You are on page 1of 91







I, the undersigned hereby declare that the work incorporated in the Summer Internship
Report Titled A Study of Employee Perceptions at the time of exit towards HR practices At
the CIMS (Care Institute of Medical Science) Hospital is original and has not been submitted
to any university as part fulfilment of award of any degree or diploma.

The material obtained and used from other sources has been duly acknowledged in the

Date: Sign of the Student

Place: Ahmedabad

It is said that practice makes a man perfect. So professional study is incomplete without its
practical knowledge. In the field of business, theory provides the fundamental stone for the
guidance of practice but practice examines the element of truth lying in the theory therefore
stand coordination between theories and practice is very essential to make MBA perfect.

Each & every activity is started for the accomplishment of goals & for this purpose
management is required. As being student of MBA, a management stream, we have to go in
different types of analysis for practical knowledge & practical training.

A project is a systematic and scientific study of Human Resource related problem with
application of HR skill and concepts. Every company has to recognize its strength and
weakness, opportunities and threats in field of HR to stay in the cut throat competition.

I was assigned a study of a project on EMPLOYEE EXIT of CIMS HOSPITAL.

Secondary is to share the practical knowledge and real experience in world of HR. The
details mention in this report is based on real situation and research.

I hope the report will be special interest to the HR students who are on look for such real life
situation beyond their class room study.

I would like to thank CIMS hospital for providing me an opportunity to grow and enhance my
knowledge and skills.

I would like to thank CIMS hospital for providing me an opportunity to grow and enhance my
knowledge and skills.

I also take this opportunity to thank Miss. Radhika Joshi, HR Department, CIMS hospital,
Mohali for her guidance and help in procurement of the required information for my project
and the jobs I was assigned.

It was the extreme cooperation of the staff members that I was able to learn a lot about the
practical aspects and got an opportunity to work for the regular affairs and get a real time
experience. The completion of the project was a not an individual but indeed a joint effort of
all the staff members.

Last but not least, I pay my deep regard to my family and the ultimate power, without whom I
would not have been able to complete this project.

Thanks to one and all..

Executive Summary

The study was conducted with a few objectives in mind which were to study the HR practices
in the organization, to find out the problems faced by employees of the organization, to find
out certain factors responsible for high Exit rate in the organization and to suggest some
ways by which the company can retain its employees.

With these objectives a primary research was conducted in the months of April and May. For
secondary data, a detailed analysis of the Exit patterns department wise, grade wise, time-
span wise, rating wise, qualification wise and month wise was done. Based on which the
hypothesis was formed. The primary data was collected through a few unstructured
interviews and questionnaire which was administered to employees of CIMS hospital.

During the research 100 employees were covered. Survey results revealed that most
important factor behind employee Exit is Opportunity for development and growth, second
most important factor is Salary, third most important factor is Job content and fourth most
important factor is Relationship with supervisor. Also contained in the report are talent report
tables and tables which show the reasons that are central to Exit in CIMS hospital and their
relative importance.

At the end I suggest certain activities that CIMS hospital can take in order to decrease Exit
rate and retain employees.

No. Topic Name Pg. No

1 Introduction Of Healthcare Industry 1-8

2 Introduction Of CIMS Hospital 9-26

3 Introduction Of Employee Exit 27-41

4 Literature Review 42-48

5 Research Methodology 49-52

6 Data Analysis & Interpretation 53-70

7 Findings 71

8 Recommendations 72

9 Conclusion 73

10 Learning From SIP 74

11 Bibliography 75
Introduction of Sector


If there has been a sunshine sector, driving employment and revenue generation for India, it
is healthcare. And no wonder! With a robust domestic demand, rise in innovative healthcare,
corporatization of healthcare facilities, influx of medical tourism and the government push
towards healthcare innovation, the overall segment has been driving the job market, even as
others have ebbed and flowed.

Whats more the consistent influx of money into research and development by
pharmaceuticals and into innovative healthcare practices, raise the bar for revenue
generation and employment.

Here are the facts:

Healthcare, in itself, is a high-cost sector for both end-users and providers, billing at an
average of 10.5% of GDP on a global basis. (World Healthcare Outlook, Economist
Intelligence Unit). The costs support several ancillary industries, be it pharmaceuticals on one
end or the health insurance segment on the other.
Introduction In the recent decades the Indian industry has changed its outlook. The
employment scene has changed its appearance. The factors like skill sets, job satisfaction
drive the employment and not just the money. The employer hence faces the heat of
continuous employee turnover. Continuous efforts are made by the companies to control the
employee turnover rate. As it directly affects the performance of the companies as many
people leave the organizations for various reasons at crucial points. This turnover is normally
known as attrition i.e., the exit of employees

With todays baby boomer generation to retire from the labour market, many companies are
finding it increasingly difficult to retain employees. Attrition is becoming a serious problem in
todays cooperate environment. The employment culture is changing as well. It is now
relatively common to change jobs every few years, rather than grow with one company
throughout the employment life as was once commonplace. In addition, employees are
increasingly demanding a balance between work and family life.

Exit costs for many organizations are very high and can significantly affect the financial
performance of an organization. Direct costs recruitment, selection and training of new
people. Indirect costs include such things as increased workloads and overtime expenses for
co-workers, as well as reduced productivity associated with low employee morale. Estimated
Page | 1
costs vary from organization to organization, some as low as a few hundred dollars to as four
times the annual salary of the employee. Employee attrition is very big problem not only in
Indian but outside India too. Attrition rate is increasing day by day and its especially the
software industry which is affected the most. Why an employee leaves a company is the
question asked by most of the employers. Companies even hire private HR professionals to
study companys work and find out why an employee is dissatisfied.

Rise in population (currently pegged at 1,261,527,930) and increasing life expectancy

underline the high domestic demand for healthcare services. Even though universal
healthcare system is run at both the centre and state levels, mistrust, low quality services
and less penetration in rural regions, have helped establish a supportive private healthcare
network. Currently 70% of those in urban areas and 63% of those in rural regions prefer to
access private healthcare services.

Currently, India stands at a cross-road of high-end, multi-specialty private healthcare

services on one end and lack of doctors, support staff, medicines and facilities at the other.
High-end facilities and education platforms are concentrated near metropolitan centres
(World Health Organisation in its 2012 report said that only 26% of healthcare professionals
were available to address the needs of 72% of the countrys population).

Page | 2
Top 5 Hospitals in Ahmedabad

Page | 3
Healthcare Industry Top 10 Risks


1 Regulatory/legislative changes

2 Failure to attract

3 Economic slowdown/Slow recovery

4 Increasing Competition

5 Damage to reputation/brand

6 Failure to innovate

7 Lack of technology infrastructure to support business needs

8 Political risk/Uncertainties

9 Workforce shortage

10 Cash flow/liquidity risk

Page | 4

Government hospitals It
includes healthcare centres,
district hospitals and general

Private hospitals It includes

nursing homes & mid-tier & top-
tier private hospitals

It includes manufacturing,
extraction, processing,
purification & packaging of
chemical materials for use as
medications for humans or

It comprises businesses &

laboratories that offer analytical
or diagnostic services, including
body fluid analysis

It includes establishments primarily

manufacturing medical equipment &
Medical equipment
& supplies supplies, e.g. surgical, dental,
orthopaedic, ophthalmologic,
laboratory instruments, etc

It includes health insurance &

medical reimbursement facility,
covering an individuals
Insurance hospitalisation expenses incurred
due to sickness

Telemedicine has enormous potential

in meeting the challenges of healthcare
delivery to rural & remote areas
Telemedicine besides several other applications in
education, training &
management in health sector

Page | 5
Scope of growth

Considering the demand given above, the domestic healthcare sector is expected to rise to
$100 billion by 2015, according to the India Brand Equity Foundation. And 71% of this growth
is expected to take place in hospitals.

Investment in private healthcare is going up too. The sector was the second favourite
destination for foreign investment in 2013, receiving 27 investments worth $181 million from
the US. Overall, hospitals and diagnostics centres received an FDI of $2191.91 million, while
medical and surgical appliances (medical equipment) received $741.80 million in the last 13
years. (April 2000-December 2013) according to the Department of Industrial Policy and

What are these funds being utilised for? Setting up new facilities, research and development
into innovative practices, super-specialisation for chronic diseases like diabetes, Hepatitis B
and medical treatments for both the domestic patients and those from abroad. These mean
rise in recruitment and acquisition of a skilled workforce too.

While established medical chains like Apollo, Max and Fortis are branching out, new ones
are coming up too. An 11-hospital set up in Kochi, called Aster Medcity is in the pipeline too
for 2014. Apollo Hospitals is looking east, with plans to set up new facilities at Kolkata, Patna,
Raipur and Guwahati.

Ambit for medical tourism

According to a sectoral outlook prepared by Accenture on India, the country hosts 150,000
medical tourists and this number will see a hike of 15% every year. To capture this segment
many corporate ventures have stepped into the sector, offering multi-specialty healthcare,
diagnosis and treatment packages.

