ABSTRACT
The purpose of this research will be investigating the impact of privatising hospitals in the United Arab Emirates (UAE) and its implications on the shortage of healthcare workers. The objectives that the study will seek to explore include: finding out if privatised hospitals in the UAE are more efficient in delivering of healthcare services, determining the impact of privatised hospitals on the problem of healthcare shortage in the UAE and examining the challenges of privatising 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 governments opt to privatise hospitals. However, the process of privatisation has both its benefits and shortcomings. Some of the benefits include improved efficiency, motivation of employees, attracting skilled employees, and provision of quality healthcare services. On the other hand, privatisation’s shortcomings include lose of dividends on the part of the government and profit may be of greater importance rather than provide quality healthcare. The UAE government can adopt different ways of privatisation depending on what they intend to achieve; in this case solving the challenge of shortage of healthcare workers. The study to be conducted will utilise a correlational research design; as it assists in establishing the relationship between privatising hospitals in UAE and the shortage of healthcare workers. The study will use an interpretivism philosophical approach as it focuses on the impact humans as the research respondents rather than policies. Additionally, qualitative methods where data is collected through interviews will be adopted because it provides an opportunity to make analysis of information conveyed through behaviour and language in a natural setting. A sample of 20 respondents will be chosen from the target population using stratified sampling and 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 and 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.

Table of Contents
ABSTRACT 2
INTRODUCTION 4
Background of the study 4
Problem statement 6
Aim of the study 8
Research objectives 8
Research questions 8
Significance of the research 8
LITERATURE REVIEW 9
Benefits of privatising hospitals 10
Problems of privatising hospitals 12
Privatisation processes and methods 13
RESEARCH METHODOLOGY 15
Research approach, methods and design 15
Target population, sample, and sampling procedure 16
Data collection procedure and data analysis 16
Ethical Consideration 17
REFERENCES 18

Assessment of the Impact of Privatising Hospitals in the United Arab Emirates: Implications on Shortage of Healthcare Workers
INTRODUCTION
The purpose of the research will be to assess the impact of privatising hospitals in the United Arab Emirates (UAE) and its implications on the shortage of healthcare workers. This research proposal has been organised into three sections which include: an introduction, literature review, and research methodology. The introduction section consists of the background of the study, the problem statement, the aim of the research, the 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. 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, data analysis and the ethics to be considered.
Background of the Study
According to Burke (2002), organisational changes have occurred and will continue as long as people organise themselves, and coordinate their efforts. The current generation of human beings is living in an era of diversity; where globalisation and technological developments influence every part of the society, individuals, and organisations. This has led to the increased demand for competition, efficiency, and effectiveness (Burke & Cooper, 2000). Many organisations have continued to develop strategies to meet the current societal changes by adapting. The adaptations by these organisations have resulted in different changes, among them: consolidation, downsizing, outsourcing, and buyouts (Quick, Gowing, & Kraft, 1998). The new developments happening in the society combined with the increased costs in the public sector and the political liberalisation have brought new requirements for the publicly managed organisations across the world (Megginson& Netter, 2001). One of the popular ways that is being utilised to meet these demands is privatising organisations. According to Ramamurti, (2000) privatisation refers to the situation where a public organisation is sold, either partly or completely to 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 privatising them. According to Tiemann, & Schreyögg, (2012) the main motivation influencing increased privatisations of healthcare facilities has been the expectation that a shift to private ownership from public ownership will facilitate an improvement in organisational performance. A study by Tiemann, & Schreyögg, (2012) on the effects of privatisation on the efficiency of hospitals in Germany revealed that efficiency increased; which ensured that scarce resources were utilised appropriately. Additionally, a study by Villa, & Kane, (2013) on the impact of privatising public hospitals in three states in America, specifically: Florida, California, and Massachusetts indicated that the process of privatisation reduced the length of stay among patients, and increased operating margins.
The increasing government spending in healthcare has led to the improvements of healthcare standards in the UAE. Currently, there are approximately 40 public hospitals managed under the Ministry of Health. Nonetheless, various Emirate are considering introduction of standard advanced private healthcare, which will also offer an opportunity to provide medical training centre to address the shortage of healthcare employees.
