Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
Training and Development Activities: A Case Study of a
Hospital in Thailand
Dr. Sakun Boon-itt,
Broad Field of Research: Operations Management, Healthcare Management
1. Introduction
Nowadays, the increasing demand for healthcare services underscores the major
challenges facing Thailand’s healthcare system. A shortage of skilled staffs and the
inefficient use of human resources have resulted in rising health expenditures and a
low quality of healthcare service. As a result, Thai healthcare systems are suffering
from a shortage of skilled hospital staffs and therefore require more training and
development programs, particularly in hospital management. As long as poor
management exists, any funding or other attempts to improve the healthcare system
will simply be wasted (Tabish, 1998; Olsson et al., 2007). As a result, Human
Resource Development - which concerns the development and training of people to
improve organizational performance and achieve objectives in the most effective and
efficient ways possible - is now recognized as critical to business success.
In light of this reality, Wagner et al. (2000) suggest that more insight is required into
human resource training and development in the healthcare context outside Western
Europe and the U.S. Franco and Almeida (2011) also state that training and
development strategy is considered as a critical factor for healthcare organizational
survival due to the rapid technological advances and highly competitive markets.
Therefore, this study aims to answer the question by focusing on the training and
development process in Thailand in order to improve organizational performance in
Thai hospitals.
Hospitals in Thailand have also acknowledged the needs of skilled hospital staffs by
increasing attention to training and development practices (MOPH, 2009). However,
many training and development activities have been carried out ineffectively, leading
to the waste of the resource in terms of time and money. For instance, some staffs
are not effective because they are assigned to inappropriate positions. Hence, one
way to reduce this ineffective performance is to improve the training and
development process to determine how to implement appropriate training programs
in the hospitals. As suggested by Adema and Timmer (2011), it is important to
develop a framework to assess the educational environment in healthcare context.
Consequently, this research is expected to provide a better understanding of a
framework related to human resource training and development in Thai hospital, and
to reveal the problems/practices that arise in human resource training and
development activities.
_______________________________________
Dr. Sakun Boon-itt, Thammasat Business School, Thailand, Email: sboonitt@tu.ac.th
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
Based on the above explanation, this study has established two research objectives.
Firstly, this study assesses the current situation of training and development
practices/activities in the selected Thai hospital. Second, this study provides in-depth
knowledge of the development of training practices and activities, including their
implementation in the hospital, especially in the emerging countries such as
Thailand.
In summary, this study will provide more insight and understanding into the current
effectiveness of training and development activities in the selected Thai hospital. On
the practical side, this study will present the specific problems that can arise as well
as recommendations for a more effective implementation of training and
development programs and includes suggestions for further research in hospital
management.
2. Literature Review
2.1 Training and development
There are several definitions of training and development which mostly emphasize a
series of organized activities that are conducted within a specific time and designed
to produce behavior change (Nadler and Nadler, 1998; Wright et.al, 1996; and
Stone, 1998). According to French (1996), in the organizational context, training can
be defined as the organizationally directed experiences that are designed to further
the learning of behaviors that will contribute to organizational goals. Noe (2002)
identifies training as planned programs designed to improve performance at the
individual, group, and/or organizational levels. Improved performance in this context
could imply measurable changes in knowledge, skills, attitudes, and/or social
behavior. In short, training and development are both concerned with changing
employee behavior and job performance in order to help further both the goals of the
organization and the individual’s goals (Stone, 1998).
Based on the definitions described in the previous section, Nadler and Nadler (1998)
and DeSimone and Harris (1998) suggest that training and development are
perceived as two main areas in human resource development (HRD), which mostly
focus on the improvement of the knowledge, skills and abilities of employees in the
organization. In fact, training and development all refer to a similar process, aiming
to enable people to acquire new knowledge, to learn new skills and to perform in a
new way. However, there is still some confusion concerning the differences between
these two concepts. Breadwell and Holden (1994) suggest that both concepts are
different in terms of their focus, scopes, time frame and purpose. Table 1
summarizes the differences between employee training and development.
-Insert Table 1Training usually emphasizes immediate improvements in job performance via the
procurement of specific skills. In other words, training typically focuses on providing
employees with specific skills or helping them correct deficiencies in their
performance. On the other hand, development aims to prepare the employee for
further job responsibilities through the acquisition of present job performance, but the
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
benefits may extend throughout an employee’s entire career and help prepare
him/her for future promotions (Stone, 1998). It could be said that training is an
expense whereas development is an investment (Nadler and Madler, 1998; Noe,
2002). In light of this reality, the distinction between training (current job) and
development (future job) is often unclear and primary using simultaneously.
