an annual GDP growth rate of 8 –10%.1
While at the time of this writing (in mid-2013), this rate has slowed to about 6%, India is
still one of the world’s fastest growing nations.2 Against this backdrop, the Indian
healthcare sector has been growing rapidly, due to increasing privatization and
corporatization of the sector (Baru 2008). Many healthcare organizations fall into the
category of rapid-growth organizations.
*Corresponding author. Email: vasanthi@iimb.ernet.in
q 2014 Taylor & Francis

1506 V. Srinivasan and R. Chandwani
HR are a critical determinant of healthcare service performance in terms of quality and

cost (Bartram and Dowling 2013). Several studies have highlighted general HRM issues in
healthcare, such as a shortage of nurses, poor commitment and job satisfaction among
doctors and medical staff, and concerns about quality and safety in patient care (Leggat,
Bartram and Stanton 2011; Townsend, Wilkinson and Bartram 2011). However, very little
is known about the specific HRM challenges and practices among rapid-growth firms in a
dynamically evolving sector in a relatively underresearched context like India. The focus
of this paper is on understanding the manner in which firms in the healthcare sector in
India have coped with the challenges of rapid growth. These include the privatization of
healthcare, the development of new business models and the increasing integration of
management systems in healthcare service delivery leading to an infusion of management

tools and methods. Our key research question was ‘How have healthcare organizations
operating in a dynamic and evolving sector in India managed their HRM challenges posed
by this context?’ We posit that to address the HR challenges related to rapid-growth
organizations in evolving sectors, firms have to adopt innovative practices, policies and
systems.
This paper is divided into four sections. First, we provide an overview of the Indian
healthcare sector and identify key changes in its structure over the past decades. Second,
we will examine several specific HRM challenges pertaining to the rapid evolution of the
healthcare sector. Third, we will elaborate on the methodology adopted for the research,
and present our findings. Finally, a discussion and conclusion section situates our findings
in the literature and highlights the importance of further research.
The context: growth and evolution of the healthcare sector in India

The healthcare system in India can be mapped into three broad domains: educational
institutions, healthcare delivery organizations and supporting institutions (Indian
Healthcare Industry 2012; Chatterjee and Srinivasan 2013). Figure 1 illustrates this
ecosystem.
Figure 1. Mapping the stakeholders in healthcare service delivery.

The International Journal of Human Resource Management 1507
A brief description of the three domains is as follows:

Educational institutions: The health sector of a country depends upon the availability
and quality of the professionals, both technical and managerial. In India, medical
colleges, nursing colleges and training institutes comprise the formal educational
system for preparing a skilled HR pool for healthcare delivery: doctors, nurses and
technicians, respectively.
Healthcare delivery organizations: The healthcare ‘delivery’ system consists of both
public and private sectors. The public healthcare system consist of facilities run by the
central and state government which provide services free of cost or at subsidized rates
to low-income groups in rural and urban areas. The private sector includes corporate
hospitals, specialist hospitals and small hospitals.

Supporting institutions: Several industries directly support health service delivery such
as stand-alone diagnostic services, the pharmaceutical industry and its clinical trials
market, and equipment manufacturers. In addition, the rising costs and complexity of
health service delivery, especially tertiary healthcare, has resulted in the exponential
growth of the healthcare financing sector – including insurance companies and third
party administrators (TPAs).
The healthcare industry is predicted to be one of the major drivers of the Indian
economy going forward. During the 1990s, Indian healthcare grew at a compound annual
rate of 16%. By 2020, with an average CAGR of 12%, India’s healthcare sector is
projected to become a US$280 billion industry (Healthcare Industry Issue 1H 2010). The
private sector (comprising large hospital chains and specialty hospitals) will primarily
drive this growth, providing about 40% of healthcare in India by 2015. The public sector
share will shrink to comprising just 19% of healthcare revenues by 2015 (Figure 2).
The growing dominance of the private sector in Indian healthcare services can be
traced back to the evolution of Indian healthcare since the 1950s. This time period can be
split into three phases:
(1) From 1947 to the mid-1970s: In this phase, the government focused its
postindependence initiatives on investing in public health services to manage the
high prevalence of communicable diseases in India. This was in response to the
Nursing Homes Top tier

Mid - tier Govt. Hospitals
2015 30 11 40 19
2005 26 14 26 34
0 20 40 60 80 100 120
Figure 2. Public and private share in Indian healthcare.

Source: Ministry of Health and Family Welfare, Government of India.
Bhore committee report (1946), which recommended investing 12% of India’s

GNP in healthcare to provide accessible services to all citizens. The report called
for establishing a vast network of primary healthcare providers and facilities in the
public sector, supported by secondary and tertiary facilities (Government of India
1946). (Note: These are defined as follows: primary care is received at the level of
the general physician and the first clinic/hospital providing basic care; secondary
healthcare providers are clinics and small- or mid-sized hospitals that provide
specialized services such as dental, gynecological and surgical; tertiary care refers
to multidisciplinary large hospitals that provide advanced medical treatment, and
these are staffed by highly skilled surgeons and experts and often require heavy
investment in equipment and infrastructure.)

(2) From the late 1970s to late 1980s: The investment in primary healthcare services
turned out to be less than that the Bhore committee recommended, as much of
the funding was used for secondary and tertiary care (Banerji 1985). As a result,
the central institutions of Indian government reviewed the underfunding and the
resulting structural inequalities, and recommended an increase in investments and
a renewed emphasis on addressing health problems in rural areas (ICMR 1981).
However, the oil shock of the 1980s and the resulting economic constraints on the
government caused continuing neglect in funding public health, thus further
stunting the growth of public health services (Jesani and Anantharam 1993; Baru
1998). In addition, as the middle and upper classes drifted toward private
healthcare services (Baru 2008), the gap in facilities and personnel grew larger
between the private and public sectors.
(3) From the 1990s to the present: Called the neoliberalization phase, this period has
witnessed the most significant investments occurring in the private sector, and an
increasing shift to private healthcare services delivery (Sengupta 2010). The
Health Policy of 2002 affirmed a need for ongoing private sector growth, though it
also called for public – private partnerships. While the public health sector
investment doubled from 1980 to 2004, the private sector grew eightfold
(Sengupta 2010).
The private sector has been the dominant provider of healthcare services during all
three phases, but the pattern of private participation has changed considerably (Jesani
and Anantharam 1993; Baru 1998, 2008; Sengupta 2010). In the first phase, private
participation mostly comprised practitioners providing primary and secondary care
through individual clinics. The second phase was marked by the rise of small hospitals
(less than 30 beds), owned and managed by doctor entrepreneurs, providing secondary
care, mainly in urban and affluent rural areas. The last decade has seen private capital
flowing more into establishing large tertiary care hospitals (more than 100 beds) and
corporate hospital chains.
Since the 1950s, significant sociocultural changes have also impacted healthcare in
India. These include a highly changing demographic profile, driven especially in the last
two decades by a growing young population, a burgeoning middle class and rising per
capita income. These sociocultural trends have impacted healthcare by changing the
patterns of disease burden and increasing the costs of most healthcare services.
Two critical trends in healthcare in India

