Implementation of employee suggestion programme: a case study of the Middle East health-care service company Mehrajunnisa, Syed Zamberi Ahmad and Fauzia Jabeen Introduction Mahrajunnisa, Syed Zamberi Ahmad and The case is about one of the leading health care service company located in the Middle Fauxin Jaboon ain all East. Health care is one of the most rapidly growing sectors of the Middle East. The demand based at Management for health care in the Middle East has increased with the growth of the ageing population, Department, Collage of persistent and long-term health problems, the focus on mandatory health insurance, the Business, Abu Dhabi focus on medical tourism, the emerging market expansion and advancements in University, Abu Dhabi, technology. In the year 2017, the NOVA Healthcare Service Company won "The Award for United Arab Emirates Excellence and Innovation". After receiving the award on behalf of her company, NOVA, a beaming Ms. Fatima, the Excellence and Innovation Manager, a key person in developing pioneering initiatives at NOVA through the Employee Suggestion Programme (Minara). shared the secret of her success at the award ceremony. The core idea was to leverage on employees' talents and innovative ideas in order to enhance capacities and potentials to create a stimulating environment for continuous improvement with a purpose to provide improved service outcomes for a healthy and happy community. Following the award ceremony, which was held at the Gulf exhibition grounds, the walked into the office and was greeted with a big round of applause. She proceeded to her cubicle and placed the award on her office desk. Staring at the award, the admired its golden sparkding star. She was happy and these glittering moments led her into deep thoughts about her past journey and the tremendous efforts by NOVA to link employees' innovative potential to its organizational development. Now even deeper in thought, she is worried about the outcomes of her efforts in the long run. How can the Minara Programme be made effective and sustainable enough to work in line with the Middle East's Healthcare Vision 2030 and meet the challenges of operating in the emerging health care market? The other would take tha op- Implementation of the employee suggestion scheme in the Middle East health-care partunity le think the whole Hi Tium of NOVA and Excalling sector and Innovation Maruigur for their support inbulking this In 2013, the Federal government of the Middle East introduced innovation as a major pillar of development to focus on building innovative solutions and pioneering initiatives and Ductalter: This cari in wilin applying them effectively in services, processes and programmes (SKGEP, 2013). Parallel mobily for aducationual purposing and is not intended lottpaint with the ambitious vision of 2021, the Middle East Government also launched the Sheikh managerial chicago-making Khalifa Government Excellence Programme (SKGEP) in 2006 under decree No: 16522, The wthere may his dis- Sea 9, to raise the bar of excellence in government organizations. The Middle East Ministry their nicogrinible infomation of Health and Prevention (MOHAP] have also launched "Afkari" as an initiative to encourage lo product conticlanbully. EMERALD EMERGING MARKETS CASE STUORES PAGEemployees to submit their creative ideas through the Employee Suggestion Programme. Afkari worked as an idea incubator to effectively manage new ideas and suggestions by following up on the implementation process under professional supervision (Gulf news, 2017). With the 2021 vision to develop a world-class health-care infrastructure in the Middle East, the expertise and services of the Middle East health-care market are expected to grow from 12.7 per cent to Dh 71.56bn. (Business, 2017)- About NOVA company The health-care organization's name is changed to NOVA for reasons of confidentiality. The NOVA Company, is an independent, public joint stock company created to meet the curative needs of the people of the Middle East. NOVA's health-care system consists of all the public hospitals and clinics within the Middle East. It is striving hard to raise its international standards through continuous improvement measures to serve the needs of customers and communities in the Middle East with world-class health-care facilities. NOVA has partnered with internationally recognized hospitals to raise the bar of quality standards in health care to meet its goal of effectively serving the community. NOVA owns several hospitals with more than 3000 beds, 70 ambulatory care, family care and emergency care centres and two blood banks. Among the health-care providers in the Middle East, NOVA is regarded as one of the largest integrated health-care networks, employing more than 19,000 doctors, nurses, ancillary care and administrative personnel. With a competent workforce, NOVA is trying hard to be a global leader through concerted efforts in research and education, partnerships and alliances, collaborative teamwork and empowered and engaged employee suggestion programmes. Strategic overview of NOVA NOVA's mission has focused on its strategic objectives, namely, achieving excellence, fostering a business culture that has customer service as its top priority, and providing world-class health-care services. These key principles are the company's raison d'etre by which it can benchmark its performance. NOVA is committed to eight strategic priorities, namely. financial performance management, patient's satisfaction, delivering high-quality services, superior operational