Hospital Authority (HA) as the largest health care provider in Hong Kong suffers the serious brain-drain problem in recent years. That is the severe shortfall of doctors and the problem will persist and become a challenge for HA in the coming years. According to the statistics provided by HA, the turnover rates of doctors rose from 4.4% to 5.2% during the period of 2009-2011 and reached 6.7% in 2006. The trend of fleeing of doctors resulted from (1) Heavy workload with increasing healthcare demand from Mainlanders. The World Health Organization’s World Health Report in 2009 showed that among global physicians’ density per 1,000 of population, the ratio was relatively high, with a density of around 1.75, compared with 2.99 in Australia, and 2.74 in The U.K.. (2) Low morale with HA ineffective human resources management (HRM) policy (e.g. less career development). (3) Attractive remuneration package offered by private health care sector, including more flexible work schedule. This paper will be focused on HA retention policies for doctors.
Evaluation on HA retention policies for doctors
a. Unable to cater the needs of doctors
The retention policies are unable to cater the doctors’ needs and contribute to low morale and organization commitment among doctors and high turnover rate. Based on Alderfer’s (1972) ERG Theory, individual’s motivation is influenced by whether he/she is able to meet Existence needs (physiological desires), Relatedness needs (relationships with others) and Growth needs (personal development). These 3 needs can be achieved simultaneously. The theory also has a “frustration-regression” dimension, if individual is continually frustrated in obtaining higher needs (e.g. growth needs), he/she will place the importance on another lower needs (e.g. existence needs).
In this circumstance, doctors are continuously frustrated by HA in unable to feed their ERG needs and result in low motivation and job dissatisfaction. For example, HA introduces the reimbursement of specialist examination fee for doctor trainees and it is a good incentive to encourage training and adds value to the staff and the organization in long term. However, it is not the current HR problem encountered by HA. The problem is that specialists are unable to gain the fringe benefits (existence needs). It causes disappointment and low morale among the doctors with experience. On the other hand, doctors in public hospitals agree that external recruiting is the only option in solving the shortage problem in short term. Yet, they think that there is inadequacy of consultation over this policy with them and the process of mutual sharing thoughts is hurt (relatedness needs). They think that their opinions are being under-valued. Finally, HA is unable to provide promising career development (growth needs) to the existing specialist and they feel frustrated. All these mismatch result in low job satisfaction and organization commitment which is highly correlated with the turnover rate.
b. Incomprehensive Environment Scanning
Environmental Scanning refers to the process of searching relevant information outside the organization to pinpoint opportunities and threats. It is especially important for HR in forecasting the workforce supply and demand and implement appropriate policies.
Failure in doing comprehensive environmental scanning causes severe doctor shortfall. In 2002-2003 Hong Kong suffered from economic recession. Moreover, the private primary care market was saturated. Doctors were less willing to leave HA and participated in private sector. The turnover rate of doctor was 3.7% in 2004, excluding the effect of voluntary retirement scheme. In the meantime, HA also limited the recruitment of graduate from Faculty of Medicine of two Universities since there were not enough vacancies in HA. In mid-2003, after the signing of Mainland and Hong Kong Closer Partnership Arrangement (CEPA), Hong Kong’s economy was quickly recovered by closer business cooperation and integration with Mainland.
However, HA HRM did not replenish the recruitment of medical graduates incrementally several years ago. Unable to make appropriate adjustment to external environment in HR planning that result in stringent shortage of doctors nowadays. A few years ago, HA should aware that there would be increasing demand for health care services from Mainland Chinese. For example, the increasing demand for Obstetrics services in public hospitals by the influx of Mainland expectancy women after signing CEPA. If HA were able to identify the situation and trained more doctors specializing in Obstetrics & Gynaecology Department (O&G) or any workforce development earlier, the specialist in O&G will not be severely overloaded and stressful which resulted in highest turnover rate among all specialties in 2010/2011.
a. Personal growth
According to a national Public Sector Rewards of Work Study done by in the U.S. 2007, career opportunities are the biggest force of turnover for employees under age 40. Career development program is what HA needs for retaining existing doctors. Career development can affect employees’ stress, limited promotion impose stress to them since they may think they are unfairly treated. Comprehensive career management programs not only benefit employees with increased personal skill, more job satisfaction, but also benefit the organization with employees’ loyalty, organization engagement and less turnover intention. HA can be attained by providing overseas training, specialty training (e.g. advanced medical technology training), improved appraisal and feedback. HA should let the doctors know that HA values their contribution and is interested in helping them succeed.
