Crowded out? The capacity of HR to change healthcare work practices

Abstract

This article analyses the role of HR in changing healthcare work practices. It uses a large, mainly qualitative, empirical study of a national HR initiative in England, document review and secondary sources to indicate how HR struggles to carve out a role for itself within the crowded space of workforce modernisation. The concept of regulatory space is used to indicate how government policy placing HR at the forefront of workforce change is challenged, first, by its complexity, and second, by the reality of regulating workforce practice at local levels. The highly technical nature of work organisation in healthcare, and constraints on the capacity and capability of the HR function, meant that such changes tended to be controlled and designed by clinicians, in contrast to the broad, strategic approach to HR envisaged by policymakers.

Keywords::

• employment regulation
• healthcare management
• public sector HRM
• workforce modernisation

Acknowledgements

This article is based on research gathered during the study of skills development activities commissioned by the Department of Health, Policy Research Programme. The full research team comprises Anne McBride, Annette Cox, Stephen Mustchin, Marilyn Carroll, Paula Hyde, Elena Antonacopoulou, Kieran Walshe and Helen Woolnough. The article represents the views of the authors and not necessarily those of the Department of Health. The authors would like to thank the reviewers for their constructive comments and thank Miguel Martinez Lucio and Caroline Lloyd for comments on earlier drafts.

Notes

^1. Subsequent to this research, more responsibility for employment relations policy has been devolved from the Department of Health to the NHS Employers organisation. The impact of these changes was not established at the time of fieldwork, and is not the focus of this article.

^2. National Institute for Clinical Excellence produces guidelines on appropriate treatment regimes; National Service Frameworks specifies the organisation and treatment of particular conditions and The Commission for Health Improvement inspects healthcare organisations.