In the end, this combination of significant structural and sociocultural changes is driving
two key trends in healthcare in India: (1) the privatization and corporatization of
healthcare and (2) the development of new business models in healthcare delivery
(Bhattacharyya et al. 2010; Sengupta 2010; Mukherji and Swaminathan 2013).
The privatization and corporatization of healthcare

The Ministry of Health and Family Welfare projections show that large corporate hospital
chains, which are growing at an exponential rate, will handle about half of the healthcare
delivery in India (see Figure 2) by 2015. This is due, in part, to the fact that the public
perceives private healthcare to be of better quality than public. Furthermore, as the
complexity of healthcare increases, especially at the level of tertiary care, there has also
been a greater need for multidisciplinary care under one roof. This requires investment in
physical and technical infrastructure. The large corporate hospitals are able to attract
private investments and are scaling up their services at a rapid pace to meet this demand
(Health Tourism: Destination India 2010; Sengupta 2010).
This privatization and corporatization of the healthcare sector has significantly altered
the management of the healthcare delivery system, particularly as it impacts doctors. Until
recently, the majority of doctors in the private sector were clinician-owner-managers of
small hospitals (Baru 1998). Because of their size, these hospitals were managed in an ad
hoc manner and the need for professional management was not recognized as important.
But the move toward the corporatization of healthcare has created the need for large
hospital chains, whose operations require professional organizational and management
skills. The effective delivery of interdependent tasks in a multidisciplinary care means that
professionals must learn to work as a team, a relatively new skill for doctors who are
experts in their respective specialization and comfortable only within their domain
(Falkenberg 2010). This also requires a shift in mind-set on the part of doctors, from the
role of clinician-owner-manager to the role of clinician-manager-employee.
As the scale and size of hospitals increase, the power dynamics are also changing
dramatically with the entry of management professionals into the role of hospital
administrators and managers. Their goal is to create ‘operational efficiency’ using better
reporting and monitoring tools, along with management systems to reduce variation in
‘patient experience’. Their authority makes them more powerful within a structure that
was traditionally the domain of the owner-doctors (Falkenberg 2010). All of these have
had a direct impact on the selection, retention and management of both doctors and the
administrators in the sector.
New business models in healthcare delivery