To retain talents, the organization should also not allow the talented get stuck on career plateau. Career plateau refers “the point in a career where the likelihood of additional hierarchical promotion is very low.” (Ferrence, Stoner, an Warren, 1997) Nachbagauer & Riedl (2002) found that there is negative linkage between career plateau and job satisfaction. HA should prevent senior doctors from going to private sector. HA can provide alternative means of recognition for employees encountering career plateaus, like Consultants, whose position to be further promotion is unlikely. HA can invite them to employee involvement programs to seek job satisfaction, such as taking part in task forces and brainstorming sessions to organization goals and giving them more authority.
b. To introduce psychological contracts
HA should introduce psychological contract to reduce turnover intention of medical staff. Psychological contract refers to unwritten expectations between employers and employees about the nature of the work. It is subjective in nature and may not be clearly defined by employee himself/ herself. The psychological contract includes tangible items (e.g. salary and compensation) and intangible items (e.g. loyalty and job fairness). Employees are more likely to be committed to the organization if they perceive they have control in the organization. For example, HA should have more consultation with doctors from each level concerning their career development. It not merely can increase the transparency and feedbacks about the policy. It also increases their job engagement and trust to the organization. Employee who believes that he/she can trust coworkers and the justice system in the organization, he/she will be less likely to leave their current employer.
Moreover, the career expectations for women cannot be neglected in forming the psychological contract with employees. HA should consider carefully in handling the pregnant doctors from working prolong hours and over-night calls, especially during the late stage of pregnancy. HA rather than turn down their requests in the excuse of workforce shortage, HA should show their effort in revising working procedures/ workflow to win the loyalty and increase morale of the staff. Otherwise, it leads to the turnover trend of expectancy doctors.
c. To Promote Work-Life Balance
To meet the vision of “Healthy People, Happy Staff, Trusted by the Community”, HA should promote the work-life balance to the existing HA staff. According to the ongoing research done by Community Business in Hong Kong from 2005-2010, it revealed that the extreme work-related pressures cause serious impact on the well-being of employees (e.g. insomnia and poor diet) and also threaten the organizations (e.g. less productive with high rate of absenteeism). To promote a work-life balance program by employer is important in modern society with changing demographics, such as more single-parent families. It is often difficult to balance work responsibilities, family care demands and personal life. A job with a more flexible work schedule is a factor getting more influential for an employee to stay in current job and it is one of the reasons why doctors left HA for more flexible working schedule in private health sector.
It is challenging to promote work-life balance in a major healthcare organization in Hong Kong, since public hospitals have to run 365 days and 24/7 in nature. However, HA has to recognize the impact of poor work-life balance. Prolonged fatigue and overloaded for frontline doctors may cause increasing number of medical negligence and hurt their morale. Hence, a long-term comprehensive communication strategy between HA and doctors is essential. To achieve work-life goals, doctors must be willing to share their specific needs with HA, it is a two-way process. In return, HA should make sure that employees’ needs have been heard and valued in implementing its work-life programmes. Furthermore, appraisals for the programmes should be reviewed by staff periodically to ensure the goal of work-life equilibrium. Thus, this kind of intrinsic reward can gain doctors’ organization commitment and loyalty and they likely to stay with HA.
To tackle the problem of doctor shortfall, a number of short-term measures have been done by HA in retaining the doctors from fleeing to private health sector, like employing more healthcare technician and overseas doctors to alleviating workload. However, the turnover rate keeps increasing. The main reason is that HA policies did not meet the needs of doctors. There are discrepancies between their goals in which leads to disappointment, low morale and high turnover intention. Communication with employees, 360 degree appraisal from employees and comprehensive environmental study are essential in HR planning. Finally, hoping that HA can create healthy and engaged employees.