Training and development are important activities in all organizations. In fact, newly
hired employees need to be trained to perform their jobs. At the same time, existing
employees need to acquire new skills and knowledge (Stone, 1998). More
specifically, changes in technology and organizational re-structuring mean that
people and organizations are continually faced with situations that require new
learning (Blanchard and Thacker, 1998). Currently, obsolescence, which refers to a
reduction in effectiveness due to a lack of knowledge and skill, is the main reason for
the growing demand for training and development. Therefore, training is important to
organizations that are incorporating new technologies. Prager (2003) identifies three
goals for training programs including: (1) increase the employee’s understanding and
knowledge; (2) improve employee skills; and (3) help create optimal performance
within the organization’s culture. In addition, companies can use training to gain a
competitive advantage (Noe, 1998). According to Daniels (2003), investment in
training is related to an increased return on investment and productivity. The number
indicates that employers spent around 1 percent of the payroll on training in 1998,
and increased this to 3 percent by year 2000 (Chance, 1998). In fact, training
influences competitiveness because it helps organizations deal with competitive
challenges and a turbulent business environment (Martochio and Baldwin, 1997;
Blanchard and Thacker, 1998). In terms of employee commitment Grau-Gumbau et
al. (2002) suggest that training can also increase the level of commitment. Once
employees are trained, their performance improves. According to Martocehio and
Baldwin (1997), training is moving from a primary focus on teaching employees
specific skills to a boarder focus on creating and sharing knowledge. The role of
training an be shown as follows:
Focus on teaching skills and knowledge: Basically, training is viewed as a means to
teach employees specific skills and behaviors. This role of training will continue into
the future. This view of training suggests that business conditions are predictable
and can be controlled by the company, and the company can control and predict the
knowledge and skills that employees will need in the future.
Link training to business needs: For the time being, as the competitive challenges
indicate that unpredictability in the external environment in which companies operate
is likely to continue. This means that because problems cannot be predicted in
advance, training needs to be delivered on an as-needed basis to help employees
deal with specific business problems as they occur.
Use training to create and share knowledge: Many organizations believe that the key
to gaining a competitive advantage is to develop intellectual capital, which includes
(1) cognitive knowledge (know what), (2) advance skills (know how), (3) system
understanding and creativity (know why), and (4) self-motivated creativity (care why).
Normally, training and development programs focus their resources on cognitive and
advanced skills. However, the core concept of training requires employees to
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
understand the process and the interrelationships between functions as well as
motivating them to be innovative and to deliver high quality service.
To summarize variety of definitions of training and underline training needs in
organization, training can be realized as an effective tool (1) to acquire skills,
knowledge and attitude, (2) of job-related, (3) for learning, and (4) to change
behavior. The training needs exist when specific job tasks or behaviors are not
important and an employee’s proficiency in them is low. Training needs assessment
aims at uncovering an employee’s true training needs and weeding out training
wants. Training needs happen when: (1) new workers are hired, (2) a worker is
promoted or transferred, (3) new jobs are created, (4) existing jobs are to be
performed in new ways, or (5) existing jobs are being done in deficient ways.
Training needs could be either perceived (felt) needs or real (analyzed) needs
(Desimone, 1998). For organization effectiveness, it is the job of human resources or
training managers and top managers to make the perceived needs identical to the
real needs. Real needs represent the gaps between “what should be” and “what is”.
Those gaps are identified through objective analysis, which is mostly theoretical. In
practice, however, management training needs can be only diagnosed by people’s
perception, which is subjective and usually has some points different from the real
needs. Where the perceived needs match the real needs is called management
training demands. In this case, the training program will provide the right answer to
the organization problem and have its full value.
In the context of the healthcare industry, several studies have shown the importance
of training and development programs. For example, Ironside and Seifert (1999)
cited a study that shows the relationship between training and its benefits for the
healthcare industry in terms of enabling employees to understand working
processes. In the same way, Tablish (1998) points out that there is a need to
introduce professional training and development in hospital management in order to
control hospital expenditure and increase work performance. In a survey of doctors
in Finland, Kumpusalo et al. (2003) also indicated that doctors in leading positions
were aware of the need for managerial and leadership skills training. Moreover,
Hallam (2004) stated that healthcare organizations could provide customer service
strength, which could increase sales and profits because of the development in
training and development programs.
Training and development process
As mentioned, effective training can increase organizational performance. However,
poor or inappropriate training can also be a source of frustration for everyone
involved. To maximize the benefits of training, managers must closely monitor the
training process, which is composed of four phases: (1) assessment of training
needs, (2) planning of training activities, (3) implementation plans, and (4) monitoring
and evaluation. Figure 2. illustrates the training and development process.
-Insert Figure 1-
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
Training needs assessment
This assessment refers to the process needed to determine if training is necessary.
Several researchers have defined needs assessment as comprising of these three
different levels: the needs of the organization, task or operation, and of the
individual. Noe (2002) adds one more process, which is the indication of the causes
and outcomes resulting from the needs assessment. According to Noe (2002), the
process of assessing training needs are detailed as follows:
Organization analysis: This strategy focuses on identifying where training is needed
within the organization as well as what conditions will occur as a result (DeSimone
and Harris, 1998). This process involves determining the appropriateness of training
given the company’s business strategy and resources such as the budget, time, and
knowledge available for training activities (Anthony, 1999). Moreover, this analysis
includes an identification of problems that an organization is facing and where these
problems are located (Breadwell and Holden, 1994). It is important to note that
training needs are considered to be a part of overall human resource planning (Noe,
2002). Noe (2002) also points out that the key success factors for organization
analysis are a positive attitude among peers and managers about participation in
training activities in which managers and peers have to provide information to
trainees about how they can more effectively apply the acquired knowledge and
skills to their jobs.
Task or operation analysis: Task or operation analysis requires a careful examination
of the work to be performed after training. It involves the following issues:
(1) A systematic collection of information that describes how work is done,
including standards of work performance.
(2) Descriptions of how tasks are to be performed in order to meet these
standards; and
(3) The degree of competency necessary for effective task performance.
In conducting a task analysis, two main factors need to be determined, namely
importance and proficiency (Noe, 2002). Basically, importance refers to the
relevance of specific tasks and behaviors, including the physical and mental abilities
required to perform a particular job and the frequency with which they are performed.
