ABSTRACT
The purpose of the study will be investigating the impact of privatizing hospitals in the United Arab Emirates (UAE) and its implications on shortage of healthcare workers. The objectives that the study will seek to explore includes finding out if privatized hospitals in the UAE are more efficient in delivering of healthcare services, determining the impact of privatized hospitals on the problem of healthcare shortage in the UAE and examining the challenges of privatizing hospitals in the UAE. Undertaking this research will be significant to the UAE government, policy makers, healthcare workers and hospitals, future researchers and students, and finally the researcher. According to the literature review, there are numerous reasons why a government opts to privatize hospitals. However, the process of privatization has both its benefits and shortcomings. The UAE government can adopt different ways of privatization depending on what they intend to achieve in this case solving the challenge of shortage of healthcare workers. The study to be conducted will utilize a correlational research design. The rationale of using this design is because it assists in establishing the relationship between privatizing hospitals in UAE and the shortage of healthcare workers. The study will use interpretivism philosophical approach having that human subject will be the research respondents. Additionally, mixed methods composing of both quantitative and qualitative methods will be adopted. A sample of 80 respondents will be chosen from the target population using stratified sampling. Data will be collected using questionnaires and interviews. Validity and reliability of the questions in these two research instruments will be tested using a pilot study. Quantitative data will be analysed using SPSS, while qualitative data through content and thematic analysis. Some of the ethics to be considered will include obtaining permission from the University, obtaining consent from the respondents and maintaining privacy and confidentiality of the research participants.
ABSTRACT 2
INTRODUCTION 5
Background of the study 5
Problem statement 7
Aim of the study 8
Research objectives 8
Research questions 9
Significance of the research 9
LITERATURE REVIEW 11
Benefits of privatizing hospitals 11
Problems of privatizing hospitals 13
Privatization processes and methods 14
RESEARCH METHODOLOGY 16
Research approach, methods and design 16
Target population, sample, and sampling procedure 17
Data collection procedure and data analysis 17
Ethical Consideration 18
SUMMARY 19
REFERENCES 20
INTRODUCTION
This study will assess the impact of privatizing hospitals in the United Arab Emirates (UAE) and its implications on shortage of healthcare workers. This research proposal has been organized into three sections which include introduction, literature review, and research methodology. The introduction section details the background of the study, problem statement, aim of the research, research objectives and question as well as the significance of the study. The literature review section provides an overview of previous studies that have been conducted on the topic of the study. Finally, the research methodology section expounds on how the data will be collected, research design and philosophy, sample size and sampling procedure, the population of the study, the research instrument and data analysis and the ethics to be considered.
Background of the study
According to Burke (2002), organizational changes have occurred and will continue as long as people organize themselves, and coordinate their efforts. The current generation of human beings lives in a period of diversity where globalization and developments in technology influence every part of the society, individuals, and organizations. This has lead to the increased demand for competition, efficiency, and effectiveness (Burke & Cooper, 2000). Many organizations have continued to develop strategies to meet the current societal changes by adapting. According to Quick, Gowing, & Kraft, (1998) the adaptations by these organizations have resulted in different changes among them consolidation, downsizing, outsourcing, and buyouts. In addition, the new developmental changes experienced by the society combined with the increased costs in the public sector and the political liberalization have brought new requirements for the publicly managed organizations across the world (Megginson & Netter, 2001). One of the popular ways that is being utilized to meet these demands is privatizing organizations. According to Ramamurti, (2000) privatization refers to the situation where a public entity is acquired partly or completely, by a private agency.
In the healthcare sector, fixed public budgets and the rising health expenditure in the past few decades have seen decision makers in many countries across the world including developed nations seek to adopt ways that can improve the performance of healthcare institutions. In particular, hospitals are being held accountable for their financial performance and their efficiency. Many countries have identified financial risks and inefficiencies in public hospitals and their response has been privatizing them. According to Tiemann, & Schreyögg, (2012) the main motivation influencing increased privatizations of healthcare facilities has been the expectation that a shift to private ownership from public ownership will achieve improved organizational performance. A study by Tiemann, & Schreyögg, (2012) to investigate how privatization affected hospital efficiency in Germany revealed that efficiency increased which ensured that scarce resources were utilized appropriately. Additionally, a study by Villa, & Kane, (2013) to determine the effect of privatizing public hospitals in 3 states in America specifically Florida, California, and Massachusetts indicated that the process of privatization reduced the length of stay among patients, and increased operating margins.
