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CHRISTIAN MEDICAL ASSOCIATION OF INDIA
COMPREHENSIVE EVALUATION
19 9 7
CONFIDENTIAL REPORT ON STAFF PERCEPTION OF CMAI
J
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1
A. PADMANABHA
PROF. P. RAALVCHANDRAN
DR. SUKANT SINGH
r
1
CONFIDENTIAL
CHRISTIAN MEDICAL ASSOCIATION OF INDIA
COMPREHENSIVE EVALUATION
S^FFP^EJ^lONOFCMAl
shitchnT^nu?1'61’0' foLT1Hafi°? Of CMAI sPecificaIIy P^vided for “Review of CMAI organisation
dM™ M
<»»»*-«- efficiency
s,t,ruchXlySti5 COn?’Cd
da'a ObfaineC1 °nly fr°m CMAI s,aff "diich can reflect the internal
orienfahon
C011‘lb°rahve tlUah,y for organisational strength, effectiveness and achievement
Specific responses obtained from the 61 respondents addressed the following organisational issues:
1
pXTthree yearstribUtlOUS
iUld depar,menfs fo support CMAI objectives in
2. Suggestions to improve each section’s department’s contribution to CMAI
3. Significant contributions made by individual staff members i
in the past three years
4. Pei sistent problems hindering individual performance
5. Suggestions to enhance individual competence
6. Communication and Cooperation between sections
Rating of CMAI organisational attributes
excepting issues 6 & / listed above, lor which closed-end questions were used.
Perception s as they emerged from the data (Given in the annexure to this report)
are discussed here
under:
1. Significant contributions made by sections and departments
over the past three years to
support CMAI objectives.
A variefy of nearly 85 responses from the sixty one respondents were reclassified into ekhf
major
majoi headings, of these only three emerged as major contribution areas.
2
SIGWJF^ANT SECTIQNAL/PEFAKTMENTAL contributions by staff grape
STAFF GRADE
CONTRIBUTION_______
Human resource
development
_
No response
A-grade
100.0
,
Figures represent % of total respondents in each co 111mn
_B*g_rade
C-grade
68.0
36.8
7.7
47.5
Management of resources
20.0
31.6
23.1
23.0
Programmes
32.0
26.3
Publications
8.0
5.3
I
Total %
21.3
23.1
9.8
►7 f-7
9.8
Christian spiritual growth
25.0
16.0
Networking with other
Institutions
25.0
8.0
5.3
6.6
Consultancy services
25.0
4.0
10.5
6.6
Social & health policy issues
25.0
12.0
Column Total (No.)
4
25
I. /
6.6
19
13
61
A. The single largest area of contribution claimed to have been made by all the sections and
the departments are towards
1
Human Resource Development ~ about 48 %. Significantly,
68 % of staff of ‘A’ grade claim this an iarea of their contribution, as against only 8 % of 4C’
grade. Actually, the responses studied in detail reveal that most of them refer to the Formal
training programmes and activities of CMAI viz. workshop/seminars etc.
B.
I he next best contribution claimed by sections/departmenfs is in management of resources.
- Ibis claim is essentially from A and B level staff, and none from C level. However, only
21% of the staff have claimed this as their sections’ significant contribution. The details
reveal that the claim refers to effective membership drive and better financial management.
C. The third best contribution mentioned was “Programmes” -- 'basically referring to
awareness and community health programmes. Significantly, this claimi was only by the A
and B level staff.
W hen the data was analysed further some interesting features surfaced.
D. More male staff members (31 %) claimed resources management contribution as
significant, than females (16 %). A similar trend is also noticeable in the claim on
programmes (24m :19F)
E. Another noticeable area is the low percentage (10 %) of staff claiming Christian spiritual
growth as a significant area of contribution by their respective departments, with just about
16 % from A level and 8 % from C level and none from B level mentioning sectional
contributions to this important area.
F. Here we may recall the overwhelming emphasis from CMAI individual members on
nurture of Christian spirit to be a major focus area for CMAI. Against this expectation, the
contribution from sections of CMAI is very low and a cause for concern. This observation
adds further weightage to the evaluation recommendation to include Nurturing Christian
spirit among the Health Professionals, as a constitutional objective of CMAI.