In addition, proficiency is the employee’s competence in performing these tasks. This
can be determined from job descriptions, performance appraisals and by conducting
either interviews or surveys.
Individual analysis: At this level, training needs can be defined in terms of the
differences between the desired employee performance and the actual performance.
In other words, this level of analysis includes evaluating an individual’s need for
training as well as determining the appropriate form of training.
Training and development activities
There are various ways to determine the objectives for a training program (Read and
Kleiner, 1996). For example, in a large organization, all of the activities described will
probably be used at one time or another. However, the use of specific methods will
depend on the objectives of the training, the abilities of the trainer to be trained, the
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
number of trainees, the job level and other factors such as the time and money
involved (Noe, 2002). In practical terms, the training unit needs to keep the objective
of the training clearly in mind and recommend the activities that will best attain the
desired results. Breadwell and Holden (1994) categorize training activities into two
main groups: on-the-job methods and off-the job methods. Noe (2002) also suggests
looking at the level of trainee involvement in the training process and the interaction
between trainee and trainer during the training program. These activities include
presentation, hands-on activity, and group building methods. More specifically, these
activities could be divided into the following sub-activities: on-the-job training,
coaching, lecture, conference and discussion, and self-study.
On-the-job training (OJT): On-the-job training (OJT) refers to new or inexperienced
employees learning through observing how their peers and managers perform the
job and the attempt to imitate their behavior. In terms of benefits, OJT can be useful
for training newly hired employees, upgrading the skills of existing employees when
new technologies or techniques are introduced, cross-training employees within a
department or work unit, and orienting transferred employees to their new jobs (Noe,
2002).From the organization’s perspective, OTJ is an attractive activity because it
needs less investment in time and money (Chruden, 1960). From the employee’s
point of view, OJT can increase employee motivation since it is clear to him/her that
he/she is acquiring knowledge needed to perform their jobs (Noe, 2002). However,
there is also a potential pitfall in this activity if OJT is unstructured and the supervisor
focuses on production rather than on learning how to perform the job in the most
efficient manner. Without a well-structured OJT, poorly trained employees are at risk
of providing an inconsistent quality of service. In other words, informal OJT can
increase the rate of errors, lower productivity, and decrease training efficiency.
Coaching: Coaching, which is considered to be the best on-the-job training, is
defined as a performance-improvement technique. Read and Kleiner (1996) define
coaching as a mutual conversation between a manager and an employee that
follows a predicable process and leads to supervisor performance, commitment to
sustained improvement and a positive relationship. Moreover, DeSimone and Harris
(1998) define coaching as a process used to encourage employees to accept
responsibility for their performance, enable them to achieve and sustain superior
performance, and treat them as partners who are working toward a mutual
organizational goal. Coaching involves either the individual’s immediate supervisor
or a mentor. The mentor usually acts as a guide, counselor, and interested party in
helping his or her subordinates perform their job more effectively and in developing a
comprehensive career plan for each one. Coaching requires time and effort. Thus,
the trainer must allow sufficient time for the trainee to develop the new behavior.
Job rotation: Job rotation is the training activity that is usually used for training
managerial and technical employees (DeSimone and Harris, 1998). Movement from
one position to another one provides managers with exposure to a member of a
different job function and a broad grasp of the overall purpose of an organization as
well as the flexibility in making the assignment. In addition, trained replacements are
available to assume positions that become vacant. However, the disadvantage of
this activity is that a trainee always feels temporary without a personal commitment
to become involved in working and accomplishing much.
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
Lectures and conference: Lectures and conferences involve the oral presentation of
information by an expert on a specific subject to a group of trainees. Many
organizations use lectures and conferences as methods for delivering training in
many types of skills. In fact, most training programs, including OJT, use lectures and
conferences as a part of their overall approaches. Lectures and conferences could
be held on-site or at facilities away from the firm.
Independent self-study: The most frequent kinds of self-study activities are reading
books and professional magazines, taking special courses through a local university
and attending professional meetings. For highly motivated individuals, independent
study and special training are excellent ways to increase job knowledge and skills.
Although most employees do not have the motivation to undertake a special study
program as an ongoing form of personal development, they can be motivated to do
so if there are adequate opportunities for promotion and pay increases (Breadwell
and Holden, 1994).
Audio-Visual techniques: Such methods, which can involve overhead projectors and
video presentations, are receiving greater attention as ways to train employees. This
approach has been used to improve communication skills, interview skills, customerservice skills and to illustrate how procedures should be followed (Breardwell and
Holden, 1994). The use of audio-visual training techniques has a number of
advantages. Firstly, the trainer can review, slow down, or speed up the lesson,
leading to the flexibility of a customized lesson. Secondly, trainees can be exposed
to equipment, problems, and events that cannot be easily demonstrated. Trainees
are also provided with consistent instruction and the interests and goals of a
particular trainer do not affect program content. Finally, video trainees allow them to
see and hear their own performances without the interpretation of the trainer. As a
result, trainees cannot attribute poor performance to the bias of external evaluators
(Noe, 2002). However, there are some problems in this activity, which result from the
creative approach used. These problems can include too much content for the
trainee to learn, which can make it difficult for the trainee to understand the critical
points.
Simulation: This activity is a training method that represents a real-life situation, in
which the trainee’s decisions result in outcomes that reflect what would happen if
he/she were on the job (Noe, 2002). Normally, simulations are used to teach process
skills as well as management or interpersonal skills.
