Post on 10-May-2022
HRM and the HR function in Dutch healthcare organizations
Melanie Coppens Lorentzstraat 55 5223 EW ’s-Hertogenbosch ANR: S726536
First Supervisor: Dr. Paul Boselie Second Supervisor: Judith van den Broek, Msc Human Resource Studies University of Tilburg
Project period: September 2009 - June 2010
Acknowledgements
I am the following persons and institutions extremely grateful for their contributions that
made this thesis possible:
- My first supervisor Paul Boselie for his accompaniment and feedback during the
research and writing period. I appreciated his effective support and
encouragement throughout the duration of this project. I am thankful for his belief
in this project and infectious enthusiasm about HR.
- My second supervisor, Judith van den Broek Msc, for her critical notes for the
final adjustments.
- The five healthcare institutions, Reinier van Arkel Groep, Cello, Stichting
Schakelring, GGZ Oost Brabant and Vitalis for giving input for this research.
They were all very generous in coming up with respondents and information.
They have shared information about their institutions, which aided me in writing
this thesis.
- Last but not least I want to thank my family and friends for all their loving
kindness and support. They helped keep me grounded in the real world that exists
beyond the university gates.
Melanie Coppens
Tilburg University
Contents
1. Research question and relevance for research ................................................................ 1
1.1. Introduction.............................................................................................................. 1
1.2 Research goal and question....................................................................................... 3
1.3. Relevance of the research ........................................................................................ 4
2. The research context ....................................................................................................... 5
2.1. The healthcare sector ............................................................................................... 5
2.2. Developments in the healthcare sector .................................................................... 5
3. Theoretical framework.................................................................................................... 6
3.1. HRM and the HR function....................................................................................... 6
3.2. The Resource-based View theory ............................................................................ 7
3.3. Research by Legge................................................................................................... 7
3.4. Research by Ulrich................................................................................................... 8
3.5. Research by Guest and King.................................................................................. 10
3.6. Theory of this research........................................................................................... 10
4. Methods......................................................................................................................... 14
4.1. Design .................................................................................................................... 14
4.2. Description of the respondents............................................................................... 15
4.3. Sample.................................................................................................................... 16
4.4. Instrument .............................................................................................................. 16
4.5. Procedure ............................................................................................................... 17
5. Results........................................................................................................................... 20
5.1 HR ‘on the table’..................................................................................................... 20
5.2 At the table.............................................................................................................. 24
6. Conclusion .................................................................................................................... 27
7. Discussion and future research ..................................................................................... 30
7. 1. Limitations ............................................................................................................ 34
References......................................................................................................................... 35
Appendix........................................................................................................................... 39
1
1. Research question and relevance for research
1.1. Introduction
The last decade the healthcare sector had to deal with a lot of changes and developments.
The healthcare sector has changed and is still changing radically in time. Demand for
care increases, while the labor market is tight (Breedveld, Wersch, Lange and Roo,
2004). These developments in healthcare demand and supply influence the strategic
policy of the institutions, the way they interact with each other, the content and the
organization of care and the deployment of staff. It requires HR professionals to serve the
organization’s people, with care, concern and compassion. But HRM in healthcare has to
deal with some other unique factors as well. HR practices can have a fast and direct effect
on patients, because employees stay in direct contact with those patients (Buchan, 2000).
This is an important characteristic of healthcare institutions and causes that, according to
Buchan (2000), HRM should have an important role in the business process. Another
important characteristic, especially in the healthcare sector, is that there is a multitude of
stakeholders such as tax payers, the government, health professionals, management,
researchers, health insurance companies, patients etcetera, and they all require and
demand different performance information and have various opinions as to what
constitutes success (Harris, Cortvriend & Hyde, 2007: 453). According to Paauwe and
Boselie (2007) HR practices are most optimal when they meet the demands of the market
place and the institutional setting, while at the same time being perceived as fair and just
by employees. To reach an optimal set of HR practices, strategic human resource
management is a possible solution. Wright and McMahan (1992) define it, as ‘the pattern
of planned human resource deployments and activities intended to enable the firm to
achieve its goals’.
The importance of the human resources management to the success or failure of health
system performance has, until recently, been generally overlooked. In the past few years
it has been increasingly recognized that getting HR policy and management ‘right’ has to
be at the core of any sustainable solution to health system performance (Buchan, 2004).
The fact that provision of service mainly goes via the relationship between employer and
2
client, makes the healthcare sector labor intensive. This leads to the healthcare sector
being the largest employer in the Netherlands. As labor is the most important production
factor in healthcare organizations (Walburg, 1997; Zuckerman & Coile, 2003), human
resource management fulfills a potentially prominent feature in the ‘livelihood’ of this
important production factor. HRM encompasses the management of work and the
management of people to do the work (Boxall & Purcell, 2008). Human resources, when
pertaining to healthcare, can be defined as the different kinds of clinical and non-clinical
staff responsible for public and individual health intervention (Kabene, Orchard, Howard,
Soriano & Leduc, 2006). As arguably the most important of the health system inputs, the
performance and the benefits the system can deliver depend largely upon the knowledge,
skills and motivation of those individuals responsible for delivering health services.
The specific characteristics of the healthcare sector described in the previous paragraph
make that studies from other industries are only partly applicable. In order to provide
clear situational analysis, Boxall et al. (2007) plead for more specific and contextual
based research. Buchan (2004) states that the irony is that the ‘health’ business is
probably one of the most research based sectors with the use of sophisticated methods,
yet HRM in health is under-researched. Therefore, it is important to investigate HRM in
the healthcare sector. There seems to be a general agreement in previous research about
HRM being an area of expertise required in an organization comparable to finance and
marketing, but can this agreement also be applied in the healthcare sector? This makes it
interesting to know, to what extent healthcare organizations actually have HR practices
and topics as priority on their agenda (Ulrich & Brockbank, 2005). In other words,
research shows the importance of good people management in organizations in order to
select, retain, motivate, reward and develop the human capital pool of the organization
(Boselie & Paauwe, 2005). But does this relevance count for healthcare institutions as
well? This issue can be referred to as the extent human resource management is ‘on the
table’.
More difficult to determine proved to be the HR responsibilities, and therefore the
position of the HR professional in an organization (Legge, 1978; Guest & King, 2004).
This topic is frequently discussed in both research and practice. The human resource
3
professionals are often ‘the victim’ of strategic decision making in organizations,
meaning that top management first makes strategic decisions and that HR is involved
afterwards. On that account, HR is not able to determine strategic decisions together with
top management right from the beginning. Ulrich & Brockbank (2005) refer to this issue
as ‘human resource management is not at the table’. This brings up the question; to what
extent has the HR professional a strategic position in the healthcare organizations? There
is a growing interest in strategic HRM because people recognize it as a key role for
competitive advantage (Boxall and Purcell, 2008). This issue can be referred to as the
extent human resources is ‘at the table’.
1.2 Research goal and question
The above leads to the main question of this research: To what extent is HR on and at
the table in Dutch healthcare organizations? The extent HR is ‘on the table’ concerns
HRM in general through the organization and the extent HR is ‘at the table’ concerns the
HR function. Preliminary by investigating the extent that HR is ‘on the table’ the
implementation of policies and what is done with HR practices in reality is explored. On
that account, it has been investigated whether human resource management themes
dominate the top management’s agenda and if they take HRM seriously in the
organizations. For example, one of the issues that was interesting to investigate was if
institutions see HRM as an area of expertise required in an organization comparable to
finance and marketing. In total five questions were asked to find out if HR was ‘on the
table’ in the healthcare institutions. Those five questions are described in paragraph 4.5
‘Procedure’.
Secondary, by investigating if HR was ‘at the table’, an outline of the influence of the HR
professional is done and verification has been made if they have a seat at the board level.
