BioMed CentralHuman Resources for Health
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Open AcceResearch
The importance of human resources management in health care: a
global context
Stefane M Kabene*1,3, Carole Orchard3, John M Howard2, Mark A Soriano1
and Raymond Leduc1
Address: 1Management and Organizational Studies, The University of Western Ontario, London, Ontario, Canada, 2Schulich School of Medicine,
The University of Western Ontario, London, Ontario, Canada and 3School of Nursing, The University of Western Ontario, London, Ontario,
Canada
Email: Stefane M Kabene* - XXXXXXXXXX; Carole Orchard - XXXXXXXXXX; John M Howard - XXXXXXXXXX;
Mark A Soriano - XXXXXXXXXX; Raymond Leduc - XXXXXXXXXX
* Co
esponding author
Abstract
Background: This paper addresses the health care system from a global perspective and the
importance of human resources management (HRM) in improving overall patient health outcomes
and delivery of health care services.
Methods: We explored the published literature and collected data through secondary sources.
Results: Various key success factors emerge that clearly affect health care practices and human
esources management. This paper will reveal how human resources management is essential to
any health care system and how it can improve health care models. Challenges in the health care
systems in Canada, the United States of America and various developing countries are examined,
with suggestions for ways to overcome these problems through the proper implementation of
human resources management practices. Comparing and contrasting selected countries allowed a
deeper understanding of the practical and crucial role of human resources management in health
care.
Conclusion: Proper management of human resources is critical in providing a high quality of health
care. A refocus on human resources management in health care and more research are needed to
develop new policies. Effective human resources management strategies are greatly needed to
achieve better outcomes from and access to health care around the world.
Background
Defining human resources in health care
Within many health care systems worldwide, increased
attention is being focused on human resources manage-
ment (HRM). Specifically, human resources are one of
three principle health system inputs, with the other two
major inputs being physical capital and consumables [1].
Figure 1 depicts the relationship between health system
inputs, budget elements and expenditure categories.
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 inter-
vention [1]. As arguably the most important of the health
Published: 27 July 2006
Human Resources for Health 2006, 4:20 doi:10.1186/ XXXXXXXXXX
Received: 13 April 2006
Accepted: 27 July 2006
This article is available from: http:
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© 2006 Kabene et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http:
creativecommons.org/licenses
y/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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system inputs, the performance and the benefits the sys-
tem can deliver depend largely upon the knowledge, skills
and motivation of those individuals responsible for deliv-
ering health services [1].
As well as the balance between the human and physical
esources, 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 thei
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, expendi-
tures 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 devel-
oped 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 prac-
titioner.
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 dis-
cussed in further detail include the size, composition and
distribution of the health care workforce, workforce train-
ing issues, the migration of health workers, the level of
economic development in a particular country and socio-
demographic, geographical and cultural factors.
The variation of size, distribution and composition within
a county's health care workforce is of great concern. Fo
example, the number of health workers available in a
Relationship between health system inputs, budget elements and expenditure categoriesFigure 1
Relationship between health system inputs, budget elements and expenditure categories. Source: World Health
Report 2000 Figure 4.1 pg.75. http:
www.who.int.proxy.lib.uwo.ca:2048/wh
2000/en/whr00_ch4_en.pdf Figure 1 identifies
three principal health system inputs: human resources, physical capital and consumables. It also shows how the financial
esources to purchase these inputs are of both a capital investment and a recu
ent character. As in other industries, invest-
ment decisions in health are critical because they are generally i
eversible: they commit large amounts of money to places and
activities that are difficult, even impossible, to cancel, close or scale down [1].
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country is a key indicator of that country's capacity to pro-
vide delivery and interventions [2]. Factors to conside
when determining the demand for health services in a par-
ticular country include cultural characteristics, sociode-
mographic characteristics and economic factors [3].
Workforce training is another important issue. It is essen-
tial that human resources personnel consider the compo-
sition 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 sug-
gests that the movement of health care professionals
closely follows the migration pattern of all professionals
in that the internal movement of the workforce to u
an
areas is common to all countries [2]. Workforce mobility
can create additional imbalances that require better work-
force planning, attention to issues of pay and othe
ewards and improved overall management of the work-
force [2]. In addition to salary incentives, developing
countries use other strategies such as housing, infrastruc-
ture and opportunities for job rotation to recruit and
etain 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 care-
fully measured and monitored.
Another issue that arises when examining global health
care systems is a country's level of economic develop-
ment. There is evidence of a significant positive co
ela-
tion 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) pe
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 examin-
ing 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 retir-
ing.
It is also essential that cultural and geographical factors be
considered when examining global health care systems.
Geographical factors such as climate or topography influ-
ence 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
esources that merit further consideration and study.
The impact of human resources on health sector reform
When examining global health care systems, it is both use-
ful and important to explore the impact of human
esources 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 effi-
ciency, equity and quality objectives [3].
Various human resources initiatives have been employed
in an attempt to increase efficiency. Outsourcing of serv-
ices has been used to convert fixed labor expenditures into
variable costs as a means of improving efficiency. Con-
tracting-out, performance contracts and internal contract-
ing are also examples of measures employed [3].
Many human resources initiatives for health sector reform
also include attempts to increase equity or fairness. Strat-
egies aimed at promoting equity in relation to needs
equire more systematic planning of health services [3].
Some of these strategies include the introduction of finan-
cial 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 coun-
tries.
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: tech-
nical quality and sociocultural quality. Technical quality
efers to the impact that the health services available can
have on the health conditions of a population [3]. Socio-
cultural 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 citi-
zens. Some of these constraints include budgets, lack of
congruence between different stakeholders' values, absen-
teeism rates, high rates of turnover and low morale of
health personnel [3].
Better use of the spectrum of health care providers and
etter coordination of patient services through interdisci-
plinary teamwork have been recommended as part of
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health sector reform [4]. Since all health care is ultimately
delivered by people, effective human resources manage-
ment will play a vital role in the success