Junior doctors' workplace well-being and the determinants based on ability-motivation-opportunity (AMO) theory: Educational and managerial implications from a three-year longitudinal observation after graduation.

PURPOSE: Junior doctors function as trainees from an educational perspective and as employees from a human resource management perspective. Employing the ability-motivation-opportunity (AMO) theory as a conceptual framework, this study longitudinally investigated the factors affecting the workplace well-being and career progression of junior doctors over a 3-year period following their graduation from medical schools. MATERIALS AND METHODS: This 3-year prospective cohort study enrolled junior doctors who graduated from 2 medical schools in June 2019 in Taiwan. This study collected data by implementing web-based, self-administered structured questionnaires at 3-month intervals between September 2019 and July 2022. The collected data encompassed ability indicators (i.e. academic performance and perceived preparedness for clinical practice), motivation indicators (i.e. educational and clinical supervision), opportunity indicators (i.e. clinical unit cultures), and workplace well-being indicators (i.e. burnout, compassion satisfaction, and job performance). A total of 107 junior doctors participated, providing 926 total responses. The data were analysed using univariate analyses and structural equation modelling with path analysis. RESULTS: Over the 3-year period following graduation, the junior doctors' confidence in their preparedness for clinical practice and the educational and clinical supervision had varying degrees of influence on the junior doctors' workplace well-being. The influence of clinical unit cultures, which can provide opportunities for junior doctors, became evident starting from the second year postgraduation; notably, unit cultures that emphasised flexibility and discretion played positive and critical roles in enhancing the junior doctors' workplace well-being lasted to the third year. CONCLUSIONS: Our findings provide insights into the distinct critical factors that affect the socialisation of junior doctors within workplace environments over 3 consecutive years. These findings can provide guidance for medical educators and healthcare managers, helping them understand and support the progressive integration of junior doctors into their work environments.

The Relationship Between Strategic Human Resource Management Practices and the Employment of Vulnerable Workers: A Two-Wave Study Among Employers.

PURPOSE: To improve the inclusion of vulnerable workers in the labor market, employer behavior is key. However, little is known about the effectiveness of strategic Human Resource Management (HRM) practices that employers use to employ vulnerable workers. Therefore, this exploratory study investigates the association between strategic HRM practices (based on social legitimacy, economic rationality and employee well-being) and the actual and intended employment of vulnerable workers in the future. METHODS: In total, 438 organizations included in the Netherlands Employers Work Survey participated in a two-wave study with a nine-month follow-up period. Logistic regression models were used to estimate the relationship between strategic HRM practices (T0) with the employment of vulnerable workers (T1) and intentions to hire vulnerable workers (T1), while controlling for organizational size, sector, and employment of vulnerable workers at baseline. RESULTS: Employers who applied strategic HRM practices based on social legitimacy (e.g., inclusive mission statement or inclusive recruitment) or economic rationality (e.g., making use of reimbursements, trial placements, or subsidies) at T0 were more likely to employ vulnerable workers and to intend to hire additional vulnerable workers at T1. No significant results were found for practices related to employee well-being. CONCLUSION: Since different types of strategic HRM practices contribute to the inclusion of vulnerable workers, employers can build on their strategic priorities and strengths to create inclusive HRM approaches. Future research is needed to study whether these strategic HRM domains also relate to sustainable employment of vulnerable workers.

Sustainable development goals and green human resource management: A comprehensive review of environmental performance.

