Anthun et al.

BMC Health Services Research (2024) 24:1131 BMC Health Services Research
[Link]

RESEARCH Open Access

What influences the use of HR analytics

in Human Resource management
in Norwegian municipal health care services?
Kirsti Sarheim Anthun1*, Kjartan Sarheim Anthun1,2, Erna Håland3 and Monica Lillefjell4,5

Abstract
Background The centrality of human resources in the provision of healthcare suggests that Human Resource (HR)
management and the use of Human Resource analytics – use of digital data to better understand, assess, plan and
organize the workforce - can play an important role in this. However, data driven decision making in the field of
human resource management is lagging, and the appropriation of HR analytics in the healthcare sector is limited.
Aim The current study explores the role of HR departments and the adoption of Human Resource analytics in four
municipalities in Norway to obtain insights into what influences the use or lack of use of HR analytics.
Methods Empirical data were generated through qualitative interviews with fourteen individuals working in HR
departments, the municipal administration, and the healthcare services. Structurational theory guided the analysis.
The findings show that none of the municipalities made extensive use of data to inform decision making related to
human resource management or workforce planning.
Results and conclusion Three conditions hampered or made irrelevant the use of HR analytics: a decoupling
between the services and HR, a weak data-culture, and HR and decision-making processes involving a plurality of
stakeholders. However, there were changes underway in all municipalities related to the role of HR and HR analytics.
Keywords Human resource analytics, Workforce planning, Structuration theory, Municipal health care services,
Norway

Introduction
The recruitment, allocation, and retention of healthcare
professionals are a major concern among policymak-
ers globally due to present and future shortages of staff
[1–4], increased life expectancy, demographic changes,
*Correspondence: and the rising number of patients with chronic illnesses.
Kirsti Sarheim Anthun
[Link]@[Link] In addition, studies have found that insufficient staffing
1
Department of Health Research, SINTEF Digital, Trondheim, Norway levels in healthcare are not only associated with adverse
2
Department of Public Health and Nursing, Norwegian University of patient outcomes [5], but staff burnout, decreased job
Science and Technology, Trondheim, Norway
3
Department of Education and Lifelong Learning, Norwegian University satisfaction and intentions to leave the job have been
of Science and Technology, Trondheim, Norway reported [6, 7].
4
Department of Neuromedicine and Movement Science, Norwegian Staff shortages in the healthcare services have been
University of Science and technology, Trondheim, Norway
5
Department of Public Health, University of Stavanger, Stavanger, Norway countered by an intensified search for technological,

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Anthun et al. BMC Health Services Research (2024) 24:1131 Page 2 of 16

organizational, and managerial initiatives that can enable increasing use of digital systems in the administration
the delivery of high-quality services while keeping costs and delivery of healthcare services.
at a sustainable level [8, 9]. As a part of this, attention has The paper is organized as follows. We start by present-
also been directed towards facilitating good working con- ing research on HR analytics (HRA) before we briefly
ditions in healthcare, and motivating and enabling staff to describe the Norwegian municipal healthcare context.
stay in their jobs [10]. As a result, scholars anticipate that Then follows an outline of the study’s research design and
the role and function of Human Resource Management methods, before we move on to report and discuss our
in healthcare will change [11, 12]. It has also been argued findings. And finally, we conclude by suggesting implica-
that use of various sources of data, including HR data, tions for further research.
can contribute to help find solutions [13].
Policymakers have high expectations of the value gains Previous research on HR analytics
from digital data in healthcare [14], and healthcare orga- According to a review of HR analytics literature [23]
nizations globally are currently under pressure to make HRA first appeared in 2004 in the human resource plan-
healthcare more ‘data-driven’ [15]. But so far, investments ning literature, where HRA was presented as something
have primarily been directed to technology that supports other than HR metrics. While HR metrics referred to
clinical work. Administrative infrastructures and func- the measures of key HRM outcomes such as efficiency,
tions have received less funding [16]. In line with this effectiveness, and impact [23, p.14], HRA was the use of
OECD reports [17] that countries generally lack systems statistical techniques and experimental approaches that
for monitoring the numbers of health workers. could identify impacts of HR activities [24]. Later, schol-
With growing competition for human resources in ars have emphasized the strategic advantages of HRA in
healthcare, coupled with more advanced digital systems identifying the relationship between human resources
and access to increasing amounts of data, there is both a and organizational performance [23, 25]. HRA should
need for, and opportunities for, changes of the HR func- not use only HR data but link a variety of information
tion, and HR analytics (HRA) has been put forward as a and data from internal and external sources and perform
key solution [18, 19]. analytics that should be closely aligned with the organi-
zation’s key priorities [23, 25, 26].
HR analytics The twenty years gone by since the introduction of
HR analytics refers to the use and analysis of internal and HRA has seen a gradual increase in research interest,
external data to support decision-making in organiza- mainly within the areas of organization- and manage-
tions [12]. Internal and external here refer to data gener- ment -studies [23]. Despite this, research has found lim-
ated within the context of the organisation (internal), or ited use of data analytics to improve decision-making in
data from outside the organization (external). It has been organizations [27, 28]. A report [29] showed restricted
argued that systematic use of HRA can help predict the use of HR analytics among 1200 HR executives from
need for personnel and turnover, it can assist in compe- around the world. Only 20% believed analytics would be
tency- and staffing level assessments, improve recruit- a primary HR initiative for them in the upcoming two
ment processes, and support management and decision years, and only 12% reported that analytics was a top
making [13, 20]. Making use of data for the good of the management concern in their organization.
employees and the recipients of services has also been Research shows that many organizations still lack the
emphasized [21]. necessary skills to conduct HRA [22, 28]. Part of the
Based on the growing optimism linked to the benefits explanation is that HRA is still in its early stages [23,
of developing more data-driven healthcare services, and 30]. Scholars have warned that unless HRA does not
the lack of studies investigating barriers and facilitators shift approach and address the strategic challenges of an
related to achieving this [12, 22], there is a need for stud- organization; hence take HRA “out of HR” ([25], p. 256),
ies exploring the use of HR analytics in the administra- HRA will not last but become just another ‘management
tion, organization, and development of the workforce fad’ [25]. Other more optimistic voices argue that HRA
in healthcare. The present study will contribute to fill- is becoming an established discipline with potential for
ing this gap in the literature. The aim of this study is to significant influence on strategic decisions making in
explore what influences the adoption of Human Resource organizations [31]. With the fast-pacing developments
analytics in workforce planning in four Norwegian in machine learning and generative AI, scholars and
municipalities’ healthcare services. Our main research practitioners also believe that HRA will be significantly
question is: what are the factors driving or limiting the improved in the years to come [32].
use of HR analytics in the four municipalities? Norway When it comes to research on factors contributing to
displays some characteristics that are relevant in a global successful adoption of HRA, it has been found that senior
context; problem of staff shortages within healthcare and management’s support is crucial, because managers can
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 3 of 16