In this investigation, the HR responsibilities, and therefore the position of the HR
department in an institution were examined. There are many frameworks for HR roles,
but there are relatively few efforts to define HR roles for HR professionals across firms,
industries, or geographies (Ulrich, et al., 1997). The findings of Boxall (1994) about the
role of the HR specialists show that constituting and renewing the top team, including the
chief executive, and building the overall capability of management in the firm, is perhaps
the most strategic concern of all. In total five questions were asked to investigate, to what
4
extent HR is ‘at the table’ in the healthcare institutions. Those five questions can be
found in paragraph 4.5 ‘Procedure’.
The findings of Boxall (1994) make it interesting to find out more about how key policy-
makers shape their approach to people management in healthcare institutions. This is
important because it identifies and gives explanations about what happens in practice. It
should help practitioners to understand relevant theory and develop analytical skills
which can be applied to their specific situation (Boxall Purcell & Wright, 2007). By
doing this research, an attempt was made to understand the cohesion between the HR
policies and practices and what healthcare institutions are doing on the area of HR.
Therefore HRM in general and the HR function was investigated.
In summary this research focuses on two main factors: HRM in general and the HR
function. The HR function represents the human resource responsibilities and tasks that
are bundled in a human resource department and performed by human resource
professionals. The HR function is part of the human resource management of an
organization. HRM in general represents a much broader concept including the role of
line managers, top management, employee representatives of work councils and
employees. It was investigated to what extent HR is ‘on’ and ‘at the table’ in Dutch
healthcare organizations. To what extent HR is ‘on the table’ depends on the
implementation of policies and the attitude of top management concerning HR. To what
extent HR is ‘at the table’ depends on the HR professional having a seat in the board or
not and their actual influence on the decisions made by the board.
1.3. Relevance of the research
This proposed research is scientifically relevant because it contributes to the knowledge
of the cohesion between the HR policies and practices and the role of the personnel
manager. In other words, are the institutions practicing what they preach regarding their
human resource policies and what is the influence of the HR professional in that process?
Legge (1978) wrote an effective and often cited paper about this same topic of HRM and
the position of HR professionals before, therefore this theory will be applied in this study.
The social relevance of this paper is apparent because of the growing share of older
people in the Dutch population (CBS, 2008). The need for quality, standards and
5
expectations will be different as there is a new ‘older generation’. Changes in the way
this sector is run are inevitable and already occurring in the Netherlands. The trend is
towards more competition, care on demand and cost awareness. Because of the
recognition of the key role of management of human resources as a basis for competitive
advantage, there is a growing interest in strategic HRM (Boxall and Purcell, 2008). A
better understanding of the effectiveness of HRM activities in the dynamic care sector is
also desired, as the claims this sector makes on the healthcare budget are large and
growing fast. On that account there is need for a good explanation regarding the reasons
for the creation or absence of excellent provision of services through HRM.
Chapter two describes the Dutch healthcare sector. Likewise the various theoretic
concepts that are applied in this research are shortly appointed in chapter three. Chapter
four explains the research method. The results that arrived from the interviews are
included in chapter five. Finally the conclusion and discussion are described in the last
chapters, six and seven.
2. The research context
2.1. The healthcare sector
This research is evidence based and contextually based research (Boxall, Purcell &
Wright, 2007) because it includes interviews in a specific sector. The context is
integrated in the development of the theoretical framework. As noted in the introduction,
the healthcare sector is the largest employer in the Netherlands. The sector is labor
intensive and radically changing in time. It is a very dynamic sector and therefore it is
important, before doing the document analysis and interviews to be aware of the most
important developments in the healthcare sector in recent years.
2.2. Developments in the healthcare sector
Breedveld, Wersch, Lange and Roo (2004), questioned nineteen leading institutions in
the Dutch healthcare sector. The institutions were known for their consciously engaged
management in strategic policy and the establishment of the organization to respond
adequate to relevant developments in the environment. According to those leading
institutions the most important developments are:
6
- Socialization, care outside the walls of institutions and chain formation; the
integration of care in the society, which leads to much more intensive cooperation
between institutions and individual caregivers. Everyone must be able to develop
themselves, be autonomously and fully participate in the society. This leads to
care being offered less between the walls of one institution. This shift causes an
increasing need for coordination of medical, social and physical care.
- Aging and increase in longevity; this results in big changes in the demand for care
and the target groups of institutions.
- Competition and care on demand; the modernization of the AWBZ, the personal
bounded budget (PGB) and the system changes (insurance and finance) causes
increased competition, the need to market-orientation thinking and critical
attention for the business.
- Shift from input- to output financing pushes institutions to greater efficiency.
Overall, the transformation of supply-oriented to demand-oriented is dominant.
Competition constitutes an incentive to focus on the client perspective. It is interesting to
see if those developments also have an impact on HR in healthcare institutions. Therefore
HRM in general and the HR function was investigated. The next chapter discusses
existing theories about the position of HRM and roles of HR professionals in institutions,
which are the basis for this study.
3. Theoretical framework
3.1. HRM and the HR function
There have been notable attempts to capture the changing nature of personnel roles in
response to major transformations in the workplace and the associated rise of HRM. The
aim of this paper is to find out to what extent HR is ‘on’ and ‘at the table’ in Dutch
healthcare organizations. In this research empirical data collected from functions at
different levels in Dutch healthcare organizations was used. Researched was to what
extent they are taking HRM seriously in the institutions. Therefore the Resource-based
View theory (Boxall & Purcell, 2008) was used in combination with the problem solver
role of Legge (1978) and the administrative expert role of Ulrich (1997). In researching
the extent HR was ‘at the table’, the four different roles of Ulrich (1997) and the three
7
different roles of Legge (1978) were used. The theory of Guest & King’s (2004) was used
as well, since they appeared effective in assessing the results of the research of Legge
(1978) by uncovering the role of HRM. Guest & King (2004) based their analysis on the
research done by two different researchers about the role of personnel managers namely,
Legge (1978) and Ulrich (1997). Therefore my data collection method is largely based on
the methods they adopted in 2004. To partly capture the process of role change, Legge’s
original typology of personnel roles was re-examined and contrasted with Ulrich’s
perspective vision for the reinvention on the HR function and the findings of Guest and
King. The next paragraphs describe the Resource-based View theory as well as the most
important findings of Legge (1978), Ulrich (1997) and Guest & King (2004). The overlap
in the different typologies is described as well.
3.2. The Resource-based View theory
Resource-based View theorists are interested in the conditions that make desirable
resources ‘inimitable’ and ‘non-substitutable’ (Barney, 1991) in order to achieve
sustained competitive advantage. Barney (1991) suggests that in order to understand
sources of sustained competitive advantage, it is necessary to build a theoretical model
that begins with the assumption that firm resources may be heterogeneous and immobile.
To have this potential, a firm resource must have four attributes: (1) it must be valuable,
in the sense that it exploit opportunities and/or neutralizes threats in a firm’s
environment, (2) it must be rare among a firm’s current and potential competition, (3) it
must be imperfectly imitable, and (4) there can not be strategically equivalent substitutes
for this resource that are valuable but neither rare or imperfectly imitable. These
attributes of firm resources can be thought of as empirical indicators of how
heterogeneous and immobile a firm’s resources are and thus how useful these resources
are for generating sustained competitive advantages.
3.3. Research by Legge
Legge (1978) identified three ambiguities in the personnel role. First there is an overlap
between normal/regular management function and specialist function. Second it is
difficult to define success in personnel management and third, personnel managers sit
uncomfortably in a position where they are seen as part of management but also have a
8
special relationship to, and responsibility for the workers. To overcome these ambiguities
in their role, Legge argued that personnel managers need power and authority. However,
in a capitalist society, dominated by the profit motive, the ambiguities in the personnel
role made it unlikely that personnel managers would become powerful unless they learnt
to play by the ‘rules of the game’ or the ‘rules’ were somehow changed. Legge (1978)
identifies two potential approaches to address the challenges facing personnel managers:
First the conformist innovator; he accepts the dominant organizational values and goals
and acquires expertise that will enable him to demonstrate a closer relationship between
his activities (means) and organizational success criteria (ends). And secondly, the
deviant innovator; he attempts to change this means/ends relationship by gaining
acceptance for a different set of criteria for the evaluation of organizational success and
his contribution to it. This is possible with the help of external Organizational
Development consultants and also with the role of employment legislation as an external
value that may challenge the dominance of the profit motive. Without the power that
derives from external sources, many personnel managers will find it difficult to operate as
deviant innovators while conformist innovation is unlikely to result in significant change.