2. Suggestions to improve contributions from CMAI sections and departments.
3
The responses were basically distributed almost evenly on three areas, out of nine
classified grouping
of nearly 90 suggestions received.
A. About 30 % of all staff (44 % of A level, 21% of B level and none from C level) recommend
improving competence, of staff members - mostly through inservice training and some new
appointments of competent staff. This suggestion significantly has come more from male staff
members (41 %) than females (16 %).
B. On the other hand, more ffemales (35 %) than males (23 %) have recommended improving
CMAI work culture, emphasising Team Work & Co-operation , If is the C (39 %) and B (37 %)
level staff who have identified this area for improvement than A level (20 %). This
recommendation also has attracted only 30 % of staff responses.
C. 23% of all staff have recommended improvement in management processes, particularly more
participative approach and better planning - More of A and C level staff (28 % and 23 %
respectively) made this suggestion than B level (11 %)
3. Individual staff contribution to CMAI in the last three years.
Forty one percent of all staff felt that their own contribution was in two areas ® Improved
Administration ® Improved methodology and content of CMAI training p rogrammes.
A. In the perception of the staff members, improving ad minis tration was through doing their
work sincerely and neatly by proper administration of programmes. More females (45 %)
than males (38 %) held this perception, and more so among B and C level staff than A.
B. In contrast more imales (59 %) than females (2G %) felt their significant contribution was
through improving training methodology and1 content, including new training
programmes.
C. Improved seivices to members featured as their best contribution, but only from about
20 ,o ot staff and that too only by the A and B level personnel. We may again recall here
that “service to members” featured as a major weakness of CMAI in the feed back from the
individual members, and the staff themselves.
4. Hindrances to staff performance
A. When asked to specify if there were any persistent problems hindering their performance,
two problems surfaced : ® Poor Administration and Management and ® Lack of
motivation, voiced by 34% and 33 % of the staff respectively.
B. Lack of role clarity and vision was voiced by about 28 %, inadequate working facility was
mentioned by about 20 %, but from mostly A grade staff (36 %).
C. In so far as poor administration and management is concerned, the major problem cited is
too many meetings and tours leading to heavy work load.
D. One other point surfacing in this context is the treatment to staff - “being treated as
students and not colleagues”.
4
E. Lack of opportunity for inservice training and self development takes the first place for
“Lack of motivation” followed by lack of interpersonal / interdepartmental cooperation and
inadequate recognition for performance.
F. Major reasons quoted by the staff pointing out “poor role clarity” is ® Foor communication
and Q) Foor coordination.
I he above points only go to strengthen the evaluation findings and recommendation focussing on (D
Planning process ® Communication ® Interfunctional coordination @ Staff development.
5. Ways to Improve staff competence
The ;single most important suggestion to improve competence of staff seeks development training for
staff, by nearly 40 % ~ again a suggestion
coming
__
J more from A and B grades. The next suggestion
given by about 20 % of staff is for decentralisation of administration, followed by improving
management processes and staff service conditions.
Turning to the specifics under each suggestion listed above, the following are the observations ;
A. Training and Development of staff:
i. Over 40 % of A and B grade staff have made this suggestion against 30 % of C grade staff.
ii. In house training comes out as the most favoured suggestion including technical skill
development programs.
iii. Study tours for knowledge upgradation of staff comes out as the second most favoured
suggestions.
B. Decentralisation :
By “decentralisation” the most often mentioned action is for freedom with independent
charge of responsibility, defined authority and accountability ~ A point that emerged in the
evaluation suggestion for “restructuring” of CMAL
ii. Though this suggestion is made by 20 % of all staff, 4A’ grade staff have chosen this
suggestion more than others.
iii. The suggestion has come more from men (24 %) than women (16 %) .
i.
C. Improving management processes
i. Again the suggestion is more from the A and B grade staff.
ii. More men (21 %) than women (13 %) have suggested this.
iii. A major aspect of this suggestion is for better direction, guidance, counselling and
motivation of staff by the superiors.
