Baltic Journal of Economic Studies 10 Vol. 10 No. 3, 2024 This is an Open Access article, distributed under the terms of the Creative Commons Attribution CC BY 4.0 1 Asfendiyarov Kazakh National Medical University, Kazakhstan E-mail: dosberdieva.g@kaznmu.kz ORCID: https://orcid.org/0000-0002-2560-6370 DOI: https://doi.org/10.30525/2256-0742/2024-10-3-10-16 EVALUATION OF HUMAN RESOURCE MANAGEMENT IN PUBLIC DENTAL ORGANISATIONS Gulbanu Dosberdiyeva1 Abstract. The article presents the results of the assessment of the performance of human resources services of dental organisations of state ownership. The subject of the study was the existing practice of human resource management services in dental organisations in several cities in the south of Kazakhstan (Almaty, Shymkent, Taraz). A scoring system was used as a research tool, and a qualitative study was conducted using a focus group that included human resource managers from dental organisations. Focus group questions included information on recruitment and selection strategies, adaptation of new staff and opportunities for staff development. As part of the assessment of the quality of human resources management, a quantitative and qualitative analysis of the composition of the workforce was carried out using indicators such as: staff turnover rate (doctors, nurses and non-medical staff), effectiveness of staff selection for interviews, employee satisfaction, implementation of human resources forecasts, preparation of a human resources reserve, existence of standardised operating procedures, existence of a corporate culture development programme. A sociological survey of 150 dentists and 120 nurses was conducted to assess satisfaction with working conditions and pay. A 36-item "Job Satisfaction Questionnaire" adapted to the objectives of the study was used. The normality of the distribution of the characteristic was tested using descriptive statistics, graphs and the Shapiro-Wilk statistical test (for small samples). Pearson's χ2 was used to test hypotheses about the significance of differences between frequencies, as well as the relationship between qualitative variables measured on nominal and ordinal scales. The purpose of the study is to examine the activities of human resources services of public sector dental organisations, identify priority problems and develop proposals for improving their work. Results. Staff turnover, vacancy filling and staff satisfaction were assessed as satisfactory. However, the work of the Human Resources Department is ineffective in key strategic areas such as human resources policy, the technologies used to manage labour relations, the development of motivation policies and the provision of resources (identification of human resources needs and the creation of a human resources reserve). Conclusion. The results of the study of the work of HR management services allowed to conclude that their activities do not meet the requirements of modern management. Modernisation of these services is impossible without mandatory training of personnel in HR management and development of unified standards of operating procedures for HR technologies. Keywords: personnel management, efficiency of personnel services, rating assessment. JEL Classification: M14 1. Introduction Without professional staff, it is impossible to imagine the stable operation of an organisation. In this respect, human resources play a crucial role in the competitiveness of a company. The management of human resources in the healthcare sector in accordance with the principles and requirements of modern scientific management theory is a necessary condition for the maintenance and development of human resources. Human resources management is carried out in an organisation by its top management, line managers and human resources staff. The personnel management service ensures the normal functioning of the organisation by managing personnel within the framework of the chosen personnel policy. Looking at the experience of other countries, it can be seen that personnel management services have long occupied a key position in the enterprise management system. For a long time in Kazakhstan, Baltic Journal of Economic Studies 11 Vol. 10 No. 3, 2024 the functions of the personnel department were limited to processing documentation, preparing reports, issuing orders, and so forth (Table 1). From Table 1 it can be concluded that the new generation of HR services should deal with the organisation's HR policy and coordinate HR management activities. The range of functional responsibilities of HR managers is gradually widening, moving from pure personnel issues to more extensive tasks such as labour market studies, conflict prevention, managing staff career development, etc. The human resource management of a healthcare organisation includes human resource planning, human resource marketing and the identification of specialist needs. The technology of personnel management covers a wide range of activities from recruitment to dismissal and provides information, medical, regulatory, methodological and legal support for the personnel management system. As a result, the HR manager's skills are expanding due to the complexity of the methods of selection, recruitment, placement, development, motivation and professional growth. In this respect, the professionalism of human resources managers becomes relevant. The main structural