title: Why we need multi-level health workforce governance: Case studies from nursing and medicine in Germany.
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.
authors: Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden. Electronic address: ellen.kuhlmann@ki.se.
authors: Ellen
authors: E
authors: Kuhlmann
authors: IWAK, Institute of Economics, Labour and Culture (IWAK), Goethe-University Frankfurt, Germany. Electronic address: c.larsen@em.uni-frankfurt.de.
authors: Christa
authors: C
authors: Larsen
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D005858:Germany; D033161:Government Regulation; D006291:Health Policy; D006280:Health Workforce / Q000458:organization & administration*; D006801:Humans; D008511:Medicine / Q000458:organization & administration*; D009726:Nurses / Q000600:supply & distribution; D009729:Nursing / Q000458:organization & administration*; D019982:Organizational Case Studies; D010820:Physicians / Q000600:supply & distribution; D011050:Policy Making
keywords: Germany; Health human resources policy; Health workforce governance; Multi-level governance; Nurses and physicians