Controlling healthcare professionals: how human resource management influences job attitudes and operational efficiency

BACKGROUND: We assess how human resource management (HRM) is implemented in Australian hospitals. Drawing on role theory, we consider the influence HRM has on job attitudes of healthcare staff and hospital operational efficiency. METHODS: We adopt a qualitative research design across professional groups (physicians, nurses, and allied health staff) at multiple levels (executive, healthcare managers, and employee). A total of 34 interviews were carried out and analyzed using NVivo. RESULTS: Findings revealed a predominance of a control-based approach to people management. Using Snell's control framework (AMJ 35:292-327, 1992), we found that behavioral control was the principal form of control used to manage nurses, allied health workers, and junior doctors. We found a mix between behavior, output, and input controls as well as elements of commitment-based HRM to manage senior physicians. We observed low levels of investment in people and a concentration on transactional human resource (HR) activities which led to negative job attitudes such as low morale and frustration among healthcare professionals. While hospitals used rules to promote conformity with established procedures, the overuse and at times inappropriate use of behavior controls restricted healthcare managers' ability to motivate and engage their staff. CONCLUSIONS: Excessive use of behavior control helped to realize short-term cost-cutting goals; however, this often led to operational inefficiencies. We suggest that hospitals reduce the profusion of behavior control and increase levels of input and output controls in the management of people. Poor perceptions of HR specialists and HR activities have resulted in HR being overlooked as a vehicle to address the strategic challenges required of health reform and to build an engaged workforce.