Feature

A Delicate Balance

The process to choose the right partner for outsourcing and make it do quality work for the organisation poses a challenge for HR managers, finds out Sonal Shukla

In the early 2000, the concept of outsourcing really kicked off when sectors like IT and banking vigorously utilised it to attain efficiency at work. BPOs and KPOs brought in a fresh perspective to the entire functioning of an organisation. As usual healthcare seems to learn late from other sectors and grows at its own pace! Today, when there have been concerted efforts to have lean organisations, avoid duplication of tasks and contain costs, hospitals also have started outsourcing their non-core activities hoping to extract the best of results.

The Trend

Today, hospitals are increasingly outsourcing their non core areas like F&B, housekeeping, laundry and security. Investment in equipment is huge in case of areas like F&B and laundry services in a hospital. Also, creating infrastructure to render services and most importantly manpower at this level which is not responsible enough with high rate of absenteeism, unavailability, and uncalled legal issues, hospitals today prefer focusing on quality of patient care and better technology. There are many corporate hospitals like Wockhardt, Max Healthcare that on one hand are outsourcing their non-core areas, while there are a few like Hinduja Hospital which has not outsourced even a single department till date. Opines Ankush Gupta, Senior Manager, HR, PD Hinduja Hospital, Mumbai, "When a hospital outsources a department, the quality is definitely going to get affected. The vendor may not comply with the qualifications and the required job specifications while hiring the people. They also cut corners in various ways whether it is salary, material or machine. So, when you do cost cutting by outsourcing, how can the quality of service be right?"

With quality of service from outsourced vendors being doubted, selecting the right vendor becomes an uphill task for HR managers.

Challenges Galore

Quality of work also depends on the training

HR can have a joint review about performance with the outsourcing agency

Finding and choosing the right outsourcing agency for the right services is believed to be the key link. Their credibility, past records, experience and systems process needs to be assessed. Cultural differences between the principal employer and outsourced agency has got immense importance on day-to-day services.

Another major challenge that the HR managers face is the urgent replacement against absenteeism of the outsourced staff. According to Dr J Damodharan, Medical Director, SRMC, Chennai, problem with outsourcing is lack of emotional attachment and accountability of the employee to the organisation which leads to frequent absenteeism and workers attending multiple worksites with gaps in continuity of work.

The hospital is liable to provide quality services to the patients, but do not enjoy entire authority over the employees. Maintaining discipline is also a challenging factor. "Basic difficulty is that the outsourced employees have two functional masters, but with one administrative head. Defining the deliverables including their job scope and responsibilities of the outsource agency is also a difficult task," shares Shubhendu Poddar, General Manager- HRMD, AMRI Hospitals, Kolkata. Thus, managing adherence to internal processes,by people deployed in 'outsourced' positions becomes difficult to attain for the HR team of the hospital. "They are not directly accountable to us, therefore their reliability factor is questionable, and they cannot be rewarded or reprimanded," concludes Anthony Handa, Manager - HR, Ruby Hall Clinic, Pune.

We try to explore as to how do they tackle this challenge from the humane as well as professional viewpoint to attain optimum efficiency.

HR — A Crucial Link

The whole process of outsourcing needs to be necessarily monitored by the HR department, especially in a hospital as it is significantly people and perceptions driven industry. HR has a vital role in policy decisions to ensure that the outsourced departments produce the required or desired results. "HR can play a strategic role keeping in the entire decision making process of outsourcing of departments and consider the issue, keeping in mind the business vision and objectives," shares Poddar.

HR's role commences from defining the roles and charting out the job description. It also includes induction of new entrants, making the personnel aware of their jobs and responsibilities and the expected outcome. "It is only HR which helps and guides the CEO to take decision whether to opt for outsourcing or not. Once the decision is taken for outsourcing, it the HR person who sets down criteria for the selection of the employees in terms of qualification, age, salary bracket, background check and experience," says Ravinder Kaur, Deputy General Manager - HR, Jehangir Hospital, Pune. HR can thus clearly spell out the job requirements with specifications, in matters related to selection of personnel for the outsourced departments. This will form the basis on which quality staff can be insisted.

The Employee-Employer Relationship

HR department does not directly deal with the employees of the outsourced departments. "Outsourcing is rarely used for 'quality enhancement' in a hospital which can be done through a structured development programme," shares Surajit Banerjee, Director - HR, Max Healthcare, New Delhi. It is the outsourced department in-charge who will be communicating with the HR. As regards to the personnel employed by the outsourced departments, if any observations is made by the HR like indiscipline, slackness in work output, indulging in unwarranted activities etc, then the in-charges are informed immediately for removal of such person from the premises. "This is one of the greatest advantages for the management. There have been some instances like willful collection of cash from patients for services, minor theft of hospital and patient items, alcoholism. These are some of the reasons for removal of employees of the outsourced departments," says S Swamynathan, General Manager - HR, SRMC, Chennai.