5
D. Improve Service Conditions :
Interestingly this suggestion has come more from A and C grade staff. (14 and 13 percent
respectively) as against only about 11 % of the B grade staff.
ii. What is more interesting is that the staff have in mind (i) Support for continuing education
(ii) Job clarity and specification and (iii) Reduction in work load - rather than increase in
emoluments and benefits.
iii. Only about 5 % of the staff mentioned nurture of Christian values for improving staff
competence. Again the question, whether CMAI has given adequate focus to this aspect,
becomes relevant. One wonders whether the staff suggestion of this need being so low is
reflective of the degree of organisational focus and direction for “nurturing Christian
spirit” among the Christian health professionals. - Indeed it appears so.
i.
6. Inter Sectional and Departmental Coordination
Effectiveness of any organisation depends largely on the degree of inter functional understanding,
coordination and co-operation, which also determines the level of team work and team spirit. This
aspect was probed with the staff.
COMMUNICATION & CO-OPERATION SCORES (POSIT1V E)
CMAI SECTIONS & DEPARTMENTS
Figures in %
Section/ Department
Communication
Co-operation
Overall
Doctors
49
46
48
Nurses
36
34
35
Administrators
38
38
38
AHP’s
38
38
38
Chaplains
44
33
39
42
38
40
Finance
54
47
51
Community Health
39
36
38
18
21 .
20
General Administration
Communication Centre
A. In the main evaluation report it was obvious that coordination between CMAI sections and
departments was lacking. The data presented above makes it abundantly clear that
communication and co-operation from all sections and departments need improvement.
B. None of the sections/departments, excepting finance, have atleasf 50 % positive scores thereby indicating that inter-functional coordination and co-operation is low. It is
intriguing that the communication centre should get the lowest rating, while the usually
difficult function “finance” gets the highest.
6
COMMUNICATION & CO-OPERATION SCORES (POSITIVE)
QE-CMALSTAFF SECTIONS & DEPARTMENT
SCORES BY STAFF
FFM AI FS
MAT FS
£—
AL
J
S e c t i o n / D ep a rtme nt Communication Co-operation Average Communication Co-operation
average
Doctors
48
48
48
48
42
45
Nurses
42
39
41
27
27
27
Administrators
29
32
31
45
41
43
AT IPs
32
42
37
41
31
36
Chaplains
42
36
39
45
27
36
General
Administration
Finance
29
26
28
65
48
52
52
49
51
59
45
52
Community Health
36
32
34
46
38
42
Communication
Centre
16
22
19
21
21
21
XA'hen the same data is turned around the staff by sex, some points of interest emerged. Excluding the
communication centre,
1. Nurses section has the least positive scores from males, indicating low level of
communication and co-operation.
2. General administration department has the least scores from females
While these two functions have to introspect on this feed back, the need for a general review of
processes of coordination in CMAI is highlighted by the staff in general, and the communication
centre comes out for special focus.
7
CMAI STAFF PERCEPTIONS OF MANAGEMENT
Ivventy live attributes that can help determine the style and image of managements were used to
understand the perceived profile of CMAI management.
After due deliberations;, the study team decided to elicit the staff perceptions on twenty five attributes
with response choice limited to two, either positive or negative. Other possible in-between response
choices were deliberately omitted to avoid probable ambiguity, in determining response direction. Of
the 25, CMAI emerged with positive image perception in respect of 15 attributes while of the balance
10 it was cleat ly negative. (Endorsed by 50% or more staff members as positive or negative against an
attribute)
Elie fifteen managerial attributes which were endorsed as positive or negative attributes of CMAI
manage men t we re;
Attributes - Positive
I.
Relationship with superiors
Endorsing staff %
85
2.
Relationship with colleagues
3.
Facilities at work
80
4.
Working environment
79
5.
Competence of staff in
general
67
6.
Job satisfaction
7.
8.
9.
80
Attributes ~ Negative
16.
17.
Decision making
perception
Endorsing staff
Process/Staff
77
Decision making process time
taken
74
18.
Security of Job
61
19.
Promotional avenues
61
20.
Concern for staff and family
59
67
21.
Facilities for further education
57
Spiritual Nurture
66
22.
Career opportunities
57
Social prestige
62
23.
Attraction for retaining
competent staff
57
24.
Guidance to staff
56
25.
Staff morale
51
Organisational help at
personal crisis
61
10.
Service rules
61
11.
Staff salaries
57
12.
Opportunities for
professional growth
54
13.
Freedom to work
54
14.
Service to community
51
15.
