What role does HRM system strength play in Italian healthcare organizations? A post COVID-19 snapshot

• Date: 04 July 2024
• Pages: 259-276
• DOI: https://doi.org/10.1108/IJPSM-07-2023-0227
• Published date: 04 July 2024
• Subject Matter: Public policy & environmental management,Politics,Public adminstration & management
• Author: Federico Ceschel,Valentina Bianchini,Fabian Homberg,Marzia Di Marcantonio

What role does HRM system

strength play in Italian healthcare

organizations? A post

COVID-19 snapshot

Federico Ceschel

Department of Business Economics, Roma Tre University, Rome, Italy

Valentina Bianchini

Department of Management and Law, University of Rome Tor Vergata, Rome, Italy

Fabian Homberg

Department of Business and Management, LUISS Guido Carli University,

Rome, Italy, and

Marzia Di Marcantonio

Department of Economics and Business Management Sciences,

Universit

a Cattolica del Sacro Cuore, Milan, Italy

Abstract

Purpose –Our study investigates the role of the Human Resources Management (HRM) system strength in

supporting Italian healthcare managers during times of uncertainty and change. The perceived HRM system

strength and its relationship with managers’taking charge behaviors, perceived procedural constraints, and

work engagement were examined.

Design/methodology/approach–Two surveyswere conductedto gather empiricaldatafrom a pooled sample

of 121 healthcare managerslocated in hospitalsacross Italy. We useregression analysisto test our hypotheses.

Findings –The data show that strong HRM systems facilitate managers taking charge behaviors and work

engagement. Additionally, the findings highlight the mitigating effect of a strong HRM system on procedural

constraints, such as red tape, in public healthcare organizations.

Practical implications –Emphasizing the positive outcomes associated with strong HRM systems, the

findings suggest that public health organizations should make efforts to put in place robust HR practices to

bolster engagement and proactive behaviors among healthcare managers in times of uncertainty and change.

Originality/value –Analyzing a unique data set, the study extends the understanding of HRM system

strength in the public sector, specifically in post-pandemic healthcare organizations. Overall, the study

contributes to the growing literature on HRM system strength by offering novel insights into its nomological

network.

Keywords HRM system strength, Taking charge, Work engagement, Red tape, Healthcare managers,

COVID-19

Paper type Research paper

International

Journal of Public

Sector

Management

259

© Federico Ceschel, Valentina Bianchini, Fabian Homberg and Marzia Di Marcantonio. 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

We would like to express our gratitude to the Italian National Federation of Nurses (FNOPI) for their

valuable support in conducting the survey. Special thanks go to Dr Mangicavalli, the FNOPI president,

Dr Mazzoleni, the national secretary, and Dr Izzo for their dedicated efforts in making the contact list

accessible to us.

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 25 July 2023

Revised 20 February 2024

18 April 2024

Accepted 24 April 2024

International Journal of Public

Sector Management

Vol. 38 No. 2, 2025

pp. 259-276

Emerald Publishing Limited

0951-3558

DOI 10.1108/IJPSM-07-2023-0227

Introduction

During the COVID-19 pandemic, governments and healthcare systems worldwide were

confronted with significant uncertainty impacting healthcare operations, resource

availability, organizational capabilities, and patient demands (Gifford et al., 2023). Italy

was one of the first countries after China to be heavily hit by COVID-19 outbreaks, with one-

quarter of the available beds in intensive care units already occupied by early March 2020 and

a staggering 20% of healthcare professionals infected (Remuzzi and Remuzzi, 2020).

As hospitals were reaching almost full capacity, Italian healthcare workers had to grapple

with treatment choices usually encountered in conflict and disaster zones (Catania et al.,

2021). Moreover, the significant regional differences in the spread of the virus implied

different emergency management policies (Troisi and Alfano, 2022).

Studies on large-scale infectious disease outbreaks have shown that their impact extends

beyond the healthcare workers’mental and physical health, affecting their work performance

and requiring appropriate managerial responses (Goulia et al., 2010). For example, such crises

trigger changes in the organization, which requires managers and employees to behave

proactively, keep engagement levels up, and overcome the rigidities of the organization.

In such contexts, the design of the human resources management system potentially acts as

an enabler for proactive, change-oriented behaviors such as taking charge (AlMunthiri et al.,

2023;Homberg et al., 2019). As the effects of the COVID-19 pandemic produced both

immediate and long-lasting consequences for healthcare organizations and workers (Burdorf

et al., 2020), we investigate what role the Human Resources Management (HRM) system plays

in post-pandemic Italian healthcare and if it enables proactive, change-oriented behaviors and

engagement among healthcare managers.

In strategic terms, HRM can be described as a combination of practices for managing

employees; it is designed to enhance organizational effectiveness and, consequently,

organizational performance (Boselie et al., 2005). The HRM causal chain model explains the

process through which HR policies affect performance (Purcell and Hutchinson, 2007;P.M.

Wright and Nishii, 2008). Crucial stages in this process are the implementation of HR

practices by line managers and the behaviors they generate in their employees. However, the

literature on Strategic HRM (P. M. Wright and McMahan, 1992) has overlooked the work

context’s impact and stakeholders’perspectives, generating a limited understanding of how

organizations strategically manage people (Collings et al., 2021). The concept of “HRM system

strength”suggests that the way HR practices are implemented influences how they are

perceived and, ultimately, their impact on important individual and organizational outcomes

(Bowen and Ostroff, 2004). The key assumption is that the relationships between HR

practices and performance will not be effective unless the practices are made salient to

employees, allowing them to collectively understand the practices and their goals (Ostroff

and Bowen, 2016).

In the last decade, interest in exploring the concept of HRM system strength has been

increasing. A research stream emerged that focused on its effects at the individual level,

where HRM system strength showed positive associations with desirable employee attitudes

and behaviors, such as knowledge sharing, innovation, performance, and lower turnover

intentions (Hewett et al., 2018;Sanders et al., 2021;Wang et al., 2020). Nonetheless, as a

relatively new construct (Sanders et al., 2021), empirical contributions are needed to improve

our understanding of its nomological network. Thus, this study aims to contribute to the

literature on HRM system strength (Bowen and Ostroff, 2004) analyzing the perceptions of

Italian healthcare managers during and in the aftermath of the COVID-19 crisis, when

adjustments to HR practices may be necessary to elicit the desired response.

A former study on HRM system strength in 4 Dutch hospitals showed its positive effects

on employees’affective commitment to the organization (Sanders et al., 2008). Other work

exploring the antecedents of HRM system strength during the COVID-19 pandemic showed

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