From Philippe Dutkiewicz & Nadine Hodler

Homes and hospitals: ‘home’ comes from the Germanic and originally meant ‘place where one settles’. ‘Hospital’ comes from the word ‘hospitalis’, originally referring to hospitality. Even today, healthcare facilities are still doing justice to these names. If I’m really unwell, I know that I can get help. No ifs and buts. No matter if I smell, no matter if I’m highly contagious. I can rely on hospital staff. I don’t care about football players, I’m a fan of doctors and nurses. This almost unconditional focus on the patient comes with a price though. And this price is often paid by hospital staff. They are exposed to infectious diseases, they work in environments that make scale effects incredibly difficult to achieve, they are subject to extreme mental strain and they tackle very particular and long working shifts. But there is one area in each home and every hospital that is tasked with taking care of these harried workers: HR. No ifs or buts here either. But there is the question of how well this HR department does its job and whether its customers are treated with the same level of hospitality. Over recent years, we have investigated a number of companies regarding the quality of their HR processes. Over the last year alone, we have taken a detailed look at HR as a whole in ten hospitals through HR team self-evaluation.

Value-adding processes vs. non-value-adding processes

In HR, we can differentiate between processes that add value and those that don’t. For example, the payroll process adds little value. Any such process can be described as a hygiene factor: if it always runs smoothly, everyone is happy. Nobody says, ‘bravo, thanks for paying me on time’. It’s a given, and the law gives you no other choice but to carry out this process correctly. These processes that add little value are generally very administrative in nature. Talent processes, on the other hand, can generate a lot of value when done well. When choosing new staff, you can shape what kind of company you are. With target setting processes, you are dictating the company’s focus and can motivate or demotivate employees. Good employee development promotes long-term employee loyalty.

Administrative Processes in Focus

HR can contribute to a hospital being top of the leader board, or not. Staggeringly, the majority of hospitals today focus very keenly on administrative tasks. On average, the HR teams admitted that they spend 60% of their focus on administrative tasks. This is also reflected in the level of digitisation: lots of time had already been invested in the digitisation of payroll administration and recording staff hours. And in areas such as organisational and master data management. So in solutions predominantly used by HR. Solutions for self services for staff, such as onboarding and offboarding, HR portals or travel and expense management solutions were much less widespread. When it comes to talent management (applicant management, target setting processes etc.), the situation is mixed. It’s difficult to say exactly what the cause is here. Pointing the finger at HR would be to simplify the matter. Hospital HR departments work in an environment where it is difficult to establish employee-centred digital processes and self services. Possible hypotheses:

• It is generally challenging to drive innovation in an environment that is often run by local government. Instead of defining a goal and then optimising and digitising step by step, lengthy tenders and rigid concepts are unavoidable. Even once a decision has been made, your hands are tied when it comes to the solution as another tender would otherwise be required.
• Many hospitals are dependent on hospital-specific solutions. For example, for scheduling. These solutions are, however, often not built from the employee perspective, rather from the viewpoint of resource planning. They are also not part of other HR systems. The result is complex interface requirements and architectures. Once these are built, you hardly dare intervene with them.
• In classic specialist organisations, it’s somewhat more difficult for people without that specialist background to carry out the necessary buy-in – with fatal consequences. HR finds itself in a purely reactive role, pushed into an administrative corner. Most hospitals work with business partners but the roles are often not taken seriously.

How ‘Good’ HR Works

If you manage to establish ‘good’ HR in hospitals and healthcare facilities, you can really contribute major value. In a study of 283 Canadian retirement homes almost 20 years ago, it was shown that institutions with a strong level of participation and strong employee support had a higher level of patient satisfaction. Various studies have shown that good recruitment and staffing contribute to achieving better outcomes in patients (e.g. lower mortality). What’s more, better wellbeing can lead to less fluctuation. What is considered good HR does not always have to be identical. But some guiding principles can help achieve quite a lot:

• Create mechanisms to ‘listen to’ staff: An employee survey every two years, for example, can do more harm than good.
• Co-creative approaches are also suitable for hospitals: Early, heavy involvement of ‘HR customers’ in projects avoids focus too strongly falling on HR administration.
• Less is more: Hospitals should focus on fewer strong solutions in digitisation. Best of breed approaches increase complexity but rarely lead to success.
• Everything in one place: There are practically no hospitals where staff can access all HR services and processes digitally in one place. This is not technically difficult nowadays and should be standard.
• Keep it simple: The framework conditions in hospitals are often complex enough. Processes should be kept as simple as possible. X-level approval processes can be avoided with good reporting. If there are multiple roles, one main responsible agent may be defined.
• HR must hold superiors responsible: Today, lots of approvals and tasks are delegated to assistants in hospitals. Such pro forma exercises achieve nothing yet pose a legal risk for superiors.
• Power to the (small) team: HR’s main task is not to establish modern organisation forms in hospitals. But it is HR’s job to recognise when staff are not appreciated enough and, for example, to make management aware of the consequences.
• Lead rather than be led:HR must lead management when it comes to HR matters, not the other way around. This also includes being able to highlight priorities and what costs may build up if investment is delayed. Process costs are also costs – nothing is more expensive than the mountain of paperwork that is still being carried out in many places.