The right staff

Finding the right staff is a numbers game for most local hospitals, but the figures aren't adding up. Vernon Baxter hears how HR departments are dropping the ball when it comes to recruitment.
The right staff
By Vernon Baxter
Mon 07 Apr 2008 04:00 AM

Finding the right staff is a numbers game for most local hospitals, but the figures aren't adding up. Vernon Baxter hears how HR departments are dropping the ball when it comes to recruitment.

It's easy to judge the quality of a hospital: just look at its staff. Competing facilities flount the number of board-accredited physicians on their roster and a doctor's reputation is built on his or her qualifications.

The infrastructure may be there soon, but that is easy to do - populating those buildings and making them into a hospital is the challenge.

The Middle East may be playing catch-up when it comes to healthcare, but if you take the United Arab Emirates (UAE) as an example, the region is not afraid to pay for world-class reputations.

High profile tie-ups with names such as Harvard Medical School, Cleveland Clinic, Johns Hopkins and Imperial College London show how aggressively the UAE is pursuing excellence in healthcare. But if industry analysts are to be believed, healthcare in the Middle East is developing along two vastly different planes.

For the affluent, first-rate facilities are finally on their doorstep. For the rest, healthcare is regressing at a dangerous rate. Last month Medical Times looked at what providers could do to improve recruitment policies. In the second instalment we discover how prevailing attitudes are holding the region back and how the recruitment business can act as a litmus test to the health of the medical industry in the Middle East.

New world disorder

"In the Middle East I see a general movement down the slippery slope from the first world back into the abyss of the third world," declares Nicholas J. Ofield, director of human resources and recruitment, Interhealth Canada, Kuwait.

His stark comment is surprising, considering the Middle East's current reputation as the 21st century's boomtown. Yet Ofield is adamant that despite substantial investment, the region is starting to move backward when it comes to public health.

"It has been very marked here in Kuwait and I see it in other places in the Gulf," he insists. "You have these wonderful buildings going up, but there is nothing supporting them. They are presenting this class of life for this ever-increasing number of highly-paid people, but they are an ever-decreasing percentage of the total."

The vast majority of the Middle East's population originates from the subcontinent and for the most part, Ofield argues, the low socio-economic status of these residents means they are disenfranchised from healthcare facilities. The sheer volume of poorer patients means even when attempts are made to address the problem, it inevitably results in decreasing standards, he says.

"The region has so assimilated these other nationalities...[that] the standard of lifestyle for the majority of the people is getting lower and especially in public healthcare."

Improving healthcare is inextricably linked to improving recruitment. Without a higher quality of staff, and a larger quantity, the region may well falter under the burden of its growing population. And ultimately that is what a consultancy firm like Interhealth Canada is being paid to deliver on. Yet Ofield is doubtful whether commitments to improving HR policies are ever more than empty promises.

"We are there to provide this level of excellence that everyone is initially very keen on, and then after a couple of years they need to save a bit of money and they make cut-backs," he complains. "You cannot keep doing that and maintain the same level of staff integrity."

It is this willingness to compromise on quality when the going gets tough that Ofield feels is holding back the development of the region's healthcare providers.

Ch-ch-changes

There is only one certainty in any global industry: the best people will follow the best money. Unfortunately, as last month's article discovered, the Gulf region simply doesn't offer top dollar. Healthcare employers might complain about external economic forces, notes Nick Sljivic, director of IMS Recruitment, but it won't change how attractive their salary looks to someone thousands of miles away.

"The wages may be tax-free, but there has been huge wage inflation globally and there are better opportunities in places like Australia or America," he says. "It is no longer that huge gravy train, so if you're economic and rational and go where the money is, it's not in the Middle East."

But money is not usually the principal reason for pursuing a career in medicine. Many expatriate physicians come to the Middle East to make a difference. Unfortunately, not many succeed, according to Ofield.

"Often what happens is that you bring in new people who are going to make changes and improve standards, but these people are not trained in change management and many of them are totally inexperienced in the Middle East," he observes.

