Keywords

Human Resources for Health HRH Human Capital Attrition Medical Officers Ser- vice Quality

Introduction

Effective organizations need high performing Human resources management ( practices and successful h uman resource acquisition and retention systems ( to enhance overall organi z ational efficiency. HRM practices is a management organ that recruits, upgrade, motivate and maintain human capital to ensure a sustainable deployment of the organi z ation and its stakeholder; on the other hand HRARs are two of any organizations most critical sustainability factors Rose et al. 2006; Cascio 2014; Macke Genari 2019). In other words we can see it as a set of strategies to manage employee prospects and ensure that they remain for a more extended period. Frequently organizations retain workers for a define d time to engage their skills and com- petencies to keep the organi z ation up and running. Given the importance of consumers /customers interaction in the service industries such as hospitality, healthcare and other more, HRARs become even more indispensable and a key driver in ensuring high quality services (Yee et al. 2008; Browing Vicky 2009). Moreover, retaining a competent workforce and decreasing unnecessary staf f turnover is an organi z ational economic and decision support requirement (Belbin 2011). For attracting and retain ing talents, policies are implemented to meet the needs of workers, regardless of multinational business or smaller business

The majority of companies are experiencing shortages of human resources I nability to retain talent, organizations in less developed countries with the double motive for boosting their economy service quality collectively witnesses these in the greater spectrum because of ( Internal growing pressures including a lack of access to finance and ( External organi z ational constraints like cultural values (Khoury Prasad 2016). Income generating organizations by providing services rather than selling physical products are known as service sectors. In developing nations such as India and a few others the service sector continues to dominate job opportunities and presents a variety of unique HR challenges Korczynski 2002). The aims of this sector in any country are: a) to increase employment by providing jobs for skilled and unskilled people, ( to contribute to a country s GDP and ( to boost economic growth and development by producing better goods Peneder 2003). Service sector s mission is to serve marginalized communities by offering services. It is evident in this sector that s taff are considered to be a key tool to help them fulfil their vision; the ability to retain workers thus determines the service industry's performance.

However, this sector is often challenged by the most basic but complex problems attract, retain, grow, compensate and retain people especially in the health sector across emerging countries Willis et a l. 2008) These concerns are closely related to both public and private organizations experiencing a decrease in quality service and the reason for this decrease is the failure to acquire talents and inability to retain them Belbin 2011) The quality of a health system depends on its attractiveness and retain suitable staff Cappelli 2000). Though, would not be an easy task, because of low public health expenditure and lack financial means to compete with other companies for talents Choudhury et al. 2 012) In an attempt to provide management insights into human resources, The study will address some of the most challenging issues affecting the creation and stability of HRH in hospitals throughout National capital territory ( Delhi, India regard-ing employee retention and turnover rates. In other word s the study will explore additional contingency factor that contribute s to HRH shortage and suggest s critical distinct HR practices for their acquisition and retention.

Problem Statement

Hospitals in India face difficult circumstances when human resources ( practices are inadequate to address their most critical needs, including meeting patient care quality and safety standards. Employees with healthcare training and experience seeking opportunities in India must meet the needs of their patients and establish a set of skills that will improve patient care outcomes. However, attracting a pool of employees to fill positions where healthcare expertise is necessary ( to establish departm ents and appoint personnel in hospitals throughout the rural and urban areas of India (Nair 2015). An existing shortage of employees is mostly a product of limited staff-ing in HRH; therefore, it is difficult for organizations to obtain leverage and to rec ruit qualified employees without a well defined framework in place. In support of this objective, a discussion of motivation theory in human resources to increase employee enthusiasm and engagement is re-quired to maximize resources and improve performance.

Significant HRH in hospitals across NCT Delhi, India requires experts in a variety of areas throughout the hospital environment, including clinical as well as administrative positions. Organ-izations should focus on a traditional strategic management fra mework that includes aspirational elements to improve performance and achieve greater effectiveness Chuang et al. 2016 Em-ployees must be motivated to achieve optimal performance and to remain with the organization. Therefore, based upon Maslows Hierar chy of Needs, employees have specific needs that must be met to achieve optimal motivation and interest in their work performance (Sandhya Kumar 2011 Furthermore, Herzbergs two factor theory of motivation also demonstrates the critical na-ture of empl oyer related factors that motivate employees to perform at the highest level coupled with hygiene factors that include safety in the workplace and the promise of recognition and future opportunities (Sandhya Kumar 2011 The success of HRH in hospitals in the NCT of Delhi, India, therefore, requires a set of critical elements that must be in place to motivate employees to remain with their organizations.

