Management Contract Workers in Healthcare Settings


Healthcare, being a labor-intensive industry requires a large number of employees to provide, billing for services provided and recording especially for larger institutions. The allied health workers represent 60% of the United States’ healthcare system workforce, while the other percentage represents healthcare professionals. They help other professionals by evaluation, diagnosis, and treatment of conditions of the patients. The human resource management should encourage teamwork between them and the managers in order to establish necessary linkages for identifying system flaws and efficient reporting. All the resources should be mobilized to increase employee participation, and boost results geared at meeting customer expectations in the healthcare sector.

Managing of workers in every job setting is very important since they are important resources whose benefits can be optimized through careful organization and planning. The type of management to which the healthcare workers are responsible, influences the competence, engagement, performance and learning organization among other things at the work place. The responsible human resource will understand the type of workforce it needs, the workforce it already has, the work criteria and policy which will lead to optimization of the work force. A number of ways to ensure that optimization of the work force is achieved to ensure that proper working conditions exist, proper management of the workforce, improvement of the workforce for instance through team building is a continuous practice, and ensuring that the needs of the workers are put into consideration. Like any type of sector or organization, healthcare is faced with the need to have to organize employees to realize the need for good working relationships and better group performance, while maintaining good individual performance at the work place. The type of working plan (e.g. casual, permanent or contract arrangement) may be only one factor that can positively or negatively influence group and individual performance. Others include the type and level of organization or teamwork relationships, job policies, amount of pay, and professionalism.

The human resource management needs to understand all the above issues to be able to organize the human power effectively. This paper discus the human resources issues in healthcare. The paper will seek to research the available literature on the subject matter, give an analysis and pose recommendations. Among the issues to be discussed include; management of contract workers, competence of the workers & the management and benefits of management of the contract workers. Other issues related to the subject matter will be discussed.

Benefits and disadvantages of contracting

Contracting has its own advantages and disadvantages on the side of the employee and the employer. In most countries, permanent employment comes with it the requirements to meet financial obligations required in the law. For example, in some countries, permanent employment will be attached to retirement benefits, fringe benefits including vacation, health and dental, which may be partly avoided all together when an employer agrees to hire on a contract basis. On a contract basis, the employer may have to pay a little more than on the other arrangement. In addition to the reduction in the financial obligations, the employer may be free to fire the employee anytime and at will. Under permanent employment, the employer may be at an obligation not to fire before meeting specified procedures or financial obligations. The employee may acquire benefits of reduced training needs and evaluation programs after hiring on a contract basis (Leyu).

On the part of the employee, the advantages accruing to contractual employment may only be a few. The employee may no longer be attached to obligations of the company which are not covered by the contract agreement. The employee may not be therefore involved in the training and other programs initiated by the company in the healthcare sector. In addition, the employee may demand a large payment for a short period of time since he or she would be required to perform highly. Therefore, it may be viewed as if the bargaining power of the employee, for example in the search for better working conditions and pay, has been enhanced or provided for. The disadvantages accruing from this arrangement include; the employee being no longer entitled to as large or any financial benefits and allowances as enjoyed under permanent employment. Another disadvantage is that the employee could be fired at anytime the employer deems fit or when he or she is said to be underperforming-deteriorated job security condition. On the other side, the collective bargaining power of the employees at the job may negatively be affected since fear of expulsion or being fired may crawl in. Organizing the workers may become more difficult at workplace since long lasting relationships (or integration of the workforce) may be broken anytime or influenced by frequent termination and expulsions. The employees may feel detached from the rest of the organization and do not own the organization, although the company may utilize them in meeting the organizational goals and objectives, the worker may sometimes see as though being utilized for the organizations benefit, for example when the company fires employees more often. Some of the disadvantages experienced by the employee may turn out to negatively affect the employer because they may have negative impact on employee motivation and general performance.

In case the employer seeks to implement contracting as an alternative to permanent employment, he should prepare to address issues of pay for performance and contracting conditions. The human resource needs to ensure that employee responsibility and accountability at work, improved morale and excellence are also achieved through appropriate contracting conditions; contracting should not change the quality of the employee’s performance and job unless where it is unavoidable. For example, after contract arrangement, the performance can still be evaluated not only for purposes of firing the employees, but also for rewarding the best performer. It has been found that the hospitals which align salaries and bonuses with the operational goals (combined human and financial goals) may improve motivation and employee participation within the organization according to Leiyu (2007). Praise and appreciation scored higher than gifts and other tangible rewards the other top ten measures involved in promoting employee recognition, in a survey conducted to assess these recognition promotion practices. Retention may be also necessary when the practitioners are highly experienced and may want to seek for better pay, elsewhere.