As the demand for healthcare grew rapidly, new business models emerged to fill gaps in
the delivery system. For example, as the cost of healthcare increased, significant
institutional changes have occurred in the ‘healthcare financing’ domain (Mavalankar and
Bhat 2000). The penetration of health insurance in India is currently less than 15%, a large
proportion of which are government employees (Pandve 2012), but this is a staggering
increase compared to just a few years ago. As awareness about the financial risks of
healthcare increased, the health insurance sector experienced growth of more than 30%
CAGR in just the last five years. This trend is expected to continue in the next five years
and beyond (Vishwanath 2013).
TPAs are another segment that has developed and grown considerably. TPAs are
responsible for administering and implementing insurance schemes and for mediating
claims between hospitals and insurance companies, ensuring seamless transactions
between the involved parties. TPAs have increased 35 – 40% in the past five years and it is
expected that this high growth rate will continue for the next five (Healthcare Industry
Issue 1H 2010). Some TPAs are also developing new business models, such as providing
preventive care and periodic medical facilities to corporations through hospitals (Bhat,
Maheshwari and Saha 2005).
Health tourism and independent pathology laboratory chains have also emerged as
important new elements in the Indian healthcare sector. According to a report published by
IBEF (India Brand Equity Foundation), titled ‘Health Tourism: Destination India’, India’s
share in the global medical tourism industry will reach US$1.1 billion by the end of 2013,
growing at a CAGR of around 21% between 2011 and 2013. India received an estimated
150,000 medical tourists in 2010; that figure is expected to grow rapidly as the corporate
hospital chains expand their marketing outreach into other nations (Health Tourism:
Destination India 2010).
The pathology market is currently 2.5% of the overall healthcare delivery market
(Indian Healthcare Industry 2012), valued at about US$500 million. This industry likewise
has been growing over the last five years at an estimated CAGR of 20% (Healthcare
Industry Issue 1H 2010), and there are now about 100,000 independent pathology labs in
the country. Although the market is currently dominated by local and unorganized players,
the organized segment has reported strong growth with the private sector entering and
expanding the chain of collection centers and diagnostic facilities in rural and semiurban
areas (Indian Healthcare Industry 2012).3
All these subsectors – health insurers, TPAs, medical tourism and pathology labs –
have emerged in just the last decade to fill the structural gaps. Services like health
insurance and diagnostics are effectively ‘intermediaries’ toward a more highly integrated
healthcare management system, centered on large hospitals. The HR challenge here is that
the knowledge and skills required for jobs in these subsectors is novel in the Indian
context. Curriculum development in the formal medical education system has not kept
pace with the demand for talent in these subsectors. Organizations therefore often need to
develop and groom people from within, or reskill employees recruited from related
industries. We can see this with health insurance organizations recruiting and retraining
talent from the general insurance sector.
To summarize, corporatization and privatization, the emergence of new business
models, and the increasing role of professional management now characterize the changing
face of healthcare in India. These trends would pose unique HR challenges for any industry,
but they are especially significant in India’s high-growth healthcare organizations.
There is a paucity of literature that examines specific HR challenges among rapidly
growing firms in the evolving healthcare sector in India. This paper is an attempt to
address this gap by examining how firms in the evolving healthcare sector in India are
managing their HR challenges.
Methodology
Our methodology was driven by two goals: (1) to identify the most challenging HR issues
in rapid-growth organizations in the evolving healthcare sector in India and (2) to examine
how organizations are addressing these issues and challenges. We adopted a qualitative
approach, as this enabled us to acquire a deep understanding of the phenomenon and
facilitated our investigation into ‘how’ and ‘why’ research questions (Yin 2003) on key
HR issues in the sector. These included: ‘How is the healthcare sector evolving or
changing?’ ‘How are these changes related to novel HR issues and challenges for the
sector at large, and for specific organizations in the sector?’ ‘How have organizations
coped with the changes in HR needs?’ Qualitative methods allowed us to explore new
dimensions of the phenomenon and were critical in helping us uncover unique, useful and
meaningful insights from the complex data. They provided for both relevance and rigor
(Eisenhardt and Graebner 2007).
We began by collecting data for the study from organizations in the health sector in India
that have been growing rapidly (more than 20% CAGR). We identified the major players in
the different segments of the healthcare industry as outlined in Figure 2. The inclusion
criteria were that the organization was involved in healthcare service delivery and was
witnessing ‘rapid growth’ as per our definition. The pharmaceutical industry and equipment
manufacturers were excluded from the study, as the challenges in those domains resemble
more the types of HR issues in the ‘product’ manufacturing sector rather than a ‘service’
sector such as healthcare. Those industries warrant a separate study altogether.
Next, we selected organizations where we had access to the top management teams for
data collection. The selection of the organizations was ‘purposeful’ to include all the major
stakeholders in the private healthcare service delivery sector. We collected data using both
primary and secondary sources, as follows.
Primary data included in-depth interviews with the top management (CEO and HR
heads) in the organizations selected, as well as with stakeholders involved in the
healthcare delivery (Table 1). Since the study was aimed at identifying the dynamics of the
Table 1. The primary data sources from different stakeholders in healthcare sector.
Number of
Domain Organization Interviews Profile of respondents
Large hospitals Narayana Hrudayalaya 4 Chairman
Managing Director
Chief Operating Officer
Manager – HR
Aravind Eye 4 Director – Projects
Executive Director
Director – IT
Director – Quality
Fortis Hospitals 1 Head – HR
Manipal Hospitals 2 Head – HR
Chief Executive Officer
Small hospitals Beams Hospital Pvt Ltd, 2 Head – HR
Mumbai Chief Executive Officer
Milestone Multispecialty 2 Head – HR
Hospital, Rajkot Chief Executive Officer
Diagnostic chains Metropolis Healthcare 2 Head – HR
TPA TTK TPA 2 Head – HR
Healthcare consultancy Vidal Healthcare Services 1 Chairman and Executive
Pvt Ltd Director
Health insurance Apollo Munich Health 2 Head – HR
Insurance Company Ltd Chief Executive Officer
Max Bupa Health 1 Chief Executive Officer
Insurance Ltd
Total 23
*Note: Narayana Hrudayalaya and Fortis Hospitals have their own institutes for training nurses attached with the
hospitals.
organizational environment and then mapping the HR strategies for achieving growth in
the environment, the top management and the HR heads of the organizations were
considered to be the most suitable respondents. In choosing respondents, we contacted the
top management teams in these organizations through a focal contact person. A synopsis
of the proposal was sent to them to apprise them of the purpose of the study. We conducted
23 interviews across all organizations. The average duration of each interview was about
one hour. Interviews were taped and transcribed with permission from the interviewee.
Secondary sources in form of cases, reports and documents from the print and the
electronic media were also incorporated to enrich the primary data, wherever possible.
The triangulation of data through other sources and the second author’s long experience in
the sector enhanced the validity of the data and enriched the theory development process
by providing multiple perspectives on the issue (Eisenhardt 1989; Eisenhardt and
Graebner 2007).
Methodology of the data analysis

The interview data was transcribed and analyzed in accordance with Miles and
Huberman (1994) and as used by Dutton and Dukerich (1991). The next step in the
analysis was coding. The coding process entailed extracting relevant categories, themes
and concepts from the data. The first-level was an ‘open coding’ of our textual database
that included the interview transcripts, field notes from the visits to the organization and
secondary data in form of documents, to uncover common themes and concepts (Glaser
and Strauss 1967; Locke 2001). As the data analysis entailed an iterative process,
flowing back and forth between the theoretical constructs and the empirical data,
additional codes emerged and the codes were further refined (Glaser and Strauss 1967;
Eisenhardt 1989).
In a second round of coding, codes similar in meaning were collapsed to second-order
code categories. The idea was to move from empirical data in the form of the informants’
accounts toward a more conceptual and general explanation, that is from data toward
theory (Locke 2001). Throughout the data analysis, we identified new emerging themes
and explored new relationships between the concepts. Following Pettigrew’s (1990)
directives for qualitative research, while we did approach the research question with
established theoretical constructs drawn from the HRM literature, we did not impose them
on the data. Rather, we considered how the detailed empirical evidence from the field
might, or might not, inform the existing theory or constructs. We especially considered
how the data contributed to our understanding of (1) the HR challenges faced by rapid-
growth organizations and (2) how the organizations were attempting to overcome these
challenges. Then, based upon the theoretical framework that emerged from the data, we
reconsidered the data and clarified particular issues, which led to the refinement of our
themes. The analysis and interpretation of the data is presented in the next section.
The two researchers did the coding independently, yet the final themes identified
showed considerable congruence. A few minor discrepancies were resolved through
mutual discussion. For example, some of the first-order categories in our codes fit into
either of two second-order categories, which is a common occurrence in a meaning
condensation process. In such cases, we discussed the categories and reexamined the
statements in the data until we reached a mutual consensus. This intercoder unanimity,
thus achieved, enhanced the robustness of our process of meaning condensation.
In order to enhance the reliability of our analysis and interpretations, we presented the
summary of findings to key informants from the organizations. The conforming feedback
from the informants enabled the researchers to resubstantiate the link between the theory
and data.
Key findings and interpretation

