Health sector reform and human resources: lessons from the United Kingdom

The objective of the paper is to assess the human resource (HR) dimension of the National Health Service (NHS) reforms in the United Kingdom, and to highlight lessons for the health systems of countries undergoing reform or restructuring. Health sector reform in many countries in the 1980s and 1990s has focused on structural change, cost containment, the introduction of market mechanisms and consumer choice. This focus has inevitably challenged the ways that health professionals and other staff are employed and deployed. The methods used to manage human resources in health care may also in themselves be a major constraint or facilitator in achieving the objectives of health sector reform. The impact on the HR function of the NHS reforms is assessed in the paper by examining three central requirements of the HR function: to maintain effective staffing levels and skill mix; to establish appropriate employee relations policy and procedures; and to be involved in pay determination. The paper concludes that the most significant changes which have occurred as result of the NHS reforms have been in staffing change and organizational culture, and the individual attitudes of NHS management and staff. Attempts to alter methods of conducting employee relations and determining pay and conditions of employment have been less successful. However, an overall approach to HR management, which would have been unthinkable in the pre-reform NHS, is now accepted, albeit grudgingly by some, as the way forward. In general, the changes in the NHS HR function can be characterized as a partially successful attempt to adopt private sector HR management techniques to meet the challenges of public sector reform.

Strategic human resource management: redefining the role of the manager and worker

Health-care managers have long been sensitive to the importance of physical resources (technology, space) and financial resources to the success of service delivery. During the last several decades, the value and potential for development of a third element, the human resource has gained new recognition. The importance of viewing personnel as an expandable resource, addressed in an organization's strategic plan, is crucial to meet challenges faced in a rapidly changing health-care environment.

Chaos and complexity--the future for health care HRM

The need to understand chaos and complexity in organisations has particular importance for health which is bedevilled by the complexity of organisations and the sometimes chaotic nature of its core activities. This article seeks to explore these issues in the context of one of the key functions which is expected to hold together this diversity: Human Resource Management (HRM). An exploration of the nature of HRM in health care as it has evolved indicates that in order for it to have a pivotal role for the future it will need to rethink this role in the changing paradigm which is now emerging; in so doing it could develop as the organisational intelligence for health care in the future facilitating organisational learning and creativity.

Self-directed work teams: the wave of the future?

Although teams are currently a popular means of solving work force needs in health care, there has been little use of self-directed work teams--autonomous units without a front-line manager and empowered to control their own work. This article analyzes key differences between self-directed work teams and traditional teams, looks at three cases in which self-directed work teams were implemented, and discusses some of the barriers to the formation and use of self-directed work teams.

Trends in multiculturalism in health care

Materiel managers are faced with a shrinking world and changing work environment. The needs and expectations of the customer have shifted because of the increasing number of multicultural groups. These groups will continue to assert their right to culturally sensitive care. Materiel managers also need to learn to support and enhance the skills of a multicultural work force. One important tool for change will be technology. However, technology that brings the world closer together also creates new challenges for managers, who will have to deal with multicultural colleagues, buyers, sellers, and manufacturers of goods and services.

A new mandate for human resources

Should we do away with HR? In recent years, a number of people who study and write about business--along with many who run businesses--have been debating that question. The debate arises out of serious and widespread doubts about HR's contribution to organizational performance. Dave Ulrich acknowledges that HR, as it is configured today in many companies, is indeed ineffective, incompetent, and costly. But he contends that it has never been more necessary. The solution, he believes, is to create an entirely new role for the field that focuses it not on traditional HR activities, such as staffing and compensation, but on business results that enrich the company's value to customers, investors, and employees. Ulrich elaborates on four broad tasks for HR that would allow it to help deliver organizational excellence. First, HR should become a partner in strategy execution. Second, it should become an expert in the way work is organized and executed. Third, it should become a champion for employees. And fourth, it should become an agent of continual change. Fulfilling this agenda would mean that every one of HR's activities would in some concrete way help a company better serve its customers or otherwise increase shareholder value. Can HR transform itself on its own? Certainly not--in fact, the primary responsibility for transforming the role of HR, Ulrich says, belongs to the CEO and to every line manager who works with the HR staff. Competitive success is a function of organizational excellence, and senior managers must hold HR accountable for delivering it.