Keywords

Achieving Task, Achieving Goals, Career Support, Training On-The-Job, Off-The-Job Training, and Employees’ Performance.

JEL Classifications

M10, M19, J24, M53.

Introduction

A research carried out by the Chartered Institute of Personnel Management of Nigeria (CIPM, 2016), which was reported at the 2017 annual conference held in Abuja, Nigeria, showed that employees’ performances in the health sector of Nigeria economy is on the low side when compared with similar sector in most developing nations. The report revealed that the increasing low performance of employees in Nigeria hospitals has imposed the current sad statistics of high numbers of Nigerians who seek medical care outside Nigerian shores (which would have been avoided).

The Nigeria former president, Dr. Goodluck Jonathan, in 2014 protested that Nigeria has the highest number of persons travelling outside the country to seek medical care in Africa due to poor employees’ performances in the health sector (Innocent et al., 2014). Moreso, many of Nigeria’s public officials, including former governors Sullivan Chime of Enugu State, Danbaba Suntai of Taraba State just to mention some few have had causes to travel out to foreign countries for medical care. Furthermore, while speaking at a presidential summit on Universal Health Coverage in Abuja, the former Nigeria President, Dr. Goodluck Jonathan, lamented the poor employees’ performance in the Nigeria health sector and insisted that the nation needed to put much emphasis on performance (Innocent et al., 2014).

Just recently, between 2016 and 2018, the current Nigeria president Muhammadu Buhari, has been on and off the hospital in the United Kingdom such that on one occasion he spent 105 days in United Kingdom for medical care; this led to a lot of protest in Nigeria. Though, Human capital development has been known as an important factor for the enhancement of employees’ capabilities to attain better performances, the Nigeria Federal Medical Hospitals have not placed much emphasis on employees’ performance. This is evident in the face of the present challenge for suitable human capital development procedures for the enhancement of employees’ performance (Paul et al., 2016).

The issues concerning employees' performances in Nigeria health sector has become a worrisome phenomenon among health management practitioners as Nigeria loses a lot of money due to the fact that her citizens travel abroad for treatment of different kinds of health condition. Worst still is that government officials including the president of Nigeria, patronises health facilities abroad. The situation is made worst in that while much is known on how human capital development has been used to improved employees performance in the other industry, as shown in studies (Harvey, 2002; Njoku & Onyegbula, 2017; Ekperiware et al., 2017; Obialor, 2017). There is still limited literature on human capital development in Nigeria health sector specifically Federal Medical Hospitals in Nigeria. Studies on issues associated with human capital development in Nigeria Federal Medical Hospitals are rarely found.

In the context of Nigeria, the Federal Medical Hospitals demonstrate the complex employees performance challenges facing most cities dwellers (Amuta et al., 2013). Therefore, this study seeks to investigate the effects of human capital development on the enhancement of employees’ performance capacity in Federal Medical Hospital Keffi (FMHK). The federal medical hospital in Keffi was chosen because it was established in the year 2000; it is the first and only federal hospital in Nasarawa state, Nigeria. The FMHK ought to provide optimal health care services for client/patient around its environ been the only access and exit of traffic to and fro Abuja, Nigeria federal capital city, from the entire northeast states and part of the middle belt zone of Nigeria, yet the narrative is different for client/patient.

Literature Review and Hypotheses

As the world economy gravitates towards knowledge based products and services, the establishment of continuous research and development on the latest knowledge, skills and competencies have become a central concern for management and practitioners at all levels. This study is grounded in the human capital theory.

The human capital theory proposed by Schultz (1960) and developed by Becker (2009) established that the enhancement of employees’ basic skills, knowledge and attitude would improve the productivity of employees’ with low skills, knowledge or/and attitude (Alika & Aibieyi, 2014; Anaduaka, 2014). Human capital theory advocates that investment in the development of employees’ knowledge, skills and competencies through employees training and career support from a very senior member of the organisation will aid the increase of employees’ productivity by exposing them to useful knowledge, skills and attitude that lead to better performance. (Ofobruku & Nwakoby, 2015; Ofobruku & Yusuf, 2016; Anike et al., 2017).

