Exploring the Impact of Talent Management Strategies and Service Quality on Beneficiaries’ Satisfaction in Jordan Healthcare Sector: Provider Point of View

Healthcare sector in Jordan has been exponentially grown in recent years, though still nascent in size and dynamic compared to other countries, it has also benefited from economic booms. In healthcare sector in Jordan, it has also been observed that the participation of private sector has been increasing significantly. This participation brings about the necessities for contentious improvements of quality [1]. Since then, the role of Ministry of Health, as provider and organizer of health services, is to maintain public health by offering preventative treatment and health control services, providing health insurance to the public, managing the health educational and training institutions, as well as supervising health services offered by both the public and private sectors that would be maximizing the utility of services provided to its beneficiaries “customers” to meet their expectations and increase their satisfaction.


Introduction
Healthcare sector in Jordan has been exponentially grown in recent years, though still nascent in size and dynamic compared to other countries, it has also benefited from economic booms. In healthcare sector in Jordan, it has also been observed that the participation of private sector has been increasing significantly. This participation brings about the necessities for contentious improvements of quality [1]. Since then, the role of Ministry of Health, as provider and organizer of health services, is to maintain public health by offering preventative treatment and health control services, providing health insurance to the public, managing the health educational and training institutions, as well as supervising health services offered by both the public and private sectors that would be maximizing the utility of services provided to its beneficiaries "customers" to meet their expectations and increase their satisfaction.
In the present based-economy, quality is considered a matter of survival for the organizations and pre-requisite for customer satisfaction in highly competitive situations [2], and to achieve a high level of quality healthcare, which is the core of healthcare sector, Ministry of Health should make sure the availability of advanced medical technological tools, talented physicians, nurses, technicians, and pharmacists and ensure providing high services quality to meet the beneficiaries'/customers' needs and expectations and in turn to maximize their satisfaction, in other words, customer satisfaction is influenced by the degree of customer awareness and perception of the role quality plays in healthcare organizations [3,4]. not been accompanied by better payment or improved profitability or attracting new talented healthcare workers. Knowing that, in the case of Jordan, the rapid population growth and the waves of asylum from neighboring countries imposed on it to increase efficiency, effectiveness, and quality of healthcare services provided to citizens and residents that would increase beneficiaries' satisfaction levels and loyalty to its institutions and hospitals. Additionally, in general, healthcare sector in Jordan, like other countries, suffers from emigration of skillful workers which resulted in shortage of talented medical physicians, nursing staff, and technicians and creates a new challenge for these institutions to seek for competencies and talents, who in turn, are capable of achieving the sector notion of continuous improvements in services delivered to beneficiaries and enhance the quality of healthcare required. Therefore, this study will answer the following questions: • Does the Princess Rahma Pediatric Hospital implement Talent Management Strategies in their staffing practices?
• Does Princess Rahma Pediatric Hospital consider the Service Quality while they perform their duties?
• What are the effects of Talent Management Strategies on Service Quality at Princess Rahma Pediatric Hospital in Irbid?
The objectives of the study The major objectives of this research are to: • Study the importance of talent management and its impact on the healthcare organizations' outcomes.
• Study the importance of service quality and its impact on the healthcare sector.
• Highlight the most important dimensions of service quality that affects the beneficiaries' satisfactions.
• Find out the relationship between talent management and beneficiaries' satisfaction through service quality improvements.

The importance of the current study
Even though many studies have been conducted for assessing the quality of health services in developed and some developing countries, a few empirical studies have been carried out in the Arab context especially in Jordan. Therefore, the importance of this study will be value-added to Arabic works of literature that will serve Jordanian policymakers and leaders to support and maintain the highest standards of quality of healthcare system. Additionally, the importance of this study stems from: 1. To shed the light on talent management as organizations strategy used to promote beneficiaries' satisfaction and achieve sustainable competitive advantage.

2.
To keep pace with modern management orientations that emphasizes on enhancing services quality and encourages new innovative activities as a tool to achieve organizations' survivability and sustainability [8].