The core of Legge’s argument is therefore that personnel managers need to become
problem-solvers. This requires a capacity to engage in conceptualization, diagnosis and
strategy. A personnel department has a key role to play here: not only in turning theory
into fact but in demonstrating both how and, the extent, ‘good’ personnel management
can and does contribute to organizational success. The problem-solver role of Legge
(1978) is quite similar to the role as administrative expert of Ulrich (1997), which is
described in the next paragraph. Both typologies are focused on the added value of HR
professionals to the organization.
3.4. Research by Ulrich
The Ulrich (1997) model is by far the most and widely used HR role model. It is also one
of the few academic HR models that are used in practice on a large scale worldwide.
Ulrich (1997) provides a focus on personnel management roles in his own unique way.
He highlights the opportunities presented by the advent of HRM for personnel managers
to become ‘Human Resource Champions’. For him, the key was to shift the focus from
what HR people do to what they deliver; in other words, to focus on outcomes. To
9
become paragons of competitiveness, Ulrich defines four main roles for the HR
professional along two axes: strategy versus operations, and process (HR tools and
systems) versus people, which you can be found below in figure one. The four roles are:
(1) ‘Strategic Partner’s help to successfully execute business strategy and meet customer
needs; (2) ‘Administrative Experts’ constantly improve organizational efficiency by
reengineering the HR function and other work processes; (3) ‘Employee Champions’
maximize employee commitment, and competence; and (4) ‘Change Agents’ deliver
organizational transformation and culture change.
Figure 1: four roles of HR professionals
Ulrich (1997) makes a clear distinction between HR in general throughout the
organization and HR as a profession. HR in general refers to the organizational systems
and processes within a firm. For example staffing, hiring, communication and
compensation that govern how work is done. The HR function is focused on championing
competitiveness. As champions of competitiveness, HR professionals must focus more on
the deliverables of their work than on doing their work better. In other words, to become
a true ‘HR champion’, all four roles must be represented in the company (Ulrich, 1997).
Successfully carrying out the administrative expert role is important in putting HRM ‘on
the table’ in organizations. Credibility must first be improved for the HR function in
order to successfully fulfill the two strategic roles mentioned by Ulrich, with HR really
contributing to a firm’s strategy implementation. Successfully carrying all the four roles
is important in putting HR ‘at the table’ in organizations. HR professionals deliver value,
10
focusing on the long term and are critical to the board all at the same time. In 2004, Guest
& King explored the current state of the role of the HR function, whether they had
successfully earned their place on or at the board table, which is described in the
following paragraph.
3.5. Research by Guest and King
Guest and King (2004) re-read Legge’s book 25 years after its publication and questioned
how much of the powerful core analysis remains relevant to personnel management, or
HRM, today. They analyzed how far HRM offers a ‘solution’ to the problems identified
by Legge (1978). Therefore they collected empirical data from 48 executives from 16
organizations in UK firms to consider whether the impact of HRM, together with
adoption of the ‘HR champion’ role advocated by Ulrich (1997), has rendered her
analysis obsolete, or whether it remains relevant to contemporary practice. The
interviews were built around 12 open-ended questions. The evidence confirms that
despite major changes in employment relations between the 1970s and 2000 much of
Legge’s analysis retains its relevance. However it is important to note that this research is
already five years old and UK oriented and done in the profit sector. Therefore it is
interesting to test this relevance in the Dutch healthcare sector. Because, as described
before, HRM in health is under-researched (Buchan, 2004) and it is important to do more
specific and contextual based research (Boxall et al., 2007).
3.6. Theory of this research
The challenge in this research is to make an attempt at building evidence, based on HRM
in the healthcare sector, by using the non-clinical research methods of Guest & King
(2004). It is clear according to Legge (1978) and Guest and King (2004) that HRM is
often not ‘on the table’ and certainly not ‘at the table’. The question is what results we
will obtain now in 2009/2010 when we do a similar research as Legge (1978) and Guest
and King (2004) in Dutch healthcare institutions. The Resource-based View theory
(Barney, 1991) and the results of Legge (1978) and Ulrich (1997) will be used as the
theoretical basis for this research. The empirical study of Guest and King (2004) will be
used as the methodological building blocks of this research.
11
By using the Resource-based View theory (Barney, 1991), it was investigated if
institutions considering their employees as sources of sustained competitive advantage. In
this sense, the respondents were asked if the institution sees their employees as important
and valuable resources. Besides that it was examined if employees are included in their
policy as (most) important assets and if this policy is reflected in actual HR practices as
well. So it is researched, if institutions are making investments in their human resources.
This is investigated in this study to find out if HR is ‘on the table’ in the healthcare
institutions.
Looking at the different typologies of Legge (1978) and Ulrich (1997), there is a partial
overlap between them. Therefore, for this research, an overview of corresponding related
typologies in these studies are grouped below:
1. Conformist innovator is closely related to the strategic partner. If HR professionals
already have a position at the board level, they have to do what the manager tells them to
do (Legge, 1978; Ulrich, 1997). For Ulrich, a strategic partner constitute the strategic
roles and imply that HRM becomes a business partner in strategy execution, whereas,
Legge (1978) referred to the strategic component as being a conformist innovator (Yusoff
& Abdullah, 2008). Both of these roles described by Ulrich and Legge, focus on aligning
HR strategies and practices with business strategy. Strategy enactment is the deliverable.
2. Problem solver is closely related to the administrative expert. Personnel managers in
this role are very much focused to deliver value to the organization (Legge, 1978; Ulrich,
1997). Both of these roles described by Ulrich and Legge, focus on delivering the basic
human resource practices to the HR customers. Administrative efficiency is the
deliverable.
3. Deviant innovator is closely related to the employee champion and change agent. The
focus is on the long term they have very often much control and are critical to the board
(Legge, 1978; Ulrich, 1997). All three of these roles as described by Ulrich and Legge
focus on attempts to change the ‘means/ends relationship’. An HR professional acting
according to one of those roles is not afraid to discuss a different set of criteria for
decision making, and is open for alternative perspectives. The deliverable is aimed at
developing employee commitment, competence and or culture.
12
The main difference between the roles of Legge (1978) and Ulrich (1997) is that Legge’s
model makes a distinction between business and ethics, while Ulrich’s model mainly
focuses on the business side of the HR role. Another important difference between the
two models is that Ulrich consider the roles as hierarchical, with the role of
administrative expert as condition for the rest of the roles, while Legge doesn’t make a
hierarchical classification. The strength of this research is simplicity and therefore the
broad classification as described before of the grouped typologies of both Legge (1978)
and Ulrich (1997) was used. According to Boselie & Paauwe (2005) there is a possibility
of a hierarchy in the three role domains. The broad classification of the different HR roles
used in this research, as seen below in figure two, also suggests such a hierarchy.
Figure 2: Broad classification of the different HR roles
In order to add value to an organization, the personnel manager should first gain personal
credibility and HR delivery. This is closely related to what Legge (1978) calls the
problem solving role in personnel management. Ulrich’s (1997) administrative expert
role shows similarities with these two competencies as well. The underlying idea is that
the HR basics should be sufficient, otherwise the personnel manager will not be taken
seriously in other areas or on other subject matters. HR units have been observed to
Deviant innovator/
Employee champion/
Change agent
Problem solver/
Administrative expert
Conformist
innovator/
Strategic partner
13
display different role orientations. They are encouraged to adopt different roles or
different mix of roles for greater influence, effect and respect (Ulrich, 1997).
