“Creating an attractive workplace for current and potential hospital employees”

The health service of EU member states facing numerous challenges. Hospitals have a catastrophic shortage of medical personnel; meanwhile, the demand for medical services caused by the SARS-CoV-2 virus is increasing. Hospitals’ pursuit of recruiting staff with a high level of professional education is more likely to be successful with potential candidates in a competitive talent market in institutions where a cultural organization, innovative treatment as a patient-centered approach is included in top priorities. The survey was conducted in the pre-COVID time with the use of the proprietary questionnaire in a traditional way. 204 employees of the Prof. dr Stanisław Popowski Regional Specialized Children’s Hospital in Olsztyn were the respondents. The paper uses the r-Pearson correlation analysis. IBM®SPSS®Statistics, version 25.0.0.1, was used to develop the correlation results. After verification of the research hypotheses, it was shown that there is a statistically significant relationship between inappropriate activities of employer branding and reduced employee retention. It has been demonstrated that there is a discrepancy in the offered and actual working conditions. The discrepancies concerned the atmosphere at work (31.4%) and the inability to develop a career path (8.3%). 19.1% are willing to change jobs due to inadequate remuneration. For the respondents, factors important in choosing a workplace included remuneration, organizational culture, and the availability of the benefits package. One hypothesis was confirmed, another was partially confirmed. The proposals presented in the paper could significantly contribute to shaping a good image of hospital employers and increasing employee satisfaction.


INTRODUCTION
The average age of hospital staff members is increasing and many healthcare employees will retire in the nearest future. There is an urgent need to attract candidates with an appropriate attitude and set of skills. Demographic and migration changes are exacerbating this process.
The above-mentioned problem has become particularly relevant in the context of the current crisis caused by the SARS-CoV-2 virus. Its effects have severely influenced human life (high death rate) as well as the economy as a whole. Increased infection rates and fatalities have closed businesses, necessitate the search for effective anti-virus treatment, and have created the opportunity for strategic reorganization.
For hospitals, both patients and employees are invariably important. The hospital is a people-creating institution, which has an invaluable resource. The job satisfaction of medical workers results not only from the salary. Therefore, the right image of the employer is very important. It creates an employer who can and wants to support the staff, create appropriate working conditions and improve the quality of services. The aforementioned activities are conducive to maintaining the motivation and loyalty of current employees and attract potential candidates for work.
The number of hospitals investing in employer branding (including in the non-public sector) in Poland is negligible. Mainly jobseekers (in medical, administrative, and other positions) follow the opinion and assessment of the brand of a medical facility. In this way, they evaluate the facility as an employer. The subject of the analysis is the friendliness of the place, the lack of negative opinions of people working there for many years. It also takes into account the high rotation of employees, which proves low job satisfaction, and the inadequacy of the conditions offered to the employees.
The subject of the study is the association of hospital employees when looking for a good job through the prism of the employer brand. The paper aims to present the factors determining the attractiveness of an employer with appropriate employer branding on the talent market to hire the best employees. Employer brand is expressive and well perceived by current and potential employees as an important element in the development of a medical facility. The best employees are very careful when choosing an employer and make their choice based on the value offered to them.

LITERATURE REVIEW
Employer branding constitutes a key component of building an effective talent transfer and turnover reduction system. Employers nowadays should also be aware that their ambassadors are, in particular, the employed staff members. For this reason, an "objective-oriented, long-term strategy of a given company, aimed at managing the awareness and perception of current and potential employees as well as the parties interested in its activities" is important (Backhaus & Tikoo, 2004). It is necessary to care for the satisfaction of employees within the framework of activities implemented as part of the internal employer branding regularly, and not only occasionally (Kozłowski, 2016).