Case studies: A case study describes how employees or an organization dealt with a
difficult situation. Trainees are required to analyze and critique the actions taken,
including making suggestions for the appropriate action or for what might have been
done differently (Noe, 2002).
Evaluation of training and development
When money is spent on employee training and development, there are some
expectations of an immediate return, such as the employee’s ability to perform the
current job better. However, there is no clear consensus within the training
community on how to determine the value of training. Certainly, the credibility of the
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
training community can be greatly enhanced by showing how the organization
benefits from training programs. There are four different ways to evaluate the
performance of a training program. Each one focuses on a different aspect of the
training program, such as the reaction of the participants to the training program, the
degree of learning that took place, the behavior changes among the participants, and
the impact of the program on the organization through cost savings, actual profits,
increased sales, the turnover rate, increased production and the degree of
absenteeism.
3. Research methodology
Most of the methodological concerns in this study are discussed in order to seek
appropriateness in selecting research approaches. The literature reveals that there is
no explicit framework to explain how training and development practices are
implemented in Thai hospital. Empirical evidences related to this specific topic are
also lacking. Therefore, this study adopts an exploratory approach. A case study
design is chosen to capture context-rich data and to ensure the validity and reliability
of the research
3.1 A case study approach: Multiple case studies
According to Yin (1994), the case study approach aims to investigate “a
contemporary phenomenon within its real life context, especially when the
boundaries between phenomenon and context are not clearly evident”. There are
two main reasons to use case study approach in this study. Firstly, the “how” and
“what” research questions are examined on the grounds that the researcher has a
little control over a set of phenomenon (Yin, 1994). Secondly, the gap between what
is espoused and what is enacted in training and development implemented
represents a lack of connection between the context and the phenomenon (Gratton
et al., 1999).
Based on the methodological approach as a case study used in this study, a
common goal behind case study research is to consider what can be learnt from the
case, rather than simply considering the extent of generalization (Stake, 1995).
Eisenhardt (1991) supports this statement by pointing out that the concern in case
study research is not whether multiple cases are better than single case. Rather, the
appropriate number of cases depends on how much is known and how much new
information is likely to be learnt from the case. Given to the constraints of time,
multiple cases with multiple units of analysis used in this study is a suitable approach
under these three following reasons.
1. The insights of the phenomenon to be investigated are revealing. Evidence
from the literature shows that the in-depth issues of training and development
in Thai hospital is under-researched. Therefore, the deeper understanding of
the implementation process in this issue is essential.
2. A case study is unique in context (Thai hospital) and contributes to theory or
framework development through a number of units departments within a
hospital.
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
3. Since the research objective in this study is to explore the guidelines or
recommendations of training and development process in Thai hospital, the
single case selected has enough significant quality that represents an
interesting research object to be studied (Pettigrew, 1990).
3.2 Case selection and access
According to the motivation to examine the depth knowledge of training and
development process in Thai hospital, a single case is selected. Based on the
company profile reviewed, a number of case candidates, with a focus on human
resource development policies, are collected to identify the most suitable fieldwork
study.
Among the few organization candidates, Hospital A, a pseudonym, one of the notfor- profit middle size hospital in Thailand, has been selected as the successful case
candidate for two main reasons. Firstly, it is a hospital that has implemented training
and development programs, and placed a high value on human resource
development. In addition, through the study of Hospital A with multiple units, it
enables the author to empirically examine the practices and implementation process
of training and development programs in terms of how the training and development
processes have formulated, and put into practices in a wider organization context. As
a result, the connections across the multiple units that cut across the hospital (top
management to department unit) can be investigated perceptions of hospital staff
toward training and development issues. Secondly, the author is able to gain access
to the hospital which is facilitated by the director of the hospital. It is important to note
that gaining access to the site and receiving the permission to conduct research are
critical issues in doing research, especially on the case study research. In order to
receiving official support, the author needs to send a research proposal, interview
protocol, and questionnaire to a team of hospital management. In summary, Hospital
A is selected due to the characteristics that meet the objective of this study.
3.3 Data collection method
Primary data will collect by sending questionnaires to key informants in Thai
hospitals in order to assess the current training and development practices. In
addition, to observe real situation in business, Semi-structured interview through
case study will be used. Open questions were mainly employed to encourage
respondents talk openly about their opinions concerning to related topics of training
and development in general in the hospital context. The method of semi-structured
interview is selected for two reasons: firstly, enabling the interviewer to gain
communicative validation, and secondly, following some divergent themes emerging
from interviewers (mason, 2002). In this study, multiple views of the interviewees
tend to give rise to follow-up questions for exploring more information.
4. Results
4.1 Role of Personnel and Training department in training programs.
Either the Department of Personnel and Training or the relevant department was
expected to conduct training programs at least twice a year. However in practice, the
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
Department of Personnel and Training rarely conducted training programs and about
82% of respondents said they were trained by their own departments. In other
words, the Department of Personnel and Training did not play an important role in
training activities. The only training activities carried out by the Department of
Personnel and Training was orientation meetings for new employees. In these
meetings, the new employees were handled with their respective recruitment
document followed by a short self introduction instead of being provided with
sufficient and necessary information. The new employees also did not receive any
special assistance from the Department of Personnel and Training.
4.2 Contents of the training programs
According to the survey, most of the new employees had received only informal
training. After completing the orientation with the Department of Personnel and
Training, the employees were sent to their respective departments. The main priority
for training focused on professional skills, which represented 32% of training content.
