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SPECIAL SECTION SLOVAKIA'S

HEALTH SYSTEM

Hospital human resource

planning in Slovakia

Hospital human
resource
planning
383

Robert Wagner

Slovak Postgraduate Academy of Medicine, Bratislava, Slovak Republic

and Health Management School, Bratislava, Slovak Republic

Svatopluk Hlavacka

Slovak Postgraduate Academy of Medicine, Bratislava, and

Ljuba Bacharova

International Laser Centre, Bratislava, Slovak Republic

Keywords Human resources planning, Hospitals, Slovakia
Abstract The study is an attempt to provide empirical evidence, in the context of acute hospital
care, of the current human resource practices in the health sector of the Slovak Republic. Using a
sample of 72 acute care hospitals the research explored the perceived functions, typical customers
and priorities of hospital human resource departments, ownership of a workforce plan, and the
relationships between ownership of a workforce plan and type of hospital, as well as the degree to
which different human resource activities are given priority. Cross-tabulation procedure revealed
statistically significant relationships between ownership of a workforce plan and the degree of
priority given to having a quick, efficient and cost-effective recruitment and selection system and,
not surprisingly, the degree of priority given to ensuring that the human resource department has
a workforce plan. The study evidence also indicates that, although the human resource staff in
hospitals seem to be aware of their role in assisting hospital management in decision making, the
human resource function in the Slovak hospitals still rather resembles that of a personnel
administration than that of an important strategic human resource activity.

Introduction
As Bhatti et al. (1998) note, organisations today operate in a world that is
increasingly deregulated, instantaneous, competitive, data computer rich and
Internet connected. This unprecedented rate of change, facing both public and
private sectors, produces a major reorientation of structures, systems and
management methods. In other words, organisations are being forced to
continue their business in conditions of cost constraints, market deregulation
and structural changes such as mergers and acquisitions. As a result, human
resource planning becomes of vital assistance in deciding which jobs are
essential and which will be lost (Zeffane and Mayo, 1994a). In a similar vein,
other writers argue that, in the current highly uncertain socio-economic climate,
human resource planning is emerging as a focal human resource activity, as it
is increasingly becoming an essential and very prominent boundary spanning
function (see, for example, Evans, 1991; Richards-Carpenter, 1989; Walker,
1989).

Journal of Management in Medicine,

Vol. 14 No. 5/6, 2000, pp. 383-405.
# MCB University Press, 0268-9235

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This view has also been supported by Marchington and Wilkinson (1996),
who strongly criticised some early 1990s writers, referring to human resource
planning as at best irrelevant, and at worst misguided and dangerous, in the
turbulent and increasingly insecure competitive environment of the late
twentieth century. Marchington and Wilkinson have stressed that such
opinions misunderstand the nature and uses of the planning process, and can
be used to justify ``ad-hocery'' and reactive management. However, planning is,
according to them, at least just as important during turbulent times, if not more
so, for at least four reasons:
(1) It encourages employers to develop clear and explicit links between their
business and human resource plans, and so integrate the two more
effectively;
(2) It allows for much better control over staffing costs and numbers
employed;
(3) It enables employers to make more informed judgements about the skills
and attitude mix in the organisation, and prepare integrated personnel
and development strategies;
(4) It provides a profile of current staff (for example, in terms of gender, race
and disability) which is necessary for moves towards an equal
opportunities organisation.
Additionally, some writers even argue that there is a new human resource
function in this economic era (see, for example, Rousseau and Arthur, 1999), which
consists of simultaneously positioning organisations and workers to respond
flexibly to market changes, while seeking stability by recruiting, developing and
retaining people whose talents are critical to the organisation. Evidently, human
resource planning should play one of the key roles in such a process.
In the light of these realities, it seems that, rather than being seen as an
anachronism, human resource planning may now be more important than ever,
and remaining constantly aware of employees' strengths and weaknesses and
catering for them in planning future needs should, therefore, form a primary
thrust of human resource management (see Margerison, 1991; Mayo, 1990).
Nevertheless, while such an importance is being assigned to human resource
planning by the western writers, research on human resource practice,
especially in the health-care context, in the central and eastern European
countries is rather scant. Moreover, some authors contend that personnel
management and human resource management practices, including human
resource planning, in central and eastern Europe still have a long way to go
before they represent anything like current practices in western organisations,
and that these activities have a low priority in many central and eastern
European organisations (see Garavan et al., 1998). If this is true for Slovakia's
health-care settings, then it is the reality that is likely to become a major issue if
left unattended, because, as Gill (1996) argues, workforce planning is of vital
importance in a service that is predominantly provided by people.

