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Is NHS Implementing Job Evaluation to Follow Principles of
Pay Equity?
(Name)
(University)
(Course)
(Instructor)
(Date of Submission)
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Executive Summary
Healthcare systems around the world have faced continuous and increasing pressure to
reduce costs and increase productivity. In order to remain competitive in today’s economic
environment, healthcare organizations have employed human resource management strategies.
Pay equity is a term used to mean the payment of the same level of wages to people belonging to
different genders, races, cultures or disabilities with the same job description. Job evaluation and
analysis have become essential in today’s working environment to establish equality of pay for
all genders, ethnicities and occupations.
To this end, the United Kingdom Parliament has passed several laws not only defining
discrimination and harassment but also identifying the rights of the victims as citizens and
employees. The National Health Service is a healthcare provider situated in the United Kingdom
which operates on the principle of free universal healthcare. Questions have been raised
regarding the effectiveness of its job evaluations and its effects on the pay of its employees.
These problems may also extend to their partnerships in the private sector, and the quality of
healthcare they provide.
The National Health Service has endeavored to find solutions to these issues by creating
proposals that are geared toward increasing patient and employee confidence in the healthcare
organizations. Presently, it has only partially succeeded in its goals. The objective of this study is
to evaluate the job criteria of people employed in the healthcare organizations, thereby enabling
them to determine the levels of implementation of pay equity principles.
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Acknowledgement
This dissertation is a milestone in my academic career. I have been fortunate learn
theories and concepts which would have been impossible if I had not extensively carried out the
needed research. I am grateful to a number of people who have guided and supported me
throughout the research process and provided assistance for my venture.
I would first like to thank my advisor, ____________ who guided me in selecting the
final theme for this research. My advisor was there throughout my preparation of the proposal
and the conceptualization of its structure. I would not have been able to do the research and
achieve learning in the same manner without his/her help and support. His/her recommendations
and instructions have enabled me to assemble and finish the dissertation effectively.
I would also like to thank all my instructors and teachers, who throughout my educational
career have supported and encouraged me to believe in my abilities. They have directed me
through various situations, allowing me to reach this accomplishment.
Finally, my family has supported and helped me along the course of this dissertation by giving
encouragement and providing the moral and emotional support I needed to complete my thesis.
To them, I am eternally grateful.
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Table of Contents
Acknowledgement……………………………………………………………………………………………………………3
Chapter 1: Introduction……………………………………………………………………………………………………..7
1.1 Background……………………………………………………………………………………………………………7
1.2 Objective………………………………………………………………………………………………………………..8
1.3 Statement of the Problem …………………………………………………………………………………….8
1.4 Purpose of the Study ………………………………………………………………………………………..9
1.5 Significance of the Study………………………………………………………………………………………..10
1.6 Research Hypothesis ……………………………………………………………………………………………..10
1.7 Research Questions………………………………………………………………………………………………..11
1.8 Disclaimer…………………………………………………………………………………………………………….11
1.9 Structure of Report…………………………………………………………………………………………………11
2.1 Introduction…………………………………………………………………………………………………………..13
2.2 Human Resource Planning………………………………………………………………………………………15
2.3 Job Analysis………………………………………………………………………………………………………….15
2.4 Job Evaluation……………………………………………………………………………………………………….16
2.4.1 Basic Approach……………………………………………………………………………………………….17
2.4.2 Analytical Schemes …………………………………………………………………………………………19
2.4.3 Hay Method……………………………………………………………………………………………………20
2.4.4 Skill-Based Schemes………………………………………………………………………………………..21
2.4.5 Market Pricing………………………………………………………………………………………………..21
2.4.6 Single-Factor Schemes……………………………………………………………………………………..21
2.4.7 Non-Analytical Schemes………………………………………………………………………………….22
2.4.8 Management Consultant Schemes……………………………………………………………………..22
2.4.9 Compensation Strategy…………………………………………………………………………………….23
2.5 Legislations in the United Kingdom ………………………………………………………………………..24
2.5.1 Equal Pay Act of 1970……………………………………………………………………………………..24
2.5.2 Sex Discrimination Act of 1975………………………………………………………………………..24
2.5.3 Equal Value Regulations of 1983………………………………………………………………………25
2.5.4 Race Relations Act of 1976………………………………………………………………………………25
2.5.5 The Disability Discrimination Act of 1995 ……………………………………………………….26
2.5.6 The Employment Equality Regulations of 2003…………………………………………………..26
2.5.7 The Employment Equality (Age) Regulations 2006……………………………………………..27
2.5.8 Equality Act of 2006………………………………………………………………………………………..27
2.5.9 Equality Act of 2007 ……………………………………………………………………………………….27
2.5.10 Equality Bill …………………………………………………………………………………………………….28
2.6 Link of Pay Equity to Job Evaluation……………………………………………………………………….28
2.6.1 Outlier……………………………………………………………………………………………………………29
2.6.2 Incentive Plans………………………………………………………………………………………………..29
2.6.3 Pay for Performance………………………………………………………………………………………..29
2.7 Job Evaluation and Pay Equity in Private Sector Health Organizations………………………..30
2.8 Job Evaluation and Pay Equity in Public Sector Health Organizations………………………….30
2.9 Quality of Health Care in Private and Public Health Care Organizations………………………31
2.10 Working Conditions in Private and Public Health Care Organizations………………………..32
2.11 Public-Private Partnerships……………………………………………………………………………………32
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2.12 National Health Service………………………………………………………………………………………..33
2.13 The Constitution…………………………………………………………………………………………………..35
2.14 Previous Studies…………………………………………………………………………………………………..36
2.14.1 Job Evaluation in the National Health Service…………………………………………………..39
2.14.2 Pay Equity…………………………………………………………………………………………………….40
2.14.3 First Job Evaluation Working Party………………………………………………………………….41
2.14.4 Agenda for Change Proposals………………………………………………………………………….41
2.14.5 Equality Features of the Scheme………………………………………………………………………42
2.14.6 Job Evaluation in the National Health Service…………………………………………………..43
2.14.7 Current Job Evaluation Structure……………………………………………………………………..43
2.15 Critical Article Analysis……………………………………………………………………………………….45
2.15.1 Job evaluation for clinical nursing by implementing the NHS JE system ……………..45
2.15.2 Job and Work Evaluation………………………………………………………………………………..48
2.15.3 First Steps of the Journey: Job Evaluation for Agenda for Change……………………….51
2.15.4 A Revision of a Job Evaluation System…………………………………………………………….55
2.15.5 An Analysis of Job Evaluation Committee and Job Holder Gendered Effects on Job
Evaluation………………………………………………………………………………………………………………58
2.15.6 Designing a Comparable Worth Based Job Evaluation System: Failure of an a Priori
Approach………………………………………………………………………………………………………………..62
2.17 Summary…………………………………………………………………………………………………………….64
Chapter 3: Research Methodology…………………………………………………………………………………….66
3.1 Introduction…………………………………………………………………………………………………………..66
3.2 Adopted Research Methodology………………………………………………………………………………66
3.3 Secondary Source: Article Analysis…………………………………………………………………………67
3.4 Qualitative Analysis……………………………………………………………………………………………….67
3.5 Performance of the Qualitative Analysis…………………………………………………………………..68
3.6 Search Strategy……………………………………………………………………………………………………..68
3.7 Criteria for the Selection of Articles for the Critical Literature Review………………………..68
3.8 Justification for the use of the Qualitative Approach………………………………………………….69
3.9 Critical Appraisal Skills Program (CASP)………………………………………………………………..70
3.10 Limitations of the Research…………………………………………………………………………………..72
3.10.1 Limitation of the Qualitative Approach…………………………………………………………….73
3.10.2 Limitations of the CASP…………………………………………………………………………………73
4.1 Introduction…………………………………………………………………………………………………………..75
4.2 Findings from Secondary Research………………………………………………………………………….75
4.2.1 Research Questions with respect to Critical Review Analysis……………………………….75
4.2.2 Findings with respect to the Critical Appraisal Test……………………………………………..77
4.2.3 Job Evaluation with Regard to Nursing………………………………………………………………77
4.2.4 Nurses in the Public Sector ………………………………………………………………………………78
4.2.5 Standard of Care……………………………………………………………………………………………..79
4.2.6 National Health Service Public Private Partnerships ……………………………………………81
4.2.7 Working Conditions in the National Health Service…………………………………………….82
4.2.8 Critical Overviews…………………………………………………………………………………………..83
4.3 Summary………………………………………………………………………………………………………………85
5.1 Implementation of Job Evaluation to Achieve Pay Equity………………………………………………87
5.2 Promotion of Job Equity under Public Private Partnerships…………………………………………….89
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5.3 Pay Equity Improving Working Conditions………………………………………………………………….89
5.4 Recommendations……………………………………………………………………………………………………..90
Reference List………………………………………………………………………………………………………………..92
Appendices…………………………………………………………………………………………………………………..106
Appendix 1: These tables and charts, reproduced from the Job Evaluation Handbook, can be
found on pages 279 to 284……………………………………………………………………………………………..106
Critical Appraisal………………………………………………………………………………………………………….111
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Chapter 1: Introduction
1.1 Background
Healthcare systems are facing extreme pressure to reduce costs, become more productive,
and create improvements in the quality of service (D’Aunno, et al., 2000). The healthcare
delivery system is one of the vital components of the government’s public welfare schemes.
Healthcare components like accessibility, quality, and cost are increasingly moving beyond the
grasp of public. The downtrend in these important components has become a major issue which
if not addressed soon may produce serious consequences for the government. The management
of healthcare is very challenging; reforms are needed through a comprehensive overhaul of the
entire delivery system, and the careful consideration of all pros and cons of developments in the
concerned public healthcare areas (Ozcan and Smith, 1998). The serious ramifications of this
issue have made this a priority of the concerned authorities. Healthcare organizations are facing
several problems; therefore, radical organizational changes need to be introduced to improve the
health delivery systems. One important area is the improvement of human resources in the
healthcare organizations. In any healthcare setting, resource availability and employee
competence are essential to guarantee the attainment of the desired performance level (Franco, et
al., 2004). Human resources in UK health organizations have become essential in creating and
improving the quality of healthcare delivery. The question that must be asked is: does NHS
implement job evaluation that follows principles of pay equity? Pay equity broadly means the
payment of the same level of wages to people who are of different genders, races, cultures or
disabilities with the same job description. The concept of pay equity deals with the different
types of discrimination. This includes the discrimination that happens when women or people of
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different colors or races are compensated less than men who have been appointed to positions
requiring similar levels of skill, effort, responsibility and working conditions (AFSCME, 2009).
1.2 Objective
The objective of this study is to evaluate the job criteria of people employed in the
healthcare organizations, thereby enabling these organizations to determine the levels of
implementation of pay equity principles. This objective will be based on the job evaluation
system that NHS has implemented for its employees. The outcome of the research would be an
assessment of its effectiveness and completeness.
1.3 Statement of the Problem
The National Health Service, or NHS, is the largest healthcare organization of the United
Kingdom. The organization employs more than 1.5 million workers throughout the country.
Globally, there are only three other organizations which employ more staff than the NHS; this
puts into perspective the magnitude of its human resource (National Health Services, 2005). In
order for hospitals to provide high quality healthcare, the different professions must work
efficiently in teams dedicated to patient care (Lowe and Lowe, 2003). The deteriorating quality
in NHS hospitals has increasingly become a major concern. With the challenges caused by
changing business equations, the healthcare industry needs highly skilled persons who are able to
work under stressful conditions. There are several business aspects that encourage HR strategies
to move toward this new work environment using a flexible and versatile approach.
The long waiting list and low quality of healthcare services in the NHS hospitals have
become major causes of concern. In healthcare, an innovative approach is needed for successful
information dissemination, implementation of new schemes, and acquisition of better resources.
In healthcare, both the methodology of the delivery system and the administrative inputs are vital
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for success. Despite the state’s sizeable spending on the healthcare system, the complexities that
encompass the inter-related processes of its various elements are contributing to its falling
standard of delivery. Issues and factors affecting the concept of safe hospitals at affordable costs
must be addressed urgently to meet the challenges of the deteriorating healthcare services. The
study is seen as an effort to gauge the performance outcome of the NHS workforce through an
evaluation of their jobs and an examination of factors like pay equity.
In terms of the quality and number of personnel required by the healthcare industry, this
study seeks to provide additional knowledge on the issue of pay equity in the NHS by studying
the effectiveness of its efforts to implement pay equity principles through a proper job
evaluation.
1.4 Purpose of the Study
The purpose of the study is to gauge the extent of the influence of job criteria and job
skills on the employee’s competitive levels, job satisfaction, and retention. Private equity in the
hospital industry also seems to have significantly increased the cost of healthcare without
promising any improvements in the quality of service delivery and patient safety; both of which
are highly dependent on the individuals who work for these health organizations. Despite the
huge spending by the government on the provision of healthcare services to the public, the
complexities that encompass the interrelated processes of the various elements of the system still
seemingly contribute to its falling standards of delivery. This concerns human resource
management in particular.
The hospitals are plagued with increasingly low numbers of staff presence, which is
adversely affecting the quality of its health delivery system. This has resulted in long waiting
lists and deteriorating qualities of healthcare services. The study would primarily be evaluating
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the job description against the existing job profiles of the staff to find out whether the principles
of pay equity have been implemented for different genders, races, and cultures in the NHS. The
study also examines the impact of such implementation on the employee performance outcome.
1.5 Significance of the Study
The objective of the study is to assess the job evaluation efforts of the NHS to determine
whether the organization is able to practice pay equity based on the job content of the different
positions. The result of the study is expected to enhance the knowledge on the impact of job
evaluation in implementing pay equity principles. This may enable the healthcare organizations
to create a restructured healthcare system that is safer, more efficient and manageable, and less
costly. Such HR strategies are aimed to help apply national practice guidelines that would
simultaneously reduce complexity and variability, and create improvements in the quality of
healthcare service delivery for millions of patients (National Coalition on Healthcare, 2004).
The study becomes relevant in light of the use of advanced technologies in the provision of
healthcare services and where there are chances of having employees from different races,
colors, ethnicities, and genders (women, in particular). Human resource being central to the
organization’s vision and goals, HR leadership initiatives become a crucial factor for creating
and organizing an effective workforce.
1.6 Research Hypothesis
The study would seek to find theoretical support for the research hypothesis, which states
that NHS implements a poor job evaluation system that undermines the successful
implementation of the principles of pay equity in the healthcare organizations.
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1.7 Research Questions
The study, while finding theoretical support to the research question stated above, will
also find possible answers to the following:
1. Does the NHS implement job evaluation to assist pay equity in its hospitals?
2. Does NHS promote job equity in projects which it forms under public-private
partnership?
3. Will pay equity create better working conditions?
1.8 Disclaimer
The research was accomplished after the proper acceptance and authorization of the
instructor. The information covered throughout this dissertation has been used with the assurance
that copyright and plagiarism issues have been fully covered. The research report was created
with intention not to be exhaustive. Although much care has been taken in the research and
preparation, business decisions should not be formulated on the basis of this report. The
distribution of the research report is subject to the condition that it shall not, in any way of trade
or otherwise, be resold, lent, or circulated on a commercial basis without the prior approval of
both the instructor and researcher.
1.9 Structure of Report
The paper has been designed to follow the following structure of chapters:
Chapter 1: Introduction
This is the introduction to the dissertation assisted by background, scope and objectives of the
research.
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Chapter 2: Literature Review
This chapter is a discussion of previous research studies related to human resource
management, job evaluation, pay equity and its link to the private and public sectors. This
chapter also discusses the importance of quality in healthcare in both sectors. It will also
introduce the National Health Service as an organization.
Chapter 3: Research Methodology
This chapter is an elaboration of the research methodology adopted for the research study
and the aspects of the research that the research methodology will cover.
Chapter 4: Findings and Analysis
This chapter is a presentation of the findings from the adopted research methodology and
literature review.
Chapter 5: Conclusion
The conclusions and recommendations are drawn from the critical literature review and
presented in light of the theoretical literature review. They outline the outcome of the critical
analysis tool used in the current research.
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Chapter 2: Critical Literature Review
2.1 Introduction
In order to compete in today’s economic environment, companies must consistently
maintain a productive work environment. Human resource planning (or management) is one of
the tools employed by companies to reach their goals and anticipate the needs of the market.
Among the tasks of human resource planning is the prediction of the traffic of individuals who
may enter or leave an organization, and knowing how best to use them as resources in order for
the company to achieve its ends (Marie, Muller and Bezuidenhout, 2006, p.248). Healthcare
management systems around the world have taken on an increasingly market driven tone in
today’s economy. Different services in the healthcare industry such as patient care, insurance,
service accessibility, and specialists’ care may be treated akin to commodity rather than
privilege.
The management of healthcare organizations is a relatively new field of research, which
is considerably different and challenging as compared to management in other sectors (Fried,
2000). This may be attributable to the complex nature of the heatlthcare industry in both public
and private sectors (Ozcan and Smith, 1998). According to a theory proposed by Anderson and
Black, the deteriorating status of healthcare delivery in the United Kingdom and, in turn, around
the world may be attributable to the disproportionate level of care provided to the people. It may
also show that within a market delivery system, the people who seek healthcare become
consumers who have the choice of buying their own preferential level of healthcare (1997). Thus
the prices and level of services in healthcare may become essential to healthcare organizations
who may wish to constantly improve the quality of their services while maintaining profitability
(D’Aunno, et al., 2000).
