|Year : 2016 | Volume
| Issue : 2 | Page : 81-85
Humanistic care in healthcare management: A comparative study in three hospitals in Eastern Province-Saudi Arabia
Azza Ali El-Mahalli
Department of Health Information Management and Technology, College of Public Health and Health Informatics, University of Dammam, Dammam, Saudi Arabia
|Date of Web Publication||25-Oct-2016|
Azza Ali El-Mahalli
Department of Health Information Management and Technology, College of Public Health and Health Informatics, University of Dammam, P.O. Box 1982, Postal Code: 31451, Dammam
Source of Support: None, Conflict of Interest: None
Background: Healthcare leadership by its very nature is essentially humanistic, and this is as critical and integral as is the leader's attention to high-quality clinical care and technical excellence. Humanistic care to employees is a requisite in organizations that wish their employees to provide humanistic care to patients. Aims: Project aimed to assess and compare perceptions of healthcare employees about humanistic care practiced by department heads in three different hospitals in Eastern Province: One Ministry of Health Hospital, Teaching Hospital - Khobar, and one private hospital. Settings and Design: Study design was cross-sectional paper-based survey done in three hospitals in Eastern Province. Materials and Methods: Target population was physicians, paramedics (nurses, therapists, technicians, and other ancillary personnel involved in medical care) who directly report to department heads. Data collection sheet was designed to assess the degree of humanistic care and Likert scale of five was used. Statistical Analysis: Data were statistically analyzed using SPSS (20). Three hospitals were compared for humanistic care offered to employees. Kruskal-Wallis test was conducted to assess significant differences of employees "perceptions between three hospitals." Statistical significance at P < 0.05 was used. Results and Conclusions: Almost all humanistic care dimensions were perceived higher in the governmental hospitals in comparison to private hospital and the difference was statistically significant (P < 0.05). Joint Commission International (JCI) Accreditation played a significant role in improving humanistic care dimensions: Interpersonal relations (124.0), respect for employees (128.0), employees involvement (126.0), employee empowerment and delegation of tasks (127.9), employee care (124.9), and work environment (130.1 ) . The difference was statistically significant (P < 0.05). JCI Accreditation improved humanistic care.
Keywords: Employees, hospitals, humanistic care, Saudi Arabia
|How to cite this article:|
El-Mahalli AA. Humanistic care in healthcare management: A comparative study in three hospitals in Eastern Province-Saudi Arabia. Saudi J Health Sci 2016;5:81-5
|How to cite this URL:|
El-Mahalli AA. Humanistic care in healthcare management: A comparative study in three hospitals in Eastern Province-Saudi Arabia. Saudi J Health Sci [serial online] 2016 [cited 2019 Jun 18];5:81-5. Available from: http://www.saudijhealthsci.org/text.asp?2016/5/2/81/193003
| Introduction|| |
The Merriam-Webster definition of humanism is that it is "a doctrine, attitude, or way of life centered on human interests or values."  Branch et al. stated that humanism in medicine involves "the physician's attitudes and actions that demonstrate an interest in and respect for the patient and that address the patient's concerns and values. These are generally are related to patients' psychological, social, and spiritual domains." Humanism in medicine clearly focuses on the individual level (patients).  However, humanism in healthcare management involves both micro (individual) and macro dimensions, as the scope of leadership and service to others becomes necessarily broader from the standpoint of management. High-level healthcare managers must serve a number of "stakeholders," both inside and outside the organization. Humanism in healthcare management should entail serving (1) patients and their families, (2) organizational members, and (3) the community.  However, this study entailed only the organizational members, i.e., employees.
In the twentieth century, a number of models of healthcare leadership were developed that were humanistic in focus. These models primarily stressed the value of attention by leaders on the needs and values of employees working in the organization. Humanistic healthcare leadership involves motivating and empowering employees. Leaders through establishing positive, supportive, and empowering environments for clinicians and other employees can facilitate humanistic care in healthcare organizations.  Accordingly, the study aimed to assess and compare the perceptions of healthcare employees about the humanistic care practiced by the healthcare managers (department heads) in three different hospitals in the Eastern Province, Saudi Arabia (SA).
Healthcare leadership by its very nature is essentially humanistic, and this is as critical and integral as is the leader's attention to high-quality clinical care and technical excellence. Humanistic care to employees is a requisite in organizations that wish their employees to provide humanistic care to patients. However, humanism is largely absent from healthcare organizations as a critical and important value. 