unit for HR management is the HR department, which performs the functions of hiring and dismissing staff, training and professional development. International experience shows that HR policy should be based on the following principles: – Systematic (includes a number of forms, methods and technologies of work with personnel); – legitimacy and openness; – professionalism and competence; – continuity of professional development; – social equality and social security. Human resource management and human resource activities in health care organisations have been the subject of a considerable amount of research. However, most studies have been conducted in primary care organisations and general hospitals. Dentistry is one of the most popular medical activities due to the high prevalence of dental diseases. State dental organisations provide dental care under state guarantees and offer free dental care to the socially disadvantaged. The increase in the number of private dental organisations creates conditions for increased competition. As a rule, private dental clinics have higher management efficiency than public ones. In these conditions, the problem of improving the efficiency of human resource management in public dental organisations is of particular relevance. The purpose of the study is to evaluate the activities of human resources services of state dental organisations in terms of modern management. Research objectives: – To analyse the activities of HR services by key indicators (HR policy, modern HR technologies, labour relations management); – to assess staff satisfaction with working conditions and remuneration; – to develop proposals for improving the work of the HR department. 2. Research Methods and Results An analysis of the activities of personnel services in state dental organisations in Almaty, Shymkent, Taraz was carried out in the main strategic areas: personnel policy, modern HR technologies, labour relations management. Table 1 Comparative analysis of the activities of personnel services HR functions in the past HR functions at present Hiring, transfer, dismissal, and vacation of employees Personnel planning – determining the need for staff depending on the development strategy Documentation management – entering new information about employees using personal cards, employment records, personal files Creation of a talent pool, selection of candidates, identification of reserve groups Familiarising employees with orders against receipt Selection of personnel from reserve groups Issue of certificates Labor contracts Maintaining a military ID card Assessment of each employee's performance Preparation of reports, registration of pensions Transfer, promotion, demotion, dismissal based on performance Preparing documents for child benefit Professional orientation and adaptation – inclusion of new employees in the team Preparation of case descriptions, formation of files in the archive Determination of remuneration and benefits systems to attract, retain and retain staff Preparation of orders on rewards and punishments Training of the organisation's staff Sick leave due to illness Training of management personnel Maintaining a time sheet Discipline control Source: compiled by the author based on (Zhashkenova, Musina, Kabdullina, Abeldinova, 2016) Baltic Journal of Economic Studies 12 Vol. 10 No. 3, 2024 The research methodology included the following stages: – Assessment of the work of personnel services; – analysis of the effectiveness of personnel services based on indicators; – conducting a survey of personnel services employees using the focus group method; – compilation of an evaluation table; – rating assessment. As indicators the following were used: the rate of staff turnover (doctors, nurses and non-medical personnel), the effectiveness of personnel selection during interviews, the satisfaction of employees with working conditions, the forecasting of personnel requirements, the preparation of a personnel reserve, the existence of a programme for the development of corporate culture (Egorshin, 2001; Lagina, Shakirova, 2007; Boyko, 2017). A scoring table was created and then a rating of the indicators was carried out – Table 2. Table 2 Rating assessment of HR performance indicators Level of efficiency of the HR service Number of points High More than 35 points Average 25-35 points Low less than 25 points Source: compiled by the author based on (Zhashkenova, Musina, Kabdullina, Abeldinova, 2016) The data obtained as a result of the study allowed to assess the overall level of performance of HR services of the selected primary healthcare organisations as low – Table 3. As can be seen from Table 2, despite satisfactory indicators for staff turnover (3 points), vacancy filling (3 points) and staff satisfaction (3 points), HR activities remain ineffective in strategic areas such as HR policy (0 points), HR technologies used and industrial relations management (0 points). There is no determination of personnel needs (to be fair, it should be noted that organisations only carry out current planning of personnel needs for the year), no work is carried out to create a personnel reserve with appropriate selection of personnel, and no evaluation of the work activity of employees is carried out (Turumbetova, Musina, 2015). To explore the views of HR professionals on activities such as staff selection and retention, staff