What can HR learn from the NHS?
2 Mar 2018
Peter Reilly, Principal Associate
Not all central business services operate in the same way as HR typically does in large organisations (with service centres, business partners and centres of expertise). It can mean that there few other models which HR can use to compare with or learn from. So, HR professionals can sometimes feel that they are 'trailblazers' in the way they deal with and resolve requests for support.
However, I was recently prompted by a conversation with a fellow HR consultant to reflect on the potentially useful parallels with the ways General Practitioners (GPs) operate in NHS settings. My colleague was comparing HR and GPs in not very complimentary terms: jacks of all trade and masters of none would be a kind-hearted interpretation of his message.
It set me thinking about a comparison that HR professionals can learn from what, on the face of it, appears to be a very different way of operating. (Full disclosure: my wife is a GP and I used to be an HR practitioner.) In some senses he is right in linking HR and GPs if you think in terms of HR business partners (HRBPs) as the GPs, with the centres of expertise acting as the hospital specialists. Both GPs and HRBPs are generalists and should know at least a little about a lot – in HR terms that means being competent on reward, learning, employment law, organisation design and development (OD) etc. What's more, just as GPs have special interests in dermatology, paediatrics, respiratory disease, so HRBPs may have skills in areas of people management. The real experts in dermatology, paediatrics, reward, learning etc sit in hospitals as consultants or in HR centres of expertise.
So far so good with the analogy.
Getting problems solved
I then started to compare the processes of getting problems solved in the NHS and in a typical HR team. HRBPs are supposed to engage with their business unit management team to identify their critical people challenges and then either tackle these issues themselves or engage others, usually in the centres of expertise, to help. In the balance of their work they should focus on the more strategic questions, avoid the administrative and operational HR activity, limiting their involvement in individual casework to the most serious incidents. As many organisations have found, the practice is not as straightforward as the theory. HRBPs can get ‘dragged away’ from their prime role into too many day–to-day operational matters, and the engagement with their expert colleagues does not go as smoothly as intended.
I have written before about the dangers of the ‘Ulrich’ model’s separation of activities into different teams:
The challenge is that this division of labour produces fragmentation that hinders the integration of HR activities and leads to poor customer service. There are lots of boundaries between activities that need to be managed and role accountabilities to be defined.
Specifically, organisations are finding that HRBPs commissioning the centres of expertise to undertake work for them is either a not well-defined process or, if defined, is not working well. In particular, there is often no transparency in the resources required to meet the HRBP ‘commissions’; no prioritisation of how these commissions sit vis à vis other projects or business-as-usual work; and scant thought given to the best staffing arrangements for the centres of expertise. By that I mean, what is the optimum level of resource needed in the light of HRBP (and other) demands, and whether the centres of expertise should undertake the work themselves or use external bodies to do it for them. Those organisations which have set up a consultancy pool to support the centres of expertise have managed this work-demand better, precisely because it makes the ‘tasking’ and the costing so much more explicit.
NHS commissioning: not too dissimilar?
For some time now the NHS has had explicit commissioning. In its current iteration, Clinical Commissioning Groups (CCGs) are groups of general practices which come together to commission most of the hospital and community NHS services in their local area. In addition, NHS England currently commissions primary care, specialised and some specific services. The CCGs agree the nature of services they need, contract ‘provider’ organisations (like hospitals) to deliver them, and decide on the cost using national ‘tariffs’. The aim is to control and prioritise spending based on community needs.
Some HR functions have a similar approach, where real or virtual money changes hands between business units, commissioning services and HR providing the services, sometimes with a baseline charge for a common infrastructure (such as an HR payroll and information system). Thus, one could imagine the HR corporate centre acting like NHS England, in determining both the common infrastructure and buying specialist services (eg occupational health), with the HRBPs acting in a similar way to CCGs in setting out and obtaining services to meet their business unit requirements. Whether money transfers or not, the point is that both systems aim to achieve better prioritisation and accountability.
Tackling the escalation challenge
Whilst organisations might establish this overall architecture in a logical manner, the challenges again lie at the interfaces or in ‘hand offs’ between the various parts of the function. A process commonly found to be creaking is the sequence from a customer calling a helpline with a non-standard problem, which is then routed to the appropriate centre of expertise to tackle before being passed to the business partner if it is a serious individual issue or has systemic implications (eg lots of calls about bullying managers). For the customer, this seems slow and complicated as they just want a quick solution. For HR it can be a resource-hungry process.
In the medical world, some GP practices are using a so called ‘triage’ system, whereby the initial call is taken by a GP who can weed out the unimportant calls and escalate the serious cases quickly to other colleagues for more intensive (usually) face-to-face review. Counter intuitively, this approach requires putting some of the most experienced and expensive people on the front line, albeit that some of the most routine issues have been dealt with over the phone via NHS 111. Nevertheless, GP triage is almost equivalent to having HR experts take ‘tier one’ calls. One organisation I know did this, but more because the centres of expertise were complaining at the volume of transferred calls from the help line. Giving the experts a taste of taking the initial calls made them realise it was not as simple as they thought. It was not just a case of providing a scripted answer, but also a matter of reassuring the customer that they had received a full and accurate answer.
Table 1 Typical Corporate tiered-service delivery model (usage figures from 2010)
Tier 0 |
Tier 1 |
Tier 2 |
Tier 3 |
| HR online | HR service desk | Centre of expertise | HR business partner |
| 50% | 30% | 15% | 5% |
| Tier 0 will be the single point of entry for all electronic, self-service client requests. | Tier 1 is the first line of HR support to employees and managers, providing assistance in the resolution of management and employee queries related to all HR policies and procedures. | Tier 2 will provide transactional, casework and administrative-services support for queries unresolved by Tier 1. | Support to resolve complex and/or strategic business issues escalated from Tier 2. |
Source: IES
These process difficulties will change again with growing automation. Online information and help will become ever more sophisticated not least with the use of chat boxes to answer queries. Much of the tier one work will become redundant as the unresolved problems become more complex – and experts will need to more readily accept their role as problem solvers.
Cost-cutting is not the answer
One lesson HR should draw from the NHS example is that it can be a false economy to equate cheap with efficient. Whether it be automating the wrong processes, using low-paid staff (whether outsourced, offshored or your own people on lower grades), or constructing customer unfriendly processes, you may be creating costs for the future. This was revealed in a study conducted at an energy company which found that HR service design was focused too much on cost and not enough on service. Staff were reluctant to use automated processes especially on sensitive or personal matters. Others did not trust the technology because they needed the reassurance of speaking to a human being. The result was that, in some circumstances, staff were bypassing the automated processes or using them as well as the call centre, meaning that, overall, more time was now being consumed than before.
I have always said that HR should learn from other functions, but it can also learn lessons from other sectors! The reflection of this piece is the need to think through the optimum deployment of your staff not just to meet your function’s budgetary constraints but to deliver good customer service. And the conception of optimum deployment has multiple elements – efficient use of resources certainty, but having people with right skills at the right place in the service chain is another. Moreover, with resources tight it is essential to prioritise activities which is why getting some form of service commissioning is essential.
Any views expressed are those of the author and not necessarily those of the Institute as a whole.
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