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There are a number of factors that contribute to the success of any organization, these factors include: capital, equipment, manpower, etc. All these factors are important but the most significant factor is the human factor, as it is the people that will put the other resources to work. Since the early 1960, management has recognized that due attention should be given to human force in order to achieve business goals and objectives. To manage an organization both large and small requires staffing them with competent personnel. The formal educational system does not adequately teach specific job skills for a position in a particular organization. Few employees have the requisite skills, knowledge, abilities and competencies (SKAC) needed to work. As a result, many require extensive training and development programmes to acquire the necessary SKAC to be able to make substantive contribution towards the organization's growth, (Barron and Hagerty 2001).
Training is the formal and systematic modification of behavior through learning which occurs as a result of education, instruction, development and planned experience. It is acquisition of technology, which permits employees to perform their present jobs to standards. It improves the human performance on the job, the employee is presently doing or being hired to do. According to De Philips et al (1964), training is a process when under ,company auspices seeks a planned, coordinated and conscious manner to develop in the employees those understanding skill and attitude, which will maximize individual's present and future efficiency and effectiveness of the overall company operations. Development also sometimes distinguished from training, as development defined in terms of broader capability to take up future work and career opportunities, beyond the competencies required for a current position. It is concerned more with career growth than immediate performance. It enables leaders to guide their organization onto new expectations and enable workers to create better products, faster services, and more competitive organizations. Collett refers to the need to "keep the twin activities of training and development in balance - to develop capability [for future work] not just competence [for current position]". Thus, manpower training and development are two interrelated processes whose importance cannot be overemphasized in any discussion of human resource management. It is related to the series of activities, which an enterprise would need to embark upon to improve the quality of its managerial capital.
OVERVIEW OF HEALTHCARE SECTOR IN INDIA
The health sector in India faces multiple challenges in the geographic distribution of human resources for health. Though about one-third of Indians live in rural areas, the population-to-doctor ratio is much higher in rural than urban areas.
Availability of adequate number of human resources with suitable skill mix and their appropriate deployment at different levels of health care set-up are essential for providing effective health care services for the population. Since independence, concerted efforts have been made to address the need for human resources for health in India. However, shortage exists in all categories of human resources at different levels. Ensuring the availability of human resources for health in rural areas and building their capacity in public health are daunting tasks. Future challenge include planning for human resource for public health at State/national level, framing of State specific human resource development and training policy, creation of human resource management information system, reorientation of medical and para-medical education and ensuring proper utilization of the trained manpower and standardization of training. It is also important to link human resource development and training policy to the National Rural Health Mission in achieving its goals.
When examining health care systems in a global context, many general human resources issues and questions arise. Some of the issues of greatest relevance that will be discussed in further detail include the size, composition and distribution of the health care workforce, workforce training issues, the migration of health workers, and the level of economic development in a particular country and sociodemographic, geographical and cultural factors The migration of health care workers is an issue that arises when examining global health care systems. Research suggests that the movement of health care professionals closely follows the migration pattern of all professionals in that the internal movement of the workforce to urban areas is common to all countriesÂ .Workforce mobility can create additional imbalances that require better workforce planning, attention to issues of pay and other rewards and improved overall management of the workforceÂ .In addition to salary incentives, developing countries use other strategies such as housing, infrastructure and opportunities for job rotation to recruit and retain health professionalsÂ , since many health workers in developing countries are underpaid, poorly motivated and very dissatisfied. The migration of health workers is an important human resources issue that must be carefully measured and monitored.
Human resources in health sector reform also seek to improve the quality of services and patients' satisfaction. Health care quality is generally defined in two ways: technical quality and sociocultural quality. Technical quality refers to the impact that the health services available can have on the health conditions of a Sociocultural populationÂ . quality measures the degree of acceptability of services and the ability to satisfy patients' expectationsÂ .
Human resource professionals face many obstacles in their attempt to deliver high-quality health care to citizens. Some of these constraints include budgets, lack of congruence between different stakeholders' values, absenteeism rates, high rates of turnover and low morale of health personnelÂ .