The present study has, therefore, attempted to examine some general aspects
of the current state of affairs in human resource planning in the Slovak health
sector. More specifically, it has focused attention on human resource planning
practices of the Slovak acute care hospitals and perceived functions, typical
customers and priorities of their personnel departments. In doing so, first, the
origins of and some conceptual frameworks for human resource planning are
briefly explored. Then, three main approaches to this activity, plus some recent
approaches to human resource planning in health care, are reviewed. Third,
human resource planning in Slovakia is briefly investigated. Fourth, a design of
the study is described and the results are discussed. Finally, some implications
for future practice are considered and conclusions are drawn.
The origins of and conceptual frameworks for human resource
planning
According to Rahman bin Idris and Eldridge (1998), modern human resource
planning dates from the 1940s when it was used to allocate staff and to develop
career structures in conditions of acute shortage of skills. However, as they
further explain, the status of human resource planning as a discipline with a
strong conceptual base was established only with Bartholomew's 1967 work on
stochastic models for social processes and Smith's 1971 models of manpower
systems. This stage of conceptual development was further reinforced by the
emergence of the corporate view of human resource planning in the mid-1970s
(see Bowey, 1975; Bramham, 1975), according to which human resource
planning follows from and is complementary to organisational strategy.
Bowey's (1975) conceptual framework involves the subdivision of human
resource planning into three broad categories of activity. First, there is an
assessment of future labour requirements, which presumably ought to be
derived from projected business expectations. Second, she refers to an
assessment of the organisation's ability to retain its current workforce, and any
replacements which may be necessary. Finally, there are predictions that have
to be made about the ability of the organisation to acquire or attract different
kinds of staff from the external labour market.
On the other hand, Bramham's (1975) concept of human resource planning
comprises four main activities investigating, forecasting, planning, and
utilising. The investigation provides an analysis of the external environment, a
review of the external labour market, and an audit of the internal labour
market. Forecasting refers to future and projected requirements and the
potential supply of that labour from within and outside the organisation.
Planning involves turning forecasts into personnel and development policies
for recruitment, training and development, absence control, and motivation and
reward. The final activity, utilisation, requires the human resource plans to be
compared against defined and important measures of organisational success,
such as customer satisfaction and product quality.
More recently, Khoong (1996) suggested an integrated system framework for
human resource planning. He claims that all the planning activities, which he

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calls perspectives, can interact with one another in intricate ways. However,
few insights have been, according to him, reported on such interactions and the
impact of these interactions on the resultant human resource plans. Khoong
maintains that the key human resource activities include:
.
establishment requirements planning;
.
career progression planning;
.
staff movement planning;
.
personnel assignment;
.
posting projection;
.
succession planning; and
.
recruitment, retention, staff promotions, postings and training as the
basic operational human resource activities that support human
resource plans.
Approaches to human resource planning
Over the years, many different approaches have been developed to accommodate
different types of constraints and the kind of policies under which the planning
system might operate (see, for example, Lawrence, 1980; Purkiss, 1981; Edwards,
1983; Gaimon et al., 1987; Wilson, 1987; Lee and Biles, 1988; Jorssen, 1989;
Dawson et al., 1990; Uwakweh and Maloney, 1991; Schuler and Huber, 1993;
Zeffane and Mayo, 1994b; Rothwell, 1995; Parker and Caine, 1996; Khoong, 1996;
Castley, 1996, Bramham, 1998). According to Marchington and Wilkinson (1996),
broadly these approaches have been applied to three sets of issues:
(1) forecasts of the demand for labour;
(2) forecasts of internal supply;
(3) forecasts of external supply.
Approaches to forecasting future demand
In general, there are basically two types of approaches to assessing future
demands for labour, the objective and the subjective. The objective approach
relies upon the projection of past trends and needs to take into account shifts
brought about by changes in technology and organisational goals. Simple
projections from the past to indicate the amount or type of labour required in
the future can be related to results from work study exercises or ratios of
customers to staff. These approaches often use techniques such as
extrapolation/regression, work/productivity, measurement, or econometrics
(see, for example, Bartholomew and Forbes, 1991; Bennison and Casson, 1984;
Verhoeven, 1982; Lawrence, 1980). On the other hand, the subjective approach,
in its most basic form, takes the form of managerial judgement about future
needs and, as Marchington and Wilkinson (1996) emphasize, in some cases it
can be an excuse for speculation and even guesses based on limited amounts of
data. For example, Schuler and Huber (1993) refer to the Delphi technique as

one of the approaches based on managerial judgement. The underlying

principle of this technique is that experts take turns in presenting their
forecasts and assumptions to others, who then make adjustments to their own
forecasts, and this process continues until a viable composite forecast emerges
(see also Torrington and Hall, 1995).

Hospital human
resource
planning

Approaches to forecasting internal supply

Walker (1992) suggests that there are two fundamental types of approaches to
forecasting internal supply to meet the future demands for labour. These are
represented by supply ``push'' and demand ``pull'' models, although there are
certain variants on this theme. In essence, both approaches rely, to various
extents, on mathematical modelling techniques and the probability that
historical movements of staff will be reproduced in the future. The supply
``push'' approaches are usually based on Markov analysis. Markov analysis is
named after a Russian mathematician to whom its development was attributed
in 1907 (see, for example, Parker and Caine, 1996). It is a descriptive technique
that falls within the family of mathematical modelling techniques known as
stochastic models. To have any chance of success, this approach relies upon
large numbers of employees in an organisation, a relatively stable and
predictable career structure, and broadly consistent aggregate wastage rates,
that is, the ratio of the number of leavers in a year to average numbers of staff in
post during that year. In addition, whilst some interaction can be modelled by
treating entities which leave the system as entering an absorbing state, the
mathematics become more complex and confusing where entities also enter the
system and a source term is needed. There are indications, however, that despite
their complexity human resource plans based on Markov models are being used
more extensively, particularly in large organisations (see Raghavendra, 1991),
and some writers even argue that there are different versions of the basic
Markov models applied to human resource planning, which are basically simple
to use and easy to implement (see, for example, McClean, 1991).
On the other hand, the demand ``pull'' approaches are based upon movements
out of grades and release from the organisation as a whole, such that flows of
staff are triggered by vacancies or promotions. A useful way in which to
portray these approaches is, according to Bramham (1998), through the use of
the so-called ``camel'' model. The ``camel'' model (see Keenay et al., 1980)
proceeds to plot a matrix, with age distribution as one axis and grade as the
other, and then assesses the proportion of staff in any one grade at a particular
age. Having the proportion assessed, it is possible to establish the age
distribution of the organisation as a whole, or of a particular subset, and predict
likely shortages and blockages within the system. This can then activate the
search for viable solutions to overcome the existing problem.