HRH throughout hospitals in Delhi, India requires the formation of human resource de-partments with comprehensive tools and services for employees. A clearly defined set of objectives and actions in the workplace will have an impact on the outcomes related to the retention of em- ployees and turnover rates. When employees are motivated to perform to the be st of their ability, they will be recognized for their efforts and will remain motivated to achieve optimal performance. An explorative qualitative based research study was designed to identify key human resource prac- tices in organizations It is necessary to achieve optimal acquisition and retention of employees in hospitals throughout NCT Delhi, India using various motivational theories and concepts to address the key issues affecting employees. The study will address some of the most challenging issues a ffecting the creation and stability of HRH in hospitals throughout Delhi, India regarding em-ployee retention and turnover rates. The study will examine the practices in five ( hospitals, of which four ( are privately owned and one is publicly owned to identify critical differences in infrastructure, policies, and employee commitment to each organization. In conducting the study, the following research questions were considered:

1. What human resource practices advance and promote the acquisition and retention of HRH in the hospital industry, with special consideration of hospitals located in the National Capital Territory of Delhi, India?

2. What are the primary human resource practices that influence HRH acquisition and retention in hospitals in NCT Delhi, India?

3. How are employees motivated to seek careers in HRH, and what are the key drivers of their motivation?

4. How do theoretical concepts such as Maslow's Hierarchy of Needs and Herzberg's Two-Factor Theory sup-port HRH employee motivation and retention rates?

These questions will provide additional insight regarding the significance of HRH in Indian hospitals and how to accomplish the specific goals and objectives of expanding human resource capabilities in these areas by understanding h uman motivation and its impact on employee perfor- mance.

Literature Review

Human Resources for Health (HRH)

Human resources for health (HRH) is defined as

"The stock of all individuals engaged in the promotion, protection or improvement of population health" (Nair 2015

HRH serves as the foundation for the whole of healthcare practice, including patient con-sultations, admissions, care at the bedside, treatment, and other tools. Without adequate HRH, a hospital cannot fully function and ac hieve its primary goals in caring for and treating patients. HRH must be established in a hospital environment to ensure that all patients receive the best possible care and treatment Few a spects of operations are significant including purchasing, re-sour ce allocation, finance, and human resources, the latter of which serves as the foundation for all other operations within the organization.

Hospitals are unlikely to survive over the long term without adequate HR practices in place because their activiti es drive other areas of the organization and strengthen performance. In India, NCT of Delhi in particular, there is significant growth within the healthcare system, as an increase in education in the health professions is part of a larger influx of employees who are trained to work in hospitals and fill available positions. One of the most challenging issues, however, is the lack of equal distribution of healthcare workers throughout India, and this is driven by the activities of human resource departments in both urban and rural areas (Nair 2015; Montgomery et al. 2014 In this context, healthcare organizations face the reality of expanded operations in many urban areas but limited resources in rural communities, thereby creating shortages in qualified e mployees ( 2015). Without an effective plan in place, hospitals in India cannot sustain ade- quate human resources practices and subsequent HRH to meet the demands of their patients. Em- ployee motivation is a critical aspect of individual performance and retention Ramlal l, 2004; Ganesh 2016) therefore, it is necessary to examine the underlying factors affecting motivation and how employees respond to their roles and the organization.

