One way of increasing productivity is to work harder. Another is to work smarter. This cliché holds a core element of truth. Both ‘smarter’ and ‘harder’ have implications for Human Resources for Health (HRH) flexibility. A paper published earlier this year by Susan Nancarrow helps us to focus on the smarter approach and understand the policy options that may work in particular contexts.

‘Flexibility’ has sometimes been interpreted as a management attempt to get more for less, by exploiting the good will of health professionals and getting the workforce to carry the burden of system inadequacies and resource gaps. But flexibility can have a more positive connotation, and is a necessary workforce element in any health system that aspires to meeting the key tenets of universal health coverage – availability, accessibility, acceptability, and quality of care.

Achieving flexibility should be about identifying the best balance of health service improvements and workforce requirements, and not ignoring one or other. The aim should be to implement HRH policies, which give ‘win-win’ flexibility.

The traditional reason for achieving some flexibility in the workforce in the health sector is to build in a margin of temporary and flexible cover to staffing levels. This is a short-term objective of more efficiently matching staffing to variations in workload. It is a necessary but not sufficient component of workforce flexibility, which must also give consideration to broader and more strategic elements of a flexible approach to HRH.

This means looking at flexibility in relation to contractual arrangements, working practices, staffing configurations, health professional roles and boundaries, ‘up-skilling’ of staff , investment in lifelong learning, and multi-disciplinary team-working.

The future is going to be flexible. The real challenge for policy makers, management and health workers will be to identify and implement positive flexibility…

One enabler of increased flexibility is likely to be the new more responsive pay and career structures, which encourage, recognise contribution, value commitment, and improve retention and motivation. In part, this is about implementing a career structure, which facilitates staff to be flexible and to continuously update their skills.

These interventions must be viewed through the lens of HRH impact – will they help achieve the ultimate goal of improved health care?

The future is going to be flexible. The real challenge for policy makers, management and health workers will be to identify and implement positive flexibility, which improves the quality of care, increases productivity, and contributes to a richer working experience for staff. Achieving only one of these three objectives will be a failure.