3.
To maximize manager's capabilities to manage quality applications in healthcare organizations.

Hypotheses
In order to achieve the purpose of this study, the following hypotheses were formulated: H1: There is no significant relationship between overall Talent Management Strategies, overall Service Quality, and overall Beneficiaries' Satisfaction of Jordan Healthcare Sector. The conceptual model Figure 1 shows the conceptual model that has been used in this research to investigate the impact of talent management strategies on service quality as well as the beneficiaries' satisfaction: The model consists of the following variables:

ii)
Service Quality which includes Tangibility, Reliability, Responsiveness, Assurance, and Empathy.

2-
Dependent variable: Beneficiaries' Satisfaction represents the dependent variable of this study ( Figure 1).

Literature Review Talent and talent management strategies definitions
Simply, there is no explicit definition of talent, while there some scholars defined it as the persons' ability that includes a person's abilities, knowledge, skills, competencies, attitudes, character, personality and potentials for future developments [7,9]. Obviously, talent people are source of power for organizations and considered primary driver for any organizational success, in other words, any individual who is committed, enthusiastic, motivated and performing more effectively and efficiently can be called a talent [2], while others agreed on that the definition of talent is blurred if not obscured [10,11]. Thus, in order to survive and grow up in a high competition economy, organizations should substantially increase their value-added in growing competition, and have to attract, cultivate and retain their talented employees, and, as long as possible, especially those who are extraordinarily talented.
The term "Talent Management" was coined by Steven Hankin of McKinsy and Company in 1997 and often used interchangeably with other terms such as succession management, talent strategy [12] and it is defined as systematic and integrated strategies for increasing organizational productivity and enhance processes used to identifies those talents, assesses their competencies, attract highly skilled workers, develop and retain current talented workers to meet current and future needs and objectives to achieve competitive advantage [13][14][15][16], stated another way, it is about putting the right people with the right skills in the right positions at the right time. Consequently, the effective and efficient work with such talents depends on flourishing talent management strategy that will be in line with organizations' philosophy and strategies.

Talent management strategies
Many scholars and theorists agree on four dimensions for talent management -Attraction Strategy, Developing Strategy, Retention Strategy, and Succession Strategy while some others call it factors that determining the success of talent management strategies. Despite the variations, this study will highlight the four main TM dimensions: Talent management attraction strategy: Undoubtedly, organizations start identifies and assessing its workforce in light of highly competition and the environmental changes that affect its working styles and produce new strategies to accommodate the new competencies and skills required for achieving the competitive advantage. Consequently, attraction strategy should be mainly concentrated on auditing organization to list the vacant positions, review or build new job description for these positions, skills and competencies required, and job performance goals for newly hired. Then, the second concentration should be directed to the recruitment process that includes the selection process which is the backbone of the recruitment process. Hiring talented individual is critical to an organization's success but in order to hire the most talented one, it must recruit them. A poorly designed recruitment process can miss attractive job candidates. Talent developing strategy: There are really two gaps to be concerned about. The first: performance gap this means the difference between current actual performance and desired results. If individuals are not performing effectively in their current jobs, they are usually not regarded as promotable. Instead, efforts are made to increase current work performance to acceptable levels. The second: developmental gap this also means the difference between the individual's present competencies and those required to perform a job at higher levels effectively. Many organizations rely on several practical approaches to pinpoint gaps and plan to close them. One way is to use performance management (appraisals). Potential assessment is carried out to assess individuals against future requirements at higher levels, in other words, to achieve the higher potential of organization requires achieving the potentials of employees [17,18]. It is important to emphasize that development does not mean the same as training. Training is a shortterm effort intended to equip individuals with the knowledge, skills and attitudes they need to do their present jobs. But development is a longterm effort intended to build competencies for the future, and most development occurs on the job. Both training and development are often necessary to help individuals build the competencies they need to function at higher levels of responsibility [19].
It is particularly important for an organization to develop good measures of each individual's skills, knowledge, and competencies. Without these indicators, it is difficult to know what the human capital resources of an organization are and therefore what type of changes and performance it is capable of. At the very least, such knowledge can help a company decide how employees can contribute to a strategy, how much training needs to be done, and what kind of hiring is necessary to yield the skill mix the organization needs. Information about skills and competencies is also critical in diagnosing the cause when business strategies run into difficulty [20]. Last but not least, a skills assessment is an important source of information about what development activities individuals should engage in. This can help individuals understand what skills they need, provide them with a development plan that allows them to acquire those skills, and set the stage for their being rewarded when they develop new needed skills. Evaluating the skills of individuals and giving them advice on their development (feedback), then, should be a critical part of every appraisal process [21][22][23].