By this, the study will look into the manpower base and quality of staff of the healthcare industry and assess their suitability with the aim of developing training programmes to enhance their performance since the progress of an organization is a function of the quality of those directing its affairs.
REVIEW OF LITERATURE
The Gallup School of Management (1978), conducted the poll through telephone interviews called "employees Speak Out on Job Training: Findings of a New Nationwide Study," found that employee satisfaction and retention are high when a company is willing to train its workers.
Terri Bergman(1995) in his study "Training: The case for increased investment" analyzed that training's greatest value to companies is increased productivity. Productivity increases are usually manifested as improvements in employees' performance (e.g., increases skills, increased initiative, reduced absenteeism), improvements in production measures (e.g., increased run rates, decreased scrap rates, increased on-time rates), and improvements in quality and customers satisfaction.
Donald L. Kirkpatrick (1997), Evaluation, Training and Development Handbook approached its, evaluation process in a more logical way. The author emphasized that while evaluating training, instead of just studying the reactions of the trainees, the study could be carried out in four different levels viz., i.e., reaction, learning, behaviour and results. The author's guidelines and discussions on each level of evaluation of training are worth mentioning.
(Dewdney, 2001),The WPRO/RTC health workforce planning workbook is one such tool that provides steps for developing an HR plan and includes a simple computer based planning model
Thought must be given to all these matters before training programmes are implemented. Similarly, evidence would also be available, locally as well as from other parts of the world on what human resource policies have been found to be successful, in what conditions and contexts, and what have been the lessons learned, with the larger goal of performance improvement
Cole (2002), has analysed that factors influencing the quantity and quality of training and development activities include; the degree of change in the external environment, the degree of internal change, the availability of suitable skills within the existing work-force and the extent to which management see training as a motivating factor in work.
Jenifer Wilson(2005), in her article "Developing A Training Culture" discuss that for implementing an effective programs, firms must go beyond simply establishing a list of courses. They must make training a part of the firm's culture". She added "There are several keys to successful training program. Many agree that firms must do the following:1- Approve training and learning budget. 2- Offer options 3- Provide soft skills training, 4- Train to retain.
Owens and Patrick (2006), conducted research on "The Relationship Between Training and Organizational Outcomes" In this research they indicated that relationships exist between turnover cognitions (i.e. thoughts of quitting, search interviews, and turnover intentions), job satisfaction, and the perception of the organizational justice as well. They added that employees who receive training will report lower levels of turnover
cognitions than those employees who do not receive training.
Steven W. Schmidt (2007), has a opinion that" Satisfaction with training and development is a major factor in decisions regarding people's careers. It is a factor that prospective employees evaluate in the job-hunting process. It is cited in surveys as to why workers accept or declines jobs with certain employers and why employees leave one employer for another .
T V Rao, Raju Rao, and Taru Yadav (2007) They examine that the HRD function is not well structured. The function seems to be convenience-driven rather than systems-driven. The HRD departments need to have professionally trained and competent staff. If they have to make an impact, they should enhance the maturity levels of all the subsystems. These subsystems have a lot of potential for giving competitive advantage through the development of employees and their competencies.
M.Srimannarayana (2011), studied the measures of training and development that are considered extremely valuable and those that are routinely used by HR professionals. He found that the traditional measures such as feedback of the training programmes, number of employees trained in various training programmes, training costs and number of training days are the more popular measures when compared to impact measures such as learning during training, transfer of training and performance improvements.
Shefali Verma and Rita Goyal (2011), made an attempt to assess the impact of training on insurance company. They found that through training opportunities, employees can develop and maintain skills that are required for employment in a continually changing workplace and will contribute their maximum for the achievement of the organizational objectives. By incorporating personality development programmes such as role play, group discussion and business games the superior and subordinate relationship can be strengthened.
Qasim Saleem, Mehwish Shahid, Akram Naseem (2011), revealed that organizations should hire already trained employees or give training and development to existing employees according to organization's requirements. Employees must be given an opportunities of training and development that lead to organizational efficiency and growth. Training may be on job or off job. Organizations should spend some amount of money for their employees not only for betterment of employees but also for the efficiency and betterment of organizations.