Low cost medical innovation is an Indian specialty too, attracting investment from both
domestic sources and foreign companies. Currently GE is in the process of setting up a
manufacturing plant in Pune, which will see production of medical and surgical products too.
This is expected to become operational by mid-2014.

Page | 6
Meanwhile, National Instruments, a US-based company, is in talks with Indian Institute of
Technology, Madras, to work on a research facility for healthcare technology innovation.
Apart from working towards newer processes to make diagnostics more efficient, this facility
would look at production of automated testing equipment and virtual instrumentation

Challenges facing Indian healthcare:

Year-on-year, the challenges facing the sector have remained the same. While we are
looking at a $100 billion growth by 2015, the perennial problems facing India are still those
arising from malnutrition (infant mortality, lacking overall development), sanitation and access
to affordable hospitalization and clinical care.

On the other end of the spectrum, availability of a skilled workforce both doctors and
nursing and support staff is cringing. Doctor-nurse density per 10,0000 persons of the
Indian population is an abysmal 19 (6.5 doctors + 13 nurses). (WHO report 2012).

Compliance to regulations is still a cause for concern in both government as well as private-
run organisations. Whats more the system suffers from the lack of a quick response and
redressal system, with matters related to medical negligence and failure largely relegated as
consumer affairs troubles.

Further, we need an effective mechanism to address demand for safe, affordable and quickly
available healthcare for all.

Page | 7

Healthcare has become one of India's largest sectors both in Healthcare sector growth
trend (USD billion) terms of revenue & employment. The industry is growing at a
tremendous pace owing to its strengthening coverage, services and increasing
expenditure by public as well private players

During 2008-20, the market is expected to record a CAGR of 16.5 per cent

The total industry size is expected to touch USD160 billion by 2017 & USD280 billion
by 2020

As per the Ministry of Health, the government is working on the development of 50

technologies for treatment of diseases such as cancer & TB

Government is emphasising on the eHealth initiatives such as Mother & Child

Tracking System (MCTS) & Facilitation Centre (MCTFC)

Indian companies are entering into merger & acquisitions with domestic & foreign
companies to drive growth & gain new markets.

Page | 8
Introduction Of
CIMS Hospital

A 350-bedded, multi-super specialty, CIMS Hospital is one of the best hospitals of

Ahmedabad (Gujarat) providing a range of diagnostic and treatment services.

Delivering the highest standards of global healthcare, CIMS Hospital is accredited by JCI
Joint Commission International (USA), NABH (National Accreditation Board for
Hospitals & Healthcare Providers) and NABL (National Accreditation Board for Testing
and Calibration Laboratories) for providing quality healthcare and patient safety across
Spread across two spacious and state-of-the-art buildings viz. CIMS EAST AND CIMS
WEST, CIMS Hospital offers a combination of the most experienced doctors, latest
technology and excellent infrastructure ensuring world -class patient care and treatment.
Then you are on the right track, as CIMS Hospital is one of the most reputed hospitals
of Gujarat being conferred recently with the Trusted Healthcare Distinction Awards
2017, National Quality Excellence Awards, 2017 for Best Multi-Specialty Tertiary Care

Page | 9
Our motto of PATIENT FIRST ALWAYS is the backbone of firm commitment to deliver the
best and safest care to our patients.

CIMS Hospital scores high on technology:

Gujarats first digitized operation theatres and ICUs.

Gujarats First ECMO facility

Latest Cancer Radiation machines

Latest Radiology- MRI and CT scans

Gujarats first certified GREEN Operation Theatres: certifying for safe practices and
environment friendly features such as low emission of carbon dioxide, infra-red rays and
radiation within permissible limits.

One of the most advanced ultra-modular and fully monitored emergency & trauma

Adding to its clinical triumphs, CIMS Hospital recently performed the 3 Heart Transplant
of Gujarat. And has recently established Paediatric Bone Marrow Transplant program.

Also, CIMS has set up its own Blood Bank within the premises of the hospital to facilitate
smoother services for all patients.

CIMS Hospital has got some amazing lifesaving results with the help of its expert team of
experienced clinicians in Cardiology, Cardiothoracic Surgery, Critical Care, Oncology,
Trauma, Neurosurgery, Orthopaedics, Gastro sciences, Nephrology, Urology, Neonatology,

Page | 10
CIMS Hospital is one of the hospital in which the relationship and the emotions always
matters. The magic of the CIMS Hospital was started in 1995 - 2001 with the first step of the
friendship between the Doctors and then they all are become the partners for the one good
cause of the society. In august 2001 the friends are becomes the partners as a care
cardiovascular consultants and the saga begins.

The friends who be together are the experts into their respective practices and they
are Dr.Keyur Parikh, Dr.Urmil Shah, Dr. Milan Chang, Dr.HemangBaxi, Dr. Anish
Chandarana and Dr. Ajay Naik and later They all are becomes the founder of Care Institute
Of Medical Science.

In December 2004, They had creating a milestone in group practice OPD- non-
invasive diagnostic centre at Balleshwar clinic, Opprajpath club, Ahmedabad with Dr.Dhiren
Shah, cardiac surgeon and later Dr. Satya Gupta. CIMS Commitment to education begins
first annual national conference organized on cardiovascular medicine and services.

At October 2007, they had taken the first step towards the CIMS Hospital they had
acquired the land for the hospital.

At March 2009, they had laying the foundation for the brighter and healthier future and
they had made the foundation stone laid for CIMS. In December 2009, the construction of the
hospital was in progress and with this they also made an auspicious beginning for a better
tomorrow with the pooja.

At November 2010, they have organised a grand inauguration of CIMS Hospital by the
Honble Minister Shri JaynarayanVyas and Mayor Shri. AsitVora. Actually the CIMS had
started serving to the society on the year 2010. With this they had also developed the cardiac
team of the CIMS Hospital.

On November 2011, The CIMS has also started the CIMS KIDS which provide the
services like Neonatology and Paediatrics. Which inaugurated by Honble health minister Shri
Jaynarayan Vyas and Honble minister of state, higher and Technical Education and Women
and Child Development Shri Vasuben Trivedi.

After that the CIMS have started to steady progress into the healthcare industry and
they have developed the many more things for the hospitals like the advanced technology

Page | 11
services and the many advanced practices which can be able to provide the safe and the
advanced medical services and the treatment to the patients.

At the November 2011, the CIMS have launched the Trauma and Critical Care Centre.
Which was inaugurated by Dr.SharadVyas, Dr. Rajesh Kishore andMaror Shri Asit Vora.

In to the time of January 2012, the hospital has spread their wings and they have also
inaugurated the CIMS Clinic in the area of maninagar by and it will also inaugurated by
Mayor Shri Asit Vora.

After that in August 2013, they had started the Radial Lounge for patients undergoing
angiography and with this they are also providing the proper professional environment for the
all the employees and try to provide all the proper policies and the procedures for the
important resource which is human resource and satisfy with the proper rewards.

On the day of February 2014, CIMS have started the Cancer Centre: A Centre of
Excellence of complete cancer care under one roof with most advanced Radiotherapy centre.

Board of Directors

Dr.Keyur Parikh Chairman

Dr. Milan Chag Managing Director

Dr. Anish Chandarana Executive Director

Dr.Urmil Shah Director

Dr.HemangBaxi Director

Dr. Satya Gupta Director

Dr.Dhiren Shah Director

Dr. Ajay Naik Director

Prof.DilipMavlankar Director

Dr.Kamlesh Pandya Director

Dr.Ashit Jain Director

Mr. Kirti Patel Director

Dr.Ashwani Bansal Chief Operating Officer

Page | 12


Board of Directors

Executive Committee

Chief Operating Officer

Finance IT
Human Clinical
Supply Resource Service
And Internal Core Delivery
Audit Team Communication
Hospitality and and Marketing

Page | 13
To be one of the most trusted hospital in India by providing personalised care for best patient

Manage lives
Save lives
To provide superior quality health Care using Innovation to Manage and save lives.

Patients well-being: It will be our top most priority.

To serve with Smile.

Adopt and encourage ethical practises.

Provide a safe and comfortable working environment to employees and associates.

Embrace technology and innovation in the delivery of healthcare.

Provide socially responsible and safe healthcare.

Comply with all applicable laws and regulations.