Previously, some studies have been done to investigate the impact of privatizing hospitals nonetheless, many of them have had their focus on the effect privatization has on the efficiency and effectiveness of the hospital. In the past, there is no study which has explored the impact of privatizing hospitals in the United Arab Emirates and how it affects the shortage of healthcare workers. This study seeks to determine how the problem of shortage of healthcare workers in the UAE can be affected after hospital privatization. According to the World Health Organization, it is estimated that the global shortage of healthcare workers is 17.4 million, of which 9 million are midwives and nurses while 2.6 million are doctors (WHO, 2017). While the shortage is widespread in many of the African and South East Asian regions, developed nations including the United States, United Kingdom and UAE continue to experience shortages. For instance, in Abu Dhabi, the health authorities estimate that by 2020 there is need for an additional 3,100 doctors (Sahoo, 2013). The increased shortage of healthcare workers in the UAE is fuelling poaching from other local providers rather than recruiting from abroad which leads to increase in costs and it is on this background that the study seeks to investigate the effect that privatization of hospitals in UAE will have on the shortage of healthcare workers.
Problem statement
The United Arab Emirates was established in the year 1971 consisting of seven Emirates specifically Ras Al Khaimah, Fujairah, Sharjah, Umm Al Quwain, Ajman, Dubai, and Abu Dhabi. The establishment provided an opportunity its leaders to make a deliberate plan that would have UAE become a developed society by strengthening national unity, promoting personal health and wellbeing, as well as continuous economic growth. In the late 1960s, it was reported that in the region, only half of the newborns would survive and in every three mothers, one would die during delivery (Koornneef, Robben, & Blair, 2017). Today, approximately 50 years later, UAE’s healthcare provision is same or better compared to some of the developed nations and this has been boosted by the rapid economic growth that has increased healthcare professionals and healthcare facilities serving in the region. For example, Mahate, & Hamidi, (2015) notes that from 2011 to 2015, UAEs’ spending on healthcare rose by 10% which given the starting point of UAE, it is remarkable what has been achieved in the past few decades. Nevertheless, UAE has set a grand plan of implementing healthcare reforms since early 2000s that would see it address the quality and cost challenges within the healthcare sector. The reforms have mainly focused on introducing private health insurance as well as encouragement of private health provision against a growing population and the increase in chronic diseases and risk factors such as diabetes and obesity (Koornneef, Robben, Al Seiari, & Al Siksek, 2012). These new developments have lead to the need for more healthcare professionals ranging from physicians, nurses, and midwives. UAE is faced with the problem of meeting the demand for quality healthcare services having that the current healthcare workers are inadequate. Conversely, UAE has an option of privatizing its hospitals, which would mean leaving private investors to deal with this problem rather than the government. The critical question is how privatization of hospitals would affect the problem of healthcare workers shortage. Therefore, this research study will investigate the impact on healthcare workers shortage following privatization of hospitals in the United Arab Emirates.
Aim of the study
This study aims at finding out the effect that privatized hospitals in the United Arab Emirates can have on the challenge of healthcare workers shortage.
Research objectives
The specific objectives of the research will include:
1. To find out if privatized hospitals in the UAE are more efficient in delivery of healthcare services
2. To determine the impact of privatized hospitals on the problem of healthcare workers shortage in the UAE
3. To determine the challenges of privatizing hospitals in the UAE

Research questions
The research questions that this study will seek to answer include:
• Are privatized hospitals in the UAE more efficient in delivery of healthcare?
• What is the impact of privatized hospitals on the problem of healthcare workers shortage in the UAE?
• What are the challenges of privatizing hospitals in the UAE?