motivation, etc. A focus group survey was carried out with HR managers from dental organisations. A total of 7 professionals participated in the focus group. All respondents were female. The average age was 43.5 years (Q1=34, Q3=51). All HR managers had higher education in economics or law. Despite considerable experience in their position (9.7 years), none of the HR managers had any training in human resources management. Table 3 Scoring of performance indicators of HR services of dental organisations No. Index Indicator value Number of points 1 Personnel turnover: (total: doctors, construction workers, medical personnel) 4% 3 points 2 Efficiency of filling vacancies: total (for all categories of employees) 90% 3 points 3 Average time to fill vacancies: total (for all categories of employees) 43 days 3 points 4 Staffing frames: total (for all categories workers) 96% 3 points 5 Staff satisfaction level: (for all categories of employees) 77% 3 points 6 Employee satisfaction survey coverage: general (for all categories of employees) 58% 2 points 7 Share of investment in staff retention 10% 1 point 8 The quality of personal file management 90% 3 points 9 Staff workload (structure indicator) 25-30 3 points 10 Availability of a developed HR policy No 0 points 11 Availability of forecast data in accordance with the methodology HRH forecasting (current, future) No 0 points 12 Availability of personnel reserve No 0 points 13 Share of employees hired from the organisation's talent pool No 0 points 14 Availability of standardised operating procedures for HR processes in the HR department (adaptation, employee motivation, and so forth) No 0 points - Hiring No 0 points - Personnel adaptation No 0 points - Staff motivation No 0 points - Employee career development No 0 points 15 Inclusion in the organisation's strategic development plan of measures to develop corporate culture No 0 points Total 24 points Source: compiled by the author based on (Zhashkenova, Musina, Kabdullina, Abeldinova, 2016) Baltic Journal of Economic Studies 13 Vol. 10 No. 3, 2024 The issues for discussion were divided into the following blocks: – Technologies for attracting, selecting, and retaining staff in an organisation; – adaptation of new employees at the workplace; – HR specialists develop a motivational strategy for the organisation (including an employee evaluation system and professional development planning); – planning and forecasting staffing needs. Most participants agreed that HR managers should actively work in all of these areas. When asked what sources of recruitment are traditionally used in one’s organisation, the answers were as follows: 67% said that applicants send their CVs themselves, 45% said that "the clinic management participates in job fairs". While 5% said that "sometimes we turn to recruitment agencies in search of non-medical specialists". Thus, the main sources of recruitment are: publication of CVs of professionals in free internet portals and journals. To a lesser extent, recruitment is based on referrals from recruitment agencies (78%) and the participation of organisational leaders in job fairs organised by educational institutions (45%). The importance of onboarding new employees, whether they are junior or senior, is well known. When asked if a pre-screening interview is conducted with the candidate using a specially designed questionnaire, all respondents answered in the negative. Half of the focus group participants noted that "in our hospital, more experienced nurses can work with newer nurses as mentors for some time". Currently, there are two opposing views on the use of different types of testing (e.g., psychological) in the selection of candidates. All focus group participants stated: "Labour law does not provide for testing, we are not obliged to conduct it. A document on education, qualifications and a work record book to confirm work experience are enough to be hired." In response to the question of whether they verify the authenticity of the documents provided by the candidate, all focus group participants indicated that they do so on an occasional basis. When making a decision to hire an employee, the HR department must inform the candidate about the following: – Working conditions and regime (100%); – wages (100%); – benefits, vacation (100%); – opportunities for advanced training (50%); – possibility of career growth (20%). The majority of focus group participants said that "our involvement in the development of the motivational strategy is limited to compiling lists of employees for advanced training, and the rest is decided by the chief medical officer". It is well known that an unsatisfactory working environment can lead to professional mistakes, burnout syndrome, violations of labour discipline and staff turnover (Wiskow, Tit Albreht, Carlo de Pietro 2010; Bussing, 2002; Vilyunas, 1990). The motivational system can be presented as a set of measures aimed at encouraging the human resources of an enterprise to perform the maximum volume of higher activities with the aim of their effective use and development in the interests of the organisation. In other words, the motivation system is a tool for managing the human resources of an organisation. The essence of creating a motivating work environment is to get the most out of an organisation's human resources. The quality of the working environment encompasses several characteristics: safety (protection from occupational risks, stress), minimising the negative impact of work on private life (working hours, workload, social policy), remuneration, opportunities for continuous training and professional development, provision of the necessary resources for work, organisational culture. The author conducted a survey of doctors and nurses to assess their satisfaction with working conditions. A total of 114 dentists and 150 nurses were interviewed. According to the study results, 69% of doctors (n=79; 95% CI 66.4-71.4) were completely satisfied with their working conditions. 