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Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany

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  • Kuhlmann, Ellen
  • Larsen, Christa

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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  • Kuhlmann, Ellen & Larsen, Christa, 2015. "Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany," Health Policy, Elsevier, vol. 119(12), pages 1636-1644.
    • Handle: RePEc:eee:hepoli:v:119:y:2015:i:12:p:1636-1644
    DOI: 10.1016/j.healthpol.2015.08.004
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    1. Ozbilgin, Mustafa F. & Tsouroufli, Maria & Smith, Merryn, 2011. "Understanding the interplay of time, gender and professionalism in hospital medicine in the UK," Social Science & Medicine, Elsevier, vol. 72(10), pages 1588-1594, May.
    2. Fierlbeck, Katherine, 2014. "The changing contours of experimental governance in European health care," Social Science & Medicine, Elsevier, vol. 108(C), pages 89-96.
    3. Ognyanova, Diana & Maier, Claudia B. & Wismar, Matthias & Girasek, Edmond & Busse, Reinhard, 2012. "Mobility of health professionals pre and post 2004 and 2007 EU enlargements: Evidence from the EU project PROMeTHEUS," Health Policy, Elsevier, vol. 108(2), pages 122-132.
    4. Kuhlmann, Ellen & Batenburg, Ronald & Groenewegen, Peter P. & Larsen, Christa, 2013. "Bringing a European perspective to the health human resources debate: A scoping study," Health Policy, Elsevier, vol. 110(1), pages 6-13.
    5. Tsiachristas, A. & Wallenburg, I. & Bond, C.M. & Elliot, R.F. & Busse, R. & van Exel, J. & Rutten-van Mölken, M.P. & de Bont, A., 2015. "Costs and effects of new professional roles: Evidence from a literature review," Health Policy, Elsevier, vol. 119(9), pages 1176-1187.
    6. Tomoko Ono & Gaétan Lafortune & Michael Schoenstein, 2013. "Health Workforce Planning in OECD Countries: A Review of 26 Projection Models from 18 Countries," OECD Health Working Papers 62, OECD Publishing.
    7. Martineau, Tim & Willetts, Annie, 2006. "The health workforce: Managing the crisis ethical international recruitment of health professionals: will codes of practice protect developing country health systems?," Health Policy, Elsevier, vol. 75(3), pages 358-367, February.
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    4. Balasubramanian, Madhan & Brennan, David S. & Short, Stephanie D & Gallagher, Jennifer E, 2019. "A strife of interests: A qualitative study on the challenges facing oral health workforce policy and planning," Health Policy, Elsevier, vol. 123(11), pages 1068-1075.
    5. Pavolini, Emmanuele & Kuhlmann, Ellen, 2016. "Health workforce development in the European Union: A matrix for comparing trajectories of change in the professions," Health Policy, Elsevier, vol. 120(6), pages 654-664.
    6. Ovseiko, Pavel V. & Buchan, Alastair M., 2015. "Medical workforce education and training: A failed decentralisation attempt to reform organisation, financing, and planning in England," Health Policy, Elsevier, vol. 119(12), pages 1545-1549.
    7. Kuhlmann, Ellen & Groenewegen, Peter P. & Bond, Christine & Burau, Viola & Hunter, David J., 2018. "Primary care workforce development in Europe: An overview of health system responses and stakeholder views," Health Policy, Elsevier, vol. 122(10), pages 1055-1062.

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