387

Approaches to forecasting external supply

In reality, forecasting external supply seems to be a human resource planning
activity to which a majority of the texts devote rather less attention than they

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do to forecasting internal supply. However, as Marchington and Wilkinson

further note, there are a number of factors which determine the supply of staff
from the external labour market, both at a national and at a local level, and
these are influenced by economic, social and legal issues. Not surprisingly,
therefore, there is a growing literature on ``the need to approach human
resource planning, especially education and skills development planning
through labour market signals. Such an approach has come to be known as
labour market analysis (see, for example, Mugtada and Hildeman, 1993).
According to Castley (1996, p. 16), this approach is a much wider concept than
human resource planning, since it includes not only enrolment guidance but
also the unemployed and underemployed and, therefore, requires additional
functions, such as measuring wages as a possible cause of skill shortages,
shifting of the cost of training from the general taxpayer to the direct
beneficiaries, or encouraging the development of private training institutions,
which are considered to be more cost conscious and market responsive.
Naturally, it may be difficult to imagine how this can be achieved at an
organisational level. However, first, taking this into consideration may help
human resource planners in developing economic and environmental scenarios,
allowing them to identify external factors that will affect the organisation and
to calculate the impacts of such change on human resource plans. Second, this
approach seems to be highly relevant for the countries in which the state still
plays an important role in the management of the health-care system, as in
Slovakia.
Some recent approaches to human resource planning in health care
Finally, it seems worthwhile to shift attention to some more recent approaches
to human resource planning, the use of which has been made in health-care
settings, namely reprofiling, skill mix, and the workload indicators of staffing
need approach (see Gill, 1995, 1996; Bevan et al., 1991; Shipp, 1998
respectively), though it is recognized that discussion on human resource
planning in health care has been around for much longer (see, for example,
Todd, 1983; Hoare and Lee, 1984; Linstead, 1984; Lockwood, 1986; Bussey,
1986; Reed, 1992; Short and Wright, 1993).
Reprofiling is typically defined as ``the process of identifying the
characteristics of the workforce, e.g. skills, profession, age, grade, numbers,
costs, and altering them to arrive at a profile that will meet the organisation's
need for providing cost-effective health care. Reprofiling will examine all of the
characteristics of the workforce and will involve choosing which of these need
to be altered to achieve objectives (Gill, 1995, pp. 14-15). There are four basic
methods of reprofiling:
(1) task analysis;
(2) activity sampling;
(3) zero based method;
(4) the combined approach.

Task analysis has two distinct phases. The first one is concerned with
measuring existing workflows and paths. The second phase refers to assessing
the skills and knowledge needed now and in the future. This method is
considered to work best where the activities are clearly defined and
measurable. Another method of reprofiling activity sampling is in its purest
form a statistical process dependent on the accurate recording of activities
being undertaken at specific time intervals. It is usual to collect this
information for a minimum of two weeks. Once this information has been
collected, it is typically analysed using a computer spreadsheet or database.
Third, zero based methods draw from a wide discussion as to the purpose of
the particular function or department. Having established and agreed the
purpose, the work, tasks and activities that need to be undertaken to meet the
objectives of the function or department are then considered. Finally, the
combined approach builds on the strengths of other methods without needing
to consider any of their disadvantages. Gill (1995) maintains that the method
works best when, first, the zero based approach to identify clearly the staff
groups who should take on the identified tasks is used. Second, the staff groups
are then compared with current activity, by using data drawn from either
activity sampling or task analysis. Finally, from this comparison an action plan
for achieving change is developed.
Skill mix, as the second approach to human resource planning in health care
reviewed here, only looks at the skill factor. As Bevan et al. (1991) explain, this
approach focuses on ensuring the optimal distribution of skills among the
workforce, so that a cost-effective service can be provided. This often means
looking at the extent to which particular skills being used are appropriate to
particular grades of groups of staff and, if necessary, having the skill
performed by another group or grade of staff with appropriate training.
Finally, the workload indicators of staffing need method for planning health
staff should be mentioned here as the one being implemented by the Ministry of
Health in the health sector of the Slovak Republic. This approach has been
developed for the World Health Organization by Peter J. Shipp Initiatives, Inc.
(1998) in response to the failure of other methods, for example, population
ratios and standard staffing schedules, to take into account the wide local
variations which are found within every country, such as the different levels
and patterns of morbidity in different locations, the ease of access to different
facilities, the patient attitudes in different parts of the country to the services
provided, and the local circumstances. This method allows for calculating:
.
the optimal allocation and deployment of current staff geographically,
that is, allocating staff to regions within a country, districts within a
region, areas within a district, and so on, according to the volume of
services which are being delivered and the different types of health staff
which are required to deliver these services;
.
the optimal allocation and deployment of current staff functionally, that
is, allocating staff between different types of health facilities or different

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.

390
.

health services in the country as a whole, in a region, in a district, in an

area, etc., according to the volume of services which are being delivered
and the different types of health staff which these services call for;
the optimal staffing patterns and levels (categories and numbers) in
individual health facilities according to local conditions (morbidity,
access, attitudes) and not based on national averages (population ratios
and standard staffing schedules);
the optimal staff categories and their activities, that is, identifying where
combining existing staff categories or creating new categories will
achieve maximum health impact with maximum economy.