Human Resources and Motivation Theory

Employers who understand the ir goals have a clear direction for their employees to take and will attract prospective candidates to fill a variety of roles; their actions should include provid-ing professional and psychological support so that employees feel valued and empowered (Sandh ya Kumar 2011 Employees who are motivated to meet the demands of the workplace will have a more significant impact, but this is not achieved without a collective effort from the employer to motivate their employees to engage in positive behavio u rs to support organizational growth (Velmurugan Sankar 2017 Motivating employees does not entirely involve rewards for a job well done but also requires addressing employee concerns, protecting their safety, and ensuring that they have the resources to be successful (Velmurugan Sankar 2017

Following Maslow s Hierarchy of Needs, the primary factors involved in motivation in- clude self actualization belonging, self esteem, psychological needs, and safety; therefore, em-ployers should aim to accommodate these needs through benefits, responsibilities, and drivers for success and comfort (Velmurugan Sankar 2017 Maslow s theory may lead to greater fulfilment among employees that will improve satisfaction and strengthen workplace performance (Velmurugan Sankar 2017 When employee needs are met, they experience greater satisfac-tion and their needs will be more attainable. Furthermore, they will develop a greater focus on the job rather than experiencing distractions from other parts of their life experience that limit their success (Kyndt et al. 2009 Employers must acknowledge their part in accommodating Masl ow s theory and in supporting the needs of their employees to achieve more significant results.

Another motivational theory with important implications for employers is the Two Factor Theory by Herzberg which indicates that hygiene and motivational fact ors impact employees motivation in the workplace (Velmurugan Sankar 2017 Specifically, the content of work is a motivator and the surrounding environment supports greater hygiene, and employers who commit to improving the lives of their employees in both ways may bring about greater motivation to perform consistently and to meet expectations (Hanif et al., 2013 When employees are highly motivated, they will perform their work duties and improve the organization; when this is not the case and emplo yees are disengaged, the organization will suffer, and the quality of work will decline (Hanif et al. 2013

Aspirational Framework

Human resource management practices strengthen organizations and provide a model for their employees to serve the needs of the public in significant ways (Moses Sharma 2020 In this manner, limited human resource practices are a product of several indi cators that include in-adequate financial support and cultural issues therefore, some organizations cannot sustain the limitations in their method s and may ultimately fail if human resource capabilities are not maxim-ized (Moses Sharma 2020 As part of the formation of a human resources team, their actions are directed by "organizational forms, practices", and routines that contribute to "institutional logics"that support a "particular value system" (Moses Sharma 2020 Therefore, the strength and ca pacity of the human resource team to accomplish its goals are largely based upon its abil ity to perform within its given constraints and to acknowledge the importance of meeting the demands for high quality service.

In healthcare settings, HR practices s hould provide a sound model for conducting opera-tions that require employees from a variety of different areas of expertise, including the health professions, finance, and procedures. It is essential for human resource teams to address some of the most cri tical challenges affecting the workplace environment but to acknowledge that their activities are a product of their organizational norms (Moses Sharma 2020 The success of a healthcare organization, therefore, requires a set of standard s and expectati ons that enable human resources teams to function effectively despite limitations or constraints within the internal envi-ronment as well as the external climate that drives economic conditions and other factors (Moses Sharma 2020 These goals are achieved by employee motivation cohesion to perform their duties and to meet the requirements of their roles.

The HRM system requires the contributions of multiple key stakeholders who are respon- sible for addressing some of the most challenging and emerging aspects of the organization They continue to evolve; specifically, areas such as legal requirements, employee performance, and in healthcare systems, patient satisfaction rates (Jackson et al. 2014 A successful organization must strategically align internal operations with the priorities of the public its customers, or its patients. Employees across all divisions must support organizational growth and demonstrate a commitment to ensuring that the organization will explore new options to improve performance that will influ- ence patient safety in the hospital environment. An organization should emphasize safety as a critical driver of motivation that is accomplished when care and concern for employees are exer- cised.

Management Practices

In healthcare settings across India, human resource departments should have greater em- ployee motivation and to address the essential aspects of the system. Therefore, their actions are critical to the success and performance of healthcare organ izations across the spectrum of opera-tions (Agarwal et al. 2011 Organizations must focus on the delivery of human resource activities that advance patient care objectives and provide the necessary resources to improve performance (Agarwal et al. 2011 The actions that human resource departments take will make a difference in addressing some of the most complex and intricate needs of the healthcare system that require employees with a vast set of knowledge and skills. In this capacity, their actions sho uld reflect critical patient care priorities and demonstrate an understanding of staffing needs within each de-partment or division. Through their efforts, employees may fulfil specific human needs that drive their roles and responsibilities, thereby suppor ting a more comfortable and safe work environment.