performance, establish brand image, leadership and support for developing national policy of emiratization, develop health-care infra-structure and international standards, promote research and development in the health-care sector. NOVA's focus on continuous improvement To win international recognition, NOVA has focused on nine strategic principles, namely, leadership, continuous improvement, human resources, training, process management, the environment, data analysis, strategic planning and quality control. These strategic priorities are further sub-divided into four primary areas: quality, access, cost and people. Quality: NOVA provides excellent services to the patient without compromising quality. Access: NOVA aims at satisfying patient, staff and community needs according to growing demands and expectations. Cost: It always focuses on cost minimization war.t. budget constraints and eliminates its dependence on government funding- People: The top priority at NOVA is its workforce. NOVA provides its employees with training, learning and development programmes to strive for, and achieve, the best performance. PAGE2 EMERALD EMERGING MARKETS CASE STUDIES VOL 9 NO. 1 201Achievement as a business entity The track record of NOVA's success in becoming a World-Class Healthcare Leader has been rewarded with several awards and accolades during its short history, as seen in Table I. Sustainability Sustainability details the performance in the social, economic and environmental commitment of NOVA in meeting quality care and patient satisfaction through continuous improvement measures. NOVA revises its health-care quality and strategies to perform effectively to meet challenges and collaboratively cultivate a fine blend of social and intellectual capital. NOVA is engaged in the construction of new hospitals rated under Estidama. "Estidama" is the Arabic word for "sustainability". The Middle East Government has been making progress towards implementing more sustainable green construction standards through a range of initiatives and policies such as the Estidama programme (Estidama, 2010). The programme is a key aspect of the "Plan 2030" drive to build the city according to innovative green standards. In addition, NOVA is committed to environmentally safe methods of recycling and waste disposal. Social responsibility The very nature of NOVA's social responsibility is inextricably linked to its fundamental commitment to provide comprehensive health care to the public. As a committed health- care organization, NOVA runs multiple free clinics and screening programmes that provide free blood pressure tests, diabetes screening, vaccinations, premarital counselling. smoking cessation, mental health, dental care for children, etc. Over 21,000 people have taken advantage of these free clinics and screening programmes. NOVA has also set up a mobile breast cancer screening programme. Over 1,800 women's lives have been saved thanks to NOVA helping them to identify problems during their initial stages, when they were readily treatable. Moreover, NOVA's blood banks adhere to the most stringent international standards in the handling of blood and blood products, ensuring the highest levels of patient safety. There have been over 200 blood drives resulting in nearly 2,000 gallons of blood being donated. NOVA proudly carries the mantle of corporate social responsibility and will continue to do so in delivering quality health care. Governance and ethics A corporate governance framework was established at NOVA in November 2010 to provide a structure for efficient and reliable corporate decision-making, monitoring and reporting of business processes in accordance with best practices and legal requirements as per NOVA's constitutional documents. Table I Awards and accolades of NOVA company from 2010 to 2017 2010 Best healing environment at the hospital build exhibition 201 1 Gold award for achievements in customer satisfaction and outstanding results 2011 Excellence award for the development of the gulf health-care sector 2012 Sheikh Khalifa award for excellence 2013 Platinum award for achievements in customer satisfaction and outstanding results 2014 The Sheikh Khalifa excellence award for ambulatory services 2015 Dubai quality award, middle east 2016 Stevie awards for great employers 2017 Service excellence and innovation award category Source: NOVA Company Annual Report 2016-2017Board of directors and committees The Board of Directors at NOVA comprises government, business and industry representatives who provide leadership and strategic direction. To ensure transparency regarding independence and potential conflicts of interest, each Board member must sign a Statement of Independence and Conflicts of Interest annually. The Board has also established an Audit Committee and a Nomination and Remuneration Committee, which is responsible for reviewing, informing, and making recommendations to the Board in accordance with the committee's mandate. In addition, an executive, corporate procurement, and corporate human resources committee has been implemented by NOVA management. NOVA is organized into a Corporate Office and separate operational business entities. The corporate structure of NOVA company is as shown in Figure 1. Need for innovation in health care Today's hyper-fast, super-competitive business world demands innovation at every level. With the incredible growth in the lifestyle of the middle-class population and the increasing number of senior citizens, the demand for better health care is increasing globally. It is important to