In this particular chapter, the researcher highlights and discusses the context and precisely explains the background of the study as well as elucidates on the scope and its significance. Furthermore, the theoretical framework, motivations, research question, main goal and the objectives, data analysis, the methods used in the data collection, and their discussion in terms of verification, ethical inclusivity, and the clarification of the key concepts are well expounded on. The chapter summarizes and concludes by positing an appropriate exposition of the main study. It is worth noting that the words “catalyst” and “motivation” are used extensively and interchangeably to imply the main factors determining to extend of the development.
Health systems sustainability in coping up with contemporary health issues is the censorious concern in many of the counties due to fervently increasing stiff competition among both the public and private health sectors to maintain their quo and the relevance in the market. Training status and the development of any health sector have over decades occupied the core of the sustainable competitive advantage in various countries (Ayeleke et al., 2016). Essentially, the health workers are key assets in the health system and exponentially investing in their talents in terms their capabilities and specialization are vital in sustaining the desired competitive advantage in Nigerian private hospitals .as a matter of concern, the private hospital in Nigeria go through a tedious process in recruiting and hiring the most qualified and deemed suitable health workers, nonetheless, more often than not the consideration of the health worker general welfare fizzles out there and off. According to Barney (1991), an organization that mutually and extensively engages in employee’s development, welfare, and the capacity building, maintain their relevance in outdoes all the prevailing competitors and their output in terms of profits increases compared to a health organization that neglects their employees’ development. The well served and the dedicated training and the development immensely catalyze the health workers’ engagement and the aggressive engagement is very crucial in the private hospital delivery of service and the financial development.
According to Collis and Hussey (2013), capitalizing in the employees’ investment and their professional development is propitious in enhancing teamwork and the health workers retention in the private hospitals in Nigeria. Collis and Hussey (2013) claim that 94% of the health workers remain loyal and stays in the hospitals for a long time if the investment is tailored to meet their professional capacity building is sustained. A report from the Gallup study shows that almost 40% of the United States workforce is driven based on the millennial. This means that the rate of retaining them for a long in their respective workplaces is efficient. As the health system landscape becomes stiffly competitive, inherent, and considerate improvement of the health worker’s training and development is imperative (Collis & Hussey, 2013). Their study, therefore, posits that the health workers or rather employees training and the development has ceased to be a bed of the organization’s fame but paramount in the professional development and the auspicious workforce that drive the health system.
Prudently, Kash et al. (2014) report that training encompasses the programs that introspectively and physically facilitate the health workers to learn the prerequisite skills required to improve and propel the private hospitals’ development in their competitive quest. According to Kash et al. (2014), development program in the private hospitals boost the employees’ plan and their progressive performance but not their current professional status. As the health issues emerge in the world discourse, so will the new health-related issues, as new diseases emerge. As a result, there will be a great impact on health development and education. Desiring to cope up with these changes by recognizing the relevant skills and the appropriate ways of inculcating them significantly boost the private hospital innovativeness and remain focused on their set goals (Kash et al., 2014). Despite, merging the modern skill and the creative development methods potentially maintain the health professionals’ dynamically adopting new changes in the contemporary health discourse in Nigeria.
According to Kumah, Ankomah and Antwi (2016), the frequency in the development initiatives and training mitigates the boredom and redundancy which emanates from the prejudiced working habits. The regular training of health workers elicits the culture of self-evaluation and regular progress analysis among the workers. Babble (2009) argues that training and the development zealously instills the sense of candid orientation in future planning. Dedicated training and development prompt the employer to assess the existing and unexploited talents among the employees and evaluate the appropriate growth. Also, identifying the new talent among the employees facilitate the private hospital to actualize the targeted skill deemed apt in the existing gaps in the health sector.
1.2 BACKGROUND OF THE RESEARCH STUDY
The study carried out by Barky (2007) posits that due to the incommensurate and the inadequate health program implemented by the Nigerian government to address a myriad of the quagmire afflicting the general health in Nigeria, they have seen the negligible improvement in the health status. According to the research, the perennial negligence by the Nigerian government to alleviate and address the public health issue has left pangs of the anticipation among the poor Nigerian citizens. There has been the meager motivation in both the private and the public health sectors. According to the World Bureau of Statistics (WBS) and the United Nations Statistical Commission (UNSD), Nigeria is globally known to be densely populated in Africa with approximately 182 million inhabitants. This number of the population do not measure up with the number of public hospitals expected to accommodate the required patient capacity. As per the World Health Organization (WHO), the overall life expectancy in Nigeria is tentatively at 54 years and the infants’ mortality rate of approximately 86 in every 1000 live birth. Also, the maternal mortality ratio is estimated to be 840 in every 10000 live birth.
In addition, World Health Statistic (WHS), on the status of the non-communicable diseases among the third world countries, Nigeria is at the receiving end as it heftily burdened with these diseases which include but not limited to; cancer, diabetes, cardiovascular disease, obesity, stroke, asthma coronary heart disease. Besides, WHS the estimated malaria mortality rate of the Nigerian population as 146 out of the 100000 randomized populations. It further reveals that the Nigerian population is leading in the tuberculosis burden and victims globally. which by extension culminating in an unbearable burden in Africa cumulatively. The genera Nigerian health sector is currently writhing in the yoke of the greatest burden that encompasses among others, the containment of the infectious and contagious disease like the current Covid-19 Pandemic and some other related emerging communicable diseases.
