Designing a Retention Model of Human Capital with an Organizational Support Approach in Mashhad University of Medical Sciences (Qualitative Approach)

Introduction

Job retention was first proposed by Mitchell et al. in 2001 and has since been considered by organizational management and organizational behavior (1). One of the first steps in recognizing employee retention problems for both policymakers and organizations is understanding the factors that employees expect. Some research has shown that one of the issues that has received less attention in the policies of educational organizations is the importance of maintaining and paying attention to employees’ tendency to stay or leave the service(2). Desire for retention refers to the behavioral desire of employees to continue membership in their job and be motivated to work harder (2:2). If their behavioral tendencies are not focused on the positive aspects, it will lead to job search and achievement of multiple jobs, which indicates that they remain unmotivated (3).

Higher education operates in a competitive environment nowadays. In this competitive environment, many higher education institutions do not offer popular student programs and do not have new programs to fill their classrooms; however, some important and reputable universities have changed their orientation from the education system to focus on the market and entrepreneurship. In other words, higher education competes not only to attract students, but also to attract and retain high-quality faculty members in popular fields (4). Job retention theory is a new theory in the field of employee attachment to the organization compared to organizational commitment. However, over the past 15 years, a considerable amount of research has been published about this issue (1), which has attracted the attention of researchers and those involved in management organizations (5). The theories that form the theoretical basis of this research are the theory of job retention by Mitchell et al. (2001) (6) as well as the theory of Eisenberger et al., (1986) (7). Job retention based on the model of Mitchell et al. (2001) has three dimensions, which are: communication, adaptation, and sacrifice.

Organizational support refers to employees' beliefs about the value of the organization for their efforts and job contributions and the extent to which the organization strives for their welfare (8: 101); Perception of organizational support is: the individual general belief through which the organization values ​​his efforts and cares about his welfare and well-being (9: 162). The most important factors affecting the human capital retention are generally divided into seven categories which are: value and culture of the university, reputation and position of the university, conditions of employment, personal and professional growth, educational atmosphere, researching atmosphere, and working environment (10).

Sleiderink (2012) (11) in a study entitled "Talent Management: Identification, Maintaining and Retention of Talents in Medicine" stated that the factors of talent retention are divided into two categories of internal and external factors. Internal factors include job independence, development opportunity, job satisfaction and gratitude, and external factors include good relationships with colleagues, working conditions, job security, promotion opportunities, and decent pay.

Liu et al. (2015) (12) in a study entitled "The relationships among perceived organizational support, intention to remain, career success and self-esteem in Chinese male nurses" with a sample of 405 male nurses, examined the relationship between the intended variables using structural equation modeling. Their results showed that self-esteem has a mediating role in the relationship between perceived organizational support and job success, and job success has a mediating role in the relationship between self-esteem and the desire to retention. This study also shows that there is a positive and significant relationship between perceived organizational support and retention.

In a study entitled "Perceived Organizational Support, Organizational Identification, and Employee Outcomes", Edwards and Peccei (2010)(13) examined the relationship between variables with a sample of 736 employees from the United Kingdom National Health Service using a structural equation model. They concluded that organizational support has a negative and significant relationship with leaving the job; however, organizational identity also plays a mediating role in this regard.

Retention of human capital is a process in which managers try to increase the employees' desire to continue and serve in the organization by using factors such as payment system, training and improvement, competency-based promotion, giving appropriate welfare facilities, etc. (14). The results of many studies have shown that organizational support affects employees' ethic and their loyalty to the organization and also reduce their leaving. The consequences of organizational support are organizational commitment, job satisfaction, organizational identity and, ideally, organizational citizenship behaviors (15).

International research shows that 51% of reputable universities have difficulty replacing full-time faculty members; however, lack of faculty members has created a challenging problem for the administrators of these institutions. Faculty members’ leaving is very costly in any university considering the quality of education, student learning, skill development, financial overhead in replacing, recruiting, and retraining new members; however, this has a negative effect on the reputation of medical universities which are a key element of the higher education and health system.

