ABSTRACT Management of Knowledge workers in healthcare is KEYWORDS Attrition, Knowledge workforce, e-health, retention strategies ABBREVIATIONS Healthcare Information Technology (HIT ), Electronic Medical Record (EMR ), Health Information System (HIS) , Electronic Data Capture (EDC), Continuing Medical Education ( CME), Hospital Management Information Systems ( HMIS) Unique Health Identification Number (UHID) DESCRIPTION This manuscript describes the work done by the Healthcare Attrition Tracking Survey (HATS) conducted to evaluate the rate of attrition among Doctors, Nurses and Paramedics and healthcare administrators. About 2000 healthcare professionals were approached for the survey. Out of this, after elimination based on certain eligibility criteria, questionnaire was filled by 807 respondents. 40 hospitals including both private and public sectors in the rural and urban areas were included for this survey. Additionally, Focused Group Discussions (FGD) were also carried out to find out factors contributing to attrition. Next, plausible retention strategies were analyzed for knowledge workforce in healthcare. Data was analysed by means of Factor Analysis on Rotated Factor Matrix using Principal Components Analysis (PCA) in SPSS 16.0 package to determine the relationships between factors influencing attrition. Six factors of attrition namely Compensation and perks, Work Life Balance, Sense of Accomplishment, Work load leading to exhaustion,Need for automation and technology improvement, Break Monotony of Work have been identified with a data reliability of 0.809%. Simplification of processes using Healthcare Information Technology (HIT) tools is a suggested as a significant strategy to reduce stress at work, time spent on administrative work and focus on core competence by knowledge workers in healthcare thereby reducing rate of attrition. INTRODUCTION Health care industry relies a lot on advanced medical technology, but it is also a labor-intensive industry. Health care providers play a vital role in the health care system. As the Indian healthcare industry experiences phenomenal growth, hospitals are moving forward towards excellence rather than survival and gearing up to fulfill the gaps in three key areas of people, process and technology. In this paper, the terms "health care providers", "health care professionals", "health care knowledge workers " and "human resources for health" are used interchangeably, although "human resources for health" may comprise people other than those who have been trained in health-related field, such as health policy analysts, health planners, medical statisticians or ambulance drivers. Previous studies in the area of attrition have been carried out amongst physicians, nurses and pharmacists [1], 4. METHODOLOGY 4.1. DATA SOURCE Data for this study came from the second round of the Healthcare Attrition Tracking Survey (HATS). HATS is a part of the multi-level study of the ongoing research program conducted to address these issues regarding attrition among healthcare professionals and to determine if implementation of Health Information Technology in hospitals and healthcare centers can work as an effective retention strategy in India. HATS was conducted among skilled healthcare professionals such as doctors, paramedics, administrative and managerial staff in public as well as private hospitals covering rural and urban regions of Northern India. informatics ( IAMI) in Hyderabad, India (Nov. 2009). This was followed by a pre-test study conducted on 30 respondents in a leading 100 bedded Private Hospital in New Delhi, India. The second round of data collection led to the present paper using a complex sampling design of 40 Hospitals randomly selected to yield a non-biased representative sample of healthcare workforce both in rural and urban areas. Out of about over 2000 respondents surveyed, 807 finally respondents filled the questionnaire. The questionnaire tool was developed by the authors, reviewed by the experts in the field and then utilized for the HATS. The major challenge faced was to take permission from the HR authorities to conduct the survey due to issues of transparency of the system and its HR policies. STUDY DESIGN RESULTS An overall response rate of 40% was achieved in this study with a total of 1000 questionnaires distributed and 807 responses. The following illustrates the descriptive statistics of the various parameters considered for the HATS. Table III Comparison of the six factors of attrition DISCUSSION Results show a significant difference in attitudes towards factors affecting attrition. These attitudes together with nature of work and income are associated with an increased propensity for migration to another job. These findings support earlier such findings, that a broader set of both push and pull factors should be taken into consideration while considering attrition in healthcare [5]. The factors that have been identified through statistical analyses provide a deeper understanding of the relationships between forces that influence attrition rate. The results also provide evidence to demonstrate that economic motivation as a factor for changing jobs is not an independent, stand-alone factor in itself, but rather a component of broader factors that takes into consideration the yearning to improvise both developments in both professional and personal front. This finding is a departure from previous studies that indicate the intention of healthcare professionals to frequently change jobs and migration to foreign countries are mainly dependent on remuneration. This may be partly because those studies did not take into account the deeper analysis of relationships between factors [24]