Page | 14
Services provided by the CIMS
East + West Wing


East Wing
Arthroscopy and Sports Medicine


Critical Care

Family Medicine


Gastro Intestinal Surgery

General Surgery


Health Check-up and Preventive Healthcare

Infectious and HIV Diseases

Internal Medicine

Joint Replacement Surgery

Laparoscopic Surgery



Obesity Management

Onco Surgery



Pathology and Microbiology

Paediatric Surgery


Spine Surgery



Obstetrics &Gynaecology

Page | 15
West Wing


Cardio Thoracic surgery


Neonatal and Paediatrics


Pain Clinic

Trauma and Emergency Care

Vascular Surgery

Sleep Medicine

Radiation Therapy

Renal Transplant

Page | 16
CIMS Special
Patient Centred
Organ Donation Awareness

Guiding the guest

H2H ( Hospital to Home visit)

Memorise the patients medicine

Communicating with lakhs of countrymen for health awareness through FOC journals

Yearly outcome book

Kem Cho Round (Complimentary tea to guests, suggestions and feedback)

Involvement of Doctors in Management through MEC

Radial lounge with more than 400-500 admissions in a month

Patient birthday celebration

Patient Anniversary Celebration

New born baby Celebration

GRE Playing indoor games with patients

Drawing Activities

Indoor games in relatives waiting area

Interactive Forums Antibiotic awareness week Hand hygiene education

Music Therapy

Magazine and Books Distribution

Patient gifts

Yoga Classes

Get Well Soon Compliments With Flowers

Thanks letter to patient after discharge

Patient Care Mega Round

Support Through CIMS Foundation

Page | 17
Staff Centred
Annual Day Celebration

Nurses Day Celebration

Birthday Celebration

Reward Ceremony

Arranging picnics and parties

Arranging movie shows

Staff Children Welfare Activities

Outside Training opportunities like AMA

Supporting through CIMS Foundation

Providing Discounts Through Employee Discount Policy

Regular Increments and Bonus

Library for a staff

Womens day celebration

Staff Accommodation / Uniform

Staff Accidental Insurance

Festival Celebration

Doctors day Celebration

Wedding Gift

Sports Activity

Page | 18

Zydus Hospital

Apollo Hospital

Sterling Hospital

Sal Hospital

Shalby Hospital

Columbia Asia Hospital

HCG Hospital




















Page | 19

The process of corporate diagnosis usually begins with SWOT analysis i.e. the
Strengths, Weaknesses, Opportunities and Treats. SWOT is a diagnostic
exercise which assist top management in integrating the organization with its
environment. The top management analyse the strengths and weaknesses of
the organization as a whole and evaluates those opportunities and threats that
exists at the time of review.

1. Strengths:

CIMS Hospital maintains quality standards.

CIMS has a huge customers base throughout the city.

Organization maintains good relationship with their employees because of good HR

Practise with supposed to achieve the organizational objectives.

CIMS is 350 bed multi-super hospital established to provide a complete range of

outpatient and indoor patient diagnostic and treatment services.

Equipped with world class technology

CIMS is an institute set to match the highest global standards of healthcare.

Backed by respected and leading medical experts.

CIMS is a commitment to provide the right and excellent medical care to each patient
who entrusts their lives in its care.

CIMS boasts of the most advanced cardiology care not only in Ahmedabad, But in the
entire western India.

The Hospital has a team of world renowned, experienced and highly qualified
cardiologists available 24/7 to attend all cardiac amergencies.

CIMS follow the latest international AHA/ACC guidelines in performing all cardiac

CIMS Cardiac team is one of the pioneers in India with over 28 years of experience.

Attitude of the staff, even the menials (human touch)


Page | 20
2. Weakness:

CIMS have a locational disadvantage because the hospital is located at a sola which is
not a much developed area so it can be said that the hospital has a one disadvantage
because of the location.

The hospital do not have the legal advisory department so it can be said one of the

One of the barrier is a language barrier because most of the nursing staff is a south
Indian and they are not able to properly understand the instruction of their senior so we
can said that a one of the disadvantage.

3. Opportunities:
As people are going more health conscious the demand for health care industry is
increasing. CIMS is making itself ready to grab the opportunities to capture the market.

The demand for CIMS is not only in India but also in other countries where the demand
for CIMS service is increasing day by day.

They can further increases their international services capacity from the existing one as
they enjoy goodwill of customer abroad.

The company has capability of achieving global standards.

A scope in expansion of its service on wider network of countries around globe.

Capacity of meeting higher demand and attain optimum utilization of existing


If the organization will manage their staff properly they can be able to achieve more
and more quality standards.

More training to the staff for improving their behaviour and medical knowledge.

To increase the facilities they provide

To become more specialised in various fields.

4. Threats:
Due to globalization more number of hospitals in healthcare sector has entered into
global market. This has enlightened the competition much more.

Another threat the company is facing is of substitutes.

It fails the competitors in advertisement and promotion.

If the company does not update itself in proper intervals the competitors may become
strong into market.

The instable government and changing policies and procedures.

Page | 21
The government is reducing the grants given to hospitals, thus making it impossible to
cater to the poor people.



1. To know terms and condition To follow all rules and regulation

of employment
2. To know remuneration and To fill up any forms related to missed
working hours punch, early going or late coming

3. To know his/her job profile Work under the guidance of

his/her superiors
Should acquire job related skills
4. Leave entitlement Procedure to take a leave like leave
form, intimation to in charge or
5. To have safeworking Maintain the quality standards,
environment policies and procedures developed
by the organization
6. To know grievance mechanism Maintain the discipline (in terms of
dress code, behavior, language and

Practice CIMS Values

Must wear I Card, when on duty.

Do not smoke Cigarette or any Tobacco products.

Do not consume / chew any tobacco or gutkha product.

Observe adequate hygiene.

Always follow all policies and procedures, related to their job profile.

Limit the use of internet for CIMS Business only.

Limit the use of a phones for a CIMS Business only.

Page | 22
Human resource policies:

Leave Policy


Working Hour Policy

Identity Card Policy

Gate Pass Policy

Training and Development Policy

Performance and Development Review

Disciplinary Action Policy

Grievance Redressal Policy

Anti-sexual Harassment Policy (VISHAKHA POLICY)

Maternity leave policy

Leave Policy:
There are 3 types of the leaves that an employee can avail
Privilege Leave
All employees will earn 21 leaves annually, credited on a monthly basis, which can be
accumulated after completion of 240 days as a new employee.
Casual Leave
All employees will earn 6 leaves annually, credited on a monthly basis, which can be
accumulated after completion of 180 working days as a new employee.
Sick Leave
All employees will earn 6 leaves annually, credited on a monthly basis, which can be
accumulated after completion of 180 days as a new employee.

Overtime Policy:

If any employee works more than his/her total working hours, he/she is entitled to take
either incentive or compensatory of, as case may be.

All overtime should have an authorization by the concern immediate supervisor within
24 hours with a prior permission or post-datereasoning for their requirement of doing
Page | 23

Working Hour Policy:
Number of working hours will normally be consistent for all employees of CIMS.

In order to support the emergency facility in a hospital, working hour of employee are
divided into various shift timing which are predefined.

There will be 6 working days in a week.

Working hours for a general shift of all employees of CIMS will be approximately 8
hours every day.

The working hour will be notified by their immediate supervisor

Identity Card Policy:

It is mandatory to wear all display Company identity card properly at the workplace all
the time. Company may deny entry to employees not displaying I cards.

Gate Pass Policy:

This policy is applicable for all CIMS staff including outsourced staff.

Staff can use gate pass for personal and professional reason .Professional reason will
be consider as on duty which will be treated as gate pass.

All staff should apply for gate pass before going out of the hospital premises.

Training & Development Policy:
All employees must attend Training Program whenever they are nominated for
Training. Absence should be informed to their HOD with valid reason and prior

Common Induction:

Common Induction will be done within 15 days of the date of joining. It is normally held
twice a month. Record related it is maintain by HR department. It includes following

HR Essential

4C and Patient Rights and Responsibilities

Infection Control Practices

Fire and Safety




Hazmat Protocol

Page | 24
Nursing Induction:

Nursing Induction will be done within 15 days of date of joining.

Refresher Training:

It is to be conducted twice a year. It includes the revision of all common induction


Departmental Training:

It is to be conducted at the time of joining, transfer, Promotion, any changes in a

departmental policy, Protocol, and for regular updates and revisions.

Performance Development Review:
The performance appraisal is a written evaluation of the employees job performance.

Information derived from the performance development review may be considered

when decisions concerning training, promotion, demotion, increases or continued
employment are made.

In organization the performance appraisal program is known as performance

development review and they are evaluate the performance of the employee.

Disciplinary Action Policy:
Disciplinary action is taken against an employee in case of any misbehaviour or
misconduct or any error in a practises or poor performance which adversely affects or
compromises companys core values or rules or integrity.

The ground of disciplinary action depends on the seriousness of the behaviour / act /
offences of employee or group.

The possible disciplinary actions are

o Verbal Warning
o Formal Written Warning
o Demotion
o Suspension
o Dismissal

Page | 25

Grievance Redressal Policy:
The first step consist of the employee and their immediate supervisor talking together
to try to resolve the grievance.

If the grievance is not mutually and satisfactory resolved, then the grievance is
appealed in writing to HR.

An employee can directly approach to Grievance Redressal Committee through

coordinator for any sought of grievance.

Anti Sexual Harassment Policy:
If any employee or consultant at CIMS believes that he or she has been subjected to
sexual harassment, such person shall have the option to file a complaint with Vaisakha

This may be done in writing or orally. Even if it is done verbally initially, it is always
preferable to have the complaint in writing. A complaint may be filed by contacting any
one person of the Vishakha Committee.