For human resource employees in healthcare settings, performance requirements and skills must be addressed, along with the development of areas of expertise that support the needs of employees (Agarwal et al. 2011 Specifically, areas such as compensation, recruitment, training, performance appraisals, rewards and incentives, and career planning are necessary to keep em-ployees happy and engaged in their roles (Agarwal et al. 2011 Without these tools employees have no real reason to remain with their organizations and may seek opportunitie s. therefore, these actions require human resource teams to work collectively to address staffing issues and resolve other concerns that affect employee satisfactio n rates. Their actions will demonstrate the im-portance of ensuring thathealthcare organizations have the appropriate strategic objectives in place that will meet the demand for high quality care and treatment for all patients.

Regarding the significance of human resources management in healthcare settings, some essential needs and targets must be met to improve performance. Specifically, many organizations seek opportunities for growth that are designed to address the complexities of the healthcare sys- te m and how to best address the issues affecting the practice environment. Bloom et al. 2014 demonstrate that human resource management in India lags behind many other countries in key areas such as rewards and incentives, general operations, and recruitme nt. It is known that

"Hospitals that are larger, who face greater competition, employ a larger share of clinically trained manag- ers and who not owned by the government are significantly better managed" (Bloom et al. 2014

Healthcare organizations must focus their efforts on the development of tools that may be used to improve performance metrics among hospitals in India by allocating additional resources to meet patient care needs and optimize employee satisfaction rates. their actions in this area re-quire a clear understanding of the elements that affect how employees are treated so that they remain motivated and committed to their organizations and in the practice of providing successful patient care and treatment.

Human Capital

Within an organization, its human resources division must identify employees who will provide the knowledge and experience necessary to fill specific roles and to offer essential skills to improve performance William et al 2002) It is a univer sal concept that affects all divisions within an organization It requires human resources staff members to understand and plan for the needs of the organization, both now and in the future. The continued success of an organization requires successful huma n capital who deliver results and meet expectations Bowen et al. 1986) These activities are instrumental in shaping a productive environment for employees to remain motivated and strengthened to perform at a high level.

In India, human capital is essen tial to the success of organizations across all sectors Still, one of the most critical issues for consideration is the capacity of individuals to meet expectations consistently with adequat e knowledge and skills. In healthcare organizations, human capita l

"I s the prime mover of the healthcare system" and "therefore talent development in this sector should be one of the primary skill development approaches of this country" (Borthakur 20 17

In this context, healthcare organizations must deliver on the promise and expectation to provide high quality care and treatment to patients, and this is best accomplished through the de-velopment of tools based upon practical knowledge and experience within each respective speci-ality area (Borthakur 20 17 A healthcare organization requires a collective unit of employees who meet the requirements for specialization and who understand the importance of their roles as part of a more extensive system where performance standards and expectations are high. Employees m ust perform at a high level consistently and provide the necessary care and treatment to patients to improve their health and wellbeing ( 2000; Delgadillo López. 2016) This process, therefore, requires human resources departments that are prepared to take on the complexities of the health care system and have a clear understanding of the needs of the patient population.

Employee Attrition

In many healthcare organizations, high rates of turnover are common and cause significant strain on these systems and their remaining employees. One of the most significant areas where turnover rates are high in healthcare systems is nursin g. N urses leave their employers for a variety of reasons that include high levels of stress, poor job satisfaction, low compe nsation, no recogni-tion for the job performed, and better opportunities elsewhere (Lakshman 2016 When nurse turnover rates are high, it is difficult to maintain a reasonable workload among the nurses who remain with the organization; furthermore, the dy namic among nurses may be challenged and cause harm to patient care in different ways. To provide effective patient care, it is essential for human resource departments to address some of the critical issues affecting staffing among nurses and to determine how to minimize turnover through increased incentives and programming de- signed to increase employee satisfaction and reduce turnover Dreesch et al. 2005) These actions are essential to the success of a healthcare organization in meeting its obligations to patients to provide excellent patient care continues to improve performance Buchan 2000)