Design of the study

The aim of the present study was sixfold. First, to explore perceptions of the
main functions of hospital human resource departments in Slovakia among the
managers of these departments. Second, to identify who are considered to be
the typical ``customers'', both internal and external, of hospital human resource
departments in Slovakia. Third, to ascertain the degree to which six essential
human resource activities, as outlined by Collins (1992), are given priority by
human resource departments in the Slovak hospitals. Fourth, to examine how
many hospitals in Slovakia do have a workforce plan. Fifth, to investigate the
relationships between ownership of a workforce plan and type of hospital; and
finally, to scrutinize the relationships between ownership of a workforce plan
and the degree to which the above essential human resource activities are
perceived as being of priority, so as to gain more understanding about the
current human resource practice in the Slovak hospitals.
Sample and sources of data
A self-developed questionnaire survey in all 81 Slovak acute hospitals in all
eight regions of the Slovak Republic (Bratislava, Trnava, Nitra, Trencin, Zilina,
Banska Bystrica, Kosice, Presov) was carried out in February 2000. The
respondent for each hospital was the topmost human resource specialist
director or manager. A total of 72 usable questionnaires were received, a
response rate of approximately 89 per cent. The questions for the survey were
partly drawn from a package of diagnostic instruments developed by the UK's
West Midlands Regional Health Authority, an extract of which was presented
by Collins (1992). An analysis of the demographic features of the sample is
presented in Table I.
To supplement the quantitative data and to get a broader view of the
current human resource practice in the surveyed hospitals, two descriptive
items were incorporated into the questionnaire, one asking the respondent to
describe briefly the main functions of his/her hospital human resource
department, and the other one asking the respondent to list the typical
``customers'', both internal and external, of his/her hospital human resource
department.

Hospitals in the sample (%)

Number of employees
100-500
501-1,000
1,001-1,500
1,501-2,000
Over 2,000
Number of HR staff
1-5
6-10
Over 10
Region of Slovakia
Bratislava
Banska Bystrica
Kosice
Nitra
Presov
Trencin
Trnava
Zilina

44.4
29.2
15.3
2.8
8.3

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73.6
15.3
11.1
11.1
15.3
19.4
12.5
11.1
11.1
9.7
9.7

Measures
In addition to two descriptive items, each respondent was asked to indicate the
degree to which each of the following six essential human resource activities is
a current priority for his/her human resource department:
(1) analysing present and future demands for staff;
(2) ensuring that the department has a workforce plan for obtaining and
using staff in the future;
(3) reducing staff turnover/improving staff retention;
(4) having quick access to accurate labour market information;
(5) selecting the highest quality people;
(6) having a quick, efficient and cost-effective recruitment and selection
system.
The respondents were asked to indicate the degree of priority on a five-point
scale, ranging from 1 not a priority, through 2 low priority, 3 moderate
priority, 4 important priority, to 5 critical priority. These original priority
categories were later compressed into only three groups to allow for the more
appropriate use of statistical processing, due to a relatively small number of
cases within the sample. In consequence, the responses from categories 1 and 2
(that is, not a low priority) were allotted to group 1 low priority; the responses
from category 3 (moderate priority) were assigned to group 2 moderate
priority; and finally, the responses from categories 4 and 5 (that is, high and
crucial) were allocated to group 3 high priority.

Table I.
Demographic features
of the sample

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Statistical procedures
To analyse the data gathered by the survey, first, the descriptive statistics were
obtained for quantitative data, and frequencies and percentages calculated for
qualitative data, based on a content analysis of the two descriptive items.
Subsequently, to investigate the relationships between ownership of a
workforce plan and type of hospital, as well as the degree to which the
aforementioned human resource activities are a current priority for the hospital
human resource department, a cross-tabulation procedure was adopted, using
SPSS 8.0 for Windows software.
Additionally, a hierarchical cluster analysis, using between-groups linkage
and square Euclidean distance method, was applied to identify relatively
homogeneous groups of hospitals based on the different priority patterns of the
six essential human resource activities mentioned before. The significance of
differences between the clusters obtained was tested using the one-way
ANOVA.
Results and discussion
The main functions of hospital human resource departments
The results of the content analysis of the responses (see Table II) suggest that
in a majority of hospitals the human resource specialists perceive the main
functions of their departments to be recruiting and dismissing the workers,
doing various kinds of statistical analysis, processing the data for social and
health insurance companies, and filing the personal records of hospital
employees. Similarly, they believe that their departments' main functions
include administering the legislative aspects of labour relationships and
retirement, providing references on their former employees, administering the
part-time job agreements and scheduling vacations, but also ensuring
employee development and education. However, in only a very limited number
of hospitals is decision making viewed by the human resource staff among the
main functions of their departments.
Clearly, this picture of the role of human resource departments in the Slovak
hospitals is far from managing diversity in the workforce (Conant and Kleiner,
Function

Table II.
Main functions of
hospital human
resource departments
in Slovakia

Recruiting and dismissing the workers

Doing various kinds of statistical analyses
Processing the data for social and health insurance companies
Filing the personal records of hospital employees
Administering the legal aspects of labour relationships and
retirement
Providing references on former employees
Administering the part-time job agreements and scheduling
vacations
Ensuring employee development and education

