Any review of HR policy and performance will be incomplete if it does not consider the influence of workplace learning on performance as well.  It is contended by Clarke (2006) that there is a “strong relationship between learning, practice, and knowledge development, which impacts on how health services are delivered”. This begs the question, therefore, as to what workplace learning methods are ethically acceptable within the context of health care services?  The author recognizes that very little research has been done, and consequently an absence of empirical conclusions on this matter.  Additionally, research has not shown that there exists within the health care sector, learning practices which may necessarily contravene ethical practices.  However, while this may be the case, in theory, it does not suggest that in practice, ethical standards are not violated.  It must be borne in mind that there is very little room for trial and error in health care services, thus minimizing, particularly at the clinical level, room for experimentation and learning, in order to ensure quality health services are being delivered.  It does not, however, negate the strength of Clarke’s proposition, that workplace learning impacts positively on performance.  Additionally, it is posited by  Dovey ( cited in Clarke 2006) that workplace learning which involves collaborative working which is driven by strong leadership,  impacts greatly on a number of clinical problem areas within health management teams.

It is important to not ignore the role of strategy as is mentioned by Cheng-Hua et al. (2009) who said: “relationship between the applications of specific employment practices and organizational performance is contingent on an organization’s overall strategy”.

It would seem therefore in view of these arguments advanced, that any further research which seeks to investigate the relationships between policy, practice and strategy specific to human resource management and firm performance, must examine some key areas, such as: national and organizational culture; HRM policies and practices specific to selection; recruitment; training and development; pay and benefits; leadership and organizational culture; and of course trust as an important lubricating variable between an organization’s HR practices and individual performances.  Central to this examination also would be the theory regarding performance management.

It is strongly argued by Ployhart (2006) who examines the challenges and opportunities in staffing in the 21st century that by virtue of the hierarchical nature of most organizations, there needs to be a multi-level connection in which there is a “top-down” effect of strategy and policy on practices.  This in effect will see a change of the behavior of individual members, by changing the organization’s HR practices. What Ployhart is purporting is somewhat dissimilar to what Cooke argues, which is that a beneficial approach which firms should take in understanding the relationship between practice and performance is to see it as a two-way relationship rather than a one-way cause and effect relationship.  The questions which therefore arise out of this, and which must be examined in further research are: Does organizational culture and context influence behavior, or is it the other way around? To what extent, therefore, does the character of HR policies, the behavior of individuals, internal and external factors, influence organizational performance?

Without seeking to elaborate in great detail on the fore mentioned questions, a partial examination is provided by Wright & Kehoe (2008) who contend that employee performance and commitment is maximized not just on the basis of an individual HR policy.  In fact, they argue that several reinforcing practices, such as “rigorous selection mechanism, ample training opportunities, peer pressure to perform, and monetary and non-monetary rewards” (Wright & Kehoe, 2008), all increase motivation and performance thus improving the organizational performance.  A view consistent with this theory is also expressed by Kehoe & Wright (2010) which states that employees who develop what is commonly called ‘organizational citizenship ‘demonstrate commitment, attitudes, and behavior which contribute to attaining organizational goals and furthering the effectiveness of the organization.  The term “Organizational Citizenship Behavior” began to be used widely by Organ et al. 1983 (cited in Podsakoff et al. 2000).

In fact, this phrase was first coined by Organ, who defined Organizational Citizenship Behavior as

“Individual behavior that is discretionary, not directly or explicitly recognized by the formal reward system, and that in the aggregate promotes the effective functioning of the organization. By discretionary, we mean that the behavior is not an enforceable requirement of the role or the job description, that is, the clearly specifiable terms of the person’s employment contract with the organization; the behavior is rather a matter of personal choice, such that its omission is not generally understood as punishable.” (Podsakoff et al., 2000).


It seems therefore that this view confirms the idea which this research presupposes -: that there are factors which influence the gap between policy and actual outcomes in the health sector.  What this research investigates, however, is the impact of this gap, on the output of the organization, specific to service delivery.

Interestingly also, another dimension to the argument, and one which considers the external impact,  is proffered by Bach(2000) who argues that in the context of health care, the influences on HR policies and performance includes government’s policies through their Ministries of Health and Finance.  In fact, the point is made very forcibly that “if at the levels of the Ministry of Health there is a failure to invest in HR expertise, it undermines the message that HR issues are important in health care” (Bach, 2000). Reference must be made to the fact that in the UK in the 1990s for example, efforts to make radical HR policy improvements in the local market, failed because the Ministry of Health did not provide the level of support and guidance to local trust hospitals in the effective implementation of HR strategies (Bach, 2000).  I must recognize therefore that in addressing the issue of the influence of the gap in HR policies and strategies on organizational performance the role of government ought to be given some consideration as well.