Kuhlmann Ellen, Larsen Christa
Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden.
IWAK, Institute of Economics, Labour and Culture (IWAK), Goethe-University Frankfurt, Germany.
Health Policy. 2015 Dec;119(12):1636-44. doi: 10.1016/j.healthpol.2015.08.004. Epub 2015 Aug 19.
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.
卫生人力需求已在改革议程上得到提升，但政策制定往往仍属“零敲碎打”，无法应对卫生人力挑战的复杂性。本文主张医疗治理创新是实现卫生人力资源更大可持续性的关键。目的是制定一种多层次方法，以帮助识别治理差距并改进政策干预措施。2013年至2015年间在德国对护理和医学进行的定性方法试点研究，用以说明基于系统的治理弱点。三个探索性案例涉及应对卫生人力短缺的主要措施，包括护士的移民/流动、护理教育改革以及医院医生的性别敏感工作管理。研究结果表明，跨国/欧盟与组织治理之间、国家与地方层面之间、职业与部门治理之间以及组织/医院管理与专业发展之间缺乏联系。因此，卫生人力创新需要一种多层次治理方法来发挥变革潜力，并有助于弥合现有的治理差距。
