India is one of the most attractive medical tourism bargains for someone in the West who is looking for high-end medical procedures or surgery overseas at a low cost. The size of the Indian healthcare industry is estimated at Rs. 1,918 billion in 2011. It is estimated to grow by 2012 to Rs. 3,163 billion at 13% CAGR. The private sector accounts for nearly 80% of the healthcare market, while public expenditure accounts for 20%. The country had 15,393 hospitals, which had 8.75 lakh hospital beds (Anderson et. al.)¹. According to the WHO report, India needs to add 80,000 hospital beds each year for the next five years to meet the demands of its growing population. Indian government has a special visa for medical tourists that allow them to stay for long periods in the country. Also, the government has an investment of US $6.5 billion in the pipeline for medical tourism. Medical tourists from South Asia and Middle East have been coming for medical treatment to India for many years now. Also, Medical tourism from UK to India has become quite common. It’s only Medical Tourism from North America (USA, Canada) to India that is a relatively new phenomenon.

According to Medical Tourism Corporation,the following aresome of the unique advantages that India provides for medical tourists:

(A) Low cost of medical treatment: Prime Driver of Medical Tourism in India

(B) Experienced and talented pool of Medical Professionals (C) Private Hospital Infrastructure

(D) Medical Tourism.

Women’s participation in economic sector is crucial for their economic empowerment and their sustainability. However, problems such as harassment in the workplace discourage women to continue working. Harassment in the workplace, though an age-old problem has emerged as a serious concern in Asia and the Pacific recently (Andersson and Pearson)². It is increasingly being recognized as a violation of human rights and human dignity, which undermines equality of opportunity between men and women. As women’s participation is growing in employment sector, it is necessary to address the problem of harassment to ensure safe and healthy working environment.

Increasing number of Asian women are going to work outside home. Many women are forced to deal with harassment and unwanted attention because they are women. Inequalities in the position of men and women exist in nearly all societies and harassment at work is a clear manifestation of unequal power relations. Women are vulnerable to harassment because they lack similar power, lack self confidence and are socialized that they are to suffer in silence.

Harassment is also used as a tool to discourage women who may be seen to be competing for power. Discussions of harassment in the international feminist and legal scholarship have been focusing overwhelmingly on the workplace; however adequate attention is yet to be given in harassment in universities and in public places.

Though women in workplace suffer from harassment, both the employees and employers deny the existence of the problem. The scarce employment opportunity and the fear of losing the job, silence the victims. In fact women are blamed for enticing men for harassment. The number of reported cases of harassment is only the tip of the iceberg, because very few women take action, unless it concerns physical assault and rape. After three decades of feminism and equal opportunities legislation, today's working woman continues to feel discriminated against, overlooked for promotion and torn between the demands of the workplace and the family (Brown et. al.)³.

Ignoring harassment will incur heavy penalties for organizations in terms of turnover, absenteeism and potential legal costs. Older women feel more excluded at work than their younger female colleagues and they feel more disturbed with networks in their company. A research indicates that a substantial number of older women, still active in the UK workforce, have never been promoted and have very limited access to the training and development that would enable them to move out of this trap (Dougherty and Smythe)⁴ .

It is unsurprising that top of the list of barriers to women trying to move up in their organization is the difficulty in balancing work and family. Management should try and put the skills of women to good use instead of discriminating against them, as often it is. When we translate harassment into real numbers it is frightening - it suggests that hundreds of thousands of female workers are subject to harassment. These things are very real barriers to women gaining promotion at work. Institutions have to deal with discrimination against women by accepting that gender is an issue that deserves attention.

Governments, employers and workers organizations and NGOs around the world are increasingly acting against harassment at work by adopting workplace polices and implementing them at the workplace. Legal protection is necessary but adopting a law is not sufficient to resolve harassment issues in workplace. In recent years there has been progress in legislation and initiatives to help women work, such as increases in maternity leave and pay, and the working families' tax credit.

There is an idea of institutional silence around gender in the workplace, which is very similar to racism. These aren’t just women’s perceptions of failures, but are the real failings of managers in regard to proper training, flexible working and development opportunities for women.

Harassment of women at work place is prevalent throughout the globe. India is no exception to this evil based on gender discrimination especially in health care set ups, is a grave form of human rights violation of a almost half of the human folk. Although the Honourable Apex Court of India has ruled in 1997 regarding the implementation of guidelines to prevent harassment of women at work place, but without effective implementation, results in violation of human rights of working women as well as service consumers in Indian hospitals (Fitzgerald and Hesson)⁵.

