The Importance of Right Person in the Right Place at the Right Time in Private Healthcare Sector in Pakistan : A Case Study of Rehman Medical Institute ( RMI )

Right person in the right place at the right time is one of the most important key for an organization to get and sustain competitive advantage. The importance of human resources and especially in healthcare sector has always been an important area of research both in developed and developing countries. The objectives of this study was to identify and evaluate the recruitment and selection strategies and practices and its effectiveness in private healthcare sector in the province of Khyber Pakhtunkhwa (KPK) Pakistan and also to examine the perceptions and experiences of key players regarding these practices. Being exploratory in nature, researchers have selected RMI as a case for this study. Data was collected through interviews from different levels of employees in RMI. Constant comparative method was used for analyzing the data. Results present that though the effectiveness of the process is encouraging, yet there is no written, coherent and centralize recruitment and selection strategy in RMI. It is true that RMI follows the main stages mentioned in competency based approach but the criteria and methods of recruitment and selection for all levels are not the same.


INTRODUCTION
Human resource is one of the most important corporate assets of an organization and it is human resource which creates competitive advantage for an organization.The overall performance of an organization depends on the way it is put to use.In order to achieve company objectives, it is necessary to recruit people with required skills, qualification and experience (Anne and Bartram, 2012).In today increasingly competitive and globalised world, people have become a cutting-edge factor.Right person in the right place at the right time is the most important key of success for today organization (CIPD, 2005).
People are individuals who bring their own perspectives, values and attributes to organizational life and when managed effectively, these human traits can bring considerable benefits to organizations.Better recruitment and selection strategies result in improved organizational outcomes.The more effectively organizations recruit and select candidates, the more likely they are to hire and retain satisfied employees.In addition, the effectiveness of an organization's selection system can influence bottom-line business outcomes, such as productivity and financial performance.Hence, investing in the development of a comprehensive and valid selection system is money well spent (Kumari, 2012).
Healthcare is an essential service and an effective healthcare system is critical for the health and well-being of the community (Anne and Bartram, 2012).Recently, there has been a significant interest among both academics and management practitioners in the use of human resource management practices within the healthcare sector across many developed countries (Leggat et al., 2010).Studies from the USA, the UK and Australia have revealed strong links between human resource management practices and improved organizational outcomes including reduced patient mortality and improved quality of patient care (Aiken et al., 2000;West et al., 2002;Bartram et al., 2007).
However, in many developing countries and especially in Pakistan relatively little is known about the management of human resources, managerial understanding or even the implementation of human resource practices, (recruitment and selection, training and development, performance management and reward management), particularly within an essential service such as the healthcare sector (Naz et al., 2012).

Problem statement:
The success of organizations in this modern business scenario depends on the quality of the workforce that runs the day to day affairs of the organizations.The process of recruiting and selecting all categories of employees into both private and public companies has been a matter of concern to many and needs attention.Managing people is a great challenge both at strategic or even organizational levels.Thus, human resources are well managed and developed in Fig. 1: Organizational chart of RMI alignment with the organizational goals and strategies.It has been examined that for any organization to achieve its stated objectives and goals there is the need for management to put in place policies or strategies that will help attract the best of employees to move towards the achievement of organizational objectives (Nartey, 2007).
Despite rising attention to delivery of healthcare services in Pakistan, little attention has been paid to the role of human resource management especially  (Naz et al., 2012).Currently, in Pakistan the healthcare system comprises two tiers: public sector healthcare and private sector healthcare.Public sector healthcare is usually provided by the government through national healthcare systems while private healthcare is provided through "for profit" hospitals and self-employed practitioners.Healthcare in Pakistan is administered mainly in the private sector which accounts for approximately 80% of all outpatient visits (Government of Pakistan, 2011).Total sixteen approved teaching hospitals are working in the province of KPK, out of which eight are public sector teaching hospitals while eight are private sector teaching hospitals (Pakistan Medical and Dental Council, 2012).Rehman Medical Institute is the largest hospital in private sector operating in KPK.
In the developed countries both public and private sectors have realized the importance of the human resource management in the delivery of quality healthcare services.But in developing nations like Pakistan, the private sector in particular, has either not recognized the importance of human resource management or they are facing severe challenges in implementing human resource management practices (Naz et al., 2012).