Employees' opinions concerning the employer are also influenced by remuneration, particularly the perception of the money earned in the categories of its attractiveness and fairness, both from the general perspective (when its amount is taken into consideration) as well as in a detailed approach (evaluating employment components and forms) (Bukowska, 2012). In combination with these aspects, "good communication is the key to success in every organization" (Bukowska, 2012), while "organizational culture determines an employer image when it is powerful, i.e., distinct, widespread and deeply rooted". Subsequent elements of such culture may have an attracting or repelling effect (Chłodnicki, 2005).
A healthcare organization communicates with the public using a set of information, which enables patients to distinguish a given organization from others (Syrkiewicz-Świtała et al., 2014). Stachowicz-Stanusch (2007) claimed that the image of a hospital is created by medical staff -first by those in initial contact with the patient, working in the admission room or the emergency ward.
Training, development, competence and talent management, additional benefits (e.g. discount cards for the company's products or services, multisport cards, additional insurance packages) have already become a standard for numerous organizations (Kozłowski, 2016). The interest in building the employer brand in the world and Poland has risen due to: • increasing tertiarization of the economy together with the development of knowledge-based economy and a shortage of knowledgeable staff and talented employees; • demographic changes in developed countries; • competition between companies for talented employees; • high dependence of the company's effectiveness on the quality of human capital (Buchelt, 2014). The modern healthcare system is characterized by aging and the retirement of its staff. According to Statistics Poland (GUS), in the first half of the year 2020, the population of Poland reached 38,354,000 citizens (GUS, 2020). Figure 1 presents the population decrease after 2014. According to GUS forecasts, in 2050, the population residing in Poland in the years 2015-2050 will be 34,856,000 persons (GUS, 2016). Increased death rate caused by the SARS-CoV-2 virus will probably result in adopting an even lower forecast. At present, it is unfortunately impossible to estimate the loss as the situation is changing dynamically on an ongoing basis.
The aging population will result in increased demand for medical services and it will be harder to recruit hospital stall as a large cohort from the baby boomer generation retreats from the healthcare system. Thus, staff aging leads to a scarcity of key employees in hospitals at the same time when the demand for their services is growing. The GUS report "Health and healthcare in 2019" presents the number of medical staff with a professional medical license ( Table 1).
The presented trend of the increase in the number of doctors authorized to practice their profession aged over 65 continues to the present day ( Figure 2).
Despite the positive growth in the number of nurses from 285,431 in 2015 to 299,629 in 2019, it is not sufficient to satisfy the demand on the market of medical services, in particular taking into consideration the fact that 15% of nurses who perform their profession are aged 65 and over (GUS, 2021a).
The current situation results from medical staff scarcities and the decreasing trend in their number (Table 2).
It should be noted that even if in some medical professions the number of staff qualified to work is slowly increasing, it is still insufficient to provide adequate care to patients. Such a situation results in long queues. The scarcity of doctors specialized in infectious diseases to face the SARS-CoV-2 virus and its discovered variants have been catastrophic.
Source: GUS (2021b). Own study based on GUS data "Size and structure of the population by age groups in the years 1989-2019" https://stat.gov.pl/obszarytematyczne/ludnosc/ludnosc/struktura-ludnosci,16,1.html  According to the "Menedżer zdrowia" (Healthcare Manager) magazine, Poland has the lowest number of doctors per 1,000 citizens among the European Union member states -2.4, while the EU average reaches 3.6. Some of them will retire soon and Poland will need from 10,000 to 30,000 new doctors and 70,000 nurses (Pakulski, 2020).
The number of candidates applying for open and new positions is constantly decreasing. The greatest scarcity of nurses is observed in the areas of roentgenology, anesthesiology, laboratory analyses, and surgery. Difficulties are also experienced in filling vacancies by nurses and in finding summer replacements.
The scarcity of nurses forces the organizations involved in healthcare services to evaluate their culture, operations, and remuneration system to ensure that these are in line with organizational efforts aimed at retaining nurses approaching their retirement age. Given the challenges resulting from the scarcity of nurses and their aging, hospitals need to ensure professional qualifications, awards, and working environments that increase the nurses' satisfaction and engagement in the performed profession.