When an institution is acting according to the Resource-based View theory by seeing
their employees as sources for sustained competitive advantage (Barney, 1991) and the
HR profession of that institution is acting according to the rules of a problem solver
(Legge, 1978) and administrative expert (Ulrich, 1997), then HRM is ‘on the table’.
When an HR professional has a seat at the board and is able to act according to the four
different roles of Ulrich (1997) and the three different roles of Legge, together at the
same time, HR is ‘at the table’.
In summary, the extent HRM is ‘on the table’ in healthcare institutions was investigated
by the extent that HRM is taken seriously throughout the organization. Therefore, five
factors were examined, by qualifying (1) if they are seeing their employees as their most
important assets, (2) to what extent they invest in their employees, (3) the extent they
were aware of the research evidence demonstrating the contribution of employees to
business performance, (4) in which way the HRM implementation was done, and (5) the
extent the HR department was seen as effective. These five factors were judged by the
extent they were present and if they enhance competitiveness (Ulrich, 1997). The extent
to which HRM is ‘at the table’ was quantified by the HR profession having a seat at the
board or not and was qualified by examining the actual influence of the HR professional.
Therefore the following five factors were examined: (1) the development of the HR
function, (2) the ideal role for HR according the respondents, (3) the extent that the HR
professional is included in strategic decision-making, (4) the extent that the HR
professional is able to understand the business, and (5) the perceived quality of the HR
professionals. The HR function was judged by the extent they focused on defined
outcomes, had a shared body of knowledge, had the essential competencies, were aware
of the ethical standards and had clear roles (Ulrich, 1997).
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4. Methods
4.1. Design
This study adopted a multiple case study approach. It is a qualitative research, whereby
‘on the table’ and ‘at the table’ were mapped. The explorative nature of this research
enabled the correctly structuring of information provided by the test subjects, without
steering the responses in a certain direction beforehand. The design for this study is
largely drawn from the one Guest & King (2004) used because their research method
appeared effective and provided clear insights about the role of HRM in the
organizations. This validates for a large part the research method. In total five healthcare
organizations in the Netherlands were examined. Within each organization four different
respondents were interviewed. Because of limited time, twenty respondents were
considered. One of the difficulties that this research faces is that it is impossible to know
how many people should be interviewed before theoretical saturation has been achieved.
Warren (2002:99) makes the remark that for a qualitative interview study to be published,
the minimum number of interviews required seems to be between twenty and thirty. This
would mean that the twenty respondents are sufficient to meet the minimum levels of
acceptability to operate. Nevertheless, by no means all practitioners would agree with
Warren’s figure.
This study can be characterized as an explorative research. The purpose of this study is to
develop ideas or hypotheses (Schreuder Peters, 2000). On the basis of the results of this
research recommendations are made for follow-up studies. Explorative research aims to
identify relationships between variables. Therefore, in this research it was considered if
there is a relationship between ‘on’ and ‘at the table’ in healthcare organizations. This
research entails an intensive study of individuals sharing certain characteristics. It tends
to be oriented to the contextual uniqueness of healthcare organizations that was studied.
Some of the details may appear irrelevant, and there is a risk of becoming too embroiled
in descriptive detail (Bryman, 2004). To minimize this risk, a topic list with the most
important topics for discussion was used. This topic list is included in appendix one. The
results and conclusions of explorative research are generalizable to a limited extent
(Schreuder Peters, 2000). This means that the cases studied are small whereby the
15
reliability is also small. The goal of this research was theoretical generalization, this
means that theoretical insights that were developed during the research can be applied in
similar situations that are not investigated, to be able to describe and explain phenomena
in such situations as well.
Comparative case study is the basic idea for this research. A characteristic of a
comparative case study is that it is an extensive research whereby different cases are
compared on certain factors. This research focused specifically on HRM in general and
HR professionals within healthcare organizations. For every organization and every HR
professional an image of their position in the healthcare organization is created.
4.2. Description of the respondents
Purposive sampling was used because this way of sampling is essentially strategic and
entails an attempt to establish a good correspondence between research questions and
sampling. In other words, there was sampled on the basis of wanting to interview people
who are relevant to the research question (Bryman, 2004). It was difficult to find
organizations that wanted to cooperate, because most organizations were in a merger or
reorganization and couldn’t find time to participate in this study. Availability was the
reason why all types of healthcare organizations were approached instead of focusing on
one specific area in the healthcare sector. In total two psychiatry, two elderly institutions
and one institution for disable people participated in this research. Although these are
three different subsectors within the healthcare sector, they are all dealing with the
general developments in the Dutch healthcare sector. The respondents were purposefully
selected and were chosen by the qualification of their function. In every organization, a
chief HR officer, a line manager and a senior staff employee were selected like Guest &
King (2004) have done. In addition to the research by Guest & King (2004), this research
also selected an employee representative of the work council in each institution. Because
the institutional character of the Netherlands, the addition of an employee representative
of the work council in this research makes it more context specific. The expectation was
that these employees together could give a complete overview of HRM in the
organization and the HR function. A more detailed description of the chosen respondents
can be found in the next paragraph.
16
4.3. Sample
Guest (1999) argues that the employees’ perception of HRM practices is crucial for the
impact of HRM on performance and therefore representatives of the work councils are
included, as they are expected to stay close to the workplace. The result of the study of
Boselie and Paauwe (2005) emphasizes the importance of using multiple respondent
groups in contrast to the dominating single respondent approaches. It is important to note
that the assessment of the HRM activities that were evaluated was not based on a
characterization by an HR manager alone, but on the activities as experienced and
reported by the four different respondents. This provides a better indication as the HR
manager alone is not always the most reliable informant (Gerhart, Wright & McMahan,
2000). Interviews were conducted in the first two months of 2010 with in total 20
respondents, including chief HR officers, line managers, senior staff employees and
employee representatives of the work councils.
4.4. Instrument
The analysis was done by in-depth interviews, since interviews are suggested to be the
best way to gain insights into the culture, organization and activities of executives
(Useem, 1995). The interview list is semi-structured with open questions and is included
in appendix two of this rapport. Besides the interview, a topic list was used to be sure that
all the important topics of this research were discussed. A semi-structured interview list
was used because of the need for some structure in order to ensure cross-case
comparability. A list of questions was used, but each interviewee had a great deal of
leeway in how to reply. This was chosen because it was interesting to see the
interviewee’s point of view and this method gave insight into what the interviewee sees
as relevant and important. Qualitative interviewing tends to be flexible, responding to the
direction in which interviewees take the interview. In this way the expectation was to get
rich, detailed answers. A pre-specified list of HR practices was not provided to the
respondents. Instead, the different respondents, both inside and outside HR departments,
were asked to give examples of their HR practices. This helped to identify ‘intended’ and
‘implemented’ HR practices and isolate inconsistencies, if present (Khilji & Wang,
2006). The interviews were built similar to the ones of Guest and King (2004), around 11
open-ended questions based upon the main research issues ‘on’ and ‘at the table’, as
17
described above. Guest and King (2004) used 12 open-ended questions in their research,
but in this research two of them were combined and therefore a total of 11 open-ended
questions were used. Examples of questions that were asked during the interviews were:
“Are you aware of the research evidence demonstrating the contribution of human
resources to business performance?” and “Is the HR function making the decisions or are
they in the driving seat at strategic decisions?” The complete interview list, which is
translated into Dutch, can be found in appendix two. The questions are slightly different
from those of Guest and King (2004) as the focus of this research is mainly on the
positions and roles of HR professionals and to a lesser extent on the ambiguities of Legge
(1978) as described before. Also questions were changed because this research is done in
the Dutch healthcare context. The interviews were designed to capture the views of the
different respondents about the five different topics of ‘on’ the table and ‘at the table’,
without steering the responses. The emphasis in the interviews was very much on getting
concrete examples and illustrations from the respondents. No specific mention of
ambiguities or vicious circles, or other aspects specific to Legge’s (1978) or Ulrich’s
(1997) analyses were made. The aim was to get spontaneous reactions on the different
topics from the respondents.
