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| Monday, 19 January 2004 |
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Health sector strikes - the way out by S M J Neangoda For several years the public has been seriously inconvenienced due to periodical strikes in the health sector. The Trade Unions claim that the strikes are being launched with a view to secure a resolution of grievances arising out of salary inequities. Wage and salary inequities arise from rewards Management and Remuneration practices adopted from time to time... The approach to the resolution of the problem of Wage & Salary inequities should be based on recognized techniques of assessing the relative worth or values of jobs and the design and management of appropriate pay structures. Stakeholder aspirations It is important to consider that all health sector employees are stake holders in the health department and their needs have got to be addressed. At the same time the duties and responsibilities that the health sector employees owe to the public who are also stake holders is an onerous one and has to be appreciated more than the other sectors because of the fact that the life of patients are at stake. Pros and cons of the claims The justification of the stand taken by each party who claim that there are serious salary anomalies can be tested only by an universally accepted job evaluation program, based on an accepted technique. Considering the pros & cons of the different techniques that can be adopted, the ideal technique to be adopted without sacrificing accuracy would be the point rating technique. Job evaluation - basis for equity Without considering the technical aspects, it is considered sufficient to apprise the authorities and those who are involved, regarding the methodology to be adopted, in job evaluation with the objective of resolving the wage and salary inequity problem. Such a program can indeed lay the foundation for the development of the human resources in the health sector with a modern H R focus as well. Although the hierarchical order of jobs in different categories is crucial and which can be arrived at through job evaluation, there are many other factors which have a bearing on the adoption of appropriate remuneration policies and practices, like job market related influences, including supply and demand for medical professionals, as well as current trends towards performance related remuneration. It must also be emphasized that the right remuneration or rewards processes are the ones that are right for this particular organization. There are many objectives of rewards management and remuneration policy which consultants in the field are familiar with and a detailed discussion is considered out of place in this article. Equitable wage payments based on an identification of the correct differentials between jobs and determination of a correct hierarchal order of jobs and the assignment of appropriate wage scales is a powerful motivator for maintaining a stable and productive organization . It may be mentioned that wages and salaries are paid to employees for the contribution they make to the organization and this contribution is made on the basis of different levels of job factors prevalent in the jobs. These job factors for which payment is made are the know-how or the skill to do the job which is acquired through training or professional qualifications and experience on the one hand and the effort, either mental or physical, which is required to perform the job on the other. In addition the responsibility and authority reposed on a job holder is the third factor. Job factors will vary depending on the levels in the job hierarchy as well as the job classification.. Further, for purposes of arriving at the hierarchal order through evaluation, each of the job factors will have degrees which will be assigned degree definitions. All of which form what is known as a factor manual or a yard stick, which will be used for evaluating every job in the organization and arriving at salary bands and appropriate wage scales. Job Facts - for fact founded decision making Job facts will be obtained for each job and will form the Job descriptions and acceptance thereof by the management and trade unions will make them authoritative as well as the foundation for the entire wage and salary structure. Concurrence and consensus is an important facet of the job evaluation process, where trade union representatives along with senior officials, guided by consultants will carry out the assignment jointly ensuring fair play. Indeed every decision will be fact founded and arguable. Considering the nature of jobs in the Health Department job factors will differ as to whether they are specialist medical officers and medical officers, middle level cadres, clerical and allied staff or manual and operative grade staff. As a first task every job in the health institutions have to be identified and agreed upon, conforming to the above four categories as extant or as agreed. Every position/job will have a position/job description as the case may be, which will highlight job characteristics as required for the evaluation. Each description will give the nature and scope of job, reporting arrangements, all the duties performed, highlighting machines, equipment used, work procedures, nature of supervision, know-how required to do the job, job variety, accuracy and precision involved, acceptable limits of quality, safety requirements, effort, both mental and physical, hazards (safety), accountability for end results and losses and effects on patients or end results of procedures.. An illustration Once a job description is prepared through analysis, using an appropriate format for the different staff categories as discussed, which is a factual statement, there will be no room for argument about the characteristics of each job, through which contribution to the end result of that job will be made. It is through these descriptions that comparison and evaluation will be made. .To take an example, the job objectives of a radiographer will involve exposing patients to ionizing radiation for diagnostic purposes and therapy. He will generally report to the Superintendent Radiographer and through him to the Radiologist. He will have an attendant, subordinate staff and dark room attendant. However, to determine the relative differentials between the other jobs, say a pharmacist or a ECG Recordist or a staff nurse or a physiotherapist or an ophthalmic technologist a greater degree of analysis and recording of data will be necessary. Further analysis will show that a Radiographers job will involve the task of calling and identifying correct patients, giving proper instructions to patients, preparing patients for emergency therapy procedures, explaining procedure to patients in non technical language to obtain consent, planning the procedure which involves exposure factors, correct film, setting the machine, selecting the screens and cassettes, selecting proper contrast media, positioning the patient. Further, there are a host of other tasks, from making the exposure to getting the film delivered to the ward. The duties may also involve nuclear medicine, CT Scan (Ultra sound) digital subtraction angiography. Even the above can not be considered as a complete description and further information will be necessary to make the description complete for comparison and evaluation purposes and establishing relative differentials. The point that is intended to be driven home is that the wage structure will have to be based on fact and not on hunch for acceptance.. Expected outcome Once all the job descriptions are prepared, the factual basis for evaluation will be complete and differentials can be established through evaluation based on a rating manual. The completion of rating will enable the final structure to be put together, devoid of anomalies. The writer considers the exposition above to be sufficient to apprise the authorities and those who are involved regarding the only approach that is available to the resolution of the salary inequity problem, which has become complex. Whatever the outcome, the interest of the patients should not be sacrificed. (The writer is the Director, Lanka Business Consultancy & Entrepreneur Development Institute and President, Asian Productivity Society of Sri Lanka.) |
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