Muhammad Farhan Akhtar & Khizer Ali (2012), studied that training for employees of an organization is considered very much important in order to achieve excellence and competence. Their research indicates that training
has a positive impact on both motivation and job involvement and clearly emphasizes the need and importance of the training on the employees in the banking sector characterized by low morale due to high work stress.
SIGNIFICANCE OF THE STUDY
This study aims to understand the factors that motivate where health workers choose to work. It examines the job attributes that under-training and in-service health workers look for in a job, particularly in a rural job.
Transfer policies and promotions (transparent policy, time of service in rural area clearly stated, no political interference in transfers).
Lack of need based training to different categories of staff, absence of a well defined HRD policy, apathetic attitude towards training, inadequate training infrastructure and training skills, absence of pre-service and induction training and duplication of efforts by different agencies without much integration are some of the major challenges for capacity building.The study is conducted mainly to find out the Effectiveness of Training and Development on employees' performance in selected public health sector of Uttrakhand. The present - day economy is very much dependent upon the various functions of healthcare sector practices; it is unthinkable for the country's economy for its growth, sustenance and development without the role of hospitals.
The role of healthcare sector is essentially carried out by the people and therefore it is essential to have a well - trained and motivated staff to manage the hospitals operations. Success of the health sector operations depend upon the people, the employee and the effectiveness of the employee
is very much depending on the training input given to the employees. The effectiveness of training is not static, it has to be periodically reviewed, updated and upgraded in tune with demanding situation of the economy, government policy, advancements in Information Technology and expectations of customers. All the above-mentioned aspects impressed the researcher to study the existing Training activities and their effectiveness in selected public and private sector hospitals and come out with recommendations for future.
OBJECTIVES OF THE STUDY
To review the present training and development activities undertaken by public sector hospitals.
To identify training and development need for enriching skill and
performance of the employees in banks.
To examine the Strategies for Attracting and Retaining Skilled Human Resources in Rural Areas
To analyze the role of training and development in employees' retention and job satisfaction in hospitals.
To compare the impact of training and development practices on employees' productivity in public and private sector hospitals.
HYPOTHESIS OF THE STUDY
1. Training and Development practices increases job satisfaction among employees of hospitals.
2. Lack of manpower training and development activities are directly responsible for the high employee turnover in the hospitals.
3. Training and development activities leads to more employees' productivity in new private hospitals as compared to public hospitals.
The research is based on primary and secondary data. A well-structured questionnaire will be used to collect the primary data. Secondary data for the study will be collected from reputed journals, magazines, websites and hospitals records.
The research design indicates the type of research methodology under taken to collect the information for the study.Descriptive research is selected for this study. Descriptive research enables to determine the answer to various questions formulated with prior knowledge of the situation or the problems under study.
Universe or Population: - The population for the study is approx 500 employees of all the hospitals of Uttarakhand state (specially in Garhwal region).
Sampling Technique: - Random sampling will be used for this study. In this study first of all we will select the important health sectors and then their employees and patients as respondents in Uttarakhand state (specially in garhwal region).
Sample Size:-The study focuses on patient's expectations and factors they consider most in selecting services offered by healthcare sector in the Uttarakhand state specially in garhwal region. Data will be collected from approximately 500 respondents on the basis of random sampling.
Statistical Tools used Regression Analysis, Chi square, Percentage analysis etc will be used for data analysis.
EXPECTED CONTRIBUTION FROM THE STUDY
The analysis will be able to help in exploring the areas for improvement .
The analysis will be helpful to management in formulating appropriate strategies for development of comprehensive management system in the field of healthcare services
Study is expected to focus on human resource issues related to rural areas.
Study is expected to enable the public and private health sector to position their human resource effectively.
The study is expected to provide some suggestions to management of hospitals that may be helpful to them in designing appropriate HR policies.
The study provides the framework by which rural health sector fulfill the requirement of rural area.