4.5. Procedure
Each interview was taped and transcribed. The analysis followed the process set out by
Ritch & Spencer’s (1994) for applied policy research.
In the analysis phase, comparative analysis was used. This is relevant to identify
differences between respondents within and between organizations. To map ‘on the table’
and ‘at the table’, it is important to analyze in an unambiguous way. In this way
differences and agreements between the respondents become obvious. Analysis in this
way is also important to be able to make a statement about the relation between those two
concepts. More specific it is, for example, interesting to compare the views of
representatives of the work councils with line management executives. It is possible that
there are differences between intended, actual and perceived HR practices (Khilji &
Wang, 2006). Intended HR practices are those designed by top management to be applied
to most or all of the employees and concern employees’ ability, motivation, and
opportunity to participate. These practices will be influenced by the articulated values of
18
the organization and found in the HR manual or the appropriate web pages. These also
include the ways work is structured and organized since this has an impact on employee
attitudes and behavior (Boxall, Purcell & Wright, 2007). Actual HR practices are those
which are actually applied, usually by line managers. There may often be a substantial
difference between the espousal and the enactment of HR practices in an organization
(Hutchinson & Purcell, 2003). When comparing these different HR practices, it is
possible to find gaps between intended HRM, the practices formulated by policy makers,
and implemented HRM, the practices operationalized and experienced by employees.
Finally it is also interesting to see if there are differences in the views of line management
and HR professionals, as there is very often a big tension between those two. HR
managers are often more positive about themselves than line managers are about HR
managers (Boselie & Paauwe, 2005; Biemans, 1999). According to Boselie & Paauwe
(2005) and Biemans (1999), line managers appear to be more critical and demanding and
are expecting support and facilities from HR to be able to fulfill their daily tasks in a
satisfactory way. Concerns of line managers are much more concerning short term
policies, closely linked to the actual business of the organization (Boselie & Paauwe,
2005). To get a clear impression of which comparisons were made between which kinds
of different occupations in this research, tables of the different comparisons made in this
research are included in appendix three, figure three.
Analyzing the data from the interviews took place through coding. Therefore the
approach of Ritch & Spencer’s (1994) and Boeije (2005) were used. Analyzing is the
process of research to separate, summarize and to interrelate them. In order to get a full
understanding of the data, the taped interviews were listened to and notes were read. This
way important themes were recognized (Rabiee, 2004). Afterwards the themes were
broken into parts by developing categories. Than the coding stage followed, were all
relevant fragments were labeled and compared (Rabiee, 2004; Ritchie & Spencer, 1994).
The codes are words or sentences which the respondents formed themselves (Boeije,
2005). Subsequently, categories were described and meanwhile a distinction was made
between relevant and less relevant elements both within and between cases. Thereafter
19
the size of the number of codes was reduced. On this basis, the cohesion between ‘on the
table’ and ‘at the table’ could be defined.
To get a clear overview about which questions of the interview list are related to ‘on the
table’ and which ones are related to ‘at the table’, the table below in figure three gives a
summary. Question one of the interview list, concerning the background of the
respondents is not included because it does not cover ‘on’ or ‘at the table’. Question nine
is a combined question, therefore a total of ten topics are included.
On the table (HRM in
general)
At the table (HR function)
Employees most important
(RBV)
×
factors constraining
investment in human
resources (RBV)
×
Research evidence
demonstrating contribution
human resources to business
performance
×
Development of the HR
function
×
What should the role of HR
be
×
Implementation process ×
At the table ×
Core business involvement/
Relation core business-HR
×
Effectiveness HR department ×
Quality HR professional(s) ×
Figure 3: Research topics of Guest & King (2004) classified in ‘on’ and ‘at’ the table
20
5. Results
5.1 HR ‘on the table’
The extent HR was ‘on the table’ in the various healthcare institutions was examined by
five topics which are mentioned at the end of the previous chapter in figure three and are
revealed in the five paragraphs below. First, the central role and investments in human
resources of the institutions are described. These two topics can be traced back to the
Resource-based View (RBV) of Barney (1991). It is examined if the institutions show in
policy and in practice that their employees are seen as resources for sustained competitive
advantage. Afterwards the awareness of the respondents about the research evidence that
is demonstrating the contribution of human resources to business performance is
discussed. Finally the implementation process and the effectiveness of the HR
departments of the different healthcare institutions can be found in the last two
paragraphs.
The central role of human resource values
Research of Boselie & Paauwe (2005) suggests that the HR basics should be sufficient;
otherwise the personnel manager will not be taken seriously in other areas or on other
subject matters. The HR basics contain that the HR professional designs and delivers
efficient HR processes for staffing, training, appraising, rewarding, promoting, and
managing the flow of employees through the organization (Ulrich, 1997). According to
Boselie & Paauwe (2005) the personnel manager should first gain personal credibility
and HR delivery in order to add value to an organization. Therefore the extent that the
healthcare institutions accepts and act upon these arguments about the central role of
human resources was considered. First, the respondents were asked whether they agreed
with the frequently mentioned statement ‘people are our most important asset’. All
twenty respondents said that the intention is there, but that various kinds of activities
cause human resources to not always have priority. For example: “The organization is
very aware that employees are our most important capital. You can not do a treatment
without a therapist, there is no technical variant for that. Everyone knows we earn money
because of them en we exceed other institutions because of them” said a Chief HR
officer. This sentence clearly shows the Resource-based View, that resources must be
21
rare among a firm’s current and potential competition (Barney, 1991). Another HR
manager said: “Something we learned is that we shouldn’t take employees being there for
granted.”
All interviewees made various comments about how their organization failed in treating
their employees as their key assets, which is described in the next paragraph.
Investments in human resources
Varied responses were collected again on the question; which factors constrain
investment in human resources? Actuality seems to differ from expressions made during
the interviews regarding this topic. Money was the factor that was mentioned by
seventeen of the twenty respondents. For instance an HR manager said: “Money as a
basis is an obstruction to invest in human capital. We didn’t select a strategy to keep
people here. An employee could go to another institution, but it wouldn’t be much better
there.” Moreover, a line manager said: “Our institution wants to offer a five star care but
we have a two star financing.” This means that investing in human resources is seen as
topic that’s important and should have top priority, but in reality other activities are given
priority. This is not in line with the Resource-based View theory (Barney, 1991). Reasons
mentioned for these contradictory findings are lack of finance and time. Besides those
factors, different comments were made about problems with people and organizational
culture constraining investment in human resources. One employee representative of the
work council called it: “they play short term politics”, because they are not investing
enough in human capital in the long run. Another representative of the work council said:
“There is deliberation from HR and HR is an important factor at this moment. They are
the think-tank of the board”. From this last sentence one might conclude that HR is ‘on
the table’. Nevertheless, this is not completely true, because the institutions are not giving
priority to investing in their human resources.
Another organization was in the middle of a culture change, where they had far reaching
plans for the future, but today’s practice was not that well developed.
Comments as described above, illustrate that today’s healthcare sector is concerned with
economic difficulties that influence the investment in human capital. In other words,
22
reality pushes the organization towards other priorities. People have different opinions
about what causes it and how to resolve it in the future.
Contribution human resource to business performance
The third topic of investigation of ‘on the table’ was the extent to which the institution
was aware of the relationship between HRM and performance. Accordingly, the
interviewees were asked whether they were aware of the research evidence demonstrating
the contribution of human resources to business performance. None of the interviewees
gave a clear answer to this question. No one made specific mention that they were aware
of it. Therefore it was not clear if they were not aware of it or if they just didn’t tell about
it. It seems that they take it for granted that good HRM improves performance, but could
not give clear examples which showed their way of thinking.