Reluctance to discuss harassment stems from the fear of those on daily wage employment or on contracts that they will lose their job if they go public. Shockingly, the biggest perpetrators of abuse were patients and their family followed by doctors and non-medical staff. Nurses are the only group harassed by everyone: doctors, non-medical staff, patients and their relatives and outsiders.

Medical tourism in India is projected to grow by six times from US $350 million now to an over US $2 billion-industry in 2015. Hence, hospitals in India have a very bright future. India is the largest democracy in the world, is one of the fastest growing economies that is projected to more than double in the next five years. India is quickly becoming a hub for medical tourists seeking quality healthcare at an affordable cost. Nearly 450,000 foreigners sought medical treatment in India last year with Singapore not too far behind and Thailand in the lead with over a million medical tourists. As the Indian healthcare delivery system strives to match international standards the Indian healthcare industry will be able to tap into a substantial portion of the medical tourism market. India’s healthcare sector needs to scale up considerably in terms of the availability and quality of its physical infrastructure as well as human resources so as to meet the growing demand and to compare favorably with international standards (Gruber)⁶.

The number of nurses per thousand persons stood at 0.9 in 2006 compared to a world average of 1.2. Added to this deficiency is the mal-distribution between rural and urban areas and shortages of specialized personnel. These ratios are projected to remain below the existing world averages even in 2016. An additional 800,000 nurses are required over the next 5 years, which in turn translates into huge investments in training facilities and equipment.

Internationally, there is a serious shortage of nurses. One reason for this shortage is due to the work environment in which nurses practice. In a recent review of the empirical human factors and ergonomic literature specific to nursing performance, nurses were found to work in generally disturbing environmental conditions (Jensen and Gutek)⁷.

Thus, in order to attract people to this noble profession, the challenges faced by them have to be addressed at the earliest. One important challenge that worries them is harassment in the workplace. Though there are number of legal provisions to take care of the issue, the problem still exists in silence. There is an immediate need to have a serious thought about this threatening problem. Not only the victim is affected, severe consequences are awaited by the hospitals too.

OBJECTIVES OF THE STUDY:

Therefore this study is undertaken with the following objectives

1. To understand the relationship between demographic factors and harassment experiences of women nurses in their workplace;

2. To understand the relationship between workplace factors and harassment experiences of women nurses in their workplace;

HYPOTHESES:

To study the above objectives the following hypotheses were framed

Ho1:There is no significant relationship between demographic factors and workplace harassment experiences.

Ho2:There is no significant relationship between workplace factors and workplace harassment experiences.

RESEARCH METHODOLOGY:

The study is based on primary data, which was collected from 700 women nurses employed in 75 hospitals located in Coimbatore city through questionnaires. Questionnaires were handed over to the respondents and the completed questionnaires were collected in person from the respondents after a week. This method was used since relatively large sample of respondents had to be contacted. Data were collected from December 2010 to May 2011.

The alpha score of 0.87 showed that the questionnaire was highly reliable and the KMO measure of sampling adequacy had a value of 0.84 showing that the workplace harassment questionnaire was highly reliable and valid.

Ho1: There is no significant relationship between demographic factors and workplace harassment experiences.

Table 1: Results of Anova: Age and workplace harassment experiences :

Harassment experiences	Criticism	Social isolation	Insulting comments	Threat	Verbal abuse
p value	0.009	0.798	0.645	0.611	0.141
df	2	2	2	2	2
Sig.	0.05	0.05	0.05	0.05	0.05

Inference: There is no significant relationship between age and workplace harassment experiences viz, social isolation, insulting comments, threat and verbal abuse. But there is a significant relationship between age and one of the workplace harassment experiences namely criticism. Respondents belonging to different age groups do not experience same level of criticism in their workplace. The level of criticism varies among respondents belonging to different age groups.

Table 2: Results of Post-Hoc test: Criticism and age group:

Dependent variable (I)Age group (J)Age group

Mean difference (I-J)

P value

Criticism <30 years 31-40

>40

- 0.9769*

-0.0896

0.012

0.969

31-40 <30

>40

0.9769*

0.8872

0.012

0.053

>40 <30

31-40

0.0896

-0.8872

0.969

0.053

Inference Post-Hoc analysis table reveals that respondents who are in the age group of 31-40 are more criticized in their workplace than respondents who are less than 30 years and more than 40 years.

Table 3: Results of Anova: Marital status and workplace harassment experiences:

Harassment experiences	Criticism	Social isolation	Insulting comments	Threat	Verbal abuse
p value	0.286	1.100	0.184	0.414	0.081
df	2	2	2	2	2
Sig.	0.05	0.05	0.05	0.05	0.05

Inference: There is no significant relationship between marital status and workplace harassment experiences viz, criticism, social isolation, insulting comments, threat and verbal abuse.