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It can be concluded that in order for healthcare organizations to maintain a certain level
of service, they must rely on a quality workforce to deliver the needed work quality. However, in
order for the workforce to do so, careful consideration must also be given to the process of job
evaluation and the pay equity system. Enabling the workforce to receive pay which they are due
on legal and ethical grounds would invariably improve the standards and quality of healthcare
delivery.
It has become important in this new era of globalization for companies to look beyond
the traditional process of labor deployment and see how it is undergoing a fast transformation,
both in terms of quality and quantity (Lemieux-Charles, et al., 2003). With the advent of
information and communication technology, there have been several changes in the models of
the work environment which may have made it necessary for both employers and job aspirants to
be updated of the various improvements that are replacing older models of office efficiencies
(Franco, et al., 2004).
The literature review will focus on the various aspects of the main thesis, seeking to
know whether job evaluation really contributes to the implementation of the principles of pay
equity in the healthcare organizations. First, a reference will be made to the concept of human
resource planning and how it relates to job evaluation and pay equity. This will provide an
understanding of the core concepts of job evaluation and pay equity by dissecting, analyzing, and
presenting various aspects of job evaluation and pay equity as well as their connections to both
the public and private sectors in the healthcare industry.
In this chapter, the differences in the quality of healthcare in various areas around
the world will then be discussed, and statistical data will be provided to prove its claims.
This will not only provide an outlook of the National Health Service with regard to the
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concepts of job evaluation and pay equity; it will also provide information regarding the
current standards and quality of healthcare in the United Kingdom through the use
previous studies. This literature review will conclude by show how these previous studies
relate to the main thesis.
2.2 Human Resource Planning
It has become essential to break down the job description in order to attract employees by
means of advertising, and to create an analysis of the job that gives the relative worth of
employment within an organization. This can facilitate the recruitment of individuals into the
company. Recruitment is a process through which the most qualified applicant can be selected in
order to be placed in the organization and help it to achieve its goals most effectively
(McConnell, 1993, pp.36-37).
The main purpose of this form of management has been to provide conditions that can
satisfy future human resource demands for an organization and to nullify any inconsistencies
within the interest of the organization’s employees. It also attempts to eliminate losses to the
company caused by less productivity, absenteeism, ineffective training regimens, and decreased
revenue. It has become an integral part of an organization’s structure and function due to its
relatively low cost and highly effective results (Advisory, Conciliation and Arbitration Service,
2008).
2.3 Job Analysis
One of the most important aspects of human resource management is job analysis. “Job
analysis is the process of systematically obtaining information about jobs by determining what
the duties, tasks and responsibilities of those jobs are in the context of a specific job” (Marie,
Muller and Bezuidenhout, 2006, p.254). What this has essentially entailed is the analysis of the
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job’s description and distinction from other jobs in order to form a valid hypothesis concerning
its evaluation to human resource managers. It is composed of two stages. The first is the
compilation of data and the second is the use of this data in the preparation of job descriptions,
job specifications, and job standards. When job description is given, it provides a written
statement which contains the obligations, capacity, principle and tasks associated with the job.
The job specification discusses the qualifications required, including ability, expertise,
knowledge, capacity to meet physical and mental demands, as well as aptitude required to
complete tasks that would be assigned (Marie, Muller and Bezuidenhout, 2006, pp.254-257;
Rowland, 1997, p.456).
The evaluation of a job is different from its analysis; however, both have shared many of
the same data functions which have precluded their involvement in the establishment and
recruitment of individuals within a company. It is also important to note that although job
evaluation and pay equity may be taken as separate entities, they would not be mutually
exclusive terms and may not be taken as such.
2.4 Job Evaluation
Keeping serviceable levels and maintaining quality control have become some of the
biggest challenges faced by HR managers and supervisors. This has led to the advent of policies
and practices that have made the determination of job description, specifications, and resulting
pay rates counter-intuitive. Today’s market has grown to require a more systematic and objective
approach to job placement and responsibility. In turn, it has become equally essential that
supervisors have a working knowledge of current laws and methodologies in the decisions
related to evaluating performance and thus deciding wages for their employees.
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Armstrong and Baron said that “Job evaluation is a systemic process for defining the
relative worth of jobs within an organization” (1995). This has been used to conclude that job
evaluation is a coordinated plan that has been used to methodologically ascertain data, leading to
suitable conclusions. These conclusions have provided the means to conclude the value of
various jobs within an organization. These values assess the contribution to the workplace by the
specified jobs and not the people themselves. In effect, it would not show the value of the job
within the market in which the company has been said to be competing; rather, it would show the
hierarchy of the job within the organization. Thus, it is contended that job evaluation does not
have any direct link to pay equity when related to the market, but it is used to determine internal
equity among other jobs in an organization (Armstrong and Baron, 1995, pp.13-15).
The main purpose of job evaluation has included the following:
• Quantify the constant quantity of job significance in a manner that is understood by
everyone
• Involve managers from the commencement until its dispensation and its eventual
modification
• Quantify the significance of the job itself and not the individuals who are doing it
• Pertain to broad clusters in functional groups (Armstrong and Baron, 1995, p.16).
2.4.1 Basic Approach
The basic approach toward job evaluation begins with decisions made by the
administrative body regarding the nature of the organization. Decisions need to be made
concerning the number of jobs required and how many of them need to be evaluated.
Additionally, there have been decisions regarding which schemes need to be employed in these
evaluations, whether they must be done on a case-to-case basis or using separate with different
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levels of responsibility. Once these decisions are made, the actual methodology of job evaluation
is put into place.
The methodology of job evaluation consists of four stages. The first stage is comprised of
the collection of data which is directly related to the responsibilities of the job itself and the
prerequisites required in order to function effectively within the organization. The second
includes the selection of compensable factors which determine the significance of the job within
the organization. This is said to include common factors such as ability, effort, familiarity,
responsibility, problem-solving ability, accountability, and physical and mental demands. The
identification of these factors has been followed by the definition of their significance within the
work concerned. The third stage has been argued to be the most essential. It is one where the
schemes in the jobs that may be evaluated are discussed (Marie Muller and Bezuidenhout, 2006,
p.258; Rowland, 1997, p.456).
There are two scheme types by which jobs are evaluated. They are analytical and nonanalytical
job evaluation schemes. Analytical schemes have been used to define the extent to
which the aforementioned compensable factors may be defined in order to present the relative
worth of the job in question. Non-analytical schemes have been employed to ascertain the value
of the job without considering such factors or the essential elements of the job being referred to.
Other schemes which encompass its broad definition include single factor based schemes, market
pricing and management consultants’ schemes (Armstrong, Cummins, Hastings and Wood,
2005, pp.4-7).
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2.4.2 Analytical Schemes
Analytical schemes are divided into two fundamental methods: the factor comparison and
the point method. The factor comparison is a quantitative method that employs the use of the
mentioned compensable factors by ranking each one in order of significance in relation to the job
at hand. Once each aspect of the job has been ranked, the factors are allotted fiscal merit
depending on their importance in the concerned job. However, it has been seen as a cumbersome
process since assigning the financial values to these factors in order to translate their worth into
actual pay equity can be time consuming (Thorpe and Homan, 2000, p.238).
In the case of the point method, it has been said to be the most widely used method to
evaluate jobs. It is based on the same principles as the factor method, but it differs by using the
concept of points rather than revenue in order to gauge the importance of the aforementioned
compensable factors. A range of points may be assigned to each individual factor, which
provides the company the importance of each factor in comparison to another. When the points
of these factors are allocated to the aforementioned job, it can be used to arrive at a conclusion
regarding the overall hierarchy of the job in question. Once such a hierarchy has been
established, the financial value of the job can be ascertained within the chain of command
(International Labour Office, 1986, p.80; Solomon, 1997, p.88-89).
An example of this would entail paying more to those above the chain rather than below.
This, as previously mentioned, is the most commonly used job evaluation scheme in
organizations today. However, although its use provides a secure system over time, it has the
weakness of having high administrative costs and it does not prove itself open to practical use
within smaller organizations (Berger, 2008, pp.100-104).
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2.4.3 Hay Method
The Hay Method of job evaluation is an analytical method developed by the Hay Group
that has been the most widely used proprietary method in both public and private sector
organizations in Britain for the past 30 years. It was developed by the use of a research program
which employed data from several thousand jobs, identifying the key elements which formed a
basic relationship to most jobs. The Hay Method may be used to employ the analysis and
measurement of three elements, which are know-how, problem solving, and accountability
(Poels, 1997, p.57).
The Hay Method further states that these three elements have further sub-elements and
are affected by environmental and physical factors. The know-how element consists of an
understanding, ability, and aptitude to not only do the job but also to have the ability to employ
specialized knowledge related to the work, organize and manage a network of relationships, and
keep them established in order to achieve results (Bramham, 1994, p.54). The problem-solving
element may show an aptitude to analyze and evaluate a situation and offer suggestions within
the boundaries of originality and policy set by the company in question. Finally, accountability
includes the responsibility of the individuals within their job set. It may be directly affected by
the amount of freedom of the individuals to act within the job and the amount of impact they
have on their peers. The factors that can contribute to the performance of these elements, namely
the physical and environmental factors, are concerned with the amount of pressure placed on the
individuals as well as the working conditions provided for them carry out their daily tasks (The
Hay Group, 2009).
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2.4.4 Skill-Based Schemes
These schemes are used to determine the various compensable factors required by
individuals at various levels. These factors are then equated toward the responsibilities held by
individuals within their job description in order to ascertain whether they can carry out their
tasks at that level. Thus, in order to ascertain the amount of skill the individual has with regard to
the job, various factors are assigned importance within the job description (Cooper and Locke,
2000, pp.18-20).
2.4.5 Market Pricing
Market pricing is a scheme that has been used either individually or in conjunction with
other job evaluation schemes in order to ascertain the pay equity within various organizations.
This method has employed the use of market appraisals of various jobs in order to fix rates and
employ policies within an organization. It should be noted, however, that this is not considered a
method of job evaluation in certain academic circles and merely provides a guideline for the pay
structure, which may be adopted by various companies. Oftentimes, internal evaluations directly
related to analytical schemes may be used in conjunction with this scheme in order to ascertain
the pay grade of various employees (Armstrong, Murlis and Group, 2007, pp.139-140;
Armstrong, Cummins, Hastings and Wood, 2005, pp.23-25).
2.4.6 Single-Factor Schemes
Single-factor schemes are those that, in accordance with its name, employ the use of one
compensable factor in order to evaluate various jobs. There are two methods which may be
employed: the first is decision banding and the second is time span of discretion. The decision
banding scheme is based on the principle that every job demands a certain standard of decision
22
making. The hierarchy of the job in question within the organization provides the level of
responsibility attributable to various decisions.
Time span of discretion is the maximum amount of time in which an employee may act
with anonymity without any authority imposed by the supervisors. The various components of
these schemes are dependent on certain variables such as the difficulties of the job itself and the
employees’ perception of time; thus, this cannot be seen to be feasible in practice (Rees and
Porter, 2001, p.154).
2.4.7 Non-Analytical Schemes
As mentioned before, non-analytical schemes have not taken the compensable factors
into consideration. Rather, they have compared the entire jobs with each other without
considering the factors that provide their makeup. The schemes that may comprise this form of
job analysis can consist of four types. The first method may be one of job ranking, which
establishes the hierarchy within various jobs (Solomon, 1997, p.83). The second can be paired
comparison, which also establishes the ranks of various jobs by using statistical measurements.
Job classification is the scheme which establishes a correlation between various jobs and job
grades by comparing both. The last scheme is considered to be internal benchmarking in which
jobs are compared with benchmarked jobs that have already been graded. These benchmarked
jobs are assumed to have been graded correctly and may be used to correlate jobs according to a
broad comparison (Treiman, 1979, pp.2-3).
2.4.8 Management Consultant Schemes
Management consultant schemes are various methods of job evaluations, which are
developed by external organizations and leased to various industrial, service and public
organizations. Once the various schemes detailed above have established the evaluation of
23
various jobs, the use of benchmark jobs may be employed in order to understand the evaluation
of jobs with less obvious qualifications. They may also be used to match these jobs with other
organizations in order to establish a market rate for these types of jobs. As mentioned before,
benchmarking is also one of the schemes used to evaluate jobs. However, in this case, it may be
used to identify a less obvious range of job descriptions.
Once the benchmarking is completed, there may be an exploration of the relative values
inherent in various jobs. Characteristic elements such as the relationship with other jobs, level of
responsibility, and impact on resources are also considered. The penultimate part of job
evaluation is role analysis where the systematic information regarding the role the job requires
from the employee may be presented as an answer to a structured questionnaire. Finally, the last
portion of the job evaluation establishes pay rates or fixes individual rates for the job in question
(Wright, 2004, pp. 54-55).
2.4.9 Compensation Strategy
In order to meet their goals, it is essential for various organizations to adopt strategies
that not only meet their goals but also meet the needs of their employees. The compensation
strategy is geared toward creating an environment that can attract and keep employees. In order
to accomplish this task, the compensation strategy follows four key elements. The first is the
compensation philosophy, which is based on an organization’s structure and culture. Financial
constraints, which show how much the company is willing to compensate its employees, is an
element based on the financial situation. The total rewards program details how an organization
may reward those who perform well and provides the structure for administering pay. The
structure for administering pay may encompass a strategy that allows certain elements to be
24
managed fairly. Among these strategies include elements such as pay grades, pay ranges, and
salary guidelines (Bogardus, 2004, pp. 88-92).
2.5 Legislations in the United Kingdom
2.5.1 Equal Pay Act of 1970
It was not until 1970 when the United Kingdom Parliament passed the Equal Pay Act
following the passage of a similar act in the United States in 1963. This act allowed the
enforcement of several laws which brought equal rights for treatment and employment of women
in the workplace. It modified all existing employment contracts in order to make them more
equitable to those of men in the workplace. It also demanded equal value within the workplace
for all women as long as their job descriptions are broadly related to those employments held by
men. However, these differences must not be of practical importance in the workplace. It was
fully legislated on December 29, 1975. It should be noted, however, that although this legislation
encompassed equal pay for women, it does not include any proposal for equal pay for minorities
who have a much larger pay gap in the United Kingdom than women (United Kingdom
Parliament, 1970).
2.5.2 Sex Discrimination Act of 1975
The Sex Discrimination Act of 1975 was an amendment to the Equal Pay Act of 1970. It
was created in order to affect laws that prevented both direct and indirect discrimination against
women. It was written in various law provisions, which defined discrimination against women in
the workplace. It spoke of discrimination as being defined by certain considerations within areas
of employment. It could encompass situations in which men had advantages over women in
terms of treatment. It also wrote into effect a statute which proposed that discrimination
encompassed women not being treated equally to men as long as the number of women who
25
were under such conditions are considerably lower than the number of men as well as in such
cases where they were in larger number than the men (United Kingdom Parliament, 1975).
2.5.3 Equal Value Regulations of 1983
The Equal Value Regulations of 1983 were another significant amendment of the Equal
Pay Act of 1970. The original Equal Pay Act was a huge step for the women’s civil rights
movement in the United Kingdom in the 1970s. It instituted conditions of employment, which
specified that women in the workplace must be paid the same as the men as long as their work
could be compared to that of men in the workplace. However, the term “like work” within the
document created certain difficulties for women who sought equal pay. The term merely
specifies that employment pay held by women is comparable to those of men according to their
job description and not the standard definition of such work. Employers may have often taken
liberties in their compliance with the act’s original intent. These regulations passed in 1983
changed this by standardizing women’s pay as being comparable to pay over various types of
employment (McCrudden, 1983).
2.5.4 Race Relations Act of 1976
This was the first act in the United Kingdom that was solely developed toward Pay
Equity for people of different races. The document is notable for defining direct and indirect
discrimination in terms of race, ethnic, or national origins. It also passed into legislation
proposals that protected such individuals from maltreatment and imposed drawbacks as when
compared to other people in the workplace. Such proposals were suggested in the areas of social
security, healthcare, social protection, and social advantage. It was further amended in 2003 to
include a new definition for indirect discrimination according to the legislation and a new
definition of harassment according to a person’s race, ethnic, or national background. The new
26
amendments also removed the size of partnerships that could discriminate against such people
and also spoke of the proof required to bring prosecution against charges of discrimination in a
court of law (United Kingdom Parliament, 2003).
2.5.5 The Disability Discrimination Act of 1995
This act was passed in 1995 and may have been created to hinder the unlawful
discrimination against disabled people in regards to employment, procurement of goods,
facilities, services, administration of a property, make stipulations regarding the employment of
the disabled, and to establish the National Disability Council. The act not only defined a disabled
person as a person who has a disability related to his or her physical or mental functioning that
may have a long-term undesirable effect on his or her day to day activities, it also provided
regulations for properly defining an individual as being disabled. The act may also be notable for
creating proposals to protect disabled people from discrimination in the workplace and ensuring
the educational rights of such people. The act also brought in law statutes that formed the
National Disability Council (United Kingdom Parliament, 1995). The act was further amended in
2003, adding new definitions for discrimination and harassment as well as imposing fines on
employers who undertake such actions. It added several new sections, which specifically speak
of proposals forbidding harassment and discrimination of such individuals in the workplace. It
also authorized the Disability Rights Commission to enforce such legislation (United Kingdom
Parliament, 2003).