Our study supports many findings from earlier researchers regarding the HR challenges
faced by organizations in rapidly growing contexts, such as scarcity of talent, high attrition
and turnover, and challenges in work/life balance (see, e.g. Budhwar et al. 2006;
Nagadevara, Srinivasan and Valk 2008; Agrawal, Khatri and Srinivasan 2012). However,
our interpretations pertain specifically to the healthcare sector. In the following sections,
we focus explicitly on describing those findings that are unique to the sector and embedded
within the larger institutional context of India.
Severe talent shortage

The scarcity of skilled HR in the healthcare sector is quite severe and ubiquitous in India
(Table 2). While the international norm is a minimum of 25 skilled health workers per
10,000 population (doctors, nurses and midwives), in India the density of health workers is
shockingly lower – only a little over 8 per 10,000 population. Of these, 3.8 are allopathic
physicians, 2.4 are nurses and nurse-midwives (Ministry of Health and Family Welfare,
Government of India), and the rest are medical personnel practicing other medical
traditions like Ayurveda, Homeopathy and Unani, which are widely prevalent and
recognized by the government.
The scarcity of talent exists at all levels of health workers: doctors (both, junior and
senior levels), nurses and technicians. As the HR head of a large hospital remarked:
We are facing a huge shortage of all types of health workers, doctors, nurses and technicians.
Among doctors, the impression is that the scarcity would be at the specialist level, but for us,
the scarcity is much more at MBBS level (entry level) . . . we don’t get enough duty doctors to
run our casualty or emergency rooms . . . most of these people are preparing for their post-
graduation entrance examinations and are not interested in working at the entry level in a
hospital . . .
The demand for doctors is accentuated due to rapid growth, while the supply of talent is
limited by the number of seats in the medical colleges. The gap is being filled in the private
sector by hiring doctors from rural areas and from public hospitals, which, of course,
further aggravates the shortage of medical personnel in the public healthcare system and
impacts accessible and affordable healthcare delivery for the poor.
The organizations studied have coped with this shortage by recruiting doctors trained
in traditional systems of medicine and then retraining them to treat casualty and
emergency cases. These doctors work under senior doctors, trained in Emergency Room
management. This allows hospitals to provide better services and also moves doctors
trained in other forms of medicine into allopathic care.
Table 2. Supply and demand of medical personnel in India.

Category Supply: statistics as of 2007– 2008 (persons) Demand: required (persons)
Physicians 660,801 1,200,000
Dental surgeons 73,000 300,000
Nurses 1,371,121 2,100,000
Source: Ministry of Health and Family Welfare, Government of India.
The talent pool availability in nursing is equally a major challenge for hospitals.
Historically, nursing has always been a sector with a perennial talent shortage in India.
Respondents from large hospitals stated that they have established their own nursing
training institutes to create a talent pool. They have also heavily invested in setting up in-
house training facilities to provide specialized and continuous training to their nursing
graduates. Nursing students are provided internships and are hired from the institutes as
campus graduates to strengthen the talent pool in the hospital. However, since demand for
trained nurses is very high across the globe, the migration of nurses overseas is very
common. The career pattern for Indian nurses is a recognized degree from a nursing
college, followed by on-the-job experience in a large reputed hospital, and often then it is
followed by a highly paid nursing job in the Middle East, Europe and the USA. Indian
nurses thus fill the shortage of nurses globally, but not in India.
In the case of paramedical and the technical staff, the HR challenges are different.
These jobs are very demanding in terms of the emotional involvement, working hours and
nature of work involved in patient care. Other rapidly growing sectors offer jobs that are
often seen as more rewarding and less demanding than the healthcare sector. As the
administrative head of a large healthcare organization mentioned:
At the level of technical staff, people don’t want to work in healthcare . . . they can easily
work in a mall where the work is easy and cleaner . . .
The other high-growth industries where the work is less demanding than in healthcare,
such as retail, garment, business process outsourcing and financial services, draw their
employees from the same talent pool from where technicians and health workers are
sourced, thus enhancing the competition and posing a challenge for healthcare
organizations. One of the respondents mentioned that their hospital, a large eye care
facility, employs more than 400 girls who have passed high school. They are trained on
various aspects of eye care including semitechnical skills like vision testing, which do not
need the services of a specialist. The Executive Director of the eye care hospital expressed
difficulty in finding enough girls who are high school pass outs (i.e. graduates) to fill these
positions, since other industries like textiles are eying the same talent pool.
The overall skills shortage in India has been noted and has become popular as ‘the
Bangalore bug’, referring to how the software industry that emerged in Bangalore in the
1990s has attracted a huge number of workers (Rajan and Subramanian 2006) from other
sectors. Over the last two decades, the high-paying software services sector exerted a
competitive squeeze on talent to the detriment of all the other sectors. The ‘Bangalore
bug’, coupled with the skill gap arising out of the problems in education, have meant a
perpetual shortage of talent in all evolving sectors of the Indian economy.
From an overall talent perspective, what is undeniably apparent in India is a severe and
continuing shortage of skills across all disciplines and job categories in the healthcare
sector. Our findings supported those from other studies (Agrawal et al. 2012) but they also
provided insights into how the talent pool is being adapted and shaped by the recruitment
strategies of hospitals to obtain a competitive advantage, such as establishing their own
schools, developing extensive training programs and identifying alternate sources of
recruitment.
Lack of HR professionals with experience