In Nigeria currently, not much emphasis has been placed on improving employees’ performance through human capital development by the government and the organized private sector. This has resulted in the present economic recession being faced by the nation and the cost associated with human capital development (Adele & Ibietan, 2017; Anike et al., 2017). In view of this, it might be argued therefore that there are distortions in the perception of human capital development in Nigeria as it is perceived as a cost in most organisations and not as an investment. It is also argued that the recent rapid health sector development in the countries of Southeast Asia in the latter part of the 20th century has been due largely to their deliberate policy on human capital development (Gunu et al., 2013). In contrast, Nigeria has displayed lack of consistent attention to the relevance of human capital development and its effect on employees’ performance (Adele & Ibietan, 2017).

Employees Performance

Performance encompasses the actual output or results of an organisation as measured against its intended outputs (goals and objectives). Mathias & Jackson (2009) maintain that a dynamic organization is the one that has low rates of incapacity in her employees’ performances. The employees should depict characteristics that are associated with high levels of performance. Employee's performance is an ill-defined concept in management science and organizational behaviour. CIPM (2007) defined employees’ performances as an individual level variable. That is, performance is something a single person does. It is important to note that there is no one universally accepted model for employees’ performance improvements, but guidelines are followed depending on the nature of the organization and approach of the individuals attempting to implement them. In simple words, employee performance means the ability of employees to achieve individual allocated task on daily bases, the achievement of department objective and improvement in individual productivity. The understanding of individual employee performance is critical to the success of an organisation as it involves a systematic approach to the assignments of work, expectations and supporting employee efforts (Tende Sam, 2011; Elarabi & Johari, 2014; Obi-Anike & Ekwe, 2014; Ofobruku & Nwakoby, 2015; Anike et al., 2017). The above studies further specified that employees' performances depend largely on the knowledge and the skills which employees’ possess to carry out their individual task.

Human Capital Development

Human Capital Development (HCD) is said to be a process of increasing human knowledge and enhancing skills and attitude for increasing productivity. Any effort to increase human knowledge, enhance skills, productivity and stimulate resourcefulness of employees is perceived as HCD effort (Tende Sam, 2011). Therefore, HCD is about supporting cum investing in career support, employees training and human capital management. Although, employee performance depends on various factors, yet various scholar has insisted that human capital development still remain the most important factors for improving employees skill, knowledge and attitude (Cole, 2002; McKinnies (2008); Stoner et al., 2011; Robbins & Judge, 2013; Mainoma, 2013).

In recent years, the introduction of new technologies in all works of life especially in the medical sector is emerging rapidly than ever before. For employees to get acquainted with these new technologies in the health sector, perform their duties efficiently and achieve a better result there is an urgent need for human capital development issues to be taken seriously. The urgent need for human capital development in Nigeria health sector to be taken seriously cannot be overemphasized. Thus, there is a need for the hospitals in Nigeria to improve their employees’ performances to catch up with the demands and preference of patients seeking health care.

Although research has shown that there exist studies on the importance of career support in developed nations, they are very limited in Africa; specifically none in Nigeria has looked at the effect of career support on Nigeria hospitals even when there are continued reports of poor employees’ performance in the health sector which is currently adjudged to be of low quality when compared to other nations (Iwelumo et al., 2016). Based on the identified research gap on career support in Nigeria hospital, this study thus posits that:

H1: There is no significant effect of career support on the achievement of employees’ productivity in Federal Medical Hospital, keffi.

Training is a process of inculcating knowledge and skills relevant to the executing of employees' assigned tasks. These scholars (Ekhator, 2009; Anki et al., 2017), assert that training denotes the primary focus on the teaching of employees on how to accomplish their current jobs better and also assist employees to acquire the relevant knowledge and skills needed to execute their duties effectively. These scholars further maintain that training builds the employees knowledge and skill such that they will be prepared to take new or greater responsibilities.

This implies that for hospital employees, training would mean a conscious effort made to improve or increase employees’ skills, knowledge, and to develop their attitudes in the desired direction, in the process of attending to their patient and meeting up with the day to day needs of the hospital (Ejim, 2014). Thus, training activities will lead to the improvements in the quality of workforce by means of better skills, knowledge and attitude while productivity would undoubtedly increase. Consequently, well trained, qualified skilled and well-guided employees’ should be involved in the handling of specialized tasks in Nigeria hospital in order to transform the health sector for better performance. Therefore, we posit thus:

H2: Training on-the-job has no significant effect on Employees performance (achieving departmental goals) of Federal Medical Hospital, Keffi?

