Training and Development at SKMCHandRC

2015 International Business & Education Conferences – June 7-11 London, UK

© Copyright by author(s) 280-1 The Clute Institute

Training and Development: A Review of Shaukat Khanum Memorial Cancer Hospital

and Research Centre Syed Sohaib Zubair, University of the Punjab, Pakistan Mukaram Ali Khan, University of the Punjab, Pakistan

ABSTRACT

This script presents description of Training and Development (T and D) practices at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC), a world renowned charitable organization situated in Pakistan. Purpose of this study is to highlight and evaluate T and D practices in order to present them as a success tale and model for other organizations. SKMCH and RC claims to pursue the strategy of having state of the art cancer treatment technology coupled with competitively developed workforce. To achieve this objective, Human Resource Department has developed a blend of several training programs that vary from a comprehensive orientation plan to training on the issues of Motivation, Leadership, Brand Activation, Customer Service, Stress Management and other soft skills. A qualitative approach has been used to address the objectives and for that matter, both primary and secondary data have been collected. The analysis focuses on entire T and D process starting from Training Need Assessment to measuring Training Effectiveness. Moreover, text of Raymond A. Noe has been referred to enlighten impact of some different learning theories on training design of SKMCH and RC. In the end, along with the recommendations, impact of environmental factors on transfer of knowledge has also been reviewed. The study also provides a framework for understanding the T and D environment at the organization under study.

Keywords: Training, Development, Human Resource Management, Hospital, Training Effectiveness

1. Introduction “Excellent firms don't believe in excellence - only in constant improvement and constant change” (Tom Peters).

Provision of Quality products and services has today become one of the key requirements of customers of all businesses whether profit or non-profit. In order to achieve quality, continuous improvement is considered to be a major principle. Training and Development (T and D) is one such mechanism of ensuring quality through continuous improvement. Amongst other Human Resource Management functions, T and D is taken as one of the core functions which in today’s competitive environment is aimed at enhancement of knowledge, skills and abilities in the workforce by investing in the employees.

1.1 Background This study explores T and D practices at Shaukat Khanum Memorial Cancer Hospital and Research Centre

(SKMCH and RC) and then highlights mechanisms to evaluate training effectiveness of programs being implemented. Purpose of this study is to review T and D function at Pakistan’s highly reputed non-profit organization in health sector and present it as a model for other institutions. For this matter a qualitative research strategy has been adopted to collect data and analyze it to meet the objectives of this study.

The brainchild of Legend Cricketer Imran Khan came into being on 29th December, 1994 when SKMCH and RC was inaugurated. It was an inspiration of Imran khan that Pakistani nation should have facility of quality cancer treatment, since his mother died from this very diseases.

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Purpose of selecting this organization for this research is the fact that SKMCH and RC has established itself as a center of excellence providing medical treatment free of cost to thousands of indigent cancer patients. This hospital is located in Lahore, capital city of Punjab province. The unique characteristic of this organization is that it is a charitable institute which generates almost 50 percent of its funds from donations across the globe. SKMCH and RC has three main departments i.e. Medical, Administrative and Supportive. The primary facility that this organization provides is medical treatment for the cancer patients. To carry out this activity the support of administrative staff is essential.

1.1.1 Training and Development in the light of Organizational Mission and Human Resource Mission Training and Development has been given high importance by Management of SKMCH and RC, the

organizational mission explicitly illustrates this as follows: “To act as a model institution to alleviate the suffering of patients with cancer through the application of modern methods of curative and palliative therapy irrespective of their ability to pay, the education of health care professionals and the public and to perform research into the causes and treatment of cancer”.

From the mission statement organizational strategy can be derived. It has been ascertained that organization wants to remain competitive in terms of international standards of cancer treatment. Along with this, organization also wants to have such financial base, which would have capacity to address the poor patients who do not have capability of bearing expense of very costly cancer treatment. So the bottom line is, organization wants to have best technical competency of cancer treatment. Technical competency has two dimensions i.e. Hi-Tech equipment and highly trained staff. So for that matter, in order to update knowledge of employees, continuous training and development is indispensable.