Contract working and related issues

Contract working involves the employee serving at a particular position only for a specified term or period which may be renewed or not. It may be used in cases where the management is more focused on job performance which may be used to determine whether the contract can be renewed or not. However, healthcare employees also have realized the need for collective performance towards better terms of contracts, transfers, leaves, fair personnel policies (AFT Healthcare, 2003), better pay, working conditions and fair treatment, for example. Therefore, the management of contract workers emerges as important part of management. Because the company requires competitive and adequate professional services at the right time and at the same time minimize operational costs, the idea of management for the contract workers further needs a keen focus in terms of their time availability, performance, qualifications, area of specialization, competence and the number of professionals to use. These need to be fused with the needs of the hospital.

The human resource in healthcare is supposed to carry out various duties and responsibilities including decision making, team building, governance and establishment, maintenance and instilling into employees the system ethics and values, strategy development, enhancing relationships among the workers, and organization. The major divisions for all skills can be considered to be organizational and analytical skills, technical or professional skills, professionalism, leadership and communication skills. Personal leadership competences include making of decisions, risk taking, evaluation and team building. In particular, the management should work at ensuring that there exists team work among the employees to foster group work results and performance, develop external relationships that not only benefits the business but also the client and the community, establish and uphold systems of conflict resolution and problem solving, establish and improve or uphold proper communication systems for example presentation of information and encouraging discussion amongst workers.

Professional issues cut across ensuring ethical standards at the work place, making sure that program (s) of self-evaluation and monitoring exists, managing overload of information and promoting and developing not only the colleagues but also the profession and the community. Technical skills will help the manager identify and put in place situational features which will make the healthcare institution have a different setting from other industries. The human resource management if not constituted in light of coverage of these issues may experience difficulties in one way or the other. The human resource management must be able to improve and establish proper working environment to improve performance on job. The management should in this light, look at the following areas: decision-making, meetings, feedback systems, and work design and coordination (Tyler, n.d.).

Human resource management may be required by work circumstances to organize employees in a particular manner, for example improving teamwork to reduce operational costs e.g. through sharing of responsibilities and equipments. Teamwork is necessary in the areas such as interdisciplinary collaborations for example in the geriatric healthcare (which may reduce healthcare costs for older adults and may for example, be achieved through interdisciplinary collaboration in the clinical and educational training of professionals in healthcare who specialize in geriatrics (Mezey, Mitty, Burger, M.P.H., R.N., & McCallion 2008; qtd. in The Commonwealth Fund, n.d.)), but knowledge on performance of the practices in specific areas may be required. Thus encouraging teamwork and employee union and relationships that foster working together is important. This knowledge may be passed through interdisciplinary academic programs and the human resource management must be able to organize and mobilize the workforce to achieve this in the best way possible. Teamwork spirit is encouraged because it is necessary for meeting institutional goals and objectives.

Teamwork and the requirement to be organized can be viewed on the other side as time consuming and therefore not a wholesome solution to healthcare conditions. While various working staff is specialized for operations, teamwork may bring reorganization and rearrangements as the people try to learn new duties and responsibility-for example through workplace seminars, leading to a waste of time which would have been utilized to improve performance. Extra-efforts and costs may be required in training the human resource to be able to mobilize the workers to work in teams, evaluate competence and performance, among other things which makes the practice not suitable.

In some cases, the human resource has been termed as being under crisis because they lack information on the present workforce, have poor worker retention criteria-force early recruitment, reduction of workers through reforms in the health sector, migration, sickness and death of workers due to HIV/AIDS and separate voluntary service from the public sector. In addition, there is the poor transfer of learning in education or training as a result of poor or limited follow-up and supervision. Those undergoing in-service training are not adequately prepared to meet the pre-service challenges, and as the disease burden shifts, the pre-service education fails to adequately prepare workers. The human resource management has also been incompetent in the appropriate realignment of the workforce. In the light of view, some people in the workforce might be overburdened with tasks that should be carried by other workers, and workers may be blocked to providing specific tasks by certain practices (McQuide, 2007).