provide political support and financial resources for HRA in healthcare

investing in IT infrastructure and software, as well as While the research on HRA in business organisations has
putting analytics and data-based management on the grown steadily, less research is available on HRA within
agenda in the organization [27, 33, 34]. Furthermore, IT healthcare organisations [11]. Nonetheless, there are
infrastructure is also a key factor for carrying out HRA positive expectations within healthcare too on how HR
[12, 22, 27, 31], together with the existence of data that information systems can assist in providing insight that
makes it possible to conduct meaningful, valid analysis can improve the management, allocation, and retention
[35]. Related to this, the importance of data exchange of staff [13]. Studies report of limited use of HR analyt-
and opportunities and potential for integrating data have ics within healthcare [11], but where it has been adopted,
also been emphasized [36], together with issues such as this has depended on the organization’s analytic maturity
communication and collaboration between units within [13]. A study from Australia found no evidence of sophis-
the organization, and a supportive culture for HRA [29]. ticated HR analytics or evidence-based decision-making
Analytical skills and a data-driven culture are also impor- among line managers in four large hospitals where the
tant preconditions for the adoption and use of HRA [23, official policy was to practice evidence-based decision-
34, 37]. However, one study [38] found that even though making and management [42]. HRA could potentially
the analytical skills of HR professionals such as statistical have improved the line managers’ manual and erratic
and presentation techniques are necessary to make use rostering practice that created a shortage of medical sci-
of HRA more effectively, possessing such skills did not entists and negatively affected their wellbeing and health.
greatly influence their adoption of HRA. The study demonstrated that HRA was neglected as a
Previous research has also reported that HR’s knowl- tool for adhering to the evidence-based strategy in the
edge of the organization, its’ products or services and organisation.
the key processes of production/service delivery, can Another study examined how the use of HR analytics
improve the validity and quality of the insights from HRA could assist in mitigating incidents of violence against
[12, 39]. One study highlights the importance of consul- workers in aged care [43]. It was argued that whereas
tancy skills, visualization, and story-telling skills, as well traditional HR has failed to protect staff against such
as translator skills to improve the influence of HRA in the incidents, HR should find new ways to integrate and ana-
organization [22]. lyze employee-related data to enhance human capital,
In the growing literature on HRA some have raised improve work experience and work performance among
concerned voices against HRA and related approaches staff. But data was not collected or analyzed on violent
such as people analytics. They are especially concerned incidents and the mental health of staff following such
with advancements in machine learning and artificial incidents. Investigating what employees needed to cope
intelligence and how this will impact HRA and employ- with such incidents was not done either. Hence, valuable
ees (see e.g [40]). The overly optimistic belief in data is and necessary groundwork in human resource manage-
seen as problematic as it may lead to mistaking data for ment that could improve the working environment and
reality and installing unrealistic ideas about having con- therefore the retainment of healthcare staff was not done.
trol, which again can result in wrong actions. Also, a
too strong belief in an allegedly “objective” data-driven HRA in the Norwegian healthcare context
decision-making in organizations may result in failure Increased attention and optimism have been directed
in seeing the need for creative human decision-making, towards the use of digital data in the delivery and man-
as well as a failure to notice new patterns and opportu- agement of healthcare services in Norway [44], but few
nities for innovation [40]. The worry is that the use of studies have explored the use of HRA [45]. We found
more advanced algorithms in HRA can lead to reduced only one study addressing this issue within the context of
autonomy for employees, as it becomes increasingly municipal healthcare [46]. The mentioned study investi-
more difficult to understand the underlying assumptions gated use and re-use of a variety of data from municipal
of algorithms [40]. The problem of reduced autonomy services, and found that lack of competency, poor data
and privacy of employees are also related to the growing quality, few incentives to use data, rigid laws and regula-
amount of data that is generated and gathered, and the tions, and system retailers’ control of the data, hindered
potential misuse of such data, for instance in identifying use and re-use of data.
poor performers and introducing a regime of monitoring While it has been difficult to find studies in Norway
and control [40]. Scholars therefore call for sophisticated on the use of HR data within municipal healthcare, there
HRA, and a policy of internal transparency to ensure that are studies looking into the use of digital tools in work-
AI does not become a tool to control employees [40, 41]. force planning. One study [47] explored the use of digi-
talized workforce planning in home-based care services
and found that this positively influenced the quality and
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 4 of 16

efficiency of the services. The authors did however point demands on municipal healthcare services and created
out that the tool could have potential positive value for greater needs for more advanced medical and health care
strategic organizational development and suggested this [54–56]. According to statistics [57] primary health care
as an important topic for further research. That study, is the sector struggling the most with recruiting person-
and others [48–50], indicate that while various techno- nel - lacking approximately 14 600 people, and all regions
logical tools and systems are implemented and used in in the country are experiencing more or less the same
the healthcare services, the effects, outcomes, and expe- [57]. Such challenges call for increased attention to how
riences from such initiatives are not taken fully advantage to attract, recruit and retain healthcare personnel.
of, nor are they being systematically integrated with sys-
tems or data in the organization to obtain an overview of Conceptual framework
the use of resources across units. Studies of what poses The theoretical framework informing the analysis is that
challenges for digitalization and data-driven decision- of structurational theory, as adapted from Giddens [58]
making in municipalities have shown that the most by Orlikowski and Robey [59]. Addressing the nature of
critical hindering factors are lack of ICT competence human actors’ use of computer systems, software, and
[51], resistance towards changes [52], and the size of the digital data to inform HR activities in healthcare requires
municipality as this often is linked to lack of maturity in a theoretical framework that facilitates an analysis of the
investing in and using ICT systems for the support of ser- dynamic interactions between subjective human actors
vices [51]. and institutional properties, or agency and structure.
To sum up, HRA is still at an early stage, and has thus These make up the duality of social structure [60]. One
far not contributed to shifting HR’s role from the oper- aspect of this duality refers to how we as human actors
ational to the more strategic. Research shows that both can never act or interact in a vacuum, there are always
technological (IT infrastructure, software and digi- structural properties that influence our interactions. A
tal data) and social issues (various skills, technological phrase often heard in organizations is “we do it this way
acceptance, management’s attitudes, institutional norms, because we have always done so” expresses this notion of
and opportunities for collaboration) influence the adop- adhering to past ways of doing things, confirming those
tion and use of HRA. Moreover, the literature identifies ways but also strengthening their influence and further
a lack of research on HRA in healthcare, despite the very existence in the present. Social structures thus exhibit
urgent need to explore how HRA can be used in exam- properties that are objective in that they provide the con-
ining how HR initiatives can impact positively on the ditions for human action to take place. This happens even
recruitment, development, work performance and reten- if we as actors, believe that we act freely, not recognising
tion of staff. In addition, empirical, qualitative research or acknowledging the structuring properties influencing
on HRA within the municipal healthcare sector is very our actions.
sparse. The second aspect of the duality of structure is the
The literature also indicates that an exploration of HRA human actor, with agency to choose not to keep to the
involves much more than implementing a new software established and the ability to initiate changes in social
tool in the HR department. There is a need for a theoreti- structure. The duality of structure and agency is always
cal approach that is holistic; integrating both the social at play, and the relationship between human action and
and material dimensions related to HRA. The present social structure is called the process of structuration [60].
study aims to investigate what influences the adoption of Three modalities are central in the process of structura-
HR analytics in human resource management in health- tion. The first modality is interpretive schemes, which
care services in four municipalities in Norway. refers to standardized, shared repositories of knowledge
that human actors use to interpret events and act mean-
The Norwegian municipal healthcare services ingfully. The second is resources, referring to any means
Norway has a tax-based national health system where the used by human actors to reach their goals, and exercise
state and municipalities share responsibility for health power (money, tools, skills, knowledge). For instance, in
care delivery [53]. Hospitals and specialist care services healthcare organizations clinical professionals will often
are accountable for health treatment that cannot be per- have a high standing, and their professional status can
formed in community care, while municipalities are in be drawn on as a resource that can influence social situa-
charge of primary care and public health (GPs, maternity tions. The third and last modality is that of norms, which
care, school health services, long-term care, and social refers to the rules for proper conduct.
services) [53]. A structurational framework allows insight into how
Through reforms and aging-in-place policies, care pro- the social structures of an organisation are influenced
vision has gradually shifted from specialized hospitalized by the use of informational technology and how the use
care to primary health care [53]. This has increased the of informational technology is influenced by the social
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 5 of 16