At the same time, it is necessary to satisfy the nurses' desire for flexibility and reduce the physical requirements connected with patient care.
Successful recruitment of nurses will mitigate staff scarcities. At the same time, hospitals should also aim at retaining their current nurses. The basis for establishing adequate relations between the staff and their employer consists in the possibility to refer to mentoring. Ensuring more flexible working conditions will improve the manager's leadership and increase the number of medical staff members together with their engagement.
Source: GUS (2021a).  Due to the interdisciplinary character of the theory, there does not exist one uniform approach towards defining the organizational image and its identity. The corporate, organizational, or institutional image is usually understood as a collection of perceptions shared by people within the organization. Levering (1996) drew attention to the fact that a good workplace can manufacture higher quality goods, supports more innovations, can attract more talented staff, and experiences lower resistance to change and lower turnover costs.
Ambler and Barrow (1996) defined employer branding, considering it to be formed by the development and communication of cultural organization as an employer on the market. It is a package of functional, economic, and psychological benefits ensured by being employed and identified with the employing organization.
Sullivan (2004) presented a long-term strategy of managing the consciousness and the perceiving of potential employees and linked interested parties regarding a given organization. A well-adjusted strategy is capable of motivating the recruitment process and manage staff efficiency, which promotes the perception of a company as a "good workplace". Barrow and Mosley (2005) argued that the main aim of employer branding is to motivate the staff and get them involved with the use of appropriate tools and techniques. This phenomenon was presented as the emotional relationship between an employer and an employee. Armstrong (2007) concluded that the goal of employer branding is to become the employer of one's choice.
Jenner and Taylor (2008) claimed that employer branding could also be defined as the organization's efforts in communicating to internal and external audiences, which makes it both desired as well as standing out among employers. According to Martin (2008), employer branding consists of attracting talented individuals to the organization. It is also important here to make sure that both current, as well as potential, employees will identify themselves with the company (its brand and mission) and provide expected results. Gorbaniuk (2010) presented the definition of image (in the context of brand image) divided into five groups: 1) group one -referring to associations; 2) group two -presenting the image as added symbolical significance; 3) group three -assigning meaning by consumers; 4) group four -referring to personality, being the consequence of natural personification; 5) group five -differentiating the cognitive and/ or emotional and motivational component of the perception of the object -brand/company.
The associations generated in the client's mind by brand names create the image of the quoted brands and refer to: • target brand user; • situations when one benefited from purchasing or using the brand; • the characteristics of services.
The associations also referring to benefits resulting from using the services create the so-called image of benefits. In practice, one can differentiate three types of benefits: functional, experiential, and symbolical. The presentation of an image as an added symbolical meaning holds and includes an important group of associations. In other words, this is the resource of sharing information, by the user with other people, on their age, preferences, success as well as membership in a given social group. Symbolic benefits associated with numerous brands are based on the characteristics of services and usually refer to their high quality. The latter depends on the staff that provides the services. This aspect represents particular importance regarding medical services. In this case, the guarantee of correct perception of symbolic benefits relies on faultless communication between, among others, the medical staff and the patients. Honest staff that the client meets in the hospital cloakroom and qualified medical em-ployees directly providing them assistance (consultation) are the safeguards of the above-mentioned benefits for the hospital image. How can involvement in the work performed be achieved?
Thanks to creating appropriate conditions, staff members identify themselves with their workplace. If such conditions are ensured by the hospital, it automatically has a greater chance of employing highly qualified staff and avoiding their turnover.
An important characteristic of the image consists in referring it to personality resulting from natural personification. It is connected with characteristics of associations for people (happy -sad; tall -short, etc.). In this way, the image of an organization can become emotionally closer to the client or, on the contrary, rejected by them. For this reason, the purchasers will choose brands they associate with their image.
The image of a service company consists to a large extent in evaluating the "moments of truth" experienced by the clients. These experiences are formed by the quality of the primary service together with a visual presentation of the company and marketing activities (Chłodnicki, 2005).
