HR Autonomy in Public Hospitals in Pakistan: Increased Employee Outcomes and Performance or a Myth Adopted?
The dissertation addresses overreaching research aim to provide insights into the mechanisms underlying the HR and performance relationship in the context of the public sector. Inspired by the autonomy reforms of New Public Management (NPM) that intend to enhance the performance of the public organizations, the public health sector in Pakistan has adopted NPM-like reforms by granting autonomy to public hospitals. This dissertation aims to uncover the HR and performance relationship in light of the level of HR autonomy of the organization. To achieve this aim, the research first provides a comprehensive picture of decentralization reforms in the public health sector in Pakistan. Focusing on contextual HRM, the research focuses on the level of autonomy granted to public hospitals, how this influences the gap between intended and implemented HR practiced and, in turn, how the link between HR practices and performance takes place. For this, the research adopted an overarching conceptual model that connected insights from three research fields, including public administration, strategic HRM, and organization behavior.
This research adopts both qualitative and quantitative research methods to collect data using multiple sources from multiple actors at multiple levels in three public hospitals in Pakistan. First, to understand the context, we adopted a qualitative research approach by using secondary data i.e., literature review and document analysis to briefly provide an overview of reforms in the public health sector in Pakistan. Moreover, to explore the level of autonomy and the gap between intended and implemented HR practices in public hospitals, we used primary data, i.e., semi-structured interviews and a complementary survey questionnaire. Second, after gaining insight into the context, we adopted a quantitative research methodology using survey questionnaires to explore the link between supervisor and employee perceptions of HR practices, employee outcomes, and performance.
Concentrating on the context of HRM, the findings highlight that different levels of HR autonomy have a profound effect on the involvement of line managers in HR decision-making and this involvement ultimately affects the gap between intended and implemented HR practices. Moving further, the study shows that supervisor perceptions do not always influence employee perceptions of HR practices, whereas the employee-supervisor relationship is an important antecedent of employee perceptions of HR practices that ultimately affect employee job satisfaction. Focusing on the mediating mechanisms between perceptions, outcomes and performance at both individual and department levels, our findings reveal mediating mechanisms exist at both levels, but not all employee outcomes mediate at both levels simultaneously. Finally, our research shows that the relationship between level of autonomy and performance is not straightforward and needs further research.
Overall, this research argues that contextualizing HRM is essential to understand the link between HR and performance. There is still more theoretical underpinning and empirical evidence needed to fully unlock the mediating mechanism between HR and performance at different levels in the organization.