|dc.description.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
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
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.||
|dc.description.referencetext||1. Mills A: Improving the Efficiency of the Public Sector Health Services in
Developing Countries: Bureaucratic versus Market Approaches. PHP
Departmental Publication no.17 London: London School of Tropical
2. Cassels A: Health sector reform: key issues in developing
countries. Journal of International Development 1995, 7(3):329-347.
3. Dussault G, Dubois C: Human resources for health policies: a
critical component in health policies. Human Resources for
Health 1:1. 2003 14 April
4. Diallo K, Zurn P, Gupta N, Dal Poz M: Monitoring and evaluation
of human resources for health: an international perspective.
Human Resources for Health 1:3. 2003 14 April
5. Martinez J, Martineau T: Human resources in healthcare
reform: a review of current issues. Health Policy and Planning
6. Buchan J: Health sector reform and human resources: lessons
from the United Kingdom. Health Policy and Planning 2000,
7. Van Lerberghe W, Adams O, Ferrinho P: Human resources
impact assessment. Bulletin of the World Health Organization 2002,
8. Chartered Institute of Personnel and Development (CIPD): The
Change Agenda: People Management and Business Performance London:
9. Caulkin S: The time is now. People Management :32-34. 2001 30
10. Richardson R, Thompson M: The Impact of People Management Practices
on Business Performance: A Literature Review London: Institute of
Personnel and Development; 1999.
11. West M, Patterson M, Lawthom R, Nickell S: The Impact of People
Management Practices on business performance. IPD Research Paper 22
London: Institute of Personnel and Development; 1997.
12. MacDuffie J: Human resource bundles and manufacturing performance:
organisational logic and flexible production systems
in the world auto industry. Industrial and Labour Relations
Review 1995, 48(2):197-221.
13. Pfeffer J: Competitive Advantage through People Boston: Harvard Business
14. Pfeffer J: The Human Equation: Building Profits By Putting People First Boston:
Harvard Business School; 1998.
15. Huselid M: The impact of human resource management practices
on turnover, productivity and corporate financial
performance. Academy of Management Journal 1995, 38(3):635-672.
16. Guest D: Personnel's paradox. People Management :25-29. 2001 27
17. Chartered Institute of Personnel and Development (CIPD): Sustaining
Success in Difficult Times: Research Summary London: CIPD; 2002.
18. Eaton S: Beyond unloving care: linking human resource management
and patient care quality in nursing homes. International
Journal of Human Resource Management 2000, 11(3):591-616.
19. Rondeau K, Wagar T: Impact of human resource management
practices on nursing home performance. Health Services Management
Research 2001, 14(3):192-202.
20. Sovie M, Jawad A: Hospital restructuring and its impact on
outcomes. Journal of Nursing Administration 2001, 31(12):588-600.
21. Aiken L, Clarke S, Sloane D: Hospital staffing, organisation, and
quality of care: cross national findings. International Journal for
Quality in Health Care 2002, 14(1):5-13.
22. Needleman J, Buerhaus P, Mattke S, Stewart M, Zelevinsky K: Nursestaffing
levels and the quality of care in hospitals. New England
Journal of Medicine 346:1715-1722. 2002 May 30
23. Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH: Hospital
nurse staffing and patient mortality, nurse burnout, and job
dissatisfaction. Journal of the American Medical Association 2002,
24. Bond C, Raehl C, Franke T: Interrelationships amongst mortality
rates, drug costs, total cost of care and length of stay in
United States hospitals: summary and recommendations for
clinical pharmacy services and staffing. Pharmacotherapy 2002,
25. Hendrix T, Foreman S: Optimal long term care nurse staffing
levels. Nursing Economics 2001, 19(4):164-175.
26. Tourangeau A, Giovanetti P, Tu J, Wood M: Nursing related
determinants of 30 day mortality for hospitalized patients.
Canadian Journal of Nursing Research 2002, 33(4):71-88.
27. Ticker J: Patient volume, staffing and workload in relation to
risk-adjusted outcomes in a random stratified sample of UK
neonatal intensive care units: a prospective evaluation. The
Lancet 2002, 359(9301):99-107.
28. Kovner C, Jones C, Zhan C, Gergen P, Basu J: Nurse staffing and
post surgical adverse events: An Analysis of administrative
data from a sample of US hospitals 1990-1996. Health Services
Research 2002, 27(3):611-629.
29. Clarke S, Sloane D, Aiken L: Effects of hospital staffing and
organisational climate on needlestick injuries. American Journal
of Public Health 2002, 92(7):1115-1119.
30. McClure M, Poulin M, Sovie M: Magnet Hospitals: Attraction Retention
of Professional Nurses Kansas City: American Nurses Association;
31. Kramer M, Schmalenberg C: Job Satisfaction and retention.
Insights for the 90s. Part 2. Nursing 1991, 21(3):51-55.
32. Aiken LH, Smith HL, Lake ET: Lower Medicare mortality among
a set of hospitals known for good nursing care. Medical Care
33. Buchan J, Ball J, Rafferty A: A Lasting Attraction? The Magnet Accreditation
of Rochdale Infirmary 2004 [http://www.lshtm.ac.uk/hsru/staff/
PDFs/Rochdale.pdf]. London: London School of Hygiene and Tropical
34. Hornby P, Forte P: Guidelines for Introducing Human Resource Indicators
to Monitor Health Service Performance Keele: Centre for Health Planning
and Management, Keele University; 2002.
35. American Nurses Credentialing Center (ANCC): The Magnet Recognition
Program for Excellence in Nursing Service. Health Care Organizations
Instructions and Application Process. Manual 2000-2001 Washington
DC: ANCC; 2001.
36. Buchan J: Staffing and Skill Mix: Indicators of effectiveness? Geneva:
World Health Organization (unpublished document); 2003.||