Implementation process
A fourth question for qualifying ‘on the table’ was the implementation processes in the
institutions. All five of them executed top down implementations. This implies that line
managers have a lot of responsibilities. Information is used within several layers of the
institution. They call this way of working, integral responsibility. Everyone mentioned
the use of integral responsibility and the information loss which sometimes is caused by
this. Since it is a new way of working for most of the institutions, it needs improvement
in the future according to the respondents. In addition, the HR professionals indicated
that line managers need more and better education to act up on their new role with more
responsibilities. If line managers are not competent enough, many HR activities will fail
because of the use of integral responsibility in the healthcare institutions. On the other
hand, line managers agree that they need more education for their new tasks but many of
them think that some tasks are not their responsibility, but HR’s. They are willing to take
more responsibility but there is a limit. They said that they are not hired and educated to
know everything about labor law and other HR information. For that, there is an HR
department.
23
Integral responsibility has a lot of pros but it also makes the HR activities fragmented
throughout the organization. This causes HR professionals to not always have control
over the implementation processes and makes them very much dependent on line
managers for their input. Because the activities are not measured, they don’t know if their
implementations are effective.
HR effectiveness
The last question concerning to ‘on the table’ was the measurement of the effectiveness
of the HR department. None of the five institutions specifically measured the
effectiveness of their HR department. Employee satisfaction measurement was done, but
most of the time the HR departments were not involved in making that measurement. All
the interviewees welcomed the use of quantitative methods to evaluate the contribution of
HR. As long as the activities of HR are not being measured, it is difficult for HR to prove
their credibility and delivery. Reasons why they didn’t use some kind of measurement
yet, are mostly that securing their HR business was not their strength. Some of the
institutions were using the plan, do, check and act cycles, but stopped very often after the
do phase. Concerns were also expressed about the extent to which it is possible to isolate
the contribution of the HR function to performance and the extent to which its
contribution is actually measurable.
Striking is the fact that mostly, HR people indicated the importance of the measurement
on the effects of their function and their department but they didn’t put it in practice.
They wanted to work more goal focused, but they didn’t practice what they preach. The
other respondents didn’t mention the importance of it and were satisfied with HR
effectiveness as long as they get their questions answered and as long as HR was helping
them when they needed them. The respondents said that HR people didn’t need to prove
their effectiveness. They only made a few comments of activities that could be done
better by the HR department.
In summary, it is clear that the institutions not always practice according to their policies.
This applies to the investment in employees as well as for measuring the HR activities.
Therefore HRM is not fully ‘on the table’ in the healthcare institutions.
24
5.2 At the table
The extent HR was ‘at the table’ in the various healthcare institutions was examined by
five topics which are mentioned at the end of the previous chapter in figure three and
these are revealed in the five paragraphs below. Firstly, the development of the HR
function is described. Secondly, the ideal role for HR and the involvement of the HR
professional in strategic decision making is discussed. Finally, the business knowledge
and involvement of the HR professional and the quality of the HR manager can be found
in the last two paragraphs.
Development HR function
The first issue that was explored to qualify ‘at the table’ is how far the advent and
influence of HRM has affected the role of personnel specialists. All twenty interviewees
referred to integral responsibility when they were asked about the development of the HR
function through the past years. They all talked about the movement of their
administrative and other basic tasks that were replaced more and more to line managers.
HR directors were increasingly asked to facilitate line management about more complex
matters, concerning individual employees. In the past, HR managers instead of line
managers were mainly focused on contributing to the personnel’s well-being in the
organization. Practical activities such as recruitment and selection, and absenteeism were
tasks of an HR manager and are now done by line managers.
The ideal role for HR
Seventeen respondents answered the question, what the role of the HR function should be
as follows: helping line managers do their jobs better, and only three answered:
representing employee interests. The main focus is thus on supporting and helping line
managers in order to get all the HR implementations right. The focus on representing
employees’ views to management is getting attention to a lesser extent. One HR director
said: “We have experiences in HR practices, but it is no longer only our responsibility, it
is also the responsibility of line managers to fulfill some basic tasks. Of course they can
come to us for some practical questions.” This is similar to what Guest and King (2004)
have found. However, here, among the twenty interviewees, there was consensus about
25
how to achieve this by managers, namely by focusing on a strategic contribution, but
keep an eye on, and still have influence on, some tactical practices. An HR director said
about this: “In the ideal situation, HR is making the policy and at the same time gives
support to line management.” Again here the respondents speak very often about the
future and not about the present.
HR and strategic decision-making
According to Ulrich (1997) the optimal HR function is being represented at the board
level. None of the five institutions had HR representatives at the board level. In other
words, HR was not ‘at the table’ in the five examined institutions. However there were
different perceptions expressed by the twenty respondents about why they thought this
was accountable and reasonable or not. “We are not in the strategic management team
because it doesn’t fit in the structure, it becomes too big”. (HR director)
Prominent was that most of the interviewees were at ease with the fact that HR was not
involved in strategic decision-making. Often their ambitions were somewhere else. They
all said that the ownership of the key strategic decisions lay with the board as a whole.
The HR directors said that they found it more important to know that they are taken
seriously by the board and that they are able to give good advice to them than actually
having a seat at the board. Nevertheless, a lot of frustration was heard as well about the
powerlessness as HR department. For example one HR director said: “We are not always
aware what we are doing in the long term. We are very dependent on the information of
our supervisor, who is sitting at the board. In the bustle of the day good information
transfer not always succeeds. That is quite frustrating sometimes, because you want and
need to know were the organization is going to and what decisions are made”. This topic
will be more extensively described in the discussion part.
Thus HR professionals of the healthcare organizations are not involved in strategic
decision-making together with top management. They are very often dependent on
information of the top management and are only allowed to give advice to them.
26
Business knowledge and involvement of HR
A fourth indicator for HR being ‘at the table’ is the level of business knowledge of HR
professionals. The respondents were asked if HR professionals in the healthcare
organizations know the business and if they thought it was essential for them to be aware
of that business. While there was a majority of positive comments about the effectiveness
of the HR department, some negative comments were made about the function’s ability to
understand the business. The belief was that HR specialists isolate themselves from the
main business, sometimes literally by moving to another office building, far away from
where the core business takes place. Most HR professionals are dependent on information
from line managers. Respondents said similar things about this. One employee
representative said: “The HR department is only sitting upstairs”. Furthermore, different
HR professionals said about this: “I think this is a culture problem of staff departments in
general that people say things like that. We are always in a split by acting as a centralized
or more decentralized department”.
In other words, the HR function was perceived as not always being able to understand the
business enough to grasp the right kind of action.
Quality of HR
The last factor that was discussed concerning to ‘at the table’, was the quality of HR
professionals. All five institutions agreed that they have highly educated HR people in
their function. The five HR professionals themselves were also confident with their
competencies for them to fulfill their job. Nevertheless there were some negative
observations about the quality of HR as well. A line manager said: “the advice of the
different HR professionals is sometimes not the same’. And an HR professional said:
“Some HR professionals tend to say this is how we agreed and therefore we do it like
that. While in your personal situation it could be better to differ”.
Three of the five institutions had just completed a reorganization or were in the middle of
one and therefore they had, concerning to their status, to deal with other issues. They
said: “We are just merged, so we are highly internally focused on that at the moment.
27
Harmonizing things, that is phase one, aimed at stability. Because the organization is
highly in motion, we are asked for many ad hoc cases. Firefighting we call it’. And
another respondent of an organization that had just a new member at the board said about
HR: “I think they always had the competences, but they were not allowed to show it”.