Talent retention strategy:
Once the talented individual recruited, selected, and developed, they must be the focused of retention efforts. In short, how managers interact with people is important to the "stay or leave" decisions of workers. When workers feel that they have been mistreated by a supervisor, they begin looking for alternative employment. In most cases, they do not leave their current jobs unless or until they find a better-paying job. It is particularly important that organizations retain their high-performance and critical talent employees. Importantly, the organization must know the market, its competitors, and their offering, and how to gain a competitive advantage over them when it comes to retaining talents. Thus, it is critical that organizations know what their employees value and do everything they can to be sure that they are offering their critical employees rewards that will retain them. It makes sense to focus retention efforts on highly performing talent. The most expensive talent to replace is highperformance talent.
Individuals can have all the right skills, knowledge, competencies and expertise and still be poor performers if they are not motivated. Whelan and Carcary [24] stated that there are several factors that contributing to talent retention strategy, hygiene factors that have a direct impact on the career success such as benefits, compensation, location… etc, while intrinsic rewards and career success might indirectly reduce talent loss [24].
Talent succession planning strategy: Under the talent management umbrella, succession planning is proactively securing the human capitals needed to ensure the continuity and prosperity of an organization. It is certainly about identification and development future leaders, therefore, an organization needs to identify, develop, and select successors who are the right candidates with the right skills at the right time for leadership positions [25]. Succession planning and leadership development are interchangeably used as important organizational business strategies to manage, develop and retain talents. As noted, succession planning is also one of the key strategies to reduce turnover costs. While in the past succession plans were primarily focused on key leadership roles, organizations are now establishing leadership development and succession planning initiatives early in the process of employee career development. Building leadership competency models is the key to a successful succession planning. Tropiano indicates that leadership competencies are identified, regularly reviewed, and updated. Potentials are assessed and developed against those competencies.

Service quality
Quality can be defined from different perspectives, it certainly defined as the satisfying or exceeding the customers' requirements and expectations of the services they delivered. Extensive pieces of literature conducted that examined the concept of services but with problems allied with measurement because the customers can perceive differences in the quality of service. Nowadays, most of the businesses in the world shifted their concentration on customers' preferences to meet their expectations of quality of services and go even beyond their expectations.
Therefore, service quality can be defined as an assessment of how well a delivered service conforms to the client's expectations. These include the ongoing improvements of quality of services provided to customers, quickly identify problems, and better assess client satisfaction. After extensive research, numerous studies have attempted to Figure out the standard dimensions of service quality by external customers' point of view [26][27][28]. Among them, Parasuraman et al. [29] conducted an exploratory study concerning consumers' perceptions of service quality. Their study revealed 10 dimensions that help consumers to form their expectation about and perception of services provided to them, later, they named it as SERVQUAL model. This model deals with five dimensions: Tangibility, Reliability, Responsiveness, Assurance, and Empathy. Numerous studies instruments exist to measure service quality where SERVQUAL model is used which is suitable for any service industry. The core reason for using this model is to evaluate customers' perception of the quality of services they expected from their provider and the actual service quality they get from them.

Beneficiaries' (customers') satisfaction
In spite of different definitions of customer satisfaction, it is seen as one key of performance indicators within a business where the cornerstone of organizations is to focus its staff on the importance of fulfilling the customers' expectations. Parasuraman et al. [29] stated that satisfaction is the decision made after the experience. Kolter and Armstrong [30] defended the customer satisfaction as the customer's perception that compares their pre-purchase expectations with postpurchase perception. Satisfaction is the difference between expectations and actual performance.
An increasing competition, changing and improving technology, and continuous shifts in regulatory environment have lead to the growing customer sophistication. Customers have become more and more aware of their requirements and demand a higher standard of services. Their perception and expectations are continually evolving, this makes it difficult for service providers to measure and manage service effectively. Measuring customer satisfaction gives an indication of how successful the organization is at providing products or services to the marketplace. The state of satisfaction depends on a number of both psychological and physical variables which correlate with satisfaction behaviors. Some researchers think customer satisfaction can be measured. Kuo [31] recognized seven factors that influence customer satisfaction: service content, price, convenience, corporate image, equipment, staff, and procedure. Huang [32] also defined five factors used to evaluate customer satisfaction: product, service, staff, overall performance of products, and closeness to expectation. As Apart from understanding beneficiaries' satisfaction dimensions, it is beneficial for managers to understand staff perceptions regarding beneficiaries' expectations and perceptions. Such an examination helps us to understand if there are gaps between staff and beneficiaries' in term of quality services and satisfaction and how to bridge the gap through training and amendments.