Percentage of 72
92
90
89
89
86
79
75
75

1998), agency and interpersonal investments in community being the essential

twin themes around which the human resource function is built (Rousseau and
Arthur, 1999), selling management values across the whole organisation and
contributing to organisational performance (Tyson, 1999), or viewing human
resource management in the health-care context as an integrated set of
processes and practices which need to be adhered to from an integrated
perspective in order to optimise individuals' performance levels and to ensure
that the human potential can be exploited fully (Zairi, 1998a; 1998b). Moreover,
it is also far from aligning human resource policies to support quality and total
quality management practices (Redman and Mathews, 1998), having
significant effects on achieving different strategic visions of the organisation
(Chew and Chong, 1999), as well as from matching the management of human
resources to service operations (Lashley, 1998).
Most importantly, however, there was no mention, among the main
functions of hospital human resource departments, of the function of human
resource planning. It seems, therefore, unreasonable to expect that, in Slovakia,
people in the hospital human resource function could quickly follow
Lockwood's (1986) suggestion to take the lead in advising top management of
the importance of planning future staffing needs. Rather, this should be
anticipated to be a longer and difficult process requiring a fundamental change
in perceptions of the human resource function in hospitals.
Typical ``customers'' of hospital human resource departments
As the content analysis indicates, human resource departments in the surveyed
hospitals ``sell'' the outputs of their work to many different individuals, units
and organisations. With respect to internal ``customers'', 94 per cent of hospital
human resource specialists in Slovakia view their hospital director as the main
``customer'' of the outputs of their department; 68 per cent of them assign this
role to their hospital deputy directors and 62 per cent to heads of the particular
hospital wards, followed by 44 per cent of human resource specialists
perceiving head nurses to be among the typical ``customers'' of their outputs.
Additionally, 38 per cent consider hospital employees and 22 per cent the
hospital economic and accounting department to belong to their ``customers''
group.
With regard to external ``customers'', 50 per cent of hospital human resource
specialists perceive the social insurance company to be the main ``customer'' of
their department work outputs; 42 per cent view the Ministry of Health, 35 per
cent labour offices, 28 per cent health insurance companies, 25 per cent the
Slovak Institute of Health Information and Statistics, and 22 per cent national
and regional statistical offices as their main ``customers''.
On the one hand, these findings show that human resource staff in hospitals
seem to be aware of their role to assist the hospital management in decision
making. On the other hand, when viewed in the light of the previous findings
on the perceived main functions of human resource departments in hospitals,
this role seems to be rather administrative. Massey (1994), however, argues that

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the contribution of the human resource function should also be made at the
strategic level. In other words, it should include not only day-to-day personnel
administration, such as personnel records, payroll, and administration of
benefit programmes, but establishing the overall direction and objectives of
key areas of human resource management as well.

394

Priorities of hospital human resource departments

The results of a hierarchical cluster analysis classify the Slovak hospitals into
five different groups on the basis of similar priority patterns that they assign to
different human resource activities (see Table III).
First, there is a group of five hospitals which can be labelled as ``HR
passive''. They assign a low, or even zero, priority to all human resource
activities investigated by the present study that is, analysing present and
future demands for staff (1.40), ensuring that the department has a workforce
plan for obtaining and using the staff in the future (1.20); reducing staff
turnover and improving staff retention (1.40), having quick access to accurate
labour market information (1.00), selecting the highest quality people (1.20),
and having a quick, efficient and cost-effective recruitment and selection
system (1.20).
Such an approach is highly inconsistent with Martin's (1994) findings of the
research in a range of health-care agencies, indicating that, even allowing for
differing notions of ``success'', high performing health-care organisations
realize the importance of the human resource dimension. The relevance of his
findings seems to be supported by the fact that the definition of successful or
high performing organisations in the research was established in relation to
local criteria. For example, in the USA, these were the hospitals or systems with
high levels of return on equity, return on assets, operating margin and net
income; in the UK, units which balance sound financial management with high
quality services (very similar to the Slovak perception of health-care success
criteria). In addition, all hospitals in this group consistently express total
HR
C1 (N = 5)
activities Mean SD

Table III.
Results of hierarchical
cluster analysis
(squared Euclidean
distance) and one-way
ANOVA for
significance of
differences in a priority
given to each HR
activity between the
clusters obtained

A
B
C
D
E
F

1.40
1.20
1.40
1.00
1.20
1.20

0.55
0.45
0.89
0.00
0.45
0.45

Clusters
C2 (N = 55) C3 (N = 7)
Mean SD Mean SD
4.09
3.64
3.69
3.67
4.53
3.87

0.62
0.62
0.74
0.88
0.54
0.61

2.86
2.57
1.71
2.86
4.29
3.57

0.90
0.79
0.49
0.90
0.49
0.53

C4 (N = 3)
Mean SD
2.33
2.67
3.67
3.00
3.00
1.33

0.58
1.15
0.58
1.00
1.00
0.58

C5 (N = 2)
Mean SD
4.50
1.50
4.00
2.00
4.50
2.50

0.71
0.71
0.00
1.41
0.71
0.71

Significance
F
p<
28.15
23.34
21.64
12.83
45.44
35.34

0.001
0.001
0.001
0.001
0.001
0.001

Notes: A: Analysing present and future demands for staff; B: Ensuring that the department
has a workforce plan for obtaining and using staff in the future; C: Reducing staff turnover/
improving staff retention; D: Having quick access to accurate labour market information;
E: Selecting the highest quality people; F: Having a quick, efficient and cost-effective
recruitment and selection system