The Vishakha Committee will also be available to discuss any concerns staff may be
have and to provide information about CIMSS Policy on sexual harassment and the
complaint process.

Maternity Leave Policy:

All female employees who have completed 240 days of continuous services with the
company are eligible for maternity leave.

The maximum period for which any which any employee is entitled to maternity benefit
shall be twelve weeks of which not more than six weeks shall precede the expected
date of her delivery.

Eligibility of benefit is restricted up to 2 surviving children only.

Page | 26
Introduction of Employee

What is Employee Exit?

When an employee terminates or resigns from a position within a department then it
is called Employee EXIT.

Exit is one of the biggest challenges and it represents significant costs to Hospital. A
high Exit reflects poorly on the hospitals ability to hold on to its people. The toughest concern
for an HR manager is the high turnover rate

Employee exit interviews are an important part of HR management and monitoring

employee retention and satisfaction. It is important to understand why an employee leaves
and what information you can use to avoid future employee losses.

Causes of Exit

Higher Pay: The most obvious reason for employees leaving any hospital is higher salaries
offered by other hospital with better job opportunity.

Unexpected Job Responsibilities: Sometimes the job responsibilities dont come out to be
the same as expected by the candidates. Unexpected job responsibilities lead to job

Job & person mismatch: A candidate may be fit to do a certain type of job which matches
his personality. If he is given a job which mismatches his personality, then he want be able to
perform it well and will try to find out reasons to leave the job.

Less growth opportunities: No or less learning and growth opportunities in the current job
will make candidates job and career stagnant. Only 20% of employees are able to go to
senior levels. The remaining 80% of employees look for other Hospital where they can get
opportunities for growth.

Page | 27
Lack of appreciation: If the work is not appreciated by the supervisor, the employee feels
de-motivated and loses interest in job.

Lack of trust and support in co-workers, seniors and management: Trust is the most
important factor that is required for an individual to stay in the job. Non-supportive co-
workers, seniors and management can make office environment unfriendly and difficult to
work in. When employees are happy with their superiors they choose to stay, if not they look
for a switch.

Stress from overwork and work life imbalance: Job stress can lead to work life imbalance
which ultimately many times lead to employee leaving the organization. If employees feel
stressed out due to the workload trusted on them they tend to look for a change.

The major stress factors are:

Longer Working Hours

Working more than standard time repeatedly makes employee stressed out and they tend to
look for a change.

Repetitive Nature of Work

Work Load & Pressure to Perform

Lack of Work Flexibility

Travel Time

Health Issues

New Job Offer

An attractive job offer which an employee thinks is good for him with respect to job
responsibility, compensation, growth and learning etc. can lead an employee to leave the

Personal problems: the exit reason for over 25% of all the exits. Unfortunately this
reason indicates incomplete data capture by HR or line managers, typically indicating a
lack of a good exit interview. HR should ensure that each employee has a formal exit
interview through which the exact reason for exit can be captured.

Page | 28
Family Reasons: This include employee exit reasons such as relocation due to
marriage, maternity, unwell family members and a number of similar situations. You can
prevent this type of exit by offering options of part-time work, work from home and flexi work

Miscellaneous Reasons: This covers about 22% exits and includes many
varied reasons such as commuting issues, interpersonal conflicts, quality of work, work-
life-balance and many others.

HR should analyse reasons such as interpersonal conflicts and determine if these are
related to the supervisor or management issues. This can prevent costly lawsuits in the
longer terms and also increase retention.

Plans for Further Studies

These days, in many hospitals, employees are joining at very young age because of lucrative
salaries being offered. But with time, they apply for higher education and try to move on to
other hospitals or sectors to occupy top positions.

Less Frequency in Giving Rewards

Appreciation by words and regular increments or rewards provides the golden handcuffs
that keep from getting away and when these are not considered by a hospital, the employee
tend to move on to other hospitals.

Marriage or Relocation

The percentage of women workers is very high, around 30%. Generally, women workers
leave the hospital after marriage to take up their house-hold duties or leave an hospital on
maternity. Even when someone relocates with their spouse or partner, it comes outside
the control of any employer.

How Does It Impact An Hospital?

Turnover brings decreased Productivity.

People leave causing others to work harder- When an employee terminates, the effect is
felt throughout the Hospital. Co-workers are often required to pick up the slack. The
unspoken negativity often intensifies for the remaining staff.

Page | 29
High Turnover rate contributes to increased costs and lowers revenue.

This forces additional cost reduction and austerity measures.

This in turn makes working more difficult, causing the best performers with the most
external opportunities to leave

Loss of Hospital Knowledge When an employee leaves, he takes with him valuable
knowledge about the Hospital, customers, current projects and past history (sometimes to
competitors). Often much time and money has been spent on the employee in expectation
of a future return. When the employee leaves, the investment is not realized

Cost of EXIT to Hospital

Cost of advertising for new positions

The cost and time involved in interviews and background checks,

Costs associated with search firms or placement agencies,

Relocation costs of new employees

Training and orientation costs

A. Recruitment Cost
The cost to the business when hiring new employees includes the following six factors plus
10 percent for incidentals such as background screening:
Time spent on sourcing replacement

Time spent on recruitment and selection

Travel expenses, if any

Re-location costs, if any n Training/ramp-up time

B. Training and Development Cost

To estimate the cost of training and developing new employees, cost of new hires must be
taken into consideration. This will mean direct and indirect costs, and can be largely
classified under the following heads:
Training materials


Employee benefits

Trainers Time

Page | 30
C. Administration Cost

They include:
Set up communication systems

Add employees to the HR system

Set up the new hires workspace

Set up ID-cards, access cards, etc.

The tangible costs of employee turnover would be the cost of training new employees, the
recruitment and selection costs, adjustment time, possible product and/or service quality
problems, costs of agency workers/temporary staff, the cost of loss productivity, the cost of
lost knowledge and the cost of the position remaining vacant till a suitable replacement is

The intangible costs, which may be even more significant than the tangibles, involve the
effect of turnover on hospital culture, employee morale, social capital or Hospital memory. All
these costs would significantly take away the profitability and the competitive advantage of
the firm.

Reasons for employee Exit

All good Hospitals always concentrate both on earning profit & preventing loss in a Hospital.
There are many reasons behind any occurrence if any one of profit or loss occurs then also
reasons must be studied for the maintenance of the success or prevention from loss.
Retention or talent acquisition is a challenge in most of the Hospitals. But if we will count
down, then there will be a no. of reasons & it differs from Hospital to Hospital, sector to
sector, location to location, job to job, person to person etc.
Following are some of the causes for increasing Turnover rate or employee turnover

Personal reasons of the employee

Getting a better opportunity

Ego crash for any issue in the Hospital

Unsatisfied Hospital climate or working environment.

The unchallenging job profile (repetition of the same work, boring work profile) Salary

Page | 31
Promotion & transfer issues (absence or compulsion or partiality)

Lack of flexibility

Lack of abroad going facility

Miss communication & miss understanding in between employee & any body else

Change in commitment by the employer

Extreme work pressure & stress

Lack of job security

Not satisfied with Hospitals welfare & other facilities

Absence in the carrier growth of employees

What the Hospital lost because of employee turnover?

High Turnover rate or employee turnover is a great loss towards any Hospital. Its true
because a Hospital invest a lot on employee with the expectation of some return. So, if the
employee leaves the Hospital in the early stage or middle stage then the loss cant be
fulfilled. Some good Hospitals are not even ready to leave their employees at their last stage
of their professional career (after retirement). Hospital keeps them in the advisory board with
less work pressure. Example- In the Hospital where I am working currently has
employed Mr. M.K. Chaudhary who was the ex-Dean of the Hospital He is 72 yrs. old.
But he is in this college since last 14 yrs. So after the retirement the management
requested him to be in the advisory board with less work pressure, time & working hour
flexibility & little bit less package in comparison to the salary he was drawing before.
Employee turnover hampers the working environment of the Hospital. De satisfaction among
employees may cause turnover. But high Turnover rate discourage the remaining employees
to continue in the same Hospital. Unknowingly employee turnover creates gap in between
the employer & the remaining employees. Misunderstanding & misbelieve will be developed
among them. At the same time it distracts the talent from the market and can create a black
spot on Hospitals brand image. All these reasons either directly or indirectly bear some
investment for the failure of the Hospital. Many Hospitals ignore it or respond it when it is
getting out of hand. Its the biggest reason for increasing employee turnover & unsuccessful

Page | 32
retention. If we note down some of the investment cost on people in the Hospital, those
1. Induction, Orientation & training cost
2. Craft cost & production cost
3. Time investment in the early stage
4. Performance appraisal cost ,welfare cost like other HR cost
5. Exit cost.

Page | 33
The traditional model of Employee Exit.

