Guest Editors’ Introduction: Human Resource Management in Health Care and Elderly Care: Current Challenges and Toward a Research Agenda

• Published date: 01 September 2015
• Date: 01 September 2015
• Author: Timothy Bartram,Fang Lee Cooke
• DOI: http://doi.org/10.1002/hrm.21742

Human Resource Management, September–October 2015, Vol. 54, No. 5, Pp. 711–735

© 2015 Wiley Periodicals, Inc.

Published online in Wiley Online Library (wileyonlinelibrary.com).

DOI:10.1002/hrm.21742

Correspondence to: Fang Lee Cooke, Professor of HRM and Asia Studies, Monash Business School, Monash

University, 26 Sir John Monash Drive, Caulfield East, VIC 3145, Melbourne, Australia, Phone: +61 3 99034666,

fang.cooke@monash.edu

GUEST EDITORS’ INTRODUCTION:

HUMAN RESOURCE MANAGEMENT

IN HEALTH CARE AND ELDERLY

CARE: CURRENT CHALLENGES AND

TOWARD A RESEARCH AGENDA

FANG LEE COOKE AND TIMOTHY BARTRAM

Given the universal pressures within the health and elderly care sectors for cost

reduction and the need for high-quality care, the effective management of the

workforce in care organizations is of critical importance. In this article, we exam-

ine the changing landscape of the health care and aged care systems and iden-

tify key challenges for the human resource management (HRM) fi eld. We assess

existing research evidence on the role of HRM and high-performance work sys-

tems in the health care sector. We also outline a number of research areas as

fruitful avenues for future studies, drawing particular attention to aged care as an

underresearched subsector, and immigrants as an important group of research

targets. The key message of our article is that future research on HRM in the care

sector has much to gain by adopting an interdisciplinary, multilevel, and multi-

stakeholder approach. More cross-sectoral and cross-country comparative stud-

ies of HRM in health care and other care work are also needed to shed light on

how policy orientations, institutional arrangements, social norms, and cultural

traditions infl uence care regimes across different societies, and to encourage the

sharing of learning across societies. ©2015Wiley Periodicals, Inc.

Keywords: care sector, elderly care, health care, high-performance work systems,

human resource management, migrant workers, training

An increasing number of nations are

facing serious challenges to human

resource management (HRM) in the

health-related care sector (e.g., health

care, elderly care, and disability care).1

These challenges are the result of aging popula-

tions, medical advancements, policy reform fueled

by the rising cost of health care, relative declines

in state funding, and shifts from state-sponsored

care systems toward market-driven and client

satisfaction–oriented regimes (e.g., Buerhaus,

Auerbach, & Staiger, 2007a; Cooke, & Zhan, 2013;

Fotaki, 2007; Kessler, 2014; Townsend, Wilkinson,

& Bartram, 2011). In this climate, the effective

management of those who work in the health-

related care sector plays a crucial role, not only in

contributing to the successful reform of the care

sector and the well-being of the community and

712 HUMAN RESOURCE MANAGEMENT, SEPTEMBER–OCTOBER 2015

Human Resource Management DOI: 10.1002/hrm

Labor costs comprise

a substantial

proportion of

operating costs

within the care

sector, and the

performance of care

and support workers

impacts greatly on

care outcomes, as

measured by client

and staff satisfaction.

Thus, encouraging

high-quality care

while controlling

labor costs is a

crucial challenge for

HRM professionals in

the care sector.

critical importance of care and support workers.

Labor costs make up a substantial proportion of

operating costs within the care sector, and the

performance of care and support workers greatly

affects care outcomes, as measured by client and

staff satisfaction. Thus, encouraging high- quality

care while controlling labor costs is a crucial

challenge for HRM professionals in the care sec-

tor. This tension is further complicated by, and

perhaps related to, a key set of challenges to the

effective management of staff across the care sec-

tor, including worsening shortages of nurses and

carers, and declining job satisfaction and organi-

zational commitment among these workers (e.g.,

Aiken, Clarke, Sloane, Sochalski, & Silber, 2002;

King, Wei, & Howe, 2013). These challenges are

often acknowledged to be a consequence of dete-

rioriating employment terms and conditions asso-

ciated with low pay, work intensification, and

negative patient experiences (e.g., Cooke & Zhan,

2013; Palmer & Eveline, 2012). In some countries,

such as Germany and Australia, care organizations

have become increasingly dependent on interna-

tional migrants as their key source of labor, add-

ing further complexity to HRM in this sector (e.g.,

Connolly, 2012; Döhner, Lüdecke, & Eickhoff,

2008; Kaine, 2010; Montague, Chhetri, Lamberry,

& Cooke, 2011).

This special issue examines current issues

confronting HRM in the care sector, with a focus

on health care and aged care. The objective is

to advance theoretical and empirical knowledge

related to workforce management in the care sec-

tor that is sensitive to cross-national differences,

and that may be drawn on to inform management

and social policy debates at the organizational,

sectoral, national, and transnational level. We

draw readers’ attention to, and stimulate debate

on, the following questions:

1. What might be the key challenges associated

with managing clinical professionals and non-

clinical care workers? To what extent might

(some of) these challenges have emerged as a

result of changes in public policy, sector-spe-

cific regulations, and sectoral reform agendas?

2. What might be the impact of HRM on per-

formance (e.g., quality of patient/client care,

patient/client safety) at the individual and

organizational level within care organizations?

3. How might care organizations overcome the

challenges associated with employee engage-

ment? Are engaged employees more efficient

and effective providers of care?

4. How might health care managers facilitate the

implementation of new HRM practices, such

as high performance management systems,

society, but also in building a resilient, productive,

and innovative care workforce. The health-related

care sector is diverse and complex, with growing

political, economic, social, and cultural signifi-

cance for many nations. The sector encompasses

not only traditional hospitals and large health

services, but also includes residential aged or dis-

ability care facilities, community health services,

and community-based care programs. Similarly,

care organizations come in different business

forms (e.g., public, private, and not-for-profit)

and operate within a changing, and

increasingly complex, set of institu-

tional and cultural contexts.

The care sector is labor inten-

sive, and it operates in an increas-

ingly regulated environment. In the

past decade or so, the role of HRM

within the health care sector has

attracted much research interest,

particularly from the United States,

the United Kingdom, and Australia,

with the potential of HRM to con-

tribute to improved health care

outcomes for patients and to the

well-being of clinicians and man-

agement and support staff, drawing

the lion’s share of attention (e.g.,

Bartram, & Dowling, 2013; Bartram,

Stanton, Leggat, Casimir, & Fraser,

2007; Kessler, 2014; Khatri, Wells,

McKune, & Brewer, 2006; West,

Guthrie, Dawson, Borrill, & Carter,

2006). In comparison, HRM issues

in subsectors of the care sector,

such as elderly care and disability

care (often delivered through social

care services organized by the local

councils), have yet to gain suffi-

cient research attention (e.g., Eaton,

2000; Kaine, 2012; Rainbird, Leeson,

& Munro, 2011; Rubery & Urwin,

2011). This is not surprising, per-

haps, in part because many of the

care organizations in these subsec-

tors are relatively small and dependent on precari-

ous external funding for survival.

At the macro level, the nature of each health

care system and the subsequent operation of HRM

practices vary markedly across countries, often

as a result of differing social policies, education

and training systems, labor market characteris-

tics, demographic profiles of the cared and their

carers, cultural traditions and accompanying

expectations of care, and attitudes toward care

work within individual nations. What appears

to be common across societies, however, is the