Significance of the research
There are several reasons why undertaking this study is significant first, the research will be critical to the UAE government in that they can utilize the findings to understand what the process of privatization entails. The UAE government can use the findings of the study to make informed decisions on the need to privatize the public healthcare sector. Secondly, for the policy makers, this research can prove to be important. Formulation of policies on hospital privatization requires extensive knowledge and understanding with the intention of developing a policy that meets the objectives envisioned. The findings of this research will be critical in furnishing policy makers with some of the content to be included in the policy. Additionally, the research is important to the healthcare workers in different hospitals. It is for their best interest to work in an environment which they feel motivated because of the flexibility in the shift schedules. Through this research, it will be set clear if privatization helps in addressing the problem of healthcare worker shortages benefiting both the employees and administrators in the various hospitals across UAE. Consequently, undertaking this study will be important for the researcher because of the extensive knowledge to be gained from this topic area. The researcher will have a deep understanding of the privatization process in the healthcare industry a critical element in building a successful career. Finally, this study will become an additional the available limited literature on the topic of privatization of hospitals in the United Arab Emirates and how it impacts the shortage of healthcare workers. Currently, there lacks enough literature focusing on the UAE but upon completion, the contribution of this study will be immense. Finally, this research will be significant for future researchers either professionals or students. The findings of this study can be used to provide a background for a related topic.

LITERATURE REVIEW
According to Weil, (2011) in the last decade, privatization of hospitals has been popular in many countries globally where healthcare organizations’ ownership as a public institution is changed to be a private organization or a non-governmental organization. However, there is the perception that privatization only includes the transfer of ownership but as depicted by Weil, (2011) it can be a change of control or leadership.
Some of the reasons why most hospitals are privatized include; first, the government may be unable to pay the wages of workers in the public hospitals. Thus, since the government cannot drastically change the number of workers by downsizing, it opts to alter the ownership of the organization where the new owners are able to reduce the wages by having new terms and conditions (Desai, Lukas & Young, 2000). Secondly, privatization has an effect on the services provided by an organization because a new leadership provides new strategies to reach certain goals which results in increased productivity and efficiency of the work done (Desai et.al, 2000). Finally, in many countries, the governments have public healthcare organizations giving free services, but a change of ownership leads to drastic reduction in the need to access health services. Often, the reduction is because some people visit the healthcare institutions with minor problems having that the care offered is free service (Desai et.al, 2000).
Benefits of privatizing hospitals
When governments are privatizing certain hospitals, they do it because in most cases, government institutions are not efficient and innovative when compared to the private sector. Through regulation, the state can hardly tamper with running of private managed businesses (Young, 1990). Hospital privatization saves the financial resources in a community because the limited public assets and finances are used to fund other critical elements in the society such as education (Young, 1990). According to Manga, (1987) the private sector is managed by leaders who are under authority of the board and they have to deliver the required services to the people, failure to which they become personally accountable and answerable to the stakeholders. In contrast to the public hospitals owned by the government, leaders have minimum pressure from the other government departments regardless of the expected outcome.
In most countries, government bureaucracies are thought to be the major causes of interruptions on innovations and development of many public institutions. However, without this bureaucracy in the private institutions hospitals are able to offer services that contribute to the efficiency of operations without any government restrictions (Manga, 1987). Moreover, the private sector is known for expanding its services depending on the demands of customers. Therefore, through privatization, hospitals are able to expand the healthcare services offered depending on the demand. According to Tiemann & Schreyögg, (2012) people like efficiency and speed in the services they are offered; a case identified with private hospitals compared to many public hospitals. For instance, before receiving treatment, private hospitals schedule appointments with patients to reduce the waiting time because the physician already understands the problem of the person waiting. Moreover, private hospitals compared to public hospitals have the highest length of stay because they cannot discharge patients before their full recovery. In many public hospitals, patients are discharged before recovering fully as they seek to cut costs. While they succeed in cutting costs, the damage in terms of negative effects to the patient later on can be worse (Tiemann & Schreyögg, 2012).
Studies have shown that after privatization of public hospitals, their medical services and healthcare quality achieves great improvements (Tiemann & Schreyögg, 2012). Additionally, these hospitals are able to acquire more medical personnel such as doctors and nurses improving the healthcare services offered. Many people prefer privatized hospitals because they have good value for money by providing adequate and reliable services for charges which are justified. Through privatization, there is increased competitiveness among hospitals which makes them provide the best services to their patients (Tiemann&Schreyögg, 2012). Finally, by hospital privatization, the government is able to save extra costs which could be used to fund other projects for the benefit of the citizens. The savings are because of the decline in the burden of supplying medical resources as well as the financial burden of supporting the staff which becomes the responsibility of the private owner.