structures of the organisation. Examining only one side no HR consultants, and one HR consultant had to turn
of this will provide a partial understanding of how orga- down the invitation to participate in the interview due to
nizations and technology, interact. In the structurational workload and time-pressure, thus only two HR consul-
framework technology does not determine social prac- tants were interviewed, and four HR executives (one HR
tices. There is always the possibility that organisational executive from each of the municipalities). HR executives
members may choose not to use technology in the way it and HR consultants in all four municipalities stated that
was supposed to be used, or they may choose not to use HR work was split between the HR department, the head
it at all. Human actors’ values, interests, knowledge, skills of municipal affairs and section leaders from the health-
and professional norms and power influence how they care services. Therefore, we decided to recruit interview-
interact with technologies. They will invoke such social ees from the senior management level and among section
structures to either undermine the use of new technology leaders in the healthcare services, making sure that we
or they will transform social structures in the organiza- had at least one of each of these categories from all four
tion through appropriating the technology. municipalities. Inclusion criteria were responsibilities in
In the present study the structurational model of tech- human resource planning and human resource manage-
nology will provide a lens through which we examine ment related to the healthcare services. Consequently,
the interactive relation between humans, technology, we interviewed in total fourteen individuals - four HR
and organization. Our aim is that attention to this, can executives, two HR consultants, four Heads of Municipal
unravel the complexities inherent in the use of techno- Affairs, and four section leaders from the healthcare ser-
logical artefacts in the management of municipal health- vices. Out of the fourteen interviewees, ten were women.
care services. Two HR consultants and two heads of municipal affairs
were interviewed a second time, allowing us to probe for
Methods more information on their use of data in HR related tasks.
This qualitative, interview-based study was conducted Participants were contacted by e-mail and received both
in four medium-sized- to small municipalities, focus- oral and written information of the study and about their
ing mainly on the HR department in each municipality, rights to withdraw from it at any time without explana-
and addressing the HR departments’ work in relation to tion. No one dropped out during the study.
the healthcare services, and especially the use of data
and analytical-work within their practice. Research-data Data collection
regarding experiences with the role and function of HR Interviews took place during the last two quarters of
and the use of HR data and other sets of data were col- 2022 and the first quarter of 2023 and were conducted
lected. All interviews except one were individual semi- mainly in a conference-room in the municipality council
structured interviews, which allowed participants time to hall, except three that were conducted digitally. All par-
share and elaborate on their experiences, thoughts, and ticipants had worked in their present role for 1 ½ years or
opinions without the interference of other interviewees. more, except for one HR executive who had started just
The one group interview was conducted with two per- four months prior to the interview. Interviewees were
sons from the HR department in one municipality: the provided information about the aim and objectives of
Senior HR executives and a HR consultant. The reason the study and that participation was voluntary. All par-
behind conducting a group interview was that the Senior ticipants gave their written consent. Interviews lasted for
HR executive had just started in the position, and there- approximately one hour and were digitally recorded in
fore wanted someone present that knew the HR depart- their entirety, and all except two were transcribed verba-
ments’ role and work more thoroughly. All data collection tim. Careful notes were taken in the two interviews that
was carried out by the first and second author, except two were not transcribed verbatim. The interviews were con-
interviews that were conducted by the first author only. ducted, transcribed, and analysed in Norwegian. Only
the quotes used in this article were translated into Eng-
Selection of participants lish. The analysis was performed on the original inter-
The municipalities had been purposefully sampled to view transcripts. To ensure correctness of the translation,
ensure variation in size and characteristics pertaining the quotes were double-checked by the members of the
to the rural-urban divide. Interviewees were identified research team, who are proficient English speakers.
and selected purposively and sequentially [61] by the The interview guide was developed and shared in the
research group. First, we recruited individuals working in researcher group. It featured open-ended questions
HR departments – such as HR consultants or HR execu- that could bring out participants’ thoughts and reflec-
tives – as they were thought to possess pertinent experi- tions. The interviews were explorative, and the interview
ence and knowledge directly related to the issue studied. guide included questions about work-role, tasks and
One of the municipalities had only one HR executive and how long interviewees had worked in their current role,
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 6 of 16

