This article is devoted to the question of human resources management in the health services sphere. Development a business-processes, enterprises in the public health, the transition to insurance medicine puts before the leader of medical founding a problem of improvement of organizing culture and quality of management, the fullest using the human resources to organizations. The decision of the given questions impossible without organizations of the managerial system by the personnel, identical development of market relations. The key problem that needs to be addressed is a hostile working environment in the healthcare sector. Outdated HR practices and employment requirements are the leading causes. The emergence of more attractive and high-paying jobs in the IT sector makes each medical worker more valuable. Therefore, better working contracts and conditions should be implemented and promoted. Furthermore, the advancements in technology should be considered in order to outsource the routine tasks; thus, it will allow hospitals to employ specialists with higher skillset.
The topic of the given proposal aims to analyze and investigate the intricacies and challenges of HR management in the healthcare sector. The purpose is to conduct a conclusive review and derive relevant recommendations for the issue. The main point involves the implementing of modern technology, addressing the problems with current medical workers, and overviewing hiring processes in healthcare. In summary, the transformation of social and economic processes in the modern society in transition dictates the need to consider the methods of multi-dimensional changes in the sphere of economics and management in the sectoral context, since many of the sectors have pronounced specific features, including in the field of human resource management.
In this regard, addressing the issues of research of personnel management systems in the health sector seems not only timely and relevant but also urgently needed. Firstly, there are significant problems accumulated over the years in the industry. Secondly, the issue persists due to underdevelopment and undeveloped theoretical approaches and the lack of practical improvements in the regulation of the human resource management system in healthcare. In addition, the problem remains because of the complexity and impossibility of adapting management practices that are traditional, for example, memberships, trade and related activities.
Review of Literature
There are numerous issues in the healthcare sector, however, the current HR practices show a significant degree of inefficiency and incompetence. The need for qualified professionals is highly important in hospitals, therefore, incorrect employment procedures are life-threatening. There are four factors that propagate the given issue: social, cultural, political, and legal (Flynn, Mathis, Jackson, & Valentine, 2016). The transformation of health from a socio-economic to a social-market resource of social reproduction depends not only on adequate transitions at the macro level but also on changes in the micro-order. It includes the reorganization of health care institutions into enterprises of social-market orientation and transition to developed market relations in health care. Market transformations could not affect the changes in the structure and quality of management (Matsumoto, 2018). The development of business processes, entrepreneurship in health care, and the transition to insurance medicine set before the head of a medical institution the task of improving the organizational culture and quality of management. In addition, it involves the complete use of the organization’s human resources. Solving these issues is impossible without the organization of a personnel management system that is adequate for the development of market relations.
The social element involves educational management and following monitoring. It is highly important to understand that the issue of training management personnel is of significant relevance. Human resources include managers, organizers of all levels of health care, and human resources managers. It also involves the development of a specialized personnel management service of a medical institution. It should be noted once again that the given issues are newly emerging. However, in developed countries, the functioning of health managers and hospital directors have long been the norm. For example, in the USA, the chief nurse, the director of the nursing service, directs the work of 1–2 thousand nurses and manages a budget of $ 1 million, fulfilling the functions of planning, organization, motivation, stimulation, and control (Matsumoto, 2018). The situation is aggravated by the underdevelopment of the market, economic mentality, lack of financial and managerial knowledge of the medical and administrative personnel of medical institutions, and the conservatism of this sphere in general.
The cultural aspect is imbedded in personnel modifications and alterations. Modeling the human resource management system assumes, from a research point of view, a preliminary analysis of regulatory procedures and relationships. This includes organizational structures in the health care institution, as well as the functions of monitoring subjects, the state of the reward system, and job satisfaction. It also involves the degree of readiness for innovations of the management practice are key parts of personnel organization units (Mihaylova, Dimitrov, Gradinarova, & Todorova, 2018). Health care is one of the most crucial elements in the functioning of any nation. Most health care is state property; the rest is under its direct control.
The political factor is represented in the form of recognizing medical institutions. Hospital facilities are in federal (state) or municipal property, but the work of these hospitals is organized in terms of the budget or revenue, and health care insurance system. It is developing market elements affected mainly the services, utilities, transport, energy and some others. The transition to market relations demanded significant changes in the health care system. The state health care system with strict administrative and economic management of state property, budget financing, departmental control over the volume and quality of medical care was relatively stable until the early 1980s (Flynn et al., 2016). Such funding allowed the state to maintain the illusion of free medical care at a cost significantly lower than it required.
There are some jurisdictional and legal influences, which include finances. The consequence of this state were the processes of deformation of the elements of the system, due to the depletion of financial resources. It was from this period that budget financing began to decline, which was manifested in a sharp decrease in the motivation of medical personnel to work and the outflow of workers from medical institutions. At the present stages of social development in order to find new economic conditions for the existence of the modern health care, the health insurance model is taken as the basis for the improvement (Mesko, Hetenyi, & Gyorffy, 2018). These trends in health care reform and objectively existing market relations in the field of medical services cause significant changes in the content and nature of health care workers.