Reduction of the workforce may lead to lesser personnel and this may not result in quality service. The influence of this may be far and wide because it may influence job scheduling and motivation. Contracting the workforce may be viewed as a way of sourcing the provider services, and at the same time reducing the overall expense on the workforce or in an attempt to increase performance. This type of hiring may be advantageous in that it may lead to improved performance for those workers who would be interested to renewing the contracts. In some cases, contracting may not be fully suited to long-term programs as compared to permanent employment. This is because it may be viewed on the other side as investing in a workforce that may finally go away at will. Therefore, the settings may not be as simple. The human resource management may choose to have short programs meant to boost morale, competence and performance, according to the lengths of the contracts and the time needed to reap the benefits. The more the healthcare institution may invest in a certain individual, the more it may require having him work with them so as to reap the advantages of the gain and competence gained. The human resource can alternatively choose to improve the knowledge, ability and skill of its workforce through requiring them to pay for the very extensive or long programs if it sees slim chances of maintaining the workers through renewal of contracts. In this case, the management may offer to extend the contracts of those who are going through extensive and more beneficial programs. The employer can therefore share the cost of running these programs with the beneficiaries. The employees in this case may be required to undergo the programs which are offered free of charges while a few others may be compulsory. The short programs offered for free may be used to emphasize the importance of team work, group results and meeting organizational goals and objectives through group efforts. Certain countries have low numbers workforce. In this case, the employer may be required to help reduce the workload of the contracted employees through appropriate scheduling of jobs and letting the more qualified nurses and practitioners have the authority to delegate tasks that can be performed by lesser skilled employees. In addition, shortage conditions may make it necessary for implementation of proper retention programs, incentives and services. These include on-site care services, day-care services and travel benefits. The employer may help out the employee to balance out training, educational and job performance needs.


According to Lane and Ross (1998), competence refers to carrying out specific tasks to result in desirable outcomes. It is acquired overtime according to Benner (1984). In order to be able to organize the healthcare workforce properly, it is important that the human resource management be aware of the competence of the workers, which refers to the ability and readiness of the health workers to provide quality services. In addition, high competence may be required where the workforce needs are contracted so that the institution will harness the maximum benefits and utilize the available resources effectively as well as increase customer satisfaction. Competence of workers in the healthcare sector is of paramount importance. It entails traits, abilities, skills and knowledge of workers and is determined through in-service training, pre-service education and the working experience. The human resource management should understand that external factors such as lack of equipments, organizational supports and drugs; and individual factors such as inertia, goals, values, traits and abilities may affect the competence of the providers and prepare to confront these issues.

There is a relationship between performance, but it has been termed as a complex one (Southgate and Dauphinee (1998) according to Neeraj, Bart, & Merri-Ann (July 2001). According to Campbell et al. (1993) performance is what an organization would hire a worker to do. However, performance is affected by other factors like motivation, time and work settings, apart from competence, and thus performance and competence cannot be used one for the other. According to Neeraj, Bart, & Merri-Ann (July 2001) performance can be measured. According to Boyatzis (1982), competence is the underlying characteristic that is causally related to job performance. In addition to investing in workforce that is qualified and understanding procedures, the human resource must be able to recruit and retain a workforce that responds to issues in a self-controlled manner with self confidence. It is necessary to measure competence periodically according to Neeraj, Bart, & Merri-Ann (July 2001). Measuring of competence of healthcare providers can be done though various methods and the following are examples;

  • Assessment of the providers’ knowledge through quizzes and questionnaires in order to decide whether there is needed to develop knowledge-development programs or improve the existing ones.
  • Establishment of the providers’ adherence to specific treatment regimens through review of records and sentinel events. This is not an expensive method compared to the practical examination.
  • Assessment of the providers’ psychomotor and interpersonal skills through practical examinations and observations with patients.

Group competence may also be necessary to measure and improve through programs that encourage relationships at workplace and team learning. The human resource must encourage programs that bring individual providers together through group work and assignments for example, in order to help achieve the institutional goals and values together.

The problem of measuring competence may be viewed as denying the workforce the freedom that they need for operating. Usually, the workforce would feel oppressed by application of too many or tedious means of measuring competence and performance. In fact, if not carefully utilized, performance evaluation can present a method of time wasting and costly. It should be followed by measures aimed at improving competence if desired. One thing that can be perceived is that provider competence may be more difficult to determine because it is influenced even by external means like lack of adequate facilities, and also can only be accurately determined by the analysis of more than one factor. If one method is inadequate in measuring competence on consideration of all the factors, then more methods would need to be used, leading to more cost of the whole project. If the healthcare institution should invest in systems that measure, monitor and boost the individual or group competence and performance, more resources will need to be used.