Mobley suggests that the decision to quit is made in a logical and step-by-step fashion,
largely in response to dissatisfaction with the present job. Individuals begin by evaluating the
current job and level of satisfaction or dissatisfaction. It they are dissatisfied, they may begin
to think of quitting, and then assess the costs of quitting and the costs and the likely success
of searching for an alternative job. It they believe they have a reasonable chance of finding
another job, they may begin a search. After the search, they compare the job alternatives
they have discovered to the present job and decide whether it is better to quit or stay. This
model suggests that the process of deciding to quit is gradual and that an alternative job is
located before the current job is left.

Assess cost of
If lternative(s)
Employee Job quitting and
seen possible
likelihood of
initiate search
Dissatisfaction finding a better
for alternatives

If alternatives alternative
are superior found evaluate
develop against
intention to current job

Traditional Model of Employee Exit.

Adopted from the book by Cynthia D. Fisher, et. Al. P. 756

According to Angelo S. DeNisi and Ricky W. Griffin (2009:266-68) the simplest view of the
employee Exit process suggests that, if job satisfaction increases employee Exit decreases.
Although this basic view is correct, the processes involved are somewhat more complex for
different reasons. These reasons are: the economy and the labour market play a role. It is
noted that the prevailing unemployment rate is as big a factor in whether a person leaves a
job as is the level of job dissatisfaction. This explanation clearly makes a great deal of sense.
Page | 34
Even if an employee is extremely dissatisfied, he or she is unlikely to quit without real
prospect of finding another job.

Job dissatisfaction

Thinking about leaving

Looking for

Intention to Quit

Employee Exit
A Model of Employee Exit
from Angelo DeNisi and Ricky W. Griffin, Human Resource Management 2nd Edition
Indian Adaptation.2009 p. 267

The process begins with factors leading to job dissatisfaction such as nature of the work,
pay and benefits, supervision and coworkers. If job dissatisfaction makes the employee
to begin thinking about quitting, that leads to a search for alternatives. Only when those
alternatives look better the employee decides to leave his/her present job a decision
first manifested by an intention to quit. According to these authors, the implication of this
type of model is that managers should reduce the sources of job dissatisfaction.

It is best to stop the turnover before the employee begins searching for alternatives
because he/she might find an alternative that is more attractive. Once an employee
begins searching for alternatives, it may still be possible to retain him/her by convincing
that the present job is really better than the alternatives. In fact, the search for
alternatives sometimes leads to increased satisfaction on the present job after the
employee discovers that the alternatives were not as positive as once believed

Page | 35
Costing of Employee EXIT
It is a common experience, perhaps of all employers/managements, that replacing an
employee is both time-consuming and expensive. According to Bohlander, Snell and
Sherman cost of turnover can be broken down into three categories: separation costs for the
departing employee, replacement costs, and training costs for the new employee. According
to the American Management Association, the cost to replace an employee who leaves is,
conservatively, 30 percent of their annual salary. For those with skills in high demand, the
cost can rise to a frightening 1.5 times the annual salary to replace them. Further, research in
the most profitable companies in America indicates that happy employees produce more,
and are less likely to leave. The Hospitals ability to retain the kind of workers wanted and
needed has a direct impact on its profitability and effectiveness. The costs are both direct
and indirect. There are the direct costs to recruit and train, and even greater indirect costs in
loss of productivity. Less obvious are the costs of maintaining morale when there are change
and threats of job cuts.

However, more complex approaches to turnover costing give a more accurate and invariably
higher estimate of total costs (Janas:2009). A widely quoted method involves estimating the
relative productivity of new employees during their first weeks or months in a role and that of
leavers during the period of their notice.

And according to Michael Armstrong (2009:502) the factors affecting the cost of employee
turnover are:

interviewing, testing, etc). Direct
Direct cost of recruitment replacements (advertising,
cost of introducing replacements (induction costs).

Direct cost of training the replacements in necessary skills.

Leaving costs payroll and HR administration.

cost of time spent by HR and line managers in recruitment, induction and

Loss of output from those leaving before they are replaced.

Loss of output because of delays in obtaining the replacements.

starters are on their learning curves acquiring the necessary
Loss of output while new
knowledge and skills.

Page | 36
In fact, there are 9 key costs associated with departing
Exit interviews








Lost productivity until they learn the job

Many of these costs consist of management or administrative staff time (opportunity costs),
but direct costs can also be substantial where advertisements, agencies or assessment
centres are used in the recruitment process.

Benefits of Employee EXIT

Not always the employee turnover has negative consequences or dysfunctional to the
Hospital. Those Hospitals which strive to keep the rate of Turnover as low as possible,
should always remember this fact. An Hospital with too low rate of employee turnover may
become stagnant and hidebound, lack opportunities for employees to move up, and retain
poor performers it would be better off without. Current thinking suggests that Hospitals should
aim for an optimal rate of turnover rather than the lowest possible rate. It is suggested by the
researchers that the optimal rate occurs where the curve of turnover crosses the curve of
retention costs ((Fisher, et. al: 2006:758).

According to Cynthia D. Fisher, ET. Al. the benefits of employee turnover to the Hospitals are
the following ones (P. 757):

Poor performers may choose to leave and can be replaced with better employees.
Leavers are replaced with more junior employees who cost less and who may also
stay longer.

Morale improves following the departure of problematic employees.

Leavers are replaced with people with more up-to-date job skills.

of other employees, thus
Vacancies are created to allow for internal promotions
increasing their career satisfaction and motivation.
Page | 37

Receptiveness to innovation and change may increase.

Voluntary turnover is less painful than retrenchment.

1. Higher pay package in another Hospital,
2. Good Working Conditions,
3. Opportunities for growth in new Hospital,
4. Change or place problem,
5. A better Boss in new Hospital, and
6. Brand image of the new Hospital.

The employer or the CIMS management is not only worried about the various factors that
cause high Turnover, but more importantly he is worried about the high cost involved in
employee Turnover.
1. Conveyance cost,
2. Cost of lodging of the new employee,
3. Training costs,
4. Cost of venue where training will be conducted, and
5. Materials to be supplied during the training process

Tips to Manage EXIT

To manage employee Exit in Hospital some 11 tips are given to us. These are:
1. Compensation and Management: Compensation and Management must be
managed based on the KSAEs (Knowledge, Skills, Attitude and Experience) of the
2. Create Opportunities for Employees: The Hospital has to create growth
opportunities for employees to enhance their learning experience and earning abilities.
3. Engaging Employees: Employees must be engaged on continuous basis and they
should not get bored with their work, which can be managed through internal transfers
and training from time to time.
4. Review Recruiting Practices: Selection and Recruitment policies must be reviewed
to suit the growing needs of the Hospital.
5. Technology Opportunities: Leveraging technology to manage the Hospital and
enhancing the technical expertise of the employees will help Hospital grow without
much problem of Turnover.

Page | 38
6. Career Path for Employees: Employee career path must be declared during the
recruitment process and should be explained to the recruited people.
7. Feel Valued in Hospital: Non-financial rewards, a pat on the back in time and
celebrating small achievements with great fan-fare will help employees feel valued in
the Hospital.
8. Contact with Senior Management: Senior Management should address employees
periodically and should make them feel like a family.
9. Feel Part of the Hospital's Mission: The Hospital's mission must be reiterated from
time to time to reinforce the learning and experience of the people.
1. Educate Employees on their Impact: Educate employees regularly on what kind of
impact they are creating on Hospital through their contribution.
2. Flexibility: Immediate bosses and middle level managers must be flexible and act as
Chief Happiness Officers to avoid triggers of Turnover.

Page | 39
Employee turnover is classified into five types, namely:

(1) Internal Vs External turnover,

(2) Skilled vs. Unskilled Employee Turnover,

(3) Functional and Dysfunctional,

(4) Voluntary vs. Involuntary, and

(5) Drag and Drive type or Pull and Push form of turnover.

Measuring Employee Turnover - The Mathematical Measure

Most Hospitals simply track their crude turnover rates on a month by month or year by year
basis. The total figure includes all leavers, even people who left involuntarily due to
dismissal, redundancy or retirement. It also makes no distinction between functional (that is,
beneficial) turnover and that which is dysfunctional.

Crude turnover figures are used by all of the major employee turnover surveys, including the
annual CIPD and CBI surveys, as they are necessary for effective benchmarking purposes.
However, it is also useful to calculate a separate figure for voluntary turnover and to consider
some of the more complex employee turnover indices, which take account of characteristics
such as seniority and experience (Suff, 2010).

Since employee turnover means departure of an employee once for all from the Hospital, the
Hospitals need to replace him/her sooner or later to keep the

Hospital moving. Hence, it is necessary to measure the rate of turnover and also its cost. To
measure the rate of turnover several mathematical formulae are available. The following are
some such formulae:

Page | 40
Page | 41
Literature Review
Khusbu S Dave (2014) with her study entitled Performance appraisal of nurses in hospitals
with special reference to Sourashtra region, the objective of the research paper is to analyze
the parameters that should be considered for performance of nurses in hospitals and based
on parameters what wheitage should be given to each parameter. For the study nurses from
Rajkot were selected. Random sampling method was used to taken sample. The study found
that ten parameters that are to be considered on priority at the time of performance appraisal
of nurses of hospitals.