Previous studies
In its paper conducted for an international conference on information and financial engineering, Horváthová [33] presented a paper on the concept, essence, content, significant, and benefits of talent management and its processes that include acquisition, development, and retention in the Czech Republic. Moreover, it explains the role and impact of talented peoples in achieving organizational success. However, Morsy [34] explored the impact of talent management on two types of employees' engagement; job engagement and organizational engagement and whether a work-family balance mediates this relationship or not. She concluded that talent management plays a critical role in organizations success and great effect on two dimensions of employees' engagement; job and organization at Zagazyg University Hospitals.
Koketso and Rust [35] conducted a study entitled "Perceived challenges to talent management in the South African public service: An exploratory study of the City of Cape Town municipality", that explored the perceived challenges to Talent Management at the City of Cape Town Municipality through a semi-structured interview with senior managers of the municipality. Their study concluded that failure to retain key talent, lack of employee recognition, succession planning and management problems, and sluggish career management as independent variables had been connected to dependent variables including pay satisfaction, turnover and intention to turnover theories, organizational commitment, employee engagement and motivation.
Referring to the human resource management as an effective tool for delivering an outstanding healthcare services and achieving patients' satisfaction, Elarabi and Johari [36] concluded in their study that effective human resource management practices has a strong impact on enhancing healthcare quality services and improving the performance of hospital's staff.
The study of Barkhuizen, Mogwere, and Schutte [37,38] aimed at investigating the relationship between Talent Management, Work Engagement, and Service Quality orientation of support staff in higher education of South Africa. The study revealed that a positive and significant relationship emerged between all the work engagement dimensions and some of the servqual dimensions of Service Quality. Unfortunately, results showed that there was no significant relationship between Talent Management and Service Quality Orientations. While Barkhuizen et al. [37,38] concluded a study aimed investigating the application of Talent Management practices in the government sector of two Sub-Saharan African countries. The study results showed that TM practices are not effectively applied in both countries. Talent Retention and Workplace Planning practices appeared to be most problematic. Significant differences existed between the current versus the importance of talent management practices for both countries. The respondents differed significantly in terms of the current application of talent management practices based on their demographic characteristics.
In his study, Nafei [39] investigated the relationship between talent management (TM) and health service quality (HSQ). Additionally, his study aimed at investigating the evaluative attitudes of employees toward talent management at teaching hospitals in Egypt. Based on the employees' perspectives, the study concluded that there were differences among the employees regarding their evaluative attitudes towards talent management and health service quality. Meanwhile, it reveals that there was a statistically significant relationship between talent management and health service quality. The study suggests that the Teaching hospitals can improve HSQ by influencing its TM.
Supportively, Nafei [39] concluded in other study that Talent Management is more effective in enhancing the quality service of the commercial banks of Egypt, the results show a significant and positive relationships between TM and SQ. The more investment in TM, the more earned profits will be achieved.

Methodology
The relevant data for the study has been collected from both primary and secondary sources. Research methodologies used in the study are descriptive methods. Simple random sampling is used to collect the information. Regression analysis was used to analyze the data which was collected through a structured questionnaire by using five-pointlikert scale. A sample of 183 respondents was selected from the Princess Rahma Pediatric Hospital in Irbid, only 120 questionnaires were valid for statistical analysis with ration of 65.6%.