15% (n=17; 95% CI 12.9-17.5) were fairly satisfied, 16% (n=18; 95% CI 11.6-17.0) found it difficult to answer. The statistical significance of the differences was χ2=124.5; p≤0.0001. The proportion of nurses who were completely satisfied with their working conditions was 78% (n=117; 95% CI 74.1-82.3). 16.7% (n=25; 95% CI 14.1-18.7) were fairly satisfied with working conditions, 5.3% (n=8; 95% CI 4.1-6.2) were dissatisfied. The statistical significance of the differences was χ2=137.6; p≤0.0001. In modern motivation theories, reward is not a significant factor. Rather, it can be said that remuneration is a factor in attracting staff. In the future, employees do not value the size of their salary, but the possibility of its growth. Therefore, it is not the salary as such that should be considered as a motivator, but the existing remuneration system. The main objectives of the remuneration system in an organisation are: equal pay for work of equal value; setting basic levels of remuneration depending on the level of professional and qualification requirements for an employee; setting the employee's salary taking into account individual job responsibilities specified in his or her employment contract; increasing the transparency of the remuneration system (the system should be convenient Baltic Journal of Economic Studies 14 Vol. 10 No. 3, 2024 for employees and employers); increasing the motivation of specialists to achieve high-quality work results (incentivising work for results), etc. That is why the remuneration system is formed by building a multi-factor system for assessing the competencies of the position, personal competencies and performance of a particular employee. An organisation's employee performance appraisal system cannot be an independent activity separated from a set of integrated human resource management processes, such as: candidate assessment during recruitment; assessment of employees' knowledge and skills; performance appraisal of employees, etc. Despite the obvious benefits of linking pay to performance, many organisations do not try to use additional pay as a motivating factor. In some cases, it can be difficult to accurately assess the performance of individual employees, especially when the outcome cannot be measured directly. The development and implementation of a fair and appropriate payment system for the organisation and its employees can be an important factor in increasing staff motivation and the efficiency and competitiveness of the organisation as a whole. The author studied the respondents' answers to the question about satisfaction with remuneration. For example, 54% (n=143; 95% CI 50.7-57.1) of doctors and nurses were completely satisfied with their salary, 16% were fairly satisfied (n=42; 95% CI 13.1-17.8), 23% (n=61; 95% CI 20.1-25.7) found it difficult to answer and 7% (n=18; 95% CI 6.6-9.6) were not satisfied. To study the problem of job satisfaction in more detail, the questionnaire included a number of questions that characterise the factors of the working environment, such as the provision of the workplace with the necessary tools, provision of modern equipment and dental materials. The respondents rated these factors on a 5-point scale, with 1 being the lowest and 5 being the highest. The results of the survey are shown in Figure 1. As can be seen from the figure, only 37% of the surveyed doctors and nurses believe that they are fully provided with the necessary materials and equipment. No statistical significance was found in the answers of doctors and nurses, p=0.1. Creating and improving corporate culture involves developing measures to improve the working environment, including the moral and psychological climate. The moral and psychological climate was rated by the respondents (doctors and medical staff) on a 4-point scale, where 4 points corresponded to "very good" and 1 point corresponded to "very bad". As a result, 97% (n=256) of respondents rated the moral and psychological climate as "satisfactory" and 3% (n=8) as "very good". The social support provided by the organisation (help for employees with many children, the possibility of flexible working hours, etc.) is seen as one of the most important motivating factors, especially considering that the majority of health workers are women. According to the survey results, 59.8% (n=158; 95% CI 55-64.6) of the doctors and nurses surveyed believed that organisations provide social support for their employees. 27.2% (n=106; 95% CI 20-34.4) of respondents disagreed. Another important motivational factor for work, which falls within the scope of the functionality of human resources services, is the planning of training and development of staff. 46% (n=121; 95% CI 43.2-49.7) of doctors and nurses have improved their skills by attending various seminars and training courses over a five-year period. 