AdministrativeProcedures
51
The above data when graphically presented provides a clearer visual image of CMAI management
8
MANAGEMENT IMAGE OF CMAI - STAFF PERCEPTION
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SPECIFIC MANAGERIAL ATTRIBUTES
The general image one gets from the responses taken together is that while on various counts CMAI
emerges with a staff perception of a fair to very fair management, yet there are areas which need to be
improved and yet others where the frustration levels appear,to be high.
At the macro level, CMAI commands a very high positive image interms of interpersonal relationship
among the staff members and work environment.
Oh a large number of attributes which are mainly work related, the image also is fairly positive. We
may, however, remember that on these attributes, between 33 to 49 % of staffs perceptions are
negative.
The third segment of management attributes concerning professional growth & satisfaction and
support tor personal career growth, the present image is fairly negative in the range of 51 to 77
percent staff saying so.
I he areas seeking high ot^ganisational concern relate to decision making processes and the time taken.
The image projected is without doubt - a negative one.
Yet another way to look at these perception for appropriate attention for managerial action for
improvement is to classify these perceptions by their current stages of seed, sprout or a flower.
9
Managerial Attributes
perceived Positive
by Staff
Managerial Attributes
perceived Negative
By over 75 % ~ Flower Stage
By over 75 % - Flower Stage
-Facilities at work
-Relationship with superiors
-Working Environment
-Decision making process/
staff participation
By 50-75% ~ Sprout Stage
By 50-75% - Sprout ~ Stage
-Competence of staff in general
-Opportunities for professional
growth
-Freedom to work
-Organisational help at personal
crisis
-Job satisfaction
-Staff salaries
-Social prestige
-Senice to community
-Spiritual nurture
-Service rules
-Ad min is trative proc e d u res
-Attraction for retaining
competent staff
-Career opportunities
-Facilities for further
education
-Promotional avenues
-Staff morale
-Guidance to staff
-Security of job
-Concern for staff and
family
-Decision making process
time taken
by Staff
By 25-49% - Seed - Stage
-Competence of staff in general
general
-Opportunities for
professional growth
-Freedom to work
-Organisational help at
personal crisis
-Job satisfaction
-Staff salaries
-Social prestige
-Service to community
-Spiritual nurture
-Service rules
-Administrative procedures
A flower stage is the stage of maturity - meaning either as positive attributes endorsed say by over
75% is developing into an organisational culture which people value and cherish. On the other hand
the flower stage of negative perception - endorsed as such by over 75 % of people - indicate a stage
getting ready to open conflict or setting in high level of demotivation.
10
I he sprout stage is the one at which proper nurturing of the positive spout would lead to positive
flower stage, or continued neglect of the negative sprout would grow into a negative flower.
Hie seed stage is the most important stage for managerial effectiveness in organisational nurture. If
properly and continually cared for, these voices of dissatisfaction would grow up to positive sprout
status. If not they will slip into become negative sprouts.
An effective way to promote participative processes by which all personnel are systematically informed
and involved is, periodic communication on organisational goal priorities and evolving action plans. It
is also equally important to specify and periodically reiterate organisational policies which are of
importance to individuals, their families and their careers.
One important message which seems to emerge from all the perceptions discussed is that while staff
value^ and relish cordial relationships appreciating their working environment, they are generally
satisfied with the professional support, rules and regulations of the organisation, but they are
dissatisfied with the existing state of support for their individual professional growth prospects, family
needs and security of job.
Decision making being highlighted by over 75 % of the respondents is a clear indication of level of
frustration and demotivation. This is very important and needs to be tackled forthwith. When people
complain of delays in decision making and the same has attained the flower stage - it is reasonable to
presume, it generates apathy as a fallout from unclear organisational direction and action plans.
EVALUATION FINDINGS
1. A review of CMAI’s oiganisation structure has brought out that there is a clear need for
oiganisational restructuring at the apex level with greater organisational emphasis on building up
CMAI from the grass roots, and making sectional orientation subservient to CMAI vision and
objectives.
2. If is also found that there is an urgent need to institutionalise planning & review systems which
would inject far more participative style of management.
3. By and large CA4AI staff carry a positive image of the organisation and are appreciative of
interpersonal relationships, working environment, managerial effectiveness in their current work
related areas. However a vast majority have expressed concern over decision making time and process.
A substantial number hold the view that, from the point of view of their individual professional
growth, support to family and security of job, CMAI management needs to pay greater attention.