In practice, the process of creating the image depends on communication. Grey and Balmer (1998) pointed to the fact that the communication channels used by an organization shape its identity together with the image.
Apart from communication, an important role in employer branding is played by the experience of the interested parties acquired while establishing the interaction with an organization. This fact represents particular importance for service companies because while providing their services, employees' behavior directly influences the opinion of the organization. In other words, the image of an organization is perceived by the clients as material and non-material features. Abratt and Mofokeng (2001) claimed that the attributes shaping the image include quality, company philosophy, staff, company logo, organiza-Source: Author's elaboration. When considering the above-mentioned definitions, it can be concluded that employer branding in hospitals should be perceived as a carefully thought-out strategy aimed at creating perfect working conditions for current employees and searching for talented potential staff members. The notion of "perfect working conditions" is possible when the communication between hospital administration and staff is undisturbed (Figure 3).
Satisfied hospital employees notice that the organization extends its care over them and will increase their effectiveness. The main lever of such a process consists in the perfect shape of the hospital internal image, created by: • organizational culture; • decent working conditions; • medical staff development; • remuneration satisfying for the staff. Kozłowski (2016) claimed that it is necessary to differentiate between internal and external employer branding. The former is addressed to current employees and its main aim is to increase their retention and professional satisfaction. External employer branding, in turn, promotes communication between the employer and candidates for specific job positions. In this way, the activities resulting in the positive image of hospitals are developed. A well-shaped internal employer branding directly influences the external employer branding of the hospital which, in turn, brings patients' trust.
An appropriate image of a hospital is based on its perception as an employer. Its reputation is important as it influences the possibility of applying for a job by potential candidates. The better the reputation, the higher the chance of attracting more talented staff. The image influences the applicants' intentions in the context of employment opportunities in a given organization. 1 Proprietor questionnaire in Polish https://www.dropbox.com/s/hz82oey1ec2xone/Ankieta%20%28orygina%C5%82%29.pdf?dl=0

AIM
The study aims to analyze hospital activities aimed at building their employer image on the labor market.

METHODOLOGY
The study was conducted with the use of the survey technique, the diagnostic survey method, using the proprietary questionnaire 1

RESULTS
The age structure of hospital staff shows a positive trend in maintaining the quality-quantity struc-ture, which is confirmed by employing 4.4% registered doctors, 3% nurses, and 0.4% of other staff members aged from 58 and over 60, which constitutes 7.8% of all respondents ( Figure 4).
Based on Figure 4, 56.3% of medical staff members are represented by employees belonging to the mobile labor group, which impacts the quality of medical services. Of those surveyed, 39% have worked in healthcare institutions for more than 10 years. The study showed that 67.5% of respondents found their job thanks to personal contacts. Such a job-searching trend is characteristic for the above-mentioned respondents, irrespective of their seniority in the Prof. dr Stanisław Popowski Regional Specialized Children's Hospital in Olsztyn. Table 3 presents data in a contingency form referring to the responses to questions 2 and 3 of the survey. The questions were formulated as follows: • How long have you been working at the Prof. dr Stanisław Popowski Regional Specialized Children's Hospital in Olsztyn?
• How did you find the job?
It was established with the use of chi-squared tests that there is a statistically significant correlation (p = 0.001) between the answers to the marked questions.
Nowadays, the Internet plays a crucial role in employer branding. The organizations use their  Table 3. Analysis of answers to questions 2 and 3 of the survey Source: Author's elaboration.

Question 2 of the survey and proposed answers
How did you find the job? Note: While conducting the chi-squared test, seven observations (3.4%) were excluded as the expected size of the studied departments was lower than five.
websites to attract potential candidates and inform them through the published content not only about the scope of their activity but, most importantly, about their organizational culture and the staff. As Table 3 shows, while searching for a job, 14.7 employees used the information on the website (7.1%) and one person (0.5%) referred to professional social media portals (Glassdoor or Indeed) for this purpose. A question thus appears concerning the lack of trust in social media for potential hospital staff members irrespective of their age. The answer can be found in their lack of knowledge on using the above-mentioned social media in acquiring staff and in the Prof. dr Stanisław Popowski Regional Specialized Children's Hospital in Olsztyn not promoting itself as a good employer.