One of the most important issues in managing human capital in organizations is the motivated retention of human capital. One of the main intellectual concerns of management is to reduce the leaving rate of educated employees, so that the organization can significantly reduce this amount, or maintain it at an acceptable level (16).

Faculty members are the main body of any university, and as the main elements of education they need to be effective in educating students and promoting the health care system which plays an important role in the health of any society (17). Given that the main purpose of retention of faculty members of medical universities is considered to be the desire to stay while motivated, factors and problems such as postponed payment of salaries, arrears of clinical and basic sciences faculty, the obligation to attend certain hours at the university, the necessity for research activities and submission of articles by faculty members of the university of medical sciences to promote academic rank, disagreement with private sector employment in full-time projects, and other cumbersome rules are among the problems of educated employees in medical universities (18).

The present study aims to examine the factors affecting the desire of faculty members to stay while motivated. Reviewing the research literature shows that no research has been conducted with the current research title in the medical universities of the country so far. Also, studies which are about the retention of human capital are sporadic and a comprehensive model has not been presented in them.

This issue is important because in the field of education and health the supply and training of committed, specialized, and efficient human capital and maintaining educated employees according to the problems and laws in the medical universities of the country such as the labor market and economic efficiency, arrears created in the payment system, cumbersome rules, the obligation to attend certain hours, gaining research points for promotion which reduces the retention of the pillars of health and education system (18) can be taken in this regard in order to respond to the existing conditions by better identifying the effective factors in retention while educated employees are motivated.

The general purpose of this study is to achieve an appropriate model for the retention of human capital with an organizational support approach in Mashhad University of Medical Sciences.

Methods

The present study is a developmental-applied research that was conducted in Mashhad University of Medical Sciences in 2018-2019 by Delphi method. Considering that the Delphi technique is used to measure the group judgment of experts in order to predict and make decisions, the sampling method was purposeful. Thus, individuals were selected based on background and experience. Participants in every stage were 32 specialists with inclusion criteria. The mentioned experts were chosen based on some characteristics including: having at least 5 years of management experience, having a master's degree, and MD with managerial positions (senior managers), from which 15 men and 17 women were selected.

Table 1. Experts' Properties participating in each stage

Inclusion criteria were all members who had educational and research activities in the fields of management, faculty management, and human capital. They were explained about the aims of the research. Initially, the extracted titles were reviewed by the researcher and thus the initial checklist with 8 dimensions and 61 components was created to design a model of human capital retention with an organizational support approach in Mashhad University of Medical Sciences. Delphi sessions were conducted in three stages. In these meetings, the experts presented their views on the importance of every components of checklist, both orally and in writing (for and against as well as presenting written suggestions). Participants were also asked to write if they were considering another factor or component that was not mentioned in the checklist. At the end of the sessions, all participants' responses and comments were reviewed and analyzed. Any variable on which more than 70% of Delphi panel members agreed was retained in the model and considered significant at this stage; otherwise it was excluded from the model (19). Thus, in this step, 5 components were removed and 13 new components were added. The modified Delphi checklist was reviewed in the second round with 8 dimensions and 69 components. Then the second round of Delphi took place. At this stage, the respondent participants were asked to express their opinions and views on each of the indicators accepted in the first stage through a Likert scale, with five options from "strongly agree" to "strongly disagree" and submit their comments and suggestions. After collecting and analyzing the opinions and views of Delphi panel members regarding each of the variables from the first stage of Delphi, the factors and components whose average score was more than 4, were preserved and variables that were equal to or less than 4, were removed from the resulting variables and excluded from the research model. Finally at the end of this stage, 8 dimensions and 53 components were accepted by Delphi panel members to design a model of human capital retention with an organizational support approach.

In order to assess the validity of the research questionnaire, face validity was confirmed by the doctoral advisor, consultant and some other expert professors in the Department of Educational Sciences. Following the proposed corrections, the questionnaires were distributed among the experts. Also, in order to assess the reliability, the final questions of a prototype included 30 pre-test in questionnaires. The reliability coefficient using Cronbach's alpha for the research questionnaire was 0.87, which indicates the optimal reliability of the research tool.