Coping with cultural differences and staff resistance is not an easy task and it usually ends in frustration. Yet it is hardly fair to blame the staff, claims Ofield, if they become cynical about fleeting changes.

"The people down the line, the guy who sweeps the floor, he has been there 15 years, and he's seen it all before," he says. "When the next guy comes to change things he is going to shrug his shoulder and say, ‘Why should I cooperate, he's not going to achieve anything and he's going to leave after two years' - it is a vicious cycle."

A naive approach to staff retention only exacerbates the problem, Ofield argues, as spendthrift employers have an unrealistic conception of market value. "One of the critical factors in the Middle East is that someone who works for three years and then leaves because they want more money, which the company doesn't want to give them," he says.

While management obviously want to curb wages costs, there is always a danger of being counter-productive. "When they try and replace those staff members they find it costs even more because the market rate has gone up."

Settling for average

Lifting recruitment standards must be a priority for the Middle East, but the reality is that, for the moment, the market is so underserved that providers are able to get away with maintaining the status quo.

However, like many aspects of life in the region, healthcare is a sector very much under construction. With a glut of hospitals set to come on to the market, recruiting the right people has never been so important.

"Once supply catches up with demand then the competition changes from the pure issue of price to that of quality," says Ziad Fares, an industry analyst. "But this is something that cannot be done overnight," he warns. "Populating those buildings and making them into a hospital is the challenge."

While increased competition should raise the standard of employees recruited by hospitals, there is also a danger it could go the other way. If the market is swamped then revenue will be sparse. Wages will drop, and the quality of staff with them.

"There are an awful lot of hospital beds coming online in the next couple of years and unless there is substantial growth to go with it, which has been predicted, then I think there is definitely a danger of overbedding in this part of the world," warns Paul Johnson, business development director for Outsourcing Consultants, a Dubai-based consultancy active in the medical industry.

Ofield is convinced this is going to be a major problem in the Kuwait market. "There are currently about four new private hospitals that are about to come onstream. My question is - where are the patients?"

Ofield contends that high immigration figures are fuelling the construction boom, but doesn't believe many of those individuals will be able to afford private medicine. "All that will happen with these hospitals coming is that they will be competing for a slice of the existing market."

The human cost

With so many expatriate workers in healthcare it is sometimes easy to forget that one country's gain is another country's loss. The Philippines is currently the biggest exporter of nurses worldwide and, although they supply nurses across the Middle East, it lists Saudi Arabia as one of its two chief destinations (along with the US) for nursing staff. Ironically, they are now suffering from desperate nursing shortages.

"Although the Philippines has more than 400 nursing colleges churning up some 20,000 nurses yearly, it also loses its trained and skilled nursing workforce to better jobs abroad faster than it can replace them," claims Dr Emer, a Filipino physician whose blog, Parallel Universes, details the pressures of the country's health service. It does not look like it is a problem that will be solved any time soon, either.

"The pressure to earn more and improve the lives of their respective families continues to drive our local nurses to seek better-paying jobs abroad," Emer complains.

Regional human resources departments are regularly criticised for their attitude towards nurses. Many believe that there is little use investing in their development because they are likely to leave for a job in the US or Europe after they have gained enough experience.

This is not an excuse to mistreat nursing staff, however, argues Mireille Kingma, a consultant on nursing and health policy for the International Council of Nurses. "I think the way nurses are treated is a very important factor in job dissatisfaction," she says.

"One of the barriers of retaining migrant nurses is that so many of them face discrimination."

Unsurprisingly, perhaps, one of the most common complaints relates to salaries. "I know that in the Middle East there has been a big problem in the past where nurses given the same responsibility and the same hours and shifts are not given the same salary," reports Kingma. "It usually depends on where they come from."

It is this archaic approach to recruitment that is holding local providers back, claims Ziad Fares. If the Middle East wants to realise its ambitions for healthcare it needs an overhaul in attitude. Unfortunately these attitudes can't be built in a day, and the region still has a long way to go.

"I don't see it happening tomorrow...it might even take 10 years before we will see a noticeable change," says Fares. "All the big names are here now, but to allow for this knowledge transfer will take time."

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