H3: Off-the-job training has no significant effect on employees performance (achieving given task) of Federal Medical Hospital Keffi?

Methodology

A trans-disciplinary research team was composed by the authors for complementary expertise direction on the procedure to be adopted for this research. The numbers of professionals who volunteer their services consist of eight nurses, four physiotherapists, five pharmacists, seven management researchers, three hospital administrators, six medical doctors, and five medical laboratory scientists. The trans-disciplinary research team concluded and agreed that a survey design comprising the use of questionnaire would be best suitable for this study. Therefore, the study employed a survey design method involving questionnaires and simple linear regression analysis to examine the hypotheses 1, 2 and 3. This is appropriate in this context (Lazarova et al., 2017).

The population of this study was targeted at staff of the Federal Medical Hospital Keffi (FMHK). The choice of FMHK as our research setting is especially appropriate since it is the only federal government tertiary hospital operating in Nasarawa state and the only access/exit for traffic to and fro Abuja, Nigeria federal capital city, from the entire northeast and part of the middle belt zone of Nigeria. In order to ensure an assured level of stable involvedness, the population considered in this study was limited to the employees whose appointment have been confirmed and working in the hospital for 10 years and above. Therefore, the total population used for this study was 2,857 staff that have been confirmed and working consistently from 2007-2016. This information was gotten from the human resources department of Federal Medical Hospital Keffi.

Based on the population in the Table 1 the sample size used for this study was determined by using Cochran, (1963). This formula is used where the population size for the study is finite. It is stated thus:

Table 1 The Population and Sample Size
S No.	Departments	Population	Sample size
1.	Admin	561	69
2.	Accts	218	27
3.	Med. Lab	257	32
4.	Clinical	620	76
5.	Nursing	874	107
6.	Pharmacy	68	8
7.	Physiotherapy	27	3
8.	Radiology	33	4
9.	Dental	25	3
10.	Ophthalmology	47	6
11.	Nutrition	23	3
12.	Legal	28	3
13	Medical Information Officers	76	9
14	Total	2,857	350

Therefore:

A stratified sampling method was also adopted to give a fair representation to the designated departments in the hospital using the proportionality formula thus:

Where, Q = The number of questionnaires to be allocated to each segment.

A = The proportion of each segment.

N = The total population of all the segments.

The above Table 1 shows the population and sample size of the study.

Instrument Description and Method of Data Collection

Permission and ethical clearance for the study was obtained from the Management Board of FMHK. The total of 350 questionnaires was administered by the door to door self-administered questionnaire consisting of closed-ended questions which were developed from a careful literature review basis; 342 valid questionnaires were obtained, representing a response rate of 98%. The survey was conducted between July 3^rd and August 30^th, 2017. The questionnaire was designed to measure participants’ notion of human capital development and employees performance. Likert scales ranging from 1 (strongly disagree) to 5 (strongly agree) were employed for each item. The constructs for this study were adopted from previous studies on high performance (Galbreath, 2005; Hariharan et al., 2004; Pike et al., 2005; Zeglat & Zigan, 2014).

Validity of the Instrument

Content validity of the instrument was carried out using Content Validity Ratio (CVR) computation formula given as CVR = ne-n/2/n/2 (Thatcher, 2010), where n is the total number of experts, ne is the number of experts regarding the item as essential. This resulted from the analysis of the opinions of twenty-one experts (eight (8) experts from the Nigeria council for management development, seven (7) professors from University of Nigeria and six (6) professionals from FMHK, who are experts in the field under investigation), who scrutinised the instrument on item by item basis to ensure that content of the instrument adequately represents the property under investigation and that they are also in line with the hypotheses of the study, yielded a content validity ratio of 0.78 which is appropriate for the study (Thatcher, 2010).

