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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Representative of the Work Council

HR ProfessionalLinemanagerHealthcare Institutions

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2222

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Representative of the Work Council

HR ProfessionalLinemanagerHealthcare Institutions