disinterest in accurate labour market information. However, an integrated

human resource planning system requires determining both internal and
external factors that may affect the organisation (Zeffane and Mayo, 1994b).
The second group is the largest, comprising 55 of the surveyed hospitals.
For this group, that could be called ``HR active'', it is typical to assign a high
priority to analysing demands for staff (4.09) and selecting the highest quality
people (4.53), with a consistently moderate priority being given to all other
human resource activities (3.64 for ensuring a workforce plan, 3.69 for reducing
staff turnover, 3.67 for having quick access to labour market information, 3.87
for having an efficient recruitment and selection system). It seems, therefore,
that 76 per cent (55 out of 72) of hospitals are at least partly aware, among other
things, that the inability of professionalisation of selection processes may
contribute to the perpetuation of poor selection practice (Lupton, 2000).
The third group consists of seven hospitals which may be labelled as ``HR
selectors''. The reason for such a label is that they give important priority to
selecting the highest quality people (4.29) and moderate priority to having a
quick, efficient and cost-effective recruitment and selection system, whilst only
low priority to other researched human resource activities. Notwithstanding
emphasis being put on the selection process, such an approach may prove to be
short of getting things right, as these hospitals may find themselves employing
a number of the highest quality staff (assuming that they have an adequate
selection system in place), when there is no actual demand for so many staff
within the hospital. As Marchington and Wilkinson (1996) note, a problem may
arise when an organisation is forced to restructure, and management realises
that it has recruited too many staff with the wrong skills, and panic measures
are taken. Naturally, this can cause difficulties, especially in today's health-care
environment which calls for cost-consciousness that requires every staff
function to justify its existence in bottom-line terms (Humble, 1988).
The fourth group of three hospitals could be best described as ``HR
maintainers'', because they seem to assign low to moderate priority to
analysing demands for staff (2.33), ensuring a workforce plan (2.67) and having
an efficient recruitment and selection system (1.33) and, at the same time,
moderate priority to having access to labour market information (3.00) and to
selecting the highest quality people (3.00). In addition, they give slightly higher
priority to reducing staff turnover and improving their retention.
Finally, there are two hospitals for which it is typical to give important, or
almost crucial, priority to analysing future demands for staff (4.50), selecting
the highest quality people (4.50) and reducing staff turnover/improving staff
retention (4.00). On the other hand, they assign rather low priority to having
efficient recruitment and selection system (2.50), having quick access to labour
market information (2.00) and, the lowest of all, to ensuring a workforce plan
(1.50). This small group of two could be called ``HR pragmatists'', as they seem
to put emphasis on three important human resource activities and objectives
without paying too much attention to the manner of their accomplishment. In
particular, they perceive the analysis of demands for staff as important, whilst

Hospital human
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giving almost no priority to having a workforce plan might simply mean that,
once having the data on future staff demands, rewriting them into a plan is a
worthless paper exercise.
Ownership of a workforce plan in hospitals
The findings indicate that only 39 per cent of human resource departments in
the surveyed hospitals have a workforce plan, whereas in 61 per cent of
hospitals they do not have any. These results quite clearly show that human
resource planning, at least at a formal level, in the Slovak acute care hospitals is
rather neglected. Adopting Marchington and Wilkinson's (1996) perspective,
this would mean that hospitals are giving up the major advantage of planning
in advance, that is allowing managers to consider a range of solutions rather
than being pressurised into adopting the only realistic option which remains
open to them as a last-ditch attempt to avoid crisis. Furthermore, Rahman bin
Idris and Eldridge (1998) contend that informal human resource planning is the
one that has greater flexibility of response and is relatively easier to enact.
Nonetheless, they admit that the drawback of informal human resource
planning is that it may exist only in the mind of the chief executive, and hence
its outputs may not be meaningful to all key decision makers.
In the context of Slovak health care, such a risk of lack of meaning seems to
be undesirable for at least two reasons. First, from the perspective of hospitals,
as the health system is still quite centralised and the Ministry of Health is a key
decision maker with respect to determining the network of health-care
providers, hospitals may find it a severe limitation that they lack the objective
data to justify the existence of their current staffing patterns and numbers.
Second, from the perspective of the Ministry, to have the appropriate data on
hospital staff future needs or workload may be important with respect to the
Ministry's budgetary planning responsibilities.
The relationships between ownership of a workforce plan and type of hospital
In order to gain more insight into the above findings, the relationships between
ownership of a workforce plan and type of hospital were examined. In the
Slovak health care system, there are three different types of hospitals. These
types are based on the hospital's bed capacity, type of services provided and
hospital geographic location:
.
Type I rural hospitals have typically 30 to 300 beds, are located in
small towns and rural areas and deliver services mostly in up to four
basic specialties (internal medicine, surgery, paediatrics, and
gynaecology).
.
Type II small urban hospitals include hospitals with approximately
400 to 800 beds, located in district cities and providing specialised care.
.
Type III large urban hospitals refers to hospitals with 900 to 1,200
beds, located in regional cities and in the capital city of Bratislava, and
providing highly specialised care, usually at a national level.

The results of the cross-tabulation procedure (see Table IV) reveal no

statistically significant relationship between ownership of a workforce plan
and type of hospital (Pearson Chi-Square 0.932; significance 0.647). In
other words, whether or not the hospital has a workforce plan is related neither
to the type of services it delivers, nor to its bed capacity and geographic
locality.
Thus, although Rahman bin Idris and Eldridge (1998) propose that informal
planning without a workforce plan may be preferable in a small organisation,
this does not seem to apply to the Slovak acute care hospital environment.
Furthermore, the fact that existence of a workforce plan is also not linked with
the type of services and the hospital geographic locality seems to suggest that
the causes of this situation may be rooted more deeply in hospital managers'
beliefs, values and attitudes.

