HRH: The effect of human resource management on performance in hospitals in Sub-Saharan Africa: a systematic literature review

5 May, 2019

'Our review identified remarkable little evidence on the relationship between HRM and patient outcomes. Moreover, the presented evidence often fails to provide contextual characteristics which are likely to induce variety in the performance effects of HRM interventions.' This is the conclusion of a recent systematic review in the OA journal Human Resources for Health. Citation, abstract and comment from me below.

CITATION: The effect of human resource management on performance in hospitals in Sub-Saharan Africa: a systematic literature review

Philipos Petros Gile, Martina Buljac-Samardzic and Joris Van De Klundert

Human Resources for Health 2018;16:34

https://doi.org/10.1186/s12960-018-0298-4

ABSTRACT

Hospitals in Sub-Saharan Africa (SSA) face major workforce challenges while having to deal with extraordinary high burdens of disease. The effectiveness of human resource management (HRM) is therefore of particular interest for these SSA hospitals. While, in general, the relationship between HRM and hospital performance is extensively investigated, most of the underlying empirical evidence is from western countries and may have limited validity in SSA. Evidence on this relationship for SSA hospitals is scarce and scattered. We present a systematic review of empirical studies investigating the relationship between HRM and performance in SSA hospitals.

Following the PRISMA protocol, searching in seven databases (i.e., Embase, MEDLINE, Web of Science, Cochrane, PubMed, CINAHL, Google Scholar) yielded 2252 hits and a total of 111 included studies that represent 19 out of 48 SSA countries.

From a HRM perspective, most studies researched HRM bundles that combined practices from motivation-enhancing, skills-enhancing, and empowerment-enhancing domains. Motivation-enhancing practices were most frequently researched, followed by skills-enhancing practices and empowerment-enhancing practices. Few studies focused on single HRM practices (instead of bundles). Training and education were the most researched single practices, followed by task shifting.

From a performance perspective, our review reveals that employee outcomes and organizational outcomes are frequently researched, whereas team outcomes and patient outcomes are significantly less researched. Most studies report HRM interventions to have positively impacted performance in one way or another. As researchers have studied a wide variety of (bundled) interventions and outcomes, our analysis does not allow to present a structured set of effective one-to-one relationships between specific HRM interventions and performance measures. Instead, we find that specific outcome improvements can be accomplished by different HRM interventions and conversely that similar HRM interventions are reported to affect different outcome measures.

In view of the high burden of disease, our review identified remarkable little evidence on the relationship between HRM and patient outcomes. Moreover, the presented evidence often fails to provide contextual characteristics which are likely to induce variety in the performance effects of HRM interventions. Coordinated research efforts to advance the evidence base are called for.

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COMMENT (NPW): 'More research is called for', as usual. In the meantime what are the priorities to 'improve the performance' of the health workforce? Is it now desirable and feasible to move towards health systems that are not only 'people-centred', but also 'health-worker-centred'? Systems that focus on meeting health workers' basic needs to empower them to deliver safe effective care, and that measure progress towards meeting those needs? I have no HR experience or expertise, but it seems clear to me that health workers currently (and this is a worldwide phenomenon) do not feel their needs are adequately prioritised nor addressed. And until they feel this is the case, patient care will suffer and the aspiration of person-centred care will remain a mirage.

Best wishes, Neil

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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org