| Materials and Methods|| |
The study was conducted in the nursing, Internal Medicine and Surgery Departments of three General Hospitals in the Eastern Province, SA: One Ministry of Health (MOH) hospital in Dammam, and King Fahd Hospital of the University (KFHU), and a private hospital in Khobar. At the time of data collection, December 2014 to March 2015, the MOH hospital was accredited by Saudi Central Board of Accreditation of Healthcare Institutions (CBAHI) and Joint Commission International (JCI), the private hospital was accredited by CBAHI only, and KFHU was not accredited by CBAHI, but JCI accreditation was in progress. The study was a cross-sectional paper-based survey. Department Heads of the Internal Medicine, Surgery, and Nursing Departments were included in the study. KFHU has 11 Nursing, 12 Internal Medicine, and 8 Surgical Departments. However, only 24 department heads were available at the time of data collection/or accepted to participate. MOH hospital has 9 Nursing, 6 Internal Medicine, and 4 Surgical Departments. All 19 department heads were available and accepted to participate. The private hospital has 10 Nursing, 4 Internal Medicine, and 7 Surgical Departments. However, there is only one department head for all nursing departments, and the same was repeated for Internal Medicine and Surgical Departments. These three department heads participated in the study. Data collection sheet was designed to collect a profile of the department heads, for example, age, gender, nationality, training program in the management and leadership, type of health administration study, and experience years in the administrative post.
A convenience sample of the employees working in the departments under study was enrolled in the research (those who were available and willing to participate). They included physicians and paramedics (nurses, therapists, technicians, and other ancillary personnel involved in medical care). They amounted to 231 (89 from KFHU, 79 from MOH hospital, and 63 from the private hospital) and all of them was given prior informed consent. The aim of the study was explained to them, and confidentiality of data was ensured.
Data collection sheet was designed to assess their perceptions regarding humanistic care practiced by their direct manager (department heads). Humanistic care dimensions included goal alignment; employee recognition; interpersonal relations; respect for employees; employees involvement; training; employee empowerment and delegation of tasks; employee care; trust and work environment. , Data collection sheet also collected types of hospital accreditation.
Likert scale of 5 was used to assess perceptions about humanistic care: "5" if humanistic care is practiced with employees >75% of time, "4" if humanistic care is practiced 50%-75% of time, "3" if humanistic care is practiced 25%-<50% of time, "2" if humanistic care is practiced <25% of time, "1" if humanistic care is not practiced. "Not available (NA)" if participants do not interact with the manager/leader in a way that would allow him/her to observe a certain humanistic care. "NA" scored as "0."  The questionnaire was self-administered and anonymous to allow participants feel free and be frank. Formal approval from the study hospitals was obtained before conducting the research. Data collection tool was pilot tested on three subordinates to test the clarity of humanistic care dimensions. Then, it was revised accordingly.
Collected data were statistically analyzed using SPSS program version 20. Kolmogorov-Smirnov test and Shapiro-Wilk test of normality was done. Data were not normally distributed. Humanistic care was compared in the three hospitals under study. Kruskal-Wallis test was used to determine the difference between the mean ranks of humanistic care in the three hospitals. Humanistic care dimensions were also compared according to the type of hospital accreditation. Five percent level of significance was used.
| Results|| |
[Table 1] shows that most of the department heads were Saudis (52.2%), and the difference was significant. Department heads in KFHU (83.3%) and MOH hospital (63.2%) had any health administration studies.
|Table 1: Distribution of heads of departments according to demographic and administrative characteristics in three hospitals in Eastern Province - Saudi Arabia (March 2015)|
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[Table 2] shows that the highest mean rank of goal alignment, employee empowerment, and delegation of tasks; trust and work environment was in KFHU. However, the highest mean rank of interpersonal relations, respect for employees, employees' involvement, training, and employee care was in the MOH hospital. On the other hand, the highest mean rank of employee recognition was in the private hospital. The difference between mean ranks of all humanistic care dimensions was statistically significant.
|Table 2: Comparison of humanistic care in three hospitals in Eastern Province - Saudi Arabia (March 2015)|
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[Table 3] demonstrates that the mean rank of all humanistic care dimensions except that of goal alignment and employee recognition was higher in hospitals accredited by JCI or in its way to get it. The differences were significant.
|Table 3: Humanistic care according to hospital accreditation in Eastern Province - Saudi Arabia (March 2015)|
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| Discussion|| |
The humanistic care was negligent in the 19 th century, it was not considered as an element of management, and the focus was more on the job productivity. In the 20 th century, the humanism was growing to be an important element of the management. 
When leaders and managers execute their duties in a caring and professional manner, their care and concern for the employees are evident. Organizational leaders and managers cannot merely tell employees that they care about them and their well-being; they must demonstrate care through their actions. "Just as the most successful organizations have worked systemically to optimize their levels of employee engagement, attention to employee well-being will provide an emotional, financial, and competitive advantage." 
The present findings revealed that employees working in KFHU and the MOH hospital perceived the highest mean rank of almost all humanistic care dimensions and differences were significant [Table 2]. This could be attributed to the impact of JCI accreditation especially the fact that the present findings showed that hospitals accredited by JCI or in its way to get JCI accreditation had higher mean rank of almost all humanistic care dimensions and the differences were statistically significant [Table 3]. Literature reported that accreditation sustains improvements in quality and organizational performance. ,,,, In addition, department heads in KFHU who had any health administration studies, for example, bachelor, diploma, master or PhD represented (83.3%), and in MOH hospital represented (63.2%). However, department heads in the private hospital had no health administration studies (0.0%) [Table 1].