Sustainable development goals and rising sustainability concerns push stakeholders and society to demand organizations adopt innovative practices that can contribute to business sustainability. This study aims to provide a systematic review through comprehensive bibliometric analysis of almost 1st quarter of the 21st century. The main focus is on how green human resource management practices promote and have a relationship with environmental performance, which is a significant part of sustainability. The authors systematically reviewed 242 top-tier articles from Scopus and Web of Science databases by following the "preferred reporting items for systematic reviews and meta-analyses" methodology. A significant relationship began in 2015 and gained popularity after COVID-19. The studies suggest that management should embrace the most demanding green human resource management practices, such as green competence building, motivation enhancement, and employee involvement, for better environmental performance. So, organizations can help acquire and retain committed and eco-friendly employees whose ecological values and objectives are compatible with the organization. The study also provides insight into the role of green human resource management practices in fostering eco-friendly behaviour of employees that, in turn, influence environmental performance. Most authors used the theory of ability-motivation-opportunity, a supporting mechanism for how organizations protect the environment through adopting green human resource management practices. In the future, corporate environmental responsibility, environmental regulations intensity, pro-environmental behaviour, and green work-life balance are suggested mechanisms to enhance environmental performance through green human resource management practices.

Perceived HRM and turnover intentions of elderly care workers: perspective from person-job fit and institutional ownership.

BACKGROUND: Although the phenomenon of high turnover rate in the elderly care industry has existed for a long time, there are few studies that have constructed frameworks to comprehensively analyze the strength of the effects of various factors on the turnover intention of elderly care workers.. This study analyzed the impact of different types of perceived human resource management practices on elderly care workers' turnover intentions and whether this relationship is moderated by person-job fit and ownership of elderly care institutions. METHODS: This is a cross-sectional and regional survey study. The study included questionnaire survey data from a total of 305 elderly care workers from 42 elderly care institutions in 21 provinces in China during June to September 2021. Descriptive statistics, Pearson correlation coefficient, multiple regression, and heterogeneity analyses were performed. RESULTS: Perceived work environment ( ß =-0.5164, p< 0.01), perceived occupational protection ( ß =-0.3390, p< 0.01), perceived welfare benefits ( ß = -0.2620, p< 0.01) and perceived competency training ( ß = -0.1421, p< 0.1) were all significantly and negatively related to turnover intentions, the quality of perceived work environment has the greatest impact on elderly care workers' turnover intentions. Under the moderating effects of person-job fit and ownership of elderly care institutions, there existed heterogeneity between perceived human resource management and turnover intentions among elderly care workers. High level of person-job fit and elderly care institutions' public feature can effectively weaken the negative impact of each type of perceived human resource management on turnover intention among elderly care workers. CONCLUSIONS: The managers of elderly care institutions should optimize the management mechanism, typically pay attention to elderly care workers' working environment, formulate and improve the professional standards and job requirements for elderly care workers, promote the public welfare value of nursing care services, and strengthen the sense of honor and responsibility of elderly care workers to reduce the turnover rate.

Using the integration of human resource management strategies at district level to improve workforce performance: analysis of workplan designs in three African countries.

BACKGROUND: There is a worldwide shortage of health workers against WHO recommended staffing levels to achieve Universal Health Coverage. To improve the performance of the existing health workforce a set of integrated human resources (HR) strategies are needed to address the root causes of these shortages. The PERFORM2Scale project uses an action research approach to support district level management teams to develop appropriate workplans to address service delivery and workforce-related problems using a set of integrated human resources strategies. This paper provides evidence of the feasibility of supporting managers at district level to design appropriate integrated workplans to address these problems. METHODS: The study used content analysis of documents including problem trees and 43 workplans developed by 28 district health management teams (DHMT) across three countries between 2018 and 2021 to identify how appropriate basic planning principles and the use of integrated human resource and health systems strategies were used in the design of the workplans developed. Four categories of HR strategies were used for the analysis (availability, direction, competencies, rewards and sanctions) and the relationship between HR and wider health systems strategies was also examined. RESULTS: About half (49%) of the DHMTs selected service-delivery problems while others selected workforce performance (46%) or general management (5%) problems, yet all workplans addressed health workforce-related causes through integrated workplans. Most DHMTs used a combination of strategies for improving direction and competencies. The use of strategies to improve availability and the use of rewards and sanctions was more common amongst DHMTs in Ghana; this may be related to availability of decision-space in these areas. Other planning considerations such as link between problem and strategy, inclusion of gender and use of indicators were evident in the design of the workplans. CONCLUSIONS: The study has demonstrated that, with appropriate support using an action research approach, DHMTs are able to design workplans which include integrated HR strategies. This process will help districts to address workforce and other service delivery problems as well as improving 'health workforce literacy' of DHMT members which will benefit the country more broadly if and when any of the team members is promoted.