The second priority focused on management skills, representing 30% of training
content, followed by language and informatics skills both of which contributed 19% of
the training content. The content of the training and development programs in
hospital A is shown in Figure 2.
-Figure 2: Contents of Training program in Hospital A-
Hospital A still does not offer a clear and comprehensive job description for each
position. Due to various historical reasons; a job analysis has never been done
before. Therefore, the content of the training programs was just, to some extent,
limited to simply equipping the employees with very general information about the
job that they were expected to perform. This is why most of the respondents said
that the employees normally feel workload. One of the administrative employees
commented:
“Most of the new employees are confused about their own tasks and those of
others because there is no clear job description for each individual and they just do
their work as a routine, but when there is anything new, they will ignore it.
Unsurprisingly, those jobs will then be added to someone else’s workload”
Apart from that, many employees seemed to be disappointed with the training
activities. According to Figure 3, most of the employees were not very satisfied with
the training and development program: only 10% were completely satisfied and 3%
of the respondents were unsatisfied. The following comment made by one
administrative staff member who worked in the marketing department summed it up
in this way:
“In the past, we were trained in unneeded skills, and now things are better.
Our supervisor takes part in determining our training needs and setting up the
training, however I think we still want our needs to be assessed systematically”
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
-Figure 4.3: Employee satisfaction with training and development programs-
4.3 Training for middle and high-level employees
The in-depth interviews with the five department heads revealed that the training
program is mostly designed for low-level employees. Training is rare for mid-level
and high-level staff at Hospital A, especially for management such as the president
and vice president and this could lead to inefficient management later. Two
department heads commented:
“The training needs for managers are partly assessed by the personnel and
training department so that we (as managers) seem to lose our focus in terms of
strategic planning. In other words, the hospital seems to focus too much on lower
level workers and not enough on management. ”
4.4 Training for reassigned employees
In addition, the training is mainly aimed at new staffs who have never worked
anywhere else. The employees who were relocated or who had been reassigned
from either one department or shift to another had no chance to participate in the
training activities. As in the case of the middle and high-level employees mentioned
above, these employees are also expected to adjust themselves to a new context as
well as to new colleagues and this oversight can negatively affect employee
performance. One of the nurses who used to work in the OPD and who now work on
ward commented:
“I was reassigned to a ward last year, but I have not received any training for
my new task. The reassigned staff members have to learn how to do their new jobs
on their own.”
The survey also showed that Hospital A’s training programs emphasized one-way
communication. Hence, the employees did not have the opportunity to discuss
issues of interest or ask questions that were of concern to them. 58% of the
respondents said that the training needs were based on Hospital A’s strategic needs
at the expense of employee needs. One of the administrative employees addressed
the issue in this way:
“The training programs seem to be policy oriented, rather than employee
oriented because they are mainly aimed at serving the hospital’s policy”
- Figure 4: The percentage of the training needs based-
The training program was criticized for focusing too much on paper work and for
being too short. For example, a training program generally lasted no longer than one
day. Moreover, there was a lack of follow-up. Unfortunately, the Personnel and
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Proceedings of 3rd Asia-Pacific Business Research Conference
25 - 26 February 2013, Kuala Lumpur, Malaysia, ISBN: 978-1-922069-19-1
Training Department head and employees who were responsible for training did not
have enough time to implement an effective training program because they were
also responsible for the payroll and staff recruitment, which consumed most of their
working time. The Personnel and Training department head said:
“I do recognize the importance of training our staffs but at the same time we
have other things to do that take priority. That’s why there is only a limited amount of
time available for the training programs. Moreover, our hospital spends much of its
budget on construction which means that projects that are not considered to be
directly related to increased profits are given less priority.”
There is also no budget allocation for implementing training programs, which
explains why staffs at the Personnel and Training department lacked an awareness
of the importance of training programs. Training was considered to be a sub-activity
that was not worth an investment of either time or money. This attitude was shared
by many department heads as well as by employees within the personnel
department.
Hospital A does not have an employee handbook, which could help employees
better understand their organization and offer job performance guidelines. The use of
tools such as handbooks, tape recorders or videotaped recordings in training
activities was not familiar to the head of the Personnel and Training department or to
the department’s employees. The in-depth interviews with the five department heads
and their staff also showed that this approach had not occurred to any of them either.
4.3 Training and Development programs purpose
As a professional organization, Hospital A’s medical staff, such as doctors, dentists,
nurses and pharmacists have to continually update their knowledge and skills.
Administrative staff members involved in customer service also need to be trained in
order to maximize their human resource potential to ensure customer satisfaction.
Faced with this reality, Hospital A is developing a human resource strategy to create
a comprehensive foundation for training and development programs. Meanwhile,
several training courses have been held in the past few years that aimed to provide
Hospital A’s employees with the needed knowledge and skills for their career
development.
According to the survey, the most important purpose of training and development is
to improve the performance of employees (39%). This high percentage showed that
both management and employees at Hospital A paid much attention to their job
performance and skills development. Training for the purpose of preparing an
organization to adapt to changes in the external environment was given second
priority, accounting for 32% of respondents in the survey. Only about one third of
respondents believed that training would allow employees to acquire professional
skills and further education or lead to a promotion, represented by 18% and 11% of
respondents respectively. Figure 5 shows how respondents at Hospital A rated the
purpose of training programs.