and they were inquired about their thoughts on human true across the four municipalities. All the themes were
resource management, their use of ICT systems and the then considered in terms of how they related to each
software applications, and the use of data as a basis for other, and the theoretical framework chosen for the
decision-making in matters related to human resource study. We revisited the list of themes in a critically reflex-
management. The interview guide can be viewed under ive and evaluative way until agreement was reached.
the Supplementary files. All interviews were conducted Credibility of the analysis was enhanced not only through
on the basis of respondent and organizational anonymity. researcher-triangulation, but also through conduct-
Interviewees would only be identified by the role title, ing a member check [65]. The study results and quotes
Based on the classification scheme of Statistics Nor- were presented at a workshop with managers and some
way [62], one municipality (M1) can be characterized as a section leaders from the participating municipalities for
medium sized, urban municipality. The second one (M2) feedback on the findings. Findings were found to reflect
is a medium sized sub- or peri-urban municipality, while the situation in HR management in the municipalities.
the last two (M3 and M4) are rural municipalities, one
medium sized and one small1. See Table 1. Results
The aim of our study was to obtain insight into what
Data analysis influences the adoption of HRA in human resource man-
To examine the data, the study followed the principles of agement in the healthcare services in four municipalities
thematic coding [63, 64], allowing us to identify, analyse, in Norway. The structurational perspective [58] informed
and interpret patterns of meaning, or themes, in text- our study, especially its application in studies of informa-
based data. Analysis was performed in conjunction with tion systems [59] since the literature indicates that the
the data collection process, permitting any indistinct appropriation of HRA involves an emergent interplay of
questions to be probed further in subsequent interviews. structures and agency in organizations. Analysing the
The first author read and re-read the material to obtain interview transcripts, we found that none of the munic-
an overview and impression of the material. Features ipalities made extensive use of data from HR to inform
interpreted to be important in answering the research strategic human resource management. The organiza-
question were coded into initial codes. The codes were tional context encompassing the use of, or rather, in this
discussed among two of the researchers who had con- case, the lack of use of HR data and HR analytics, was
ducted the interviews, and potential themes were decided characterized by some structural conditions that contrib-
on. All the coded data relevant to the themes were then uted to an undermining of HRs ability to take on a more
collated. Codes and themes were then discussed in the strategic function in the organization. Adopting a more
whole research group. Themes were then checked in strategic function has been highlighted as key in develop-
relation to both coded extracts and by returning to the ing a strong HRA culture [25, 66], as this improves HR’s
interview transcripts. The themes were discussed again ability to perform HRA that are strategically important
in the researcher group, to develop themes that reflected and thus will have impact.
the ‘essence’ of the material while also responding to the We have organized the findings in four themes. The
study’s research question and to make sure themes held first theme we have called a decoupling between health
services and HR in matters related to HR management.
This included statements and reflections from interview-
Table 1 List and brief information on the municipalities included
ees describing a divide between the healthcare services
Name of municipality Size HR:
man- and HR where HR performed the administrative tasks
labour related to human resources, while the section leaders did
yearsa the practical day-to-day human resource management
M1 Large sized, urban 6 such as staff rostering, competency planning, and skills
M2 Medium-sized peri-urban 4 development. A second theme common across munici-
M3 Medium-sized rural 1 palities was weak data-culture with a lack of resources in
M4 Small-sized rural 4 terms of proper IT systems and knowledge and skills to
a
These resources work for all sectors in the municipality, not just for the carry out HR analytics. The third theme had to do with
healthcare sector.
the need to satisfy a plurality of stakeholders rendering
1
strategic and long-term recruitment planning difficult. In
According to Statistics Norway’s classification scheme [62], municipalities
with 20 000 or more inhabitants are large sized, municipalities with 10 000
sum, these social and technological structures have led to
to 19 999 inhabitants are medium sized, whereas municipalities with less weak emphasis on and adoption of HRA. However, as a
than 10 000 inhabitants are small sized. 81% of the inhabitants in Norway fourth theme, the analysis revealed that certain changes
live in the hundred largest municipalities, with more than 11 000 inhabit-
ants. The average number of inhabitants in Norwegian municipalities is 15
are under way and that some actors, especially within the
000.
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 7 of 16

HR departments, saw a need for change. In the following underline the necessity of first-hand knowledge about
the themes are presented in more depth. the ward, the patients, the clinical work and the staff to
make the right decisions in the day-to-day organization
Decoupling between the health services and HR in matters of human resources. HR was too far removed from clini-
related to HRM cal work, thus could not be involved in making decisions
Employees in the HR departments across the four about staffing or competency planning. Section leaders
municipalities described their work in a similar fashion pointed to how the services must deal with an increased
where a large share of the work is dedicated to admin- demand for specialization in healthcare, as patients have
istrative work related to payroll, recruitment and hiring, more complex and serious conditions. “We’ve become a
employee benefits and sick leave following-up. HR was mini hospital”, said one of the leaders at a nursing home
also involved in committee-work and was responsible for (M3), and added that each ward at the nursing home
facilitating the collaboration between trade unions and faced unique challenges based on the skills-mix that the
the employer. HR was brought in in an advisory capac- staff represented and the group of patients they care
ity in relation to rules and regulations, and in a practical for. This development strengthened the need for more
capacity, handling formalities in the hiring process. One detailed knowledge about the services when organizing
of the HR executives described HR’s work as follows: resources and competencies in the services. The changes
within healthcare were also recognized among the HR
HR does recruitment and development of the HR
professionals in all four municipalities. One of the HR
unit. We are involved in organizational develop-
Executives saw that a closer collaboration between HR
ment, but at an overall or systemic level. We are
and the services could be required in the future:
responsible for following up on matters related to
health-environment- and safety-regulations, and There are competency plans for the healthcare ser-
processes linked to salary negotiations. Each of the vices, but you’ve got to talk to the section leaders
section leaders are responsible for the recruitment about that. The municipal healthcare services now
processes in their sections, but we support them and ten years ago, that is not the same when it comes
when they hire new staff. And HR deals with real- to the advanced healthcare service that is being pro-
location of staff within the organization (HR execu- vided today. But in HR we are not involved in that.
tive, M1). But perhaps that is something that HR should be
involved in in the future? (HR Executive, M1).
All HR departments are organized directly under the
chief municipal executive, with the HR executive serving Interviewees from the services in all four municipalities
in the municipal executive’s cabinet. The HR departments were however content with the current relationship and
comprise 1–6 employees, including the HR executive. In division of work between services and HR, and in two of
three of the four municipalities the HR consultants serve the municipalities (M2 and M3), the HR consultants were
all municipal sectors, meaning none of the HR consul- also content with how things were. They said that HR had
tants are dedicated to one sector only. One of the HR enough to deal with as it was. One of them added that
consultants even said, “You have to be a generalist work- HR wasn’t supposed to do much else besides operational
ing in HR”. In the fourth municipality, the HR consultants and administrative tasks linked to hiring and following
had recently divided the sector areas between themselves up on those who were on sickness-leave. Implicit in this
on a permanent basis. This change was initiated when an there was an understanding that HR professionals should
employee transferred from one of the sector areas to the keep to their work as bureaucrats.
HR unit. Then it seemed reasonable to dedicate that per- As a result of this, human resource management had
son to the sector area s/he knew well, and the remaining to be divided and be part of management at all levels of
HR consultants were equally assigned to a specific sector the organization. Resource planning, staff rostering, and
area. Since this was a recent change, they had not regis- competency planning- and management were taken care
tered specific results related to this, though the HR exec- of by the section leaders, whereas the more overarching
utive said this could be the case in the longer run. issues related to management of resources were discussed
The HR departments were in the view of the section between section leaders and the Head of Municipal
leaders expected to take on a support role for the munici- Affairs. Personnel administration was performed by HR.
pal executive and the different administrative sectors One of the Heads of Municipal Affairs stated in relation
such as health and welfare, education, and technical ser- to this: “HR-work is probably done every other place
vices. While section leaders acknowledged and appreci- except where the HR-competency is located”. The result,
ated HR’s competency on laws and regulations in matters according to the same person, was that the more strategic
related to the administration of personnel, they would side of human resource management could suffer, since
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 8 of 16

