Human resource management innovation in health care: the institutionalisation of new support roles

• Author: Paul Heron,Ian Kessler,Karen Spilsbury
• Date: 01 April 2017
• DOI: http://doi.org/10.1111/1748-8583.12114
• Published date: 01 April 2017

Human resource management innovation in health

care: the institutionalisation of new support roles

Ian Kessler,Management Department, King’sCollege London

Paul Heron, University of Oxford

Karen Spilsbury, Schoolof Healthcare, Universityof Leeds

Human Resource Management Journal, Vol 27,no 2, 2017, pages 228–245

This articledraws upon the notion of an ‘HRMinnovation’to explorethe development of twonew work roles in

differenthealth-care settings.Arguing that the establishment of a new workrole represents a distinctiveform of

HRM innovation, thearticle elaborates on and refines an influential theoretical model on how and why such

roles become institutionalised. Principally, based on interview data from key actors actively engaged with

the newroles, the article elaboratesby focusing on underdeveloped featuresof this theoreticalmodel, identifying

a range of micro-processes underpinning the emergence and acceptance of the new workroles. In refining, the

article highlights the fragility of new work roles, the contribution of key actors to their development and the

interaction between workplace,organisation and system-levelprocesses in their emergence and acceptance.

Contact: Ian Kessler, Management Department, King’s College London, Stamford Street, London,

UK. Email: Ian.kessler@kcl.ac.uk

Keywords: job design; institutionalframework; change management;human resource strategy

INTRODUCTION

Research on the relationship betweenworkforce management and innovationhas taken

a number of forms, often framed by debates in the strategic HRM literature. First,

organisational innovation has been presented as one of a number of corporate

outcomes associatedwith various bundles of HRMpractice. These bundles have typicallybeen

correlated with process or product innovation, on the assumption that the composite HR

practices foster the employee attitudes and behaviours needed to stimulate and support

innovation (Laursen and Foss, 2003; Shipton et al., 2006; Cooke and Saini, 2010; Zhou et al.,

2013). Second, attention has focused on the ‘black box’issue of whether and how HRM

practices more directly stimulate innovative performance amongst employees, particularly

those involved in creative work (Mumford, 2000; Lopez-Cabrales et al., 2009; Jiang et al.,

2012). Studieshave, for example, exploredthe nature and antecedents of knowledgegeneration

and sharing capabilities amongst staff working in R&D departments (Thompson and Heron,

2006) and high-technology firms (Collins and Smith, 2006).

Third, and less commonly, an HRM practice has been viewed as an innovation in its own

right. Drawing upon Kossek’s work (1987), Wolfe (1995) defines an HRM innovation as ‘an

idea, programme, or system of practice which is related to the HRM function and new to the

adopting organisation’. As a new approach to workforce management, high-commitment

practices have sometimes been presented in these terms (Thompson, 2007), with studies

drawing upon the organisational studies literature on the diffusion of innovation to explore

their take-up (Wood and Albanese, 1995).

This article contributes to debate on the latter stream of research, HRM practice as an

innovation. Wolfe’s (1995) broadly drawn definition of HRM innovation as including an HR

practice ‘new to the adopting organisation’is inclusive and likely to embrace experience in

many employment contexts. It is, however, a definition in need of refinement. Wolfe (1995) is

228 HUMAN RESOURCEMANAGEMENT JOURNAL, VOL 27, NO 2, 2017

©2017 John Wiley & Sons Ltd

Please cite this article in press as: Kessler, I., Heron, P. and Spilsbury, K. (2017) ‘Human resource management innovation in health care: the

institutionalisationof new support roles’.Human Resource Manag ement Journal 27: 2, 228–245

doi: 10.1111/1748-8583.12114

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unnecessarily restrictive in equating HRM innovation solely with the HR function. HRM is a

generic activity as well as a specialist function (Legge, 1995), and in exploring the source and

development of innovative HR practice, consideration needs to be given to the potential

contribution of organisational actors other than or complementary to the HR practitioner, for

example theline manager or employee. We therefore view an HRMinnovation as any workforce

related idea,programme or system new to the adopting organisation.

Moreover,there is scope to sharpen Wolfe’s (1995) conceptualisation of an HRM innovation

by recognising thatit can take different forms. Thus, an HRM innovation might be associated

with the following:

•Ways of managing: new systems to recruit, retain and motivate employees;

•Ways of working: newroutines to deliver products by thosein established work roles; and

•Work roles: the assignment of tasks to a completely new job role.

This article focuseson the development of two new clinicalsupport roles in the health-care

sector as an example of an innovative HRM practice. In exploring the development of new

work roles rather than new ways of managing or working, the study highlights the analytical

value of distinguishing between different forms of HRM innovation. We argue that

establishing a new role is marked by a distinctive set of drivers, processes and outcomes. The

article also draws upon an influential but incomplete model developed by Reay et al.(2006)

to explainhow a new work role becomesinstitutionalised. In applyingthis model, we elaborate

on and refine it, so deepening our understanding of how new work roles, as an HRM

innovation, become established.

The article is divided into the following parts: the policy context for HRM innovation in

health care; a reviewof new institutional analysis; our research approach; the findings; and a

concluding discussion.

THE POLICY CONTE XT

As governments in developed countries seek to ‘modernise’health-care delivery, often by

privileging patient choice, and by addressing rising service demand in the context of a

shrinking resource base (Sermeus and Bruyneel, 2010), so an interest in service innovation

has come to the fore. In England, for example, the (former) National Health Service (NHS)

Chief Executive has claimed that

We need to radicallytransform the way wedeliver services.Innovation is the way –the only way

–we can meet challenges.Innovation mustbecome core business for the NHS (Department of

Health, 2011:1).

In a labour-intensive sector, where despite the ongoing introduction of new medical

technologies service provision remains rooted in the unmediated relationship between the

carer and the patient, it is unsurprising that an interest in health-care innovation has

increasingly centred on HRM. In most OECD countries, labour still constitutes around two-

thirds of total health-care costs (Dubois et al., 2006: 13), while as Buchan (2004: 2) has noted

‘getting HR policy and management right has been seen as core to any sustainable solution

to health system performance’.

Traditionally, the three forms of HRM innovation distinguished previously have not been

pursued withease or alacrity in health care.Often centrally funded by thestate and comprising

highly regulated professions, national health-care systems have been characterised by an

Ian Kessler,Paul Heron and Karen Spilsbury

HUMAN RESOURCEMANAGEMENT JOURNAL, VOL27, NO 2, 2017 229

©2017 John Wiley& Sons Ltd.