Problems of privatizing hospitals
Certain researchers have proposed that in developing countries, provision of health services through public hospitals with a central supplier is much efficient compared to provision of the services with marketed-oriented approaches mainly the private hospitals (Scarpaci, 1989). When a public hospital is privatized, it joins the competitive market created by other private hospitals. Therefore, the problem arises in that most customers need to have knowledge about the services available in the privatised hospital. Often, this is a big challenge because many people know little about medical care (Scarpaci, 1989). Additionally, the consumer is unable to make a free choice and opts to seek medical care from other institutions or ignore them completely.
Market competition can be disadvantageous to a newly privatized hospital because private insurance companies can take advantage of the market and skim it with an aim to minimize the risks and maximize profits (Manga, 1987). Additionally, privatization ensures that the hospital is responsible for the profits or losses they make. At times, this can result to some of the employees initiating unnecessary treatments to increase their profits a scenario which reduces the quality of healthcare offered (Manga, 1987). At the same time, privatization of hospitals impacts negatively on the universal provision of healthcare. Some people especially the poor can find themselves unable to access quality care.
Privatization processes and methods
There are various processes in which privatization is carried out and the variation in these processes impact hospitals differently. The first process is known as deregulation where the private hospital is still allowed some privileges which were present within the public hospital such as public insurances (Forde &Malley, 1992). Secondly, there is the contracting out process which involves public hospitals being part of various transactions with the private hospitals. In this case, the public hospital can contract a privatized hospital for them to offer medical and auxiliary services that may not be available in the public hospital (Forde &Malley, 1992).
The government uses the proceedings from privatization of a certain hospital to help members of the society in other ways. Some governments use the income to establish trust funds that can be used for community health care (Bovbjerg, Held &Pauly, 1987). Moreover, the government can use the resources from privatization to reach local people who may not have access to adequate treatment. According to Smith &Lipsky, (1992) privatization can occur when the equipment in a hospital is leased to a management firm which is given the task of running the hospital. The government owns the hospital although it is not involved in the organization internal issues because they only receive payment from the management firm depending on the contract agreement. When this happens, privatization impacts the lives of the people positively since they are able to get improved healthcare services (Smith &Lipsky, 1992). In other cases, the government sells part of the hospital although it remains with the greatest portion and is given the power to appoint the board members to run the hospital. This mainly happens when the hospital is having loses and a new owner is needed to curb this problem.
Bovbjerg, Held &Pauly, (1987) noted that there are many cases where the government opts to collaborate with various firms in the running of a hospital. This type of privatization gives both parties a 50% stake to make decisions regarding the organization. The private institution is able to bring new ideas and merge them with the former administration which ensures that the hospital is run in a smooth and efficient way. In many countries, privatization has impacted the hospitals positively (Weil, 2011). Nevertheless, where a public hospital has been privatized, there are always some negative defects that require to be eliminated and evidence shows that most organizations have been successful (Smith &Lipsky, 1992). Privatization is mainly used to reduce the debt of a public hospital, raise more income for the running of the hospital or create a more developed system for serving customers (Desai et.al, 2000).
In other cases, a hospital may not be needed in a certain location due to certain external factors and the government may consider selling the whole facility for putting up another valuable project. This is known as service shredding and although the facility left is not a hospital, it is meant to help the government and the people who live in the surrounding area (Weil, 2011).

RESEARCH METHODOLOGY
In this section of the proposal, the methodology that will be utilized during the actual study has been detailed. Some of the areas that have been highlighted include the philosophy of the research, the study method and design, the target population and the sampling procedure and sample size, procedure for data collection, data analysis as well as the ethical consideration.