Areas which are variably manned, requiring quick up-scaling or down-scaling and requiring moderate levels of skills are preferred by the hospitals for outsourcing. On the contrary, outsourcing would be less effective in areas providing niche medical care because in such areas, knowledge and skills would get developed over a period of time for delivering sustained levels of medical care.

Ways & Means

"Once gap between desired level of performance and present performance is identified, we facilitate training programmes" - Shubhendu Poddar General Manager- HRM & D AMRI Hospitals Kolkata

"We do induction, regular briefings, on the job training, review and also we have interaction with vendors" - Surajit Banerjee Director - HR Max Healthcare New Delhi

"I personally feel that even the outsourced contractor/ vendor needs to have quality-based or service KRAs to deliver" - Ravinder Kaur Deputy General Manager - HR Jehangir Hospital Pune

HR can organise joint interviews of the employees at the time of entry and also can have a joint review about their performance with the outsourcing agency. The HR of the hospital can sit with the outsourcing agency and customise training programmes, vis-à-vis the requirements of the hospital.

Adequate unbiased supervision by the hospital is crucial in maintaining quality. However, the quality of work also depends on the training and supervision given by the outsourced agency and the motivation of the staff employed by him. Therefore, expectations from the hospital have to be made clear in the beginning and adequate disclaimers and penalties in the agreement are crucial to good performance.

"We ensure that the outsourcing company does the minimum amount of training and we also provide our own training. In fact, there is a monthly programme of honouring the best employee, and we allocate the best employee for house-keeping , which is an outsourced area in the hospital. For all the practical purposes, we ensure that they feel that they are part of the whole family," says Kumar Krishnaswamy, Group Head - HR, Wockhardt Hospitals.

AMRI Hospitals has appointed senior officers to oversee the functions of outsourced employees. According to Poddar, this is being done with a view to maintain and ensure consistency in quality services, job specification, induction, selection procedure and norms, culture and experience. All these will have a definite impact on quality of the people and outcome of work.

Adequate Protocols

There is a need to have good processes around people who get inducted. They have to be appropriately briefed, familiarised and given an induction to be able to come to the ground and deliver consistent quality. "There are processes around all the outsourced people who come into Max Healthcare. We do induction, regular briefings, on-the-job training, review and also have interaction with vendors. Eventually, this provides a certain level of consistency in the service," shares Banerjee.

On the other hand, weekly meeting, review of services in line with incident reported for services/ feedback collated after analysis, regular training to be imparted on behaviour, defining the services providers THE KRAS in line with service deliverables are few effective methods to improve on the performance given by the outsourced employees.

"The outsourced agency is liable to show us their new recruitees before the prospective workmen are deployed at our site. Once we identify gap between the desired level of performance and the present performance, we facilitate to organise for counseling session and training programmes for outsourcing employees. However, we identify the patient's requirements by critically analysing the patient's feedback reports. Being a NABH-accredited hospital, we need to maintain our laid down protocol in a very specific manner. Their efforts are always appreciated," shares Poddar.

Choosing the Right Vendor

Hospitals are laying great emphasis on having a good relationship with the outsourcing vendor supplying the employees in the hospital. According to Kaur from Jehangir Hospital, the impact can only be seen only if the hospital makes the vendors as business partners than mere vendors/ facility management service. The desired quality can only be achieved when they (vendor/ facility management agency) understand the organisational quality policy/ mission/ vision. "I personally feel that even the outsourced contractor/ vendor need to have quality-based service KRA's to deliver," says Kaur. Agrees Krishnaswami, "Vendors will be taking flexible assignments with different establishments. Why will they give us alone the good people and not to others? This means that HR needs to ensure that there is a good relationship with them."

According to Shrabani Basu, Managing Consultant & Corporate Mentor, "Outsourcing is expertise oriented, wherein there are shared responsibilities in terms of quality deliveries and a continuous communication channel, hence your outsourced partners must be experts and be able to value add, not just merely handle your job."

With regards to identifying the vendor— it must be providing similar or close to similar services in other good quality professional organisations. The hospital must also see the quality of the people and processes that the vendor has before associating with it. "It is also essential to see as to how closely these processes align with the hospital processes and work culture. After you select the vendor, then together you need to decide on what should be the common frame of reference," shares Banerjee.

It should be taken into consideration that when a patient comes in the hospital, he doesn't know the difference between an outsourced employee and a regular employee. As far as the patient is concerned, the experience should be good. To ensure that the person who delivers the service should be good and training that is given to the person is upto the mark, HR has to play an active and important role.

sonal.shukla@expressindia.com