According to WHS, for the last 10 consecutive years, there has been an acute shortage of health workers in the Nigerian both in the public and the private sector. This shortage has been attributed to the social brain drain. These multidimensional predicaments are escalated by the newly risen sociopolitical of Nigerian history and the inadequacy in the institutionalized capacity policies to curb the menace. The continued negligence on the health sector and the respective authorities are crippled by the already unstable situation. The United Nations Development Program (UNDP) reports that the GDP for both the private and the public sector is approximately 2.6% and 0.8% respectively. Intriguingly, the respective authorities and the government has notably tried to alleviate the challenge. However, there has been any substantial and material move to fully iron out the perennial problem. The current Nigerian national health has well-informed policies on the health program, for instance, the blood transfusion, HIV/AIDS food and nutrition, child and drug substance abuse, national healthcare system, food hygiene, and the safety as well as health national policies. All these revised health policies have not significantly curbed the pinch of this excruciating pain on the health sector.
The Nigerian government inter-sectorial movements and the cooperation among the various respective government ministries have not outdone the challenge in the health sector. According to WHO and the Nigerian Bureau of Statistics (NBS), the national health system still wallows in the cocoon of the poor management and ineffective operation in term of management, there is skewed resource distribution in the public and the private sector. Besides, 70% of the doctors are urban residence because the high population of Nigerian is in the rural. As a result, the high percentage of the citizens living in the rural are left in the hand of unscrupulous and incompetent health workers. The Nigerian government, in its quest to assuage this health-related problem, in cooperation with the federal health ministry constituted a National emergency response and preparedness team. Although this team coupled with the public health emergency, the Nigerian citizen still experiences the great challenges in accessing the quality health service. According to the Nigerian federal ministry of health, (FMOH) every year the country records a new case of an outbreak of a disease which in most cases leaves thousands of Nigerians succumbing to the disease. While these emergency outbreaks have been experienced in the recent past there has been an appropriate cushioning measure to alleviate the challenge. According to UNICEF, the outbreak of cholera in Nigeria is deemed to affect about 3 to 5 million populations in Nigeria and the 100,000 to 150,000 cases of deaths yearly.
1.3 SIGNIFICANT OF THE PROBLEM
The formulation of any reasonable research problem is the most critical and profound first step of any academic research process (Kumah, Ankomah and Antwi, 2016). These scholars liken this academic research process the tee ginning of every journey by which an individual has to decide about the destination before kicking off the journey. Furthermore, this author posits that without a destination, it is always difficult to determine the kind of inputs one has to inculcate in their journey. The identification of any research problem is deemed a very crucial part of any of the academic research processes. The research problem provides an appropriate avenue to expounding on the variable and the concepts used. The problem of the research gives an appropriate direction of the whole research and the whole context. In addition, the statement of the problem in a context where the various theoretical frameworks are demystified with the extent to which the statement problem relies upon it.
Concerning the provided explanation on the background, the esteemed researcher keenly attempts to shed light on what is needed in this research by formulating a relevant problem of the study. Due to this reason, the problem of the statement will be formulated as follows: There is no research-based information on the significance of the up skilling and the development as the motivational aspects to competitive performance in the health sector. According to the Gallup study, there is no much awareness on various organizational institutions on the importance and the significance of the training and the development to the employees and the impact on an organization. According to Kumah, Ankomah and Antwi (2016) on the workplace learning reports, the investment in the training and the capacity building on the health workers has a prosperous impact on the output in terms of quality service and the profits. The 2017 study on the workplace by the Gallup company that engages on the employees’ professional growth has the rate of employee retention.
From Reinertsen (n.d) perspective, 82 percent of the middle-skills level needs an appropriate training mechanism in the professional capacity building. He further explains that as the skills gaps widen further, the employers are under a great obligation to train their employees in upskilling to suit the first moving world. The process entails the creation of a meticulous plan that is associated with set goals. The scholar also argues that employees and employers should always evaluate their capabilities that will greatly boost their organization’s results. As per Reinertsen (n.d), while the functional training exists in an organization the development in terms of employee development capacity, building will not be functional if the prevailing working environment does not provide for adequate learning on the professional skills. According to the World Health Statistics, Nigeria faces various health-related problems ranging from infectious diseases, air pollution, solid waste disposal, health insurance, and the appropriate control of the vector-borne diseases. Furthermore, WHO reveals that about 58 million people succumbed in the year 2005 due to the infectious diseases globally and by extension, 18.8% were from the African region. In Nigeria, vector-borne and infectious diseases are the major problems threatening the health sector.
Based on the above mention detailed background, the researcher strikes a conclusion. There is an ardent need for substantial and qualitative research to widen knowledge on the value of the training and the advancing as the key factor in motivating the private hospital in Nigeria. This research is tailored to demystify the underlying facts about prior research on the importance of training in health workers. Furthermore, the study identifies and discusses how and what training and development to qualitatively meet the urgency of the contemporary health sector in Nigeria.
