Why HR Has Failed to Address Healthcare's Workforce Crisis: The Need for a Systems Partner Role

Abstract

Attempts to remedy sustained workforce challenges facing healthcare organizations globally have been largely ineffective, despite increased political attention. In this paper we draw on contextually based human resource theory to explain why these challenges remain intractable. We demonstrate that professional healthcare workers' employment relationships are embedded within systems as well as organizations, and that system-level constraints limit organizational capacity to address workforce issues. Informed by UK and US examples of issue-oriented, place-based and system approaches to stakeholder convening we argue that progress requires both stakeholder coordination at the system level (premised on “deviant innovation”, Legge, 1978) and strategic HR innovation (“conformist innovation”, Legge, 1978) within organizations. We develop a framework identifying three potential HR roles in system-level engagement: systems partner (actively convening stakeholders), participant (contributing to system-level initiatives), and bystander (remaining organizationally focused). While acknowledging barriers to HR adopting a systems partner role, we advocate for enhanced HR engagement as a systems participant, combined with strengthened within-organization “conformist innovation” as a business partner to support health workforce recruitment, retention and reform. We identify corporate HR managers and OD specialists as particularly well-positioned to pioneer system-level engagement, whether as participants in existing initiatives, as collaborators through intermediaries or, where feasible, as systems partners driving stakeholder coordination.