Research objectives:
In this study, the researchers set out to identify and evaluate the recruitment and selection strategies and practices and its effectiveness in private healthcare sector in KPK and also to examine the perceptions and experiences of key players regarding these practices.As RMI is the largest hospital in private sector in KPK, so, in order to dig out the issue in depth researchers have used RMI is a case study for this research.
This study contributes to the human resource management and hospital management literature in a number of ways.First, it is one of the first comprehensive research studies conducted on private healthcare sector in Pakistan and especially in KPK.Second, in order to analyze the issue in depth this research study triangulates the views of both management and employees of RMI.Researchers have used multi-level respondents to drill down and unpack the research problem.Finally, for proper understanding of the research problem this study also provides best practices of developed countries.
Organizational context: Rehman Medical Institute is founded by Surgeon Professor Muhammad Rehman in 1991 in Hayatabad, Peshawar.Located at the gateway of Khyber, Rehman Medical Institute has revolutionized the concept of medical care in the K.P.K.For the first time ever, the people of this area have access to healthcare facilities of international standards (RMI, 2012).
The mission of the RMI is to provide quality healthcare services through state of the art diagnostic facilities and treatment of the highest possible standard in a comfortable, caring and safe environment and also to facilitate the health professionals in their education, training and careers.The organizational structure of RMI is very simple.The whole organization has been divided into four directorates (Directorate of Administration, Directorate of Medical Services, Directorate Finance and Account and Directorate Procurement) and twenty one departments.The HR department is working under directorate of admission (ibid) (Fig. 1).

Structure of HR department:
HR Department consists of five personnel.HR coordinator is heading the HR department.There is no written HR strategy statement.HR department almost entirely focuses on administration and low value added activities such as dealing with contracts of employment, low-level recruitment and training or paper work associated with new starters and leavers.There are nine hundred and fifty (950) employees are currently working in RMI (ibid).

METHODOLOGY
As the study is exploratory in nature, so, the researchers have used a case study research approach.According to Healy and Perry (2000) the case study approach, with multiple perceptions of a single reality provide more detail and in-depth understanding of a research problem.Multiple in-depth interviews were held with key stakeholders to compile information regarding the recruitment and selection strategies and practices within RMI.Ten persons: HR coordinator, HR assistant, two male and two female doctors and two male and two female employees from administrative staff were interviewed.
Data were collected by interviewing different levels of persons in RMI.Firstly, the coordinator was interviewed to gain understanding about the recruitment and selection strategies and practices and the challenges faced by the organization internally and externally.Secondly the HR assistant was interviewed to gain insight into the reality of the implementation of recruitment and selection practices and its implications for HR department in operational level.Both male and female employees were interviewed not only to ensure equality but also to know about the reality of the challenges faced by the HR department during recruitment and selection process.A semi-structured and flexible interview approach was used to collect data.The interviews were supplemented with documentary analysis (internal documents regarding HRM policies and practices, company correspondence with candidates during recruitment and selection and organizational charts).Data collected was compared with theory.

LITERATURE REVIEW
People are the greatest asset in an organization.Making the most of the asset means making people as effective as possible in shortest time (Cook, 2004).
According to CIPD (2005) having the right person, in the right place, at the right time is crucial to organization's performance.That's why recruitment and selection is so important.A recruitment process is about establishing whether there is a match between an individual and the requirements of a particular job before they are placed in it.Recruitment and selection process are important practices for human resource management and are crucial in affecting organizational success Jovanovic (2004).Literature suggests that recruitment and selection provides a foundation to all other central activities of human resource management: namely, the acquisition, development and reward of workers (ibid).In order to achieve organizational goals, organizations should focus on the key decision that need to be taken in managing recruitment processes and on the skills needed to undertake them with maximum effectiveness, efficiency and fairness (Nartey, 2007).
According to Costello (2006) recruitment is described as the set of activities and processes used to legally obtain a sufficient number of qualified people at the right place and time so that the people and the organization can select each other in their own best short and long term interests.Recruitment is the process of attracting potential candidates from within and outside an organization.It is a kind of positive activity of going into the labor market communicating opportunities and information and generating interest.Selection involves identifying selecting the most suitable candidates for organization.It can be seen as a negative activity concentrating on the elimination of unsuitable applicants (Taylor, 2002).
According to CIPD (2005) that effective recruitment is central and crucial to the successful dayto-day functioning of any organization.Successful recruitment depends upon finding people with the necessary skills, expertise and qualifications to deliver organizational objectives and the ability to make a positive contribution to the values and aims of the organization.
According to ACAS (2005), best practice describes the main features of such system and other related issues.System should be: • Efficient-overall goal of recruitment and selection for a position is to be cost effective in methods and sources • Effective-producing enough suitable candidates without excess and ensuring the identification of the best fitted for the job and the organization • Fair-employer has the responsibility to ensure that no unlawful discrimination occurs in recruitment and selection process on the ground of sex, race, disability, sexual orientation and religion or belief.
The recruitment process: The recruitment and selection is a systematic and step by step process (Erasmus et al., 2000).According to them effective recruitment strategy as a fourteen steps process starts with identifying a need for recruitment and it ends with evaluating the success of recruitment process (Fig. 2).
In order to achieve its objectives, an organization should follow these steps to attract right person for right job.
Similarly like recruitment Erasmus et al. (2000) have also divided selection process into six different phases as mentioned in Fig. 3.
However, CIPD (2005) has given a brief and more comprehensive recruitment and selection strategy.According to them an organization with the most effective recruitment and selection strategy follow the following process (Fig. 4).