2.5.6 The Employment Equality Regulations of 2003
These regulations enacted on December 1, 2003 were created to protect individuals from
victimization and harassment due to their sexual orientation by defining the statutes surrounding
employment contracts in the United Kingdom. It provides regulations that give details on how
27
such contracts may be decided. It also provides protection for individuals from sexual
discrimination by their employers in the workplace. It has several sections that specify the terms
of discrimination in various areas of employment in the United Kingdom and also prohibit
discrimination against the procurement of goods, facilities, education, and public services
(United Kingdom Parliament, 2003).
2.5.7 The Employment Equality (Age) Regulations 2006
The Employment Equality (Age) Regulations was passed into law in 2006. It protects
individuals from harassment and discrimination in the workplace on the grounds of their age.
The regulations may not only provide protection for the employee but also for the employer as it
establishes regulations regarding age which would allow an employer to keep an employee under
contract. It also provides the employee with legislations protecting their pensions and death
benefits (United Kingdom Parliament, 2006).
2.5.8 Equality Act of 2006
The Equality Act was passed in January 2007 and was created to provide equity in all
areas of employment and services in the United Kingdom. It speaks about outlawing
discrimination on the basis of religion or belief and also against discrimination in provision of
services due to sexual orientation as well as promoting equity in gender roles in the workplace.
The act also proposed the creation of the Equality and Human Rights Commission, which
replaced the Commission for Racial Equality and the Equal Opportunities Commission and the
Disability Rights Commission (United Kingdom Parliament, 2006).
2.5.9 Equality Act of 2007
The Equality Act of 2007 provides further legislation to prohibit discrimination on
grounds of sexual orientation in the procurement of facilities, goods, education, and public
28
services. It also provides requirements by which standards of discrimination may be addressed
and an assertion of unlawful action may be brought before a court of law (United Kingdom
Parliament, 2007).
2.5.10 Equality Bill
The Equality Bill is a proposal that has been published in 2009 with the aim of being
passed as a law by spring the following year. The goal behind this bill may be to merge the
framework for discrimination legislation in the United Kingdom as well as tackle problems with
equality and discrimination, which continue to persevere. The bill not only harmonizes previous
legislations, it also provides proposals to lessen socioeconomic boundaries ad gender pay gap
using public services to improve equality and changing definitions of discrimination and
harassment to include a much broader viewpoint (Government Equalities Office, 2009).
2.6 Link of Pay Equity to Job Evaluation
As mentioned before, Job Evaluation and Pay Equity are not mutually exclusive
concepts. Rather, they are part of the same process of wage determination within organizations.
The importance of job evaluation may be directly related to the establishment of Pay Equity. Job
evaluations are essential to the determination of both internal and external equity. Internal equity
is the value of the job within the organization according to an established internal hierarchy
while the external equity is the comparison of internal equity to market rates. Generally, the
compensation plans for jobs within organizations are set according to the internal or external
equity rates. Thus, those individuals in a managerial position may be paid more than those in a
candidate position. It may follow that the financial revenue of the organization is dependent on
the increasing or decreasing number of employees (Caruth and Handlogten, 2001).
29
2.6.1 Outlier
Occasionally, there will be certain occupations that have higher or lower compensation
rates due to market demand thus causing the underpayment or overpayment of such individuals.
Such occupations are known as outliers. Outliers may not be affected by market rates and are
more prone to compensation rates decided by internal equity. Hence, it is important to give
consideration to the fact that certain professions have a high and low outlier due to a higher or
lower number of candidates respectively. An example of a high outlier would be of physicians
practicing cardiac surgery who tend to be overpaid and one of low outlier being nurses who tend
to be underpaid (Solomon, 1997).
2.6.2 Incentive Plans
Incentive plans are those in which an employee may receive some form of bonus due to
an increase in performance judged by pre-decided indicators. Incentive plans have generally
been seen as essential in organizations in order to achieve integration among staff. The
application of such incentives may be in the form of annual leave, payment rates, sickness
policy, improving working lives initiatives, flexible working initiatives, and the overall terms
and conditions of employment (Solomon, 1997, pp.95-99).
2.6.3 Pay for Performance
Pay for performance refers to the implementation of a new organizational structure,
which has been adopted by the Health Maintenance Organizations in the United States and the
National Health Service in the United Kingdom within the last 10 years. The pay for
performance plan is used to decide internal equity within these public organizations using
performance indicators similar to those used in incentive plans. A 2007 annual survey conducted
30
by Hewitt Associates found that 90 percent of companies in the United States use some form of
pay for performance program (Berger, 2008, p.544; Kovner, Knickman and Jonas, 2008, p.423).
2.7 Job Evaluation and Pay Equity in Private Sector Health Organizations
In order to construct a compensation plan, which may include considerations for job
evaluation and pay equity private hospitals and organizations, companies may delegate such
work to a consultant. However, it should be noted that companies who undertake the decision to
outsource their compensation concerns merely delegate the process of data collection, published
wages, and salary surveys. All administrative decisions are undertaken within the organization.
Two systems which are most commonly employed for job evaluations in private sector health
organizations are point systems and the Hay Method. A survey of 316 companies, of which 55
percent were from the private sector, found that 32 percent of the private sector companies that
used a job evaluation system used the point systems while 68 percent used the Hay Method
(Armstrong and Baron, 1995, pp. 279-84).
2.8 Job Evaluation and Pay Equity in Public Sector Health Organizations
Compensation plans, job evaluation, and pay equity in public healthcare organizations are
usually decided by the use of alliances and networking between different hospitals. Thus, they
may conduct their own evaluations of internal equity in order to ascertain the pay rate. They can
do this by employing a joint task force, which can identify several performance factors directly
related to different professions within the medical industry. The other method to accomplish this
internal evaluation is for individual hospitals to employ a point plan in order to form their own
database for job analysis and evaluation. The difference between these two methods is that by
employing a taskforce, public health organizations can employ standard pay grades for different
occupations while the hospital job evaluations can provide information to establish individual
31
hospital pay grades. The system that is most commonly employed in public sector health
organizations is the Hay Method. A survey of 316 companies, of which 66 percent were from the
public, found that 32 percent of the public sector companies that used a job evaluation system
used the point systems while 68 percent used the Hay Method (Armstrong and Baron, 1995,
pp.279-284).
2.9 Quality of Health Care in Private and Public Health Care Organizations
In order to assess the effectiveness of private and public healthcare organizations, it is
important to use quality of care as one of the measures of assessment. Implementation of
performance measures and the use of these results are essential in order to promote the best
healthcare standards. This is essential in attaining patient and physician satisfaction (Tooker,
2005). In China, arguments against the quality of care have actually resulted in the legislation
banning private practice in rural areas. They have provided data which shows that the level of
private care is lower than that of public institutions since they are not geared toward promoting
preventative care (Meng, Liu and Shi, 2000).
On the other hand, in Africa, it has been found that private healthcare providers are the
most important sources of healthcare and pharmaceutical needs in the country. However, its
public health sector is severely lacking in proper funding and providing benefits for its
constituents (Prata, Montagu and Jefferys, 2005). Another study conducted in middle- and lowincome
countries found that there is a growing concern over the guidelines and protocols
established by local pharmacies despite their importance in promoting healthcare (Smith, 2009).
Another comparative performance survey conducted in Sierra Leone found that the
workforce in government hospitals to maintain a higher level of HIV-infected supplies in
comparison to private hospitals due to a shortage of knowledge and resources among the
32
population (Kingham, Kamara, Daoh, Kabbia and Kushner, 2009). In order to maintain the
quality of healthcare in several countries, the decentralization of the healthcare delivery and
financial system has been recommended in order to cut costs without impacting the quality of
care provided. Decentralization refers to separate entities assuming responsibility for both these
institutions in an effort to create better performance levels (Geyndt, 1994, p.55).
2.10 Working Conditions in Private and Public Health Care Organizations
Companies in private and public healthcare organizations are constantly trying to
improve working conditions and environment for their staff as one of the incentives for their
continued performance at work. With the increasingly deteriorating world economy, there have
been apprehensions regarding the quality of work life in the public sector. This is especially true
considering the increasing practice of non-permanent employment (Virtanen, et al., 2006). There
has been a growing concern within the public sector, however, of the increasing privatization of
hospitals due to financial incentives. There are concerns within the healthcare industry that with
increasing privatization of healthcare, the call for individual contracts within the public sector
will cause the equal pay for work aspect to disappear and affect the rights and dignity of medical
practitioners (Soumeli and Nergaard, 2002). However, there is evidence that there is a greater
deal of stability in the public sector compared to the private sector and that if public
organizations paid wages that were comparable to those in the private sector, it would increase
employment in said sector (Bellante and Link, 1981).
2.11 Public-Private Partnerships
Before this aspect of the healthcare system is delved into, it is important to first consider
what public-private partnerships actually are. Public private partnership rather than be defined as
privatization of certain aspects of public sector healthcare may actually be an undertaking by
33
both sectors in order to share the responsibilities of a task in order to reach a successful outcome.
Perhaps, the most prolific example of this system is in Africa, where the public sector healthcare
does not have many inroads into the African population and thus, cannot effectively deliver unto
them the medicines and healthcare they would require to survive. In order to resolve this
problem, the government is using its partnership with companies in the private sector to ensure
that there is a wider distribution net not only for pharmaceuticals but also for healthcare among
its people (Widdus, 2001). Other partnerships in recent years have included the medicine and
reason project in Austria, which was created to provide flyers with disease and treatment options
for patients as well as an online component with the same information accessible, along with
guidelines for doctors. The project printed 260,000 flyers and provided 18,000 guidelines, all at a
reasonable price. Another project from Denmark known as the Infomatum has an objective to
increase the existing standard of knowledge of doctors regarding medicines so that they may
make better decisions regarding their patients. To date, a website along with a book has been
created in order to complete this task (Pharmaceutical Forum, 2008).
2.12 National Health Service
The National Health Service was launched 60 years ago and is currently the world’s
largest publicly-funded health service under the Department of Health. It operates upon the ideal
of free universal healthcare and is open to 60 million residents of the United Kingdom.
The name of the National Health Service may be used in reference to four public sector
healthcare organizations in the United Kingdom. The system of NHS operates not only in
England but also in Northern Ireland, Scotland and Wales. Each of the system operates without a
central body, meaning, they are autonomous from each other and is politically attached to its
respective government. It does not discriminate against any individual in terms of services in the
34
United Kingdom. Any resident who is a member of the National Health Service may receive
treatment in another.
The NHS is known to employ more than 1.5 million people in the United Kingdom. 1.3
million of these individuals are situated in England. It hires 90,000 hospital doctors, 35,000
general practitioners (GPs), 400,000 nurses, and 16,000 ambulance staff who cater to patients in
England, Scotland, Wales, and Northern Ireland. On a 36-hour average, the system deals with 1
million people, with each general practitioner treating 140 patients every week on average. It
spends 60 percent of its budget to pay the staff and 20 percent on drugs, with the rest being used
for various reasons such as equipment or training (National Health Service, 2009).
Currently, there is an allocation of one hundred and £64 billion pounds to the National
Health Service between 2009 and 2011, of which £80 billion will be used in 2009-10, and £84
billion will be used in 2010-11. It has recently established a new agreement in November 2008
with successful negotiation of the new Pharmaceutical Price Regulation Scheme. This scheme
will save their companies’ funds to the tune of 350 million pounds a year in 2009-10 and 550
million pounds thereafter.
Although the National Health Service was originally established as a free universal
healthcare system, it has since been systematically started to become more privatized and has
dismantled various health services. Due to their increased capital spending in the 1970s and
increased financial losses in the ‘90s, the NHS changed their modus operandi and became more
business-like. It has consulted its staff and general practitioners to act more like businessmen
rather than doctors offering free healthcare. The original concept of service integration and cost
sharing disappeared and the current organization adopts a more case by case based policy
(Pollock, 2004, pp.1-46).
35
In 2008, the National Health Service began an expansion of its patient choice program
based on survey, which showed that an overwhelming number of patients, 65 percent, wanted
choice of treatment. This program entails that patients would be given a choice which specialist
they wished to see within any hospital covered by the National Health Service, and they may
choose between being treated by private hospitals as well as National Health Service providers.
These choices would not be applicable when it comes to maternity issues and mental health
(Department of Health, 2009). The National Health Service currently provides several services
including those related to doctors, hospitals, social care, opticians, minor injuries and walk-in
centers.
2.13 The Constitution
The National Health Service Constitution was published on the 21st of January 2009 and
established the principles and values of the National Health Service. It provides for the first time
in its history guidelines for what its patients, staff, and the general public can expect from the
healthcare system. It also provides guidelines regarding rights and responsibilities of the patients
and staff affiliated with the National Health Service.
The National Health Service Constitution provides seven key principles which are said to
embody the guiding values of the NHS. They are as follows:
• Provision of comprehensive health services to all individuals regardless of age, gender,
race, disability, sexual orientation, religion, or belief. It further speaks of its duties
regarding the promotion of equality in its services and providing improvements in sectors
which require it
• Provision of health services according to need, not payment, with an emphasis on free
healthcare
36
• Provision of the highest standards of healthcare, with an emphasis on training and
management toward achieving said goals
• Provision of services according to the preferences of the patients, their families or those
who take care of them
• Working with private, public, and third sector organizations to provide improvements in
healthcare for the interests of their patients
• Providing the best healthcare indicative of public funding
• Accepting accountability for its decisions regarding the organization and the patients and
the communities it serves (Department of Health, 2009).
2.14 Previous Studies
A survey conducted by the job evaluation handbook of approximately 1,000
organizations concerning their job evaluation methods had a response rate of 33 percent with 316
organizations responding. According to the book, 24 percent of the respondents were from the
public sector, 33 percent from the private manufacturing sector, 36 percent were from the
voluntary sector, and 7 percent were described as being from another sector altogether. The
survey showed that 59 percent of these organizations employed 500 people or more, 32 percent
employed between 100 and 499 people, and 8 percent employed between 50 and 99 people, with
1 percent employing less than 50 people (Armstrong and Baron, 1995, pp.13-35).
Of these respondents, a total of 55 percent were found to use job evaluation techniques.
Of these, 66 percent were in the public sector, 52 percent were in the private sector, and 55
percent were respondents who described themselves as being from another sector.
37
Among the ones who said they did not use a proprietary system, the point’s factor rating
classification scheme was said to be widely used. However, 34 percent said that they had to
customize the scheme for their own uses.
According to the answers provided by the questionnaire, 68 percent of them used a
proprietary brand scheme of which the Hay Guide Chart was the most popularly used at 78
percent of the respondents at some or all levels of their organization. Forty-six percent of
respondents said they used the Hay Guide Chart at a managerial level while 28 percent said they
used it at all levels of their organization (The Hay Group, 2009).
Among the respondents who did not use job evaluation, 41 percent said they used
supervisory judgment in these cases. While 36 percent made use of market rates, 26 percent said
they used skill-based systems. Moreover, 14 percent used pay statistics and 12 percent cited
union negotiations. Six percent cited individual negotiations, and finally, 6 percent said they used
other means to decide the pay rate of their staff. Among these, 45 percent did not use job
evaluation techniques, and 22 percent cited plans to implement such a system in order to
establish a fair and balanced pay rate. Sixty-one percent of these individuals purported to
establish their own customized scheme of job evaluation while 19 percent said they would
employ proprietary systems in this case. Sixty-five percent of the respondents said they were
satisfied with their current job evaluation scheme, with 21 percent expressing some
dissatisfaction and only 4% being completely dissatisfied (Armstrong and Baron, 1995, pp.279-
84).
According to the Department of Health, the biggest constraint facing the National Health
Service today is the shortage of human resources (Department of Health, 2000). With the
increasingly rising demand for healthcare, surveys have shown that the National Health Service
38
is experiencing one of the worst shortage of nurses in its history. The survey found a fall of 26
percent in qualified nurses between 1990 and 1998. Additonal information from the survey
showed that the biggest issues facing the organization involve the retention of nurses who have
already been recruited (Newman, Maylor and Chansarkar, 2002).
According to Humphrey and Ehrich,when they studied the real-world implications of the
policies set by the National Health Service, they found that the policies of the National Health
Service directly impacted human resource management and had a direct effect on the standard of
care despite not being intended for such a purpose. The article also stated that the long-term
effects of such policies are vague due to effects detailed previously (2003).
A survey by Newman, Maylor and Chansarkar found that the Health Service had
considerable difficulties retaining nurses of Grade D and E. Grade D refers to those nurses who
are responsible for direct care and Grade E nurses are considered as replacements for Grade G
nurses as well as providing direct care. Grade E is considered senior to Grade D. Reasonings
behind the fall in rentention included but were not limited to longer working hours, heavy
workloads, staff shortages, inability to finish work at the end of shifts, overtime work not
rewarded, lack of funds for training, vacancies not being filled, and a fostering of a culture where
nurses pay for their own training. The survey further found that job satisfaction was the number
one reason for retention among nurses with job characteristics and personal motivations taking
subsequent places (Newman, Maylor and Chansarkar, 2002).
Another study on the methods employed by the National Health Service to benchmark its
various institutions found that the main method used by the NHS to guage performance was a
balanced scorecard. This balanced scorecard not only acted as an indicator of performance, but
also provided a framework for future financial growth (Chang, 2007).