focus on the drivers that enable the innovation process and on the constraints that impede it. Health care is working hard to improve quality standards through quality circles, gain-sharing and suggestion programmes. Without enhanced employee involvement, service organizations will never be able to cope with the "high tech world". An Employee Suggestion Scheme (ESS) can make the health-care services sector thrive and help retain its distinctive competence in gaining a competitive advantage. The more innovation efforts are put into health care, the greater its transformation. ESS has great potential to accelerate the innovation process. ESS helps solve concerns with regard to employee participation, service to customers, cost reduction, increase in productivity, increase in performance, maximization of profits and an increase in employee commitment and employee satisfaction. Employee suggestion scheme (MINARA PROGRAMME) in NOVA The NOVA has launched a new employee suggestion programme called Minera. MINARA is an Arabic word which means "participation, collaboration, and sharing". The intent of the programme is to engage our employees in NOVA's mission of continuous quality Figure 1 Corporate structure of NOVA company Board of Director Internal Audit Managing Director MO Office [CED Office H CEO H Strategy and Parformance Continution Support Service Source: Adapted and revised from NOVA company annual reportimprovement and to solicit their participation in the achievement of their vision. In return, they not only share the credit for improvements, but they can also share the benefits derived in the form of a financial incentive. The ideas can be about any quality management issue that directly inoronace the officionoy or offootiveness of NOVA's performance. The footors or drivers of innovation in health-care delivery are important because of technological changes, changes in operating competition, the changing nature of the operating environment, persistent and long-term health problems, sustainability endeavours, changing patient needs, etc. In 2013, the federal government of the Middle East introduced innovation as a pillar, focusing on the extent to which organizations build innovative solutions and pioneer initiatives and apply them effectively in services, processes and programmes implemented (SKGEP, 2013). To make the Employee Suggestion Programme (Minara) work in line with the national agenda, the Board of Directors at NOVA assigned the new responsibility and challenge of accelerating the innovation process to Ms. Fatima, the Excellence and Innovation Manager (Ms. Fatima, 2017). Problems and challenges at NOVA with the employee suggestion programme Ms. Fatima faced quite a few challenges in implementing the Employee Suggestion Programme (Minara). The reasons are many and varied: employee engagement and participation in the programme was declining: unclear goals and undetermined incentives formed a major barrier to tacit knowledge transfer, implementation of good ideas was neglected due to the lack of robustness of the evaluation committee, and the lack of a proper policy mechanism for checking the feasibility of ideas received. The major challenge was to motivate employees to come up with constructive ideas effectively. Another major challenge she had to deal with was focusing on continuous improvement through total quality management in areas such as leadership accountability, training for skill development, making information accessible to all and building a favourable culture of trust. Transformation at NOVA The strategic direction was to focus on innovation at NOVA with leading practices. It was on the 9 May 2013 that Ms. Fatima took the initiative to kick-start the innovative Employee Suggestion Programme, "MINARA", as a part of NOVA's continuous improvement initiative. The MINARA Programme is an innovative programme that was established to hire approximately 19,000 of NOVA's employees in a creative environment which supports innovation and encourages them to participate with their ideas and use them to develop and improve its corporate performance. NOVA's Innovative programme "Minara" supports the business development and the enhancement of operations efficiency in the work environment in line with the national agenda of innovation. "The intent of the programme is to engage our employees in NOVA's mission and solicit their participation in achieving our vision" (Ms. Fatima, 2017). The ideas could be related to improving the efficiency or effectiveness of NOVA's performance, such as reducing waiting lines for patients, effecting process and procedure improvements, increasing customer satisfaction, enhancing safety. improving quality outcomes, reducing costs, coming up with ideas to eliminate waste, redirecting savings, etc. A huge transformation was effected by Ms. Fatima at NOVA, including an approved budget and commitment from top management to support administrative resources, promotional activities, the cost of awards and technical resources to boost creative performance through Minara. The traditional way of dealing with the ESS was to use a share-point link with a committee receiving suggestions in the HR Department. One person was responsible for filtering the suggestions. This was a centralized authority, with bias and lack of communication. Ma. Fatima decided to frame effective empowering strategies that could reduce bias and involve everyone effectively in the decision-making process. Her focus wassystem, with an employee ID and login with a password, at NOVA's intranet to submit