Employee Engagement and Retention

In healthcare organizations, the effectiveness of employee engagement and retention activ- ities play a critical role in shaping the work environment and patient care. A ctivities conducted by human resource department plays a vital role in advancing healthca re outcomes promoting posi- tive results in patient care quality and safety. Healthcare organizations must seek opportunities to expand their services and provide employees with the resources that they need to thrive in this setting therefore, their object ives should reflect key priorities that address speciali z ation in healthcare such as nursing along with other needs. Employee engagement requires a commitment to promoting a successful organization and in providing the necessary tools to be content as wel l as effective in each role (Mutsuddi 2016 Employee engagement and retention require a success- ful platform in human resources to improve satisfaction rates and to keep employees engaged in their activities. The effectiveness of the organization in accom plishing these goals requires a com- mitted staff of human resource professionals who understand the needs of the healthcare environ-ment and will establish clear objectives and expectations to improve performance (Mutsuddi 2016 The success of health care organizations in this area requires a definitive understanding of the needs of the healthcare professions and how to address gaps in knowledge and staffing that affect patient care quality and safety. By keeping employees motivated, they will understand ho w their roles fit into the larger organization and the steps required to achieve higher retention. These actions will play a critical role in shaping a thriving environment for HRH They will provide the necessary resources for employees to be successful, productive, and satisfied in their roles over the long term that will support patient care needs and objectives.

Medical Officers

Healthcare organizations throughout India face the challenges of limited staffing and high turnover across different areas. However, one of the most problematic issues involves medical officers ( or doctors who are employed in hospitals to care for and treat patients (Purohit Bandyopadhyay 2014 There are significant discrepancies among different areas of India in the number of MOs that staff various healthcare organizations:

"The doctor to population ratio is as high as one per 470 people in the state of Delhi to as low as one per 15,547 in the state of Haryana" Purohit Bandyopadhyay 2014

Under these conditions, it is difficult for healthcare organizations to operate efficiently and to provide care and treatment that is of consistently high quality when there are not enough MOs to meet the demands of patients (Purohit Bandyopadhyay 2014 Organizations must determine how to best address the shortage of MOs affecting different organizations and how to meet the demand for new MOs best to serve the public across differenthealthcare environments (Purohit Bandyopadhyay 2014 MOs should al so be motivated to perform with pride to strengthen the organization and improve patient care quality.

The primary objective of the research study is to identify the essential components of hu-man resources practices in the NCT of Delhi, India. that will le ad to effective outcomes and will provide the necessary resources to improve performance within hospitals. The information gener-ated from the study will have an impact on determining the next steps for organizations to take to recognize motivation as a ser ious risk factor and to promote effective employee recruitment and retention practices throughout these organizations.

Research Methodology

The research study methodology will obtain information regarding the practices and meth-ods required to achieve successful outcomes in human resources departments in hospitals in Delhi, India. The study was designed using a set of interviews that included study participants f rom five ( hospitals throughout the National Capital Territory of Delhi, out of which three ( were se- lected based on proximity, and the remainder volunteered for the study as illustrated below in Table 1 The convenience sampling technique was used fro m the three hospitals, in the Walled City which is the central part of the NCT Delhi, India. Two other hospitals were approximately a 15 minute drive by car in the northeast part of the region. These were selected based upon volun- tary sampling because they volunteered to participate in the study. Therefore, all five hospitals were relatively close by and were convenient for the researcher to access on multiple visits.