1.4 THEORETICAL FRAMEWORK
According Parniangtong (2017), the theoretical point of view in substantial research becomes a foundation in transforming and shaping the types of questions that prevails. As a result, it influences the methods of collecting data and evaluate to meet then call and the urgency of change. In most cases, theory serves as a bottom line in catering the factual information since it specifically identifies the types of data to be analyzed since its element and the variable are logically intertwined. Therefore, the hypothesis can be easily inferred basing on the specific elements and the variables of a particular theory. This research is deduced upon the reinforcement approach and the social learning approach that facilitates in exploring and expounding the appropriate training and the development of health care and the health workers using various theoretical perspectives.
1.4.1 Perspective of Reinforcement Theory
This theory stresses the knowledge on behavior of individual and further claims that an employee will tend to reprise a behavior associated with positive outcomes. According to Piotti, Satchell and Lockhart (2018), the theory of reinforcement is training and programs in terms of organizational set goals. It further suggests that training and development is reinforced with appropriate human resource practice. The scholars further elaborate this concept explaining that there are various types that a reward can be administered, for instance, the award of the certificate after a training and progress program may elicit a positive influence on the employees (Piotti, Satchell & Lockhart, 2018). Basing on this theoretical perspective, an appropriate and repeated training will inculcate the culture of determination among the employees and in this case the health workers.
1.4.2 SOCIAL LEARNING PERSPECTIVE
This is the theoretical perspective that is thus appropriate for the qualitative study of this research. According to De Coster (2017), this theory addresses the fact that the direct reinforcements on an individual have a significant impact. Furthermore, some training programs cannot be imparted through training but learned from the environment. This particular learning, according to the theory of learning, is called observational learning since it involves the observation of human behavior. In an institution, therefore, the surrounding plays a critical role in promoting professional capacity building. It further explains that in any organization, the working environment should be suitable and professional such that the employees should be able to learn from it. De Coster (2017) claims that human psychology also plays a role the controlling the human behavior and skills acquisition process. What if a psychological status of an individual is contemptuous then, there will be no impact on the skills acquisition process even if he or she is compelled to do so they will not achieve any meaningful gain in the learning process. Therefore, for any given organization to realize a meaningful impact of their training on their employees, they must create a serene environment for their workers. This act wail, in turn, helps them change their attitude and gain in any training given to them.
According to this theory of social learning, the mental state of mind positive toward the organizational training orientation and the development program by closely associating the benefit and the reward gained having gone through any given training this process will, in turn, help the health workers develop a positive attitude towards any given training program in any organization. Both the social learning perspective and the reinforcement perspective are focused in the prioritization of the health worker as a human being who can the status quo of the bad health conditions to better condition (Morcom, 2015). In addition, the two approaches also attempt to put a firm emphasis on the already prejudiced practice that if done and implemented it will lead to an appropriate improvement on the health sector. with the conceived notion that the human beings have the capabilities when their various talents are well natured and blended into usefulness in the organization .The two approaches harmoniously links well with the problem under the study that the up skilling and the advancement in the employees are the catalysts of the competitive advantage .the apt utilization of the two approaches in mitigating this health-related challenge will greatly help the health workers realize their unexploited talents and capabilities in improving the private hospital output (Morcom, 2015).
According to a Smith and Prior (2020), the investment in the employees’ training and development should be tailored to meet the expectation. The employees should be always viewed as capable and motivated whenever necessary. The skills acquisition process is always paramount process to any manpower in terms of professional development. In most cases, an institution aspires for a qualified and competent employee. Further, the competency in terms of the gained experience in performing a given duties is always a priority. Therefore, it suffices to say that training and any up-skilling process should be a continuous aspiration to any given organization to boost the anticipated goals in terms of quality (Smith & Prior, 2020). It is also deduced that the improved process of up skilling inculcates the sense of awareness about the availability of an opportunity to be tapped. The purpose of up skilling varies depending on the stipulated goals of an organization, based on the urgency and efficiency of the available personnel.
1.5 Research Question
This section discussed the concept of training and the development importance to an organization and the process in identifying the talent among the employees. From the observation made, well train employees are the critical pillars of success in any organization. According to the research, the most productive employees are those who receive extensive training and the development. When careful employee selection is done, it does not necessarily promise exemplary performance in an organization (Smith & Prior, 2020). Also, the performance and the employees are always two separate entities. According to the theory of reinforcement, the employees always associate a reward with the kind of training offered. Therefore, the type of motivation administered to employees during and after a given training period determines the level of success and performance by the employees (Piotti, Satchell & Lockhart, 2018). The theory of social learning also articulate that employees learn much from their environment they are working in, hence the training and the development alone cannot determine the capability and the competency of employees. Since there is no enough research-based information on the fact that the training and the development are the catalysts for the competitive advantage, the combination of the two theoretical perspectives significantly helps to identify the hypothetical information on the importance of the two motivational aspects. Therefore, the mutual understanding and succinct investment on the employers will not only improve the organization performance but also the output of an organization.
