Fluid workforce management in the health sector: navigating the changing face of workforces and their management

• Date: 03 June 2024
• Pages: 593-609
• DOI: https://doi.org/10.1108/IJPSM-10-2023-0311
• Published date: 03 June 2024
• Subject Matter: Public policy & environmental management,Politics,Public adminstration & management
• Author: Daniel Samaan,Aizhan Tursunbayeva

Fluid workforce management

in the health sector: navigating

the changing face of workforces

and their management

Daniel Samaan

International Labour Organization, Geneve, Switzerland, and

Aizhan Tursunbayeva

Parthenope University of Naples, Naples, Italy

Abstract

Purpose –This paper demystifies the fluid workforce phenomenon increasingly discussed in the circles of

organizational innovators and explores the characteristic aspects of the fluid workforce in the healthcare

sector.

Design/methodology/approach –We analyze the concept and provide a generic review of definitions of a

fluid workforce in relation to other similar concepts established in the academic and practitioner literature,

contextualize the fluid workforce phenomenon in healthcare and distinguish relevant drivers and categories of

fluid workers in this sector. We also discuss the implications of a fluid workforce for healthcare organizations,

drawing on the health labor market and human resource management (HRM) practices frameworks.

Findings –The fluid workforce in healthcare is not new. Today’s main novelties are related to the wide

diversity of types of fluid workforce that have emerged, the expanding scale of diffusion of the fluid workforce

and the emergence of digital technologies to support HRM decisions. While a fluid workforce may provide

solutions to address mismatches in the supply and demand of health workers, it can also worsen working

conditions, increase dual practice and have implications for existing HRM practices.

Originality/value –We disentangle a novel term for the public sector, healthcare and HRM literature. We

discern similarities and distinctions, presenting a framework for managing and analyzing this workforce at

organizational and labor market levels in the healthcare sector. Acknowledging the challenges in estimating

the existing fluid workforce labor market size, we offer practical methodologies to empirically estimate its

prevalence within the healthcare industry and build an agenda for future research.

Keywords Human resource management, Healthcare, Fluid workforce, Non-standard work, Digitalization

Paper type General review

Fluid

workforce

management in

health

593

© Daniel Samaan and Aizhan Tursunbayeva. Published by Emerald Publishing Limited. This article is

published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce,

distribute, translate and create derivative works of this article (for both commercial and non-commercial

purposes), subject to full attribution to the original publication and authors. The full terms of this licence

may be seen at http://creativecommons.org/licences/by/4.0/legalcode

The authors would like to acknowledge and thank Dr Juana Paola Bustamante Izquierdo from the

WHO in Geneva for her significant intellectual contributions made to an earlier version of this

manuscript.

The authors contributed equally to this paper. They are listed alphabetically.

Funding:This study is partof a larger researchproject “Towards an agilepublic sector: reinventingthe

publicadministration by designinghuman-centredand sustainable organizational models,HRM practices

and work(places)”funded by theItalian Ministry of Universityand Research withinthe PRIN PNRR 2022

program - CUP I53D23016460001 - “Finanziamentodell’UnioneEuropea –NextGenerationEU–mission e 4,

componente 2, investimento 1.1. importorendicontato V238.732”.

Daniel Samaanis Senior Economist and Researcherat the Research Department of theInternational

Labour Organization (ILO) inGeneva. Any views expressed or conclusions drawnrepresent the views of

theauthor and do not necessarilyrepresent ILOviews or ILO policy. Theviews expressed hereinshould be

attributed tothe author and not to the ILO, its management or its constituents.

The current issue and full text archive of this journal is available on Emerald Insight at:

https://www.emerald.com/insight/0951-3558.htm

Received 21 October 2023

Revised 19 January 2024

9 March 2024

Accepted 13 March 2024

International Journal of Public

Sector Management

Vol. 37 No. 4, 2024

pp. 593-609

Emerald Publishing Limited

0951-3558

DOI 10.1108/IJPSM-10-2023-0311

Introduction

Governmental public health provision has a broad mandate encompassing health promotion,

protection,and diseaseprevention.The way public healthsystems worldwidefulfill thismission

varieswidely, but they alldepend on diverse andstrong workforces.Comprehensiveworkforce

planning and human resource management (HRM) strategies have to be defined that address

the needfor and leverage synergiesbetween individual entitieswithin the healthecosystem. To

achieve this aim, health sector managers need to understand their workforce better (Dinkin et al.,

2022), especiallyin light of the significant recentchanges the sector has undergone.

The labor force of most economies has become more diverse over the last decades, and

digitalization and other trends have been changing the world of work. Moreover, not all

employment relations today occur within a bounded space, a structured time, or a task-based

job description (Alfes et al., 2022;Minbaeva, 2021). All of these developments have triggered

the proliferation of workforces consisting of freelancers, independent contractors, gig

workers, paid-crowdsourced workers, moonlighters (Altman et al., 2021;Capgemini Research

Institute, 2020), as well as workers borrowed from partners, volunteers, remote or even virtual

workers (Altman et al., 2021).

These groups of workers have given rise to the umbrella term “fluid”workforce. Overall,

there is no single, commonly accepted definition of the fluid workforce. It is generally

acknowledged that many people today do essential work for organizations that cannot easily

be subsumed under the classic employee-employer relationship. The line between who is an

employee, and hence part of the traditional, regular workforce, and who is not has become

blurred. However, it is clear that the fluid workforce is an integral part of the broader

“workforce ecosystem,”which also includes regular employees; the whole workforce

ecosystem is vital for creating value for organizations (Altman et al., 2021).

A fluidworkforce offers organizations a certaindegree of flexibilityto react to market needs

without maintaining an excessive regular workforce. Organizations make use of a fluid

workforcewhen they want to obtainexperts to enhance quality,accelerate processing speed,or

competein global markets(e.g. Alfes et al., 2022;Capgemini Research Institute, 2020). But a fluid

workforcealso poses challenges. Unlikethe regular workforce,fluid workersare often not on the

organization’s payroll; they have temporary, time-limited contracts; they enjoy either no or

limited benefits including social security; and their work is not as well-regulated from a legal

standpointin many contexts (e.g.IL O,2015). Therefore, some have raisedquestions about their

quality of lifeand well-being (e.g. Caza et al., 2021) and attracted the attention of policymakers,

HR specialists, and managersto the phenomenon of the fluid workforce (e.g. Alfes et al., 2022;

Capgemini Research Institute, 2020). More knowledge is crucial as most of thediscussions on

fluid work are rather generic, positioning it as an emerging innovation, and overlook sector-

specific circumstances (e.g. Altman et al., 2021;Capgemini Research Institute, 2020) and the

synergiesneeded between HRM practicesin a broader labor marketsystem (Boon et al.,2019).

In this generic review paper, we aim to address this knowledge gap. Specifically, we aim to

disentangle the fluid workforce phenomenon, which is considered more and more often in the

circles of management innovators, and to review its potential implications for organizations

and the broader labor market. In doing so, we focus specifically on the healthcare sector.

Healthcare is one of the largest sectors and largest employers in many countries (World

Health Organization, 2021). It is challenged by the constantly growing consumption of

healthcare services due to aging populations and rising chronic illnesses, leading to a

continuous expansion in terms of employment and added value. The health labor market

(HLM) follows, in principle, the same economic laws and legal regulations as the labor market

in general. Nevertheless, certain distinctive features stand out.

Firstly, a significant proportion of employees within the health sector are public sector

workers. According to a recent estimate by the World Bank, about 64% of all salaried

workers globally are in the public sector, ranging roughly from 75% in Europe and Central

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