The reliability of the instrument was determined through the use of pilot study; seventy of the questionnaires were pre-tested before the final fieldwork. These were sent with the support of the human resources department as well as the head of the various units, who are directly connected with the research population to inspire their involvement in the study. There was a covering letter attached to the questionnaire guaranteeing the confidentiality of answers and declaring the purpose of the research. The reliability of responses was checked using Cronbach coefficient alpha, the result of the pilot test of the instrument showed that the reliability coefficient of the questionnaire yielded 0.81, thus indicating that the instrument is reliable. This means that the questionnaire was reliable enough for the conduct of this research, as Pallant & Manual (2010) and Creswell & Creswell, (2014) opine that Cronbach Alpha statistic of 0.7 and above imply that the data is reliable.

Model Specification

The linear regression model was used for this study to analyse data generated from the field so as to establish the relationships between the variables. Linear regression model assumes that there is a linear, or “straight line”, relationship between the dependent variable and each predictor. This relationship is described in the following formula for hypothesis one, two and three:

Where,

β0= The intercept or autonomous parameter estimate.

β1-β3- The slope of the coefficients of the independent variables to be determined off-the-job training.

EPP = Employees Performance Productivity

CS = Career Support

EPAAT = Employees Performance Achieving Allocated Task

TOTJ = Training On-The-Job

EPADG = Employees Performance Achieving Departmental Goals

OTJT = Off-The-Job Training

The data generated from the field was analysed with the aid of econometric computer software package, E-Views version 9.0.

Results

The hypotheses formulated for the study were tested using the OLS statistical tools.

H1: There is no significant effect of career support on the level of productivity in federal medical hospital Keffi.

The above Table 2 shows responses from respondents as to the type of relationship that exists between career support and productivity.

Table 2 Responses to Career Support and Productivity
S No.	Questions	SA	A	NS	D	SD	Total
CS	Supervisors supports subordinate to enhances employees productivity	56	139	13	56	78	342
CS	Superior made available supportive resources to ensure better employees productivity	98	133	4	50	57	342
CS	Management provides professional advice to subordinate in order to ensure better employees productivity	90	92	29	53	78	342

From the regression result in Table 3, the calculated t-value for career support of 2.97 is greater than the critical value of 1.96. It falls in the rejection region and hence, we may reject the null hypothesis (H0). The conclusion here is that there is the positive and significant effect of career support on employees’ performance (productivity) in federal medical hospital Keffi.

Table 3 Regression Result on CS and EPP
Stepwise Regression Analyses of career support on Outcome Variables
Dependent Variable: employees performance (productivity) R2 =0.6342; F = 10.95; Sig = 0.0064
Independent Variables	Beta	t-value	Pearson Correlation(r)	Probability value
career support	0.24	2.97	0.75189	0.0064

H2: Training on-the-job (TOTJ) has no significant effect on employee’s performance (achieving allocated task).

The above Table 4 shows responses from respondents as to the type of relationship exist between Training on-the-job and employee’s performance (achieving allocated task).

Table 4 Responses to Training on-the-job and Employees Performance (Achieving Allocated Task)
S No.	Questions	SA	A	NS	D	SD	Totals
TOTJ	The management encourages apprenticeship to enhances employees performance (achieving allocated task)	160	59	13	62	42	342
OTJT	Our superior carries out regular orientation for her employees to ensure better staff performance (achieving allocated task)	109	163	5	21	44	342
TOTJ	Our management insists on internship practices in order to ensure better employees performance (achieving allocated task)	103	103	20	46	70	342

From the regression result in Table 5, the calculated t-value for training on- the- job (TOTJ of 2.04 is greater than the critical value of 1.96. It falls in the rejection region and hence, we may reject the first null hypothesis (H01). The conclusion here is that training on the job has significant effect on employees’ performance (Achieving allocated task).

Table 5 Regression Result on TOTJ and Epaat
Stepwise Regression Analyses of training on-the-jobon Outcome Variables
Dependent Variable: employees performance (Achieving allocated task) R2 =0.7390; F = 4.09; Sig = 0.004
Independent Variables	Beta	t-value	Pearson Correlation(r)	Probability value
Training On-The-Job (TOTJ)	0.11	2.04	0.75189	0.0041

H3: Off-the-job training has no significant effect on Employees performance (achieving departmental goals).