Human resource management research in healthcare: a big data bibliometric study.

Human resource management (HRM) in healthcare is an important component in relation to the quality and efficiency of healthcare delivery. However, a comprehensive overview is lacking to assess and track the current status and trends of HRM research in healthcare. This study aims to describe the current situation and global trends in HRM research in healthcare as well as to indicate the frontiers and future directions of research. The research methodology is based on bibliometric mapping using scientific visualization software (VOSviewer). The data were collected from the Web of Science(WoS) core citation database. After applying the search criteria, we retrieved 833 publications, which have steadily increased over the last 30 years. In addition, 93 countries and regions have published relevant research. The United States and Australia have made significant contributions in this area. Current research articles focus on topics clustered into performance, hospital/COVID-19, job satisfaction, human resource management, occupational/mental health, and quality of care. The most frequently co-occurring keywords are human resource management, job satisfaction, nurses, hospitals, health services, quality of care, COVID-19, and nursing. There is limited research on compensation management and employee relations management, so the current HRM research field still has not been able to present a complete and systematic roadmap. We propose that our colleagues should consider focusing on these research gaps in the future.

Part-time work and sickness absence - an organization-level analysis.

BACKGROUND: Absenteeism is consistently higher in public than in private organizations, as is the use of part-time employment. The aim of this study is to identify whether there is a relationship between part-time work and sickness absence at the organizational level. METHODS: The data is a six-year panel for the full population of Norwegian municipalities (N = 422), linking objective register data on both part-time employment and sickness absence. Using OLS regression with fixed effects for municipality and time, we estimate the statistical effects of the municipalities' use of part-time work on sickness absence. RESULTS: The bivariate correlation between percentage position at the municipal level and percentage sickness absence is positive and significant (Pearson's r = .25, sig LE 0.01). When controlling for fixed effects for municipality and time, as well as municipality economy, municipality size, ratio of female employees in the municipality and characteristics of the general population, the multivariate regression coefficient is still positive but insignificant (coefficient = 1.56, robust standard error = 1.31). CONCLUSIONS: The main findings are that the organizations' use of part-time work is unrelated to sickness absence indicating that organizations with extensive use of part-time work do not experience higher levels of absenteeism than those having less extensive use of part-time employees.

Measuring and improving performance of clinicians: an application of patient-based records.

BACKGOUND: Efforts to measure performance and identify its driving factors among clinicians are needed for building a high-quality clinician workforce. The availability of data is the most challenging thing. This paper presented a summary performance measure for clinicians and its application on examining factors that influence performance using routine patient-based records. METHODS: Perfomance indicators and difficulty score were extracted from electronic medical records (EMRs). Difficulty adjustment and standardized processing were used to obtain indicators which were comparable between specialties. Principal component analysis (PCA) was used to estimate the summary performance measure. The performance measure was then used to examine the influence of person-job fit and burnout through a mediator effect model and cluster analysis. RESULTS: A valid sample of 404 clinicians were included in this study, and 244 of them had valid response in the questionnaire. PCA explained 79.37% of the total variance presented by the four adjusted performance indicators. Non-performance attributes and performance driving factors help distinguish different clusters of clinicians. Burnout mediates the relationship between person-job fit and performance in a specific group of clinicians (ß = 0.120, p = 0.008). CONCLUSIONS: We demonstrated the analytical steps to estimate clinicians' performance and its practical application using EMRs. Our findings provide insight into personnel classified management. Such practice can be applied in countries where electronic medical record systems are relatively less developed to continuously improve the application of performance management.

British doctors' work-life balance and home-life satisfaction: a cross-sectional study.