According to Gomes and Romão (2018), a research question is an appropriate tool that strikes a balance on what we want to find out. A research question may presumably take different forms but it serves the intended research purpose. The research question encompasses the important question in addressing the main concern of the research. It fine-tunes the succinctly on what a researcher needs and the kind of knowledge to be added to the topic under study. In most cases, the research question is precise and concise such that the questions asked are the real reflection of the topic under the study. In addition, a research question gives a basis in terms of viewing and analyzing the topic under the research. Throughout the research process, a researcher is focused in knowing how the underlying assumption of the phenomena under research impact on the research question formulated .out of the research question, the researcher was able to reflect on his already existing knowledge in terms of the biasness and the speculations made about the phenomena under the investigation .for the purpose of understanding the importance of training and how the process is done, the researcher formulated the following question;
To answer the research question, the researcher was guided by the following set goals and objectives.
1.5.1 Research Goals
Develop a multidimensional understanding on importance of the training and the growth of employees professionally and the institutional objective in Nigeria.
1.5.2 Research Objectives
According to Parniangtong (2017) and Piotti, Satchell and Lockhart (2018), the overall purpose and the usefulness of the of research is the main objective of research. In this case, the ideas from the research study is translated into substantial and the concrete data and an analytical approach as well as the qualitative approach. It is used to unravel the underlying fact of in the research problem. Furthermore, the objects represent the core part of the study wherein the sub-objective is the main guideline that drives the main objective of the materializations (Piotti, Satchell & Lockhart, 2018). Therefore, based on the stated objective, the following are the objectives of the study found;
To be able to conceptualize the reinforcement;
This chapter reviews the content that has been in the topic under the research in the field of the study. This review tries to interrelate the reviewed theoretical perspective and the topic under the study. According to Piotti, Satchell & Lockhart (2018), the great future of the organizational goals is the well trained and skilled employees. On the other hand, the theory of reinforcement states that a well-reinforced training is an appropriate way of motivating the employees in an organization. Therefore, this chapter will be expounded in detail in the theoretical perspective and the general knowledge on the topic under the study.
2.2 Historical Background
According to Culpan (2008), for any study, there must be a reflection on the historical information to determine the type of direction of the study. Basing on the topic under the study, the researcher was trying to investigate on the precarious state of health in Nigeria. There is a chronic mix of challenges including inaccessibility of the affordable and quality health service, lack of preparedness, an outbreak of the pandemics like Covid-19, malnutrition and related diseases, lack of qualified personnel in the public and the private sector, inadequate health facilities, insufficient health, and investment are poorly done, and lack of sufficient health person. The health ministry performance in improving the health sector has been insignificant (Culpan, 2008). Furthermore, the government has not put into consideration good remuneration of the health worker and mitigates brain drain to the US and other overseas and developed countries. According to the research, the annual budget of the government for the health sector is 4.17%, which is not commensurate in improving the vast worse situation in the health sector.
2.3 Theory relevant to the Research Question
The applied theoretical perspective on this research is the reinforcement perspective and the social learning perspective. Comparatively, the two theoretical perspectives converge under one bottom line promotes the sense of belongingness and the capacity building among the employees. Furthermore, the two perspectives are in line with the topic of study, in that, they both conceptualize their principles in the context of the motivational aspect. According to the Co‐creation at orange and Cisco systems (2010), motivated employees are always focused on improving the performance of an organization. On the other hand, the two theoretical perspectives differ in the sense that the learning perspective claims that the behavior of individual employees in an organization does not necessarily involve the training. The learning is just acquired through the observation of human behavior.
Also, the proponent says that when a given behavior is repeatedly done, it will elicit a given behavior that will remain as part of the culture in an organization. Therefore, out of the theoretical point of view, health promotion generally becomes a central and key factor in many countries. Due to the frequent outbreak of various pandemic diseases, according to the WHO report, workplace health promotion is the greatest achievement in alleviating the risk involved in the health sector. The report further suggests that the improvement of the employees’ professional capacity immensely improve. Based on the current literature relevant to research, the researcher deduced that there is an annual increment of the outbreak cases of the various contagious diseases in the Nigerian country. Despite the policies and the measures to mitigate the menace has not been able to actualize the permanent solution. The inability of the government to iron out this health problem is attributed to poor remuneration, poor working condition, and lack of appropriate training and the development among the health workers both in public and private health sector.
The implementation of the various health emergency teams like the national health emergency team, life skill program, the national strategy for the pandemic, and contagious diseases among others which are all under the ministry of health play a crucial role in helping the individual deal with any outbreak. Nonetheless, there is an existing gap between the main objective of the government and the implementation. According to the World Health Statistics, there has been a structural stumbling block to the realization of these auspicious measures to alleviate the menace (Co‐creation at orange and Cisco systems, 2010). The Nigerian government integrated the program of action and the department of health and response to a contagious disease to help reduce this affliction.