no one would be able to grasp the whole picture and different systems, making it cumbersome to integrate
think and plan on a longer-term basis. The interviewee data or perform analysis across the data.
also claimed this was part of tradition and how things Interviewees from HR expressed a wish for more accu-
had always been, thus difficult to change. rate and digitalized workforce data. They also said that
In sum then, HR is mainly involved in routine adminis- moving from several different software systems to a more
trative work, servicing the healthcare units, ensuring that advanced and integrated system would make life easier
recruitment and exit processes are dealt with according and contribute to more efficient workforce planning and
to laws and regulations. Historical and cultural expec- recruitment processes. One of the HR executives pointed
tations and norms about who should do what and who out that they could all (Heads of Services, section lead-
serves whom result in a decoupling between HR and the ers, Heads of Municipal Affairs) sit down and discuss
services. Descriptions of their work and professional pri- the recruitment situation, but without any data, this was
orities indicated that they adhered to different institu- somewhat pointless. The HR executive also said that HR
tional logics; that of public administration (HR), and that could make an effort, curate data, and present a more
of professional clinical work (section leaders). The differ- accurate basis for decision-making, but it was tedious
ent institutional logics were maintained in their interac- work given the state of data and the fragmented nature of
tion and by the institutional set up and routines, resulting it. Interviewees from the HR departments also said they
in a continued decoupling and what can be termed a still use simple spreadsheet programs for data analysis
siloed or compartmentalized structure when it comes to (i.e., Excel).
HRM work. All interviewees described a similar situation where
they worked in several different software applications
Weak data-culture that all performed different tasks (i.e., one for payroll
In all four municipalities HR collects, registers and moni- and benefits, one for recruitment, and one for archiving
tors data, meaning; HR does a fair share of ‘data-work’ information on employees such as hiring date, position,
[67]. However, as we will see, this is not systematically education etc.).
curated to be used as input for workforce planning, Most interviewees from the top-management level and
human resource management or to inform strategic deci- the healthcare services in the municipalities did not see
sion making. Common to all four municipalities was a the value of data and HR analytics in supporting deci-
weak culture or weak social attribution to data-driven or sion making in human resource management and issues
evidence-based decision making. related to staffing. Strategic planning by use of his-
An organization’s data-culture refers to organization- torical data or statistics was not something they saw as
wide structures, practices and capabilities related to the necessary or relevant. At the same time, however, they
production, collection and utilization of data [68, 69]. expressed worry when it came to how healthcare could
Thus, it is not limited to the IT department’s capabilities recruit and retain human resources both in the near and
and resources, but includes all organization members’ far future, and several stated that something had to be
capabilities to find, analyze and utilize data, as well as the done, but HRA was not mentioned as a potential solution
institutional structures necessary to support this [68, 69]. here. Section leaders made decisions founded on con-
This is why we in this theme include statements related to crete and first-hand insight into patients, staff and work-
data awareness and skills, work and routines in perform- practices, without seeking support from data or initiating
ing data-work, and material/technological structures efforts to systematically assess dynamics between such
supporting data-work, such as computer systems and factors over time. One of the section leaders complained
software. that an increasing amount of computer work has been
The data-work that HR does is mainly linked to statu- introduced into healthcare and stated:
tory reporting and regular reporting to national authori-
All of them [the computer systems] are a little bit
ties and registries. The reporting included data on
different, and we must learn these systems. My staff
absenteeism, numbers on full-time equivalence, and
complains and says, ‘This is not why we started
employees’ working hours. HR also reported internally
working in healthcare – working with computer-sys-
to the municipal administration and to the municipal
tems instead of people’ (section leader, M3).
executive board on many of the same issues. HR was
also responsible for conducting work environment sur-
veys every second year and attending to policies and fol- One of the HR executives uttered matter-of-factly that:
low up of pay and benefits. All of this would equip them
I don’t believe there is a tradition to think strategi-
with some data on the workforce. They would however
cally about HR in the public sector. We use HR sta-
complain that different sets of data were registered in
tistics and data too little (HR executive, M1).
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 9 of 16

The section leaders interviewed did not see how HR They [section leaders] don’t use [computer] systems
could contribute with analytics work that could be valu- for that. This is rather something they […] have in
able in the strategic planning of human resources. Nor their heads. They calculate such things like the dura-
did they see HR data as relevant or useful for the manage- tion of a duty, the duration of lunch breaks, other
ment of the services. “How could we use such data?” one breaks, and they know their employees. […] And the
of them asked. Another unit manager uttered: “I wouldn’t reason for it not being used much is related to time-
know what to ask for. What data would I need?” (section pressure. When you are pressed for time, you go for
leader, M2). Both statements indicate a lack of awareness the most critical tasks, those that are rather short
and skills in interpreting and using data. term, …you take what is ‘burning’, and that is staff
Both at the operational (service level) and strategic rostering […]. But the bigger picture, with numbers
planning levels (among chief municipal officers/leaders), and stuff like that … no one takes time to go into that
there seemed to be a lack of attention to promoting work (HR consultant, M4).
practices supported by HR analytics, nor did there seem
to be a widespread recognition of what could be gained When asked whether HR performed any predictive
from HR analytics. For instance, in one of the munici- analysis based on historical data from the services, the
palities (M3) various measures had been implemented interviewees said no. Nor did HR seem to conduct any
in the healthcare services, but no systematic assessment prescriptive analytics that could be used as support or
of the outcomes of the measures had been performed. basis for decision-making by the section leaders when
The measures involved flexible roster arrangements, doing workforce planning. The section leaders did not
options for staff training and development, and job craft- require reports or statistics that could be organized, ana-
ing opportunities for employees who in periods experi- lyzed, or translated for the purpose of planning at service
ence reduced work capacities. Having HR follow up and level. In general, little seemed to be requested from lead-
assess for instance employee work satisfaction or absen- ers at the various levels in the organizational hierarchy.
teeism prior to and after implementing such measures One interviewee from HR posited that HR could pro-
could have given important insight into what influences duce some reports, but that they didn’t, since it wasn’t
sickness-absence and work engagement positively and requested from them:
negatively.
Municipal leaders and politicians ask for reports
Spreadsheets were used in HR and among section lead-
on the share of employees working full-time. Other
ers in all four municipalities, but data around work inten-
reports are not asked for. We can create various
sification were not collated to determine human resource
reports, but these are not asked for upwards in the
needs, nor were data on the human resource situation
organization. They request very little. […] We can
and related issues such as absenteeism, turnover rates,
produce some reports from our current HR system,
patient outcomes, leadership span or social climate being
but we don’t use this much (HR consultant, M2).
systematically curated and analyzed to learn more about
staff requirement.
When queried about whether managers at different During interviews HR consultants and HR executives in
levels asked for HR analytics reports, HR professionals all four municipalities were very open about the problem
said “no”. One of them explained that this was also due to of a general lack of data. This became especially apparent
poor data because of outdated computer systems: when it came to mapping, or the failure to map, compe-
tency profiles in the healthcare services. They had com-
They do not ask for such reports […] We have some
piled information about employees’ job title and level of
data. And they can ask us for some reports, but we
education but lacked details about employees’ skills and
do not have much data really. And the data we have
exact competencies. Employees could register this type
is a little bit inaccessible because our system is some-
of information in the HR system themselves, but few had
what outdated (HR consultant, M2).
done so. This recurring statement on the lack of good
data on the staff ’s competency can be exemplified by two
In none of the municipalities did the services use HR data HR consultants, who said:
or HR analytics as a basis for decision making or plan-
I think the challenge is about not having a proper
ning. Interviewees said that planning and allocation of
overview of the competency available among staff.
human resources were done without the support of data
We don’t have a system, or we have a system, but
from HR or HR analytics because the size and scale of it
the system is outdated when it comes to registra-
didn’t require it and because section leaders did not have
tion, and too few of our employees have registered
time to do so.
any information in the competency module. […]
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 10 of 16