Table 1 Details of the Interview Conducted
Name and Speciality of the Hospital	Location & Ownership	Number of respondents (26)	Designation of Interviewees	Sample questions
Metro Hospital/ multi-speciality	Nortwest/ Private	(4)	Chief HR Officer (2) General HR Manager (4) Assistant HR Manager (3) Employee Relation Manager (6) Executive HR (3) Employment Manager (2) Deputy HR Manager (1) Compensation HR Analyst (5)	What is your specific role within the human resource department and what are your primary responsibilities within this role?
Moolchand Medcity/ Super speciality	Northeast/ Private	(3)		What are the most critical needs within your current role?
Roswalk healthcare/ Super speciality	Southeast/ Private	(3)		What is your specific role within the human resource department and what are your primary responsibilities within this role?
Fortis hospital / Multi- speciality	Southwest /Private	(5)		What is your specific role within the human resource department and what are your primary responsibilities within this role?
Saint Stephen Hospital/ General	Central region/ Government	(11)		What motivates you to be an effective employee? How are you motivated in your current duties?
Secondary data
List of Journals		Method	Representative Keywords	Number of articles and reports
International Journal of Management & Social Science		Qualitative / Empirical	HRH: Human resources for health	Over 50 articles and 10 reports were reviewed
Indian Journal of Clinical Medicine; Center for Economic Performance and Harvard Business School			HRARs: Human resource Acquisition & retention system
The service industry Journal; Diss. University of Southern Queensland,
National Institute of Public Finance and Policy, Journal of management, International Journal of Human Resource Studies

The interviews conducted by the researcher were recorded on a device, analyzed, and tran- scribed to identify key themes within the context of healthcare employees in the hospital setting. Participants were selected from the pool of employees within each hospital A total of 26 partici- pants were included in the study, including (11 participants from three hospitals located in the cent ral part of the city, and 7 participants from two hospitals located in the northeast part of the city. Each of the interviews included a set of five primary questions and the average length of each interview was 4 5 minutes.

These questions in the t able 2 were provided to each study participant to examine the cur- rent activities and future needs of each organization. The information provided by each participant was important in determining how to address human resource practices and activities for the future that will have the desired impact on patient care quality and safety at each organization Figure 1

Results and Discussion

The study results provided was based upon the collective responses to each of the questions asked during each interview. This information is critical in identifying patterns regarding the im- port ance of different issues at each organization that affects human resource practices and how to make the necessary improvements to accomplish specific goals and objectives.

What is your specific role within the human resource department and what are your primary responsibilities within this role?

The responses from participants as shown in Table 2. indicated the following roles or divi- sions within human resources: recruitment ( education and training ( compensation and ben-efits ( employee relations ( and compliance ( The responsibilities of each role varied and indicated that some role s tend to overlap, particularly those in the smaller, rural organization, where employees are expected to perform roles that include areas that are typically differentiated in larger human resource departments. Each organization has limited staffing for th e number of employees that work there, and it is difficult for the human resources groups to clarify expectations and demands. The smallest organization only has five human resource employees in total to man-age a variety of areas, while the larger organiza tion has a total of 20 employees within this sector. The team in the smaller organization, therefore, is likely to be less productive because of limited staffing and they are unable to meet the great er demands of the organization and its patient popu- lation on a larger scale. The urban organization has more employees to meet the needs of its pa-tients, but it is also understaffed, and it is difficult to manage its duties and responsibilities effec-tively Table 3

Table 2 Questions for the Participants

1)   What is your specific role within the human resource department, and what are your primary responsibilities within this role? 2)   What are the most critical aspects of human resources management from your perspective? 3)   What are the most critical needs within your current role? 4)   How do you think the organization can improve its human resource management practices better to serve the needs of your patients in the hospital? 5)   What motivates you to be an effective employee? 6)   How are you motivated in your current duties?

Table 3 Representative Role of Divisions Within Human Resources
	Fortis hospital       (5)	Metro Hospital    (4)	Moolchand Medcity (3)	Roswalk healthcare (3)	ST. Stephen Hospital (11)	Total/26
Recruitment	2	1	1	1	4	9
Training	1	1	1	1	2	6
Compensation	1	1	1	1	1	5
Employee relation	1	1	0	0	3	5
Compliance	0	0	0	0	1	1

What are the most important aspects of human resources management from your perspective?

The responses from the participant as summarised in chart1indicate that majority of the study participants named adequate staffing as an essential aspect of human resource management that affects each resource management that involve s each organization. Since there is limited staff- ing, employees feel overworked and most ly unappreciated in their roles. Under these conditions, it is difficult for them to accomplish specific goals and objectives and they often struggle to meet the demands of their leaders and managers. After staffing, the second most crucial component of human resources is compe nsation, as many employees do not feel that they are adequately com- pensated for the work that they perform. It is a difficult situation for many employees because they lack the support and confidence to address the issue openly with their managers and do n ot feel that they have the support to earn a raise.