Job analysis:
Job analysis is the process of determining the essential characteristics of the job and circumstances in which it is performed.Analysis may be carried out by observation, questionnaires, interviews or work diaries.The advantages of job analysis is that it has improved human resource management through a greater understanding of the skills and training needed for particular job and provided an opportunity to review roles and policies on selection and training.But the disadvantages of job analysis are that it needs more time and resources (Greenwood, 1996).

Job description:
A job description is a written statement of those facts that are important regarding the duties and responsibilities and their organizational and operational interrelationship (ACAS, 2005).According to Taylor (2002) job description include job title, grade, rate of pay, main location, supervisor's name, details of any subordinates, summary of the main purpose of the job and list of principal duties with very brief description.
A good job description is useful for all jobs.It can help with induction and training.It enables prospective applicants to assess themselves for the job and provides a benchmark for judging achievements (ibid).
The disadvantages of job description is that firstly it takes time to prepare and inflexible.Secondly it also has to be kept up to date to be useful and could be regarded as an unnecessary demand on time and effort.Thirdly that job descriptions is not suited for jobs where job involve discretion (Kumari, 2012).

Person specifications:
It is an interpretation of the job description in terms of the human characteristics.It must be written carefully to avoid any kind of discrimination, which could then be perpetuated The advantage of person specification is that it maintains objectivity and avoids bias and discrimination.The processes of person specifications help employer to develop and implement a policy of equal opportunity in recruitment and selection of employees.It can also be used to inform the criteria you use to shortlist applicants (Kumari, 2012).
Attracting applications: Recruitment is the activity that generates a pool of applicants who have the desire to be employed by the organization, from which those suitable can be selected.Where there is a vacancy to be filled, employer has choice to recruit either internally or externally (CIPD, 2005).
Internal methods: Most private-sectors organizations use the internal methods for recruitment and selection before looking for people outside the organizations (Newell and Shackleton, 2000).Through internal methods current or former staff is made aware that the company pursuing a policy that provides career development, promotion and transfer opportunities.Internal methods include internal promotion, lateral transfer, job rotation schemes and rehiring former staff.The CIPD survey Recruitment, retention and turnover 2005 found that 84% of UK organizations had a policy of advertising all vacancies internally.
Internal recruitment is very cost-effective.It also enhances motivation and commitment among existing staff.Other advantages include better knowledge on the part of new recruits about the way organization operates and what to expect in the job.It also makes shorter the learning time for new job holders (Kumari, 2012).
The disadvantages of internal methods include that they tend to perpetuate existing ways of thinking and carrying out tasks.Fresh blood is needed to challenge the status quo, particularly at more senior levels and this can only be possible through external recruitment (ibid).
External methods: There are many different approaches used to attract applications from outside the organization.In practice, for most jobs the formal methods include, print media, external agencies, education liaison, other media and professional contacts.However the CIPD survey finds that despite the increasing popularity of the internet-based methods in recent years, local newspapers currently remain the most frequently used means of attracting candidate, closely followed by recruitment agencies.The advertisement should be clear and provides all the details related to job (Robert, 2002).
If we look to external recruitment in terms of fairness, it fulfills the criteria of fairness, because it provides full opportunity to all.In term of effectiveness it brings best persons into the organization.But disadvantage of these methods are that they are expensive in terms of time and resources (Anne and Bartram, 2012).
Managing the applications: Application can be made by form or by Curriculum Vitae (CV).From employer's perspective there are advantages and disadvantages of both to application forms and CVs.Application forms can help the recruitment process by providing necessary and relevant information about the applicant and their skills and therefore easier to assess objectively the candidate's suitability when short listing applicants.CV on the other hand gives applicants the freedom to sell themselves in their own way.They are thus able to tailor their applications to their own strengths and are not restricted to fitting relevant information into boxes of predetermined size (ACAS, 2005).