The codes for competencies are outdated and do not to make any real calls, or would drag out decision making
reflect for instance that an employee has a master’s processes to the point where decisions needn’t be made:
degree in such and such a discipline (HR consultant,
M2). Things take longer time here, compared with the pri-
We have an HR system where employees can register vate or business sector where there is more leeway
their competency, but not everyone has done that. to move things forward more quickly. We must work
Every unit should have an overview of the compe- very hard sometimes to get approval from everyone
tency available at the unit, but this is currently not involved. And sometimes when we finally get those
the case (HR executive, M4). green lights, the case has been closed. There are a lot
of red lights here (HR executives, M4).
Outdated computer and software systems were also a
problem in all the municipalities. Working in several The need to involve a wide selection of stakeholders also
separate systems was time-consuming since information contributed to the slowness and the rigidity:
often had to be registered numerous times in the differ-
You need to have the different groups on board if you
ent systems and it made it hard to obtain a good over-
want to get things done here. A lot must go through
view of the workforce through workforce data. One of
the trade unions. There’s loads of involvement,
the HR consultants said this also contributed to a distrust
approvals, discussions, and negotiations before you
in the quality of data, as one could not be sure whether
can get any real ‘action’ (HR executive, H4).
people remembered to manually double and triple regis-
ter information.
The interviews also revealed that even though HR pro- One HR consultant exemplified the rigidity in the sector
fessionals saw the need for more data-driven decision by discussing the hiring process when there is a vacant
making when it came to human resources management, position:
the computer systems they had to work with, and the
For instance, when a nurse leaves his or her position,
data they had available created difficulties when trying to
this nurse’s position is advertised as vacant. It must
do analytics work. One of the HR executives (M1) found
be discussed and negotiated with the trade union if
this frustrating and said:
the competency requirement for that position is to be
And recruitment, what are we dealing with there? altered. So, we [in HR] must keep firm control over
We may have opinions about several issues, but this (HR consultant, M4).
without having the facts and knowledge straight….?
[…] We lack data to support our decision making.
One HR executive stated that they [the municipality, and
We sometimes try to develop reports on these mat-
the healthcare services] were falling behind and not really
ters, but those are generated manually. HR has done
managing matters in the way they should when it came to
that, but it is very cumbersome.
staffing. Certain laws would set limitations. For instance,
part-time workers who during the past twelve months
Overall, this theme shows that the data-culture in the had regularly worked more than agreed working hours
municipal organization around HR and the healthcare were by law entitled to a post equivalent to the actual
services is weak. There is a lack of awareness of how data working hours during this period. The HR executive said
can inform decision making, and a lack of proper IT soft- that the municipality often saw that small and temporary
ware to collect, curate, analyze, store and monitor data. positions would fail to attract the necessary competency
Additionally, the data that is collected is stored and han- to the services, but following the law, they were forced
dled in separate systems. The state of data is also said to to let employees with a lack of competency or a different
be quite poor or inconsistent. competency than what was needed work their way into
larger and permanent positions. The services would then
Plurality of stakeholders still lack nurses or social educators. The HR Executive
When asked to reflect around why HR was not involved saw this as a failure to perform strategic HRM.
more in the strategic management of resources, the
Sometimes I think we tend to practice strategic ‘poor
interviewees would point to the highly institutionalized
governance’, unconsciously. […] During the last year
nature of the healthcare sector and how laws, regulations
we have handled many such claims on extended
and bureaucratic processes contributed to rigidity, which
positions. Most of these claims are redeemed, but by
again made strategic human resource management diffi-
redeeming these claims, we lose our ability to man-
cult. Tedious democratic processes left little room for HR
age competency strategically (HR executive, M3).
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 11 of 16