Hospital human
resource
planning
397

The relationships between ownership of a workforce plan and degree to which

six essential human resource activities are given priority
This section discusses the results of cross-tabulation procedure applied to
investigate the relationships between ownership of a workforce plan and the
degree to which the following are given priority by hospital human resource
departments (see Table V):
Type of hospital
I
II
III
Total

Count
Expected
Count
Expected
Count
Expected
Count
Expected

count
count
count
count

Priority
Analysing
Low
Moderate
High
Total

Count
Expected
Count
Expected
Count
Expected
Count
Expected

count
count
count
count

Yes

Workforce plan
No

Total

10
11.7
14
12.1
4
4.3
28
28.0

20
18.3
17
18.9
7
6.7
44
44.0

30
30.0
31
31.0
11
11.0
72
72.0

Yes

Workforce plan
No

Total

2
4.3
3
3.1
23
20.6
28
28.0

9
6.7
5
4.9
30
32.4
44
44.0

11
11.0
8
8.0
53
53.0
72
72.0

Table IV.
Results of
cross-tabulation
procedure for the
relationships between
ownership of a
workforce plan and
type of hospital

Table V.
Results of
cross-tabulation
procedure for the
relationships between
analysing present and
future demand for staff
and ownership of a
workforce plan

JMM
14,5/6

.
.

.
.

398

.
.

analysing present and future demands for staff;

ensuring that the department has a workforce plan for obtaining and
using staff in the future;
reducing staff turnover/improving staff retention;
having quick access to accurate labour market information;
selecting the highest quality people;
having a quick, efficient and cost-effective recruitment and selection
system.

The findings show that there is no statistically significant relationship between

having a workforce plan in the hospital and the degree to which the hospital
human resource department considers analysing present and future demands
for staff to be a current priority (Pearson Chi-Square 2.444; significance 0.354).
This means that it does not necessarily follow that the hospital which gives a
high priority to analysing present and future demand for staff will have a
human resource plan. To determine the causes of such a practice, however, or
whether this is a typical case of an espoused priority, with ``ad-hocery''
muddling through in reality, further research is needed.
Not surprisingly, the findings demonstrate the existence of a statistically
highly significant relationship between the degree of priority to be assigned to
ensuring that the hospital human resource department has a workforce plan
and actually having such a plan (Pearson Chi-Square 10.059; significance 0.006)
(Table VI). This confirms that, at least in this case, there is no gap between
claiming the importance of having a human resource plan by the hospital
human resource departments and their actual actions.
The results do not imply any statistically significant relationship between
ownership of a workforce plan and the degree of priority being given by the
hospital human resource department to reducing staff turnover and improving
staff retention (Pearson Chi-Square 2.025; significance 0.341) (Table VII).
Nevertheless, under more careful scrutiny of the expected and actual counts of
the cases, there seems to be a slight tendency of the hospitals which do have a
Priority
Table VI.
Results of
cross-tabulation
procedure for the
relationships between
ensuring that the
department has a
workforce plan and
ownership of a
workforce plan

Ensuring
Low
Moderate
High
Total

Count
Expected
Count
Expected
Count
Expected
Count
Expected

count
count
count
count

Yes

Workforce plan
No

Total

2
5.4
6
8.9
20
13.6
28
28.0

12
8.6
17
14.1
15
21.4
35
35.0

14
14.0
23
23.0
35
35.0
72
72.0

workforce plan to assign higher priority to reducing staff turnover and

improving its retention, than among those that have no plan at all. Thus,
achievement of these two objectives might be one of the reasons behind the
hospital efforts invested in development of a workforce plan.
Also in this case, no statistically significant relationship was found between
ownership of a workforce plan by a hospital and the degree to which having
quick access to accurate labour market information is a current priority for the
hospital human resource department (Pearson Chi-Square 3.435; significance
0.221) (Table VIII). However, as above, again there seems to be scant indication
of a tendency to give higher priority to having quick access to accurate labour
market information by the hospitals with a workforce plan, in comparison with
those without such a plan.
The findings in Table IX show an absence of a statistically significant
relationship between possession of a workforce plan and the degree of priority
given by the hospital human resource department to selecting the highest
quality people (Pearson Chi-Square 2.813; significance 0.329). This means that,
even though the hospital pays attention to choosing the best people to work for
it, meeting this objective is not inevitably linked to the development of a
workforce plan. The risk in such an approach, however, results in the
possibility of ending up with high quality but redundant people.
Priority
Reducing/improving
Low
Count
Expected
Moderate
Count
Expected
High
Count
Expected
Total
Count
Expected

Yes

count
count
count
count

Priority
Having quick access
Low
Count
Expected
Moderate
Count
Expected
High
Count
Expected
Total
Count
Expected

count
count
count
count

Workforce plan
No
8
7.9
16
13.4
20
22.6
44
44.0

13
13.0
22
22.0
37
37.0
72
72.0

Yes

Workforce plan
No

Total

12
9.2
12
11.6
20
23.2
44
44.0

399

Total

5
5.1
6
8.6
17
14.4
28
28.0

3
5.8
7
7.4
18
14.8
28
28.0

Hospital human
resource
planning

15
15.0
19
19.0
38
38.0
72
72.0

Table VII.
Results of
cross-tabulation
procedure for the
relationships between
reducing staff
turnover/improving
staff retention and
ownership of a
workforce plan

Table VIII.
Results of
cross-tabulation
procedure for the
relationships between
having quick access to
accurate labour market
information and
ownership of a
workforce plan