4. As was evident from the perceptions of individual members of CMAI, that there is an urgent need to
improve coordination and cooperation among various sections and departments of CMAI
5. The need for improving the competence of staff is palpable. In service training to personnel,
adequately dove-tailed to current and future role and responsibilities of individuals is a strong need.
G. Interestingly perceived contributions by sections and individuals orbit around CMAI’s training
programs and activities - with little or no focus on either “relief to human suffering”, “Assisting the
healing minishy” or “nurture of Christian spirit among health professionals”.
Il
1. Restructuring of the organisation with greater emphasis on building CMAI than sectional
development has already featured in the main evaluation report and is also endorsed here.
2. I lie recommendation made for institutionalising planning and review systems should, over a period
ol time say about two years, make substantial improvement in inter-sectional/departniental
cooperation and coordination.
3. The need of the hour to bring about clarity interms of work, workloads and to improve efficiencies
is to determine meticulously the “jobs” in CMAI with job analysis, workloads and job descriptions for
every position. Following this should be the exercise for fitting the most suitable person among
exisfmg CMAI staff for each job (not vice-versa). Assess consequent excesses and shortfalls to plan
necessary training to help retain existing staff to fill vacancies or a plan to ease out such persons
without tears.
4. It is recommended that CMAI assess its statf competence individually interms of current and future
levels of responsibility. On the basis of such assessment identify specific areas of short term (next 2
years) and long term training needs of individuals, from CMAI point of view, operationalise the
emerging plan through appropriate internal and external training intetventions.
5. On the basis of surfacing perceptions of the 25 managerial attributes, identify needed actions
interms ot A. Modification of existing rules and regulations to enable and encourage individual
protessional growth as far as possible, B. Through the planning process, provide for specific review of
pending grievances, proposals, requests and/or complaints by staff- take appropriate decisions and
communicate. Even deferred decision should be appropriately communicated to concerned / affected
persons to improve decision making credibility of the management.
Ihis paiticular aspect of decision making process of management needs urgent attention for
impiovement to raise the professional morale and effectiveness ot the organisation.
12
ANNEXURES
SIGNIFICANT SECTIONAL/DEPARTMENTAL
CONTRIBUTIONS BY SEX
Figures represent % of total respondents in each column
SEX
CONTRIBUTION
FEMALE
MALE
TOTAL
Human Resource
Development
45.2
50.0
47.5
16.1
31.0
23.0
Programmes
19.4
24.1
21.3
Publications
12.9
6.9
9.8
9.7
10.0
9.8
Networking With Other
Institutions
3.2
10.3
6.6
Consultancy Services
6.6
6.9
6.6
3.2
10.3
6.6
31
30
61
Management Of Resources
Christian Spiritual Growth
Social & Health Policy Issues
COLUA4N TOTAL (No.)
13
SUGGESTIONS TO IMPROVE SECTIONAL/DEPARTMENTAL CONTRIBUTIONS BY STAFF GRADE
Figures represent % of total respondents in each column
STAFF GRADE
SUGGESTIONS
NR
A-GRADE
B-GRADE
Improve Staff Competence
75.0
44.0
21.1
Improve CMAI Work Cuiture
25.0
20.0
36.8
38.5
29.4
Improve Management
Services
50.0
28.0
10.5
23.1
23.0
7.7
8.2
C-GRADE
TOTAL
29.5
Improve Communication
16.0
Structural Improvements
12.0
10.5
8.2
Improve Network
4.0
10.5
4.9
50.0
4.0
4.9
Infrastructure
4.0
1.6
Improve Service Conditions .
4.0
1.6
Improve Identity & Image
COLUMN TOTAL (No.)
4
25
19
13
61
14
SUGGESTIONS TO IMPROVE SECTIONAL/DEPARTMENTAL
CONTRIBUTIONS BY SEX
Figures represent % of total respondents in each column
SEX
SUGGESTIONS
FEMALE
MALE
TOTAL
Improve Staff Competence
16.1
43.3
29.5
Improve CMAI Work Culture
22.6
36.7
29.5
Improve Management
Services
22.6
24.1
23.0
12.9
3.4
8.2
3.2
13.3
8.2
3.2
6.9
4.9
6.5
3.4
4.9
3.4
1.6
3.4
1.6
30
61
Improve Communication
Structural Improvements
Improve Network
Improve Identity & Image
Infrastructure
Improve Service Conditions
COLUMN TOTAL (No.)