Previously, some research studies have been conducted to investigate the impact of privatising hospitals. However, many of these studies have focused only on the effect privatisation has on the efficiency and effectiveness of the hospital. Furthermore, there is no research which has explored the impact of privatising hospitals in the UAE 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 privatisation. According to the World Health Organisation, 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. It is on this background that this study seeks to investigate the effect that privatisation of hospitals in UAE will have on the shortage of healthcare workers.
Problem Statement
UAE is a young nation that was established in 1971, as a federation of seven Emirates including: Ras Al Khaimah, Fujairah, Sharjah, Umm Al Quwain, Ajman, Dubai, and Abu Dhabi. This establishment allowed its leaders to make a deliberate plan for developing the UAE society with an aim of strengthening national unity, promoting personal health and wellbeing as well as continuing economic growth. In the late 1960s, it was reported that in the region, only half of the new-borns would survive and one in every three mothers would die during delivery (Koornneef, Robben, & Blair, 2017). Nonetheless, 50 years later, the health services are at par or better than most of the developed nations. Healthcare in this region has benefited from the rapid economic growth which has seen an increase in the number of healthcare professionals and healthcare facilities. For example, between 2011 and 2015, healthcare spending in the region rose by 10% (Mahate, & Hamidi, 2015). With consideration of the starting point of UAE, it is remarkable what has been achieved in the past few decades. Nonetheless, UAE has been involved with an ambitious plan of implementing healthcare reforms since the 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 led 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 and having an adequate amount of appropriate healthcare workers. Conversely, UAE has an option of privatising its hospitals, which would mean leaving private investors to deal with this problem rather than the government. The potential benefits of hospital privatisation would include improved efficiency, lack of political interference, and increased competition which would mean offering of quality healthcare. Nevertheless, some of the problems associated with hospital privatisation include priority being given to profit making rather than quality patient care. The critical question is how privatisation of hospitals would affect the problem of healthcare workers shortage. Therefore, this research study will investigate the impact on healthcare workers shortage following privatisation of hospitals in the United Arab Emirates.
Aim of the Study
The aim of this study is to find out the effect that privatised hospitals in the United Arab Emirates can have on the problem of healthcare workers shortage.
Research Objectives
The specific objectives of the research will include:
1. To find out if privatised hospitals in the UAE are more efficient in delivery of healthcare services.
2. To determine the impact of privatised hospitals on the problem of healthcare workers shortage in the UAE.
3. To determine the challenges of privatising hospitals in the UAE.
Research Questions
The research questions that this study will seek to answer include:
• Are privatised hospitals in the UAE more efficient in delivery of healthcare?
• What is the impact of privatised hospitals on the problem of healthcare workers shortage in the UAE?
• What are the challenges of privatising hospitals in the UAE?
Significance of the Research
Undertaking this research is significant for a number of reasons. Firstly, the research will be critical to the UAE government in that they can utilise the findings to understand what the process of privatisation involves; and the UAE government can use the findings of the study to make informed decisions on the need to privatise the public healthcare sector. Secondly, for the policy makers, this research can prove to be important – formulation of policies on hospital privatisation requires extensive knowledge and understanding with the intention of developing a policy that meets the objectives envisioned, and it is anticipated that this research would facilitate this process. 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 privatisation 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 privatisation process in the healthcare industry a critical element in building a successful career. Finally, this research will add to the limited literature on the topic of privatisation 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; and 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, privatisation of hospitals has been popular in many countries globally where healthcare organisations’ ownership as a public institution is changed to be a private organisation or a non-governmental organisation. However, there is the perception that privatisation 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 privatised 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 organisation where the new owners are able to reduce the wages by having new terms and conditions (Desai, Lukas & Young, 2000). Secondly, privatisation has an effect on the services provided by an organisation 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 organisations 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; as the care offered is free service–which perpetuates the financial crisis and contributes to mismanagement of patients (Desai et.al, 2000). In this case, there lacks previous studies which have been conducted to establish how privatisation would impact on the shortage of healthcare employees in the UAE.
