Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany |
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| Institution: | 1. Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden;2. IWAK, Institute of Economics, Labour and Culture (IWAK), Goethe-University Frankfurt, Germany;1. College of Nursing, Research Institute of Nursing Science, Seoul National University, South Korea;2. Department of Nursing, Kangwon National University, South Korea;3. School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC;1. Department of General Practice and Health Services Research, University Hospital Heidelberg, Germany;2. Health Innovation Program, University of Wisconsin-Madison, United States;3. National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (Wessex) and University of Southampton Centre of innovation and Leadership in Health Sciences, United Kingdom;4. Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Québec, Canada;5. The Australian Health Workforce Institute, Melbourne School of Population and Global Health, The University of Melbourne, Australia;6. Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre and Knowledge Centre of Sustainable Healthcare, Nijmegen, The Netherlands;7. HAN University of Applied Sciences, Nijmegen, The Netherlands;1. NIVEL – Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, The Netherlands;2. Utrecht University, Department of Human Geography, Utrecht, The Netherlands;3. Utrecht University, Department of Sociology, Utrecht, The Netherlands;4. Hochschule Fulda – University of Applied Sciences, Department of Health Sciences, Leipziger Straße 123, 36037 Fulda, Germany;1. University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC;2. Commission on Graduates of Foreign Nursing Schools, Philadelphia, PA |
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| Abstract: | Health workforce needs have moved up on the reform agendas, but policymaking often remains ‘piece-meal work’ and does not respond to the complexity of health workforce challenges. This article argues for innovation in healthcare governance as a key to greater sustainability of health human resources. The aim is to develop a multi-level approach that helps to identify gaps in governance and improve policy interventions. Pilot research into nursing and medicine in Germany, carried out between 2013 and 2015 using a qualitative methodology, serves to illustrate systems-based governance weaknesses. Three explorative cases address major responses to health workforce shortages, comprising migration/mobility of nurses, reform of nursing education, and gender-sensitive work management of hospital doctors. The findings illustrate a lack of connections between transnational/EU and organizational governance, between national and local levels, occupational and sector governance, and organizations/hospital management and professional development. Consequently, innovations in the health workforce need a multi-level governance approach to get transformative potential and help closing the existing gaps in governance. |
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| Keywords: | Health workforce governance Health human resources policy Multi-level governance Nurses and physicians Germany |
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