In a nutshell, at SKMCH and RC, training and development is responsibility of Human Resource (HR) department. Mission of the HR department vividly fits with organizational strategy that continuous training and development is necessary is to make sure that development of qualified and diverse workforce have expertise in their respective areas, HR department aims:

“To guide, facilitate and coordinate organization-wide efforts to provide innovative, cost effective human resources programs with measurable outcomes in support of the strategic goals of the organization to recruit, retain a highly qualified diverse workforce, develop and reward employees, our most valuable resources and creates a culture that promotes excellence throughout the organization. In doing so, the department of human resource will provide equality of opportunity and workplace equity for all members and employees of the organization.”

1.2 Research Objectives This case study attempts to conduct a comprehensive review of T and D practices at SKMCH and RC using

a qualitative approach and aims to:

• To explore T and D practices and design at SKMCH and RC • To understand the Strategic importance of T and D • To understand the importance of Training Need Assessment • To measure the effectiveness of T and D through evaluation designs

2. Literature Review Training and Development has now become the key feature for an organizations survival today. According to

D.A. Olaniyan and Lucas. B. Ojo (2008), organizations are consistently working on improving performance and productivity; therefore, T and D has now become the prerequisite of enhancing the performance of an organization. Importance of T and D can be judged from its emphasis towards of a training effort as an investment rather than expense. In this global world, organizations have started thinking seriously towards adopting T and D practices. Training is to enhance and develop new knowledge skills and abilities in order to perform jobs. Therefore to bring new hiring’s on to same pitch, training can play a vital role.

Pilar Pineda (2010) emphasis upon evaluation of training programs and suggested that training programs cannot be left in isolation, hence it is necessary to evaluate T and D programs in order to monitor the success rate. Unfortunately, there are quite a few organizations that evaluate trainings in depth due to the obscurity involved and




unavailability of valid instruments and feasible models. Moreover, according to John Wilson and Steven Western (2000), it is necessary for organization success that most of training and development plans must be directly related to the need of the job otherwise, opposite behavior may lead to failure of not just the training effort but also organizational collapse. Jaffet (1969) has explored other dimension of training that Training Need Assessment is a good approach to determine whether an employee needs training or not and also to what extent. In response to this, study concluded that if proper information of an employee has been collected, then it becomes easy for organizations to determine the type of trainings that need to be provided to the employee.

In another study where need of TNA has been discussed, the study seeks to provide an indication of the concept of TNA, existing models and the effect of TNA that is having on nurses of public hospitals in Australia. Thus, “the paper should aid future research in the area of TNA of nurses through helping researchers to clarify the conceptual boundaries of training needs of nurses; providing a theoretical framework that could help researchers in framing their research efforts in the area;” and making a research outline and recognizing the contact this research will potentially have on HR managers in hospitals all over Australia.

Moving from HR context to strategic HR arena, organizations have opened up their gates of T and D towards strategic part of HR. They have started to align their T and D function with part of organizational strategy. This is due to the presence of highly competitive environment within this globalize world. But for existing organizations it is important to get top management support for strategic training and development. “For the organization to gain true value from strategic training and development, senior management must be fully committed to organizational learning”. Moreover, study concluded with the importance of strategic T and D that T and D alone have less significance until aligned with corporate strategy. Because long term existence of T and D plans are related with strategy of organization, otherwise that may lead to end of T and D programs in near future (SHRM, 2008). Furthermore, Zubair and Khan (2014) have asserted that strategic HRM is now being acknowledged by all sorts of organizations and that strategic alignment between different HRM functions can surely contribute highly towards organizational performance.

T and D in medical arena is not new. It is a crucial aspect in medical field or for health professionals as research in medical sciences is fast paced and sensitive because of its involvement in life care. According to Parle et al., (1997), health professionals not only need technical skills but they also need to understand the importance of soft skills as well such as communication, leadership, and others.

3. Methodology and Conceptual Framework of the Study In order to address the objectives of the study, the research methodology that has been adopted is Qualitative.

Qualitative study emphasizes more on appropriateness of the data rather than amount of data, so for this purpose primary data was collected through in-depth interviews with seven individuals from SKMCH and RC’s Human Resource Management (HRM) team first and then Training and Development section under the main HRM department using purposive sampling. Other than the primary interviews, secondary data was also used that included orientation manuals and other T and D specific literature of the organization.

Following diagram (Figure 1) basically, depicts the overall structure of this research and the overall picture of the T and D review conducted at the organization under study. Figure 1 tries to link the different items under study and shows that how T and D has devolved from organizational and departmental mission, what T and D department does and the influence of Management Commitment and Environment on the working. In the end, measurement of Training Effectiveness is focused i.e. how this important function is performed at SKMCH and RC?