39
However, the study found that this scorecard was not viable as a strategic management
tool since it does not take into account the various goals of healthcare organizations. The study
also found that the scorecard did not serve the public trust, rather, was more politically motivated
and cited targets for delivery of healthcare which were unfeasible and did not significantly
impact local operations or performance. Instead, it merely created percieved performance levels
from its various constitutents in order for the NHS to secure its various shareholders and thus its
monetary concerns (Chang, 2007).
Within these performance evaluations are also proposals for clinical governance of
doctors, which have been percieved by doctors in the National Health Service as being an
imposition rather than a prospect. They see such governance as a compulsion put upon them
rather than an opportunity (Som, 2005). Another study showed that the fault may not lie in
clinical governance of doctors but rather in the management which does not have the skills or
training to engage with their colleagues (Davies, 2006).
2.14.1 Job Evaluation in the National Health Service
After the Second World War and the formation of the National Health Service, there was
no formal job evaluation or pay equity system in place within the organization. The negotiations
for pay structures would be primarily handled by bargaining on a case by case basis and would
remain relatively unchanged for the next 40 years. The General Whitley Council and several
other committees and sub-committees were responsible for these negotiations.
It was only thereafter that in the 1930s when the NHS abandoned the bargaining structure
and introduced a system of clinical grading. One of the most well-known forms of this system
was the type that was attributed to nurses and midwives. The grading system used grades A to I
to gauge the skills and competency of various nurses. This methodology was similar to the job
40
evaluation analytical scheme known as the point method. Much like the point method, the
grading system used various factors inherent to nursing or any other position in an effort to form
a financial hierarchy within its hospitals.
The establishment of such grading practices was followed by the introduction of
independent pay reviews in 1971. These pay reviews held a similarity to the market pricing
scheme as it took information from various sources and using this recommended pay increases. It
also used these sources to do various job analyses and to form various job descriptions. Despite
this, certain staff continued to use bargaining in order to increase their pay grades.
It was not until 1992 that the NHS introduced new grading and pay structures which were
based on existing job evaluation systems. One of the systems this structure was based on was the
Hay System, which was purported to be one of the most widely used evaluation systems in the
world. Once the new system was in effect, discrepancies emerged in salaries between individuals
with the same job description but differing in occupational backgrounds. Problems with
establishing pay grades also cropped up and this led to low pay grades in the National Health
Service, leading to problems with employment and retention of individuals. It can be clearly seen
through this that the National Health Service at this time did not only have a compensation
strategy for its employees, but had also not fully implemented any job evaluation system, leading
to unequal pay among its employees. Thus, inevitably, the path to the decentralization and
increased privatization of the National Health Service was paved (Department of Health, 2004).
2.14.2 Pay Equity
Before the inception of the Pay Equity Act of 1970, the female medical staffs were paid
lower rates than their male colleagues despite equal pay being promised by The Royal
Commission on Equal Pay in 1948. As mentioned above, although the Equal Pay Act made such
41
gender gaps illegal, the concept of “like work” or similar work under a job evaluation scheme
restricted the effect of such laws in healthcare. It was not until 1984 that an amendment to this
act considered that women could carry out work of equal value as their male counterparts.
Currently, the National Health Service has a single-job evaluation scheme, which supports a
review of their pay policies. They have created three pay hierarchies that cover doctors and
dentists, professional groups, and remaining non-pay body staff (Department of Health, 2004).
2.14.3 First Job Evaluation Working Party
Created in the mid-1990s, the First Job Evaluation Working Party was to review various
job evaluation techniques and to develop a “kitemarking” system in order to meet equality
standards set by the health reform legislation in 1992. Through kitemarking, they would use a
number of schemes within the National Health Service in order to determine which one of them
functions best.
Not only did this committee wish to find a job evaluation scheme that would meet all the
criteria of the National Health Service but also employ a system that would ensure that there was
no discrimination among its employees. The findings of these tests showed that not all criteria
would be met by kitemarking schemes. It was decided that the only way for the National Health
Service to achieve its criteria would be to tailor its own schemes according to its own
specifications (Department of Health, 2004).
2.14.4 Agenda for Change Proposals
In 1999, the National Health Service, in an effort to modernize its pay structure published
a set of proposals known as the Agenda for Change, which proposed a single-job evaluation
scheme to cover all employments in the National Health Service and using it in order to review
payment plans as well as other terms and conditions for their health service employees.
42
Following the publishing of this paper, the National Health Service reformed the Job Evaluation
Working Party to create a new job evaluation and payment structure for their organization. In
order to accomplish this, they first identified the key factors that were central to any work
associated with the National Health Service. Once they identified these draft factors, they refined
them by means of a questionnaire and then set “draft levels of demand” for each factor. These
draft levels were then used to create a specific questionnaire, which was reviewed by job analysts
to ensure their accuracy. Then, results of this survey were input into a computer database, and
the results of the scoring were used to match them to jobs which would be suitable. This was
continued to be developed over time. This development includes the use of computerization in
order to automate the job evaluation system (Department of Health, 2004).
2.14.5 Equality Features of the Scheme
In order to ensure equality in its job evaluation scheme, the National Health Service
certified that there were certain characteristics in its construct. The features which promote
equality in this system are as follows:
• There were a significant number of factors being considered.
• There was an inclusion of specified factors in order to ensure that jobs, which are
predominantly occupied by the female gender such as nursing, are fairly measured.
• A conscious avoidance of the use of the factor level definitions in defining the skills of an
individual and thus operating in a discriminatory manner.
• The scoring and weight portion of the evaluation are fabricated in order to reflect the
principles of gender neutrality. It is also to ensure that no responsibility factor is given
preference over another.
43
• A detailed overview of the matching procedure was also taken in order to ensure that all
the jobs being evaluated were done according to the national benchmarks associated with
them.
• Insurance that there is no bias within the process.
• The use of a thorough job analysis questionnaire in order to make all pertinent
information was made available for local examinations (Department of Health, 2004).
2.14.6 Job Evaluation in the National Health Service
The current job evaluation structure of the National Health System is based upon a
mixture of the Point and Hay’s Method. The job evaluation measured various factors that were
used to conclude further based on the skill level of the individual in the given factor and the
nature of the factors being measured. The factors which encompassed the job evaluation included
communication and relationship skill, knowledge, training and experience, analytical and
judgmental skills, panning and organizational skills, physical skills, responsibilities for the care
of the patient, policy and service responsibility implementation, financial and physical resources
as well as for human and information resources. Other factors included the freedom for research
and development as well as the freedom to act, the physical, mental and emotional effort and
finally the working conditions available (Department of Health, 2004).
2.14.7 Current Job Evaluation Structure
With the inception of the agenda for change, the National Health Service instituted eight
pay bands within the organization. These pay bands are gauges for financial incentives within the
organization, which are attributed to various individuals on the basis of the National Health
Service Job Evaluation Scheme.
44
This job evaluation scheme begins with collaboration between the Department of Health
and various representative unions. The two parties endeavor to work together to ensure that the
job evaluation scheme is equitable to both the company and its employers.
At first, employees will be asked to complete a job analysis questionnaire that gives
consideration to certain specific job-profiling factors (Department of Health, 2003). These
factors have been pre-decided within the job evaluation scheme along with the questionnaire that
will assess them. The job factors which are profiled include the following:
• Interaction Skills
• Experience, Expertise and Education Received
• Investigative and Reasoning Skills
• Preparatory and Managerial Skills
• Physical Skills
• Accountability for Patient Care
• Accountability for Strategy and Service Developmental Implementation
• Accountability for Monetary and Physical Resources
• Accountability for Human Resource Management
• Accountability for Research and Development
• Liberty to take Action
• Physical Effort
• Mental Effort
• Emotional Effort
• Working Environment
45
Once the questionnaire has been completed, it is then assessed by a job evaluation
committee, which creates a job profile for the post in question based on the answers given in the
questionnaire. This job profile may be further altered according to the requirements of the staff
where it is being implemented. The creation of the job profile can follow nationally established
guidelines along with changes that may be made locally to the job framework.
Aside from the factors that were considered above, there are also other factors which are
taken into consideration in the questionnaire. These factors are directly related to the working
conditions within the post in question. These factors can range from level 1 to level 5. Level 1
gives consideration to occasional exposure to unpleasant or dangerous working conditions, while
level 5 gives consideration to frequent exposure to such hazardous working conditions.
The completion of the initial profile allows it to be considered by various agencies and parties
until changes can be implemented, which give it more recognizable features of the post in
question. Thus, the creation of the job posting is a combination of organizational, personal and
specific job descriptions (Savage, 2004).
2.15 Critical Article Analysis
2.15.1 Job evaluation for clinical nursing by implementing the NHS JE system
This study focuses on evaluating all the clinical nursing jobs that implement the NHS job
evaluation system in four hospitals. The aspects of job evaluation are used by many
organizations and job evaluation is considered as systematic procedures that are actually
designed to know the relative worth of a job. It is a measurement between the worth of the job
and wages (Kahya and Oral, 2007). Different organizations of the world have adopted this
phenomenon, and the ultimate role of job evaluation is salary administration. The National
Health System was developed in UK and initiated by the Department of Health. In the healthcare
46
system, this job evaluation system is considered as a significant change in the last few years. A
number of 13 national nursing jobs in the nursing service arena are associated with NHS JE
system. The common jobs in the nursing circle like nurse specialists, nurse team leader, and
nurse team manager among others are evaluated through this system. This system strengthens up
the human resource system of an organization and this NHS system strengthens up the HR
systems of hospitals.
The NHS JE is considered as one of the most viable changes in the nursing sector (Kahya
and Oral, 2007). This system changes the conventional methods of pays and the career structure,
payment scales and the condition of employment. There are about 16 factors on which the NHS
JE system evaluates. These factors are classified into five groups which are skills, responsibility,
freedom to act, responsibility, effort and the working conditions. Different factors are allocated
to these groups. Besides that, certain weights are also allocated to these groups which are 48
percent, 42 percent, 7.5 percent, and 2.5 percent. In this system, there are certain job scores that
are calculated and they range from 340-385 points for the nursing job. Furthermore, there are
certain bands that are linked to the points and the range of these points and band are given below:
Band 1= 0-160 points
Band 2=161-215 points
Band 3=216-270 points
*There are 9 bands. Only 3 are discussed here.
Strategists suggest that the element of job evaluation can be conducted through two
different processes (Kahya and Oral, 2007). These two processes are matching and local
evaluation. Similarly, these two processes are further divided as the matching process involves
47
three stages. The first one is the 44-page questionnaire of job analysis, seeking the assistance
from the line manager and reviewing the questionnaire.
The NHS system has been reviewed extensively by different experts and is accepted in
different parts of the world. However, it has also been agreed upon by different analysts that this
system is fit for the purpose. The second edition of this system was published in the year 2004.
A total of 13 job titles are used in the nursing services and these service categories are
linked with the meaning to staff in terms of career development and are associated with the
nursing profession. The ultimate aim of this study is to score all the nursing jobs in the study
hospitals (Kahya and Oral, 2007). Therefore, it can be said that the NHS system is appropriate.
This case study was developed in four hospitals and the procedure includes: 1) selecting the job
category; 2) gaining the information using the job analysis; 3) evaluating and the scoring the
jobs; and 4) comparing the job scores. Similarly, the participants who took part in this project are
nurses and their supervisor who belong to regional and local hospitals. Among the entire
population, 158 nurses were sampled in this research. A questionnaire was used to collect the
data, and the questionnaire was designed with the factor headings of NHS. However, the
response rate of the questionnaire was 79.11 percent, and certain questionnaires were cancelled
because of contradictory comments (Kahya and Oral, 2007).
In order to attain the results, the questionnaires were analyzed through different factors
and preference was given to a particular given factor. The differences of views were resolved
through the superior nurses. When proper consensus level was achieved, an appropriate level
was applied to every relevant factor. The results were repeatedly checked for consistency, and
against NHS and other relevant jobs. However, disagreements in the study were quite rare and all
the evaluation processes took a total of three months to complete (Kahya and Oral, 2007). The
48
results were calculated for all the fields related to the nursing profession, and the results for nurse
team leader and nurse team manager were calculated through this approach.
This research analyzed around 94 jobs in the clinic categories and these categories are
placed in four hospitals that are located outside the UK. This can also be concluded that pay
bands are quite different within the different jobs of the nurses. However, it is also evaluated that
it is not difficult to match the jobs of clinical nursing in a healthcare organization. It has also
been evaluated that NHS JE systems have certain flaws such as the weights being improperly
devised such that the results achieved are not accurate. Some aspects are given more weight age
and this causes difficulty in evaluating. Similarly, the responsibilities of the staff management
would focus on two dimensions and these dimensions are: 1) the number of staff to be managed
and 2) the depth of professional knowledge. However, the NHS JE does not include the
variations that are present in staff management (Kahya and Oral, 2007).
Thus, in a nutshell, it can be said that NHS JE is considered as the most appropriate and
robust system available in the recent years, besides its faults and repercussions. The benefits of
NHS are wide and varied and they supersede the flaws. This is the reason why it is regarded as
the one of the best and most viable job evaluation system over the years (Kahya and Oral, 2007).
Although the flaws are a major concern of NHS JE, analysts and strategists believe that the
issues attached to NHS JE would be resolved after some years.
2.15.2 Job and Work Evaluation
Job evaluation systems are considered to be an important system is every organization,
and the human resource department usually puts great emphasis on job evaluation system.
However, they are more common in the private sector and have come under serious attack in the
public sector. In the public sector, the criticisms are ranging from favoritism to organizational
49
politics (Heneman, 2003). The ultimate purpose of this review is to help the human resource
professionals of the public sector and train them to avoid using job evaluation systems for
compensation purposes. The collected literature review is more on work evaluation, a concept
which is broader than job evaluation. It incorporates different aspects in an organization’s setup
such as the evaluation of competencies, roles, and work. However, it is believed that the current
techniques that are associated with job evaluation should be changed and must be aligned with
the changing nature of the work (Heneman, 2003). It can be said that job evaluation techniques
must be aligned with the work evaluation techniques so that the organizations, especially those in
the public sector, will benefit in both the short and the long run.
The methods that are associated with job evaluation are quite common, such as
classification, while the less known methods are market pricing, and so on. However, there are
two approaches that are involved in the work evaluation method: single and multiple standards
for work evaluation (Heneman, 2003). The single standards are in comparison with marketing
pricing, banding, and ranking, as far as other jobs are concerned. Similarly, the written standards
that are associated with it are classification and single-factor plans. In the same way as multiple
approaches, the comparisons for other jobs are factor comparisons, and point factor system and
competencies for written standards. These phenomena are discussed in the paragraphs below.
Ranking is considered as the most straightforward method used in work evaluation. In this
phenomenon, jobs, teams, and individuals are ranked on the basis of different factors. In this
approach, each entity is compared with the other entity, and the basis of comparison is the value
to the organization. The advantages of this approach are that it requires less time, it is simple to
use, and requires minimum amount of administration (Heneman, 2003). However, the
disadvantages of this approach are that the criteria for evaluation is not understood, the ranking
50
between the evaluators are not comparable with each other, there is a huge possibility of
biasness, and inequity may enter the system.
The market pricing system stresses on the external markets which include jobs, teams,
and groups, which are factors compared with internal aspects. However, careful measures must
be taken in order to make sure that jobs are comparable with each other. The advantages of this
approach are its quick procedures in the job market, the market facing validity of employees, and
market data being available in abundance (Heneman, 2003). Similarly, the disadvantages of this
approach are measurement and sampling errors, the difficulty in locating market data, and
possible discriminatory practices.
Another system that is widely used in the job evaluation is banding and it takes place
when the jobs are grouped together and certain bands are formed. These groups are arranged in
ranks and are placed in different bands. The advantages of this approach are that it is easy to
produce, it allows the organization to be flexible, and minimum administration is required in it.
However, the disadvantages of this method are that differences among groups can be ignored and
it may invite different inequity perceptions (Heneman, 2003). The classification method defines
the value of the people and the work with the written standards. The factors are classified in this
process and evaluation is done on the basis of classification. The advantages of this method are
its easy formation of structure, the explicit values designed in this process, among others.
However, the disadvantages of this approach are that it creates hierarchies within organizations
and it requires extensive amount of administration. Besides those, there are certain other systems
such as point factor system, factor comparisons, competencies, and so on.
There are certain major perspectives that are involved in this research which are critically
developed to conduct the entire research and frame its literature. These major perspectives are
51
traditionalists, realists, strategists, market advocates, social reality perspective, the development
of organization, competencies, and so on (Heneman, 2003). However, the work evaluation
factors are closely related to certain aspects: evaluator characteristics, evaluate characteristics,
environmental conditions, organizational conditions, and work evaluation outcomes. Similarly,
the work evaluation process relates the work with work analysis, and work description with work
evaluation and hierarchy of work.
Therefore, it can be concluded that there has not been enough research on this aspect of
work evaluation but in the current scenario of the rising trends of human resource management
organizations stressing on work evaluation and job evaluation. In this way, the job of an
individual can be easily analyzed. Therefore, it can be said that work evaluation is not static, but
is an ongoing process. Work evaluation can be a viable source of competitive advantage for the
organization in both the short and the long run (Heneman, 2003). The stress is on the
phenomenon that jobs still exist in the market place and people are willing to do these jobs.
Numerous processes are involved in job evaluation, and power influences the decision of
organizations. However, there are many evaluation systems, most of which are not evaluated,
creating a gap between the employer and the employee. However, it can be said that job
evaluations and work evaluation techniques are quite viable in both the short and the long run.
