What difference does ("good") HRM make?

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 reform-related 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 sector. 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 complications). 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

A Near-Total Decline in Caribou on Prince of Wales, Somerset, and Russell Islands, Canadian Arctic

The number of caribou (Rangifer tarandus) on Prince of Wales, Somerset, and Russell islands in the south-central Canadian Arctic declined by 98% in 15 years, from an estimated 6048 (16% calves) in 1980 to an estimated 100 (0% calves) in 1995. Those estimates were obtained by systematic aerial surveys that used the same design and methods and comparable survey coverage. We do not have the data needed to determine the rate of decrease between 1980 and 1995 or its possible causes. There is no evidence for large-scale winter mortality in any one year or few consecutive years. A probable explanation for the decline is consequential reductions in long-term survival rates, both of breeding females and of calves in their first year of life, associated with continued caribou harvesting and markedly increased wolf (Canis lupus) predation on the dwindling number of caribou through the 1980s and early 1990s. The delay in detecting the decline and the lack of understanding of its causes will handicap the development of an ecologically sound recovery plan. As previous caribou declines have been followed by recovery, some comfort may be drawn from the likelihood of unaided recovery. However, the number of caribou has declined to the point where recovery will be tenuous and lengthy, at best. Unaided recovery could easily fail to occur, so we should not be complacent, especially as extirpation of these few remaining caribou would remove a distinct genetic group and reduce the biodiversity of caribou on Canada’s Arctic Islands.Le nombre de caribous (Rangifer tarandus) se trouvant sur les îles Prince of Wales, Somerset et Russell, dans le centresud de l’Arctique canadien, a chuté de 98 % en 15 ans, passant d’un nombre estimé à 6 048 (dont 16 % étaient des veaux) en 1980 à un nombre estimé à 100 (dont aucun veau) en 1995. Ces estimations ont été obtenues au moyen de relevés aériens systématiques recourant aux mêmes définitions, aux mêmes méthodes et à des aires de relevés comparables. On ne possède pas les données nécessaires pour déterminer le taux de diminution entre 1980 et 1995 ou les causes possibles de cette diminution. Par ailleurs, rien n’indique qu’un taux de mortalité hivernal élevé a été enregistré pendant une année quelconque ou pendant quelques années de suite. Il se peut que le déclin du nombre de caribous enregistré dans les années 1980 et au début des années 1990 soit attribuable aux réductions correspondantes des taux de survie à long terme chez les femelles de reproduction et les veaux pendant leur première année de vie, le tout jumelé au prélèvement continuel des caribous ainsi qu’à la prédation grandement accrue des caribous par les loups (Canis lupus). Le retard à détecter ce déclin et le manque de compréhension de ses causes pourront nuire à l’élaboration d’un plan de récupération solide du point de vue écologique. Puisque les déclins précédents de caribous ont été suivis de récupération, on peut se consoler en se disant qu’il est possible que la récupération se fasse spontanément. Cependant, le nombre de caribous a chuté au point où la récupération sera longue et difficile, même dans le meilleur des cas. Il se peut qu’il n’y ait pas de récupération spontanée et par conséquent, on ne devrait pas se contenter de cette situation, surtout puisque l’extirpation des quelques caribous qui restent pourrait éliminer un groupe génétique distinct et réduire la biodiversité du caribou dans l’archipel Arctique canadien

Sense-giving in health care: the relationship between the HR roles of line managers and employee commitment

In this article, we examine line manager prioritisation of HR roles and the consequences for employee commitment in a health-care setting. Our analysis is based on a quantitative, multi-actor study (509 employees and 67 line managers) in four Dutch hospitals. Using sense-giving as a theoretical lens, we demonstrate that, in addition to the effects of high commitment HRM, prioritising the Employee Champion role alone and the Employee Champion and Strategic Partner roles in combination is associated with higher employee commitment. We argue that through performing roles that are evocative of deep-seated values, such as excellent patient care and concern for others, line managers can have a positive effect on staff attitudes. In a sector often beleaguered by staff turnover, exhaustion and burnout, we offer an important, empirically based framework that has the potential to improve employee commitment and, from there, enhance performance

Integrated Application of Active Controls (IAAC) technology to an advanced subsonic transport project: Current and advanced act control system definition study. Volume 2: Appendices

The current status of the Active Controls Technology (ACT) for the advanced subsonic transport project is investigated through analysis of the systems technical data. Control systems technologies under examination include computerized reliability analysis, pitch axis fly by wire actuator, flaperon actuation system design trade study, control law synthesis and analysis, flutter mode control and gust load alleviation analysis, and implementation of alternative ACT systems. Extensive analysis of the computer techniques involved in each system is included