Patil and Choudhari (2013) with their study entitled Investigation of HRM Practices in
hospitals of Jalgaon districts; the study found that HRM practices are very skilfully applied
by private hospitals. They have applied all superficial practices in higher proportion as
compared to govt hospital but the core practices are applied only in govt hospitals. In this
study data was collected through self developed questionnaires and chi square test was
used to test the hypotheses. Study addressed that mission and vision there awareness is

Lamba and Chaudhary (2013) done study on Impact of Human resource management
practices on organisational commitment of employees, the study aim of study to is to
examine The impact of human resource management practices on organisational
commitment of employees in various sectors in India. Researcher has used secondary data
sources for this study and data was gathered through various research papers. The study
showed that HRM practices have a significant role on organisational commitment of

Singh and Negi (2013) conducted study on Human resource management practices in
large hospitals of Dehradun, Uttrakhand; the study analyze the human resource
management process and practices into large hospitals of Dehradun. Three hospitals were
included in this study and assessment was carried out on the basis of primary and secondary
information based on the personal visits. Study suggested that HR functions are very
important in healthcare facilities. The HR processes and procedures are fairly good in
hospitals and HR policies are very important for healthcare facilities

Osman et al (2011) in their study on the Relationship between human resource practices
and firm performance: An empirical assessment of firms in Malaysia, found that the
effectiveness of implementing HR practices in a company does indeed have a major impact
of 50 per cent towards a firms performance.
Page | 42
Saxena and Tiwari (2009) examined the HRM Practices implemented by leading IT
Companies such as TATA, Infosys and Wipro in India. They developed the 3cTER
Framework of HRM practices and identified Training and Development, Employer-Employee
Relations, Recognition through Rewards, Culture building, Career Development,
Compensation and Benefits as important HRM Practices.

(J. Bruce Tracey, Ph.D, Cornell University School of Hotel Administration Timothy R.
Hinkin, Cornell Hospitality Quarterly February 2008 vol. 49 no. 11)
From this another study we observe that how salaried employees having share in
development activities of organization. Here we study conducted analysis of a survey through
this we understand that 667 employees think that on job trading which is providing to
employees positively increased the commitment of employees towards organization and
create positive image about organization and will result in reducing the rate of employee the employee Exit can be reduced through providing them job related training
and prepared them for marketable place and improve their skills. Promoted the employees
and build good relationship to reduce the Exit rate.

Satheeshkumar L. (2008) in his article entitled Payment System has stated that
concentration on quality is increasingly a characteristic of strategic planning. It is an
important element in HRM as employees effort is directed towards organization survival and

W. Cathirne Anitha (2007) conducted a research study on Human Resource Management

in Neyveli Lignite Corporation Limited. The conclusion was that the challenge before human
resource management department was to actively coordinate, synergize and monitor the
various areas of human resources and achieve the objectives of the corporation.

Jacobson (2006) in his research paper has emphasized that the most widely used and an
effective tool for performance appraisal as perceived by human resource professional is 360-
degree competency assessment process. Ramesh (2005) studied the changes occurring in
the field of human resource management in todays era.

He observed that todays competitive business climate presents the HRM function with a
number of important challenges and opportunities dramatic advances in technology, in
recruiting, selection, training, appraisals, rewards and other human resource practices.

Page | 43
Sandra King and Kauanui et al (2006) took a study on Impact of HRM : SME Performance
in Vietnam. A sample of 200 Hanoi manufacturing SMEs was surveyed regarding their
training, performance appraisal and incentive compensation have positive effects on
Vietnamese SME performance, with incentive compensation having the greatest impact.

(George S. Benson, MAR 2006, Human Resource Management Journal, Volume 16,
Issue 2, pages 173-192)
Here in this study we find that salaries issues and incentives are the reasons of employee
Exit and low productivity. For this we collected data from 400 retail shop of in UK all
the 400 shops compensate their employees on hourly basis, and there is no reward for
workers on their productivity basis. When there is no productivity reward for workers then it
create negative image. The employees who are productive will leave the firm and only low
productive employees remains with the firm. When employees are satisfied with their jobs
then productivity will increased.

Hanif Khaki (2006) is of the views that, todays businessman have understood the value of
hiring professionals with experience working in HR. The companies have learned the
importance of good relations with their workforce. The company which does not realizes the
importance of its human resource cannot progress. The employee also likes an organization
which cares for them and rewards their services accordingly. Likewise, health benefits are
probably the second most important factor, besides financial benefits which is always
welcomed by the employee. The HR department is generally very open for such aspects in
the workspace.

Suman Shikha (2006) studied the knowledge athletes in organizations. Successful

companies effectively manage their human resources to create and market new products and
services. Human resource management strategies have the potential to fuel innovation and
creativity in the organization

Andre Luiz Fisher and Lindolfo Go De Albuquerque (2005) undertook a study on Trends
of HRM Model in British Companies A Forecast according to Opinion Leaders from the
Area. Having consulted more than 160 people, it was observed that themes such as the
management of competences, corporate education and encouragement for organizational
learning will be gradually assimilated by companies.

Page | 44
Cherrie Juhna Zhu et al (2005) attempted a research study on A Problematic Transition to
a Strategic Role: HRM in Industrial Enterprises in China. The study revealed the
changingbusiness environment in China and participation by the HR function in strategic
decision making were the strongest predicators of HRM practices.

Fiona Edar and Alan J Geare (2005) conducted a study on Employee Voice on HRM. This
exploratory study examined the current views of 626 New Zealand employees about HRM in
their organizations. The study revealed that from an employees perspective training and
development is becoming an increasingly important issue.

Kassahun (2005) As per his findings, there is a significant difference in perceptions of Indian
employees towards the level of their commitment to their organization.

Sanne (2005) their paper examined the effects of Human Resource Management (HRM)
practices and antecedents (personal variables, job and role characteristics, and work
experiences) on organizational commitment among Dutch university employees.

(Kevin M. Morrell, John Loan-Clarke, Adrian J. Wilkinson, (2004) "Organisational

change and employee turnover", Personnel Review, Vol. 33 Iss: 2, pp.161 - 173)

From this study we get understanding 353 nurse leavers the hospital in the national health
and service of England nad describe why the nursing Exit rate is so higher in
hospital of national health and service.its reason is that the understanding and image of
hospital is not good in the minds of nurses that's why their Exit rate is so high.the analysis of
this research is that how employee Exit rate can be can be reduced by improving
the understanding of image of hospital in the minds of is also benificial for
management and organization that their nursing Exit can reduced and it will be cost effective
for hospital.

(Kevin Morrell, John Loan-Clarke, Adrian Wilkinson(NOV 2004), British Journal of

Management, Volume 15, Issue 4, pages 335-349, December 2004)
We do another study Here we find what kinds of expensess and how much expensess can
be faced to an organization due to the high employee we study that if any
employee leaves the organization then organization have to face expensess like recruitment,
selection and training again.and it will be time consuming for organization.if employee leaves
the organization then it will be difficult for management to hire suitable and productive
employees and trained him easily and guide him.

Page | 45
Pawan S. Buhdwar and George Boyne (2004) conducted a study on, Human Resource
Management in the Indian Public and Private Sectors: An Empirical comparison. The
Investigations is based on a questionnaire survey of 137 large manufacturing firms(public
sector=81;private sector=56). In functional areas like compensation and training and
development, Indian private sector firms have adopted a more rational approach than their
public sector counterparts.

Simmons (2003) highlighted the need for balancing performance, accountability and equity
in stakeholder relationships by pursuing socially responsible HR practice.

(Chevalier, Arnaud, Siebert, W. S, Viitanen Tarja, May 2003 University College Dublin.
Institute for the Study of Social Change (Geary Institute)
In this study we find that when the top management or leaders of an organization change the
policies or structure at grand scale without proper planning or the frequency of these
changes is high this results in high employee Exit and also cause senior employees to leave
as it becomes difficult for them to cope with these changes as they have practiced old
policies for a long time and are not able to change themselves quickly.

Singh (2003) examined that the aim of the human resources in the organization context is to
ensure the availability of competent, motivated and learning employees to the organization to
facilitate the achievement of its business objectives.

Wright et al (2003) with their study entitled The impact of HR practices on performance of
business units; the study evaluate the HR practices and organisation commitment on the
operating performance and profitability of business units. The purpose of this study is to
examine the relationship between HR practices and firm performance in a way that improves
the casual inferences that can be drawn. Questionnaires were used to survey employee
attitude. So business units were sampled within on large corporation. The articles revealed
that both organisational commitment and HR practices are significantly related operational
measure of performance, as well as operating expenses and pre tax profits.