2.15.3 First Steps of the Journey: Job Evaluation for Agenda for Change
First Steps of the Journey: Job Evaluation for Agenda for Change by Angela Watts and
Simon Green was the next article to be analyzed in the context of this study. The article was
published in 2004 in volume 10 of the Nursing Management Journal. According to the authors,
job evaluation is a primary concern for trusts. The authors believed that if pay modernization was
to be effectively introduced, it would have to rest heavily on job evaluation systems. The article
52
began by providing a basic insight into job evaluation, and proceeded by introducing the NHS
(Watts and Green, 2004). However, it was observed that the authors chose to subject the NHS to
a critical perspective since they expressed that the NHS Job Evaluation System was still in a
testing phase and it would be too early to consider it an outright success.
The authors were of the opinion that the NHS Job Evaluation was based on the degree of
validity of the knowledge, skills, and experiences that a person held. The authors further
elaborated that in consideration of the fact that these three categories were far too broad to
perform an effective job evaluation, they had been broken down further into a total of 16 factors
that were considered at the time of the job evaluation. It was established that each job is
evaluated and is assigned a quantitative measure that is then used to judge the exact
remuneration that a person holding the job should receive (Watts and Green, 2004). Generally,
the quantitative measure assigned is based on the analysis of the 16 factors with respect to the
job as it is positioned alongside its supplementing job.
The article was quite different from other articles analyzed in the study as the authors
chose to shed light on the actual processes that were undertaken by the evaluators in carrying out
job evaluation. It was established that matching and local evaluations are two techniques used by
job evaluators. In a brief elaboration on the two job evaluation techniques, it was presented that
in cases where the specifications, responsibilities, and requirements of a job match that of
another job, the pay scale of the job under consideration is matched with the pay scale of the job
to which it is similar (Watts and Green, 2004). In the case where the pay of the job under
consideration is not similar to any other job to which it can be matched, then the job is evaluated
locally.
53
The authors highlighted the fact that matching is used more often than it is credited in job
evaluation. They highlighted that although it would be pointless to ignore the fact that the debate
for the determination of the authenticity of matching is still ongoing, it can be agreed upon that
in cases such as those of nurses working on the same level with the same degree of utilization of
knowledge, skills, and responsibility with only a minor difference in tasks assigned, there is
hardly any room left to doubt the authenticity of matching as an evaluation technique (Watts and
Green, 2004). Matching, according to the authors, is brought about effectively through the
establishment of core job descriptions that can then be used to acquire an understanding of
numerous jobs in a hospital or a medical institute in order to establish characteristics that may
allow matching. However, as the authors point out, matching is not a process that is as easy as it
may appear to be on paper. It is in essence a highly volatile process since it calls for the
extensive judgment of jobs, and it is therefore essential that it is performed by professionals who
are not only qualified in the process of matching but are also aware of the intricacies of the jobs
they are evaluating.
Further, the article sheds light on local evaluation and describes the three-stage process
that local evaluation incorporates. The first stage, as the article elaborates, is the filling out of a
job analysis questionnaire by the person holding the position. The authors are careful to mention
the fact that the job analysis questionnaire is designed to be incredibly in-depth and seeks to
bring to light as many attributes of the position holder’s position as possible. The authors
highlight the fact that it is common for job evaluation questionnaires to span lengths of over 40
pages at times. Once the questionnaire has been filled out, it is submitted to highly trained job
analysts who review the questionnaire (Watts and Green, 2004). The analysts also check the
filled out questionnaire for contradicting answers, clear responses, and concise replies to
54
mandatory questions. Once the analysts have ensured that the filled out questionnaire is ready for
evaluation, it is forwarded to a panel of that is constituted primarily of two members of the staff
and two members of the management of the institute/organization/hospital that the subject
employee is working in. The questionnaire responses are then evaluated in light of the 16 factors
to determine the exact value of the job to the institute/organization/hospital.
It is essential to realize that this article makes extensive use of secondary data and while
it presents the findings in exquisite detail, the absence of primary data puts the research
performed in the article in a position where the credibility of the findings of the article suffer
significantly (Watts and Green, 2004). This can be concurred on the basis of the fact that the
larger share of articles that were considered for evaluation for the purpose of this paper included
primary data and the analysis of that data in a manner that was nothing less than in depth. In light
of this fact, while the article is highly detailed and presents credible elaborations, the findings of
this particular article can only be considered as a minor contribution to the research into job
evaluation in NHS.
The authors bring the article to a conclusion with recommendations for the matching
process and the evaluation process. The matching process is one that requires extensive
incorporation of enhanced levels of flexibility, and the evaluation process has become far too
complex and time consuming in attempts to make it as accurate as possible (Watts and Green,
2004). The authors end with an optimistic note on the NHS Job Evaluation System, stating that
errors such as those of the NHS Job Evaluation System can be trusted to be ones of only minor
significance and should evolve out of the system as time passes and modifications and
amendments are brought about.
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2.15.4 A Revision of a Job Evaluation System
The next article on the list to be evaluated was a revision of a job evaluation system by
Emin Kahya, the Associate Professor in the Department of Industrial Engineering of the
Eskisehir Osmangazi University. The article was published in 2006 in the Journal of Advanced
Nursing. The researcher sought to determine the exact effectiveness of the NHS in the UK by
applying the same within the perimeters of four Turkish hospitals (Kahya, 2006). The research
was conducted in consideration of the context that modern day job evaluation is a relatively new
area of professional development in the UK, and a large number of the related studies performed
have chosen to direct their attention to the actual implementation of the system. The author was
of the opinion that it is just as imperative to consider the authenticity of the constituents of the
NHS in light of the fact that the implementation of an effective, efficient, and productive NHS
was next to impossible unless the constituents of the same were clearly established, defined, and
prioritized. The research singled out five key areas that were of primary concern to the analysis
performed in the research: knowledge, education, experience, environmental conditions, and
hazards.
According to Kahya (2006), as most studies have focused on the implementation of the
whole system in a health organization and not on the proficiency of the system in terms of
factors and their level definitions, a job evaluation system was developed in the United Kingdom
in 2003-2004.
The primary data in this research was accumulated by making use of the implementation
of a survey questionnaire. As mentioned earlier, a total of four hospitals were incorporated into
the research, and the survey questionnaires implemented on the personnel of the four hospitals
were ones that were designed to test the degree of significance of a total of 19 variables. The
56
primary participants for the survey were nurses and clinics (Kahya, 2006). The primary data was
extracted from around 90 participants, out of which the larger number was that of nurses and the
smaller number was that of clinics.
It is essential to highlight that the purpose of this research, unlike other certain researches
discussed in this paper, was not to determine possible errors that were being ignored or overseen
in the implementation of the NHS but to identify possible areas and methods for improvement.
The research initiated by highlighting the fact that recent economic trends had put
hospitals and medical institutions into a position where they have no other option but to bring
about transformations in their human resource infrastructure. Generally, these transformations
have incorporated the heavy remodeling of the human resource infrastructure in an attempt to cut
back on costs. The research highlights the fact that other medical institutions and hospitals have
countered the same scenario by incorporating a heavy degree of performance-based
remuneration in their human resource infrastructure (Kahya, 2006). This functions primarily by
remunerating employees on the basis of the targets that they manage to achieve. The research
further sheds light on the fact that this modernization of human resource systems is often brought
about by either allotting the employee with a fixed pay while linking it to a job evaluation score
for which the employee is periodically tested, or a scenario where the employee’s pay is
considered for continuous revision with regard to performance scores.
The research diverted a considerable degree of attention to the fact that a large number of
hospitals and medical institutions chose to adopt the point-based job evaluation system.
According to the author, the point-based system, when implemented on white collar positions,
was based heavily on skill-oriented, responsibility-oriented, effort-oriented, and workingcondition-oriented
factors. Skill-oriented factors included those such as knowledge, education,
57
problem-solving, experience, decision making, language, complexity, communication, and
software knowledge (Kahya, 2006). Responsibility-oriented factors were established to be
inclusive of financial and physical resources, delegation, and HRM. Effort-oriented factors
included emotional, mental, and physical factors, whereas working-condition-oriented factors
included hazards posed by environmental conditions.
The author was of the opinion that it had been after World War II that these factors had
come to light, highlighting that half the employees in the United States were affected by wage
rates based on job evaluation. The author presented that the modern day NHS Job Evaluation
System had come forth in 2003 and had been subjected to a revision in 2004, both of which were
of a nature so profound that the NHS had never been revamped so directly in the last 50 years of
its history.
When the research was practically conducted by putting the survey questionnaires into
implementation, the achieved response rate was around 60 percent (Kahya, 2006). It is, however,
highly imperative to highlight at this point that almost all of the survey participants were women
and had an average length of nursing experience that spanned around 10 years if surgical and
intensive care unit nurses were to be considered together. The research made use of the T-test to
carry out statistical analysis, and made use of a statistical hypothesis in the same regard. When
the survey findings were accumulated, it was observed that a significant degree of difference was
going unnoticed. This difference was amongst the clinic categories if nursing tasks were to be
considered.
It was concluded in the research that while current NHS practices may be providing a
stable degree of effectiveness and efficiency, there was still need for more personnel. The
research therefore suggested that two new positions should be generated in the NHS system.
58
These new positions were ones that belonged to the emergency unit, and the intensive care unit
(Kahya, 2006).
On a more specific level, the research concluded that it would be unwise to generalize
wage rates for nurses since every specific nursing position in a hospital entailed a unique set of
characteristics. These characteristics spanned across not only the nurses responsibilities but also
across financial and physical resources, as well as information resources (Kahya, 2006). The
research attempted to bring to light that while the NHS Job Evaluation System was a system
unlike no other in terms of its effectiveness and efficiency, there is still significant room for
improvement with regard to the number of jobs developed and implemented in order to carry out
the large number of clinical supervisor nursing jobs.
2.15.5 An Analysis of Job Evaluation Committee and Job Holder Gendered Effects on Job
Evaluation
An Analysis of Job Evaluation Committee and Job Holder Gendered Effects on Job
Evaluation was the article selected for discussion, analysis, and evaluation. The research had
been conducted by Chad T. Lewis and Cynthia Kay Stevens in 1990 and was from Volume 19 of
Public Personnel Management. The research was based heavily on primary data analysis to
develop a case and made use of previous research studies in the form of secondary data to
strengthen the claims and findings of the research.
The rationale of the research was based on the fact that remuneration trends in regions
such as Great Britain and Australia had taken on a rather uniform outlook, and the research
appeared to be motivated by the presence of the trend in the public sector. The authors initiated
the research by presenting fundamental definitions of the key constituents of the research. The
primary key constituent in this regard was that of the very definition of job evaluation
59
methodology itself. The authors continued by stressing on the differences between the
ideological perception of job evaluation and the practical form of the concept (Lewis and
Stevens, 1990). It was their perception that job evaluation, when put unto its practical form,
incorporated a heavy degree of biasness, and it was for the same reason that they chose to
highlight the causes of the development of biasness in job evaluation.
They were in agreement with the previous research studies such as those that chose to
single out the reasons for the generation and development of biasness in job evaluation scenarios.
One such research was of a nature such that it presented four potential causes that could be
attributed as the causes of the development of biasness in a job evaluation scenario. The first was
that of the dimensions selected to be performed in the job evaluation. The second was that of the
degree of significance that each dimension was attributed with (Lewis and Stevens, 1990). The
third was the actual application and implementation of the specific system designed to carry out
job evaluation in the organization. The fourth was that of the procedures brought into use to
determine the salaries of the employees. The article seconded the motion that each one of these
steps is vulnerable to the development of biasness, and as a result of this vulnerability, the very
practice of job evaluation can be expected to suffer.
The research also sought to employ the Z-test in an attempt to incorporate statistical
accuracy into the research, but it became highly implausible when the research findings were
accumulated and was therefore limited in its application in the research. The research
methodology was one that was based on a sample size of over 200 participants. Considering the
nature of the subject of the research, the research methodology implementation participants were
ones who were primarily students of business studies. The participants were either from the
60
University of Washington or from Everett Community College (Lewis and Stevens, 1990). The
research proceeded by presenting the participants an orientation on the Willis Position Job
Evaluation System, after which the participants were divided into segments and were provided
with a job evaluation task of an external person. The gender details of the external person were
not provided to the participants and once the participants had spent a considerable amount of
time analyzing the subject and the professional position of the person with respect to the person’s
job, they were asked to guess whether the subject they were analyzing was a male of a female.
The research continued to employ the Z-test and it was established that a total of three
factors of Willis Position Evaluation System would be brought into use in the research. These
three factors were job accountability, knowledge and skills, and mental demand. Job
accountability in this regard was considered as the actual perimeters that a job entailed with
respect to the freedom that the position gave to the subject to take action. In this area, job
accountability also gave regard to the financial implications that the decisions made by the
position entailed (Lewis and Stevens, 1990). The factor of knowledge and skills was based on
the blend of managerial capabilities that the subject had and required in order to effectively carry
out the functions and operations of the position in which the subject was placed. The third factor
of mental demand was the degree of authority that a position entailed with regard to the extent of
independent judgment that the holder of the position could exercise in order to carry out
problem-solving operations. It was established that these three factors were such that they could
be considered as compensable.
It is at this point in the research that one cannot help but feel that by focusing centrally on
gender-based biasness in job evaluation, the authors have left out a significant number of
variables that have even more profound implication on job evaluation than gender biasness. The
61
very methodology of the research appears to be one that is designed to centrally address gender
biasness trends in job evaluation. While the research took off with an appreciable note by
shedding light on the numerous intricacies of job evaluation, it appears to have narrowed down
the scope of its analysis far too much than a research on the subject of job evaluation merits.
Also, the selection of the sample size has been limited to only two institutes, whereby the
limitation of gender biasness amongst the research participants can be expected to increase
(Lewis and Stevens, 1990). This is primarily because of the fact that by taking participants from
only two institutions, the research has limited itself to the observation of only two sources: forms
and natures of gender biasness. If a generalized understanding of gender biasness in job
evolution was to be sincerely developed, a more reliable approach would have been to acquire
participants from as varied institutes as possible, even if the sample size was maintained at the
same limit.
Another customization that was performed in the research was that of the elimination of
the extreme values observed in the charts. It is essential to note at this point that observations
were collected from the participants in a highly organized manner. Once the participants had
been given the orientation had been divided into segments, they were only approached once a
significant amount of time had passed to allow them to consider the task that had been assigned
to them (Lewis and Stevens, 1990). However, even though the extreme values were not
incorporated into the study, the incorporation of two independent Seattle City Personnel Analysts
serves to add a considerable degree of authenticity to the research findings.
The research concluded with the results that gender biasness did, indeed, have significant
implications in the area of job evaluation. However, in consideration of the three compensable
factors that the research had brought into consideration at the time of the implementation of the
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research methodology, it was observed that the most profound of implications were in the areas
of the knowledge and skills required for the job, as well as the mental demands that the position
entails. It was concluded that job accountability has the lowest level of significance in the case
where Willis Position Job Evaluation System is concerned (Lewis and Stevens, 1990). As the
research came to a conclusion, it was fair in highlighting the vulnerabilities to which it had been
exposed as a result of the chosen and implemented research methodology, but claimed all the
same that the trends uncovered by the research were ones that previous research studies had
failed to do effectively.
2.15.6 Designing a Comparable Worth Based Job Evaluation System: Failure of an a Priori
Approach
Designing a comparable worth based job evaluation system: Failure of and a priori
approach was published in volume 19 of the Public Personnel Management Journal. The article
initiates by bringing to light the latest trends in public sector job evaluation practices. According
to the authors, the renewed concern in this regard is one that has been brought forth due to
concerns in the area of pay equity. The authors however seem to be established in their opinion
about the presence of gender bias in job evaluation practices as they highlight the essential
reasons because of which job evaluation and pay equity are given supplementing significance
(Tompkins, Brown and McEwen, 1990). For its foundations, the research relied heavily on a
study by the National Academy of Sciences. The research highlighted the fact that it was
essential to realize that modern day employers choose to employ varying job evaluation
procedures to different job categories. This practice makes it increasingly difficult and complex
to ensure that pay equity principles are followed. The second attribute in this case that the
research highlights is that the frame of reference established and used in the purpose of job
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evaluation by modern day employers is one that is designed to reflect upon market-based wage
rates. According to the research, this aspect has significant implications on the authenticity of the
outcomes of the job evaluation.
The research proceeded by giving special attention to the Montana Project and by doing
so shed light on the point based job evaluation system. According to the research, the pointbased
evaluation is one that is extremely time consuming and requires further modifications in
order for it to be implemented in a manner such that the desired degree of effectiveness can be
achieved (Tompkins, Brown and McEwen, 1990).
The authors gave special consideration to the methods that were employed in the
selection of factors used to perform point-based job evaluations and the attribution of weights to
the same. The research highlighted a developmental process which incorporated the selection of
an advisory council, the establishment and elaboration of benchmark jobs as a frame of
reference, the selection of tentative compensable factors, the establishment of a standard for the
assessment of the authenticity of the factors established, and the weights assigned to each factor,
as well as the validation of job factors.
The article was based heavily on the development process that was employed in the case
of the latest attempt by the State of Montana to establish and implement an effective Job
Evaluation System. In doing so, the article in essence advocated for the need of a policy-based
approach in job evaluation in order to ensure pay equity (Tompkins, Brown and McEwen, 1990).