Tenure, mobility and retention of nurses in Queensland, Australia: 2001 and 2004

[Abstract]: Aim: Data were collected on tenure, mobility and retention of the nursing workforce in Queensland to aid strategic planning by the Queensland Nurses’ Union. Background: Shortages of nurses negatively affect the health outcomes of patients. Population rise is increasing the demand for nurses in Queensland. The supply of nurses is affected by recruitment of new and returning nurses, retention of the existing workforce and mobility within institutions. Methods: A self-reporting, postal survey was undertaken of Queensland Nurses Union members from the major employment sectors of aged care, public acute and community health and private acute and community health. Results: Only 60% of nurses had been with their current employer more than five years. In contrast 90% had been nursing for five years or more and most (80%) expected to remain in nursing for at least another five years. Breaks from nursing were common and part-time positions in the private and aged care sectors offered flexibility. Conclusion: The study demonstrated a mobile nursing workforce in Queensland although data on tenure and future time in nursing suggested that retention in the industry was high. Concern is expressed for replacement of an aging nursing population

Reviewing The Benefits of Health Workforce Stability

This paper examines the issue of workforce stability and turnover in the context of policy attempts to improve retention of health workers. The paper argues that there are significant benefits to supporting policy makers and managers to develop a broader perspective of workforce stability and methods of monitoring it. The objective of the paper is to contribute to developing a better understanding of workforce stability as a major aspect of the overall policy goal of improved retention of health workers. The paper examines some of the limited research on the complex interaction between staff turnover and organisational performance or quality of care in the health sector, provides details and examples of the measurement of staff turnover and stability, and illustrates an approach to costing staff turnover. The paper concludes by advocating that these types of assessment can be valuable to managers and policy makers as they examine which policies may be effective in improving stability and retention, by reducing turnover. They can also be used as part of advocacy for the use of new retention measures. The very action of setting up a local working group to assess the costs of turnover can in itself give managers and staff a greater insight into the negative impacts of turnover, and can encourage them to work together to identify and implement stability measures

An approach to classifying human resources constraints to attaining health-related Millennium Development Goals

BACKGROUND: For any wide-ranging effort to scale up health-related priority interventions, human resources for health (HRH) are likely to be a key to success. This study explores constraints related to human resources in the health sector for achieving the Millennium Development Goals (MDGs) in low-income countries. METHODS AND FRAMEWORK: The analysis drew on information from a variety of publicly-available sources and principally on data presented in published papers in peer-reviewed journals. For classifying HRH constraints an analytical framework was used that considers constraints at five levels: individual characteristics, the health service delivery level, the health sector level, training capacities and the sociopolitical and economic context of a country. RESULTS AND DISCUSSION: At individual level, the decision to enter, remain and serve in the health sector workforce is influenced by a series of social, economic, cultural and gender-related determinants. For example, to cover the health needs of the poorest it is necessary to employ personnel with specific social, ethnic and cultural characteristics. At health-service level, the commitment of health staff is determined by a number of organizational and management factors. The workplace environment has a great impact not only on health worker performance, but also on the comprehensiveness and efficiency of health service delivery. At health-sector level, the use of monetary and nonmonetary incentives is of crucial importance for having the accurate skill mix at the appropriate place. Scaling up of priority interventions is likely to require significant investments in initial and continuous training. Given the lead time required to produce new health workers, such investments must occur in the early phases of scaling up. At the same time coherent national HRH policies are required for giving direction on HRH development and linking HRH into health-sector reform issues, the scaling-up of priority interventions, poverty reduction strategies, and training approaches. Multisectoral collaboration and the sociopolitical and economic context of a country determine health sector workforce development and potential emigration. CONCLUSIONS: Key determinants of success for achieving international development goals are closely related to human-resource development

Sustained TL1A expression modulates effector and regulatory T-cell responses and drives intestinal goblet cell hyperplasia

The tumor necrosis factor (TNF) superfamily protein TNF-like 1A (TL1A) is the ligand for death receptor 3 (DR3). TL1A is induced on activated dendritic cells (DCs) and its expression has been linked to human inflammatory bowel disease. To address how TL1A might influence intestinal inflammation, we generated transgenic mice that constitutively express TL1A on DCs. TL1A transgenic mice developed striking goblet cell hyperplasia in the ileum that was associated with elevated interleukin (IL)-13 levels in the small intestine. IL-13- and IL-17-producing small intestinal lamina propria T cells were increased in TL1A transgenic mice. TL1A also enhanced regulatory T (Treg) cell turnover in vivo and directly stimulated Treg cell proliferation in vitro. The presence of TL1A attenuated the ability of Treg cells to suppress conventional T cells, an effect that required DR3 signaling in either conventional T cells or Treg cells. Our findings identify mechanisms by which chronic DR3 signaling could promote pathogenesis in inflammatory bowel disease.<br/