Healthcare

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INTRODUCTION
Today, due to the emergence of multispeciality hospitals, India is being looked upon as an upcoming destination for medical tourism. In the midst of this, HR departments in various healthcare organisations face the challenging task of attracting, recruiting, training and retaining healthcare professionals.

Human resources (HR) departments play a vital role in helping the organisation meet its strategic goals by managing the workforce effectively and efficiently.

The HR departments in various healthcare organisations have implemented several functional changes by conducting a detailed review of the operations. Of these, talent management is of paramount importance. Hence, attracting and retaining the much-needed talent & preventing them from migrating to greener pastures remain a major challenge for HR professionals in the healthcare sector. Agrees Ankush Gupta, Senior Manager – Human Resource, P D Hinduja National Hospital & Medical Research Centre, “Healthcare organisations are people-intensive organisations. Despite the influence of the downturn, the healthcare industry has not witnessed any rightsizing activity. This is due to the simple reason that despite all the technological advancements, service delivery is largely based on human intervention.” Evolving HR practices in healthcare

The past decade has witnessed a sea change in the functioning of HR departments. Today HR departments are impacting the organisation like never before – they are not only recruiting the employees but also training them and ensuring that they are good performers. In addition, they are involved in the strategic planning process and formulating policies accordingly in order to ensure that the organisation attains its objectives.

Besides, according to Gupta, the biggest paradigm shift that has taken place in the last decade in the healthcare sector is that the patient has now started demanding a complete service experience rather than just a clinical outcome regarding a particular disease or disorder. A popular workplace

An individual spends maximum amount of time in his organisation. Hence, it is important to have an environment that results in high productivity and growth. Opines Gupta, “Employees are looking forward to compensation at par with industry standards, good work life balance, a sense of equity & justice and a robust performance management system linked to a well-balanced reward system. It is important for HR departments to ensure that they regularly organise continuous learning & development programmes and career advice sessions for them. SaysVivek Thakur, Manager – HR & Administration, Dr L H Hiranandani Hospital,“They should focus on areas like compensation benchmarking and effective on-job training programmes. Further, they should also introduce new types of awards effective grievance handling mechanism, welfare measures, a friendly atmosphere and safe & ambient working conditions.”

Human resources, when pertaining to health care, can be defined as the different kinds of clinical and non-clinical staff responsible for public and individual health intervention [1]. As arguably the most important of the health system inputs, the performance and the benefits the system can deliver depend largely upon the knowledge, skills and motivation of those individuals responsible for delivering health services [1]. As well as the balance between the human and physical resources, it is also essential to maintain an appropriate mix between the different types of health promoters and caregivers to ensure the system's success [1]. Due to their obvious and important differences, it is imperative that human capital is handled and managed very differently from physical capital [1]. The relationship between human resources and health care is very complex, and it merits further examination and study. Both the number and cost of health care consumables (drugs, prostheses and disposable equipment) are rising astronomically, which in turn can drastically increase the costs of health care. In publicly-funded systems, expenditures in this area can affect the ability to hire and sustain effective practitioners. In both government-funded and employer-paid systems, HRM practices must be developed in order to find the appropriate balance of workforce supply and the ability of those practitioners to practise effectively and efficiently. A practitioner without adequate tools is as inefficient as having the tools without the practitioner.
Key questions and issues pertaining to human resources in health care