These circumstances allow identifying a number of implications and recommendations that should be used when forming the personnel management system in a medical institution. First, the modern health care system, based on the model of medical insurance, exists relatively recently and somewhat changes its orientation in the healthcare activity. In the work of medical workers, there was a change of priorities from treatment to prevention, from mainly to inpatient care – to outpatient care, from the number of services provided – to their quality. In addition, the work of a medical worker has always been aimed at providing affordable, high-quality medical care to the population (Kessler, Heron, & Spilsbury, 2017). In conditions of competition with commercial medical structures and the emergence of extrabudgetary sources of funding, public health should pay great attention to this.
Second, the constant development of medical science, dynamism, the use of new methods of diagnosis and treatment necessitate professional and material and technical improvement. The functions of the doctor are changing, and fundamentally new workplaces of medical professionals are being created, equipped with modern equipment. That, in turn, requires considerable material costs. Moreover, with the introduction of medical insurance, the quantity and quality of services provided by health care institutions are accompanied by their financial responsibility to insurance organizations and citizens (Richman, 2015). At the same time, high-quality treatment leads to a reduction in costs for the treatment and prevention of diseases of a particular person, and consequently, an increase in the profits of the medical institution.
Third, the work of a health worker is initially subject to daily risk. Mistakes in many medical professions are unacceptable and can lead to tragic consequences. Thus, the work of a physician should constantly be aimed at reducing the likelihood of making mistakes and eliminating them in a timely manner, which requires an appropriate level of qualification and continuous improvement. In institutions related to the state and municipal healthcare, it is difficult to regulate the level of remuneration, as a result of which its incentive function is reduced (Buchelt, Fraczkiewicz-Wronka, & Kaminska, 2017). The system of incentives and wages is strictly regulated by the head department, which also makes it difficult to manage motivation based on economic methods.
Furthermore, competition from commercial clinics forces budgetary medical institutions to expand the range of services offered, to include additional services not included in the compulsory health insurance program. It also involves targeted comprehensive plans of the Healthcare Department to traditional medical services. The health worker’s daily responsibilities are prone to change over time. Due to the reduction of financing of healthcare institutions by means of the budget, the financial burden of medical institutions increased (Uduma et al., 2017). The introduction of the extrabudgetary sector of financing requires creative workers to take the initiative and put forward new ideas to increase the effectiveness of both the preventive treatment process and the managerial one. Further research attention should be focused on investigating the motivational factors of medical workers in order to design effective human resource management practices.
The next peculiarity is due to the specific manifestation of the result of the professional activity of persons engaged in health care. The therapeutic effect manifests itself not immediately; in addition, the service is both social and individual. The result, in spite of its individuality, can be of different volume. From the facility of one doctor to only one patient, to the service of one doctor to groups of patients of various numbers, specific diseases, then the result will be distributed to the whole group. An example of this may be the activity of the local doctor (Car, Kyaw, & Atun, 2018). Thus, it is difficult to take into account the result of labor, to build an effective incentive system based on a fair accounting of the employee’s labor contribution.
Thus, at present, many hospital institutions are beginning to restructure their activities, taking into account the possibility of obtaining funds, not from budget funds. In connection with the transition to the market, the work of health care workers began to acquire new substantive aspects, including competitiveness, creativity, and innovation (Uduma et al., 2017). The leaders of health care institutions are beginning to realize that they need to become increasingly competitive in the market of medical services. For this, the organization should use all its available resources, including human, as efficiently and fully as possible.
When considering the human resource management system in health care institutions, it is mandatory to take into account several characteristics inherent in the management system of the industry. It will have a direct impact on the process of implementation of certain functions in the field of HR management. Among these elements is the monopolism of the department and red tape in management, including the division of labor (Richman, 2015). In addition, the strict hierarchical structure alongside with professional prejudices, such as the reluctance of medical professionals to recognize the role of other employees in the field of health care – economists, lawyers, personnel managers. In-depth specialization and the focus of the organization, especially on consumers make the working conditions even more unpleasant for the medical worker (Flynn et al., 2016). Lastly, there are strict obedience and precise execution of orders of the leadership, which diminish the freedom of medical employees.
In conclusion, the key problem is an unwelcoming and hostile working environment created for medical workers. In the past, these circumstances were tolerable due to the pay. However, the emergence of alternative and more attractive jobs in the IT industry makes every healthcare specialist more valuable. Labor incentives are mainly based on material incentives for workers, while the possibility of material incentives is limited by the options of the state budget. Insignificant attention is paid to non-material incentives: moral encouragement through the system of delivery of certificates, letters of thanks; socio-psychological incentives; creative; organizational, social, which are developed extremely poorly. Among the functions of personnel management, such personnel management subsystems as selection, labor movements, adaptation and planning of personnel require deeper work. Special attention needs to be given to the staff motivation subsystem and the rewarding management system.
In addition, when building personnel management systems in health care, it should be understood that there are many features of general management and HR management, including in individual healthcare institutions, in individual teams. Understanding the need for scientific management of personnel in this area came relatively recently. Consequently, those managers and organizations that are on the path of forming a personnel management system in a health care institution will have to develop new methods of personnel management. Thus, the management system of medical institutions has a number of features that have evolved gradually and under the influence of market principles of the economy. These features should be considered in an integrated approach to building a human resource management system.
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