Demographic variables
Analysis of demographic information in Table 1 revealed that 82.5 percent of respondents were females because of the nature of hospital which is treated children's below 10 years old. Also, it shows that the hospital workers were young and aged between 20-29 years (34.1 percent), 30-39 years (31.7 percent), 40-49 tears (24.3 percent) and the rest more than 50 years (10 percent). Around 52 percent of the sample respondents had graduated and 51 percent were hold 6-10 years' experience; out of the total sample 25.8 percent of the respondent's experience was more than 18 years; 55 percent of the respondents were working in operational level and the rest of respondents were supervisors and above (Table 1).

Questions tests
To test the questions of this study means and standard deviations have been operated to examine the level of implementation of Talent Management Strategies and Service Quality at Princess Rahma Hospital as one of Jordan public healthcare provider in Irbid. As depicted in Table 2, the respondents attitudes toward the level of implementation of Talent Management Strategies at Princess Rahma Hospital was obviously high (mean=3.770) which came identical to the expectations of high levels of importance of Talent Management in general at Jordan public healthcare provider, Princess Rahma Hospital. This implies that the degree of decision makers' consciousness and awareness are evolving toward the necessity of having talented physicians, Nurses, Pharmacists, allied health professions, and administrative workers. Consequently, the level of implementation of each TM strategies shown in Table 2

Level of Satisfaction
Beneficiaries' Satisfaction 3.760 0.680 High SD=0.680). Researcher believes that the operated hospital has focused on the main beneficiaries' needs in terms of quality treatments and services and then they are seeking for talented physicians and medical and non-medical workers to satisfy their needs and to stop waiving to other hospitals around (Tables 2 and 3).