When examining health care systems in a global context, many general human resources issues and questions arise. Some of the issues of greatest relevance that will be discussed in further detail include the size, composition and distribution of the health care workforce, workforce training issues, the migration of health workers, the level of economic development in a particular country and sociodemographic, geographical and cultural factors. The variation of size, distribution and composition within a county's health care workforce is of great concern. For example, the number of health workers available in a country is a key indicator of that country's capacity to provide delivery and interventions [2]. Factors to consider when determining the demand for health services in a particular country include cultural characteristics, sociodemographic characteristics and economic factors [3]. Workforce training is another important issue. It is essential that human resources personnel consider the composition of the health workforce in terms of both skill categories and training levels [2]. New options for the education and in-service training of health care workers are required to ensure that the workforce is aware of and prepared to meet a particular country's present and future needs [2]. A properly trained and competent workforce is essential to any successful health care system. The migration of health care workers is an issue that arises when examining global health care systems. Research suggests that the movement of health care professionals closely follows the migration pattern of all professionals in that the internal movement of the workforce to urban areas is common to all countries [2]. Workforce mobility can create additional imbalances that require better workforce planning, attention to issues of pay and other rewards and improved overall management of the workforce [2]. In addition to salary incentives, developing countries use other strategies such as housing, infrastructure and opportunities for job rotation to recruit and retain health professionals [2], since many health workers in developing countries are underpaid, poorly motivated and very dissatisfied [3]. The migration of health workers is an important human resources issue that must be carefully measured and monitored. Another issue that arises when examining global health care systems is a country's level of economic development. There is evidence of a significant positive correlation between the level of economic development in a country and its number of human resources for health [3]. Countries with higher gross domestic product (GDP) per capita spend more on health care than countries with lower GDP and they tend to have larger health workforces [3]. This is an important factor to consider when examining and attempting to implement solutions to problems in health care systems in developing countries. Socio-demographic elements such as age distribution of the population also play a key role in a country's health care system. An ageing population leads to an increase in demand for health services and health personnel [3]. An ageing population within the health care system itself also has important implications: additional training of younger workers will be required to fill the positions of the large number of health care workers that will be retiring. It is also essential that cultural and geographical factors be considered when examining global health care systems. Geographical factors such as climate or topography influence the ability to deliver health services; the cultural and political values of a particular nation can also affect the demand and supply of human resources for health [3]. The above are just some of the many issues that must be addressed when examining global health care and human resources that merit further consideration and study.
The impact of human resources on health sector reform

When examining global health care systems, it is both useful and important to explore the impact of human resources on health sector reform. While the specific health care reform process varies by country, some trends can be identified. Three of the main trends include efficiency, equity and quality objectives [3]. Various human resources initiatives have been employed in an attempt to increase efficiency. Outsourcing of services has been used to convert fixed labor expenditures into variable costs as a means of improving efficiency. Contracting-out, performance contracts and internal contracting are also examples of measures employed [3]. Many human resources initiatives for health sector reform also include attempts to increase equity or fairness. Strategies aimed at promoting equity in relation to needs require more systematic planning of health services [3]. Some of these strategies include the introduction of financial protection mechanisms, the targeting of specific needs and groups, and re-deployment services [3]. One of the goals of human resource professionals must be to use these and other measures to increase equity in their countries. Human resources in health sector reform also seek to improve the quality of services and patients' satisfaction. Health care quality is generally defined in two ways: technical quality and sociocultural quality. Technical quality refers to the impact that the health services available can have on the health conditions of a population [3]. Sociocultural quality measures the degree of acceptability of services and the ability to satisfy patients' expectations [3]. Human resource professionals face many obstacles in their attempt to deliver high-quality health care to citizens. Some of these constraints include budgets, lack of congruence between different stakeholders' values, absenteeism rates, high rates of turnover and low morale of health personnel [3]. Better use of the spectrum of health care providers and better coordination of patient services through interdisciplinary teamwork have been recommended as part of health sector reform [4]. Since all health care is ultimately delivered by people, effective human resources management will play a vital role in the success of health sector reform. PROBLEMS

Managing human resources in healthcare set-ups like hospitals and clinics is a challenging task for HR departments. Says Gupta, “The biggest challenge in the healthcare industry today is the rising salaries and acute shortage of trained manpower at all levels of the hierarchy.”

Moreover, with India being looked upon as an upcoming destination for medical tourism, it is essential to have the right talent in place at the right time. Further, the quality of the workforce in an industry where health services are rendered cannot be compromised. HR staff recruiting healthcare professionals need to continuously keep adopting novel ways of screening their candidates, conducting different examinations & tests to judge the skill of the professional and his/her ability to handle pressure situations effectively. Further, India records an extremely low nurse to population ratio. Many well-qualified & trained nurses are recruited by hospitals in countries like the US, UK, Australia and New Zealand, among others