PURPOSE: To assess British doctors' work-life balance, home-life satisfaction and associated barriers. STUDY DESIGN: We designed an online survey using Google Forms and distributed this via a closed social media group with 7031 members, exclusively run for British doctors. No identifiable data were collected and all respondents provided consent for their responses to be used anonymously. The questions covered demographic data followed by exploration of work-life balance and home-life satisfaction across a broad range of domains, including barriers thereto. Thematic analysis was performed for free-text responses. RESULTS: 417 doctors completed the survey (response rate: 6%, typical for online surveys). Only 26% reported a satisfactory work-life balance; 70% of all respondents reported their work negatively affected their relationships and 87% reported their work negatively affected their hobbies. A significant proportion of respondents reported delaying major life events due to their working patterns: 52% delaying buying a home, 40% delaying marriage and 64% delaying having children. Female doctors were most likely to enter less-than-full-time working or leave their specialty. Thematic analysis revealed seven key themes from free-text responses: unsocial working, rota issues, training issues, less-than-full-time working, location, leave and childcare. CONCLUSIONS: This study highlights the barriers to work-life balance and home-life satisfaction among British doctors, including strains on relationships and hobbies, leading to many doctors delaying certain milestones or opting to leave their training position altogether. It is imperative to address these issues to improve the well-being of British doctors and improve retention of the current workforce.

Nurses' work experiences 5 years after hospital merger in the province of Quebec/Canada-An exploratory qualitative study.

In recent years, healthcare organisations in North America have undergone major structural changes. In particular, the province of Quebec in Canada adopted a reform in 2015 which led to the merging of healthcare organisations into centralised regional administrations (the 'CISSS'). As research indicates negative impacts of mergers on patient outcomes and difficulties for the nursing work group in particular, the present paper aims to answer calls for more research about the long-term effects of major organisational changes on nurses' professional practice and well-being. We used an exploratory qualitative research design and report on data collected from 42 nursing professionals, ranging from clinical nurses, nurse practitioners, to head nurses and nursing advisors. Drawing on the job demands-resources model and the person-environment fit theory, our findings yield three main conclusions regarding the state of nursing practice 5 years after the 2015 reform: (1) emergence of a new demand for work harmonisation; (2) growing gaps in the nursing practice environment across departments; (3) evidence of a structural disempowerment of the nursing practice in healthcare organisations. There is hope that a vast project for practice harmonisation initiated and led by local senior nursing advisors will bring about positive outcomes for the nursing practice, and nurses' overall working conditions in the province.

A multilevel conceptual framework on green practices: Transforming policies into actionable leadership and employee behavior.

As organizations have recognized their cause/solution relationship with the environment, increasing attention is being given to the role of employees make in achieving green organizational objectives. Even though, business sustainability initiatives are often led by leaders; employee green behavior (EGB) plays a vital role in success of such initiatives. The current paper focuses on relatively less researched topic of EGB. It uses a narrative review approach to develop a multi-level conceptual framework that draws upon the connectivity of leadership influence at firm and team levels, and how this influences individual level EGB. The paper offers a holistic approach to influencing effective green strategies in organizational contexts. By doing so, it contributes to the larger debate on different dimensions, mechanisms, and levels of environmentally responsible behavior in organizational settings and opens up new avenues for multi-level and cross-layer empirical research.

Remote work and the COVID-19 pandemic: An artificial intelligence-based topic modeling and a future agenda.

As remote work has become more common than ever throughout the COVID-19 pandemic, it has drawn special attention from scholars. However, the outcome has been significantly sporadic and fragmented. In our systematic review, we use artificial intelligence-based machine learning tools to examine the relevant extant literature in terms of its dominant topics, diversity, and dynamics. Our results identify-eight research themes: (1) Effect on employees at a personal level, (2) Effect on employees' careers, (3) Family life and gender roles, (4) Health, well-being, and safety, (5) Labor market dynamics, (6) Economic implications, (7) Remote work management, (8) Organizational remote work strategies. With further content analysis, we structure the sporadic research into three overarching categories. Finally, for each category, we offer a detailed agenda for further research.