Results

Initially, demographic characteristics of experts are presented based on frequency and percentage. This information can be seen in Table 2.

Table 2. Demographic characteristics of experts

Table 2 shows that among the experts, 45.5% are men (15) and 54.5% are women (17) and the experts have more than 10 years of service in Mashhad University of Medical Sciences, so that 48% (15 people) of the experts have 16 to 20 years of service and 86% have a PhD degree and 14% have a master one. Also, 53% of the experts participating in this study were in the range of 40-49 years old.

After reviewing the answers and the results of the opinions of experts in the first stage of the Delphi technique, duplicated topics were removed, similar opinions were merged, 5 components were removed, and 13 components were added. From a total 61 components and 8 factors, the modified checklist of human capital retention with an organizational support approach was developed for the second phase with 8 factors and 69 components.

After reviewing and analyzing the answers in the second stage, out of a total of 8 factors and 69 components, 16 components were removed, one new component was added, and the rest remained unchanged. Finally, due to the lack of consensus among the responses of Delphi panel members, the third stage of the Delphi technique was performed. After obtaining the views and opinions of Delphi panel members on the importance of each of the components to design a model of human capital retention with an organizational support approach in Mashhad University of Medical Sciences, the researcher implemented the third stage of Delphi technique to reach a consensus.

The results of this stage showed that all the factors and components studied (8 factors and 54 components) were removed from the modified checklist of the second stage and finally 8 factors and 53 components obtained an average score higher than 4. Therefore, the appropriate model of human capital retention with an organizational support approach in Mashhad University of Medical Sciences was finalized with 8 factors and 53 components.

In this study, in order to determine the degree of consensus among experts while using the Delphi method, Kendall rank correlation coefficient has been used. Kendall rank correlation coefficient is a scale to determine the degree of coordination and agreement between several rank categories for N individuals (19). The criterion to decide whether to stop or continue Delphi stages is strong consensus among panel members (19).

Table 3. Interpretation of Kendall Rank Correlation Coefficient Values

The value of Kendall rank correlation coefficient for different stages of the Delphi process related to this research is shown in Table 4. It should be noted that the Kendall rank correlation coefficient test for the present study was performed in SPSS software 24.

Table 4. Results of Kendall Rank Correlation Coefficient Test

The results of Kendall rank correlation coefficient was 0.316 in the first stage, 0.78 in the second stage, and 0.86 in the third stage. The Kendall coefficient in the third stage showed that there was a strong consensus among experts. The model was designed as Figure 1. In addition, in order to reinforce the results of the present study, the significance of all dimensions and components identified from the third stage of the Delphi technique was evaluated using the Student T-test and compared the mean with a constant value. In this test, the scores of experts' opinions about each of the dimensions and components were calculated and then their average score was compared with a constant value of 4. This test showed which of the identified dimensions and components are higher or lower than 4. According to the above explanations, also collecting the required parameters, and the calculation of t-test statistics as well as the P-value, the results showed that all the factors and components obtained from the third stage of Delphi technique were significant; Therefore, all the assumed variables of the conceptual model of the research including 8 factors and 53 components, that make up the design of the model of human capital retention with an organizational support approach in Mashhad University of Medical Sciences, were identified and finalized. Table 6 presents only the findings related to the factors of this model and does not mention the findings related to the components and indicators due to the prolongation of the article.