SOLUTIONS

It is said that identifying a problem is half way towards resolving it. Fortunately, the healthcare industry has woken up to the fact that human resources play a pivotal in its success and already identified the bottlenecks that are hindering its progress. Slowly and gradually, both the government and the industry players are changing their old and outmoded methods of human resource management to inculcate better and effective practices. Over the past few years, HR policies and the role of HR have undergone a strategic change in India. HR, today, plays an important role in organisational change and development of human resource. They have become integral business partners of the organisation," says Suyash Borar, COO, B. M. Birla Heart Research Centre. Thus, HR is coming to age in India and has evolved from being just a stagnant, paper pushing business to integral part of the healthcare business. Efforts are on to tackle the challenges in the human resource management of the country's healthcare sector. "Employee demand has changed and so has the environment. Immediate deliverables and opportunities for speedy growth are prerequisites for sustainability today. The need to effectively partner business, retention and continuous focus on operational excellence through technology are challenges faced by HR professionals. HR policy has to become more creative and innovative to retain existing talent," says Borar. The same views are endorsed by Dr (Prof) DP Saraswat, CEO, Action Healthcare. He opines, "HR personnel need to become more creative in the way they retain employees. They need to guide human resource into a dynamic organisation that attains its objective with high degree of morale. For an organisation to do well and earn productivity it is essential that high potential employees stick to it for a longer duration and contribute effectively. Every organisation should have retention strategies in place - the reward system should have linkages with employee performance so that their motivation remains high. Also practices like investing differently for different talent groups, can be incorporated in which we identify our HI-Pots and develop them through learning and development, rewards, career growth and recognitions. He goes on to say, "Only an organisation having robust HR practices like talent management, leadership development programmes, good succession planning, coaching, mentoring, good retention strategy would succeed in retaining high value and high potential

employees in long run." Yet, retention of employees is not the only challenge, though its importance cannot be denied. Hiring practices in healthcare are also undergoing a sea change. The employers have become more discerning while selecting their employees, which in turn will lead to better productivity. "The staff hired for hospital must fit into the scheme. The staff should be technically competent to perform their roles at various stages of preventive, diagnostic and therapeutic procedures. They are required to take a wide variety of forms. Readiness to deal with life and death situations and also cover health education to communities. The essential ingredients of staff for hospitals are competence, empathy, effective communication skills and understanding of financials to offset increasing cost of treatment," claims Dr Saraswat of Action Healthcare. Similarly, Borar of BM Birla opines,"For hiring a staff for hospital, the prerequisites required are: passion to serve, requisite qualification, proper training and experience, knowledge, communication skill, commitment and dedication." Thus, it is evident that the hospitals have started looking towards creating a talent pool which will ensure better quality in the healthcare system. They have also woken up to the fact that medical education and training have crucial roles to play in creating a talent pool as far as human resources in healthcare are concerned. Dr KR Anthony, a former Health and Nutrition Specialist for UNICEF and former Director, State Health Resource Centre, Chhattisgarh says that with a clear vision for the future, careful assessment must be done on the current status and projection of health staff requirement. Questions such as: What are the gaps now? What is the likely output of various cadres from the existing training institutions? What is the current trend of graduates joining public health system as well as skill migration.....needs to be asked. Many of them are also lobbying for more specialised and detailed courses for health personnel. "The Governance in healthcare is about co-ordinating the available resources to their optimum level. Co-ordination can be better performed by a person who has undergone a formal training in management. There is dire requirement of formally qualified hospital administrators at middle level in the hierarchy for an understanding of inventory management, financial management, perceived needs of the patient as well as their attendants. The clinicians turned administrators have good understanding of the patient as well as of their attendant's needs, but are not trained and programmed for effective management of inventory and finances. As a result clinicians turned administrators may not achieve optimal utilisation of resources placed at their disposal. To address this challenge at a national level, the medical and paramedical personnel may be selected for hospital administration courses some for long and others for short duration", says Dr Saraswat. "In order to improve healthcare management in the country more number of medical and nursing colleges needs to be built to offer degrees in healthcare management, health administration or public health. Every hospital should have some hours of weekly academic activities in relevant areas. For e.g. doctors have a minimum number of fixed hours of CME's (30 hours annually) which will improve their clinical knowledge and skills. In the same way a minimum number of credit hours are required for general staff as well for improvement in job productivity," is Borar's opinion. Thus, slowly and gradually but definitely the HR practices in India is undergoing a transformation for the better. One serious problem that still needs a solution is the issue of skewed distribution of existing resources. However, government is also making efforts

towards mitigating this situation. One step towards it is the plan to introduce a new medical course i.e. Bachelor of Rural Medicine and Surgery (BRMS). How this pans out remains to be seen, yet the intent is good enough. Moreover, better opportunities, working conditons and better hospitals in rural regions have also helped the better the situation to some extent. The Way Forward Going ahead, inculcating some of the following steps would enable the healthcare industry to improve their HR management and achieve new peaks of success:      Developing a new talent management strategy Developing a communication plan for the employees Situation assessment - assess the organisations' current performance levels on an outgoing basis to determine the gaps between current performance and desired performance. Recruitment - To have right person in the right role with the right set of skills at the right time Jugaad - The famed Indian resourcefulness would be a great tool for human resource management. Until the demand-supply gap in HR gets filled, the existing resources can be made to multi-task with the help of adequate training and incentives.