The above Table 6 shows responses from respondents as to the type of relationship exist between off-the-job training and employee’s performance (achieving departmental goals).

Table 6 Responses to off-the-job Training and Employees Performance  (Achieving Departmental Goals)
S No.	Questions	SA	A	NS	D	SD	Total
OTJT	Employees’ are sent to conferences to help improve their performance (achieving departmental goals).	167	56	14	63	42	342
OTJT	Employees’ are sent to the workshop to assist improve their performance (achieving departmental goals).	117	155	5	21	44	342
OTJT	Employees’ are sent for field trips to help improve their performance (achieving departmental goals).	107	99	20	46	70	342
OTJT	Employees’ are sent for diploma and degree program to assist improve their performance (achieving departmental goals).	85	141	15	60	41	342

From Table 7, the calculated t-value for off- the- job trainings 2.66 and the tabulated value is given as ±1.96, under 95% confidence levels. Since the calculated t-value is greater than the tabulated value (2.66 > 1.96), we, therefore, reject the null hypothesis (H3). We conclude that off-the-job training has a positive and significant effect on performance (achieving departmental goals).

Table 7 Regression Result on OTJT and the Epadg
Stepwise Regression Analyses of off-the-job training on Outcome Variables
Dependent Variable: employees performance (achieving departmental goals) R2 =0.7082; F = 7.10; Sig = 0.012
Independent Variables	Beta	t-value	Pearson Correlation(r)	Probability value
Off-the-job training	0.66	2.66	0.61892	0.0128

Discussion and Implication

This study expanded the contemporary research on human capital development as it affects employees’ performance capacities in Nigeria hospital. We case studied the Federal Medical Hospital Keffi. The investigation resolved the issues associated with the current embarrassing low employees’ performances in Nigeria hospital which gave birth to the current huge traffic of Nigeria citizens (among them are the top government officials) that travel outside the shores of Nigeria in search for medical care owing to the present poor hospital services delivery.

As predicted by H1, there is a significant effect of career support on the level of employees’ productivity. Table 2, shows the value of the intercept of regression coefficients as 1.589. This value represents the estimated average impact of career support on the level of productivity. The result showed that career support has a significant impact on the level of employees’ productivity in Nigeria hospital.

In addition, the regression is higher than the residual sums of squares which indicate that the variation in the level of productivity is explained by the model. The significance value of the F statistic is less than 0.05, which implies that the variation explained by the model is not due to chance. Based on results presented in Table 2, the significance value of 0.0064 was less than 0.05. The findings from this study, therefore, agree with earlier related studies on this subject (Ofobruku & Yusuf, 2016; Adele & Ibietan, 2017; Anike et al., 2017).

Therefore, the result implied that currently in Nigeria federal medical hospitals, there are no cautiously planned career support program geared towards transferring needed or specific knowledge, skill, and attitude from top professionals to subordinate in order to fill identified knowledge, skill, and attitude gaps. Hospital employees are posted just to fill existing vacancies but not prearranged for career support of the employees to acquire requisite knowledge, skills and attitude to improve their performance on their duties. This is a major hindrance to top employees’ performance in Nigeria hospital.

H2 predicted that Training on-the-job would positively affect employees’ performances (achieving the allotted task) in Nigeria hospital. As shown in Table 3 Training on-the-job would positively affect employees’ performances.

The significance value of the F statistic is less than 0.05, which implies that the variation explained by the model is not due to chance. Based on results presented in Table 3, the significance value of 0.001 was less than 0.05. Findings from this study therefore agree with earlier related studies on this subject (Olu & John, 2008; Ofobruku & Nwakoby, 2015).

Therefore, it infers that the present practice of training the hospital employees on the job in Nigeria does not follow a planned and organised pattern which are directed towards filling an identified skills, knowledge and attitude gap, rather employees are just deployed to various departments to fill existing vacancies to meet the day-to-day operational needs and duties, without adequate plan that such posting should enable the employees to acquire experiences that will improve their skills for better performances. Again, this is a major drawback for peak employees’ performances in Nigeria hospital.

H3 postulated that off the job training has no significant effect on employees’ performance (achieving departmental goals) of the federal medical hospital, Keffi. The results in Table 4, establish the effect of off the job training on employees achieving departmental goals.