The third most important aspect is education and training, as employees feel that there is a good foundation in place for employees to start working at each organization Still, it is difficult for employ ees to maintain their success because they lack the continued support that is needed to remain with the organization. They believe that this is a significant reason why employee turnover rates are high at both organizations. Finally, an essential component of human resources is em-ployee relations because although most employees who participated are satisfied with the relation-ships that they have established with their colleagues, they do not believe that the issue is as reli-able in other departments and div isions. Specifically, they report that some nurses and doctors experience tension and conflicts within each profession and in multidisciplinary settings, thereby making it difficult to work effectively in these situations without incurring additional risks

What are the most critical needs within your current role?

Within their current roles, study participants argued that their long-term success requires continuous improvement and adequate staffing to accomplish their goals. Each employee must receive the necessary tools and resources from their managers to learn about the business of human resources in a hospital setting and to develop strategies to improve the organization and its human capital. These opportunities will make a difference in demonstrating the importance of key factors affecting the practice environment and how to accommodate patient care needs effectively and efficiently. The success of each organization Is dependent on employees who can deliver by meet-ing their specific goals and objectives. However, this cannot be accomplished, as each employee stated, without the necessary resources and support from leaders and managers to make their roles successful and productive. When resources are adequately available, human resource professionals can meet or even exceed their goals and accomplish new objectives. Nonetheless, none of the participants could state with confidence that their organizations have adequate staffing and re-sources to ensure that they can meet their goals with maximum productivity and effectiveness. The organization must focus its effort on expanding the delivery of products and services to employees and acknowledge the importance of meeting the demands for new opportunities for employees to learn new skills and train in new aspects of the job to provide greater value to the organization.

How do you think the organization can improve its human resource management practices better to serve the needs of your patients in the hospital?

The participants noted that their respective organizations require continuous improvement in human resource practices to improve outcomes. Participants recommended options such as weekly team meetings, scorecards, checklists, and enhanced communication to address gaps in knowledge. These activities are likely to improve the organization and to provide additional op-portunities for growth within each human resource team. In each organization, it was noted that the human resource team could not sustain their operations in their current state and that changes are required to meet the demands of patients with complex health issues. As patient care is the primary focus of the organization, all supporting areas require employees who are experienced and knowledgeable in their roles and responsibilities. These actions, therefore, need a human resources team that has similar knowledge and experience in their respective roles. The collective unit in-volved in these decisions can make a difference in addressing some of the most critical aspects of human resources that affect other departments within the organization. It will provide the neces-sary staffing and other forms of human capital to serve the needs of patients effectively and with greater consistency.

What motivates you to be an effective employee?

The responses indicate that in the current workplace, employees are motivated for a variety of reasons, including compensation and benefits, the opportunity to save lives, the means to shape healthcare decision-making, and individual roles and responsibilities. Their primary drivers of mo-tivation include stability and job security, compensation, promotions, and feelings of safety within the workplace environment. These align with Maslow's Hierarchy of Needs and demonstrate that employees have human needs that affect how they make decisions and their levels of motivation at work that lead to strong performance. Participants indicated that motivation is deep within them-selves. Still, they recognize that their employers' actions and policies play a role in their motiva-tional activities and that without a clear direction and focus provided by leadership and manage-ment, they are less likely to be effective and to be motivated to make a difference.

How are you motivated in your current duties?

Participants acknowledged that they are more motivated when they have a high workload because they are more focused and driven to complete the work on time. They also recognized that being in the healthcare environment is inspiring because the goal of saving lives offers a greater sense of pride and inner strength. However, when employees are not treated with respect or given the resources that they need to be successful, they may be less motivated to perform consistently. For employees, they value most of their direct communication with leaders and managers better to understand their roles and placement in the organization. They also recognize that some of their motivation is personal to do a good job and to make a good impression on others. Finally, when employees have additional training and education, they feel a sense of pride in their worth and understand that an investment is being made that will improve their future performance.