To sum up the whole scenario, it is to be accepted that though the bottlenecks remain, steps are also being taken to resolve them. The healthcare industry is reviewing its existing HR practices and trying to enhance and improve upon them. Thus, the industry is undergoing a transformation, a time-consuming endeavour but hopefully would serve a greater good and help to propel the sector towards further growth and glory. EXAMPLES
As providers of essential services and places where people's lives are literally on the line, hospitals are commonly expected to be best practice workplaces, set apart by good management, effective leadership, and engaged and motivated workforces. But the management of hospital workers has not been rigorously researched. Australia has probably one of the better healthcare systems in the world, if not the best, notes Patrick Bolton, the director of Clinical Services (Medical) at Sydney's Prince of Wales Hospital. Australian government spending on health is around the average of other developed countries, according to a comparative league table. "Yet when you talk to people who work in the healthcare system, they say it stinks," says Bolton. He believes the federal government has caught up with the fact there is dissatisfaction within the ranks, but not the actuality of what is happening inside hospitals. That's about to change due to a collaboration that joins business school thinking with health management and clinical practice. Julie Cogin, a management professor at the Australian School of Business leads a research team with Ian Williamson, a Melbourne Business School professor, and Bolton. They are investigating how healthcare workers experience management and how that affects productivity and patient care. The research will shed light on what can be done to improve health workers' satisfaction and boost health outcomes for patients. Cogin and Williamson have both previously investigated human resource management in the commercial and not-for-profit sectors, and have been spurred on by a lack of empirical research outside of the business world, particularly in relation to hospitals. "It struck us as odd that we have all this information on how, for example, accountancy firms or law firms can be best managed, yet we hadn't looked in a systematic way at how effective management could influence healthcare outcomes," says Williamson. The project is timely due to the federal government's new plan to create a nationally funded but locally staffed single hospital network to replace eight separate state and territory systems. And previous indicators suggest there's significant room for improvement. On the Brink In 2008, the Australian Commission on Safety and Quality in Health Carepublished a report that exposed problems with patient safety in hospitals. Subsequently, commissioner Peter Garling's report into acute care services in New South Wales (NSW) public hospitals made 139 recommendations for change, portraying a health system on the brink with many hospitals in deficit, and recruitment often frozen or delayed, putting existing clinicians under additional stress.