39% (n=103; 95% CI 36.0-42.4) of respondents were unable to complete training due to insufficient work experience. 15% (n=39; 95% CI 12.1-16.8) did not complete their training because they did not have the required number of cycles. Rank analysis was used to analyse the highest and lowest importance of various work environment factors. The results are presented in Table 4. Figure 1. Opinion of doctors and nurses on workplace equipment Source: compiled by the author   37% 22% 41% Fully provided Not provided Not fully provided Baltic Journal of Economic Studies 15 Vol. 10 No. 3, 2024 Thus, it was found that salary (5th place) and working conditions (4th place) are of the greatest importance. The second most important factor was team relations (3rd place). According to employees, organisational culture is of the least importance (1st place). 3. Conclusions This study has shown that the activities of HR services of state dental organisations remain ineffective in the main strategic areas (HR policy, labour relations management technologies, development of motivational policy). The need for personnel is not determined, no work is done to create a personnel reserve with appropriate recruitment, and no employee performance is evaluated depending on the volume and quality of work. There are no corporate culture development programmes. In public healthcare organisations, as a rule, the HR department is not a methodological and information centre for HR work and does not have a high organisational status. The HR department has no special training in human resource management. The results obtained made it possible to establish that in order to improve the working conditions of doctors and nurses, it is necessary to improve the organisational culture, modernise the work of personnel services, which includes mandatory training in personnel management and the development of uniform standards of operating procedures for personnel technologies (Turumbetova, 2015; Koikov, 2017). In the author's opinion, the following measures should be taken to improve the work of the staff in general: – To analyse all regulatory documents: orders, instructions, regulations, SOPs, job descriptions, etc. to understand the extent to which these documents need to be reviewed and improved. For example, how clear and complete the job descriptions are and how well employees themselves know their duties, powers, responsibilities and rights. Such an analysis may help to reduce management documentation; – to develop, together with managers, a program for improving working conditions and introducing differentiated pay depending on the quality and volume of work; – to develop a programme for the prevention and control of risk factors, a programme for the health improvement and rehabilitation of personnel after illness/injury; – to take an active part in improving the organisational culture; – to modernise the work of HR services; to train employees of these services in HR management. Table 4 Ranking of work environment factors based on survey results Work environment factors Value Rank Pearson correlation coefficient Wage 3.8 5 0.9 p=0.001 Working conditions 4.0 4 Respect and prestige of the profession 2.8 2 Relationships in the team 3.5 3 Organisational culture 2.1 1 Source: compiled by the author References: Kibanov, A. Ya. (2005). Organizational personnel management. Moscow: INFA, 638 p. Zhashkenova, N. S., Musina, G. A., Kabdullina, M. M., & Abeldinova, D. Zh. (2016). "Methodology and indicators for assessing the activities of human resources services and the effectiveness of HR management in healthcare departments and medical organizations": Methodological recommendations. Astana, 27 p. Egorshin, A. P. (2001). Personnel management: a textbook for universities / 3rd ed. N. Novgorod: NIMB, 720 p. Lagina, M. A., & Shakirova, D. V. (2007). Organization of work with personnel and its improvement. Moscow: VNIIEgazprom, 276 p. Boyko, V. V. (2015). Criteria for assessing the effectiveness of clinical management results. Available at: https://dentalcommunity.ru/articles/949/ Ch. Wiskow, Tit Albreht, Carlo de Pietro (2010). How to create an attractive and supportive work environment for health professionals. WHO Regional Office for Europe, R. 40. Bussing, A. (2002). Human Resource Management / Ed. M. Poole, M. Warner. St. Petersburg: Peter, 1200 p. Vilyunas, V. K. (1990). Psychological mechanisms of human motivation. Moscow: Moscow State University Publishing House, 288 p. Baltic Journal of Economic Studies 16 Vol. 10 No. 3, 2024 Turumbetova, T. B., Musina, G. A., Kabdullina, M. M., & Zhashkenova, N. S. (2015). Methods of planning and forecasting of human resources for healthcare (Methodological recommendations). Ministry of Health and Social Development of the Republic of Kazakhstan, Republican Center for Health Development. Astana, p. 41. Koikov, V. V. Strategic management of human resources for health. Modernization of personnel services with the introduction of modern HR technologies. Available at: https://www.researchgate.net/publication/338570490_ Strategiceskoe_upravlenie_celoveceskimi_resursami_dla_zdravoohranenia_Nacionalnaa_politika_upravlenia_ HRH_Modernizacia_kadrovyh_sluzb_s_vnedreniem_sovremennyh_HR-tehnologij_Strategiceskaa_sistema_ upra Received on: 18th of June, 2024 Accepted on: 23th of August, 2024 Published on: 20th of September, 2024