Overall, there are some doubts among the respondents in this sample about the ability of
HR managers to enact the roles identified for HR champions by Ulrich (1997) and the
deviant innovator role of Legge (1978). However no one doubted about the persistence of
the competences and quality of the HR professionals. They mentioned different kind of
reasons why HR fails to have a strategic position and have real influence. There were a
variety of reasons illustrated above, why HR sometimes failed to adopt a more strategic
role or a role as champions of transformation and change. It is clear that HR is not ‘at the
table’ in the healthcare institutions. While many of the institutions examined in this study
have big plans concerning to HR for the future, the question is what and which activities
will really be done.
6. Conclusion
The aim of this paper was to determine the position of HRM and the roles of HR
professionals in Dutch healthcare organizations. The central question was: To what extent
is HR ‘on’ and ‘at the table’ in Dutch healthcare organizations? The research was based
on the research of Legge (1978). The answer to the main question is that in all the
organizations, HR was partly ‘on the table’ but in none of them, HR was ‘at the table’.
HR is partly ‘on the table’ because three of the five questions that were qualifying ‘on the
table’ could be answered positively. However, two important factors, the implementation
processes and the investment in human resources were answered negatively for all the
five institutions. Communication with line managers and the education of line managers
is in need for improvement in order to let integral responsibility succeed. Besides that,
money was a constraining factor for investing in their employees. The institutions
promote in their policies that their employees are their most important production factors,
but in reality limited investments are made. Therefore, HR is not fully ‘on the table’ in
the healthcare institutions.
28
Below in figure four and five the results that are described above are mapped per
question of the interview list. The topics are classified by ‘on’ and ‘at the table’. In this
way, you can see within a quick view, about which topics there is consensus between the
five healthcare organizations and the different respondents and for which topics there is
no consensus. The reasons are shortly appointed.
Topic Consensus No consensus
Employees most
important
Yes but not always in
practice.
Factors constraining
investment in human
resources
Mostly Money.
Research evidence
demonstrating
contribution human
resources to business
performance
None of them were aware
or at least made mention of
it.
Implementation process Integral responsibility.
Effectiveness HR
department
None of them are measuring
it. There are some plans for
it.
Figure 4: Overview of the results of ‘on’ the table
29
Topic Consensus No consensus
Development of the HR
function
Integral responsibility.
What should the role of
HR be
Some think it is ok now.
Others think much
improvement must be made.
At the table None of them were at. Different opinions why and
level of agreement.
Core business
involvement/ Relation
core business-HR
Not enough involvement.
Difficulty balancing work
centralized and
decentralized.
Quality HR
professional(s)
Overall most of them are
confident.
Some of them think
improvements can be made.
Figure 5: Overview of the results of ‘at’ the table
There is consensus between the different respondents about most of the topics.
Overall you can say that HR is partly ‘on the table’ and not ‘at the table’ in the Dutch
healthcare institutions. There is deliberation for HR in the institutions and HR is seen as
an important factor. The HR department is called the “think-tank” of the board but the
respondents argued that the ownership of the key strategic decisions lay with the board as
a whole. Nevertheless, there was some frustration as well. Three of the five institutions
were merged or had undergone reorganization in the last year and said that this was the
reason that they were now highly internally focused. According to the respondents, HR
was mainly busy with improving their internal structure, rules and regulations before they
really could add their value to the organization. The respondents called it “firefighting”
what they were doing, but they were not able to make strategic policy yet. The
uncertainty about the outcomes of investment in HRM was another frustration of mostly
HR directors. Striking was that the inability to influence key HR decisions did not
emerge as an issue. In general, the HR directors felt that it was more important to know
30
that they were taken seriously by the board and that they were able to give good advice to
them.
Most respondents admitted that they did not fully put into practice the belief that people
are their most important assets. Interestingly the most frequently mentioned field for
improvement was not concerning HR but concerning to the behavior and education of
line management. Different respondents said that line managers were very often not
competent enough to meet the standards that are needed for realizing integral
management. Apparently, the infrastructure of the organization and the design of integral
management needed more attention. The strategic partner role (Ulrich, 1997) and the
conformist innovator role (Legge, 1978) were found in practice in the basic HR practices.
Furthermore, there were some indications of the employee champion role of Ulrich
(1997) but the focus was mainly on the short-term. The other roles of Ulrich and Legge
were not seen in practice. Some striking and interesting results will be discussed further
in the next chapter.
7. Discussion and future research
As described earlier, research suggests that the HR basics should be sufficient; otherwise
the personnel manager will not be taken seriously in other areas or on other subject
matters (Ulrich, 1997). Most of the HR basics, such as efficient designs and delivering
HR processes for staffing, training and promoting, were sufficient, so the problem solver
role (Legge, 1978) and the administrative expert role (1997) were visible. However two
important factors were missing for qualifying HRM as being ‘on the table’, namely the
implementation processes and real investments in their human capital. A striking fact was
that all respondents told that people are their key assets of the organization, but
contradictory enough, HR doesn’t play a key role in the current Dutch healthcare sector.
An important question is, if employees are considered as very important why not spend
more money on them? Apparently top management doesn’t give priority to this.
Although formal policy describes the value of the employees in the organization, the
actual HR practices are not including investments in human resources. Given the
complex relationship between human resources and competitive advantage it is possible
that a firm doesn’t fully understand the source of that advantage (Barney, 1991). Another
31
explanation could be found in the communication challenge. Bowen and Ostroff (2004)
provide a framework that is based on communications theory and explain the linkage
between the actual HR practices and the perceived HR practices. This can be true for the
institutions including in this research, because within the different policy papers of the
healthcare institutions, extensive texts are describing how and why employees are their
key assets. But in reality not all the descriptions are reflected in practice. The theory of
Bowen and Ostroff (2004) explores how different aspects of the HRM systems can either
promote or impede the message. Future research could use the theory of these authors to
get a deeper understanding of the strategic human resource process. The theory can be
useful to explain the difficulty of information transfer from top management to HR and
the other way around concerning the long term policies as mentioned in the ‘Result’
chapter as one of the frustrations of not being involved in strategic decision making.
Moreover, this theory can also be used to explain the critical role posed by line managers
in the implementation of HR practices. In general, the respondents were confident about
the quality and education level of HR managers, but many of them felt that the skills of
line managers had to be improved to make a success of the HR implementations. Line
managers are seen as one of the causes of information lost in the integral responsibility
process, as they not always have the right competences to fulfill the job. All these
problems can be partly traced back to communication problems in the organization.
Moreover, many institutions were using the plan, do, check and act cycles, but they
stopped very often after the do phase. This could be an indication why HR is not seen as
credible. If HR finished what they started, they could prove their added value for the
organization and get a higher status. However to reach that point, HR first has to
overcome the problems with measuring HR activities. None of the five institutions
measured the effectiveness of their HR activities. The existing employee satisfaction
researches that are already used in all the five institutions can be a tool to examine the
effectiveness of HR. So when an HR department actively is involved in making and
examining the employee satisfaction research, it can be helpful to understand their
position and it will give insights in which activities HR must be make improvements.
32
Furthermore, all the respondents talked about the gap between practice and plans. There
is a clear ‘ist’ and ‘soll’ situation, but the question is: why don’t they practice what they
preach? In other words, many institutions have much intended HR activities, but how
realistic are those plans? This topic was described in the ‘Instrument’ paragraph before.
In some institutions, the HR agenda was wide-open for change agents, but if HR doesn’t
step up to the task, someone else will. Many HR professionals had change maker
aspirations, but this key role was never found in practice. The theory of Khilji & Wang
(2006) can help healthcare institutions and future researchers to identify ‘intended’ and
‘implemented’ HR practices and insolate inconsistencies more specific.