Albeit the NHIS Act implemented an appropriate provision for children who according to the world statistics take the largest population in Nigerian population. Children still incur for the cost of health services given that they are forced to pay for health care services even though most of these children are from poor families who cannot in any way afford to pay and even gather for their upkeep. As a result, they suffer financial constraints (Sheposh, 2019). The Nigerian government has also strife to provide free health policies and accommodative mechanisms by some of the affiliate states, tailored at children, pregnant women and the entire group in the Nigerian society, Therefore, the sluggishness to permanently solve the Nigerian multidimensional public health atrocities has culminated to the perennial and continued great level of abject poverty and carelessness and the recklessness the in the Nigerian health system. Economical constrain bad governance. All these stated issues have rendered the various moves by the government to mitigate and bring normalcy to be null and void. Considering the objective of the study, Sheposh (2019) deduces the following measures used in reducing the challenges facing the Nigerian health sector.
An appropriate Integration of the adequate medical intelligence and surveillance team
The medical surveillance team is a body tasked to check the general happening in the health sector. Tasking this team and given proper motivation in terms of training and the general wellbeing, it will be able to relay the challenges faced in the health sector in Nigeria. According to the WHO, the presence of the MIS will be in a position to provide more reliable statistical data that will lead to more professionalize and the critical analysis in obtaining the reliable data that will be used in coming up with the well-informed decision to curb the challenges in the health sector.
Carrying out regular health campaigns and the awareness
This another way to primarily improve the general healthcare in Nigeria. It is the empirical way of disseminating and transforming the masses on the appropriate way of maintaining a self-actualize status of a country. When the citizens are well informed about good health care, the whole nation will benefit from the National Primary Health Care Developing Agency (NPHCDA). Ochonma and Nwatu (2018) also state that the appropriate prioritization of the employees’ welfare is to the benefit of the whole organization.
Harmonious coordination in the health sector
According to Gautam and Bhandari (2017), there must be a mutual understanding among the health worker both in the private and the public sector according to the Nigerian statistical bureau, the continued atrocities in the health sector are attributed to the poor coordination among the health practitioners. According to Gautam and Bhandari (2017), two critical issues were discussed. First, lack of coordination among the health workers, fervently deteriorating health services, limited prerequisite resources, including drug and accessibility, insufficient and dilapidated infrastructure, skewed in the distribution of the available resources. Therefore, for the employees of any given organization to competently build their professionalism and become the specialist, substantial training and development must be adequately imparted. Gautam and Bhandari further states that the employees who are virtually trained tend to reciprocate meagerly in terms of the output while on the other hand the trained employee wholeheartedly works towards the achievement of the set goal of an organization. The reason behind dismal performance among the various private sectors is that after hiring qualified employees they exposed them to little or no training leading to continued retrogressive performance. Furthermore, Muhammad and Fard (n.d) assert that the employees or any other social worker are trained in various institutions presumably because of their field of specialization which renders the main narrow-minded in terms of various skills needed to combat various unforeseen atrocities.
MATERIALS AND METHODS
3.1 Study Design
This was a descriptive cohort study that entailed a review of Training records of several training records in Isalu Hospitals Limited.
3.1.1 Research Design
In this study, the meta-analytic design was employed in the early phase, followed by a quasi-experimental technique in a later phase. Regardless of the precincts associated with quantitative meta-analysis, more than a few conclusions were drawn, which assisted in drawing formula for getting sample size. A quasi-experimental design was executed using an online questionnaire at the pre-intervention baseline. Participants answered questions premeditated to elicit rejoinders that elucidate their knowledge of the subject matter. The questions checked the level of Training of participants, the impact of Training and development on the junior staff and senior management staff of Isalu Hospitals, and gave answers on know-how Isalu hospital’s junior staff and the senior management staff contributed to the attainment of sustainable competitive advantage. Analysis of the Outcomes was done to examine if all the factors are deemed useful in the know of the knowledge and frequency of to know how Isalu Hospitals junior staff and senior management staff were contributing to the attainment of sustainable competitive advantage. Age, gender, and position of staff in the Management of Isalu Hospital were considered.
3.1.2 Threats to Validity of the Research Design
External and internal validity are ideas that reflect if the results of a study are meaningful and trustworthy. Whereas internal validity focuses on how effectively a study is carried out (its structure), external validity gives focus to how usable the findings are in the actual world. During my research, I identified a number of Factors That posed Threat Internal Validity. These included;
Instrumentation: The impact of the online questionnaire utilized in a study would affect the response of the participants. Whereas it appears to be strange, it’s probable that participants would be primed into a study in particular ways and measures used, which would make some them show a reaction in a manner that differs from what they would have reacted.
Statistical regression: It is possible that several participants would respond in a given direction just as a result of passing the time and not as a result of any particular intervention.
Attrition: Some participants individuals could stop studying, which therefore means that the outcomes would be centered on a subjective sample group of persons who chose to continue.
Diffusion: This means the treatment in studying spreading from the participating group to control the groups by ways such as interactions as well as conversations with each other as well as observation. This may culminate in another issue, such as resentful demoralization. Here, the control group fails to take part in activities as they direct hate on another group.