Research approach, methods and design
The research to be conducted will adopt interpretivism as the appropriate philosophical approach. Studies that use interpretivism are characterized by providing priority to the subjective meanings and socio-political issues as well as symbolic actions. According to Saunders, & Lewis (2009) interpretivism studies involves a process where human beings construct and reconstruct the reality where they live. In addition, this philosophical approach puts emphasis in conducting research where people are the respondents rather that utilizing objects. In this case, the study aims at finding out how privatization of hospitals in the United Arab Emirates can impact on the shortage of healthcare workers. This study will involve human beings as the research participants. Thus, this philosophy applies to the research topic.
Consequently, the study to be done will use a mixed methodology approach where both quantitative and qualitative methods will be adopted. The use of a mixed methodology will be beneficial to the final findings as the researcher aims to utilize the strengths of each method. The quantitative method is where the data collected is numerical in nature while qualitative methods collect data that cannot be tabulated. Finally, a correlational research design will be used in this study. The rationale of choosing this research design is because it will assist in establishing the relationship between privatizing hospitals in UAE and the shortage of healthcare workers (Yin, 1994).
Target population, sample, and sampling procedure
In this study, the target population will be government officials responsible for healthcare in the United Arab Emirates, policy makers within the government and those practicing privately on matters related to privatization, hospital administrators and some healthcare workers. A sample will be selected from this population. It is proposed that a sample size of 80 research participants will be recruited for the study. The research will use stratified sampling technique when selecting the respondents to be involved in the study. Stratified sampling ensures that various individuals who can add value to the research findings are included in the sample.
Data collection procedure and data analysis
The data for this research will be collected using a questionnaire and interview questions as a representation of quantitative and qualitative data respectively. The researcher will prepare a structured questionnaire that takes into consideration all the research questions. The questionnaires will be administered online using a survey monkey. On the other hand, interview questions will be prepared beforehand. These questions will seek clarifications on the some of the questions in the questionnaire. To ensure questions for questionnaire and for the interview are valid and reliable, a pilot study will be conducted. The pilot will be done using 15 respondents with an aim of checking the respondent’s ability to understand the language and sentence structure to ensure that the wrong intention is not put forth during actual study. Adjustments will be done to these questions for purposes of achieving clarity when actual research participants respond to them. Importantly, the results from the pilot study will not be tabulated as part of the actual study.
The collected data will be analyzed differently. For the quantitative data, a scientific tool, SPSS will be used in combination with Microsoft Excel. Descriptive analysis will also be utilized. Data will be presented using tables, figures, charts, frequencies and graphs. On the other hand, the qualitative data will be analysed using content and thematic analysis.
Ethical Consideration
When dealing with human subjects, it is critical to adhere to certain ethical rules. In this case, the researcher will seek the necessary permission from the University’s Committee on Ethics. Secondly, before undertaking the study, the researcher will seek to obtain consent from the research respondents. The respondents will be informed of the research purpose and their right to withdraw. They will be part of the sample upon signature or approval through a consent form. Finally, the privacy and confidentiality of the research participants will be guaranteed during the entire period of research.

SUMMARY
In summary, this research proposal has provided in detail the topic under investigation, and how data for analysis and findings will be collected. This proposal has been subdivided into three major sections. These sections include the introduction, literature review and research methodology. The introduction provides the reader with an opportunity to familiarize with the topic under study which is examining the impact of hospital privatization in the United Arab Emirates on the shortage of healthcare workers. Additionally, the introduction provides a background to the topic as well as the statement of the problem which gives way for the aim of the research, the research objectives and questions. In the introduction, a sub-section on the significance of the research has been provided among the critical ones being helping policy makers in the formulation of effective hospital privatization policies as well as to the researcher who will gain more knowledge on this subject area. Consequently, the literature section of the proposal has reviewed various studies relating to the topic under the sub-topics; benefits of privatizing hospitals, problems of privatizing hospitals, and the privatization processes and methods. The literature section has extensively relied on past studies. The final section of the research proposal is the research methodology. This is the section where how the study will be conducted has been spelled out. The study will utilise a mixed methodology which means both quantitative and qualitative methods. Data will be collected using questionnaires and interview sessions with an estimated sample of 80 respondents. The researcher will conduct a pilot study to test for the reliability and validity of the research questions. Analysis of quantitative data will be done using a scientific tool and content and thematic analysis for the qualitative data. It will be critical to adhere to certain ethics as detailed in this research proposal.

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