Another key finding of our study is related to paucity of HR professionals with prior
experience in healthcare before moving into the profession. To wit, the researchers did not
meet a single HR professional who had a background in the healthcare sector. Prior to its
rapid growth in the last decades, as outlined earlier in this paper, the health sector did not
require HR professionals since it was largely composed of public hospitals and small
private hospitals. Owner-doctors managed HR functions themselves rather than hire a
professional. Most HR professionals in the hospitals were usually not from the domain of
healthcare and had not been specifically trained for the sector.
Our interviews and visits to various institutions lead us to argue that the context of
healthcare is unique and HR professionals trained in other sectors may find the job
transition difficult. The HR head of a large chain of hospitals agreed with us, saying: ‘In
the healthcare space, HR does not exist, virtually . . . To manage hospitals you need high
quality/high profile HR professionals specifically trained for the purpose . . . ’
The dynamics of the healthcare sector pose distinct challenges for HR professionals in
the future. We see two unique issues for HR professionals in this sector, namely (1) the
customer is a patient who is suffering, not simply purchasing a service, and (2) healthcare
organizations have a unique organizational structure.
The customer is a patient: In the healthcare sector, the customer or the client is a
‘patient’ who is suffering from a disease and has come to the healthcare service provider
for improvement in his health. The definitions of ‘customer care’, ‘customer satisfaction’
and ‘quality of care’ have different meanings in the context of healthcare compared to the
hospitality sector. As explained by HR head of one of the large hospitals:
Many times a comparison is made between a hotel and a hospital, but the situation is entirely
different. People come to hotel for pleasure, but here they come because of pain. While
hospitality is a glamour-oriented industry, here it is a matter of life and death . . . .
Furthermore, the characteristics of the healthcare context emphasize the role of adhering
to ‘ethical practices’ and promoting a ‘caring’ environment. A key organizational
challenge for healthcare service organizations – and hence a critical HR issue – is to
promote and maintain an organizational culture that reinforces the values and ethos
required for compassionate healthcare service delivery. The care and compassion aspects
in the delivery of health services become critical especially in the context of the delivery of
accessible and affordable quality healthcare services. The nurses, who constitute about
two thirds of the staff in a large hospital, are primarily involved in the care-giving role.
Hence, to promote a culture of compassionate care, proper acculturation of nursing staff is
essential.
Healthcare organizations addressed the talent shortage among nurses by entering into
the ‘nursing education sector’. Most of the large hospital chains now have their own
nursing schools (see Table 1). They also take fresh graduates from nursing colleges and
provide them with further training in order to socialize them to organizational values and
culture. As the CEO of a large hospital chain stated:
Attrition in nurses is very high and will remain so till there is continued demand from the Gulf
countries . . . . We have established a teaching institute for nursing through which we attempt
to bridge this gap . . . when we have the in-house training facilities, we can train the nurses
according to our [own] organizational values and culture . . . we don’t take experienced
people for nursing staff as it is difficult to mold them according to our values and culture . . .
We get a pool of trained nurses from which we can select the [best] candidates if they fit with
our organization’s ethos . . .
Unique structure of healthcare organizations: Unlike other sectors where organizational
structures are pyramidal, healthcare delivery in large multispecialty hospitals requires
one-on-one interaction and coordination between employees from various departments
and is therefore seen as ‘cylindrical’. According to CEO of one of the large hospitals:
We have to deal with many categories of employees: unskilled/paramedical/technical/

managerial/senior leadership . . . all of them in their own way form a critical link in the
delivery process . . . This makes the HR function complex . . .
Patient care delivery teams at tertiary levels often comprise doctors and support staff from
different branches of medicine. For example, in the case of cardiac care, several personnel
from cardiology, cardiac surgery, anesthesia, intensive care and nursing are required to
come together and make decisions. These are not reporting relationships, but rather peer
professionals. Learning from others and analyzing and developing the best case strategy for
a patient are important aspects of quality medical practices in these situations. Similarly,
there are often junior doctors learning skills and sharpening their knowledge by working
with senior doctors from different fields, and these, too, are not reporting relationships in the
context of the traditional organizational structure. The ‘learning’ in patient care delivery
involves a high tacit component, which takes place in an ‘apprenticeship’ mode with
observation, sharing and mentoring across members of a team, rather than reflecting the
classical hierarchical control paradigm. As explained by HR head of a large hospital:
Learning in hospital takes place in a typical gurukulum (a traditional Indian school where
education required staying and being with a teacher for several years) style, where there is a
close relationship between the teacher and the student, the senior and junior . . . . like a
mentor– mentee relationship . . . the juniors learn by being with the senior on the job and
imbibing softer aspects of skills and behavior along with technical medical knowledge . . .
HR professionals in healthcare organizations need to recognize this unique structure of
healthcare organizations and the interdependence between different levels of the work
force required for delivering effective care. Although large corporate hospitals have
started recruiting MBA graduates from top business schools to manage their rapid growth
and deal with privatization and corporatization, many have found that they need to train
and develop the new entrants on the unique HR aspects of the healthcare sector.
In such contexts, the HR function has to add value by building effective patient care
delivery teams that can create higher contributions through collaboration, patient
satisfaction and quality care. Many traditional HR practices must be redesigned to meet
the short-term operational pressures, while catering to long-term strategic goals, such as
staffing and culture building. Overall, this means that HR professionals need to be more
results-oriented and well-balanced in their knowledge as they take on more the role of
being business partners than simply HR people (Ulrich, Brockbank, Yeung and Lake
1995; Yeung, Woolcock and Sullivan 1996). In our assessment, the capability of the HR
function and professionals to meet this need in the Indian healthcare sector appears to be
only nascent and slowly evolving.
Need for strong performance management and reward systems

As healthcare organizations grow in size, strengthening HRM systems and processes
becomes a critical requirement. In this regard, many respondents highlighted the need to
improve performance management and reward and recognition systems. In the large
hospitals of our study, evaluating performance of doctors and linking them to rewards was
indeed seen as the most important challenge of HRM.
Hospitals are complex and have highly interdependent work-flow systems between
various members of the work force. The increasing complexity of healthcare management
entails a multidisciplinary approach to treatment, thus involving close coordination
between different departments. Effective healthcare delivery is dependent upon teamwork
within and across the departments in a hospital.
As a doctor’s professional competence involves both interpersonal and technical skills,