3.1.3 Factors That posed Threats to External Validity
External validity will always be endangered if the study fails to put into account the interactions of variables in reality. Some of the dangers include but not limited to;
Situational factors: For instance, as the time during the day, noise, researcher behavior, location, as well as the number of measures deployed might have an effect on the generalization of the findings.
Pre/post-test effects: It means that before the test and after the test situation, which is coherent with the effect observed in the study in given ways, for example, the cause-and-effect relationship vanishing despite lack of those additional tests.
Sample features: Pointed out to the case whereby particular characteristics of a given sample was the cause of the effect (or maybe partly responsible), resulting in the insufficient generalization of the findings.
Selection bias that included the issue of variations among individuals in a study group that may result from the independent variable (for instance, readiness self-motivation to participate in the study, specific groups of participants ending up with a more likelihood of resulting to an online study.
To enhance the study’s external validity of a study and avoid threats, these points were taken into account;
Exclusion and inclusion criteria well utilized in order to guarantee a categorically defined population in study research.
Psychological realism: The aim of the study was well explained to ensure that, participants behaved the way they would in real life
Replication: Meta-analysis was used to regulate the effect of the variable that is independent.
Field experiments would as well be deployed whereby you carry out a study without utilizing thee laboratory hence doing it outside in a natural environment.
Reprocessing or calibration: This was deployed as a form of regulation of problems related to external validity.
The Figure of the Design
3.1.4 Study Site
The study was conducted at Isalu Hospitals Limited. Isalu Hospitals Limited was chosen based on its ability to provide high quality medical and related services to clients using the best existing professionals, empowered with a suitable level of technology and progressive Training (Muhammad and Fard, n.d). It was noted that Isalu hospital had grown in an enormous way over the years and developed a good reputation and goodwill in the society. The Hospitals also enjoyed enormous goodwill and occupied a desirable position as a strong and competitive leader in the market within the healthcare industry since it offered. Due to the different services offered in the hospital, it became the ideal hospital for the study.
3.2 Sample Size Consideration
The Cochran formula (51) was applied to determine the minimal sample size.
Equation one: Cochran formula for sample size calculation.
n= Z2 * p (1-p)
Where: Z is level of significance (1.96) at an α-value of 0.05 for a two-tail hypothesis.
P was the prevalence of MRPs
d was precision of estimate around MRPs (5% or 0.05).
N was the sample size.
3.3 Sampling Method and Sample Size
A convenient sampling method was employed. Every staff who met the inclusion criteria outlined in the eligibility checklist was included in the study until the desired sample size was met. Convenient sampling was to be adopted in the research in order to eliminate voluntary response bias as well as to eliminate under coverage bias. The research population was made up of the entire 220 staff (170 junior staff and 50 senior management staff) employed by the organization while the sample size was made up of 22 senior management staff and 75 junior staff. Both the senior and junior management staff were considered for the study because they were both responsible for the daily running of activities of the organization, and they all interacted with customers at one level or the other. The senior management staff comprised of heads of departments and strategic business unit managers who oversaw the various departments of the hospital while junior staff comprised the nurses, assistant nurses, pharmacy technicians, records personnel and other operational staff.
3.2.1 Eligibility Criteria
Staff was included if they had worked in the hospital for at least five years. Staff who had worked for less than five years were excluded.
3.2.2 Data Analysis Approach
Analysis of data would be carried out in descriptive statistics with a five (5) point Likert scale. The advantage of Likert scales is that they produce a cumulative response process, i.e., they make it possible to sum up, the scores and produce a cumulative score. Likert scales enhance speed, confidentiality, and collection of honest feedback. However, it is possible for the respondents to give false information in an attempt to maintain privacy. Lack of understanding of the question asked may also make respondents give wrong feedback. Another major shortcoming of Likert scale is difficulty in achieving the internal consistency of the scale, which can affect result interpretation. Also, intervals between the different points on the scale may not be a true representation of the changes in individual attitudes.
In view of the hypotheses stated above, nominal and ordinal data would be collected for the research because they were both classified as categorical data, i.e., non-quantitative and could be represented by string variables. Nominal data do not have quantitative values and are used for the ‘naming’ of variables, as the name implies. Ordinal data, on the other hand, have their variables arranged in an ordinal form but are not measured mathematically. They are in the form of labels used form representing opinions. Similarly, a nonparametric test would be conducted since the hypothesis was aimed at determining how senior management and junior staff contributed to organizational performance as well as the impact of Training and development on the organization’s competitive advantage. A nonparametric test was considered because the analysis does not require data to fit a normal distribution. Nonparametric tests rely mostly on ranking and orders in which data are sorted.
3.3 Validity and Reliability
Reliability and Validity of research mean to the depth of the outcomes of the study. The results` validity could either be external or internal. Internal validity is defined as the analysis of the preciseness of the achieved results. External validity means analyzing the results in relation to if it is possible to generalize them (Smith & Prior, 2020). Whereby measurable quantities are utilized, there are various kinds of validity; face, that explains the magnitude to which the measurement deployed is sensible and is able to obtain such measurement, convergent validity, this one explains the depth in to which the utilized measurement may end up with same outcomes if used elsewhere and then divergent validity which explains the degree to that one construct is differentiated from each other (Smith & Prior, 2020). More so, particularly, four types of the validity of qualitative research is available, and are mostly emphasized upon. They are interpretative, theory-based, descriptive, and can be generalized. Descriptive validity is usually linked to the extent where the real description of the outcomes factual. Interpretative validity is often linked to good interpretation.