The NSW government's response was to commit an immediate A$485 million to implement Garling's recommendations. But the commissioner also identified problems that didn't require funding solutions. Garling's report was highly critical of the culture in hospitals, highlighting a lack of good communication between clinicians and management, a hierarchical top-down structure that often led to bullying and an administrative workload that left doctors feeling bogged down. NSW wasn't alone in revelations about demoralised healthcare staff. In 2009, Cogin's research revealed increases nationwide in workplace conflict and bullying. Adding to this picture has been the ongoing, chronic shortages of nurses, doctors and other healthcare professionals that are behind the current nurses dispute over nurse-patient ratios and their impact on patient safety. Various research papers have linked understaffing to patient mortality and illness, accidents and near misses, all of which can cost the healthcare system up to A$2 billion a year, according to the National Health & Hospitals Reform Commission (NHHRC). This figure does not take into account the impact on staff morale, high turnover and the increased cost of hiring and training new staff, using temporary workers and paying overtime costs. "There's a tremendous amount of pressure to use money well and you can't waste it on bad bets," says Williamson. As a hospital's largest expenditure is staff-related, the research can point where best to use funds to generate the greatest return such as the types of training opportunities, and who to hire. The way that workers are organised in a hospital has an impact on how an employee experiences the work and also on the effectiveness of patient care, Williamson says. "For example, when you have a patient with multiple complaints, it requires collaboration across experts," he says. "Doctors are knowledge workers and their training rarely provides opportunities to collaborate with other experts. It's not just a healthcare problem, it happens a lot in research and development (in other organisations) and in law firms. It's a management problem and has a big impact on the effectiveness of the organisation. Managers need to be more savvy about the social capital they have in their units." Key questions to be scrutinised by the researchers include: Are human resource management systems working to the extent that healthcare workers feel supported, have trust and feel commitment to their job? Second, how does good – and bad – human resource management (HRM) influence the quality of healthcare provided for individuals and at an organisational level? A benefit of this study is that one of the partners, Queensland Health (QH), has provided unprecedented access to proprietary data on sensitive measures of hospital performance, including mortality rates, bed waiting times, errors, re-admissions, patient satisfaction and engagement. For this reason, Queensland will be the initial focus of the research and, says Cogin, "we should be able to say with some certainty what's working and what's not working." Queensland Health centrally manages its data, measuring performance in all its hospitals across the state. Data is collected quarterly. Not all states have such comprehensive and coordinated data collection of hospital performance. Factoring in Variables There are a lot of variables between hospitals, so how does the research team approach such a multi-faceted problem head on? Cogin agrees the size and location of a hospital is relevant to its people management practices. "A small rural hospital in northern Queensland will have a completely different context to a hospital in urban Sydney," she says. "The resources and talent available are very important to consider." Williamson says one of the major problems hospitals face is the ability to attract and retain talent – and retaining staff so that they're not burning out is an extremely difficult job. Rural hospitals in particular struggle with this. The study will begin by meeting executives who have to cope with such problems in three different types of hospital: a metropolitan or large teaching hospital, a medium-sized facility on the fringes of a city and a rural or regional hospital. "We want to look at the types of strategies they employ," says Cogin, "and the demands they face such as funding, patient issues, talent available and their strategic orientation." The next stage will be interviews with a sample of department heads and managers – they may be from oncology, cardiology, physiotherapy or the nursing unit. Cogin says the idea is to look at how they work, identify successful practices that achieve the best results from their staff and also the opposite – what they don't do well. "In this way we will find out what strategies work in developing trust and motivation with clinicians such as nurses, doctors, physios and pharmacists." In the third part of the study, the researchers will work closely with the professional healthcare staff to find out the elements of their job that have positive and negative effects on them. Whether, for example, they feel valued, whether there are reward systems in place, and how rostering occurs. It isn't just a one-way process, Williamson says. While the researchers will be conducting qualitative investigation by talking with physicians and managers to discover new insights, they also hope to use prior research to address some of the problems they find. "We definitely come into this with some clear theory that works," Williamson says. "There are proven leadership behaviours that are effective at leading staffs of knowledge workers. But we anticipate seeing a lot of variance across hospitals: some managers will be doing them, some will not." Where Cogin and Williamson find successful people management practices, they will be tested for efficacy. "Let's say we have a manager who says, 'This is the way I like to lead and the behaviours that I engage in with my staff and that's why my patient satisfaction and staff retention is so high,'" Williamson says. "We'll measure those behaviours and see if another manager engaging in those same behaviours realizes similar patient satisfaction levels and employee satisfaction levels." Bolton believes the relationship hospital healthcare workers have with their managers is different to other industries, and the role of a healthcare manager is to be invisible; to make it possible to get out of the way and let the professionals get on with the job. "What a doctor really wants to do is the doctoring," he says. Williamson agrees that hospital managers don't come in and mandate like in other industries. "A hospital unit head has to be able to influence [productivity] in other ways by shaping the way in which people engage," he says. "It's not unique to hospitals but it's quite critical in them." The research results are keenly anticipated by the industry partners – Queensland Health, the Australian Healthcare & Hospitals Association (AHHA) and the South Eastern Sydney and Illawarra Area Health Service (SESIAHS). Cogin says it will help them "to achieve their strategic objectives of recruiting and retaining qualified healthcare professionals and providing an organisational work environment that promotes wellbeing of staff and enhances overall hospital performance."