Effective machine learning, Meta-heuristic algorithms and multi-criteria decision making to minimizing human resource turnover.

Employee turnover is one of the most important issues in human resource management, which is a combination of soft and hard skills. This makes it difficult for managers to make decisions. In order to make better decisions, this article has been devoted to identifying factors affecting employee turnover using feature selection approaches such as Recursive Feature Elimination algorithm and Mutual Information and Meta-heuristic algorithms such as Gray Wolf Optimizer and Genetic Algorithm. The use of Multi-Criteria Decision-Making techniques is one of the other approaches used to identify the factors affecting the employee turnover in this article. Our expert has used the Best-Worst Method to evaluate each of these variables. In order to check the performance of each of the above methods and to identify the most significant factors on employee turnover, the results are used in some machine learning algorithms to check their accuracy in predicting the employee turnover. These three methods have been implemented on the human resources dataset of a company and the results show that the factors identified by the Mutual Information algorithm can show better results in predicting the employee turnover. Also, the results confirm that managers need a support tool to make decisions because the possibility of making mistakes in their decisions is high. This approach can be used as a decision support tool by managers and help managers and organizations to have a correct insight into the departure of their employees and adopt policies to retain and optimize their employees.

"Raising the curtain on the equality theatre": a study of recruitment to first healthcare job post-qualification in the UK National Health Service.

BACKGROUND: UK equality law and National Health Service (NHS) policy requires racial equality in job appointments and career opportunities. However, recent national workforce race equality standard (WRES) data show that nearly all NHS organisations in the UK are failing to appoint ethnically diverse candidates with equivalent training and qualifications as their white counterparts. This is problematic because workforce diversity is associated with improved patient outcomes and other benefits for staff and organisations. AIM: To better understand the reasons behind underrepresentation of ethnically diverse candidates in first NHS healthcare jobs post-qualification and to identify any structural or systemic barriers to employment for such groups. METHODS: The study was informed by critical theory and the authors' interdisciplinary perspectives as educators and researchers in the healthcare professions. Data collected from semi-structured face-to-face interviews with 12 nurse and physiotherapy recruiting managers from two NHS trusts in London were analysed using a healthcare workforce equity and diversity conceptual lens we developed from the literature. Using this lens, we devised questions to examine six dimensions of equity and diversity in the interview data from recruiting managers. RESULTS: Recruiting managers said they valued the benefits of an ethnically diverse workforce for patients and their unit/organisation. However, their adherence to organisational policies for recruitment and selection, which emphasise objectivity and standardisation, acted as constraints to recognising ethnicity as an important issue in recruitment and workforce diversity. Some recruiting managers sense that there are barriers for ethnically diverse candidates but lacked information about workforce diversity, systems for monitoring recruitment, or ways to engage with staff or candidates to talk about these issues. Without this information there was no apparent problem or reason to try alternative approaches. CONCLUSION: These accounts from 12 recruiting managers give a 'backstage' view into the reasons behind ethnic inequalities in recruitment to first healthcare job in the UK NHS. Adherence to recruitment and selection policies, which aim to support equality through standardisation and anonymisation, appear to be limiting workforce diversity and creating barriers for ethnically diverse candidates to attain the jobs that they are trained and qualified for. The Healthcare Workforce Equity + Diversity Lens we have developed can help to 'raise the curtain on the equality theatre' and inform more inclusive approaches to recruitment such as contextualised recruitment or effective allyship between employers and universities.

Pandemic and the human factor.