31
15
INDIVIDUAL STAFF CONTRIBUTIONS TO CMAI BY STAFF GRADE
figures represent 96 of total respondents in each column
STAFF GRADE
CONTRIBUTIONS
NR
A-GRADE
B-GRADE
C-GRADE
TOTAL
40.0
4 7.4
46.2
41.0
75.0
48.0
47.4
7.7
41.0
Improve Services to members
25.0
24.0
26.3
Improvement in work culture
25.0
12.0
5.3
23.1
13.1
Improved
communication/publications
25.0
12.0
5.3
15.4
11.5
16.0
10.5
7.7
11.5
12.0
15.8
Improved Administration
Improve Methodology &
content of training
programme
Promotion practice of
Christian values
Improved Networking
25.0
Leadership
12.0
New Ideas & Innovations
8.0
5.3
25
19
Column Total (No.)
4
19.7
11.5
4.9
4.9
13
61
s
16
INDIVIDUAL STAFF CONTRIBUTIONS TO CMAI BY SEX
Figures represent % of total respondents in each column
SEX
CONTRIBUTIONS
FEMALE
MALE
TOTAL
Improved Admin is t ratio n
45.2
37.9
41.0
Improve Methodology & content of training
programme
25.8
58.6
41.0
12.9
27.6
19.7
Improvement in work cu 11ure
12.9
13.8
13.1
Improved communication/publications
12.9
10.3
11.5
Promotion & practice of Christian values
12.9
10.0
11.5
Improved Networking
6.5
17.2
11.5
Leadership
3.2
6.9
4.9
10.0
4.9
30
61
Improve Services to members
New Ideas & Innovations
Column Total (No.)
31
17
HINDERANCE TO STAFF PERFORMANCE BY STAFF GRADE
figures represent % of total respondents in each column
STAFF GRADE
PERSISTENT PROBLEMS
NR
A-GRADE
B-GRADE
C-GRADE
TOTAL
Poor Administration
75.0
36.0
31.6
23.1
34.4
32.0
47.4
23.1
32.8
50.0
44.0
10.5
15.4
27.9
25.0
36.0
5.3
7.7
19.7
Incompetent Staff
24.0
5.3
Personal Problems
16.0
Poor Service Conditions
4.0
Other Problems
4.0
5.3
25
19
Lack Of Motivation
Lack Of Role Clarity/Vision
Inadequate Working Facilities
COLUMN TOTAL (No.)
4
11.5
6.6
15.4
4.9
3.3
13
61
18
WAYS TO IMROVE STAFF COMPETENCE BY STAFF GRADE
figures represent % of total respondents in each cokntin
r
STAFF GRADE
SUGGESTIONS
NR
A-GRADE
B-GRADE
C-GRADE
TOTAL
i Provide Development
; Training
25.0
44.0
42.1
30.8
39.3
50.0
8.0
31.6
23.1
21.3
25.0
28.0
15.8
7.7
19.7
24.0
10.5
23.1
18.0
24.0
21.1
18.0
16.0
5.3
9.8
12.0
10.5
8.2
8.0
5.3
4.9
26
19
j Others_____
I
j Decentralise
; Better Service Conditions
i---------------------------------------------
! Improve Management Process
Increase Network For
Recognition & Effectiveness
25.0
Staff Support
Nurture Cliristian Values
i COLUMN TOTAL (No.)
4
13
61
WAYS TO IMROVE STAFF COMPETENCE BY SEX
Figures represent % of total respondents in each column
" sex
SUGGESTIONS
r
FEMALE
MALE
TOTAL
Provide Development
Training_____
41.9
37.9
39.3
Others
22.6
20.7
21.3
Decentralise
16.1
24.1
19.7
Better Service Conditions
16.1
20.7
18.0
Improve Management Process
12.9
23.3
18.0
Increase Network For
Recognition & Effectiveness
9.7
10.3
9.8
Staff Support
3.2
13.8
8.2
Nurture Christian Values
6.B
3.4
4.9
COLUMN TCrFAL /No.)
30
31
61
19
Position: 1824 (3 views)