Table 5. Primary checklist of factors and components of human capital retention model with an organizational support approach in Mashhad University of Medical Sciences

Table 6. Student-t-test about the identified dimensions of the human capital retention model with an organizational support approach in Mashhad University of Medical Sciences

Discussion

By examining the models of human capital retention, it can be understood that a group of researchers such as Ghamari and Zainabadi (2018), Mohseni (2015), Ghazizadeh et al. (2008), and Haverdink (2018) emphasized that human capital sustainability is a process that the manager tries to increase the desire to continue the service of employees in the organization by using factors such as payment system, training and improvement, promotion based on worthiness, providing appropriate welfare facilities, and so on (14). Although numerous studies have been conducted on the retention of human capital and its dimensions and components in various organizations, studies that examine the retention of faculty members in universities are rarely found and so far, only Mohseni (2015) has studied the retention of faculty members in Yazd University; however, no research has been done on the retention of faculty members in the Iran's medical universities. It should be noted that the retention of faculty members of medical universities has a great importance due to the training of specialists in the field of health and increasing public health. On the other hand, the findings of the present study are consistent with the results of many researchers referenced in (16), (20), (17), (18), (21) and (22).

The present study, with the Delphi approach and all the effective factors in designing the retention of human capital with an organizational support approach, has identified the main factors and components of human capital retention. So it has developed and presented a model of human capital retention with an organizational support approach. Based on the opinions of academic experts in this study, it can be concluded that the effective factors in the retention of human capital with an organizational support approach included personal, organizational, job-motivational, environmental, job properties, organizational justice, organizational activities, and job tensions.

Paying more attention to human capital retention while motivated requires simultaneous attention to the identified dimensions and components. Although the overall purpose of this study was to develop a model of human capital retention while motivated, it can be said that introducing the importance and necessity of paying attention to organizational support which employees believe in their attitudes, is the ultimate goal.

 It is very clear that the growth and development of this goal requires the efforts of superior managers in paying special attention to the necessity and role of organizational support in the country's universities. The ultimate goal of this research has been achieved. It is noteworthy that plan makers and managers of medical universities pay special attention to creating a supportive atmosphere in universities.

The most important limitation of the Delphi method is the use of non-random sampling method; therefore, the results of this study cannot be generalized to other medical universities.

According to the findings of the present study, it can be concluded that the eight dimensions that seemed to be effective in the retention of faculty members Mashhad University of Medical Sciences were: personal, organizational, job-motivational, environmental, organizational activities, organizational justice, job properties, and job stress dimensions. Also, job-motivational and job tension factors were the most effective dimensions of the retention of educated employees in mentioned university.

Based on the results of this research, the following suggestions and solutions are presented:

Considering the role and position of faculty members in educating and training specialist human capital in the health segment, experts and managers of universities, especially in Mashhad University of Medical Sciences, all dimensions and components of the human capital retention model with an organizational support approach should be considered. In other words, specialists and managers of medical universities should pay special attention to personal, organizational, job-motivational, environmental, job properties, organizational justice, organizational activities, and job tensions. They should plan to develop the necessary organizations based on the effective dimensions and components of human capital retention while motivated, in order to avoid future problems that cause financial expenses and excessive costs for leaving and relocating faculty members.

Based on the findings of the present study, it is suggested that managers of Mashhad University of Medical Sciences should pay special attention to job-motivational and job tension factors; because these factors showed the highest mean score among the studied factors and also had the lowest rate of standard deviation.

Based on the components of job-motivational dimension:

• Paying attention to the absence of discrimination in offering organizational positions, organizational rewards, and providing university rank is effective in the retention of faculty members of Mashhad University of Medical Sciences.

• Encouraging faculty members to use new ideas in creative work, and informing and holding educational courses to familiarize faculty members with new technologies in the relevant field is effective for their retention.

• Selection of capable faculty members according to their assigned responsibility and the symmetry between the educational-research performance of faculty members with the improvement of educational quality and research fields is effective for their retention.

Based on the most important components of job tensions, the following should be considered:

• Job Exhaustion (Enthusiasm to return to work, cumbersome rules about work hours, faculty lack of interest to their jobs)

• Role Ambiguity (transparency of authority, transparency of goals, transparency of time management, transparency of responsibilities, transparency of expectations)

• Role Conflict (disagreement between law and function, inconsistency of requests, lack of public acceptance, lack of facilities)

• Job Stress (lack of resources, lack of support from managers, related field and specialty)