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-Figure 5: Purposes of training programs at Hospital A-
4.4 Training needs assessment (TNA)
Training needs assessment is critical for ensuring the success of training and
development. Regrettably, TNA has not been systematically carried out until now at
Hospital A.
TNA is carried out annually to facilitate the design of a short-term training plan and
the procedure to implement TNA is quite simple. As required by the Department of
Personnel and Training, other departments submit their training needs. Based on
these training needs and other factors such as the training budget, the Department
of Personnel and Training draws up an annual training plan. The matter that, the
TNA is not researched with appropriate consultation with individual concerned but
the departmentally level only. Most respondents said they had never been officially
asked about their training needs. TNA has not been implemented methodically at
Hospital A due to various reasons that are discussed in more detail below.
Firstly, although the roles and responsibilities of Hospital A’s departments have been
defined, they have not been defined clearly enough, leading to the lack of a clear job
description for each position. This oversight has created many difficulties in
recruitment and staff management because the required professional skills for each
employee are not explicit. As a result, employees are not sure about their
responsibilities or about the skills they are expected to have. This makes it very
difficult to carry out an effective TNA.
Secondly, the personnel department employees, who are in charge of training and
development, have not been invited to participate in any training courses on human
resource activities. They have neither participated in human resource management
planning in general, nor in the implementation of TNA in particular. Usually the
personnel employees come from other departments or they may be new recruits who
have no background in human resource management training and may hold degrees
in other subjects.
The in-depth interview with the personnel employees showed that they have never
been provided with any TNA training. In particular, Hospital A’s personnel staffs have
never been taught about the following specific TNA concepts:





Objectives, signification and requirements of the TNA
Classified target groups to be included in the TNA
Approaches and tools for data gathering
TNA procedures
Time frame and implementing plan
This is why they knew nothing about TNA, let alone how to apply it methodically and
systematically. This is also one of the main reasons for the ineffectiveness of TNA at
Hospital A.
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Personnel and Training employees did say however, that they expected to be trained
about TNA concepts soon.
“We have to join the TNA training course in order to be able to implement the
training needs assessment and explain it to the department heads.”
Thirdly, the culture of the specialized organization is the other important cause of
training needs assessment’s effectiveness in hospital A. As a professional
organization, Hospital A recruits specialized staffs such as doctors, dentists,
pharmacists and nurses, from the public universities in Thailand. Therefore training
and development are less emphasis compared to other kinds of organizations. In
addition, the high rate of turnover in Hospital A also discourages the training and
development program.
4.5 Training and Development planning
As mentioned above, human resource planning (HR planning) has not been paid due
attention. There has been no HR planning at all so far at Hospital A. The strengths,
weaknesses, opportunities and threats analysis (SWOT Analysis), which facilitates
the drawing up of a comprehensive HR plan, still needs to be carried out. Due to
Hospital A’s ineffective TNA, the hospital does not have a feasible training and
development plan.
Most of the survey’s respondents said that the training and development plan seems
to be quite “subjective”. That means the current training and development plan in
Hospital A is still, to some extent, not participatory. The training and development
programs mainly rely on the opinions of management or personnel department staff.
This is another result of the failure to carry out an effective TNA.
Some training courses have been ineffective and inconvenient, resulting in a waste
of money and human resources. For example, training needs for employees were
assessed through their department heads, not through a survey conducted with
concerned individuals. That is why when the professional skills training courses were
organized, many employees did not attend because they did not have enough time
to arrange to take time away from their work. In addition, many employees could not
choose to take part in a training course that interested them.
-Figure 6: The causes of the ineffective training programs-
From Figure 6, it can be seen that the training location was the main barrier for the
employees (41%), and 29% of the respondents said that the cause of the ineffective
training program was the inappropriate training content. The other 18% of
respondents criticized the insufficient amount of time allotted for the training. Last but
not least, 6% blamed a lack of good training equipment and another 6% said the
training evaluation was inadequate.
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There was also a poor dissemination of information. Employees were not informed
about either the long term or the annual training and development plans. Many
respondents said they were informed about a training course just weeks before it
began. This is why many employees could not attend. One nurse said:
“I have worked here for almost two years but I have never been through any
training programs that completely match with my training needs. And I hardly ever
leave my work and my patients to attend the training courses”
Hospital A’s training and development programs seem to be quite passive. The
annual training plan makes no mention of the planned number of trainees joining in
long-term professional skills training courses each year. Training at the master’s or
doctoral levels, especially for courses abroad, depends mainly on scholarships
offered by either donors or other outside resources. Even the personnel employees
do not know how many employees can be sent abroad for training each year. These
are all examples of a passive approach to training and development. Moreover,
Hospital A has emphasized on personal relationship, which leads to unfair decision
making.
Many employees also complained that in some cases, overseas training was offered
only to employees who had worked at the hospital for a long time, as a form of a
reward. This could explain the very limited quota for overseas training opportunities.
However, in the last few years, many more scholarships have been made available
for external training. All qualified department employees at Hospital A are now
considered as candidates, which has led to a gradual increase in competition. There
are also now more training opportunities for new as well as younger employees,
which have improved employee satisfaction.
However, the length of time an employee has worked at the hospital is still a factor
when applying for training abroad, which is the seniority culture in Thailand. This is
why there are many young employees, especially in departments where many
employees joined at the same time or where many employees had not yet
experienced any training abroad and as a result had to wait a long time to take their
turn. This “queue” status should no longer be an issue however, as HR policies
change.