Figure 1: Framework for Training and Development at SKMCH and RC

4. Data Analysis and Discussion As discussed in the previous section, it has been observed at the SKMCH and RC that a strategic fit exists

between the organizational mission and the operational objectives of the Human Resources Department. This section of the study highlights and analyzes T and D practices at the organization under study and also attempts to relate them to learning theories with reference to transfer of knowledge along with the impact of environmental factors on the entire T and D process. To begin with, following are some of the generic or basic Trainings that are conducted at SKMCH and RC:

• General Orientation: This feature of the T and D is one of the most primary ones that is usually a part of every organization when a batch of new employees is recruited, purpose of such a program is to familiarize individuals with the systems and norms of the organization, these include: General Information about the hospital, Infection Control, Fire Fighting, Radiation Protection, Handling of Hazardous material, Patients’ Rights and Responsibilities, Usage of Medical library, Pharmacy Orientation, Hospital facilities Tour and HIS (Hospital Information System) software orientation.

Other soft skills trainings include the more important:

• Motivation: Motivated employees are more likely to produce maximum results for the organization, SKMCH and RC tends to motivate its workforce by empowering and engaging them.

• Customer Service/Patient Care: The term customer service seems to be more associated with profit making organization, an organization that focuses on customer satisfaction to boost its sales, but SKMCH and RC being a non-profit organization, focuses highly on the satisfaction of its patients through a well-mannered team.

• Empathy: Continuous sessions on empathy are being conducted by HR to ensure excellence in patient care.




• Conflict Management: Conflicts arise at different levels and to resolve them amicably employees are trained in conflict management and mediation.

• Stress Management: SKMCH and RC acknowledges the difference in responsibilities and domain of its medical staff and administrative or support staff, and hence different stress related training are conducted for both type of employees and does not follow the phrase, “one hat fits all”.

• Brand Activation: Brand Activation is one of the most important features of T and D at SKMCH and RC for the Marketing Team particularly. The hospital is basically a charity based organization, whose major portion of finances comes from several forms of donations not just within Pakistan but also overseas, therefore an emotional connection between the hospital and its donor’s needs to be maintained.

• Problem Solving and Decision Making: Multidimensional approach to problem solving and to make right decisions is another important aspect in which employees are given training.

• Leadership: SKMCH and RC believe in developing leaders from within the organization; therefore ensure specific training on leadership for its employees to enhance leadership skills in its workforce.

4.1 Training Methods used at SKMCH and RC SKMCH and RC is using the following training methods at present in order to enhance different skills of its

diverse workforce:

• Classroom Teaching: o In-house Training Sessions The Organization uses presentations and videos for soft skills

training such as Motivation, Customer Service/Patient Care, Stress Management, Team Work, Leadership and various others.

o External Training Session: Employees are nominated to attend various training outside SKMCH and RC.

• On the Job Training (OJT): This practice at SKMCH and RC mainly includes rotation/job enlargement opportunities for employees. Fresh employees move from one section to the other section to get comprehensive knowledge of all the work of respective department. They learn different aspects personally and experience those by staying in job. As per the analysis OJT is one of the best methods which the organization uses because it helps new employees to understand what are the real problems which they might face in future and how can they deal with them.

• Job Enrichment: Employees are assigned in new roles to organize and plan in order to gain more control over their duties and work as a manager.

• Distant Learning/ Course of Study: Employees are enrolled in distant learning programs, under educational enhancement and course of study.

4.2 Dynamics of Training Need Assessment (TNA) As training is an ongoing activity, Training Need Assessment is integrated with the Performance Management

function of HRM. HR department carry out periodic TNA across SKMCH and RC. As per a senior respondent, “the chief source of TNA is Performance Appraisal which is done annually. There is separate column in PA with the title “Areas where Development is required” which is devoted to identification of potential area that require training or development of an employee”. Appraisal is done by immediate supervisors and then endorsed by Head of departments/ Divisional Heads. This is to reduce/eliminate chances of bias in performance appraisal of an employee. TNA is extracted from the appraisals by Human Resources department.

4.3 Learning Theories and Transfer of Knowledge

Purpose of any learning or training activity is to actually transfer some sort of knowledge into the target audience and enhance their current skills or equip them with new ones. This section of the study does not explain any theory rather it only discusses the relation between some learning theories and how they are being used at SKMCH and RC what more can be done with them:




4.3.1 Reinforcement Theory From training perspective, the role of reinforcement theory is quite important in directing the behaviors of

trainees. In SKMCH and RC, reinforcement of any training or transferred knowledge that results in change in behavior is done through positive feedback and empowerment.