Goal alignment means that manager tries to match employee's personal goal and value with department goal and value.  Results of the present study revealed that employees working in KFHU perceived the highest mean rank of goal alignment (135.8) [Table 2]. This could be attributed to the fact that 83.3% of department heads in KFHU had health administration study such as bachelor, diploma, master or PhD in comparison to the MOH hospital (63.2%) and the private hospital (0.0%) [Table 1].
With the economic and market changes currently taking place, organizations cannot survive or prosper without quality employees. The key to employee loyalty, performance, and retention is the relationship between the leader, manager, and employee.  The present study found that the highest mean rank of interpersonal relations was in the MOH hospital (131.03), followed by KFHU (117.79) in comparison to the private hospital (94.63). The difference was significant [Table 2]. This could be attributed to the effect of JCI accreditation as the present study showed that hospitals accredited by the JCI or in progress to get it had higher mean rank of interpersonal relations (124.0) than other hospitals not (94.6), and the difference was significant [Table 3].
Employee recognition means that manager rewards employees in public situations where employees' family members are invited to attend. Moreover, manager recognizes contributions or achievements of the employees, for example, certificates of appreciation, letters of commendations, or public announcements of achievements. , Recognition of contributions or accomplishments is an excellent way to motivate and reward someone. It is especially powerful if done in a public forum because public recognition motivates the employee to become more productive. Public recognition bolsters the employee's morale, exemplifies valued contributions by the organization, and demonstrates the pride the manager has in the team.  The current findings revealed that employees of the private hospital perceived the highest mean rank of employees' recognition (139.62) [Table 2].
This could be attributed to the fact that the private hospital is more concerned with the employee recognition to retain its employees. Moreover, it could be referred to the fact that department heads recognized the importance of employees' recognition through their training programs in the management and leadership specially the fact that the present findings showed that 100% of the department heads in the private hospital attended training programs in management and leadership in comparison to KFHU (70.8%) and MOH hospital (89.5%) [Table 1].
Nowadays, subordinates want and expect their heads to actually care for them. They want heads to know what makes them tick, how they are doing, how they are feeling. They want heads to care for their total "Well-being."  Consequently, leaders and managers must become masters of their positions and execute their duties well. When this happens, not only do employees benefit the organization as a whole also benefits. Hence, employees are then prone to be more satisfied, and organizations will be better positioned to attract and retain quality employees. In combination, this will increase productivity, improve the quality of work, decrease absenteeism, and increase customer satisfaction.  The present findings showed that the highest mean rank of employee care was at the MOH hospital (127.04), followed by KFHU (122.97) in comparison to the private hospital (92.31) and the difference was significant [Table 2]. This could be referred to the effect of JCI accreditation on bosses especially the fact that findings revealed that employee care was higher in hospitals accredited by JCI or in its way to get it (124.9) than hospitals not accredited by JCI (92.3) and difference was significant [Table 3].
| Conclusions and recommendations|| |
Almost all humanistic care dimensions was perceived higher in the governmental hospitals. Accreditation played a significant role in improving humanistic care. Based on the findings, the following is recommended:
- Department heads should have any health administration study, for example, bachelor degree, diploma, master, or PhD
- Motivating department heads to get more training programs in management and leadership
- Encouraging hospitals to get the JCI accreditation.
This work cannot be completed without the help of Abrar Al-Hamad, Jenan AL-Badi and Fatimah AL-Khawajah. They were responsible for data collection and entry.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Branch WT Jr., Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, et al.
The patient-physician relationship. Teaching the human dimensions of care in clinical settings. JAMA 2001;286:1067-74.
Kilpatrick AO. The health care leader as humanist. J Health Hum Serv Adm 2009;31:451-65.
McAlearney AS, Garman AN, Song PH, McHugh M, Robbins J, Harrison MI. High-performance work systems in health care management, part 2: Qualitative evidence from five case studies. Health Care Manage Rev 2011;36:214-26.
Stewart DW. Leaders, managers, and employee care. Health Care Manag (Frederick) 2012;31:94-101.
Sack C, Lütkes P, Günther W, Erbel R, Jöckel KH, Holtmann GJ. Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology. BMC Health Serv Res 2010;10:120.
Song PH, Robbins J, Garman AN, McAlearney AS. High-performance work systems in health care, part 3: The role of the business case. Health Care Manage Rev 2012;37:110-21.
Sack C, Scherag A, Lütkes P, Günther W, Jöckel KH, Holtmann G. Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37,000 patients treated by 73 hospitals. Int J Qual Health Care 2011;23:278-83.
Wendy N. The value and impact of health care accreditation: A literature review. Canada: Accreditation Canada; 2015.
Flodgren G, Pomey MP, Taber SA, Eccles MP. Effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes. Cochrane Database Syst Rev 2011;9:CD008992.
[Table 1], [Table 2], [Table 3]