Theory-based validity leads to sufficiency that the 39-theory proposed is, for example, if the theory backs up the subject of study. Generalizable validity is known as to which degree the outcomes of the study may be generalized. For example, are the outcomes of this study coherent with those of other organizations in the same category? (Morcom, 2015). In this study, validity was considered. For instance, since the questionnaire is framed by the researcher, it is constructed on the basis of the researcher’s requirements in relation to the topic of study t and therefore is advantageous in the sense that it measures precisely what the researcher wants to. The researcher, therefore, does not depend on any other researchers for any data on, for instance, problem areas and significance of the items incorporated in the questionnaire. In addition, also, interpretative, descriptive, and theory-based validity considered. Exhaustive review literature in the areas of study was carried out cautiously before commencement of the research. That made it possible for the theories as well as the questions in the questionnaire to be recognized. Themes as well as theories are well supported by the research findings. Reliability means the steadiness of the measure utilized to study the correlations between different variables (Morcom, 2015). The questions in the questionnaire were framed, considering the issues pertaining to the problem and goals of the study and the subject theories. Therefore, it is believed that the answers and results from this study are trustworthy.
3.4 Data Collection Instrument
The research made use of quantitative technique and primary data, while the online questionnaire would be used for data collection. The quantitative technique was chosen because, being social science research, the research would explore social phenomena, and literature had confirmed the appropriateness of quantitative technique in measuring social phenomena such as perception, attitude, employee behavior, etc. (Parniangtong, 2017). The quantitative technique made it possible to easily analyze social phenomena and make statistical inferences.
The questionnaire would be used to collect vital information for the study. It would collect data that would be used to examine the application of Training and development as means to sustainable competitive advantage at Isalu hospital as well as the impact of Training and development on the senior management staff and junior staff. The questionnaire would be divided into two sections. The first section of the questionnaire would focus on participants’ demographic information, which includes sex, age bracket, education level, duration of employment, and the rate of Training in Isalu Hospitals (Parniangtong, 2017). The second section would measure variables relating to ‘how training and development had helped the senior management and junior staff to contribute to attaining sustainable competitive advantage in the organization’ as well as how Training and development had affected employee intellectual capability, staff turnover, service or product innovation, brand equity (or value) and quality of service or product. The mean value will be calculated using a 5-point Likert scale whereby Disagree=2, Neutral=3, Strongly Disagree=1, Agree=4, and Strongly Agree=5.
Gathering of information by questionnaires varied in the techniques of contacting the participants in the means of delivery and the manner in which the questionnaire was administered, and these factors could impact on the level of accuracy of the collected data. These dissimilarities could render it difficult to pick out the impacts of each on the data quality and could mean the difference in the responses obtained. In order to evade this, the questionnaire would be designed in a simple and easily comprehensible manner devoid of bias. The questionnaires would be disseminated at the start of the day’s work, and the respondents asked to drop them in a box near the receptionist desk after completing it. This was to ensure that the researcher did not know the order in which questionnaires were dropped. The box containing the questionnaire would be collected later during the lunch break. Every participant would be issued with the same questionnaire to fill with no intrusion from the researcher so as to avoid the ‘Hawthorne effect,’ i.e., an alteration in participants’ behavior because they know that they are being monitored.
3.5 Reasons for Data Collection Method Used
3.6.1 Phase 1
This phase was executed in two months. It involved involving mixed reviews to investigate characteristics ranging from potential outcomes and barriers. The review focused on several variables. Additionally, the knowledge possessed by the hospital staff was to be reviewed. The contingent mixed review used quantitative and qualitative data. It also required tractability for describing the questions and extracting data in a method that brought forth the results of the questions and analysis. The literature verdicts should have scraps of facts to strengthen the analysis further. The purpose of the analysis was to use the results in every step of the study. Therefore, the following two measures would be used for the analysis.
Identified the research questions and the aspects that aided in the development of those questions. A review of the literature was to be used to come up with logical questions to aid the understanding of Training and development as a form of accelerating the achievement of sustainable competitive advantage in private hospitals of Nigeria:
The course of action shifted from the scope to the exploration level by applying systematic approaches. There was the development of inclusive and exclusive defined criteria, strategies, and screened literature. The search strategies in hospital database components were fashioned to pinpoint the trial’s descriptive studies in the views of the staff at different levels of management. The qualitative research was checked, and sub-questions centered on the findings were developed.
3.6.2 Phase 2
Once the primary components had been assembled, the student required to perform an in-depth interview with a sample of few participants. The interviews were conducted electronically via phone and video conferencing. During the interviews, the participants were asked how participation in the Training and development of junior staff, as well as senior management staff, put Isalu Hospitals at a maintainable competitive advantage. The interviewer was the team and carried the responsibility of ensuring the interview’s success. Every interview was recorded, transcribed then efficiently analyzed. Depending on the feedback, the methods` efficiency was analyzed to come up with a questionnaire and any other materials required to carry out the study.