4.3.2 Social Learning Theory This theory explains that employees learn by observing people in their peer group, they usually follow their

supervisors or senior to whom they think are area experts. SKMCH and RC encourage social learning and also use On the Job Training method to enrich the skills of different employees.

4.3.3 Goal Setting Theory Goal Setting theory suggests that goals of a task or project or a training effort should be clear to both trainer and

the trainee i.e. stakeholders should know that what outcome do they desire after the entire hard work or investment. SKMCH and RC uses this approach to training where at the beginning of a session, all objectives and goals are debated and clearly conveyed to all participants so that they are well aware of the outcome. Moreover, clear objectives may also help in measuring training effectiveness later on.

4.3.4 Need Theories The three famous need theories include, Maslows hierarchy of needs, Alderfer’s ERG (Existence, Resource,

Growth) and McClelland’s Achievement, Power and Affiliation needs. Some part of the literature defines the word need as a deficiency in an employee that the individual wants to fulfill or satisfy. Applying need theories to SKMCH and RC enables the trainee to identify by one’s own self that what are the areas that require attention and once individual’s needs and training objectives are matched, the trainee will on its own become motivated and make an extra effort to make sure the knowledge is transferred (received) in the appropriate way.

4.3.5 Expectancy Theory This theory focuses that an individual’s behavior is based on three factors that include expectancy,

instrumentality and valence. When an individual is ready to accept change (or something new) and is sure about the fact that a training activity or program will give him desired outcome and the individual values the importance of entire effort, then the entire investment is likely to result in a greater good for the individual as well as the organization. T and D at SKMCH and RC makes its workforce believe that they can do it and they need it, and does not force them into different activities.

4.4 Employee Development SKMCH and RC not only focuses on training needs of its employees , rather they also try to address the long

term developmental needs of its employees, give importance to individuals set goals and invest in their future. Training is a relatively short-term activity whereas development is a more comprehensive and long term effort. SKMCH and RC has different developmental plans for different cadre of employees’ i.e. Medical, Nursing, Paramedics and Administrative staff. The organization uses several education mechanisms for development of its workforce in ways that are aligned with an individual’s objectives. Following are some of the tools used at SKMCH and RC:

• Medical: Residency Training Programs in different specialty, approved by College of Physician and Surgeon of Pakistan (CPSP), Fellowships in different specialty areas approved by College of Physician and Surgeon of Pakistan (CPSP).

• Nursing Education: Educational Pathway, Diploma in Oncology and Cancer Nursing, Critical Care Nursing Program, Basic Cardiac Life Support, Cytotoxic Drugs handling and administration, Infection Control, Basic Pharmacology and Drug Calculation, Risk Management and Nursing Quality Assurance Workshop and many other related courses.

• Paramedics: Diploma in Respiratory Therapy, Post Graduate Diploma in Medical Laboratory Technology.

• Administrative Staff: SKMCH and RC is committed to develop staff by providing them opportunities for educational enhancement/ course of study according to the need of the hospital and in line with the policy on Return on Service Obligations (ROSO).




4.5 Training and Work Environment It has been observed that SKMCH and RC have got a very congenial working environment for all employees no

matter in which capacity they are providing their services. No traces of a dictatorial culture can be found at this very organization. According to a respondent, “even the C.E.O and a security guard share equal status when they are using a common facility like canteen services”. Employees are always listened and acknowledged by the top management in different ways. All these are indications of a true democratic and friendly culture where recognition is only for merit and effort. This environment has a very positive impact on all tasks and ultimately creates a learning culture within the organization where T and D is eventually appreciated by the entire workforce.

4.6 Training and Management Commitment Management Commitment or Management Support is one of the very important factors that can contribute to

success of any small or large organization. It is actually the top management in any organization that controls the resources and provides resources for some activity. As per one of the employees interviewed, “Management of SKMCH and RC is very supportive when it comes to development of its employees, may they be from any department, which is very encouraging for all of us”. All justified trainings are approved by the management irrespective of costs they may incur.