ideas. Each employee at NOVA has a unique login ID and can submit ideas online. The ideas are delivered to the MINARA Programme managers at their individual departments. The goal was to have a paperless process that is very simple, easy to understand, user-friendly and which adheres to all environmental aspects. Due to employees' lack of awareness of the Minara Programme, their participation at NOVA was decreasing. Ms. Fatima focused on raising employee participation in and awareness of the ESS programme "MINARA" through an advertisement at the NOVA website, portals, hoardings, the media, etc. Those employees whose suggestions were implemented had their photos printed on company manuals and records. Induction training was provided for new hires to make them aware of the programme and mission of the organization. As a manager, keeping employees engaged was perhaps the biggest challenge she faced. As a remedy for poor morale and low productivity, she introduced empowering strategies at NOVA to enable employees to share a significant degree of decision-making. Empowering strategic policies were designed in cooperation with the committee members to portray best practices and boost employee engagement and performance. Employees were empowered in the decision-making process to come up with innovative ideas that would increase their ability to respond more effectively to the extensive changes in health-care work environments. The programme was supported by new innovative initiatives through access to information, empowering strategies and appropriate rewards. Strategic direction for Minara Empowering strategies were introduced at NOVA by Ms. Fatima with a purpose: "To enhance capacities and potentials to create a stimulating environment for global innovations and continuous efforts to focus on innovative services for a healthy and happy community". The various dimensions of innovation activities include: creating a stimulating business environment; empowering creative talents; providing more innovative services and tools that exceed expectations; and enabling partnerships with innovative entities The organization structure is shown in Figure 2, with the jury (committee members) as top managers and a specialized work group consisting of line managers or department managers. Innovation values Innovation values at NOVA were introduced to involve employees effectively in the decision- making process and contribute to the continuity of the success of the programme through four pillars: persistence; team spirit; empowerment; and knowledge and learningFigure 2 Organizational chart: NOVA Target is Bort approved employees'100 and rejected * participant ' Auriorul dry more the objective of the brian's plants ininghen Mandarin Source: Adapted and revised from NOVA company annual report Designing a new information management system. Previously, access to information at all levels in the organization was difficult, which impeded the idea-generation process. Ms. Fatima wanted to design an effective Information Management System (IMS) that would be simple, reduce paperwork and make information accessible to all. To do so, she organized ceremonies, simulation for staff and took their opinions. She solicited opinions from personalized expert groups over the internet. Her rigorous efforts bore fruit and an information exchange system was developed. The new Information Management System was designed by Ms. Fatima in collaboration with the IT department, which was more employee-friendly, informative and process- oriented, as shown in Figure 3. The electronic system receives innovative ideas as a solution to the problem. The innovative ideas are then moved to the implementation phase if proven feasible. Ideas are considered to be innovative if they achieve financial benefits or returns for the organization. The mission of the Information Management Figure 3|Information management system: NOVA Innovation Management System Leadership for Innovation DEAS Innovation #+ RESULTS Gramation Planning tor the IVIS Improvement off Source: Adapted and revised from NOVA company annual report VOL . NO. 1 201 EMERALD EMERGING MARKETS CASE STUDIES PAGE 7System is to transform NOVA into the health-care leader with the highest medical quality by: establishing a commitment to top management and leadership; planning innovation practices; enhancing the innovation management process; and improving the performance of IMS through evaluation. Creating a fun-loving culture. Ma. Fatima's next challenge was to improve employee participation and look into what was impeding the process. Individual behaviours, which include attitudes, personality, perception, learning, and motivation, varied from one individual to another. Most of the employees were interested in enjoying their day-to-day life, not in profiting from it. She wanted to improve individual as well as team suggestions. She realized that the predictor of workplace satisfaction was not merely pay. She had a strong belief that "The most innovative companies of the future will be dominated by those that do not simply focus energies upon innovation, but those who have managed to build enduring environments of human communities striving towards innovation through the creation of appropriate cultures". She wanted to create fun with a purpose. Thus, Ms. Fatima introduced an Innovation Stock Exchange Idea with an innovation currency index to stimulate a fun-loving culture. It was called "Innovation Exchange" for innovative ideas. For each idea contributed, the employee would receive 10 points in the employee