In another development, regulations that encourage employees to upgrade their
knowledge by themselves have not been promulgated in Hospital A. Getting a highlevel professional education and experiencing many training courses are not
considered as a priority when promotions or salary rises are considered. Even if
someone is a doctor or has a Master’s degree, the salary still increases
automatically every two or three years. This is why many employees are not
motivated to take part in training and development programs. Three doctors raised
this concern:
“Training abroad is very competitive because there are only a few scholarships
for this kind of training and so many doctors are trying to get that, especially the new
graduates.”
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Additionally, when the trained employees return to work this also presents a
problem, which requires more attention from management as well as from Personnel
and Training staff. Many opinions point to a gap between training and development
programs regarding the reassignment of the newly trained and returning employee.
The in-depth interview with some department heads revealed that the skills training
did not match with the trained position. That fact is caused mainly by the lack of a
training and development strategy, as mentioned above. This also leads to a waste
of financial and human resources.
4.6 Training methods
The results from the survey indicated that on-the-job training is the training method
that is most frequently used at Hospital A (80.6% of respondents). The reason might
be that this method is relatively inexpensive yet is an effective hands-on method.
New employees at Hospital A usually have to be trained through this method since
there is a big gap between the theoretical knowledge they learned in school and the
practical requirements of the job.
The second highest training method was the self-learning method (approximately
77%). It also appeared to be the preferred method of most respondents since it
allows Hospital A’s employees to acquire more knowledge and skills while at the
same time allowing them to fulfill their duties without interrupting their work.
-Figure 7: Training methods at Hospital AThe coaching method was represented by 36.1% of the survey’s respondents. Like
on-the-job training, this method seems to be quite effective for Hospital A’s
employees to correct their performance mistakes. Apart from the training courses on
foreign languages and informatics provided by Hospital A, many employees are selfequipped these skills. Additionally, with the aim that acquiring more knowledge in
specific field such as obtaining bachelor in nursing, service, language and etc, the
officials are also participating in the in-service training class held by the universities.
This kind of training method accounts for 40.3% of total respondents. In this training
method, the employees have to pay for the training themselves. Hospital does not
take it in consideration. The other training methods at Hospital A included distance
learning, job rotation, case study and simulation, which combined to represent only
15% of the total. However, due to the limitation of equipment, distance learning has
not expanded much. It is very difficult to implement training by job rotation. In many
cases, it has disadvantages. It usually requires a certain amount of orientation time
to familiarize the new employees to a new situation. It also makes employees of
temporary on their job, and then leads to less commitment to their jobs. Because of
many reasons at both the employee and management levels - especially for
psychological reasons - there have been very few recent job rotation cases. The
case study and simulation approaches are rarely used at Hospital A since they
require too many resources.
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5. Discussion and conclusion
This research identifies the problems regarding the training and development
activities at Hospital A and explored these activities through interviews with several
heads of departments, personnel employees, doctors, nurses and administrative
employees, and through questionnaires which focused on training and development.
After analyzing the data, the general conclusion regarding Hospital A’s training and
development activities is that the training and development programs have not been
implemented systematically. In addition, there is still no comprehensive human
resource development strategy in place to provide a foundation for a training and
development plan. As far as human resource development is concerned,
recommendations are given for implementing training and development programs
more effectively, for improving the skills of Hospital A employees in particular as well
as for improving Hospital A’s overall performance.
5.1 Training and development
As we can see, training and development is not considered to be as important as it
might be. Hospital A does not consider training and development a priority and
instead forces its staff to either learn independently or to simply maintain regular
routines. The training is mainly one-way communication between employees and
management, hence the employees do not have the chance to discuss their
concerns or offer comments. Therefore, in order to make training programs more
effective for the employees, the following recommendations should be followed:

Training should be paid more attention to by management of Hospital A,
especially the top management. Without the management level understanding
and support, the training and development cannot be implemented effectively.

The role of Department of Personnel and Training in carrying out training
activities should be strengthened. Personnel and Training employees should
take part in providing more assistance to each department in training needs
assessment, training planning and also in the facilitation of the training
activities.

A well-planned training should be conducted comprehensively for all
employees. A training plan is needed for each department and more
specifically, for each employee.

Training should be implemented for all kinds of employees, both the
graduates as well as relocated/appointed employees.

Employee handbook should be designed and provided. Apart from that, the
videotape or tape recorder can help to clarify Hospital A’s staff responsibilities
and functions and should be distributed to all employees.
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5.2 Training needs assessment (TNA)

A systematic and practical TNA should be implemented at Hospital A twice a
year, by sending questionnaires to all employees concerned in order to find
out the real training demands of the employees. It is clear to see that a
precise, comprehensive and bottom-up training and development needs
assessment is crucial for setting up a training and development plan in the
short-term as well as a long-term training and development strategy. Such a
comprehensive TNA would be a foundation for planning an objective,
participatory approach, which would take a trainee-oriented culture approach
to planning the training and development and strategy, avoiding the waste of
financial and human resources.

In order to do that, a comprehensive job description for every job position in
this hospital should be clear with the explicit delineation of roles and
responsibilities for both individual and departments. This would provide a
base from which the training planner at Hospital A would draw up a specific
training and development strategy with the aim of meeting both present and
future requirements and encouraging staff to make the most of their career
opportunities.

Additionally, an appropriate budget to implement TNA should be planned as a
part of the training budget to facilitate this essential step.
