How poor people-management is debilitating the hospital system

Too much control by HR departments in hospitals is leading to disengagement and burnout among staff and a delay in the introduction of improved standards for patient care.



Some of the pressing issues facing Australian hospitals may be alleviated by empowering highly skilled hospital workers – including doctors and department heads – to make their own decisions.

Studies in 20 Australian hospitals by UNSW Business School researchers reveal human resources (HR) practices rely too much on control and are preventing medical staff from using their discretion to make autonomous decisions on some basic people management tasks, including hiring to replace a departing staff member.

The upshot of too much control is disengagement and burnout among healthcare professionals and a delay in the introduction of improved standards for patient care.

"We believe there's an overuse of control for management in hospitals," says Julie Cogin, a professor, deputy dean, and director of AGSM @ UNSW Business School.

"The primary human resources management (HRM) approach to people working in hospitals is about control, with prescribed procedures – for everything from hand-washing to hiring – and excessive bureaucracy," she reports.

While control in hospitals is indisputably vital for some routine tasks and responsibilities, in others it is counterproductive and impinges on the efficiency of the hospital system and the morale of staff.

Control issues are just part of a series of confounding dilemmas in the hospital system that also include tight budgets shifting the emphasis from patient care to financial outcomes, and a culture in which many external stakeholders set training requirements for hospital staff, suggests Cogin and her co-researchers.

On top of this is a delay to better patient outcomes due to an unrealistic approach to healthcare reform that has set the bar too high, giving unachievable goals to the complex hospital system. 

'They are committed to their jobs and patients, but not the hospitals they work in or their employers' 


Patient-centred care

Healthcare is a thorn in the side of governments across the world with common outcries about rising costs, inequality of access and increasing demand for hospital services exacerbated in no small part by ageing populations.

In Australia, news stories capture tales of newborn babies accidentally gassed, babies born in hospital toilets, insufficient hospital beds, protracted waiting times in emergency departments, ongoing staphylococcus infections and patients inappropriately treated.

There's been a keen focus in advanced economies – across Europe, North America, Australia and New Zealand – on "patient-centred care", a central tenet of healthcare reform, which takes a holistic approach to the patient based on their needs.

It requires healthcare workers and hospital services to revolve around the needs of the patient rather than the needs of the hospital, and for the patient to be educated and informed, as an important stakeholder in their own treatment.

Uptake of patient-centred care has been slow, though "research has shown its benefits include improved efficiency, fewer delays, increased diagnostic referrals and reduced overall costs due to less waste of hospital resources", notes Cogin.

Read the full story on the Business Think website.