As the staffing crisis in the UK deepens, it is time for the policy-makers and professional bodies to rethink the approach to the most vital and yet most fragile component of the healthcare system-the human beings. The austerity measures, combined with pandemic and more recently the vision of a backlog with attached unrealistic expectations of tackling it, have brought the NHS and many other healthcare systems to the brink of a crisis. It is a human factors approach, which emphasises clinician's well-being as the core aspect of optimising performance that should become our goal. Delivery of healthcare under circumstances of physical, legal or moral threat cannot be optimal and is not sustainable. The pandemic served to highlight this quite clearly. Also, an injured, tired or burn-out healthcare professional cannot be expected to repair the system that has precipitated his or her condition. The approach to changing the culture of medicine may be multifaceted, but ultimately, we should rethink professionalism and the definition of duty of care putting emphasis on the well-being of those delivering the care as the way to assure best possible care.

Human resource management in Ethiopian public hospitals.

BACKGROUND: In Ethiopia, public hospitals deal with a persistent human resource crisis, even by Sub-Saharan Africa (SSA) standards. Policy and hospital reforms, however, have thus far resulted in limited progress towards addressing the strategic human resource management (SHRM) challenges Ethiopia's public hospitals face. METHODS: To explore the contextual factors influencing these SHRM challenges of Ethiopian public hospitals, we conducted a qualitative study based on the Contextual SHRM framework of Paauwe. A total of 19 structured interviews were conducted with Chief Executive Officers (CEOs) and HR managers from a purposive sample of 15 hospitals across Ethiopia. An additional four focus groups were held with professionals and managers. RESULTS: The study found that hospitals compete on the supply side for scarce resources, including skilled professionals. There was little reporting on demand-side competition for health services provided, service quality, and service innovation. Governmental regulations were the main institutional mechanism in place. These regulations also emphasized human resources and were perceived to tightly regulate employee numbers, salaries, and employment arrangements at detailed levels. These regulations were perceived to restrict the autonomy of hospitals regarding SHRM. Regulation-induced differences in allowances and external employment arrangements were among the concerns that decreased motivation and job satisfaction and caused employees to leave. The mismatch between regulation and workforce demands posed challenges for leadership and caused leaders to be perceived as incompetent and unable when they could not successfully address workforce needs. CONCLUSIONS: Bottom-up involvement in SHRM may help resolve the aforementioned persistent problems. The Ethiopian government might better loosen regulations and provide more autonomy to hospitals to develop SHRM and implement mechanisms that emphasize the quality of the health services demanded rather than the quantity of human resources supplied.

Motivations of medical students and doctors leaving the NHS explored in a residency training application webinar series.

BACKGROUND: Recent reports show that about 10% of UK-graduate doctors leave the country to pursue specialty training elsewhere. Our article aims to evaluate the motivating factors for UK graduates to leave the National Health Service (NHS), especially during the COVID-19 pandemic and Brexit. STUDY DESIGN: Cross-sectional study. METHOD: A novel 22-item questionnaire was disseminated at a webinar series regarding the application process to pursue residency training in six different countries/regions from 2 August 2020 to 13 September 2020. The data was analysed using Kruskal-Wallis rank-sum with post-hoc Wilcoxon test to compare the difference in significance among the motivating factors. RESULTS: 1118 responses from the UK medical students and doctors were collected; of which, 1001 (89.5%) were medical students, and 88 (7.9%) were junior doctors. There was a higher propensity for leaving after the Foundation Programme compared with other periods (p<0.0001 for all comparisons). There was no difference between desire for leaving after core surgical/medical training and specialty training (p=0.549). However, both were significantly higher than leaving the NHS after medical school (p<0.0001). Quality of life and financial prospects (both p<0.0001) were the most agreed reasons to leave the NHS, followed by clinical and academic opportunities and, subsequently, family reasons. CONCLUSION: Future work on the quality of life for doctors in the UK should be explored, especially among those considering leaving the NHS. Policymakers should focus on assessing the difference in working hours, on-call hours and wages that may differ among healthcare systems.

What gets resident physicians stressed and how would they prefer to be supported? A best-worst scaling study.