evaluation matrices must be comprehensive and cover both aspects adequately. Some
hospitals have adopted the ‘bell curve’ and ‘normalization of performance’ from other
sectors, but many respondents, including some doctors, were ambivalent about the impact
of this practice.
Many of the large organizations in our study had adopted 360-degree feedback in their
performance evaluations of doctors. This meant that patient feedback was incorporated
into the reviews and assessments. However, most of the HR professionals interviewed felt
that the performance management systems used in healthcare sector need to be simplified.
Some hospitals were in the process of simplifying their evaluation systems and making
them more meaningful, even though doing so was a challenge. As the HR head of one
large hospital noted:
with regards to the issue of performance assessment, we tend to follow the same standard 360
degree feedback mechanism as is followed in other large hospitals . . . we give high
importance to the patient feedback . . . but if you ask me whether we are fully satisfied and
capturing what we want . . . I am not sure . . . In fact sometimes we are not sure as to what we
want to assess . . .
Wherever redesign of reward and punishment systems for doctors appeared to be
happening, it seemed directly tied to the organization’s strategy. Some hospitals that
followed a low cost, high volume ‘social enterprise-based’ business model were realigning
their reward systems with their strategy to provide ‘equitable’ healthcare to all patients
irrespective of their socioeconomic backgrounds. In such cases, a fixed salary with almost
nonexistent bonuses was prevalent – clearly to keep their costs down. In a commercial
organization, by contrast, we found various combinations of fixed salary plus variable
bonuses. However, commercial hospitals were growing so fast that they, too, were
experiencing challenges in realigning their reward systems with their growth in a way that
could meet the requirements of all employees.
Above all, the reward systems in most hospitals appeared to recognize the
development of the medical professionals’ role as a clinician only. Given the changes
in the organizational context, with administrative and managerial roles gaining importance
in the role of a doctor, the reward systems did not as yet seem to recognize the significance
of the managerial element among professionals and thus did not reflect the changing
priorities of the organization.
In short, many healthcare organizations have not yet begun to address the need for
differentiated reward and recognition systems and performance management systems to
cater to the diverse organizational requirements of managerial, clinical and administrative
employees in the healthcare workplace. As the HR head of a large hospital said:
We have not adapted our reward and punishment systems according to the evolution of our
organization . . . we have grown from 250 beds to 3000 beds but the incentives still favor the
‘medical professional’ aspect . . . It’s high time that we think of managerial and leadership
skills as important aspects [of our reward system].
Slow internationalization of HR practices

It has often been argued that the HR profession in Asia is imported from the West through
American and European multinational corporations, the business media, and Western
business schools – and then diffused to local firms (Pio 2007; Yeung, Warner and Rowley
2008). Such diffusion, or isomorphism, occurs because organizations, especially large-
sized ones, have a strong tendency, or are under strong pressure, to copy the most
progressive management trends and ‘best practices’ from successful organizations that
operate under a similar set of environmental conditions and institutional constraints
(DiMaggio and Powell 1983). As firms in Asia become bigger and more global in business
operations, they are more receptive to learning, and copying, HRM practices from Western
or Japanese multinationals.
As a result, Indian subsidiaries of multinationals are under pressure from foreign
partners or parent firms to adopt their practices in people management (Bjorkman and Lu
2001). While other sectors in India have experienced this phenomenon, isomorphism in
the healthcare sector in India was largely diffused through experienced HR professionals
entering the healthcare sector from other sectors, as well as through their interactions with
third-party service providers like consulting and health insurance firms that reflected
the HR practices of their own global organizations. However, the direct transfer of
international practices in hospital and healthcare management does not yet appear to have
entered the sector significantly. Only a few organizations in our study were implementing
globally accepted HR practices.
Lack of training for emerging new ‘positions’ and services

The growth of healthcare sector in India has seen the entry of health insurance and TPAs,
who have created several new positions. Such ‘emerging’ jobs involve new knowledge
and skills, hitherto not required in other sectors. In particular, segments like clinical trials
and actuarial services in health insurance are two areas in which large numbers of
professionals will be required. However, formal education and vocational training systems
have yet to initiate specific training programs for such new jobs. According to Chief
Medical Director of a healthcare consultancy firm:
There are no formal institutions to build competencies in health insurance. There are some in
the life insurance space but not in health. Also, most of the literature [comes from] non-health
[fields]. The National Insurance Academy faculty does not have experience in healthcare . . .
To overcome the acute shortage of skilled employees in these emerging fields, we found
that organizations are introducing job rotation among their existing employees in an effort
to move them into the new roles. Another common practice is to hire people from other
related fields. As a result, organizations are investing heavily in training and development
of these employees, thus raising their human development costs. Another problem is that,
while these training programs may help develop talent for the short term, they cannot
replace the formal and standardized curriculum of a university. Respondents from large
corporate hospitals we interviewed mentioned that their organizations had therefore
started to form partnerships with universities to design courses and build curriculum for
these emerging fields at the national level.
While investing in employees by moving them into these new roles allows the
organizations to develop HR capability from within, those employees who possess
multiple skills and competencies soon become very attractive for competitors. As the
sector grows, such skilled employees either tend to leave their original organization to join
a competitor, or move into other subsectors within healthcare offering ‘niche services’,
which in turn aggravates the talent shortages.
Another challenge faced by rapid-growth organizations is the need for leaders at key
senior decision-making levels. Since these positions are currently filled by employees who
do have insufficient competencies to perform the role effectively, there is a suboptimal
deployment of leadership talent in India. To manage the shortage, many rapid-growth
organizations simply end up tailoring top leadership jobs to suit the competencies of the
individuals. This in turn results in large gaps within the organization, both in terms of
managerial competences and decision-making capability.
Excessive workload on certain individuals, high training demands on new recruits,
positions staffed by individuals with low competencies and many positions remaining
unfilled – all these augment the severity of HR challenges within healthcare organizations
in India.
Slowness in adapting to corporatization

The corporatization and the increased use of management systems in the sector require a
comprehensive change in the mind-set and practices of medical professionals. However,

the training and education of medical professionals in India has historically emphasized
only the clinical or the technical aspects of health. There is very little focus on the use of
management tools and techniques. When doctors and nurses are hired by corporate
hospitals, they often require long periods of socialization to management practices,
information systems and technologies.
Several studies have highlighted the slow diffusion of modern management practices
and technology innovations in healthcare; for example, the unsuccessful implementation
of electronic medical records (EMR) in most hospitals in India (Kumar and Aldrich 2010).
As hospitals transform into corporations, the use of sophisticated management and
technological tools to enhance organizational functioning become imperative. As
explained earlier, the corporatization of the healthcare sector has transformed the role of
doctors from the clinician-owner-manager of a small hospital to an employee of a large
organization with clinical and managerial responsibilities. According to CEO of a private
multispecialty hospital, ‘A major issue is managing the doctors . . . they are highly
educated and skilled . . . how to make them understand and adapt the management
practices of an organization is an issue . . . it requires a change of mind-set . . . ’
All respondents cited that they are now focused on training their professionals in
management systems and information communication technology for the healthcare field.
Special sessions are conducted for employees on healthcare management practices
adopted by other hospitals in India and globally.
Synthesis and summary