Table 4: Results of Anova: Years of work experience and workplace harassment experiences:

Harassment experiences	Criticism	Social isolation	Insulting comments	Threat	Verbal abuse
p value	0.070	0.127	0.342	0.753	0.758
df	2	2	2	2	2
Sig.	0.05	0.05	0.05	0.05	0.05

Inference: There is no significant relationship between years of work experience and workplace harassment experiences viz, criticism, social isolation, insulting comments, threat and verbal abuse.

Ho2: There is no significant relationship between workplace factors and workplace harassment experiences.

Table5: Results of Anova: Age group of patients and workplace harassment experiences:

Harassment experiences	Criticism	Social isolation	Insulting comments	Threat	Verbal abuse
p value	0.070	0.127	0.342	0.753	0.758
df	2	2	2	2	2
Sig.	0.05	0.05	0.05	0.05	0.05

Inference: There is no significant relationship between age group of the patients and workplace harassment experiences viz, criticism, social isolation, insulting comments, threat and verbal abuse.

Table 6: Results of Anova: Gender of the patients and workplace harassment experiences:

Harassment experiences	Criticism	Social isolation	Insulting comments	Threat	Verbal abuse
p value	0.536	0.001	0.159	0.018	0.160
Sig.	0.05	0.05	0.05	0.05	0.05

Inference: There is no significant relationship between gender of the patients and workplace harassment experiences viz, criticism, social isolation, insulting comments, threat and verbal abuse

Table 7: Results of Anova: Department of the respondent and workplace harassment experiences:

Harassment experiences	Criticism	Social isolation	Insulting comments	Threat	Verbal abuse
p value	0.070	0.127	0.342	0.753	0.758
df	2	2	2	2	2
Sig.	0.05	0.05	0.05	0.05	0.05

Inference: There is no significant relationship between gender of the patients and workplace harassment experiences viz, criticism, social isolation, insulting comments, threat and verbal abuse

Table 8: Results of Anova: Average number of staff working with most of the duty time and workplace harassment experiences:

Harassment experiences	Criticism	Social isolation	Insulting comments	Threat	Verbal abuse
p value	0.753	0.481	0.380	0.318	0.120
df	2	2	2	2	2
Sig.	0.05	0.05	0.05	0.05	0.05

Inference: There is no significant relationship between gender of the patients and workplace harassment experiences viz, criticism, social isolation, insulting comments, threat and verbal abuse

CONCLUSION:

From the above results it is concluded that the hypotheses are accepted / rejected as follows:

Ho1: There is no significant relationship between demographic factors and workplace harassment experiences. Accepted in the case of workplace harassment experiences viz, isolation, insulting comments, threat and verbal abuse, but rejected in the case of criticism.

Ho2: There is no significant relationship between workplace factors and workplace harassment experiences. Accepted in the case of workplace harassment experiences viz, criticism, isolation, insulting comments, threat and verbal abuse.

REFERENCES:

1. Anderson, C. A., Anderson K. B. and Deuser, W. E. (1996) ‘Examining an affective aggression framework: weapon and temperature effects on aggressive thoughts, affects and attitudes’. Personality and Social Psychology Bulletin. 22: 366-76.

2. Andersson, L. M. and Pearson, C. M. (1999). ‘Tit for tat? The spiraling effect of incivility in the workplace’. The Academy of Management Review. 24 (3): 452–471.

3. Brown, S. L., Birch, D. A. and Kancherla, V. (2005) ‘Bullying perspectives: experiences, attitudes, and recommendations of 9- to 13-year-olds attending health education centers in the United States’. The Journal of School Health. 75 (10): 384-392.

4. Dougherty, D. S. and Smythe, M. J. (2004) ‘Sensemaking, organizational culture, and sexual harassment’. Journal of Applied Communication Research. 32 (4): 293-317.

5. Fitzgerald, L. F. and Hesson-McInnis, M. (1989) ‘The dimensions of sexual harassment: a structural analysis’. Journal of Vocational Behavior. 35, 309-326.

6. Gruber, J. E. (1989) ‘How women handle sexual harassment: a literature review’. Sociology and Social Research. 74: 3-9.

7. Jensen, I. W. and Gutek, B. A. (1982) ‘Attributions and assignment of responsibility in sexual harassment’. Journal of Social Issues. 38: 121-136.

Received on 05.05.2012 Accepted on 29.06.2012

Asian J. Management 3(3): July-Sept., 2012 page 119-122