A holistic view on implementing hospital autonomy reforms in developing countries: a systematic review

Ravaghi, Hamid; Foroughi, Zeynab; Nemati, Ali; Bélorgeot, Victoria D.

doi:10.1093/heapol/czy095

Cited by 13 publications

(28 citation statements)

References 25 publications

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“…They caused financial inequalities among employees that were perceived as unjust and led to dissatisfaction and demotivation. Some studies [ 16 , 19 ] support our finding that differences in regulations, political forces and shortages of critical resources complicate attempts to address urgent HRM issues. Previous studies added financial inequalities, lack of coordination and ineffective policy implementation as causes for incoherence and regulatory/policy failures to address HRM issues [ 45 – 47 ].…”

Section: Discussionsupporting

confidence: 59%

“…Moreover, the complementary open questions and inductive analysis enabled us to identify additional factors and insights. Our study therefore adds to previous studies that were largely based on secondary data, gave little attention to these external factors and addressed other contexts (e.g.,[ 2 , 3 , 19 ]).…”

Section: Discussionmentioning

confidence: 95%

“…Third, institutional health system issues hamper effective reform implementation, despite the robust regulatory framework put in place [ 16 , 17 ]. Among these institutional challenges are budget constraints and centralized decision making, which are subject to political dynamics [ 8 , 13 , 14 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

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Human resource management in Ethiopian public hospitals

Gile

Klundert

Buljac-Samardžić

2022

BMC Health Serv Res

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Background In Ethiopia, public hospitals deal with a persistent human resource crisis, even by Sub-Saharan Africa (SSA) standards. Policy and hospital reforms, however, have thus far resulted in limited progress towards addressing the strategic human resource management (SHRM) challenges Ethiopia’s public hospitals face. Methods To explore the contextual factors influencing these SHRM challenges of Ethiopian public hospitals, we conducted a qualitative study based on the Contextual SHRM framework of Paauwe. A total of 19 structured interviews were conducted with Chief Executive Officers (CEOs) and HR managers from a purposive sample of 15 hospitals across Ethiopia. An additional four focus groups were held with professionals and managers. Results The study found that hospitals compete on the supply side for scarce resources, including skilled professionals. There was little reporting on demand-side competition for health services provided, service quality, and service innovation. Governmental regulations were the main institutional mechanism in place. These regulations also emphasized human resources and were perceived to tightly regulate employee numbers, salaries, and employment arrangements at detailed levels. These regulations were perceived to restrict the autonomy of hospitals regarding SHRM. Regulation-induced differences in allowances and external employment arrangements were among the concerns that decreased motivation and job satisfaction and caused employees to leave. The mismatch between regulation and workforce demands posed challenges for leadership and caused leaders to be perceived as incompetent and unable when they could not successfully address workforce needs. Conclusions Bottom-up involvement in SHRM may help resolve the aforementioned persistent problems. The Ethiopian government might better loosen regulations and provide more autonomy to hospitals to develop SHRM and implement mechanisms that emphasize the quality of the health services demanded rather than the quantity of human resources supplied.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 95%

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Human resource management in Ethiopian public hospitals

Gile

Klundert

Buljac-Samardžić

2022

BMC Health Serv Res

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show abstract

“…They caused nancial inequalities among employees that were perceived as unjust and led to dissatisfaction/demotivation. Some literature [16,19] supports our nding that differences in regulations, political forces and shortages of critical resources complicate addressing urgent HRM issues. Previous studies added nancial inequalities, lack of coordination and ineffective policy implementation as a cause for incoherence and regulatory/policy failures to address HRM issues [22][23][24].…”

Section: Discussionsupporting

confidence: 55%

“…While Ethiopia's public hospitals operate within a robust regulatory framework, institutional health system issues hamper effective implementation [16,17]. Among these institutional challenges are budget constraints and centralized decision making, which are subject to political dynamics [8, 13,14,19].…”

Section: Introductionmentioning

confidence: 99%

Human Resource Management in Ethiopian Public Hospitals

Gile

Klundert²,

Samardzic

2021

Preprint

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Background In Ethiopia, public hospitals deal with a persistent human resource crisis, even by SSA standards. Policy and hospital reforms, however, have so far resulted in limited progress towards addressing the resulting strategic human resource management (SHRM) challenges Ethiopia’s public hospital face. Methods To explore the contextual factors influencing these SHRM challenges of Ethiopian public hospitals, we conducted a qualitative study based on the SHRM framework of Paauwe. A total of 19 semi-structured interviews were conducted with a purposive sample of hospital CEOs and HR managers from 15 hospitals across Ethiopia. An additional 4 focus group discussions were held with professionals and their line managers. Results The study found that hospitals compete on the supply side for scarce resources among which the human resources of skilled professionals. There was little reporting on demand side competition on health services provided, service quality, and service innovation. Governmental regulations were the main institutional mechanism in place. These regulations also emphasized human resources and were perceived to tightly regulate employee numbers, salaries and arrangements at detailed levels. These regulations were perceived to restrict the SHRM autonomy of the hospitals. Regulation induced differences in allowances and external employment arrangements were among the concerns that decreased motivation and job satisfaction and caused employees to leave their jobs. The mismatch between regulation and workforce needs posed challenges for leadership and caused leaders to be perceived as incompetent and unable when not successfully addressing workforce needs. Conclusions Bottom-up involvement in SHRM may help resolve the aforementioned persistent problems. The Ethiopian government might better loosen regulations, providing more autonomy to hospitals for SHRM and implement mechanisms that emphasize the quality of health services demanded rather than the quantity of human resources supplied.

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Challenges in moving toward universal health coverage: rising cost of outpatient care among Vietnam's insured rural residents, 2006–2018

Sepehri

Minh

2023

Public Health

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A holistic view on implementing hospital autonomy reforms in developing countries: a systematic review

Cited by 13 publications

References 25 publications

Human resource management in Ethiopian public hospitals

Human resource management in Ethiopian public hospitals

Human Resource Management in Ethiopian Public Hospitals

Challenges in moving toward universal health coverage: rising cost of outpatient care among Vietnam's insured rural residents, 2006–2018

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