The literature on rapidly growing organizations highlights the importance of HRM with
regard to identifying, hiring and retaining committed and skilled human capital (Kotter
and Sathe 1978). It is clear that the HR challenges of rapid-growth organizations differ
significantly from their low-growth counterparts (Rich 1999; Barringer and Jones 2004).
The emerging economies with their high growth rates appear to be especially vulnerable to
some of the HRM challenges. In a special issue of ‘HRM in Asia’, Yeung et al. (2008)
focused on the growth of Asian tigers, arguing that as firms in Asia continue to grow in size
and complexity, critical HR issues like attracting and retaining key talent, developing a
talent pipeline, and creating a high-performing culture must eventually capture the
attention of senior business leaders – either by choice or by crisis. The challenges of talent
management are particularly severe in developing and transitional economies, where
demand for high-caliber HR far exceeds the supply.
Studies on talent shortage in India point to an increasing gap between the Indian
educational system and the requirements of the corporate sector (Nasscom-McKinsey
Report 2005). This is true across all sectors of the Indian economy. Studies on the IT and
software services sector in India, which had experienced a rapid-growth phenomena,

allude to the very similar HRM challenges mentioned above, especially in acquiring and
retaining key talent, developing a talent pipeline, enhancing the performance of employees
and adapting the mind-set of the employees as the organization increases in size and scope
(Kotter and Sathe 1978; Agrawal and Thite 2003; Barringer et al. 2005; Budhwar et al.
2006; Nagadevara et al. 2008; Agrawal et.al. 2012). Educating for the present and future
will continue to be a major hurdle and challenge for corporations in their HR strategies,
policies and practices. The situation will require innovative HR strategies for both the
short term and the long term (Pio 2007).
Given the specific needs of the healthcare sector within India’s national institutional
framework, this study was an exploratory attempt to begin mapping the terrain of HR
issues in a fast-evolving sector. The unique HR issues and challenges faced by healthcare
organizations that this study has been able to identify are enumerated in Table 3.
The table highlights the five key HRM themes that emerged in this study – talent
shortage, absence of HR professionals with experience in healthcare, organizational
systems and policies for emerging organizational forms, emergence of new ‘positions’ and
services in the sector, and adapting existing workforce to the changed context.
It is also evident that many organizations are adopting innovative HR practices to meet
these HR challenges. Table 4 synthesizes the key practices being used to cope with rapid
growth.
Such innovations will be critical in the future, but organizations must take a long-term
view of their HR challenges. For example, while recruiting from other industries, such as
insurance personnel from other domains like life insurance or general insurance, enables
organizations to mitigate their risks in the short term, it requires them to invest heavily in
the training and development of their HR. This is not a sustainable solution in a high-
growth environment.
The future will also call for new ways to create flexibility. For example, one of the
large hospitals designed and implemented a ‘work force differentiation’ strategy (Huselid
and Becker 2011), discriminating between ‘care’ and ‘cure’ employees, which enabled
them to adopt different HR practices for two sets of employees. The selection process for
nursing staff was changed to recruit graduates from college without prior experience. On
the other hand, specialists were recruited based on referrals from existing employees. The
use of differentiated policies for different set of employees have thus provided greater
flexibility to help this organization deal with its unique challenges at each level of staffing.
We also believe that organizations will need to pay close attention to the power
dynamics among doctors and administrators. With corporatization and the increased size
and scale of hospitals, the role of doctors has clearly morphed from the traditional owner-
professional (in small self-owned hospitals) to professional-employee-manager. We
project that organizations will need to adopt innovative HR practices to ensure an
equitable distribution of power between administrators and doctors.
At a national level, with the evolution of new segments like TPAs and health insurance,
Indian educational and management institutions will need to design specific curriculums
and/or formal training programs to develop the skills and knowledge required for jobs in
these new sectors. Educational institutions need support and lead times to change their
curriculum and offer new courses to bridge the skill gap (Dunne and Rawlins 2000).
A review of the guidelines and regulations regarding medical colleges will be essential to
improve the availability of doctors for the country’s health system in the future. Finally, we
believe that the Indian government must begin to play a stronger role in ensuring that
education keeps pace with the rapidly evolving nature of the healthcare sector.
Table 3. Emergent HR themes in the healthcare industry in India.

HR issues in the dynamic healthcare Five emergent themes for HR in
Characteristic feature Sectoral aspects with HR implications sector in India high-growth organizations
Unique aspects † Customer is a patient in distress † Cannot transplant HR solutions from 1. Absence of HR professionals with
of healthcare any other industry to health sector relevant domain knowledge and
understanding
† Highly demanding job † Creating a culture of ‘service’
† Technical as well as relational skills † Establishing smooth coordination
essential between departments
† High interdependence
† Cylindrical structure rather than
pyramidal
† Highly skilled expert employees
Privatization † Greater emphasis on tertiary care † Neglect of capacity in primary care 2. High (and uneven) demand of
specific category of personnel with
required knowledge, skills, abilities,
and other characteristics (KSAOs),
suited for the emerging organizational
structure and forms
† High degree of specialization for † Higher demand for specialists
multidisciplinary care
Corporatization of † From small hospitals to large hospitals/ † Changing role of doctors from 3. Adapting the mind-set of people to
hospitals groups owner-manager-professional to new and emerging power dynamics
professional manager- employee
† Increased use of management tools and 4. Developing new HR systems and
technology (like health management policies for the emerging organizational
information systems (HMIS)) structures and forms and the changing
industrial dynamics
The International Journal of Human Resource Management
Emergence of new † Novel organizational forms and struc- † Absence of formal standard 5. Absence of talent pool with new and
segments like ture and new models of healthcare curriculum for creating skilled HR appropriate knowledge and skills
TPA, Health insurance, delivery requiring specific KSAOs
consultancy
1521
Table 4. HR issues in high-growth sectors &innovative HR practices.
HR issues in the dynamic healthcare Innovative HR practices adopted by the organiz-

sector in India ation to meet the HR requirements
† High attrition rate in nursing staff † Backward integration – establishing training
institutions for the nursing staff
† Creating a culture of ‘compassionate † Hiring fresh nursing graduates and
service’ acculturating and training them in in-house
facilities
† High (and uneven) demand of specific † Hire and train ayurvedic and homeopathic
category of personnel with required graduates to run the casualty and attend
knowledge, skills, abilities, and other emergencies

characteristics (KSAOs), for example
duty doctors to run the emergency room
† Absence of formal standard curriculum † Hiring personnel from other industries with
for creating skilled HR somewhat relevant experience, for example
general insurance personnel for health
insurance
† Absence of HR professionals with † Heavy investment in training and development
relevant domain knowledge and of the existing work force
understanding
† Design new curriculums and programs to
develop specific KSAOs required
† Changing role of doctors from † Areas of concern with several organizations
owner-manager-professional to struggling to develop new HR systems and
professional manager-employee policies for the emerging organizational
structures and forms and the changing
industrial dynamics
† Establishing smooth coordination
between departments
† Managing the changing power dynamics
in the healthcare organizations
Recommendations for further research