Benefits of Privatising Hospitals
When governments privatise 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 privately managed businesses (Young, 1990). Hospital privatisation 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 do so holds them 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 privatisation, hospitals are able to expand the healthcare services offered depending on the demand; which could contribute to better long-term outcomes of prevalent public health issues. 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 as well as because of the shortage of employees in many of the public hospitals. While they succeed in cutting costs, the damage in terms of negative effects to the patient later on can be worse such as complications because of lack of medication (Tiemann&Schreyögg, 2012). Therefore, privatisation is a method that can solve the current problem of healthcare workers shortage in UAE.
Studies have shown that after privatisation of public hospitals, provision of medical services and healthcare quality are greatly enhanced (Tiemann&Schreyögg, 2012). Additionally, these hospitals are able to acquire more medical personnel such as doctors and nurses improving the healthcare services offered. This means that the problem of healthcare workers shortage is addressed mainly because private hospitals put in place strategies and mechanisms to motivate workers hence attracting them from different parts of the world. Moreover, private hospitals can invest in medical training centres that they can rely to develop new professionals to serve in the healthcare industry. Many people prefer privatised hospitals because they have good value for money by providing adequate and reliable services for charges, which are justified. Through privatisation, there is increased competitiveness among hospitals which makes them provide the best services to their patients (Tiemann&Schreyögg, 2012). Finally, by hospital privatisation, the government is able to save extra costs that 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 Privatising Hospitals
Certain researchers have proposed that in developing countries, provision of health services through public hospitals with a central supplier is more efficient compared to provision of the services with marketed-oriented approaches mainly seen in the private hospitals (Scarpaci, 1989). When a public hospital is privatised, 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 which 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 privatised hospital because private insurance companies can take advantage of the market with an aim to minimise the risks and maximise profits (Manga, 1987). Additionally, privatisation 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, privatisation of hospitals impacts negatively on the universal provision of healthcare. Some people especially the poor can find themselves unable to access quality care; which can lead to exacerbation of conditions, serious complications and premature mortality.
Privatisation Processes and Methods
There are various processes in which privatisation 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 privatised 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 privatisation 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 privatisation to reach local people who may not have access to adequate treatment. According to Smith &Lipsky (1992), privatisation can occur when the equipment in a hospital is leased to a management firm which is given the task of running the hospital. Whilst the government owns the hospital, it is not involved in the organisations internal issues because they only receive payment from the management firm depending on the contract agreement. In such circumstances, privatisation impacts the lives of the people positively as they are able to receive 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 in financial deficit 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 privatisation gives both parties a 50% stake to make decisions regarding the organisation. 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, privatisation has impacted the hospitals positively including attracting young people to undertake studies in professions related to healthcare largely because of the motivating factors present in privatised hospitals(Weil, 2011). Nevertheless, where a public hospital has been privatised, there are always some negative defects that require to be eliminated and evidence shows that most organisations have been successful (Smith &Lipsky, 1992). Privatisation 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 a move known as service shredding. 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 utilised 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, methods of data collection and 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 characterised by providing priority to the subjective meanings and socio-political issues as well as symbolic actions. According to Saunders, & Lewis (2009), interpretivism studies involve a process where human beings construct and reconstruct the reality where they live. In addition, this philosophical approach puts emphasis on conducting research where people are the respondents rather that utilising objects. In this case, the study aims at finding out how privatisation 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 conducted will use qualitative methods approach where interviews will be adopted as the form of collecting data. 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 privatising 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 privatisation, hospital administrators and some healthcare workers. A sample will be selected from this population. It is proposed that a sample size of 20 research participants will be recruited for the study. The research will use a stratified sampling technique when selecting the respondents to be involved in the study; as this will ensure that a group of diverse individuals who can add value to the research findings are included in the sample.
Data Collection and Analysis Procedure
The data for this study will be collected using interview questions as a representation of qualitative data. The researcher will prepare interview questions beforehand. These questions will seek clarification on some of the questions in the questionnaire. To ensure that the interview questions are valid and reliable, a pilot study will be conducted. The pilot will be done using 5 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 because they contain bias which can inhibit on the accuracy of the conclusive findings.
The collected data will be analysed differently where the qualitative data will be analysed using content and thematic analysis. This will help in providing depth and insight from the interviews conducted something that cannot be attained from quantitative methods. Moreover, qualitative methods attempts to provide pre-judgments by providing a detail picture on certain things in the society.
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 purpose of the study 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.
 
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