The importance for the alignment of the healthcare institutional goals towards the future in terms of human resource planning and strategies is also important. The healthcare sector is a dynamic institution where various factors may influence demand and supply. For example, it is expected in the United States that there might be increased demand for healthcare services come the year 2011 and beyond, when the baby boomers begin to retire and the political impact on healthcare may be felt. Changes are also taking place as relates to technological approaches towards medication solutions. This would require that the human resource align the staff and its employees to suit demands for future, for example through provision of re-training programs for the existing and expected technological developments. The human resource management should effectively utilize the capability of the practitioners in the healthcare unit to carry out research for future trends, demands and institutional needs.


The first step to dealing with any problem is the careful analysis or examination to make sure that the real issues are being attacked appropriately. While issues of work force management may cut across all the healthcare institutions, they may be as specific to the company in question and although a common solution may be adopted, it may be necessary to localize it to fit the scenario. This paper therefore proposes an analysis or closer examination of the problem should difficulties or problems with workforce management arise. In addition, the paper proposes the following;

  • Continuous monitoring, evaluation and improvement of the workforce and human resource management to be able to identify loopholes and difficulties while they are still younger stages. Earlier diagnosis may be better before efficiency of the organization is negatively affected. Monitoring of the management may be accomplished through application of appropriate qualitative analysis systems with efficient reporting systems on the applied mechanisms, type, efficiency and management practices through out. These systems will require data collection, recording, analysis, and reporting for example on employee complains and other issues like the number of instances of complains and job-related difficulties reported by the customer. Proper and quick control measures will be required where necessary.
  • In order to reduce job-related problems, managers should initiate programs for ensuring that there is continuous monitoring, evaluation and improvement of working conditions at the healthcare units, improvement of the professionals through training and further education, and promoting of job-related relationships. Participation of the employees in these programs will be of importance. The management can utilize the employees to improve, monitor and report on these programs. Educational training programs can for example emphasize on the need for team building and group performance. Additional programs such as the Norwich Union Healthcare Employee Assistance Programs in healthcare institutions to help employees with a range of issues that may affect job performance, for example, personal relationships; can help by offering counseling, necessary information, critical incident services and legal assistance on issues related to the employee problems (Norwich Union Healthcare, n.d.).
  • The institution or company can organize special training and seminars for its management-not only the human resource managers but also others-to attend with other managers from other companies so as to improve their management skills through sharing of experiences, help them become informed of the existing issues in human resource management in the healthcare sector and how others are confronting them, and challenging them to have a wider scope of the solution they have already implemented or are implementing. In addition, such programs as performance coaching to managers can equip them with knowledge on effectiveness and performance (Norwich Union Healthcare, n.d.).
  • Need for creation of more cadres of workers including the lay workers, youths and volunteers. In addition, more workers should be contracted to meet the needs of the institutions. The workers should be given supportive supervision.
  • Need for improved working conditions and pay. The management should have systems that assist in and emphasize or establish job descriptions and performance-based evaluations (McQuide, 2007).
  • All programs need to be assessed in terms of impact, costs and benefits as relates, not only to the contract workers, but also other types of workers. In addition to this, innovative methods such as telework applications in healthcare need to be explored.
  • Establishment of the research-based approach towards management of the human resources at the healthcare institutions. The research should analyze the benefits of the contract working, identify the managerial challenges, challenges to teamwork among contracted workers, necessary efforts implemented and their achievements, and seek for the appropriate solutions. The managers can encourage the participation of the employees or practitioners in these studies to foster ownership of solutions.


Human resource management need to understand the workforce it needs, and that it already have, in order to utilize it effectively. The factors to consider include the competence and performance, other external factors such as availability of equipment and internal factors affecting competence. The benefits of contracting workers include avoiding payment of large retirement benefits involved in the permanent employment, payment for monitoring and evaluation and improvement programs, and the right to suspend the employees at will as opposed to permanent employment. The employee performance may be affected in that contracting may make him or her feel disassociated from the rest of the workers, among other disadvantages. The employee needs to make sure that contracting employees does not compromise on quality of service and performance.

Teamwork is important in meeting the organizational goals and objectives. The management need to establish programs that boost the teamwork, individual and team performance and competence. However, careful analysis of the impact, benefits, and costs of these programs as relates to the contract workers need be considered. Although teamwork is encouraged, it may involve programs that are time consuming as those required to boost competence.


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