13 Chapter 2: Critical Literature Review 2.1 ... - Dissertation

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38is experiencing one of the worst shortage of nurses in its history. The survey found a fall of 26percent in qualified nurses between 1990 and 1998. Additonal information from the surveyshowed that the biggest issues facing the organization involve the retention of nurses who havealready been recruited (Newman, Maylor and Chansarkar, 2002).According to Humphrey and Ehrich,when they studied the real-world implications of thepolicies set by the National Health Service, they found that the policies of the National HealthService directly impacted human resource management and had a direct effect on the standard ofcare despite not being intended for such a purpose. The article also stated that the long-termeffects of such policies are vague due to effects detailed previously (2003).A survey by Newman, Maylor and Chansarkar found that the Health Service hadconsiderable difficulties retaining nurses of Grade D and E. Grade D refers to those nurses whoare responsible for direct care and Grade E nurses are considered as replacements for Grade Gnurses as well as providing direct care. Grade E is considered senior to Grade D. Reasoningsbehind the fall in rentention included but were not limited to longer working hours, heavyworkloads, staff shortages, inability to finish work at the end of shifts, overtime work notrewarded, lack of funds for training, vacancies not being filled, and a fostering of a culture wherenurses pay for their own training. The survey further found that job satisfaction was the numberone reason for retention among nurses with job characteristics and personal motivations takingsubsequent places (Newman, Maylor and Chansarkar, 2002).Another study on the methods employed by the National Health Service to benchmark itsvarious institutions found that the main method used by the NHS to guage performance was abalanced scorecard. This balanced scorecard not only acted as an indicator of performance, butalso provided a framework for future financial growth (Chang, 2007).
39However, the study found that this scorecard was not viable as a strategic managementtool since it does not take into account the various goals of healthcare organizations. The studyalso found that the scorecard did not serve the public trust, rather, was more politically motivatedand cited targets for delivery of healthcare which were unfeasible and did not significantlyimpact local operations or performance. Instead, it merely created percieved performance levelsfrom its various constitutents in order for the NHS to secure its various shareholders and thus itsmonetary concerns (Chang, 2007).Within these performance evaluations are also proposals for clinical governance ofdoctors, which have been percieved by doctors in the National Health Service as being animposition rather than a prospect. They see such governance as a compulsion put upon themrather than an opportunity (Som, 2005). Another study showed that the fault may not lie inclinical governance of doctors but rather in the management which does not have the skills ortraining to engage with their colleagues (Davies, 2006).<strong>2.1</strong>4.1 Job Evaluation in the National Health ServiceAfter the Second World War and the formation of the National Health Service, there wasno formal job evaluation or pay equity system in place within the organization. The negotiationsfor pay structures would be primarily handled by bargaining on a case by case basis and wouldremain relatively unchanged for the next 40 years. The General Whitley Council and severalother committees and sub-committees were responsible for these negotiations.It was only thereafter that in the 1930s when the NHS abandoned the bargaining structureand introduced a system of clinical grading. One of the most well-known forms of this systemwas the type that was attributed to nurses and midwives. The grading system used grades A to Ito gauge the skills and competency of various nurses. This methodology was similar to the job
Page 1: 13Chapter 2: Critical Literature Re
Page 4 and 5: 16job’s description and distincti
Page 6 and 7: 18levels of responsibility. Once th
Page 8 and 9: 202.4.3 Hay MethodThe Hay Method of
Page 10 and 11: 22making. The hierarchy of the job
Page 12 and 13: 24managed fairly. Among these strat
Page 14 and 15: 26amendments also removed the size
Page 16 and 17: 28services. It also provides requir
Page 18: 30by Hewitt Associates found that 9
Page 21 and 22: 33both sectors in order to share th
Page 23 and 24: 35In 2008, the National Health Serv
Page 25: 37Among the ones who said they did
Page 29 and 30: 41gender gaps illegal, the concept
Page 31 and 32: 43• A detailed overview of the ma
Page 33 and 34: 45Once the questionnaire has been c
Page 35 and 36: 47three stages. The first one is th
Page 37 and 38: 49politics (Heneman, 2003). The ult
Page 39 and 40: 51traditionalists, realists, strate
Page 41 and 42: 53The authors highlighted the fact
Page 43 and 44: 552.15.4 A Revision of a Job Evalua
Page 45 and 46: 57problem-solving, experience, deci
Page 47 and 48: 59methodology itself. The authors c
Page 49 and 50: 61very methodology of the research
Page 51 and 52: 63evaluation by modern day employer
Page 53: 65toward this cause was the Equal P

13 Chapter 2: Critical Literature Review 2.1 ... - Dissertation

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