Some HR professionals believed HR should be consulted for part-time at the wrong terms. But in healthcare
more in such matters and that HR could contribute to you need to have staff twenty-four-seven, creating
finding better, long-term solutions together with all rel- some definite challenges when it comes to working
evant stakeholders, thus it was an issue that had to be hours if everyone works full-time, thus we can’t do
discussed at the regular meetings with the trade unions without part-time employees (HR executive, M1).
and the managers in the municipal organisation. One of
the HR consultants did however express worry that since HR professionals would also highlight the need to see
many stakeholders were involved, such as trade unions, different concerns in combination and several expressed
managers from different sectors and services, and HR, concern that the different stakeholders would often fail to
this could make things difficult. Stakeholders would typi- do so. Trade unions had their interests, politicians theirs,
cally focus on their key interests or concerns and would and managers at different levels and in different sections
fail to see the whole picture. According to this person, would be concerned with their specific issues.
there was a need to address the manner of collaboration This third theme highlights how public sector HR prac-
too: tices are characterised by a high degree of institutional-
ization; as they are influenced by laws, regulations and
I think that we should talk more about how we can
influence from politicians at different levels and trade
improve our collaboration to develop the health care
unions. As a result, the strategic management of human
services. […] We should gather all stakeholders and
resources becomes difficult. The theme also shows that
develop a common understanding of the goals and
the adoption of HR practices is embedded in specific
how we can contribute to deliver good services while
organizational structures and cannot be seen separated
aiming to innovate at the same time (HR consultant,
from those.
M2).
Changes are under way
Politicians in all four municipalities had put pressure on In all four municipalities, the implementation of more
HR and the services to increase the share of full-time advanced HR systems was either on the verge of taking
employees, ordering an investigation of involuntary part- place or were to be implemented in the upcoming year
time work in one municipality and demanding regular or two. One of the HR consultants said the municipality
reports with updated numbers on the full-time equiva- had signed a deal with the contractor for a new cloud-
lent in two of the other municipalities. The HR profes- based system that would provide HR with far better tools
sionals were divided on how positively they viewed this to work with, a system where data could be stored, inte-
political pressure. Some would for instance question grated and searched for more easily. A substantial digital
the politicians’ interest in mere numbers, without look- upgrade was on its way in another municipality, but the
ing into the causes behind the high share of part-time financial situation hindered that the upgrade could be
work. In addition, some expressed worry about political done all in one go. It had to be portioned out over a few
hot topics, political symbol-making and opposing signals years. In two of the other municipalities, HR profession-
from the national and local political levels. This is exem- als had high hopes for the HR Information System that
plified in the quote below. was soon to be installed:
Back in 2020, there was a political decision in this We have an HR Information System. We added
municipality to report on and investigate how many another component to it not so long ago. Now we
employees were working involuntary part-time. can use it as a system that can support management
That was a political order. We [in HR] started work- and that can provide us with an overview of employ-
ing with that quickly, thinking that it could be use- ment positions. This is real-time data on everything
ful knowledge. But we wanted to look at the causes related to personnel, sickness absence, full-time posi-
here too. What drives part-time work? The general tions, part-time positions. Nearly down to the level
idea around here was that employees in the health- of individuals. It can also provide information on
care services cannot work full-time because the work how much we spend on temporary staff and stand-
is too hard. So, is part-time work something that is ins, and how much we spend on sickness absence. By
involuntary or is a choice that the employee makes? acquiring this system, we want to give the managers
We found that it was a combination. And at the an easier life, provide them with HR information
national policy level there is this idea that full-time that can support them in their work as managers
should be the rule in healthcare, hence we should not (HR consultant, M2).
investigate whether part-time is voluntary or invol-
untary since that sends the wrong signal and opens
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 12 of 16

Soon, we will implement several new digital systems, One of the other HR professionals believed s/he saw
and the aim is, seen from the management level at signs of a growing awareness of the need for data-driven
least, that we should make better use of such systems decision-making in human resource management:
to develop the services and move forward (HR con-
sultant, M4). I think our municipality has a job to do here [in the
strategic management of competency]. What do we
need now? And what about the future? [...] I think
the management is quite aware that we need to
With the new system that will be implemented, we improve when it comes to HR and using our com-
can start mapping the competency of our staff. And puter systems in a way that contributes to develop-
it will be easier for the managers of the services to ing the services (HR consultant, M2).
develop competency plans for the service and for the
individual employee, according to what is needed in
the future (HR executive, M4).
Discussion
What has been explored in this study relates to the
Interviewees from HR departments in all municipalities increasing crisis of staff shortage within healthcare sys-
saw that HR could play a more significant role in strate- tems globally. At the outset, we referred to the demo-
gic human resource management compared to what was graphic changes that are posing challenges to the
the situation today. Workforce shortages in the health- Norwegian municipal healthcare services. We posited
care services had brought the issue of human resource that this would bring forth some changes in strategies of
management to the forefront, both locally, nationally and municipal administrations, and that especially HR would
globally. Locally, one HR executive alluded to how a vari- come to see the use and analysis of HR data as valuable
ety of the municipality’s concerns converged in the issue input to strategic management planning. We wanted to
of resource use. Subsequently, by lifting the issue out of investigate if this was the case in the four municipalities
separate service units, collaborating at a higher orga- participating in this study.
nizational level, solutions could be found, and HR, who We made use of structurational theory [58] that could
served the whole organization could play an important unravel the dynamics between social and technologi-
role. However, the HR executive also saw that there was a cal structures and the interactions between the two and
long way to go before getting there: enable an understanding of how this relationship influ-
enced HR work. This framework allows insight into the
Using our resources effectively and wisely is touch-
structural properties that enable human actors to stick
ing upon a range of issues; it is about focusing on
to or deviate from old structures. The data showed that
increasing the full-time equivalent, sharing the nurs-
social structures; pertaining to the institutional context
ing resources, collaborating more extensively across
and the human actors (interpretive schemes, resources
units in healthcare, and strategically managing the
and norms) constrained the use of such information
competency in the services. We have a long way to go
technology, data, and therefore HR analytics work, HR
there in municipality healthcare services (HR execu-
data or HR analytics was not asked for in the organiza-
tive, M1).
tion. Lack of insight into how it could be used, motiva-
tion and skills to use it were mentioned as barriers here.
The same HR executive added that since human Also, it seemed that forms of reasoning or systems of
resources were in shortage, the solutions to the future rules, professional ethics, laws and regulations, drove
delivery of services could mainly be found in the use of decision-making in recruitment and staffing. These social
these resources, something that should make HR more structures worked as disincentives to use HR data in such
central: matters.
Moreover, human actors were engaged in different
There is a shortage of competencies in the health-
social realities that put different weight on the added
care services. At the same time, we are required to
value of HR data. Section leaders did for instance empha-
deliver the same secure and sound services and to
size getting the short-term workforce planning in place,
follow the laws and regulations. But people cannot
and there was a tension between getting the staff plan-
just run faster, that is only possible to a certain limit.
ning ready and finding time to go into a more thorough
Instead, we must use our resources more cleverly. HR
and long-term strategic planning. Digging deeper into, or
should play a role in this (HR executive, M1).
pursuing, the long-term strategic resource and compe-
tency planning would involve time and efforts that they
appeared not to have. They seemed uncertain about the
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 13 of 16