(Kevin Morrell, John Loan-Clarke, Adrian Wilkinson (DEC 2002), International Journal
of Management Reviews, Volume 3, Issue 3, pages 219-244, September 2001)
From this study we can find what the relationship between organizational change and
employee Exit is. Organizational change means the environments are not suitable for
employees and employees are not compensating according to their rights that's why
employee Exit rate is higher. If the organizational changes are in favor of employees then
Exit can be reduced and it is also important for manager that the Exit can be controlled.
Page | 46
(Daniel J. Koys, Personnel Psychology, Volume 54, Issue 1, pages 101-114, March
From this study we understand that satisfaction level and perception of employees about jobs
can be examined by checking the behavior of employees and organization. We examined
that if employees are treated well they have good image of organization and satisfied with
their jobs. If employees are satisfied with the behavior of organization that organization treat
them fair attitude then satisfaction level about jobs of employees will be higher and Exit will
be low.

(Naresh Khatri, Chong Tze Fern, Pawan Budhwar, Human Resource Management
Journal, Volume 11, Issue 1, pages 54-74, January 2001)
From this study we examined that there is high employee Exit rate in private clubs and
industries. It is said by management that the reason for this is that employees are leaving
their jobs on hourly basis that leads to high rate of employee turnover. Managers of private
clubs and industries are appointed to find the reasons of employee turnover. Because
manager having vast experience in their relevant field they can easily suggested that what
are the reasons of employee turnover. We find that it is difficult for a team manager to create
positive environment in industry to build the image of clubs and industries in the mind of
employees to control the employee Exit rate.

(Naresh Khatri, Chong Tze Fern, Pawan Budhwar, Human Resource Management
Journal, Volume 11, Issue 1, pages 54-74, January 2001)
We do another study we get understanding that how employee Exit can be control. Here 153
New Zeeland companies are selected to determine their employee Exit rates.153 companies
of New Zeeland use the skilled based and grouped based compensation plan to control the
employee Exit rate. Its means that they compensate their employees according to their skills,
experience and qualifications. We observed that if employees are compensate according to
their rights,that are provided bounses,incentives then the employee Exit can be reduced.

(Daniel J. Koys, Personnel Psychology, Volume 54, Issue 1, pages 101-114, March
From this study we understand that satisfaction level and perception of employees about jobs
can be examined by checking the behavior of employees and organization. We examined
that if employees are treated well they have good image of organization and satisfied with
their jobs. If employees are satisfied with the behavior of organization that organization treat

Page | 47
them fair attitude then satisfaction level about jobs of employees will be higher and turnover
will be low.
Dhawan (2001) found in his study that job satisfaction varies with the type of job, level of
organizational hierarchy, personality types etc.

(James P. Guthrie, University of Kansas, Group Organization Management December

2000 vol. 25 no. 4 419-439)From this another study we find that there is problem of
employee Exit is discussed. We can find here how employee Exit can be measured in
different situations and importance of employees in organization.employee is the backbone
of organization. It is discussed here how Exit rate can affect the organization effectiveness to
chieve its objectives.there is need to reduced the employee Exit rate to prevent organization

(Magid Igbaria,Tor Guimaraes,Journal of Management Information Systems,Volume 16

Issue 1, June 1999 table of contents)
From another study we understand that the attitude and behavior of employees affect the
organization outcomes and profit. We can see if the organization is not encouraging the
employees according to their rights then there will be higher rate of employee turnover. We
can say that organization behavior, employee turnover, employee satisfaction can affect
profitability and buyer satisfaction. We collect data from different sources like employee
survey, manager survey, and customer survey and from the record of company for showing
that how employee attitude and behavior can affect the company objective. From collected
data we can observe that if human resources works well then there will be fewer turnovers in
employees and business results will be better.

(Magid Igbaria,Tor Guimaraes,Journal of Management Information Systems,Volume 16

Issue 1, June 1999 table of contents)
From another study we understand that the attitude and behavior of employees affect the
organization outcomes and profit. We can see if the organization is not encouraging the
employees according to their rights then there will be higher rate of employee turnover. We
can say that organization behavior, employee turnover, employee satisfaction can affect
profitability and buyer satisfaction. We collect data from different sources like employee
survey, manager survey, and customer survey and from the record of company for showing
that how employee attitude and behavior can affect the company objective. From collected
data we can observe that if human resources works well then there will be fewer turnovers in
employees and business results will be better.

Page | 48
Research Methodology
Research methodology
Research methodology is purely and simply the framework or a plan for study that guides the
collection and analysis of data. Research is the scientific way to solve the problems and is
necessarily used to improve market potential. This involves exploring the possible methods,
one by one, and arriving at the best solution, considering the resources at the disposal of
Research methodology is a way to systematically solve the research problem. It may
be understood as a science of studying how research is done scientifically. In it we study
steps that are generally adopted by a researcher in studying his research problem along with
the logic behind them.


The objective of the proposed study wants to shows that there is a relationship/impact
between organization culture, pay scale, evaluation by fair standard and tension and is
directly or indirectly related with employee Exit.

The objective of this study is to know the organizational culture that effect on
employee Exit.

To calculate and analyse the Exit rate of Employees of CIMS Hospital.

To suggest the activities that they might undertake in order to decrease Exit rate &
retain employees.

To understand the rules and policies followed by the organization of Exit interview.

This study also identifies the employee mental level satisfaction and tension that
causes employee Exit.
Research Design

A research design is a specification of methods and procedure for acquiring the

information needed. It is the overall operation pattern or framework of the project that
stipulates what information is to be collected from which sources by what procedure, it
also refers to the blue print of the research process.

Research Design: Descriptive Study

Data: primary data & Secondary data

Research: Pre-existing CIMS Exit NOC documents

Research instrument: Questionnaire

Sampling Method: simple random sampling

Page | 49
Data Collection: The required data for the project has collected from Primary and
Secondary Data.

Primary Data:
Primary data is information that you collect specifically for the purpose of your research
project. An advantage of primary data is that it is specifically tailored to
your research needs. A disadvantage is that it is expensive to obtain.

Advantages of Primary Market Research

Targeted Issues are addressed.

The organization asking for the research has the complete control on the process and the
research is streamlines as far as its objectives and scope is concerned. Researching
company can be asked to concentrate their efforts to find data regarding specific market
rather than concentration on mass market.

Data interpretation is better.

The collected data can be examined and interpreted by the marketers depending on their
needs rather than relying on the interpretation made by collectors of secondary data.

Proprietary Issues.
Collector of primary data is the owner of that information and he need not share it with other
companies and competitors. This gives an edge over competitors replying on secondary

Disadvantages of Primary Market Research

High Cost.
Collecting data using primary research is a costly proposition as marketer has to be involved
throughout and has to design everything.

Time Consuming.
Because of exhaustive nature of the exercise, the time required to do research accurately is
very long as compared to secondary data, which can be collected in much lesser time

Page | 50
Inaccurate Feed-backs.
In case the research involves taking feedbacks from the targeted audience, there are high
chances that feedback given is not correct. Feedbacks by their basic nature are usually
biased or given just for the sake of it.

More number of resources are required.

Leaving aside cost and time, other resources like human resources and materials too are
needed in larger quantity to do surveys and data collection.

Secondary Data:

Secondary dataarethosewhicharegenerallypublished sourc

whichare e s b e e n c o l l e c t e d originally for some other purpose they are
not gathered S specially to achieve the objectives of particular research project. d a t a i s
econdaryd collectedthroughthedocumentsprovidedbyHRsuc
e p a r t m e n t h a s almanac and annual report of the company.

Advantages of Secondary Market Research

Time and Cost effective : Usually time and cost required to collect secondary data is
less than efforts required to collect primary data. Data is available freely or at far lesser
cost through secondary sources.
Extensiveness of data : Data collected by governments and other institutes is usually very
extensive and covers a large spectrum of issues. An organization can filter that data and
consider only parts which they are targeting.

Basis of Primary Research : Data collected from secondary sources gives an idea to
organization about effectiveness of primary research. From secondary data one can form
hypothesis and can evaluate the cost and efforts required to conduct own surveys. One can
also note down issues, which are not covered from secondary research and, need to be
addressed through primary research.

Disadvantages of Secondary Market Research

Data Definitions: Secondary Researcher needs to understand various parameters and

assumptions that primary research had taken while collected information. A term may
have different meaning for different people, example a term 'youth' used is ambiguous and
one needs to find what is the assumed age taken by primary researcher.
Page | 51
Inaccuracy of Data: As we are not gathering our own information, first-hand, we are
totally dependent on someone else's efforts. Primary researcher may have been biased or
may have used questionable methods to collect data; this can be pretty risky for secondary
researchers to base their report on such data.

Time Lag Issues: Information collected from books, historical surveys are usually not
sync with the times and might have changed drastically. Thus making such information a
foundation of research may be highly risky for the business or project.

May not be Specific: Extensiveness of such information is its benefit as well as

drawback. Organization will not get answers to their specific issues through this data
directly and one needs to 'mine' further into it to get relevant information.