Hypothesis tests
Correlations: In order to examine the effects of Talent Management Strategies on both Service Quality and Beneficiaries' Satisfaction that represent the first hypothesis, a correlation test employed to investigate if positive and significant correlations appear between variables (Table 4). Table 4 shows that there is a strong statistically significant correlations between Talent Management Strategies and Service Quality (r=0.935, p ≤ 0.05) and Beneficiaries' Satisfaction (r=0.978, p ≤ 0.05). Obviously, results show that each TM Strategies has significant and positive relationship with Services Quality; Talent Attraction Strategy (r=0.887, p ≤ 0.05), Talent Development Strategy (r=0.842, p ≤ 0.05), Talent Retention Strategy (r=0.901, p ≤ 0.05), and Succession Planning Strategy (r=0.823, p ≤ 0.05) and Beneficiaries' Satisfaction; Talent Attraction Strategy (r=0.931, p ≤ 0.05), Talent Development Strategy (r=0.736, p ≤ 0.05), Talent Retention Strategy (r=0.824, p ≤ 0.05) and Succession Planning Strategy (r=0.895, p ≤ 0.05). Therefore, these results didn't support the first hypothesis that stated there is no significant relationship between overall Talent Management Strategies, overall Service Quality, and overall Beneficiaries' Satisfaction of Jordan Healthcare Sector, thus we reject the null hypothesis and accept the alternative hypothesis which obviously shows the positive and significant relationships between all independent variables; Talent Management Strategies and Service Quality and dependent variable; Beneficiaries'' Satisfactions.
Regression analysis: Regression Analysis was applied to test the effect of Talent Management Strategies and Service Quality and Beneficiaries' Satisfaction individually. Tables 5 and 6 scrutinized the results of testing hypotheses 2, 3, and 4 (    It has been noticed from Table 5, that R-value for the overall Talent Management Strategies namely Talent Attraction Strategy, Talent Development Strategy, Talent Retention Strategy, and Succession Planning Strategy is 0.716 suggested that there is a strong effect of these five independent variables on dependent variable (Service Quality), and 0.809 suggested that a strong effect on Beneficiaries' Satisfaction. Consequently, it can also observed that the coefficient of determination i.e. the R-square (R 2 ) value is 0.846, which representing that 84.6% variation of the dependent variable (Service Quality) is due to the independent variables (Talent Management Strategies), remarkably, the coefficient of determination (R-square (R 2 )=0.655) which represent 65.5% variation of the dependent variable (Beneficiaries' Satisfaction) due to the independent variable (TMS), which in fact, both are a strong explanatory power of regression. Moreover, Table 5 shows that R-value for the overall Service Quality dimensions; Tangibility, Responsiveness, Reliability, Assurance, and Empathy is 0.865 which also suggested that there is a strong effect of these independent variables on dependent variable (Beneficiaries' Satisfaction). The coefficient of determination i.e. the R-square (R 2 ) value is 0.748, which representing that 74.8% variation of the dependent variables (Beneficiaries' Satisfaction) is due to the independent variables (Service Quality and its' dimensions). Table 5 indicates that the regression model predicts the dependent variable significantly well. The results for the predictors identified that the value of F-stat is 121.641 and 91.570 and this significant as the level of significance is less than 5% (p ≤ 0.05). These indicate that the overall models were reasonable fit and there were statistically significant association between Talent Management Strategies and Service Quality dimensions from one hand and Beneficiaries' Satisfaction from other hand. Additionally, there is a statistically significant association between Service Quality dimensions and Beneficiaries' Satisfaction where F-value was 106.623 and significant level is less than 5% (P ≤ 0.05).
These results support the model summary of regression analysis and thus the null hypotheses are rejected and alternative hypotheses are accepted for the hypotheses 2, 3, and 4. Hence it can be concluded that Talent Management Strategies have significant impact on Service Quality dimensions and Beneficiaries' Satisfaction of Healthcare Sector of Jordan and in turn Service Quality enhances Beneficiaries' Satisfaction at all.
The beta coefficients of the three models appear in Table 6 Table 6).
Based on the results above have come to support the alternative hypotheses 2, 3, and 4 and by this we reject the null hypotheses by accepting the alternative hypotheses as follow: (Table 7).
Stepwise Regression was used to test the effect of both independent variables (Talent management Strategies and Service Quality) on dependent variable (Beneficiaries' Satisfaction). Table 8 clarifies the results of stepwise multiple regression analysis of this effect ( Table 8).
The above results indicate that P-value is 0.000 hence the regression model was fit. The R 2 -value is 0.677 it implies that there is 67.7% variance by Talent Management Strategies on Beneficiaries' satisfaction. The adjusted R square shows the amount of variance explained by independent variable on dependent variable. From the coefficient table it was revealed that Service Quality is (β=0.823, t=17.569, and significance P=0.000). In terms of both Service Quality and Talent management Strategies effect on Beneficiaries' Satisfaction, the β-value of Service Quality is 0.521, t=6.46, and the P-value is 0.000 it shows that Service Quality and Talent Management Strategies have also positive influence overall Beneficiaries' Satisfaction of Jordan healthcare sector therefore we reject the 5 th null hypothesis and accept alternative hypothesis which says there are significant and positive effects of Talent Management Strategies and Service Quality on Beneficiaries' Satisfaction of Jordan Healthcare Sector (Tables 9 and 10).

Conclusion
Health care delivery is considered important nowadays and is a service based industry. Healthcare institutions and organizations face many challenges of retaining their talents to meet their beneficiaries' satisfaction which is a critical success factor in measuring the hospitals performance. Based on the results above, it can be said that Talent Management Strategies have positive and strong effect on both Service Quality and beneficiaries' Satisfaction and it is concluded that Service Quality and its dimensions have also positive and significant effect on Beneficiaries' Satisfaction, while Talent Management Strategies and Service Quality as independent variables have also strong and significant effect on Beneficiaries' Satisfaction. The researchers justified that all management of healthcare providers seek to support their   human resources by high performing and potential employees to achieve their strategic goals. Even though Jordan healthcare sector suffering from shortages in such qualifications, the co-founders have strategically invest in their human resources as they considered the intellectual capital that drive its competitiveness overall other rivals by sponsoring, attracting, developing, and retain them since the first day of contracting.
While this study contributes the relevant literature and reveals some considerable information for the healthcare managers, it also has some limitations. Results of this study are applicable just for Jordan healthcare sector. On the other hand, the displacement of large numbers of refugees has created major challenges over Jordan's healthcare sector and the large burden in providing medical qualified and talented cadres to meet the growing demands for the public healthcare sector services. Additionally, only questionnaire technique was used to gather data, but to achieve in-depth findings more studies containing both qualitative and quantitative research methods should be conducted.