It is particularly important when the hospital is not listed in the national rankings, which can make it harder to attract the best talents.
It is crucial to recognize the suggested value of employees. Each position includes the suggested value of employees, unique for their internal culture. How should this value be measured? In this case, it is necessary to explain what makes the culture of the hospital and employees' offers attractive to current and potential staff members.
While preparing the offer, it is necessary to attempt to capture values for employees and present how the hospital actually functions. The respondents marked the factors important for them while choosing a workplace ( Figure 5).
To secure the effective work of the employed staff, it is necessary to guarantee them good remuneration matching their qualifications, as this constitutes the basis for satisfactory cooperation be-tween hospital administration and the team. The answers expressed in percent reflect the weights of factors presented in Table 4.
The presence of a substantial difference between working conditions presented in the job advertisement and the reality is shown by the gaps in the hospital's external employer branding.
The following questions related to working conditions appeared in the questionnaire: • Do the conditions presented in the job advertisement reflect reality?
• Does the difference mentioned consist in the atmosphere at work; no possibility to develop the career path; the difference in the amount of remuneration? Table 4 presents numerical data referring to answers to questions 4 and 5 of the questionnaire.
It was established with the use of chi-squared tests that there is a statistically significant correlation (p < 0.001) between the answers to the marked questions.
64 respondents (31.4%, including 12.7% aged 27-35; 12.3% aged 36-46; 5.9% aged 47-57 and 0.5% -58 and over) indicated the atmosphere at work (which may contribute to tensions in the medical staff team) as one of the main differences. This incompatibility is important for all age groups.
Only 17 employees (8.3%) who took part in the survey noted a lack of the possibility to develop a career path, while 39 respondents (19.1%) reported a difference between the amount of remuneration Source: Author's elaboration. The obtained results constitute the basis for noting weak internal and external employer branding of the Prof. dr Stanisław Popowski Regional Specialized Children's Hospital in Olsztyn and inappropriately selected methods for communicating with potential employees.
Failure to find a remedy for issues in the above-mentioned fields may lead to increased staff turnover. This is confirmed by the answer to questions 5 (5.1; 5.2; and 5.3) and 10 of the questionnaire: • Does the difference consist in the atmosphere at work; no possibility to develop the career path; the difference in the amount of remuneration?; • Would you decide to change your workplace if you could do so?
Answers in a numerical form were provided in Table 5.
It was established with the use of chi-squared tests that there is a statistically significant correlation (p < 0.001; p = 0.004; p = 0.004) between the answers to the marked questions.
Due to an inappropriate atmosphere at work, 32 respondents declared the intention to change their workplace if they could do so. Note: While conducting the chi-squared test, one answer (0.5%) was excluded from the total as the expected size of the studied departments was lower than five. No possibility to develop the career path constituted the basis for changing the workplace for 11 respondents. A difference in the amount of remuneration would be a sufficient reason to change the workplace for 20 of those surveyed.
Meeting the needs and expectations of medical staff requires important efforts and is a work-consuming but profitable process, as it would lead to increased quality of medical services and lower reduction of staff turnover. While organizing the work of hospital administration influencing the quality of the entity operations it is necessary to note the need to constantly develop the staff knowledge. Of those surveyed, 95.6% confirmed that training was carried out within the facility, while according to 79.9% of employees, the amount of training was sufficient, and 20.01% of them expressed the opposite opinion.
Negative answers could have been considered subjective if not for the fact that a sufficient amount of training depends on seniority in the hospital. Suggested questions 2 and 7 of the survey were formulated as follows: 1) How long have you been working at the Prof. dr Stanisław Popowski Regional Specialized Children's Hospital in Olsztyn?