INDIAN PERSPECTIVEExpenses incurred by the Indian Government on health care are the highest amongst developing countries. India’s expenses on the healthcare sector
comprise 5.25% of the GDP. Chances are that the health care market could experience a hike and attain a figure ranging between $53 to $73 billion with in five years from now. This in turn will reflect an increase in the gross domestic product to 6.2% GDP. The healthcare industry in India earns revenues accounting for 5.2% of gross domestic product. Employment opportunities are provided to as many as 4 million people in the healthcare segment or other related sectors catering to the healthcare industry in India in some way or the other. Owing to the vast differences in medical expenses in western countries and that of India, India has become one of the favorites for healthcare treatment. Due to the progressive nature of the healthcare sector in India, several foreign companies are intending to invest in the country. Existing healthcare organizations are expanding by opening hospitals in new service areas and new organizations are entering with state of art equipment latest technology and marketing strategies. Consequently competition in the healthcare sector is on the rise. Hitherto available options were limited to healthcare consumers. But they have now more and better options. Added to this, increased incomes and awareness levels are driving the costumers to seek quality health care. The providers in turn need to be more innovative in their approach and offer quality services at competitive prices. They are therefore increasingly confronted with the challenges to ensure cost effective quality acre at affordable prices. All this necessitates a specially trained cadre of professional management graduates in healthcare. Until recently doctors without any professional training in management were managing the hospitals. This was not only tough but made it difficult to devote time for their patients. Thanks to rapid corporatisation, a lot of medical graduates are taking up further specialization in hospital administration. Even non-medical professionals are increasingly taking the mantle of hospital administration. Even the government is veering round to the view that public hospitals also need to be run professionally. Hence there is strong need for offering a course in healthcare management. It is evident that there is a wide gap between supply and demand for gained healthcare managers/administrators to work for hospitals, pharmaceutical companies, health insurance and third party administrators and other health care provider organizations. There are bright opportunities even in the government sector. The National Rural Health Mission (NRHM) envisages appointment of health care administrators. The demands for health care professionals is envisaged to increase manifold in the years to come with more and more hospitals expected to come up in semi urban and rural areas. In current times, the average age of the workforce in any hospital right from the middle level management to a senior level is 29-35 years of age, all handling pivotal and mammoth responsibilities. The entire administrative structure is turning over a new leaf wherein the human resources departments are on a spree of hiring individuals between the age of 28-32 at middle level posts to inject the much needed innovation, energy and vigor to the pulse of their organization. There is a strong conviction that it is this Gen X which will take healthcare to its next level. Moreover, this vibrant young lot is also equally eager to cash in on the boom in healthcare. A management graduate who studies only general functional areas such as marketing production, finance will need to develop an appreciation of the healthcare domain to contribute meaningfully tot his sector. Similarly a health science professional lacks knowledge and application of management principles. The Healthcare program bridges the capabilities required to use and apply management principles in people management, finance, operation, communication and other areas to the Healthcare Sector. A specialized program in healthcare ensures that participants are: 1) able to understand management principles and practices; 2) functional elements of management business environment and its influence on organizations in the Indian context; 3) prepare and implement business plans; 4) develop human relationship skills; 5) to provide theoretical and practical knowledge of Healthcare services, Hospital Organization – Operation and planning. 6) Address healthcare issues specific to the Indian context with exposure to real life cases/technical know how in the healthcare services sector and to give the student a starting edge in the healthcare industry. Welingkar Institute of Management will soon launch an 11 month post graduate program in Healthcare management so that Health care Executives 1) Can ensure that their organizations have strong medical, operational and financial footing to serve the needs of parents their families and the communities. 2) Are skilled, trained professionals who care deeply about the quality of care patients receive. They partner with physicians, nurses, and other professionals to provide care. 3) Help in educating community members about important health issues 4) Ensure that hospitals and other healthcare organizations serve as safety nets in their communities by providing emergency and ongoing care, as well as accurate and timely information about public threats in times of crisis. This program is ideal for MBBS, BDS, B. Pharma, BEMS, BHMS, BAMS graduates or B/ Com, B.A. BMS graduates with 1-2 years experience in healthcare sector. To ensure multi faceted expert guidance , Welingkar Education has eminent personalities on the Advisory board from the Pharma sector, leading hospitals and the education sector. –

CONCLUSION
We have found that the relationship between human resources management and health care is extremely complex, particularly when examined from a global perspective. Our research and analysis have indicated that several key questions must be addressed and that human resources management can and must play an essential role in health care sector reform. The various functions of human resources management in health care systems of Canada, the United States of America, Germany and various developing countries have been briefly examined. The goals and motivations of the main stakeholders in the Canadian health care system, including provincial governments, the federal government, physicians, nurses and allied health care professionals, have been reviewed. The possibility of a major change in the structure of Canadian health care was also explored, specifically with regard to the creation of a two-tier system. The American health care system is currently challenged by several issues; various American case studies were examined that displayed the role of human resources management in a practical setting. In Germany, the health care situation also has issues due to a surplus of physicians; some of the human resources implications of this issue were addressed. In developing countries, the migration of health workers to more affluent regions and/or countries is a major problem, resulting in citizens in rural areas of developing countries experiencing difficulties receiving adequate medical care. Since all health care is ultimately delivered by and to people, a strong understanding of the human resources management issues is required to ensure the success of any health care program. Further human resources initiatives are required in many health care systems, and more extensive research must be conducted to bring about new human resources policies and practices that will benefit individuals around the world.

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