INTRODUCTION: Physician burnout has severe consequences on clinician well-being. Residents face numerous work-stressors that can contribute to burnout; however, given specialty variation in work-stress, it is difficult to identify systemic stressors and implement effective burnout interventions on an institutional level. Assessing resident preferences by specialty for common wellness interventions could also contribute to improved efficacy. METHODS: This cross-sectional study used best-worst scaling (BWS), a type of discrete choice modelling, to explore how 267 residents across nine specialties (anaesthesiology, emergency medicine, internal medicine, neurology, obstetrics and gynaecology, pathology, psychiatry, radiology and surgery) prioritised 16 work-stressors and 4 wellness interventions at a large academic medical centre during the COVID-19 pandemic (December 2020). RESULTS: Top-ranked stressors were work-life integration and electronic health record documentation. Therapy (63%, selected as 'would realistically consider intervention') and coaching (58%) were the most preferred wellness supports in comparison to group-based peer support (20%) and individual peer support (22%). Pathology, psychiatry and OBGYN specialties were most willing to consider all intervention options, with emergency medicine and internal medicine specialties least willing to consider intervention options. CONCLUSION: BWS can identify relative differences in surveyed stressors, allowing for the generation of specialty-specific stressor rankings and preferences for specific wellness interventions that can be used to drive institution-wide changes to improve clinician wellness. BWS surveys are a potential methodology for clinician wellness programmes to gather specific information on preferences to determine best practices for resident wellness.

Systematic review of interventions to improve gender equity in graduate medicine.

Women are substantially underrepresented in senior and leadership positions in medicine and experience gendered challenges in their work settings. This systematic review aimed to synthesise research that has evaluated interventions for improving gender equity in medicine. English language electronic searches were conducted across MEDLINE, CINAHL, Academic Search Complete, PsycINFO and Web of Science. Reference list screening was also undertaken. Peer-reviewed studies published between 2000 and March 2020 that evaluated interventions to improve gender equity, or the experiences of women, in academic or clinical medicine were reviewed. Dual reviewer data extraction on setting, participants, type of intervention, measurement and outcomes was completed. Methodological rigour and strength of findings were evaluated. In total, 34 studies were included. Interventions were typically focused on equipping the woman (82.4%), that is, delivering professional development activities for women. Fewer focused on changing cultures (20.6%), ensuring equal opportunities (23.5%) or increasing the visibility or valuing of women (23.5%). Outcomes were largely positive (87.3%) but measurement typically relied on subjective, self-report data (69.1%). Few interventions were implemented in clinical settings (17.6%). Weak methodological rigour and a low strength of findings was observed. There has been a focus to-date on interventions which Equip the Woman Interventions addressing systems and culture change require further research consideration. However, institutions cannot wait on high quality research evidence to emerge to take action on gender equity. Data collated suggest a number of recommendations pertaining to research on, and the implementation of, interventions to improve gender equity in academic and clinical settings.

Competence-based human resource management to improve managerial competence of first-line nurse managers: A scale development.

AIM: This study aimed to develop and psychometrically test a competence-based human resource management scale to improve managerial competence of first-line nurse managers in public hospitals. BACKGROUND: To ensure the high competence of the first-line nurse managers, the competence-based human resource management should be evaluated using the best-fit instrument. However, no instrument has been identified in the hospital setting. METHODS: This methodological study consists of three main steps: (1) generating scale items based on literature review and expert interviews, (2) pilot testing of face and content validity and (3) evaluating psychometric properties with 300 first-line nurse managers from 16 public hospitals in Indonesia selected using a multistage sampling. Data were collected from May to December 2017. Principal component analysis and Cronbach's α were used for construct validity and internal consistency reliability. RESULTS: The final scale consists of 30 items in five dimensions, which explained 65.48% of the total variance. The dimensions include 'training and evaluation, career planning and development, rewards scheme, recruitment and selection, and appraisal system'. Cronbach's α for the scale was .89, with a range of .85 to .88. CONCLUSION: The competence-based human resource management scale is reliable and valid to use in public hospital settings.