Dealing with applications:
All solicited applications should be acknowledged and where possible all unsolicited applications.Prompt acknowledgement is good practice as it presents a positive image of the organization (CIPD, 2005).
Selecting the candidates: Selection decisions should be made after using a range of techniques and tools appropriate to the time and resources available.Care should be taken to use techniques that are relevant to the job and the business objectives of the organization.To ensure the validity, fairness and reliability all tools used to be reviewed constantly (ibid).

Short listing:
Whatever form the applications take, there may be a need to sift them before moving on to the interview stage.Such a sift serves to match the applicants as closely as possible to the job and person specification and to produce a shortlist of people to interview (Anne and Bartram, 2012).To be efficient, effective and fair, Torrington et al. (2002) suggest that the drawing-up of criteria is best done by a panel.

Selection interviews:
According to CIPD surveys (2005), interviews are the most commonly used selection technique even then are very poor predictors of future job performance if conducted by untrained individuals in an unstructured way.To have any value they should always be conducted or supervised by trained individuals in a structured way and the candidate should also be allowed to ask questions (Anne and Bartram, 2012).

Assessment centers:
The assessment centre has been referred to as Rolls-Royce of selection methods.It is found that assessment centre techniques to have good predictive ability and they appear to be liked by candidates too.According to CIPD survey (2005), 34 % of organizations in the UK use assessment centers.The only drawback is the cost associated with their preparation and administration.
Psychological testing: There are numerous tests commercially available which can assist in measuring aspects of personality and intelligence such as reasoning, problem solving, decision making, interpersonal skills and confidence.Although many large organizations have used them for a number of years, but even then they are not widely used (Jansen and Jongh, 1997).
Making the decision: For a fair and effective process it is necessary to inform all the applicants of the outcome as soon as possible, whether successful or unsuccessful.Keep in touch if the decision is delayed.Offer of the employment should be made in writing to aware candidate about legal regulations (ACAS, 2005) Induction: Well-planned induction enables new employees to become fully operated quickly and should be with the recruitment process.According to CIPD references, medical examinations and documentation are other points to be considered during effective, fair and efficient recruitment and selection process (CIPD, 2005).

Internal and external influences on recruitment and selection activities:
Internal and external environmental influences play a major role in recruitment and selection.Organizational climate, culture and management style help to shape HR policies and practices, which, in turn, have an impact on the quality of candidates that a firm can attract, as well as its ability to retain desired workforce.In the internal environment the factors that have the most direct impact on recruitment and selection process in an organization, includes organizational culture, organizational climate, management style and budget process (Nancy, 2004).
Having a positive culture earns critical acclaim and has a positive impact on both retention and recruitment (Anne and Bartram, 2012).Within the internal environment management style especially towards employees is another factor affecting recruitment and selection processes in an organization.The lack of resources could also limit the effectiveness and fairness of recruitment and selection processes in an organization (ibid).
The economic environment labor market conditions and unions play a role in determining the quality and variety of employees that can be attracted and retained.When labor markets tighten, as in late 1990s recruitment activities assume greater importance.This occurs because it becomes harder to find staff of the caliber and skills required, so more time and expense is required (Taylor, 2002).There are external challenges that are dramatically changing the environment of HRM.These challenges include demographic trends and increasing workforce diversity, trends in technology, increasing government involvement in the employer-employee relationship, globalization and changes in nature of jobs and work (Anne and Bartram, 2012).