In this regard, the authors argue that the implementation of a job evaluation system based on a
policy-capturing approach can be trusted to deliver a job evaluation-based wage structure that is
compatible with an organization’s present hierarchy.
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The article was quite limited in its scope because of the absence of any primary data, and
this particular implication was observed to be most clear in the conclusion where the article was
only able to present a summary of sorts of the research findings (Tompkins, Brown and
McEwen, 1990). The article addressed the central issues of this research but was quite narrow in
its approach, and it is for the same reason that the scope of the article was limited to only a
retrospective analysis of sorts.
2.17 Summary
It is desirable for healthcare organizations today to establish a system which is not only
economically viable but draws in and retains its employees. One of the methods by which it can
accomplish this task is by the use of human resource management. Human Resource Planning is
the prediction of the traffic of individuals who may enter and leave an organization and how best
to use these individuals as resources in order for the company to achieve its ends. The
management of human resources is a relatively new field and its application in healthcare
involves its own opportunities and challenges. The main purpose is to satisfy the demands for
human resources and nullify any inconsistencies. In order to accomplish this task, HRM uses
methods known as job analysis and job evaluation. Job analysis is the process of systematically
obtaining information about jobs by determining what the duties, tasks, and responsibilities of
those jobs are in the context of a specific job. Job evaluation is a systemic process for defining
the relative worth of jobs within an organization. The uses of different schemes in job evaluation
are essential to establishing pay equity within an organization.
Due to companies not meeting equality of pay within its organizations, the UK
parliament has proposed several legislations into law which provide for the equality in public and
private sectors for women, various ethnicities, and disabled individuals. The first major act
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toward this cause was the Equal Pay Act of 1970. Although these laws have existed for years,
their enforcement in public and private organizations has left much to be desired. Pay equity
within organizations is essential to maintaining quality of care and worker satisfaction.
One such healthcare organization which employs these methods is the United Kingdom’s
National Health Service. It is currently the world’s largest publicly-funded health service under
the department of health, and operates upon the ideal of free universal healthcare open to 60
million residents of the United Kingdom. Though the National Health Service was originally
established as a free universal healthcare system, it has since been systematically started
becoming more and more privatized and has dismantled various health services.
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Chapter 3: Research Methodology
3.1 Introduction
Research methodology is basically a portmanteau. It is the correlation of the two that
makes up a significant part of the most important field of scientific research and technology
(Kumar, 2005). Research is the quest for knowledge, to weigh, evaluate and observe facts in
order to explain opaque proceedings (Kothari, 2005). It is the systematic investigative delving
into an unknown scientific process, whereas methodology is the system of methods followed in a
particular discipline. Methodology includes a collection of theories, concepts, ideas, and
ideologies as they relate to a particular discipline or field of inquiry (Yin, 2003).
To put it simply, the two linked together come to mean inquiry of facts within a particular
field using a particular method suited to that field. In layman’s terms, research is the surgeon
about to perform a surgery and the methodology is the tool (Adèr and Mellenbergh, 1999). To
clarify further, one cannot delve into the realms of a particular field unless he or she applies the
correct tool. After all, one can hardly use surgical instruments for cooking (Detterman, 1985). In
the same way, a specific methodology must be applied to a particular field of inquiry.
3.2 Adopted Research Methodology
The organization which is the focus of the adopted research methodology is the National
Health Services. The National Health Service has been taken and analyzed in order to determine
whether public health services are implementing job evaluation in a manner such that it is
abiding by the basic principles of pay equity. The research methodology that has been adopted to
determine whether or not pay equity serves to improve work conditions is one of a qualitative
analysis approach.
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3.3 Secondary Source: Article Analysis
The secondary source for this paper is one that makes use of a specific number of articles
to perform a qualitative analysis. The articles have been selected on the basis of specific criteria
which have been discussed under a separate heading in the paper. Each article has been analysed
individually and the findings extracted from the articles have then been put together to form a
definite derivative conclusion of sorts.
3.4 Qualitative Analysis
As mentioned above, the research methodology for the paper is one that has been
designed to follow a qualitative analysis. The qualitative analysis allows for an in-depth
understanding of the research subject to be acquired. The qualitative analysis is generally used in
situations where the subject of research at hand is one that incorporates a significant degree of
study of behavioral attributes or the study of trends that cannot be expressed using quantitative
figures.
In order to carry out this qualitative analysis effectively, the literature review was brought
into use. The literature review, unlike the literature review that rudimentary studies incorporate,
was a critical literature review and served to present a critical analysis of the selected articles.
Each article was critically analyzed whereby the discussion presented on each article was not
limited to a description or summary of its contents.
In order to conduct a research based on qualitative analysis, it is essential to analyze the
documentation related to the subject under observation. More than often, peer-reviewed
publications are analyzed in an attempt to develop a clear understand of the trends and
tendencies that exist in the subject being analyzed (McNabb, 2004).
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3.5 Performance of the Qualitative Analysis
The qualitative analysis in this research study has been performed in a two-step process.
The very first step is that of the execution of the critical literature review. Once the articles
mentioned had been analyzed and evaluated for their reviews and their findings, the critical
literature review chapter came to a close. The second step was then carried out in the findings
chapter, where the essential findings from the critical literature review were subjected to a
critical appraisal. It is in the same chapter that the findings of the critical literature review shall
be discussed.
3.6 Search Strategy
The search strategy was one that was based on the singling out of particular articles that
could be expected to contribute to this research. A particular criterion was developed and
followed to carry out an organized and comprehensive search strategy. This was done in order to
ensure that the articles incorporated into the research were credible and could be trusted to
provide the research with a sufficient understanding of the subject of the research study. It is for
the same reasons that the number of articles to incorporate in this research study was limited to a
maximum of six articles.
3.7 Criteria for the Selection of Articles for the Critical Literature Review
The articles selected for the literature review were based on specific criteria. The first
essential requirement was that the articles had to be related to job evaluation at all costs. The
second prerequisite was that the articles could not be mere discussions on job evaluation,
preferably attempting to provide the research with critical findings so as to allow this research to
expand the horizon. It is essential to highlight at this point that special consideration and
preference was given to articles that were related to NHS job evaluation in particular.
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3.8 Justification for the use of the Qualitative Approach
The qualitative approach has been employed in this research study because of the fact
that there are hardly any elements of this research that can be considered to be of a nature that
could be subjected to statistical comparison and/or calculation. Much of the study regarding the
NHS job evaluation is one that has been performed through the use of peer-reviewed
publications, and since job evaluation in itself is a process that is highly qualitative procedure in
excesses, it would have only served to decrease the credibility, authenticity, and reliability of the
research and its findings had a quantitative approach been followed.
A qualitative analysis generally proceeds by analyzing the cause and effect relationships
that exist in a naturally existing setting. The researcher delves into the numerous variables
pertaining to the scenario, and attempts to acquire an understanding of the scenario that is often
argued to be non-generalizable. This is because of the fact that in the case of the application of a
qualitative analysis, the research has to be anchored to a specific context and has to operate
within the perimeters of that context. Generally, qualitative data once accumulated through
secondary sources is subjected to extensive analysis in an attempt to confirm or disclaim preexisting
perceptions regarding the research subject.
It is essential to understand that while the argument between the legitimacy of qualitative
and quantitative analysis is one that holds credibility and the result of which may serve to
revolutionize the way modern day research is carried out, the present scenario merits that the
approach most suitable to the subject of research is selected and implemented. This is because of
the fact that both research approaches have specific attributes and while each research approach
may differ from the other in a number of ways, they are both meant to facilitate the effective
execution of the research.
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3.9 Critical Appraisal Skills Program (CASP)
This is an assessment tool which has been created to aid those individuals who are
unfamiliar with qualitative research and its theoretical perspectives. This tool is used to identify
within research studies the various theories and assumptions which characterize qualitative
research.
In order to accomplish this task, the program employs the use of ten questions which are
used to broach four issues which may be addressed in studies using qualitative research. These
issues consist of rigor which contends whether a thorough approach has been applied to the
study. Another issue which is given consideration is the key research methods within the study
and whether the findings from these methods employ any form of credibility. Finally, the
relevance of the findings of the study at an individual and at an organizational level is considered
within the program.
The first two questions within the appraisal tool are screening questions which are used to
ascertain whether the study in question does employ qualitative theories in its research. The first
question considers what the study aims to accomplish. The second question gives consideration
to whether qualitative research should be employed in this study.
Answering these two questions leads to a more detailed assessment of the study in
question by asking if the researcher has given justification for the research design employed.
This is followed by another which asks how the participants of the survey were chosen, how the
most appropriate participants can be chosen to maximize the pertinent knowledge required in this
case, and why certain participants may be reluctant to take part in the survey.
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This is followed by a question regarding the collection of data which asks whether the
research data collection is justified. The collection of this data is further explored by asking the
methods of collection of data, the form of data collected, the methodology of data collection, and
the saturation of data.
Following this the reflexivity of the data is explored which gives consideration to the
relationship between the researcher and the participants of the study. This question explores the
inherent personal bias of the researcher, as well as how the questions were made and data was
collected. There is also consideration given to how the researcher has responded to any changes
within the research design. This is followed by an exploration of the ethical design of the study
which discusses issues of ethical standards within the study, as well as those related to the
participants, such as informed consent and confidentiality. The question also asks if the
researcher sought approval from the board of ethics before publishing his study.
This is followed by data analysis which asks if the data analysis process has been
described in sufficient detail and whether the data has been categorized into themes. This is
followed by other considerations such as whether there is sufficient data to provide an analysis
and thus the findings, and whether there is any contradictory data taken into account. It ends with
examining the potential bias of the researcher in assessing the data taking for analysis.
The second question considers the findings of the study and the various components of it
and questions whether it encompasses both sides of the argument and has its credibility assessed
by the researcher.
The final question asks how the current research conducted can contribute to any future
studies or researches. It also considers whether the findings can be transferred or be used to
identify new areas of necessary research.
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In order to assess the study and references which have been employed in the research, a
critical appraisal will be employed to evaluate and address specific areas of the research. In order
to differentiate it from the Critical Appraisal Skills Program, it must be taken into consideration
that this form of critical appraisal is merely a subjective review of all the researches which have
been introduced within the dissertation. It has been designed to present an analysis of the
research study in a manner such that the key components of the research can be evaluated with
respect to the primary essentials that a credible research should constitute. The critical appraisal
has been designed to address areas such as the primary center of attention that the research
focused upon, the possibility of critical research studies that the research may have missed out
on, the criteria that were established and used to select articles and other publications for review
in the research study, analyze whether or not the studies incorporated into the research study
were adequate enough to address the questions at hand, and give an overview of whether or not
the results observed held a pattern of similarity and the manner in which the results were
presented. Additionally, the critical appraisal also evaluates whether said researches may provide
a viable result for the research questions considered and how they relate to the conclusion.
Furthermore, the appraisal will provide a systemic review of the information provided in each
study.
3.10 Limitations of the Research
The quest for unsystematic and undefined knowledge comes with its own set of
limitations. It may walk toward unfamiliar paths, but it has its own share of obstacles as well.
The present study succumbs to a number of obstacles due to reasons that largely affect the
progress of this research (Goddard and Melville, 2004). Strenuous efforts have been made on the
part of various research analysts in order to maximize the degree of authenticity, accuracy, and
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correctness of the report, but to no avail; the reason for this is that the limitations of the research
are not subject to the lack of effort but to the lack of external factors. These factors are clarified
below (Walden, 2006). The obstacles mainly include geographical, financial and time hurdles.
The top most reason that lends support to the numerous obstacles lies largely on the fact that the
resources are scarce. There are insufficient resources available to researchers in order to
complete the task at hand.
3.10.1 Limitation of the Qualitative Approach
While the qualitative approach may appear to be effective with regard to the current
research, it would be a mistake to carry out the qualitative research without considering its
limitations. It is essential to realize that while qualitative research allows the enhanced study of
behaviors, opinions, preference trends and similar elements, the accuracy of the findings
obtained through a qualitative analysis is far from that which is derived from the implementation
of a quantitative analysis. This is because of the fact that while the results obtained from a
quantitative analysis have a definite appeal to them, the results obtained through a qualitative
analysis incorporate limitations more often.
3.10.2 Limitations of the CASP
The limitations of the Critical Appraisal Skills Program are inherent upon the personal
bias of the person using it. The personal bias of the user can lead to inaccuracies in which the
data within the studies is represented, leading to an inaccurate portrayal of the critical appraisal
of such data. Additionally, the standards which are attributed to the quality of information,
ethical standards, findings, analysis and other considerations do not have a base value within the
appraisal. This leads to the users forming their own opinion regarding various factors which are
being employed in this study. Another limitation which is present within this assessment tool lies
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within the contention that this program does not encompass all the theories associated with
qualitative studies. The possible lack of understanding of these theories on the part of the user of
this program must also be taken into consideration. The employment of these questions may not
lead to the same conclusions as the use of actual qualitative theories, seeing that the
interpretation of both formats may be different. The limitations of the critical appraisal are
directly related to the personal biases of the individual who fills out the appraisal. It must be
considered that the critical appraisal does not provide any standard for studies chosen, nor does it
in any way critique the information used within the chapters. Rather, it prominently displays the
information used to derive the appropriate results for the research questions.
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Chapter 4: Findings & Analysis
4.1 Introduction
The chapter will be used to introduce the secondary research conducted on the National
Health Service by way of journal articles, as well as books, newspapers and organizational
websites with credible information related to the topic of this dissertation. It will be ensured that
all of the material used from these sources has been reviewed by an individual or a group of
individuals who have been involved with a study or have performed extensive research within an
area which is directly or indirectly related to the main question of this dissertation.
Additionally, a total of six of these articles will be assessed under the critical appraisal skills
program. This critical appraisal will be used to determine the relevancy of various issues related
to the research and the methodology of its survey techniques.
4.2 Findings from Secondary Research
4.2.1 Research Questions with respect to Critical Review Analysis
The objective of this study is to evaluate the job criteria of people employed in healthcare
organizations and thereby enabling the healthcare organizations to determine the levels of
implementation on pay equity principles. In order to answer the research questions, an in depth
analysis of six articles has been performed and each article, along with the literature review,
contributed significantly to the findings.
Judging by the analysis performed, it can be concurred that NHS really performs job
evaluations to assist in the pay equity of its hospitals. From articles such as Designing a
Comparable Worth Based Job Evaluation System: Failure of an a Priori Approach by Jonathan
Tompkins, Joyce Brown and John H. McEwen, and Critical analysis of Job and Work
Evaluation by Robert L. Heneman, it is evident that NHS makes extensive use of job evaluation
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in its hospitals and also attempts to incorporate enhanced levels of pay equity through the
performance of the same. However, the study also suggests that there is a significant degree of
research required into the area in order to make the effective implementation of job evaluation
systems in NHS possible because the current setup is not delivering standards that a system of a
magnitude of scale in NHS requires.
With regard to the research question that pertains to the tendency of NHS to promote job
equity in the projects that it forms under public-private partnership, it can be concurred that NHS
tends to exercise measures in order to promote job equity but the measures are far from
satisfactory and require improvements in numerous areas of implementation.
The third and slightly more general question that the research addressed was one that
pertained to the implications of pay equity on working conditions. Since the NHS was used as an
example and numerous research studies were utilized to acquire an understanding of the
implications of pay equity on working conditions, it was observed that if effectively
implemented, pay equity could actually serve to bring about improvement in work conditions.
However, as elaborated in the critical literature review above, articles such as Designing a
Comparable Worth Based Job Evaluation System: Failure of an a Priori Approach by Jonathan
Tompkins, Joyce Brown and John H. McEwen, and A Critical Analysis of Job Evaluation for
Clinical Nursing by implementing the NHS JE System by Emin Khaya and Nurtel Oral – present
the perspective that if pay equity is implemented inappropriately, work conditions will
experience negative implications. Derivations such as these were also observed in First Steps of
the Journey: Job Evaluation for Agenda for Change by Angela Watts and Simon Green.
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4.2.2 Findings with respect to the Critical Appraisal Test
From the application of the Critical Appraisal Test, it is acceptable to conclude that the
trends in the research subject of this study – the need for extensive research and insight – is still
profound. However, this does not imply that the previous research is flawed or useless in any
way but it means to suggest the adoption of alternative methods to carry out research in the area
of job evaluation and its implications on pay equity. The Critical Appraisal Test also suggests
that the research in this area will have to be of certain nature such that it encompasses a
significant magnitude of scenarios. This concurrence is based on the fact that the larger share of
research on the subject of discussion is qualitative; while qualitative analysis is allowing for a
thorough insight to be acquired into the research, there is a significant need to develop research
studies that yield to findings which can then be generalized and are not limited in their
application to the cases that they take as their foundations for qualitative analysis.
The research performed through the implementation of the Critical Appraisal Test has also
shown that while the NHS job evaluation system is one that is unlike any other and has evolved
significantly, it is far from a system that can be considered to have pioneered job evaluation in
healthcare settings. This is because of the fact that job evaluation techniques being employed
require significant degrees of refinement and standardization, in order to allow for a uniform and
comprehensive job evaluation, there is a procedure across all NHS facilities where pay equity
has to be promoted in the work place.
4.2.3 Job Evaluation with Regard to Nursing
In the job evaluation system of the National Health Service, nurses are employed to only
13 unique positions within the organization. These positions are attributed to each commonly
occurring task in a hospital. However, it must be said that the duties of these nurses are variable
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in terms of physical exertion, responsibilities, as well as monetary and human resources. It is
according to the occupational responsibilities of these nurses that they are assigned points. The
increased number of points affords them a higher pay band with the NHS.