This study contributes to the existing literature on healthcare in high-growth economies,
by providing a nuanced and contextual understanding of a complex domain in the
provisioning of a public good. Our findings indicate that the sector requires large-scale HR
interventions, especially in the domains of education, and training and development of
specific talent for the sector. Further scaling up of the health sector, both private and
public, will be dependent upon the effective and efficient capacity-building endeavors at
the organizational and national level.
There is a need for further systematic studies to understand how HR systems evolve to
cope with the powerful forces of growth. Additional research is called for regarding what
Asian healthcare organizations should focus on to better prepare them to capture such
unprecedented opportunities created by dramatic growth and globalization (Yeung et al.
2008). Several scholars have already highlighted the importance of HRM on the
performance of hospitals (Khatri, Wells, McKune and Brewer 2006; West, Guthrie,
Dawson, Borrill and Carter 2006; Bartram, Stanton, Leggat, Casimir and Fraser 2007), and
it is evident that improved HR leadership is needed to implement progressive policies and
procedures to help firms leverage their competitive advantage into the next decades.
As our research methodology was qualitative, future researchers are urged to extend
the current findings to conduct quantitative research that can triangulate the data and
strengthen our insights. Furthermore, though we attempted to cover the temporal
dimensions in our interviews, the research was essentially carried out as a cross-sectional
study. Longitudinally designed studies across time frames will be required to explicate the
linkages between the different aspects of HRM in healthcare sector in India.
This study also points to some corollary directions for future research. For example,
researchers can explore how healthcare organizations resort to HRM innovations as the
sector evolves and which of the innovative HRM practices or policies are most effective in
tackling the issues related to growth in an evolving environment. In addition, there is a
need to examine HR issues and challenges across multiple levels of healthcare employees.
While this paper provided a comprehensive view of HRM in the sector, which was in
accordance with our purpose, further research is necessary to (1) conduct an in-depth
examination of specific HR issues at each level and (2) examine how healthcare
organizations implement differentiated HR systems for these levels.
Due to the complexity of the healthcare sector, we also focused on just a few
organizations in each segment. More in-depth research needs to include a greater number
of organizations within each segment, thereby allowing for theory building in this context.
Finally, we also suggest that future research should test the findings in other industry
sectors that are also witnessing rapid transformation such as financial services and retail.
Such studies can enhance the generalizability of the findings and enable more robust
theory building.
Acknowledgements
The authors acknowledge the contribution from Professors Nagadevara and Mithileshwar Jha and
Mr D.T. Devare for their suggestions on the earlier versions of the paper. The data presented in this
paper forms a part of a larger project support by SAP Labs and NHRD network Bangalore Chapter.
The authors thank Mukta Kulkarni and Jossy Mathew for their comments on the previous versions.
Thanks to the two blind reviewers whose comments helped to significantly improve the paper.
Notes
1. http://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG (accessed on 12 June 2013).
2. http://data.worldbank.org/indicator/NY.GDP.MKTP.KD.ZG (accessed on 12 June 2013).
3. http://healthcare.financialexpress.com/201107/labwatch01.shtml (accessed on 12 June 2013).
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HRM Innovations in Rapid Growth Contexts: The Healthcare Sector in India

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HRM innovations in rapid growth contexts: The healthcare sector in India

Article in The International Journal of Human Resource Management · May 2014

Vasanthi Srinivasan Rajesh Chandwani

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ISSN: 0958-5192 (Print) 1466-4399 (Online) Journal homepage: http://www.tandfonline.com/loi/rijh20

HRM innovations in rapid growth contexts: the

Vasanthi Srinivasan & Rajesh Chandwani

To link to this article: http://dx.doi.org/10.1080/09585192.2013.870308

Published online: 08 Jan 2014.

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HRM innovations in rapid growth contexts: the healthcare sector in

Organizational Behavior and Human Resource Management, Indian Institute of Management,

Human resource management (HRM) researchers have shown that rapid-growth

*Corresponding author. Email: vasanthi@iimb.ernet.in

q 2014 Taylor & Francis

HR are a critical determinant of healthcare service performance in terms of quality and

management systems in healthcare service delivery leading to an infusion of management

The context: growth and evolution of the healthcare sector in India

Figure 1. Mapping the stakeholders in healthcare service delivery.

A brief description of the three domains is as follows:

hospitals, specialist hospitals and small hospitals.

Nursing Homes Top tier

Figure 2. Public and private share in Indian healthcare.

Bhore committee report (1946), which recommended investing 12% of India’s

investment in equipment and infrastructure.)

Two critical trends in healthcare in India

The privatization and corporatization of healthcare

New business models in healthcare delivery

Methodology of the data analysis

Key findings and interpretation

Severe talent shortage

Table 2. Supply and demand of medical personnel in India.

Lack of HR professionals with experience

We have to deal with many categories of employees: unskilled/paramedical/technical/

Need for strong performance management and reward systems

As a doctor’s professional competence involves both interpersonal and technical skills,

Slow internationalization of HR practices

Lack of training for emerging new ‘positions’ and services

Slowness in adapting to corporatization

comprehensive change in the mind-set and practices of medical professionals. However,

Synthesis and summary

software services sector in India, which had experienced a rapid-growth phenomena,

Table 3. Emergent HR themes in the healthcare industry in India.

Table 4. HR issues in high-growth sectors &innovative HR practices.

HR issues in the dynamic healthcare Innovative HR practices adopted by the organiz-

knowledge, skills, abilities, and other emergencies

Recommendations for further research

Concerns, Ahmedabad: Indian Institute of Management.

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