FINDINGS AND DISCUSSION
Analysis was based on data collected from interviews, organization's web site, organizational brushers and annual reports.To know about the recruitment and selection strategy and practices in RMI, researchers examine in particular the evidence from the interviews of the HR coordinator and HR assistant and consulted secondary data obtained from the organization's literature and compare it with theory and best practices.The major findings of this HR audit are as follows.
Recruitment and selection strategy: A written, coherent and centralize recruitment and selection strategy improved the reliability and validity of the process (Iles, 2001).Being a largest private sector hospital, it is necessary for RMI to have a clear written and centralized recruitment and selection strategy.When asked about recruitment and selection strategy, the HR coordinator replied: 'Being a small HR department we have no written strategy.
"We mainly focus on day to day administrative activities including recruitment, training, wages, employees' motivation and performance management.We have no permanent strategy; we prepare our strategy on case to case bases".
Methods of recruitment and selection: Both primary and secondary data reveal that the recruitment and selection process of employees in RMI focuses on attracting and retaining the best possible employees; those who are committed to provide quality service in order to meet organizational goals.In the words of HR coordinator the main methods use in RMI for recruitment and selection are: "The selection and recruitment processes in RMI consist of a variety of methods, a combination of which is used for each specific position in order to cater to its unique needs.For position lower in hierarchy, requiring minimal skills, recruitment is initiated by applications forms and criteria are based on age and location.For mid-level position another level of screening is added, that of a written test.For more specialized positions, requiring a high level of skill and experience, considerable screening is done before inviting them to an interview." Criteria for recruitment and selection: In RMI the criteria of selection is different for each level.When asked about the selection criteria, the HR assistant provides details in these words: "For lower positions such as housekeeping services, selection criteria is based on age and location to ensure the suitability and availability of applicants to the job.Selection criteria for middle level positions such as data-entry operators include basic computer knowledge, typing and communication skills.For specialized positions academic record and practical experience of the applicants are consider main criteria for selection." Recruitment and selection process: Best practices describe different stages in recruitment and selection process, when asked about the different stages followed by RMI in recruitment process, the HR coordinator commented: "All positions at RMI have a detailed job description which is prepared whenever a new position is created.Applications forms are used in RMI for recruitment.Both internal and external recruitment methods are used at RMI, though no figure can be provided; a significant proportion of recruitment is external."Involvement: For effective efficient and fair recruitment and selection it is necessary that recruitment and selection should be done by human resource department in close coordination with the line managers.When asked this question that who conducts the recruitment and selection process in RMI, HR assistant remarked: "Recruitment is initiated by the HR coordinator in close co-ordination with the department where a position is vacant.Once applications are received, the relevant department has an important role in reviewing applications.For senior positions it is the department head that makes the background checks, but for midlevel and lower level staff, it is the HR department that is responsible for the initial checks.Experts from within and outside RMI participate in the final interview and make their recommendations which are then approved or rejected by the senior management." Validity: The success of an organization depends on having the right number of staff, with right skills and abilities.About the validity and effectiveness of the process in RMI and its outcomes the HR coordinator commented: "These processes have proved to be very effective for RMI and they have undergone considerable changes since recruitment and selection first started at RMI.The selection process in RMI is fair and free of bias because all the selection interviews are done by a panel.Feedback received from department heads suggests that the present sets of methods being used are achieving the desired objectives."Fairness: When asked about the fairness and transparency of recruitment and selection procedure, one employee from the administration replied: "The recruitment and selection process in RMI is fair and transparent to a greater extent.But sometimes external factors affect the transparency of the process which is not a good sign for organization."Barriers: When asked about internal and external barriers to recruitment and selection strategy, the HR coordinator remarked: "A number of internal and external factors influence the recruitment and selection process.The main external factor which has been observed is that when the applicants approach through other/higher sources to get the job which mostly results in recruiting non qualified and non experienced employees in the organization and it can hence affect the quality of work too.The particular culture of the society also places certain restrictions on the recruitment and selection processes.Limited time and financial resources are the main internal factors that lessen the number of interviews that can be conducted which is why considerable screening of applications is made on the basis of application forms and CVs".

Fig. 2 :
Fig.2: The recruitment process;Erasmus et al. (2000: 303) Fig. 3: The selection process Fig. 4: Recruitment process (CIPD, 2005) throughout the whole recruitment process (ACAS, 2005).The advantage of person specification is that it maintains objectivity and avoids bias and discrimination.The processes of person specifications help employer to develop and implement a policy of equal opportunity in recruitment and selection of employees.It can also be used to inform the criteria you use to shortlist applicants(Kumari, 2012).