A study that was conducted to compare various factors which were present within each
nursing service with the standard variables for physical, mental exertion and responsibility,
found that the collected results and the standard factors established by the NHS were comparably
similar (Khaya and Oral, 2007).
4.2.4 Nurses in the Public Sector
Since the inception of the program in 2001, the National Health Service has endeavored
to improve the working conditions of its employees and to meet their expectations in terms of
providing proper working environment and job satisfaction. However, despite their efforts and
reassurances, the NHS has not implemented any successful plan which includes such promises
(Skinner, Saunders and Duckett, 2004). As mentioned before, it has been observed that the pay
grade for nurses in the public sector is quite low in terms of the work required of them. This is
due to a low outlier which is associated with their profession. The inconceivable matter in
considering this is that the nursing profession is by far the one in which individuals are exposed
to the most hazardous and unpleasant situations within hospitals (Savage, 2004).
A recent study conducted in 2005 regarding the perception of nurses toward their
working environment found that nurses who were associated with the National Health Service
experienced higher levels of stress than those who were in the private sector. Additionally, the
study also found a correlation between the increased stressors on nurses working in the public
sector and low levels of satisfaction with their working environment, as well as negative
experiences at work (Working Well Initiative, 2006). Other studies found similar results with 65
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percent of nurses who were dissatisfied with their positions and intending to quit. Their main
dissatisfaction in this case however was with the promotion and training opportunities rather than
workload or pay. Recent policies have been instituted by the National Health Service to improve
the compensation of these nurses, but such methods have been considered to be ineffectual in
terms of their retention (Shields and Ward-Warmedinger, 2001).
Another study conducted on the topic of nurse satisfaction within the public sector found
that the most important elements which brought about nurse satisfaction comprised of the quality
of working relationships, adequate staff on hand with the expertise to cope with their workload
and also to a lesser extent, achieving advancement in both their professional and personal lives.
However, unequal nursing experiences such as the disparity of nurses with ward managers,
increased pressure and managerial responsibilities for ward managers, and fewer responsibilities
for nurses with lower grades are all contributing not only to the dropping level of healthcare, but
also to the decreasing level of job satisfaction within the NHS (Adams and Bond, 2000).
4.2.5 Standard of Care
As an organization, the National Health Service has always been one that has endeavored
to serve the public. It has introduced several new quality initiatives and practices which are
indicative of macro and micro level support toward the betterment of quality healthcare (Ritchie,
2002). However, with increasing costs and decreasing quality of healthcare provided, it is
inevitable that the National Health Service would take on certain corporate tactics in order to
safeguard its interests. One of these is the implementation of costing systems in the United
Kingdom. Costing systems are similar to the payment for performance systems which exists in
the Health Maintenance organizations of the United States. However, measuring performance
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only seems to work to a certain extent and the costing systems do not completely measure the
non-monetary factors involved (Druker, 2003).
Despite all the measures which have been put in place by the National Health Service to
provide a better quality of service in the healthcare industry, their efforts may not have shown
the desired results. Two newspaper articles which date back to 2004 have found that less than
half of the hospitals under the National Health Service have a good or excellent rating of
cleanliness (Meikle, 2004). The issue is even more profound taking into account that there is no
health legislation in place to close down hospitals which have a 15-count higher rate of infection
more than the next safest country, which costs the National Health Service one billion pounds a
year (Sergeant, 2003).
Another news item shows that reforms made to simplify the pay structure of dentistry
within the National Health Service have not only caused dentists to boycott the new contract but
also found fewer patients who saw a dentist on the introduction of the contract, as compared to
two years prior it (Smith, 2008). Additionally, despite the National Health Service’s drive toward
establishing quality service within its organization, it has not shown any positive results from its
previous efforts (Gainsbury, 2009). Even proposals to cut costs have met limited success, with
little or no increase in productivity (Bowcott, 2009).
Nevertheless, there have been other proposals which started within the NHS that have
shown promise. The advent of the Nursing Development Officer has created a significant
contribution within the NHS, especially toward increasing the performance and skills of nurses
inhabiting the lower working grades. It has been found that the introduction of NDO’s has
significantly improved the healthcare performance of nurses working in other grades as well
(Webb, 1998).
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On the other hand, there have been several studies with conflicting reports regarding both
the positive and negative effects of clinical supervision within the NHS. Studies have shown that
with the increasing cost of healthcare, it may be more prudent for the NHS to concentrate its
supervision of nurses on junior grade nurses rather than any other grade in order to provide much
need guidance and support during their early years as practitioners (Teasdale, Brocklehurst and
Thom, 2000).
Additionally, the development of assistant/associate practitioners within the NHS has
helped the organization cope with increasing future demands for well-trained individuals who can
be a part of their patient focused workforce. The cost effective nature of the associate
practitioners’ role within the organization has made them a valued unit. The positive nature of
these positions is also creating an increase in support for these individuals to inhabit fully
qualified positions (Leach, 2009).
Other proposals that have been set forth include the advent of primary care mental health
workers who are primarily trained to treat mental health as a part of an individual’s primary
healthcare package. The line of thinking behind this idea is that majority of the issues associated
with primary healthcare in medicine are directly related to mental health, thus the creation of such
a position creates a method to improve services. Despite concerns regarding inter-professional
tensions and quality of healthcare, the program has shown to be quite successful with the only
problematic factor of the retention rate among primary mental health workers (Harkness, Bower,
Gask and Sibbald, 2005).
4.2.6 National Health Service Public Private Partnerships
The private sector has always worked alongside the National Health Service since 1948.
In 1997, 12 million people in the United Kingdom were covered by companies such as insurance
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companies, friendly societies and cash plan companies—with 7 million people being covered by
private health insurance (Doyle and Bull, 2000). In an effort to deliver better quality healthcare
to its constituents, the National Health Service has outsourced some of its services to private
organizations, allowing them to take up the tasks and the risks associated with them (Akintoye,
Beck and Hardcastle, 2003). The National Health Service not only make contracts to private
providers, they also engage with various psychiatric services which encompass the needs of the
elderly, women who have had their pregnancy terminated, as well as waiting list initiatives.
Other services outsourced quite recently include several wellbeing centers for elderly individuals
and for those with mental health issues such as dementia (Department of Health, 2009). The
Medicines Information Project has been outsourced to private companies. The task within the
project required the establishment of an online medicine guide with links to information about
the conditions and various treatment options available. Surveys, in relation to its success, have
found that 88 percent of individuals find the information useful and 85 percent find it trustworthy
(Pharmaceutical Forum, 2008).
4.2.7 Working Conditions in the National Health Service
The National Health Service and its fundamental public structure differ in several ways
from the private sector. The main differences from the private sector mainly occur in a
managerial policy for financial incentives. Workers within the National Health Service do not
receive as many benefits as in the private healthcare system and cannot opt to challenge their
contracts in order to receive more benefits. This is due to the fact that an NHS staff position must
keep abreast with the standardized salary within their organization and to pay within range of it.
Private companies allow individuals to act as autonomous bodies who can negotiate for better
rates, benefits and private health insurance policies. Additionally, there are also other benefits
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offered by private companies that the National Health Service simply does not offer such as
access to training programs, an opportunity for pro bono work as well as access to better
facilities (Private Health Advice, 2009). Despite all these factors, it does not mean that the
organization does not recognize the need for recruitment and retention of their staff as well as to
reward them for their efforts. The National Health Service has set out several strategies in order
to improve the working conditions of their employees. This includes, but is not limited to,
offering childcare support, flexible timings, an option for reduced hours, career support, annual
hour arrangement, and team-based employee self-rostering. They have also committed creating a
more organic working environment by having better arrangements, practices and managers for
their staff (Department of Health, 2000). However, their actions have not reflected their
intentions especially in the case of minorities. In an editorial for a British medical journal,
Esmail and Carnall have written that there is still widespread discrimination in the medical
profession which is permeated in every facet from examinations to job applications (cited in
Fearfull and Kamenou, 2007).
Another study which considered the experiences of African women in the United
Kingdom National Health Service found that they had an overall negative experience working in
the said country. They found themselves to be victims of discrimination in pay, in terms of
responsibilities and were also exploited by their supervisors (Likupe, 2005).
4.2.8 Critical Overviews
On the 4th of October 2007, the Department of Health published a report known as Our
NHS, Our Future: Next Stage Review: Interim Report. This publication spoke about the findings
on the National Health Service reform and detailed various changes which were dedicated
toward a 10-year vision for the National Health Service. The vision was shaped from the
84
responses received by the staff and their patients in order to lead to a fairer and more personal
survey version of the healthcare system which places more responsibility in the hands of the
NHS staff (Department of Health, 2007).
However, there are continued efforts on the part of the National Health Service to
establish equality of pay while ensuring a constant high standard of healthcare within the system.
There are several unions in the United Kingdom which are against government set pay ranges.
These individuals may feel that with the current rate of inflation and economic downturn, such
wages do not reflect their employment conditions and requirements within the National Health
Service. Members of this union have voted 53 percent in favor of the strike and 76 to 23 percent
in favor of the action which comes just short of going on strike (BioPortfolio, 2008).
To combat this, the National Health Service is currently undergoing a system of pay
modernization where most of its staff is seeing increases in basic pay so as to increase
recruitment and retention of its employees. However, with the budget for the NHS increasing
every year, there is a consensus that the NHS will not be able to award a pay increase greater
than 2.5 percent (GMB, 2005). The increasing costs can be attributed to various reasons which
include, but are not limited to the growing cost of new medical technologies. The ever-increasing
budget of the National Health Service has also led them to propose cuts in several areas of
healthcare such as one in the region of Heatherwood and Wrexham Park NHS Trust, where they
have reduced available services to two Medical Wards, one Gynecology Ward and one Walk-In
Medical Assessment Unit (GMB, 2009).
Despite these issues, the NHS has endeavored to put several proposals in place in order to
ensure that a high rate of retention remains among its staff. Recently, a study found that the
National Health Service Trust has begun encouraging nurses who left their positions because of
85
domestic matters to return to work full time. The increased shortages within the nursing sector
have led to the creation of various returns to practice programs which have shown a generally
positive outlook on the part of the returning nursing staff (Barriball, Coopamah, Roberts and
Watts, 2007).
With the latest NHS dentistry bill plummeting the standards of care and patient inflow
within the organization, the National Health Service has created a review aimed at not only
providing quality care for its patients but also at a compatible level of pay for its doctors and
nurses. The review itself spoke of the current dismal state of the NHS dentistry and how
providing access to the quality healthcare for patients and fair pay for its employees has become
an issue over the last few years (Department of Health, 2009).
With these issues facing the National Health Service in the future, it has been predicted
that the National Health Service would undertake in an enterprise that is focused toward Market
based healthcare. Meaning, they would outsource more from companies in the private sector.
Secondly, they may provide a more tightly regulated healthcare distribution system or finally,
they may have a selective market for providing healthcare with various services being planned to
offer only sustainable care pathways (Lewis and Dixon, 2005).
4.3 Summary
This chapter will discuss secondary research findings using the National Health Service
as a case study. The secondary sources discussed will use all relevant material such as books,
journal articles, publications from the National Health Service website and newspaper articles
that have been reviewed by an individual or a group of individuals who are involved with a study
or have performed extensive research within an area which is directly or indirectly related to the
main question of this dissertation.
86
The use of job evaluations in the NHS did not begin until the establishment of the First
Job Evaluation Working Party in 1992. Although the use of kite marking schemes was not
successful, it allowed the NHS to realize that they must tailor their schemes to their own
organization. In an effort to ensure pay equity, they have launched several programs in the last
few years. The inception of these programs has not improve the working conditions and general
satisfaction among employees of the organization and it has even led to a decrease in the quality
of healthcare and reliance on outsourcing to private companies.
It is possible that with its increasing budget, the National Health Service will change its
mode of operations to a market driven, tightly regulated or selection-based healthcare provision
system. It has brought about several new proposals and positions within its organizations to
ensure better quality of healthcare and a well-established work force within its organization.
Positions such as those of the associate practitioner, primary care mental health worker and
nursing development officer have brought positive changes within the healthcare quality of the
organization. Though, it must be observed that job satisfaction is still a huge issue within the
organization especially in the case of nurses who now experience greater levels of stress due to
shortage of nurses in the public sector.
These factors and others such as discrimination of foreign workers within the NHS
necessitate a system that is created to work more toward the retention of its staff and improving
healthcare rather than appeasing stockholders.
87
Chapter 5: Conclusions
In light of this research, it can be concluded that pay equity and job evaluation in the
scenario of NHS are cases that require extensive research and development. The research has
also disclosed the fact that if job evaluations are performed without the establishment of
appropriate systems, it shall only serve to contribute red tapes to the scenario and fail to promote
pay equity. Furthermore, the critical literature review has allowed the research to conclude on the
note that the NHS job evaluation system requires broad modifications and may require a
complete overhaul if First Steps of the Journey: Job Evaluation for Agenda for Change by
Angela Watts and Simon Green, and Job Evaluation for Clinical Nursing by Implementing the
NHS JE System by Emin Khaya and Nurtel Oral were to be given consideration. By reading the
Literature Review and the Secondary Research, it can be clearly seen that the following
conclusions to the research questions detailed above have been reached.
5.1 Implementation of Job Evaluation to Achieve Pay Equity
The secondary research regarding the effectiveness of job evaluation establishing pay
equity in the National Health Service has found that the National Health Service has improved its
system of pay quite considerably when compared to the last 50 years. The new system does not
seem to serve the staff employed at the National Health Service; rather it simply seems to be an
image for the company to attract investors.
It is understood that the current job evaluation scheme within the National Health Service
is the result of trial and error and its establishment has brought a greater deal of equality
regarding compensation within the organization. However, there is evidence of the use of such
system for job evaluation toward the establishment of confidence in the Health Service, on the
part of the shareholders rather than on its employees (Chang 2007) that has created a detrimental
88
effect on the image of the organization. It is not surprising then to see surveys which [detailed] previous researches conducted, showing only 25 percent of individuals being dissatisfied with
their company’s job evaluation techniques (Armstrong and Baron 1995, p. 279-84). In contrast,
other surveys conducted in hospitals show a number of nurses being dissatisfied with their job
experience.
Previous studies also show a direct correlation between quality of health and job
satisfaction among individuals in the field of healthcare (Humphrey, et al. 2003). The relative
decrease in performance levels of the NHS, as seen in the secondary research provided, as well
as studies regarding the general dissatisfaction of nurses in this sector may not show how the
NHS has not established pay equity (Newman, Maylor and Chansarkar 2002). However, studies
showing a discrimination in compensation toward foreigners and other issues that exhibit a
correlation between job satisfaction and pay grade present how the organization has failed in
establishing pay equity.
The ongoing pay increases and major changes within the organization toward delivery of
quality healthcare rather than looking after its financial concerns is a step in the right direction.
In addition, it has shown improvement in pay equity within the organization. It has illustrated
how such issues – which were prevalent within the National Health Service decades ago – have
begun to improve these days, where there have been several legislations passed by the parliament
of the United Kingdom. Despite all these measures, it seems that the NHS has not provided
individuals with pay equity within their organizations. The incessant discrimination and unequal
pay within gender roles indicate a certain kind of behavior that the NHS has no right to possess.
89
5.2 Promotion of Job Equity under Public Private Partnerships
The secondary research collected has shown that the responsibilities regarding job equity
within the private sector of organizations is not the function of the National Health Service,
rather it is the exclusive function of the private companies themselves. The relation between the
private sector and public sector transpires on service for funds which does not involve job
equality within organizations. The secondary research data shows how the National Health
Service does not directly affect the employment decisions of its private contractors.
5.3 Pay Equity Improving Working Conditions
From the research data collected, it may be concluded that the establishment of pay
equity within the National Health Service has improved working conditions in the public sector
but it should be noted that it is not the only factor which is a determinant in this case. The
continued pursuit for the shareholder confidence rather than quality of healthcare by the National
Health Service has led to a decline in recruitment of healthcare professionals and to the actual
quality of healthcare. It has also led to problems within the organization in retaining nurses
whose shortage will further affect the quality of healthcare in the coming years (Newman,
Maylor and Chansarkar, 2002).
Other factors such as the elimination of discrimination and harassment of staff, along
with better management of resources and a greater drive toward establishing a quality system of
care, are far more important in this case in accordance with the personal survey given above
which are in the process of being addressed by the public sector. However, the infectivity of such
measures toward the establishment of proper pay equity and hence of better working conditions,
may be one of the primary reasons for the numerous problems currently faced by the National
Health Service.
90
It must be said, however, that the National Health Service has not reached its goals of pay
equity within its organization despite the establishment of job evaluation schemes.
5.4 Recommendations
• The National Health Service must establish a job evaluation system which is not only
centralized to the organization but takes other factors—such as cumulative workload,
geographical position, and the employees’ working environment—into consideration.
• The National Health Service must pass proposals within its organization that work toward
the principles of job equity as well as stop discrimination and harassment of ethnic and
disabled people. It should conduct studies within its organization to gauge the factors behind
any incidents of discrimination or harassment, and endeavor to find lasting solutions for
them.
• The NHS must realize that a public-private partnership does not absolve them of the
responsibility for actions taken within the private sector. It is their responsibility to ensure
that standards are met and the satisfaction of individuals working both in the public and
private sector is taken into account.