Summary

The study participants indicated important patterns of growth that are necessary within each organization to accomplish the broader goals of human resources. Leaders and managers must be on board with any changes to current processes or methods that are necessary to improve oper-ations and to address some of the most challenging needs of each organization. The success of the human resources team in each organization is contingent upon adequate resource allocation to support increased staffing, to acknowledge the importance of training and education for each em-ployee as a motivating factor, and to select employees who meet the requirements for employment with their knowledge and experience. These activities will make a difference in each hospital en-vironment. They will offer the opportunity to develop programs and activities for recruitment that will attract qualified employees and will retain their employment for long periods. A successful health care organization requires a comprehensive human resources component that will address a variety of challenges and provide the necessary human capital to accomplish critical goals and objectives, including employee motivation at a high level to improve performance.

Conclusion

Human resources for health ( in India is its growing field that requires further evalu- ation. The identification of essential human resource practices that affect hospitals in rural and urban parts of India is critic al to advance organizational objectives and to provide adequate re- sources to improve human health. Establishing comprehensive human resource practices within hospitals requires a set of clearly defined expectations that are based upon organizational norms and cultural needs within the external environment. Hospitals in India should create human re- sources departments that will have the desired impact through effective recruitment, training, and retention strategies. Furthermore, their actions should include offering adequate compensation and benefits for the services performed. Finally, the most important factor in maximizing retention rates is employee motivation, and they play a role in determining how to increase motivation to improve performance. The deci sions made to fund human resource departments and hire personnel should be based upon the needs of the surrounding environment as well as the internal structure of the organization, as these activities will make a difference in how the organization operate s and makes decisions that affect each employee. As human resource departments evolve, it is imperative that their actions are practical and reflect key strategic priorities and align with other needs throughout an organization that affect operations and d ecisions.

As noted in the study, the development of specific areas of knowledge and expertise within human resources will make a significant difference for hospitals in India. These areas of expertise include recruitment, compensation and benefits, employee relations, training and education, and compliance. Professionals in each of these areas are required for hospitals in India to address some of the most critical issues involving HRH that affect patient care quality and safety. It is necessary for hospi tals in India to determine the scope of the human resource practice environment that is required and how to retain employees throughout the organization With this model in place. The actions of experts within each respective role will likely have an impac t on issues such as employee recruitment and turnover rates. As key drivers of employee retention, motivation is critical in pro- moting employee success and in demonstrating how employees perform in their roles. The success of an organization in its creatio n and management of human resources serves as a precursor to all other operations involving employees who are motivated to perform effectivel y. these actions should address the significance of new opportunities for growth within the industry that will have a lasting impact on each organization and its operations.

The continued operational and financial sustainability of hospitals in India requires the development of tools that will have a lasting impact on operational actions and decisions. Human resource s are critical to these operations and will demonstrate the importance of meeting the needs of each organization and in demonstrating an effective means of doing business that will improve performance and manage patient care needs. In the hospital environment, staffing is critical and without a strong and effective human resource team in place, an organization will not thrive and meet its obligations to its patients. They must be motivated to remain in place and to bring their most significant characterist ics to the organization to improve outcomes. Their actions must coin-cide with the demand for high quality patient care and staffing that includes qualified and experi-enced employees to support organizational objectives.

Limitations and Further Research

It is essential to address some of the key limitations that affect the research study and its outcomes. Specifically, the study only included employees from five hospitals, three within the central parts of the region and two in the Northeast part The res pondents in this study had managers and middle line managers in HR department only therefore, the study sample and the total number of participants was small, as only 26 interviews were conducted in total. It is neces-sary to examine a larger population o f participants including doctors and nurses, and a larger number of hospitals in future studies to establish a more representative sample of the landscape of hospitals in India. Furthermore, the interview format was limiting because it was only based on the perspectives of only a limited selection of employees from one department who were given the same set of questions. Future studies should include a more extensive set of questions to ex-amine other issues within their respective organizations. Finally, it is essential to address other issues related to strategic human resource management as part of future studies to determine how leaders will respond to emerging needs for staffing

Corresponding Author Detail

Sweta Dixit, Associate Professor, School of Business Stu dies, Sharda University sweta.dixit@sharda.ac.in Steve Katanga, Research Scholar, Sharda University School of Business Studies, Sharda University 2017015298.steve@dr.sharda.ac.in

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