stock basket. If the idea reached the direct line, the points would be incremented to 20 points. The innovation currency was calculated based on the following formula: Innovation Currency Index = number of ideas involved number of employees The greater the employee's participation and contribution, the higher the value of their innovation currency index. An ethical copyright system was introduced by NOVA to protect the employee's right to the ideas suggested. That right would be passed to NOVA even if the employee left the organization. It was introduced to safeguard the company's own rights. Collecting points. The approved ideas were credited with points and kept in the Bank of Ideas and then translated into money after an employee has accumulated 5,000 points, equivalent to AED 500. Process flow Ms. Fatima needed to know how many individual employees/teams were engaged in submitting suggestions/process and to what extent the submitted ideas were feasible. Looking forward to innovation, Ma. Fatima took the next step to reduce biases and make leaders and line managers accountable and committed to the decision-making process in determining the feasibility of the suggestions. As the most valuable ideas were either ignored or neglected due to an ambiguity between the sender and the receiver, a set of predefined criteria was laid down, and a Johari window approach was introduced to build trust and communication and obtain constructive feedback on the decision-making process. Some of the pre-defined criteria introduced are: knowledge of the suggestion information system; knowledge of the evaluation procedures to decide the viability of ideas; provision of feedback; effective knowledge of the reward system; and adherence to fair and transparent assessment procedures.Effective management support was required to spur the effectiveness and efficiency of the system while maintaining a balance of trust and healthy relationships. The Johari window concept was introduced to focus on building soft skills, such as emotional intelligence, empathy, cooperation, communication, interpersonal and intergroup relationships and personal development ability. Ma. Fatima introduced the leaders and focus groups to a special training session on the usage and applicability of the Johari window, as shown in Figure 4, in taking appropriate and feasible decisions with regard to the ideas submitted. Leaders were responsible for welcoming new and creative ideas, encouraging employees to express their thoughts and feelings freely, inviting people to openly discuss any disagreements and ensuring that the staff was working towards a common goal. Thus, the Johari window at NOVA has helped in strengthening employee involvement and has contributed to effective decision-making by removing ambiguity from the decision-making process relating to the ideas received by the Minara Programme. The process flow is shown in Figure 4. Once an employee logs into the portal and submits ideas, these go to the direct line (manager) in charge of the Minara Programme. The employee is awarded 10 points per idea submitted. The line manager is responsible for deciding whether to go ahead with the idea or reject it. In decision-making, the line managers are trained to use the Johari window, as shown in Table II, to test the feasibility of the idea. Line managers are responsible for checking the feasibility of any idea submitted. Any negligence by line managers raises a RED FLAG and all managers are held accountable being negligent in their duties; this, in turn, will affect their performance appraisal. If the idea is found to be feasible, it is approved, upgrading the points to 30, and a letter of appreciation is sent to the employee in question; if it is not feasible, it is rejected. Feasible Figure 4 Process flow: NOVA Andipm Source: Adapted and revised from NOVA company annual report99.5 CM GREAT TOEA! 175 CM Source: Adopted from NOVA company annual report through emails sent to all employees in the entity, and then "Appreciator" presents certificates of appreciation to the most innovative employees at NOVA. To encourage and recognize the creative ability of employees, the Minara Programme was introduced, with a number of awards in different categories: Best Idea, Best Implementer, Best Supportive Manager, Best Project, etc. Conclusion. As the major provider of health-care services in the Middle East responsible for health-care strategy formulation for the Middle East, NOVA must involve all its employees across every facet of NOVA's operations, whether front-line patient care or back-office administration. As employees are the internal stakeholders of the organization, NOVA's strategic objectives and HR processes and practices should be revised to enhance the employee's skills and competencies to keep pace with the challenging environment both internally and externally. The Excellence and Innovation manager is in a dilemma. After all her efforts, she remains Keywords: uncertain of the outcome. What type of management style must be adopted to increase Employee active employee involvement and make the programme more effective and sustainable? participation/engagement, How can NOVA remain the most prominent service provider with innovative solutions and Human resource management, meet the challenges of operating in the emerging health-care market? These questions Organizational must be answered in order to realize the Middle East's Healthcare Vision 2030 and to make performance, the Minara Programme work in line with the national health-care agenda. Innovation