• The increasing reliance on a strategic outlook rather than one which focuses on delivering
quality healthcare to its constituents has brought the drop in healthcare quality and general
dissatisfaction among patients and employees in the NHS. Their focus must change toward
establishing quality protocols while ensuring financial viability.
• The National Health Service can end its reliance on private organizations to take on the
responsibilities of its work load and establish new avenues where they can meet their own
organizational needs.
91
• The NHS can conduct research within its own organization and take the opinion of
various doctors and nurses on how to improve working conditions and quality of healthcare
without sacrificing excessive funds to accomplish this objective.
• The NHS can establish training programs within its organizations for individuals in
nursing and managing positions, with the cost of such programs being paid by the
organization itself.
• It is essential for the NHS to shift its focus away from the shareholders and move toward
its patients and delivery of quality healthcare, with greater emphasis on primary prevention.
• The NHS should tailor their performance evaluations according to variables which can
affect the performance of various institutions such as hygiene, geographical position,
socioeconomic standing, number of staff, availability of equipment, and others.
92
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106
Appendices
Appendix 1: These tables and charts, reproduced from the Job Evaluation Handbook, can be
found on pages 279 to 284.
107
108
109
110
111
Critical Appraisal
SYSTEMATIC REVIEW: The validity of the results in the personal survey may be questioned
due to their unethical nature and the absence of any affiliation with the National Health Service
(NHS). However, they do provide a conflicting viewpoint with the secondary research data
collected that shows a much better perception of the public towards the National Health Service
than what may be indicated by the studies mentioned. However, a conclusion was reached that
the NHS has not successfully implemented job evaluations due to their current efforts towards
establishing pay equity within their organization. In addition, they have not also they pursued
pay equity within the private sector, and this in turn has caused problems regarding pay equity
and the quality of healthcare and work environment in reference to their patients and their
employees respectively.
The statistical information related to the systematic review has been provided within the Personal
Survey, Secondary Research, previous studies in the literature review, and the appendix.
The first study is a survey from the job evaluation handbook. This survey found the percentage
of individuals using job evaluation techniques in the private and public sectors. It also provided
information regarding its use in the organization, and satisfaction levels and types of evaluation
and pay equity techniques employed. It concluded by showing that job evaluation was widely
used as a proprietary system in private companies, while public companies used derivative
systems.
The second is a research from the department of health which found that the biggest constraint
facing healthcare was the shortage of resources.
The third is a survey of the retention and recruitment rates of nurses in the National Health
Service, which found that the biggest issues facing the organization was the retention of nurses
already recruited. It also found out that job satisfaction was the number one reason for nurse
retention.
The fourth study considers the real world effects of the NHS policy, and found out that they had
real world effects regarding the quality of healthcare despite not being intended for such a
purpose.
The fifth study showed how the balanced scorecard employed for the performance review by the
NHS is not an indicator of performance, but rather an indicator to safeguard the organization’s
financial concerns.
The sixth study shows how doctors do not appreciate such reviews and consider them a
compulsion upon them rather than an opportunity.
The final study shows how some of the problems inherent in the NHS working conditions are
due to the lack of training among its managing staff.
What question (PICO) did the systematic review address?
What is best? Where do I find the information?
The main question which is endeavored to
be answered in this dissertation is, ‘Does
NHS implement a poor job evaluation
The research questions to be answered can
be found in Chapters 1.6 and 1.7, while the
Literature Review in Chapter 2 and the
112
system which undermines the successful
implementation of the principles of pay
equity in the healthcare organizations?’ In
order to answer this question, three sub
questions are asked. These questions are
answered by the use of various literatures
which are both directly and indirectly
related to the topic, as well as a personal
survey conducted by the researcher. The
results found that the NHS had not
successfully implemented the principles of
pay equity but observed that there were
several improvements in pay equity within
the organization.
Personal Survey and Secondary Research in
Chapter 4 encompass the information used
to derive the conclusions given in Chapter 5.
This paper: Yes
Comment: The questions were addressed and the relevant information required to answer
them was collected.
F – Is it unlikely that important, relevant studies were missed?
What is best? Where do I find the information?
The secondary research detailed several
studies from scholarly sources, as well as
newspaper articles which detailed critical
reviews of both NHS performance, job
evaluation and also the working
environment for both doctors and nurses.
There were also studies focused on the
performance of the public sector in
comparison to the private sector.
Methods: Searches were conducted using
the internet and local libraries in order to
find books which focused on job evaluation
and pay equity. All official documents from
the NHS were released on the NHS website
and local libraries were used to research
newspaper articles which directly provided
an appraisal of NHS performance.
Results:
There were several studies found which
relayed information regarding the
methodology and importance of job
evaluations. There were also several studies
found which considered if the current
proposals adopted by the NHS were helping
or harming their status as a public health
service. Though there was no direct study
which encompassed all of these search
criteria, inference from the researcher was
required. All figures are catalogued in the
index and appendices. It is conceivable that
certain studies were missed; however, most
of the relevant studies are present, which
allowed this researcher to attain an accurate
conclusion.
113
This paper: Yes
Comment: The information gathered may be incomplete and is missing certain studies
although the studies do confer the researcher with the information necessary to answer the
primary question of this dissertation.
A – Were the criteria used to select articles for inclusion appropriate?
What is best? Where do I find the information?
The criteria required that all journal articles
be from peer-reviewed sources.
Information gained from books was
verified by the use of journal articles and
other literature, while all information
provided from websites was insured to be
from well-known organizations with
projects related to the topic being
researched.
Methods: Journal articles which were not
peer-reviewed were excluded from the
dissertation. This was also true for books
which could not be verified by cross
checking. Newspaper articles were insured
to be from well-known newspapers while
websites were excluded unless they were
UK organization-based or well-known and
updated.
The terms used to search for these articles
were the following:
Job evaluation
Pay equity
Job evaluation in public sector
Job evaluation in private sector
Pay equity in public sector
Pay equity in private sector
Job evaluation in NHS
Pay equity in NHS
NHS
NHS performance review
NHS proposals
Job equity in NHS
This paper: Yes
Comment: The criteria for the inclusion of articles insured that the information provided
within the dissertation was as accurate as possible. It also ensured that all sources could be
used without any reason for conflict due to the information provided.
A – Were the included studies sufficiently valid for the type of question asked?
What is best? Where do I find the information?
The research study did not sufficiently
meet the valid criteria to answer the type of
questions asked within the dissertation.
However, the other studies provided met
the criteria mentioned above and were
chosen based on their relation to the current
topic.
Method: The validity of the personal survey
was contingent upon its authorization by the
department of health or any other governing
body or organization. Meanwhile, the
validity of the other research was contingent
upon the criteria mentioned above.
Results: The quality of the studies provided
met the criteria detailed above and were thus
used to form a conclusion to the research
question put forth. However, the personal
114
survey did not meet these criteria.
This paper: Yes
Comment: The majority of the information detailed in this paper and the information used
to correlate the findings were chosen under strict criteria detailed above.
T – Were the results similar from study to study?
What is best? Where do I find the information?
Most of the studies showed a correlation in
the information given. Meanwhile, the
personal survey taken by the researcher did
not conform to the information gained from
various studies.
Results: The results of the studies provided
in Chapters 2 and 4 showed a correlation
which allowed the researcher to form a
conclusion regarding the research questions.
On the other hand, the personal survey
showed information which strongly
disagreed with this hypothesis.
This paper: Yes
Comment: Since the information in the personal survey was not employed, the results of
the remaining surveys were given more credence within the dissertation and allowed to
form the final conclusion despite the opposite contentions of the personal survey.
What were the results?
The results showed that the NHS has implemented a poor job evaluation system which
undermines the successful implementation of the principles of pay equity in the healthcare
organizations.
How are the results presented? The results were presented as a series of answers to
the sub questions asked in the first chapter. The answers to these sub questions were
used to form the conclusion given above. This conclusion was followed by
recommendations to the National Health Service on how to successfully implement
job evaluation for pay equity.
Appendix 2: Critical Appraisal Skills Program (CASP)
A critical analysis of job evaluation for clinical nursing by implementing the NHS JE
system by Emin Khaya and Nurtel Oral.
Was there a clear statement of the aims of the research?
��Yes
2. Is a qualitative methodology appropriate?
��No
The research required the use of quantitative methodology.
Detailed questions
Appropriate research design
3. Was the research design appropriate to adequately address the aims of the research?
115
Yes, the research design was appropriate to adequately address the aims of the research. An
analysis based on the 9 bands was included and a survey questionnaire was used to carry out the
research.
4. Was the recruitment strategy appropriate adequately to the aims of the research?
The Participants of the study were the participants that participated in this project are nurses and
the supervisor of nurses that belong to regional and local hospitals.
Data collection
5. Were the data collected in a way that adequately addressed the research issue?
The researcher justified the methods used in the study and has not modified the method during
the study in order to form a consistent outcome.
6. Has the relationship between researcher and the involved participants been adequately
considered?
The relationship between researcher and the involved participants remains unaddressed in the
research article.
Ethical Issues
7. Have ethical issues been taken into adequate consideration?
Even though the researcher has not discussed how the ethical standards of the study were
maintained the criterion utilized in the research is one that leaves little room for violation of
research ethics.
Data Analysis
8. Was the data analysis sufficiently rigorous?
The data analysis was designed to be continuously rigorous with respect to the implementation of
the research methodology of the research.
Findings
9. Is there a clear statement of findings?
The findings of the study are clearly presented and highlighted. The evidence is adequately
discussed in order to reach a concise conclusion by use of the findings presented.
Value of the research
10. How valuable is the research?
The research furthers the existing knowledge of the National Health Service regarding its
performance appraisals and also provides new avenues in which this study may proceed further.
116
Critical analysis of Job and Work Evaluation by Robert L. Heneman
1. Was there a clear statement of the aims of the research?
��Yes
2. Is a qualitative methodology appropriate?
��Yes
Detailed questions
Appropriate research design
3. Was the research design appropriate to address the aims of the research?
The research has been designed to follow a qualitative analysis and rests primarily on the
literature review.
Sampling
4. Was the recruitment strategy appropriate to the aims of the research?
The research made use of literature that pertained specifically to the subject of the research.
Data collection
5. Were the data collected in a way that addressed the research issue?
The data was extracted from the literature review in a justified manner.
Reflexivity (research partnership relations/recognition of researcher bias)
6. Has the relationship between the researcher and the participants been adequately
considered?
No such explanation was provided since no primary data was used.
Ethical Issues
7. Have ethical issues been taken into consideration?
The research does not address any ethical issues at any point in the article.
Data Analysis
8. Was the data analysis sufficiently rigorous?
The data analysis was sufficiently rigorous since it made use of charts, diagrams and extensive
elaborations.
Findings
9. Is there a clear statement of findings?
The author has presented a section regarding the research’s summary and conclusion, and has
singled out the major findings from the literature review as well.
117
Value of the research
10. How valuable is the research?
The research makes a significant contribution to the understanding of the impact of different
variables in job and work evaluation procedures and perceptions.
118
First Steps of the Journey: Job Evaluation for Agenda for Change by Angela Watts and
Simon Green
1. Was there a clear statement of the aims of the research?
��Yes
2. Is a qualitative methodology appropriate?
��Not entirely
The research employs the use of existing secondary research data in order to form conclusions in
relation to the subject matter and leaves a significant part of the research area untouched.
Detailed questions
Appropriate research design
3. Was the research design appropriate to address the aims of the research?
The researcher has not presented the research methodology separately and has not given the
research design details at any point.
Sampling
4. Was the recruitment strategy appropriate to the aims of the research?
No participants were recruited into the study since there was no primary data involved.
Data collection
5. Were the data collected in a way that addressed the research issue?
The collection of data was structured around the research subject and continued to proceed in an
almost hierarchal manner of analysis through the article.
Reflexivity (research partnership relations/recognition of researcher bias)
6. Has the relationship between researcher and participants been adequately considered?
The researcher has not considered the inherent limitations.
Ethical Issues
7. Have ethical issues been taken into consideration?
Ethical considerations were not raised or taken into consideration during this study.
Data Analysis
8. Was the data analysis sufficiently rigorous?
The data analysis was not what could be referred to as rigorous since the various themes of the
data were merely presented in the article and were not critically evaluated.
Findings
9. Is there a clear statement of findings?
A brief Results & Outcomes chapter constitutes the findings of the research.
119
Value of the research
10. How valuable is the research?
The research is valuable in providing a decryption of aspects pertaining to job evaluation but
does not present any significant findings.
120
A revision of a job evaluation system by Emin Kahya
1. Was there a clear statement of the aims of the research?
��Yes
2. Is a qualitative methodology appropriate?
��No
The research had to make use of a mixed approach in order to deliver a significant conclusion.
Detailed questions
Appropriate research design
3. Was the research design appropriate to address the aims of the research?
The researcher has justified the research design given within the study and has decided the
methodology for the survey questionnaire.
Sampling
4. Was the recruitment strategy appropriate to the aims of the research?
The research incorporates a realization of the necessity of an appropriate recruitment strategy
and has followed one that is in line with the aims of the research.
Data collection
5. Were the data collected addressed the research issue in a way?
The setting for data collection and the methodology for data collection are justified. The
methodology used to reach their conclusions is also justified.
Reflexivity (research partnership relations/recognition of researcher bias)
6. Has the relationship between the researcher and the participants been adequately
considered?
The relationship between the researcher and the participants has not been considered.
Ethical Issues
7. Have ethical issues been taken into consideration?
The ethical issues inherent within the research have been considered and have been taken into
account.
Data Analysis
8. Was the data analysis sufficiently rigorous?
The data analysis is sufficiently rigorous. The author has provided an in depth description of the
data collected as well as tables and charts depicting the data which has been collected.
Findings
9. Is there a clear statement of findings?
There is no clear statement of findings while conclusions relating to the research have been
appropriately discussed.
121
Value of the research
10. How valuable is the research?
The research contributes to the paper by giving recommendations regarding the issues discussed
within the study.
122
An Analysis of Job Evaluation Committee and Job Holder Gendered Effects on Job
Evaluation by Chad T. Lewis and Cynthia Kay Stevens
1. Was there a clear statement of the aims of the research?
��Yes
2. Is a qualitative methodology appropriate?
��No
The methodology used is highly quantitative and is appropriate for the research since the
researcher has used a questionnaire in order to reach a conclusion.
Detailed questions
Appropriate research design
3. Was the research design appropriate to address the aims of the research?
The research design is justified to address the aims of the research, and the study constitutes a
discussion on the methodology employed as well as the reasoning behind the usage of such
methodology.
Sampling
4. Was the recruitment strategy appropriate to the aims of the research?
The recruitment strategy was not as appropriate as needed for this research and was far too
narrow than what would have been ideal for the case of this particular research.
Data collection
5. Were the data collected in a way that addressed the research issue?
The data collection within the research was mentioned in detail in the article. Moreover, the form
of data collected has also been clearly presented.
Reflexivity (research partnership relations/recognition of researcher bias)
6. Has the relationship between the researcher and the participants been adequately
considered?
The researcher has not adequately considered this relationship as the potential bias and influence
of the researcher has not been examined.
Ethical Issues
7. Have ethical issues been taken into consideration?
The ethical issues within the research as well as the maintenance of ethical standards have not
been considered within the research.
Data Analysis
8. Was the data analysis sufficiently rigorous?
The researcher has provided an in depth description of the data analysis and has employed
statistical instruments to do so effectively as well.
123
Findings
9. Is there a clear statement of findings?
The findings have been discussed under the Results section. However, the credibility of the
findings has not been discussed.
Value of the research
10. How valuable is the research?
The value of the research and the contribution the study makes to the existing knowledge of the
issue in question have not been discussed. However, the research remains imperative to this
study since it assists in the elaboration of factors that were essential to job evaluation.
124
Designing a Comparable Worth Based Job Evaluation System: Failure of and a Priori
Approach was written by Jonathan Tompkins, Joyce Brown and John H. McEwen.
1. Was there a clear statement of the aims of the research?
��Yes
2. Is a qualitative methodology appropriate?
��Yes
Detailed questions
Appropriate research design
3. Was the research design appropriate to address the aims of the research?
The research design was appropriate to address the aims of the research in consideration of the
fact that it sought to develop a procedure and not to oppose or support a hypothesis.
Sampling
4. Was the recruitment strategy appropriate to the aims of the research?
Primary research was not a part of this study. Therefore, no recruitment strategy had to be
formulated.
Data collection
5. Were the data collected in a way that addressed the research issue?
The data was collected through the analysis of previous research studies and the examination of
contradictions and similarities between present and suggested methods of job evaluation.
Reflexivity (research partnership relations/recognition of researcher bias)
6. Has the relationship between the researcher and the participants been adequately
considered?
The absence of primary data did not allow this question to be raised.
Ethical Issues
7. Have ethical issues been taken into consideration?
The reader is informed of no details regarding whether ethical standards were maintained, and no
issues regarding informed consent or confidentiality were discussed.
Data Analysis
8. Was the data analysis sufficiently rigorous?
The researcher has provided an in depth analysis of the process of data analysis but has not taken
into account the potential researcher bias within the study.
Findings
9. Is there a clear statement of findings?
The researcher has not provided a clear statement of findings and has proceeded directly to the
conclusion.
125
Value of the research
10. How valuable is the research?
The research attempts to unveil new horizons pertaining to job evaluation and is of the utmost
value.