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400

Finally, the results in Table X indicate that a statistically highly significant

relationship exists between ownership of a workforce plan and the level of
priority assigned by the hospital human resource department to having a
quick, efficient and cost-effective recruitment and selection system (Pearson
Chi-Square 8.695; significance 0.011).
These findings seem to suggest that the hospitals which plan their staff
demands do not perceive this activity as isolated. Rather, they view it in
association with an efficient recruitment and selection system that would be
able to meet the envisaged requirements.
Conclusions and implications
The data collected as part of this study suggest that, in terms of the
contemporary western concepts and views of the main HR functions, human
resource planning is rather underdeveloped in the acute care hospitals in
Slovakia. In this respect, there seems to be little evidence that human resource
specialists in the Slovak hospitals recognise it as being important, for example,
that, if proper attention is devoted to the human resource issues, then this is
very often followed by high productivity and better competitiveness (Zairi,
1998a); or that, in the current socio-economic environment, the human resource
function should become more directly involved in the overall business
Priority

Table IX.
Results of
cross-tabulation
procedure for the
relationships between
selecting the highest
quality people and
ownership of a
workforce plan

Selecting
Low

Table X.
Results of
cross-tabulation
procedure for the
relationships between
having a quick,
efficient and costeffective recruitment
and selection system
and ownership of a
workforce plan

Priority

Moderate
High
Total

Count
Expected
Count
Expected
Count
Expected
Count
Expected

Having a system
Low
Count
Expected
Moderate
Count
Expected
High
Count
Expected
Total
Count
Expected

count
count
count
count

count
count
count
count

Yes

Workforce plan
No

Total

1
2.3
0
0.8
27
24.9
28
28.0

5
3.7
2
1.2
37
39.1
44
44.0

6
6.0
2
2.0
64
64.0
72
72.0

Yes

Workforce plan
No

Total

1
3.9
3
5.8
24
18.3
28
28.0

9
6.1
12
9.2
23
28.7
44
44.0

10
10.0
15
15.0
47
47.0
72
72.0

activities, including strategy implementation and reorganisation (Zeffane and

Mayo, 1994b), especially in the health-care environment, in which human
resource management is a critical way in which hospitals deliver care and
attention to their patients and as such it impacts ultimately on performance
(Zairi, 1998a).
Furthermore, the human resource function in Slovak hospitals still
resembles rather that of a personnel administration than that of an important
strategic activity. This is conspicuously significant in the light of the fact that,
in the hospitals today, staff costs represent a major proportion of their overall
budget, and under the ongoing structural changes within the Slovak health
sector, there is strong emphasis on creating financial accountability and
increasing cost-effectiveness. However, in deference to Baker (1999), one should
expect that in such a situation the cost-effective deployment of the workforce
would be among the key priorities.
In attempting to explain this, it is inevitable, first, that one should draw
attention to Garavan et al. (1998), who point out that the communist system
was not conducive to the growth of human resource activities, so there was
significant ground to be made up. Second, rephrasing these authors'
conclusions on managing human resources in the Polish post-command
economy, the reasons behind the Slovak hospitals' focus tending to be on
administration and welfare issues with only limited attempts at human
resource planning can be that the ``strong'' notion of human resource
management, that this approach suggests, may be culturally inappropriate not
only in the Polish but, as the findings seem to indicate, in the Slovak health-care
context as well where, similar to Poland, significant value is placed on the
family and egalitarianism (see also Letiche, 1998).
Notwithstanding this, the survey evidence also shows that, in a majority of
the acute care hospitals in Slovakia, at least moderate priority is being given to
such human resource activities as:
.
ensuring that the hospital human resource department has a workforce
plan for obtaining and using staff in the future;
.
reducing staff turnover and improving staff retention;
.
having quick access to accurate labour market information; and
.
having a quick, efficient and cost-effective recruitment and selection
system.
Additionally, a majority of hospitals give high priority to analysing present
and future demands for staff, and selecting the highest quality people.
These findings seem to indicate that an increasing number of hospital
human resource managers in Slovakia are probably starting to feel the
pressures of health-care reform and a very difficult transition to more marketoriented and decentralised management systems, even in the health-care
settings. In consequence, they seem to perceive the emerging need for a more
comprehensive and systematic approach to management and planning of

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hospital human resources in order to be able to ensure the best use of the
limited resources available.
One of the major challenges for the Slovak health-care administrators,
however, is to grasp the opportunity for implementation of modern human
resource planning practices, as there seems to be a gap between the degrees of
priority given to analysing present and future demands for staff, as well as
selecting the highest quality people, on the one hand, and actual ownership of a
workforce plan, on the other. To put it in the light of the more market-oriented
principles of supply and demand, there seems to be a higher need for some
system, method or procedure of analysing and selecting the appropriate
hospital workforce, but one of the potential satisfiers of that need developing
a workforce plan is not being recognised as a possible solution to this. More
importantly, the results suggest that this applies to all the acute care hospitals
in Slovakia, irrespective of their type, and thereby their bed capacity, extent
and pattern of services provided and their geographic location.
To summarize, the implications of the present study seem to be threefold.
First, the study contributes to the understanding of what is essentially a
greenfield site in the Slovak health-care management, that is comprehensive
and systematic human resource planning. Second, it shows that, because of the
emerging recognition among hospital human resource managers of a need for
such planning, it may now be the right time for implementation of the new
methods in this field. Finally, these early findings indicate that further
consideration should be given to how the existing workforce plans are
integrated into an overall hospital strategy. Researchers might also find a rich
vein in discovering the real-life effects of human resource planning, and the
existence of workforce plans, on the hospital performance indicators and/or
cost consciousness.
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