HR Leadership in Healthcare: A Reflective Interview Report

Introduction

The role of HR in nursing is of paramount importance, as the profession relies on the skills and knowledge of its employees, as well as the motivation and dedication of staff (Keem and Bruvold, 2003). The aim of this paper is to assess the role of the head of HR in a medical setting, examining their responsibilities and tasks, and reflecting on how HR and nursing departments should — and do — collaborate to create value. This was undertaken through a semi-structured interview with the Managing Director of Human Resources and Housing at a university medical center in New York.

The Interviewee

The interviewee did not study HR formally. He was educated at Michigan State University and Eastern Michigan University, graduating from the latter in 1998 with a background in history and political science (LinkedIn, 2017). After leaving college, he entered a career in sales at Future Electronics before moving to Citigroup as a training coordinator (LinkedIn, 2017). It was this move into training that led him into HR.

His first role in a healthcare setting was with HealthPlus between 2003 and 2004, serving as a trainer and internal organizational development consultant (LinkedIn, 2017). From there, he moved to Lutheran Medical Center, starting as a manager of recruitment and retention and earning several promotions before taking on the role of Director of Compensation and HRIS at Piedmont Healthcare (LinkedIn, 2017). Following ten months in that position, he joined the university in January 2011 as Total Rewards Leader, becoming Director of Human Resources Operations in October 2012, and Managing Director of Human Resources and Housing in May 2014 (LinkedIn, 2017). His extensive experience in healthcare HR in New York made him an excellent subject for this interview.

Interview Summary

The interviewee was interviewed using a predetermined question framework based on a semi-structured interview approach. The semi-structured format provides a solid foundation for the interview while retaining the flexibility to explore answers in greater depth (DiCicco-Bloom and Crabtree, 2006). A copy of the question framework is provided in Appendix 1.

The first question concerned his role at the organization. He stated that he has overall responsibility for the design and execution of HR strategy across the institution. The organization has a tripartite mission encompassing research, clinical care, and education, which means HR strategies must be aligned with all three functions and with the different departments that realize them. He noted that this is not unusual in itself, but it does mean the role extends beyond simply developing, implementing, and maintaining HR strategies; it also requires consideration of the diverse needs of multiple departments. He further observed that the HR role can be especially complex in a medical environment due to its layered hierarchy. In addition to traditional seniority-based hierarchies, there are professional hierarchies necessitated by regulatory and professional body requirements. Accordingly, he often serves as a mediator between divisions and departments, collecting and correlating information in order to find acceptable solutions and develop suitable policies.

The second question asked who he works with in order to fulfil the head-of-HR role. He explained that his division includes a number of subordinates who are key to supporting the strategic management of HR across the organization, encompassing specialists in rewards and compensation, recruitment, training, and general HR administration. Importantly, many functions typically associated with HR — such as training and development — are undertaken within parallel professional hierarchies. Many employees are subject to ongoing professional development requirements, so HR plays a supporting role in facilitating that development while the substantive work is carried out within the professional hierarchy. This requires a high level of cross-departmental integration and demands that IT systems provide suitable infrastructure for recording and documenting individual training and development. It also means he must work with a large number of department and division heads across the organization.

Recruitment is similarly interdependent. The HR department handles the initial placement of job advertisements and the associated administrative tasks, while the relevant divisions conduct the substantive recruitment process, including application review and interviews. Administrative tasks such as reference checks are handled within the HR department. This level of coordination has benefited considerably from the development of clear recruitment policies.

The third question concerned specific programs or strategies that have been implemented or strongly supported within the organization. The interviewee is a strong advocate of a participatory approach characterized by teamwork and consultation. While this does not undermine the required professional hierarchies, it does enable the sharing of knowledge and information. He noted that this participatory culture already exists within the organization, though he has sought to extend it further through the concept of organizational learning in order to improve overall performance. Organizational learning — and the movement toward a learning organization — is identified as an important proactive strategy for continually identifying and improving practices in support of the tripartite mission. He described organizational learning as an expansion of knowledge not only at the individual level but also in terms of how individuals apply that knowledge collectively as a group or team to improve outcomes. These teams range from small ward-based groups to larger cross-departmental collaborations.

He offered a practical example: when a teenager presents with a terminal illness, immediate medical care may require staff from several departments and pharmacy involvement, but professionals working as a team can also identify additional needs, such as psychiatric or psychological support. He acknowledged this was an oversimplification, but it illustrates the high level of interdependency within an organizational structure that resembles a complex network.

He also stressed the importance of accurate and honest feedback from employers and supervisors, including a high level of positive feedback to sustain motivation. In an environment characterized by significant stress and pressure, he noted that positive feedback is vital to supporting staff. Among the practices he highlighted as integral to organizational success were an extensive mentoring program that goes beyond standard professional development, counselling services for staff dealing with stress and patient loss, a recognition and rewards program, a strategy of promoting from within wherever possible, and a strong organizational culture of care.

The fourth question asked about the most challenging aspects of his role. After laughing, he acknowledged that virtually every element of the job could be challenging, given the scope and scale of the organization and the highly regulated nature of its work. He likened his role to that of a circus master combined with a juggler and a mind-reader, noting that the most difficult aspect was having enough hours in the day to speak with everyone and to gather and analyze data for decision-making — though with a capable department, these challenges were manageable. In terms of external pressures, recent changes in the regulatory environment have significantly increased administrative demands on the hospital, requiring substantial training and development efforts. Balancing these compliance requirements against budgetary constraints has been particularly challenging. He ultimately identified one of the most difficult aspects of his role as attempting to provide staff — and through them, patients and other stakeholders — with everything they need, while being constrained by budget; in short, too many demands and not enough money.

The fifth question asked what he would change about HR management within the organization. He considered increasing the budget to make more resources available for training and development, particularly for administrative support staff, noting that training budgets for other professional groups typically come out of their own departmental budgets rather than his. However, he acknowledged that increasing one department's budget carries an opportunity cost and a potential human impact elsewhere. He also identified improving cross-departmental communication regarding employee management as a key priority. He noted that the barrier was not a lack of communication skills but rather the time pressures placed on busy professionals who must prioritize clinical responsibilities. He cited post-incident review teams as an example of where a no-blame approach could facilitate more open exchange of ideas. He noted that while a caring culture exists among professionals, physicians in particular have concerns about liability and insurance premiums, which acts as a barrier to open communication. Adopting no-blame meetings to explore incidents, he believed, would not only improve the utilization of human resources in pursuit of the tripartite mission but would also strengthen internal support for employees.

The final question addressed strategies and policies for retaining talent, particularly among nursing staff. He acknowledged that retention is a persistent challenge, given the general shortage of nursing staff and the competitive recruiting environment in which many health organizations are actively headhunting. Retaining staff is therefore critical. The organization seeks to maintain a supportive culture — including mentoring and counselling services — to encourage staff to stay. Exit interviews are conducted to identify factors contributing to job dissatisfaction, and terms and conditions of employment are kept under continuous review, with the organization aiming to offer competitive salaries.

Conclusion

Human resource management is a linchpin within the organization, even if it is often undervalued. By recognizing the value it does — and could — create, there is real potential to enhance its contribution by treating it as a strategic department rather than simply a reactive one. The HR division could play an important role in expanding the organization's capacity for learning, moving toward the learning organization model, and improving performance across areas from recruitment and development to levels of patient care supported by motivated staff. Human resource management is therefore a critically important division, and deeper collaboration — particularly with nursing — could help the organization achieve its goals and support its tripartite mission.