The significance value of the F statistic is less than 0.05, which implies that the variation explained by the model is not due to chance. Therefore, the finding of this study reveals that off the job training has significant positive effect on employees’ performance (achieving departmental goals) of the federal medical hospital, Keffi. Based on results presented in Table 4, the significance value of 0.001 was less than 0.05. Findings from this study, therefore, agree with earlier studies on this subject (Ekhator, 2009; Anike et al., 2017).

From the result therefore it may denote that that hospital in Nigeria is reluctant to send their employees for full time (off the job) training. Where in-house arrangements for off-the-job training exist, the practices are not organised in that employees just apply for approvals for a program of their interest, that is affordable and not an identified areas of the paucity of skills and knowledge required for improving the employees performance towards achieving their departmental goals (Adele & Ibietan, 2017; Anike et al., 2017).

Conclusion

The findings of this study showed that improvement in employees’ performances could be achievable in the case study area through comprehensive human capital development practices. This study established that career support played a critical role in the improvement of employees’ productivity. The current career support practices in Nigeria Federal Medical Hospitals are unorganised; this has been responsible for the low employees’ productivity in Nigeria public hospitals. The study also finds out that training on the job positively affect employees achieving the allotted task in Nigeria hospital. Nonetheless, it was discovered that the process of training on the job in the federal medical hospital is still limited in that it is haphazardly done and unorganised; again this has been a factor responsible for poor achievement of the allotted task in Nigeria medical hospital.

Thirdly, the research findings additionally show that off the job training has a significant effect on employees’ achieving departmental goals. The study, also observed that federal medical hospitals in Nigeria are hesitant to send their employees for off-the-job training that can improve employees’ performances. More so, there is no design strategy in place directed at filling identified deficiency of skills and knowledge which would improve the employee's performances. The above reinforced the reason why employees possess skills in the general areas and have paucity of substantial skills/knowledge in critical areas in Nigeria hospital.

Based on the findings and conclusion of this study, the following recommendations were proposed:

1. In order for career support to be effective at improving employees’ productivity in the various hospitals, career support program should be more organised in Nigeria federal medical hospitals. Our research advocates that career support practices should also be directed at equipping employees to acquire needed knowledge, skills and attitude that are required for the improvement of individual productivity for the hospital.

2. Training on the job with the right strategy will positively affect employees’ achievements of the allotted tasks in the hospital. This will assist in ending the current poor performances experienced in Nigeria federal medical hospital at present. Employees training on-the-job should be tailored towards filling identified knowledge, skills and attitude gap so as to equip employees to overcome specific challenges they face in their allocated tasks in day-to-day operations.

3. Furthermore, it is important for the federal medical hospital to re-examine why off-the-job training is unorganised and not encouraged. Whereas this study discloses that the acquisition of new technological knowledge through off-the-job training would enable the achievement of various departmental goals of employees in the federal medical hospital, it is important to note that it may become detrimental if it is not organised and gear towards the filling of identified knowledge, skills and attitude gap in the hospital. Therefore, this study advocates that training need assessment must be carried out before off-the-job training is approved and should be geared to fill identified knowledge, skills and attitude deficits so as to enable employees to improve their performance in achieving various departmental goals.

Limitations

Unexpectedly, the core limitation of this study was the paucity of literature on the effects of human capital development on employees’ performance in Nigeria federal medical hospitals. There is also the practical difficulty for some respondents to answer questions in the questionnaire due to the fact that they were not authorised. This limitation notwithstanding was overcome by getting a letter of approval from the human resources department of federal medical hospital Keffi.

Implications for Future Research

The samples for this study were obtained from the Federal Medical Hospital, Keffi only. Therefore, it is recommended that future investigations, should also be collected data from government and private hospitals, more cities should be involved in one study. Financial and other restrictions also constrain this study not interrogate some important questions on the application of technology to employees performance capacity in Nigeria hospitals. The following subjects are therefore recommended for further research:

1. Effect of applied technology on the employees’ performance in Nigeria hospital.

2. A review of the economic implications of human capital development on sustainable employees’ performance in Nigeria Hospitals.

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