Furthermore, three out of five organizations in this study were in the middle of a merger
or reorganization or had one behind them. It is difficult to determine the influences of
those reorganizations according to the opportunities and threats for the organizations. But
at least, it partly justifies, the reason why all the respondents mainly talked about the
plans for the future and to a lesser extent what they are doing now. This is also what
Boselie & Paauwe (2005) noted in their research. According to them, the strategic
contribution, including the focus on implementing “fast change”, will gain importance
when institutions have to reorganize and experience continuous change. The main
challenge for the HR manager will be to take care of continuing HR delivery and
maintaining credibility, while being involved in implementing and facilitating all kinds of
changes in order to enable corporate restructuring. This research shows that this is a
difficult job for HR managers to fulfill in those situations.
In this research period, all five HR managers were acting the role as administrative expert
(Ulrich, 1997) and problem solver (legge, 1978) but were not able to really make a step
upwards. The strategic partner role (Ulrich, 1997) and the conformist innovator role
(Legge, 1978) were sometimes seen in practice as well. This was visible in some
institutions were the HR professional aligned HR strategies and practices with the
business strategy. The decisions of those strategies were made by the CEO and the HR
professional speaks the language of that CEO. There were some indications of the
employee champion role of Ulrich (1997), because in many institutions the HR
professional was involved in the day-to-day problems, concerns and needs of employees.
Nevertheless, those involvements were ad-hoc and had short-term effects. The change
33
agent role (Ulrich, 1997) and the deviant innovator role (Legge, 1978) were not seen in
practice at all.
In other words, although HR was making plans for the future, the current focus on their
activities was mainly on the short-term. The HR managers were chiefly acting as
troubleshooters and not as policy makers. It will be interesting to see if this will change in
the near future. Most of the HR managers are convinced it will change some day soon.
Finally, there were some HR directors who were able to partially influence the strategic
decision-making, but none of them were directly involved in it. Respondents had
different opinions why the HR function was not being a partner on the highest level. In
the five Dutch healthcare organizations in this study the board of directors consisted of
one or at maximum two persons. The board of directors was responsible for decisions
that were taken at a strategic level. What does this mean and why is it like that? Is the
definition of ‘at the table’ maybe too narrow? Can we expect that the HR department is
represented at these boards if the boards are so small? This kind of questions goes to the
core of what makes SHRM strategic. While HR’s role is driven by the underlying firm
strategy, the manifestation of that strategic imperative is the commitment of the board to
realizing a strategic role for HR.
Another question that is interesting for follow up research is: Is the HR function maybe
also valuable when they are considered with mainly operational tasks? They probably
are, because most of the respondents were positive about the effectiveness of HR. In
general, the HR directors felt that it was more important to know that they were taken
seriously by the board and that they were able to give good advice to them. Other
departments like financing and marketing were also not ‘at the table’ and were
functioning well, according to the respondents. So maybe, being ‘at the table’ should not
be the ideal and most desired situation for HR.
In addition, it is interesting to investigate if the board really believes that HR can be more
than a cost center and that most of the employees are more than a cost to be minimized?
Maybe it is the bad financial situation where the healthcare sector is in at the moment,
that makes organizations not see the need for investment in their human capital. An HR
manager said: “we didn’t select a strategy to keep people here. An employee could go to
another institution, but it wouldn’t be much better there.”
34
All in all it is interesting to get more in depth information and to do more specific
research about which factors are constraining a strategic position for HR.
7. 1. Limitations
Looking back on this research, there are several limitations in this study which are linked
to the nature of the approach and methods used. Firstly, the data is cross-sectional, which
means that the data was collected in one point in time (Singleton & Straits, 2005) and
therefore causality (for example, linking plans to changes in HR some time later) could
not be fully tested. Also reverse causality was not tested (i.e. does a strategic position for
HR result in improved HR effectiveness or does improved HR effectiveness result in a
strategic position for HR?). Understanding how a strategic position can contribute to
effectiveness or the other way around is important. Secondly, this study focuses on the
position of HRM and roles of HR and not that much on the effectiveness and
performance of the HR department. Finally, this study is of an explorative nature and
uses data from only five organizations. The five healthcare institutions that were
approached for this research focus on different areas within the healthcare sector. The
participated institutions consisted of two psychiatry and two elderly institutions and one
institution for disabled people. In order to increase reliability, more cases need to be
studied, because these institutions are heterogeneous (Singleton & Straits, 2005). The
results might not be applicable in other organizations in different contexts.
Nevertheless, although it was hard to find enough institutions who were wanting to
participate, it is satisfying that a sample size of twenty interviews was reached in such a
short period of time. The current study has identified new factors and questions that
require attention in developing the position of HRM and HR roles analyses.
35
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Appendix
Appendix 1
Topic list
1. functiebeschrijving
2. werknemers belangrijkste
3. investeren menselijk kapitaal
4. relatie menselijk kapitaal en bedrijfsperformance
5. ontwikkeling (P&O afdeling) HR functie
6. rol HR functie
7. implementatie proces
8. at the table
9. core business betrokkenheid
10. relatie core business-HR
11. effectiviteit HR department
12. kwaliteit HR professional
Appendix 2
Interview list: Dutch/translated questions:
1. Kunt u in het kort iets over uw huidige functie vertellen? ( Naam, leeftijd, positie,
werk ervaring, aantal jaren werkzaam voor het bedrijf).
2. Bent u het eens met de volgende stelling “werknemers zijn de meest belangrijke
onderdelen van de organisatie”. Kunt u hiervan voorbeelden geven. (waarom bent
u het met de stelling eens/oneens?
3. Welke factoren beperken investeringen in menselijk kapitaal? Kunt u hiervan
voorbeelden geven? (geld of andere middelen, heeft men het er niet voor over?).
4. Onderzoek wijst uit dat investeren in menselijk kapitaal een bijdrage levert aan de
bedrijfsperformance. Bent u hier zich van bewust? Zo ja, kunt u hier voorbeelden
van geven. Zo nee, hoe denkt u dat dit komt? (opleidingsbeleid, werven en
selecteren).
5. HRM wordt steeds belangrijker en krijgt steeds meer invloed. Op welke manier
heeft dit de rol van de persoonsafdeling en de personeelsfunctionaris beïnvloed?
Kunt u hiervan voorbeelden geven? (denk aan voorbeelden voor beide factoren).
(verschil vroeger en nu, voorbeeld werving en selectie, belonen, teamwork).
6. Wat zou volgens u de rol van de HR functie moeten zijn? Kunt u hiervan
voorbeelden geven? (bijvoorbeeld de taakinhoud, welke belangen ze moeten
behartigen) (In hoeverre wijkt dit af van de werkelijkheid).
7. Op welke manier wordt de implementatie van het HRM beleid aangepakt in u
organisatie? Kunt u een voorbeeld geven van een HRM implementatie en wat was
het resultaat van deze implementatie? (Hoe zijn resultaten gemeten, bijvoorbeeld
via evaluatie, wie heeft deze evaluatie uitgevoerd, zijn er factoren die een goede
implementatie belemmeren).
40
8. Is de HR functie vertegenwoordigd bij het maken van strategische beslissingen op
het hoogste niveau? Zo ja, kunt u hier een voorbeeld van geven. Wat is hierover u
mening?
9. Is de HR afdeling betrokken bij de core-business van de organisatie? Zo ja, kunt u
hiervan voorbeelden geven? Denkt u dat het inzicht hebben in de core-business
invloed heeft op de prestatie van HR? (value chain en de value propostion, hoe
vergaart de organisatie rijkdom)
10. Wat vindt u van de effectiviteit van de HR afdelingen? Kunt u hiervan
voorbeelden geven? (effectiviteit: leveren investeringen merkbare resultaten en of
verbeteringen op) (Toename personeelsbetrokkenheid, personeelsverloop)
11. Wat is uw algehele oordeel over de kwaliteit van mensen werkzaam in de HR
functie? Kunt u hier een voorbeeld van geven. (Denk hierbij aan de competenties
van de medewerkers)
Appendix 3
Figure 3: Overview of the comparisons made in the analysis
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HR ProfessionalLinemanagerHealthcare Institutions
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Representative of the Work Council
HR ProfessionalLinemanagerHealthcare Institutions