3.6.3 Phase 3
For three months, results were collected. False identities, incognito, and sobriquet was used to guarantee secrecy. Before engaging in the research, both staffs gave informed consent. Data were collected as per the online questionnaire.
Very thorough interviews were transcribed and documented at all times. The evaluated process approaches were utilized to define patterns related to that which the intervention likes or dislikes. This would also be made use of to determine what components were lacking, used, and not included. Each of those elements centred on the preparation, duration, results, as well as evaluating aspects of the intervention. The outcomes of the research were useful and suitable in the adjustment to the process or preparation. The analysis was incense on the quantifiable measures used to estimate the changes in the scores and variances using median, mean percentage, or figures if it is applicable in the occasion.
All the data was collected at different phases. This study was crucial as it monitored junior staff and managers. Besides, the analysis involved sub-scales, which were calculated on a Likert scale of 3 points (Parniangtong, 2017). According to Kash et al. (2014), an appropriate value is 72 out of 100 per subscale.
3.8 Quality Assurance and Data Management
The data collection instruments were pre-tested and optimized appropriately by the researcher, where necessary. The filled instruments were reviewed by the researcher at the end of each day against the source documents for completeness and accuracy. All the raw data collected were entered into Epi-info version 7 (2007-2010) software, and a database created. The data was backed up on a weekly basis by the researcher. Data cleaning and validation were done before exporting to STATA (version 14) for analysis. All information extracted was coded, and staff identifier information was not included. The electronic data was password protected. All hard copy documents were restricted to researchers and supervisors. The backing-up of data was done weekly to protect data from loss (Kabene et al., 2006). Soft copies of documents were password-protected and encrypted. Hard copies of the interview notes and questionnaire forms were securely kept and locked in a filing cabinet, which could only be accessed by the principal investigator.
3.9 Ethical Consideration
Approval to carry out this study was sought from the Isalu Hospitals Limited. The Chief Medical Director was granted permission to access the potential participants; hence there would be no barrier to data access. This study was registered with the Research and Development Department of the Isalu Hospitals Limited and an official research study number given and recorded in the registry as per the hospital research guidelines. To implement the study, permission was sought from the relevant hospital management—informed consent for participation.
Potential Participants were met and informed about the objective of the research. It will be emphasized that participation was voluntary. They were being informed that questionnaires would be retained on a secure, password-protected University of Liverpool. The researcher took the utmost care to guarantee the maximum confidentiality and privacy of the information obtained during the study. Staff codes were used instead of staff identifier information. The data instruments were stored in a password-protected database only accessible to the researcher were to be secured under lock and key. At the end of the study, they were handed over to the department of Research and Development for a duration of 5 years. A password-protected electronic version of the primary data was also deposited to the department e-repository. Reassurance was made that data would be used exclusively for the study purpose and kept until the finish of the Master’s dissertation module. Confidentiality, privacy, anonymity, and other ethical factors were given due consideration in the course of the study.
3.10 Data Analysis
The Shapiro-Wilk test was used to check if continuous variables were distributed normally. Descriptive data analysis was done, and continuous variables were expressed as either the median, or mean and standard deviation, and inter-quartile range. Also, Categorical variables were presented in the form of proportions, percentages with the 95% confidence intervals. The main outcome calculated was Bivariate logistic regression. It was used to analyze associations between dosing errors and predictor variables identified in the data. Their odds ratio, 95% confidence intervals of the odds ratio, and the related p-values computed.
Multivariable logistic regression was constructed to investigate association while adjusting for possible confounding. The predictor variables associated with medication-related problems were determined using the Forward stepwise model building. STATA version 14.0 software, which was utilized for the purpose of analyzing. P values that were less than 0.05 were deemed to be significant statistically.
3.10.1 Assumptions Based on the Statistical Analysis
With regard to the statistical tests used, assumptions were made to ensure that the data collected were consistent with the nature of the analysis being conducted. These assumptions included normality, independence, linearity, and homosexuality. Failure to comply with these assumptions would have resulted in inaccurate results, which would have been problematic. Testing the data assumptions that violated the statistical test assumptions, depending on the violated assumptions, would have produced both false negatives and false positives.
The normalcy hypothesis meant that the data approximately matched the bell curve before any statistical or regression tests were performed. The hypothesis followed that the study was statistically independent. The hypothesis was that all participants in the sample would only count once. The use of the questionnaire allowed each participant to make independent comments. The independence of observations meant that the variations of each participant affected the overall analysis only once. The assumption of homosexuality ensured that the variance around the regression line was the same for all values of the predictive variables. The study did not break this assumption. The statistical software packages used do not automatically check these hypotheses but assume that they are fulfilled, as they are the conditions underlying the logarithmic functioning of the program.
3.10.2 Determination of Statistical Significance
Fixed standards were used to verify the significance of zero assumptions, and only 0.05 was used as a criterion for assessing or reporting statistical significance.
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