Proprietary Issues : Some of the secondary sources might have copyrighted their
information and using them without permission can lead to various legal complications.

Type of sampling:

T yp e o f s a m p l i n g u s e d i n t h i s s u r v e y w a s s i m p l e r a n d o m s a m p l i n g
. I n t h i s m e t h o d , t h e sampling units had chosen randomly from the total ex-employees
at all the levels of the organization.

Sample size determination:

Sample Size: 135
Total on roll employees = 900
Therefore 15% of 900 =135
(As per NABH guidelines 15% of employees for hospitals with 501-1000 employees)

Research Instruments:

Questionnaire refers to a device for securing answer to a formally arranged list of questions
by using the term, which the respondent fills in himself.
Exit NOC of CIMS hospital was used as secondary data to collect the data for the calculation
of turnover rate.
Page | 52
Data Analysis &


Category percentage

Male 60%
Female 40%


60% Female

This data shows that about 60% of the employees at CIMS are male and 40% of them are

Page | 53

Category 18-25 26-35 36-45
Percentage 27% 49% 16% 6%


16% 28%
45 Above


The above data shows that 27% of the employees fall under the age group of 18-25 years,
49% of them falls under the age group of 26-35 years, 16% of them falls under the age
group of 36-45 years and 6% of them are of age above 46 years.

Page | 54
What Are the Reason for Leaving
Social or Personal Reason 16%

What Are The Reason For Leaving

CLOSER TO HOME Social or Personal Reason

10% 17%
3% 5%


The above data shows the reason behind leaving the organization. Among which 17% of
the employees has given the reasons closer to home and better career opportunity.
Page | 55
What Irritants Did You Face While Working

What Irritants Did You Face While Working





2% 1% 6%




The above data shows the irritants that the employees face while working in the
organization. Among which the major irritant is HOIME SICKNESS which is faced by 30% of
the employees.

Page | 56
Joining Formalities
Excellent 30%
Very good 25%
Good 42%
Fair 0%
Poor 3%

Joining Formalities
Good 30%

Very good

The above data shows the joining formalities of the organization. Among which 45% of
the employees shows that the joining formalities are good.

Page | 57
Training Opportunity

Excellent 31%
Very good 32%
Good 28%
Fair 5%
Poor 4%

Training Opportunity
5% 4%
GOOD 31%

Very good

The above data shows the training opportunity in the organization. In which 32% of
the employees rated it very good.

Page | 58
Employee Morale

Excellent 22%
Very good 26%
Good 38%
Fair 8%
Poor 6%

Employee Morale

GOOD Very good

38% 26%

The above data shows the employee morale of the organization. Among which 38% of
the employees found it good.

Page | 59
Support of Work life Balance

Excellent 18%
Very good 24%
Good 42%
Fair 7%
Poor 9%

Support Of Work life Balance


7% 9% 18%


The above data shows the support of work life balance. In which 42% of the employees
rated it fair.

Page | 60
Communication between Management And Employees

Excellent 22%
Very good 25%
Good 28%
Fair 14%
Poor 11%

Communication Between Management &


11% Very good

14% 22%
25% GOOD


The above data shows the communication between management employees of the
organization. Among which 28% of the employees rated it good and 11% of them rated
it poor.

Page | 61
Performance & Development Planning And Evaluation

Excellent 28%
Very good 20%
Good 33%
Fair 11%
Poor 8%

Performance And Development

Planning & Evaluation
11% 28%
Very good
33% 20%

The above data shows the performance & development planning and Evaluation of the
employees of the organization. Among which 33% of the employees rated it good and 8%
of them rated it poor.

Page | 62
Administrative Policy and Procedure

Excellent 22%
Very good 27%
Good 34%
Fair 6%
Poor 11%

Administrative Policy & Procedure

6% 22%
Very good
34% 27%


The above data shows the administrative policy and procedure of the organization. In
which 34% of the employees rated it good.

Page | 63
Concern with Quality and Excellence

Excellent 24%

Very good 38%

Good 27%
Fair 6%
Poor 5%

Concern With Quality & Excellence

6% 5% 24%

Very good


The above data shows the concern of employees with quality and excellence. Among
them 38% of the employees rated it very good.

Page | 64
Behaviour of Hr

Excellent 24%
Very good 34%
Good 27%
Fair 8%
Poor 7%

Behaviour Of Hr
8% 24%

27% Very good
34% FAIR

The above data shows the behaviour of HR towards the employees. In which 34% of
the employees rated it very good.

Page | 65
Internal Communication worked well


Neutral 0%



Internal Communication Worked Well





The above data shows the responses on internal communication worked well. In which 16%
of the employees strongly agreed, 59% of them agreed, no employee remained neutral,
14% of them disagreed and 11% of them strongly disagreed.

Page | 66
Supervisor line Manager Had Sufficient Knowledge Of The Job


Neutral 0%

Supervisor line Manager Had Sufficient Knowledge

Of The Job

The above data shows the satisfaction of employees over the sufficiency of the job
knowledge their supervisor had. Among them 16% of the employees strongly agreed, 64%
of them agreed, no employee remained neutral, 13% of them disagreed and 7% of them
strongly disagreed.

Page | 67
Supervisor/Line manager is experienced in supervision


Neutral 0%

Supervisor line Managers Experienced In Supervision

7% 12%
0% 13%

The above data shows the experience of supervisor line managers during the supervision.
In which 12% of the managers strongly agreed, 68% of them agreed, no employee
remained neutral, 13% of them disagreed and 7% of them strongly disagreed.

Page | 68
Supervisor/Line manager was open to suggestions


Neutral 0%


Supervisor line Manager Was Open To Suggestions






The above data shows the openness of the supervisor line managers in taking
suggestions. In which 13% of the employees strongly agreed, 68% of them agreed, no
employee remained neutral, 14% of them disagreed and 5% of them strongly disagreed.

Page | 69
Supervisor line Manager Was Available to Discuss Job
Related Issues
Neutral 0%

Supervisor line Manager Was Available To Discuss

Job Related Issues




The above data shows the employee satisfaction on the availability of supervisor line
manager for the discussion on job related issues. In which 8% of the employees strongly
agreed, 68% of them agreed, no employee remained neutral, 18% of them disagreed and 6%
of them strongly disagreed.

Page | 70

It was observed from the study that most of the employees exit the organization due to
the distance of the organization from their homes.

Most of the employees i.e., 37% of the employees felt home sickness and gave it as a
reason for their dissatisfaction.

Survey result showed that 24% of the employees found the working hours very long.

The employees are getting full support from CIMS in balancing their work life.

From the survey it was found that in CIMS there is good communication between the
employees and the supervisors.

The employees are very much satisfied with the HR persons as they treat the
employees friendly.

Employees are satisfied with the knowledge and experience their supervisors had in
their supervision.

68% of the employees agreed that their supervisors are always available for them to
discuss and solve their issues.

Page | 71

The distance and home sickness issues should be considered by the organization as
these two are the main reasons for their exit.

Introducing more recreational activities to give a feel of fun at work.

Reducing workload by eliminating staff shortage through new staff recruitment and
retaining the existing staff.

The dedicated employees should be appreciated on their work to increase nad

maintain their interest towards their work.

Page | 72
Due to high cost of staff replacement in health sector, controlling attrition is a priority for
organization. We found that during exit interviews leaving employees quote blanket
responses such as better opportunity and personal reasons as the reason for quitting the
job. However, existing employees when interviewed in-depth asked about reasons for
attrition quote several issues such as low salary, partiality/poor recognition for good work,
improper assignment of tasks, and monotonous work. However, none of these issues
emerged during exit interviews. Hence, exit interviews somewhere fail to probe into the
real reasons of attrition and existing employees are never asked about such issues.

To improve retention, it is imperative that the hospitals keep track of their existing
employee's intention to continue working in the organization. Further, any sign indicating a
poor intention to continue the job must be addressed immediately to avoid ripple effect
among other employees. Moreover, leaving employees must be interviewed in-depth and
face-to-face to uncover the actual reasons for quitting the job.

This will probably help the organization to use exit interview as a tool to improve
employee retention and enhance reputation of the organization.

Page | 73

It has been a pleasure working with CIMS Hospital. I have a lot of praise and respect for
the Organization and its people. The environment that the Organization provided for the
internship was rich with opportunities for us to gain vital insights into the corporate world. I
have provided by the knowledge, guidance, direction, and a sense of oneness with the
company making us feel as if I am a part of their huge family.

Besides it being our first experience in a practical environment, we learnt the dynamics of
work in the corporate world, how the operations are managed and frictions handled.

Page | 74
International Journal of Research in Business Management (IMPACT: IJRBM)

ISSN(E): 2321-886X; ISSN(P): 2347-4572 Vol. 2, Issue 5, May 2014, 129-136

Human Resource Management Gary Dessler

CIMS Portal

Google Scholar

African Journal of Business Management pp. 049-054, June 2007 Available

online ISSN 1993-8233 2007 Academic

Page | 75
Thank You

Page | 76