2) If training is conducted, is it sufficient? Table 6 presents the answers expressed in numbers. It was established with the use of chi-squared tests that there is a statistically significant correlation (p = 0.020) between the answers to the marked questions.
As can be seen in Table 6, the greatest demand for participating in training is expressed by 19 respondents (9.3%) working at the hospital for 1 to 3 years. The need for an increase in the amount of training expressed by 10 hospital employees (4.9%) with seniority of over 10 years results from the need of the representatives of the senior generation within this group of respondents to follow the innovations in medical technology and modern treatment methods. The percentage of employees working at the hospital from 4 to 5 years -2.5% (5 respondents) and from 6 to 10 years -3.4% (7 respondents) is not considerable. However, they also need to be taken into account. The possibility of the employees expressing their need for additional training and developing their knowledge is certainly better than exposing the patients to danger.

DISCUSSION
The conducted study confirmed the correlation between the hospital's internal employer branding and the reception of their workplace by employees. The results indicated a lack of effective communication between managers and medical staff members already at the stage of the recruitment process, which is proven by discrepancies between the offered and actual working conditions. It seems interesting that staff members are recruited by the intermediary of "close acquaintances", which resulted in a scarcity of medical staff during the pandemic. During the period when the study was carried out, the management did not employ sufficient staff members and tried to solve the problem by offering their employees the possibility of earning extra income at the hospital. What is more, the number of beds available for patients was reduced, which confirms the lack of demand At the same time, the majority of interested parties declared that the organizational culture of the hospital was not at an appropriate level. Improving organizational culture or establishing a new culture would enable the hospital to acquire staff with appropriate skills to join their team. Managers adjusting to employees' expectations would bring positive effects not only by increasing the effectiveness of work but also by reducing staff turnover.

CONCLUSION
Hospitals are currently facing the challenge of acquiring new staff members, nurses, and doctors. The number of applicants for open and free workplaces has dropped. There is an acute need not in the number of hospitals or beds, but a critical shortage of medical workers. The reason for this is an unclear image of the employer brand of hospitals. To solve this problem analysis of hospital personnel policy was carried out.
Based on the results of the study, it is necessary to take appropriate measures to perceive hospitals as a friendly workplace for current and potential employees by: • improving the quality of communication, including internal communication, to get better employees and reducing the manpower shortage due to the appalling shortage of staff in hospitals, which is an international problem; • creating development programs through various training courses along with the provision of compensation and acceptance of professional rotation to expand knowledge. The conducted study did not confirm H2, which indicated a relationship between the length of service of a medical employee and sufficient training. The pandemic revealed the necessity to conduct training connected with acquiring new skills in stress management and communication with patients' families; • shaping the appropriate level of organizational culture of hospitals as a friendly workplace; • creating a value system; • developing the proper process of adapting new employees.
The above-mentioned activities in practice are long-term activities because only in this perspective they make sense and build the employer's credibility.
Building appropriate employer branding in hospitals constitutes a long-term and work-consuming process, although it is necessary to secure their future on the market of talented medical staff. The present paper constitutes only a contribution to the development of scientific research connected with the presented topic. The current characteristics of building the image of the above-mentioned facilities consist of applying the tools to shorten, facilitate, and simplify the recruitment process. At the same time, appli-cants need to be able to present their skills and capacities. A medical facility needs to possess authentic knowledge of its staff. For the development of good employer branding, it is also worth encouraging the staff to present their preferences and opinions in the field of work and the knowledge of culture to be perceived as honest and authentic. Such actions can be complicated as they confirm the necessity of modifications in some areas, but they are crucial in improving the image of hospitals.
The scope of further studies may include quantitative studies based on the developed conceptual frameworks for specifying the attributes of employer branding and the aspects which are the most desired by employees while looking for a job. Developing the study with level 1 and 3 referral hospitals together with taking into consideration their location and specialization will identify a unified attitude towards shaping the internal employer branding of hospitals.