What difference does (good) HRM make?
Citation
Buchan, J. (2004) What difference does (good) HRM make?, Human Resources for Health, vol. 2, , ,
Abstract
The importance of human resources management (HRM) to the success or failure of health system
performance has, until recently, been generally overlooked. In recent years it has been increasingly
recognised that getting HR policy and management right has to be at the core of any sustainable
solution to health system performance. In comparison to the evidence base on health care reformrelated
issues of health system finance and appropriate purchaser/provider incentive structures,
there is very limited information on the HRM dimension or its impact.
Despite the limited, but growing, evidence base on the impact of HRM on organisational
performance in other sectors, there have been relatively few attempts to assess the implications of
this evidence for the health sector. This paper examines this broader evidence base on HRM in
other sectors and examines some of the underlying issues related to good HRM in the health
sector.
The paper considers how human resource management (HRM) has been defined and evaluated in
other sectors. Essentially there are two sub-themes: how have HRM interventions been defined?
and how have the effects of these interventions been measured in order to identify which
interventions are most effective? In other words, what is good HRM?
The paper argues that it is not only the organisational context that differentiates the health sector
from many other sectors, in terms of HRM. Many of the measures of organisational performance
are also unique. Performance in the health sector can be fully assessed only by means of indicators
that are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff per
occupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated)
or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgery
complications).
The paper also stresses the need for a fit between the HRM approach and the organisational
characteristics, context and priorities, and for recognition that so-called bundles of linked and
coordinated HRM interventions will be more likely to achieve sustained improvements in
organisational performance than single or uncoordinated interventions.