5.3 Training and development planning

Based on a practical TNA, an effective short-term training and development
plan and a long-term training and development strategy should be drawn up
to fill the current gap between management and front-line employees. This
training and development plan/strategy must be comprehensive, objective and
appropriate and it must address both the whole organization’s performance as
well as that of staff. In addition, the annual training and development plan
should be specific and active, avoiding a dependency on external factors.

The training and development plan/strategy should be related to the human
resource development strategy, aimed at applying and enhancing employee
skills. The right usage of trained employees to maximize their knowledge and
skills is the best way to motivate potential employees.
Moreover, in compliance with the training and development planning/strategy,
specific regulations should encourage employees to attend training and development
activities provided by Hospital A and should also encourage independent learning
opportunities.
5.5 Training methods
Hospital A applied on-the-job training methods, which are inexpensive for most
employees. However, with the changes of the global economy as well as challenges
of modernization, the other training methods should be applied. For management,
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methods such as simulation and the case study, which facilitate management skills,
should be used. Additionally, training courses on management skills such as
motivating, leadership, decision making and coaching should be paid due attention
and organized. When implementing the training and development strategy and the
short-term training plan a wide range of training methods should be considered.
These would include training methods such as on-the-job training, self-learning, and
distance learning to encourage employees to upgrade not only their knowledge and
professional skills but also to improve their social understanding and ability to use
foreign languages. In addition, modern forms of training such as information
resources, seminars, conferences and visiting consultants should all be paid due
attention in training and development activities. The role of the Department of
Personnel and Training in organizing such training methods should also be
strengthened through close cooperation with other hospital departments.
To choose the appropriate training method for Hospital A’s employees, the first step
is to identify the trainees. Then, the next step is to consider the extent to which the
method facilitates learning and transfer of training, the cost related to development
and the use of the methods as well as their effectiveness. Once again, the necessity
of a practical and comprehensive TNA cannot be denied.
5.6 Training monitoring and evaluation
The evaluation of training and development programs should be implemented as
soon as possible at Hospital A. Through evaluation sheets received from both
trainees and lecturers, personnel staff will be able to evaluate the effectiveness of
training courses and development programs. And then, the most feasible and
appropriate training courses and training and development plan can then be drawn
up.
5.7 Enhancing personnel department staff capabilities
In order to implement a comprehensive and practical TNA, planning an appropriate
training and development strategy for both the long and short term involves focusing
on the individual human being. Since personnel department staff members are the
front-line workers in this context, they should be the first to receive the kind of
training that will set the tone and example for others to follow, especially since these
are the people who will be responsible for motivating everyone else.
The training courses on human resource development should include both general
issues as well as specific training issues such as TNA implementation, training and
development planning and training evaluation. These should be offered to personnel
staffs to upgrade their skills since they should also be responsible for their
implementation. Once the personnel staff is systematically trained in this way, this
should guarantee the effective implementation of training and development programs
at Hospital A. Personnel department staff should also be encouraged to anticipate
training and development needs by actively calling for training opportunities,
especially by promoting scholarships for overseas training offered by government
agencies or external sources such as foreign donors.
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5.8 Support from top management for training and development activities
The support from top management is essential for Hospital A to implement an
effective training and development strategy. The support should be expressed in
terms of a willingness to allow subordinates to take part in training courses, either in
the long-term or short-term, by allocating a sufficient training budget, cooperating
with related agencies as well as foreign donors to create more scholarships, issuing
regulations to encourage employee participation in training and development
programs and offering chances for promotion for educated employees. Apart from
that, an appropriate and updated Human Resource Information System (HRIS)
should be established with the aim of strengthening human resource management. A
comprehensive HRIS will provide useful information about the employee training
process by providing a training record for personnel staff and training planners to
refer to when drafting effective programs. Last, but not least, the training budget
should be submitted on time and according to required procedures in order to get the
support from top-level management. An appropriate budget allocated for training will
facilitate the successful implementation of an effective training and development
plan/strategy.
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Training
Focus
Scope
Current job
Job
Time
Immediate
frame
Purpose Fix
current
skill
deficiency
and
prepare for current
job
Development
Current and future job
Workgroup
and
organization
Long term
Prepare for future work
demand and changes and
produce
a
flexible
workforce
for
the
organization in the future
Table 1 Comparison between training and development
Figure 1: The training and development process
(Adapted from Noe, 2002)
Training Needs
Assessment
Monitor and
Evaluation
Planning of
Training
Activities
Plan
Implementation
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Figure 2: Contents of Training program in Hospital A
19%
32%
Professional Skills
Language Skills
Management Skills
Informatics skills
30%
19%
Figure 3: Employee satisfaction with training and development programs
3%
10%
Completely
Partly
Not at all
87%
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Figure 4: The percentage of the training needs based
0%
42%
58%
The demand of
employees
Strategy of the Hospital
Other
Figure 5: Purposes of training programs at Hospital A
Improved employee's
performance
32%
39%
Achieved promotion
Acquired further
education
18%
11%
Improved hospital
competitiveness
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Figure 6: The causes of the ineffective training programs
Content not appropriate
Period of time unsuitable
29%
41%
Lack of good training equipment
6%
Lack of training
evaluation
18%
6%
Inappropriate allocation of training
course
Figure 7: Training methods at Hospital A
90
80.6
80
76.4
70
%
60
50
36.1
40
40.3
30
15.3
20
10
0
On-the-job
training
Self-learning
Coaching
In-service
Others
25