value of HR beyond the support function HR played in organizational processes and tasks are supported by digi-
relation to the services. Several HR executives and con- tal technologies are important [72]. Changes that need to
sultants did see some advantages of using HR data for be considered do not only involve the individual users’ abil-
strategic planning and resource allocation, though found ity to handle the technology and learn how to adapt to it or
it too difficult to overcome the norms, values, policies how to “lift” one’s work into the technical realm. Matters
and practices in other contexts (healthcare services, trade are more complex and may involve another way of thinking
unions). Also, they saw it as the top management’s call about work and what HR can do. As Kraus et al. [73], has
to acknowledge the potential of HR analytics and invest aptly remarked, there is a need to build more holistic adop-
in the proper material artefact that could realize this tion models for the implementation and use of information
potential. technologies within healthcare structures [73].
The technology’s or software system’s structural prop- Our findings are in line with research done elsewhere.
erties constrained the human actors in especially two The HR function in healthcare plays a marginal role and
senses: one was pertaining to interconnectivity; the is underdeveloped, and leaders, clinicians and support
other was that of data-quality. When it came to intercon- staff fail to understand the value of analytics as a tool for
nectivity, the different software applications were not decision making [74–77]; data quality is poor [78, 79]; the
connected or could not communicate with each other, HR function may lack the skills, knowledge and insights
preventing the transferring of data from one to the other, to ask the right questions of the HR data they have access
or the cross-utilization of data. Interviewees said this to [25], HR is not posited sufficiently at the core of the
made the use of data less valuable, and efforts to make services’ strategy work [25], HR and the services are
data more usable involved too much work. Poor data loosely coupled and do not join forces to develop sound
quality also contributed to making HR data less valuable, strategic policies [77, 80, 81].
less usable and less reliable. Financial resources are tight In a report assessing the healthcare services in Norway
in municipal healthcare, and thus far such technologi- [81] it was concluded that despite the critical role of plan-
cal systems have not been prioritized. This may also be a ning and analysis for tackling future demand for health-
result of the stronger power and influence of certain pro- care services, most municipalities have been forced to
fessional groups over others. As pointed out by Bach [69] shrink their administration, and thus have limited capac-
HR must transcend its own functional boundaries and be ity and competency in analysis and planning of services,
more involved with the processes in the services, in the including providing needs analysis and service-profiling
planning, execution and evaluation of important initia- [81], p. 31). The Office of the Auditor General of Norway
tives. If not, the HR function in the health sector must has also posited that the state lacks a proper overview of
remain in a marginal position. According to Bach [69] the municipalities’ efforts in ensuring right capacity in
HR’s legitimacy and worth require that HR can show how eldercare and that little work has been done locally when
it contributes to improved patient care. The status and it comes to analysis and planning [82].
standing of healthcare workers as public servants and
professionals are also significant here. By tradition these Methodological limitations
services are associated with regulation of work condi- Some cautions should be taken in interpreting and
tions and high levels of job security. This can undermine extrapolating the results from this study, since this is a
the potential for HR to adopt a more strategic orienta- small scale, qualitative study conducted within the con-
tion. Bach and Della Rocca [70] have argued that the sta- text of one country. However, the findings are in line with
tus of healthcare workers as public servants prevents the studies conducted elsewhere, i.e [12, 25, 74]. There is a
disruption of health services, and this is a way of ensuring need for further research on how improved data on the
standard and professional conduct. But through closer workforce in healthcare, in combination with data on
collaboration between HR and the services, HR can service delivery, can contribute to improve workforce
address the most critical challenges experienced in the organization and planning, as well as how it can be used
services, and thus generate input that contributes with a to support the recruitment and retainment of employees.
focus on employee-centered outcomes that are linked to More research on how better use of workforce data and
the performance of the services. planning can impact on patient care and healthcare qual-
Furthermore, Dremel et al., [71] have argued that digi- ity is also needed.
tal transformation demands a data-sharing and data-
driven culture where data is recognized as a valuable Conclusion
resource and enabler. Hence, attention should not only Our study found that the adoption of HR data and HR
be directed to the role of digital technologies, but also to analytics were restricted by a combination of social
the dynamism between organizational units and how this rigidities such as responsibility allocation, structures for
influences the investments in technologies and which interaction and collaboration, hierarchies and detailed
Anthun et al. BMC Health Services Research (2024) 24:1131 Page 14 of 16

Acknowledgements
policies guiding recruitment and hiring, and poor soft- Our gratitude and thanks go to the 14 interviewees who shared their thoughts
ware systems and data. What is studied here suggests that and experiences.
the municipal healthcare system has not yet been signifi-
Authors’ contributions
cantly transformed technologically when it comes to HR Initial paper idea by Kirsti Sarheim Anthun (KSA1) and Kjartan Sarheim Anthun
data and HR analytics. The management of healthcare (KSA2), KSA1 and KSA2 jointly conceptualized the paper, KSA1 and KSA2
services is not data-driven to a great extent, but a change conducted the interviews. KSA1 conducted the data analysis. KSA1, KSA2,
Erna Håland and Monica Lillefjell interpreted the findings and contributed to
is gradually taking place and will perhaps be inevitable the analysis. KSA1 wrote the manuscript. All authors contributed to, read and
against a background of wider changes associated with approved the final manuscript.
expanding digital data-systems where social spheres are
Funding
mediated, linked, and monitored digitally to an increas- The study is part of the larger project ‘EHCOM’ (Ensuring sustainable e-health
ing extent. transformation in primary health care through competent full-time workers),
A note of caution should be made, however. Care work funded by the Research Council Norway, grant no. 226537.
Open access funding provided by SINTEF
is a form of work that has its own logic [83] and it is an
ongoing process between the care-provider and the care- Availability of data and materials
receiver that to some extent is unpredictable and there- The primary data of this study consists of qualitative interview transcripts,
which were exclusively carried out for the purpose of this study and have
fore resists standardization [11]. Thus, we agree with not been published elsewhere. To protect interviewee confidentiality they
Francis & Keegan [21] who argue that the HR profession are not publicly available. Request regarding the data should be made to the
needs to reflect on the framing of HR work, and how HR corresponding author.

should contribute with a focus on employee-centered

outcomes that are linked to the performance of the ser- Declarations
vices. Analytics work can be dedicated to predicting Ethics approval and consent to participate
resource needs, identifying what leads to employee job The project was reported to and assessed by the Norwegian Agency for
satisfaction, and exploring ways of freeing up resources. Shared Services in Education and Research prior to commencing data
collection (approval number 659487). The Agency deemed the project not
Good working conditions are a critical precondition for to be under the jurisdiction of The Regional Ethics Committees of Norway, as
attracting and retaining human resources to the services the project was not classified as Medical or Health research defined by the
and for providing quality services. Norwegian Health Research Act Paragraph § 4a and § 33. Consequently, the
project did not need further approval and was not submitted to The Regional
This study’s findings have implications for research and Ethics Committee. All participants gave their written and verbal informed
practice. As socio-material entities and the dynamism consent to participate in this research. Data collection and analysis complies
between them influence technological transformation, with the General Data Protection Regulation. We confirm that the study was
performed in accordance with relevant guidelines and regulations.
research should exercise caution and not mistake the
social as only related to human skills at the individual or Consent for publication
microlevel but acknowledge that technological transfor- Not applicable.

mation is also significantly related to the larger institu- Competing interests

tional context. HR practices and use of HRA needs to be The authors declare no competing interests.
contextualized when studying organisations.
Received: 21 November 2023 / Accepted: 19 September 2024
For practice, this study’s findings imply that rigidity or
slowness is an integral part of technology transforma-
tion. There is a need for a balanced view on transforma-
tion. National governments might well emphasize the
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