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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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    5. 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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    7. 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.

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