How do countries design and govern staffing levels? A comparative analysis of European approaches

Background Staffing levels are increasingly used to help address workforce shortages, safeguard quality and support health system performance. However, comparative evidence on why countries define staffing levels and how these policies are designed and governed remains limited. Objective By comparing approaches across countries, the study provides new evidence on the governance and implementation of staffing levels and supports policy learning on designing staffing policies that are both responsive to changing population and workforce needs and aligned with broader health system goals. Methods This article draws on a report developed with the European Commission’s Expert Group on Health Systems Performance Assessment which conducted a comparative analysis of staffing-level policies across European Union Member States and Norway, using a structured questionnaire, complemented by a policy workshop and Policy Focus Group. Results Countries employ fixed, flexible and hybrid staffing approaches across health system sectors in pursuit of different policy objectives. These choices reflect differences in service organisation, workforce capacity and governance arrangements. Staffing policies are governed through varying combinations of national regulation, decentralised decision-making, professional standards and provider-level implementation, and are unevenly integrated with workforce planning, financing and education. Conclusions There is no universally applicable staffing model. Effective staffing policy requires context-sensitive design, clear governance and stronger integration with wider health workforce and health system policies. Comparative monitoring can support policy learning without imposing uniform staffing benchmarks across Europe.