4.7 Measuring Training Effectiveness ‘Training is an investment’, this quotation is often used by training officials to justify training budgets. But the

question is how it can be determined that the resources invested for training purposes are an investment or an expense. In order to answer this query, determining the effectiveness of all training programs is very essential. Following section illustrates how training effectiveness is being gauged at SKMCH and RC:

4.7.1 Evaluation Design Effectiveness of training means the benefits that have been obtained by both the organization and trainees

after the training effort. According to Noe (2005), there are number of evaluation designs that have been followed by organizations:

• Post-Test only • Pre-Test and Post-Test • Pre-Test and Post-Test with comparison group • Time Series • Solomon four group In SKMCH and RC, effectiveness of training is determined through Post-Test evaluation design. This

organization has developed the instrument to evaluate the training from both trainer and trainee point of view. According to a trainee, “one evaluation form is given to the trainees (participants) which consists of two major heads i.e. Instructor Evaluation and Content Delivery. The first head determines mainly the trainer delivery style, his/her knowledge about the subject, attitude towards trainees and the overall satisfaction towards trainer by the trainees. The second head determines mainly the proper organization of content and its distribution to the trainees well in time”.

This evaluation design determines the validity of training program immediately after training from trainee’s point of view. But the effectiveness of training cannot be determined in just 1 or 2 weeks later. It may take up to 3 to 6 months after which the hospital’s training department circulates the “training effectiveness form” to the supervisors in which they determine the effectiveness of training program from supervisor’s point of view. The focus is to gauge the desired change in attitudes, behaviors, knowledge, skills and abilities of trainees. In the end, feedback every in-house training a summary is prepared, which actually presents how effective a training program has been in achieving its set objectives which is also shared with the trainer.

5. Conclusion Quality service and quality output cannot be achieved until and unless the organization (May it be from any

sector) values the importance of adapting to changes in the environment and introduction of new practices in order to ensure continuous improvement. This can only be achieved if the organization has a well-structured Training and Development department (which is a component of HR department) that is supported by the idea of Management Commitment. According to this study, Training and Development at SKMCH and RC is in a very good shape and is




not only strategically aligned with organizational and departmental objectives but also with other HRM functions. Like this organization, Training and Development programs should always be taken as an investment rather than an expense. Being a Health Care facility /Cancer hospital, SKMCH and RC’s employees not only need to be actively engaged in learning new life saving practices in the medical sciences but they also need to acquire soft skills because of their continuous interactions with patients and their families, and SKMCH and RC values this idea.

6. Research Implications The Study basically attempts to conduct a Training and Development review at a Non-Profit Organization

(NPO) i.e. a Hospital, methodology and framework developed for this research can be used by other researchers interested in conducting a T and D review particularly at similar NPO’s. Such a study shall portray a comprehensive picture of not just the practices at an organization but also help in understanding the impact of factors such as environment and management commitment. Moreover, the framework of this study may also guide researchers in gauging the strategic “fit” between organizational mission and departmental objectives. .

7. References

John, P. W., and Steven Western. (2000). Performance appraisal: An obstacle to training and development. Journal of European Industrial Training 24(7): 384-90.

Noe, R. A. (2005). Employee training and development (3rd edition). Boston:McGraw-Hill/Irwin

Olaniyan, D. A and Lucas. B. O. (2008). Staff Training and Development: A Vital Tool for Organizational Effectiveness. European Journal of Scientific Research. Vol.24 No.3, pp.326-331

Parle, M., Maguire, P., and Heaven, C. (1997). The development of a training model to improve health professionals' skills, self-efficacy and outcome expectancies when communicating with cancer patients. Social Science and Medicine. Volume 44, Issue 2, January 1997, Pages 231–240

Pineda, P. (2010). Evaluation of training in organizations: a proposal for an integrated model. Journal of European Industrial Training 34(7): 673-93.

Society for Human Resource Management. (2008). Strategic Training and Development: A Gateway to Organizational Success. From www.shrm.org/hrnews.

Zubair, S. S., and Khan, M. A. (2014). Job Analysis and Performance Management in Pakistan Army: A Strategic Human Resource Management Perspective. Information and Knowledge Management, 4(10), 51-58.

(n.d.). Retrieved from Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH and RC): https://www.shaukatkhanum.org.pk/

Acknowledgments

a). Mr. Muhammad Ali Khan-Human Resources Manager-SKMCH and RC, Lahore, Pakistan.

b). Ms. Aisha Latif-Assistant Manager-Training and Development- SKMCH and RC, Lahore, Pakistan.

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Training and Development at SKMCHandRC

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description of training

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training design of skmch

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