Human Resource Management in Homecare in England: Managing People for Safe Care During Crisis

Human Resource Management in Homecare in England: Managing People for Safe Care During Crisis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Human Resource Management in Homecare in England: Managing People for Safe Care During Crisis Thoai Le, Simon Bishop, Carl Macrae This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4875799/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Dec, 2024 Read the published version in BMC Health Services Research → Version 1 posted 4 You are reading this latest preprint version Abstract Background: Human resource management (HRM) of healthcare organisations plays an important role in improving the continuity of care, managing staff, and ensuring patient safety. During COVID-19, there were several HR-related issues, creating a significant challenging situation for health and social care institutions. This study explored the HRM issues that are associated with the patient safety in homecare, and how homecare providers have responded to these HR-related challenges during the COVID-19 pandemic. The aim of this is to explore the role of HRM practices in helping care organisations operate efficiently and supporting their workforce to adapt to future disruptive changes and crises. Methods: Qualitative strategies include narrative inquiry involving gathering information in the form of storytelling by the research participants. Between February 2021 and December 2021, data were collected through semi-structured interviews of 31 participants, including homecare staff (homecare transition practitioners, homecare social workers, and carers), family members, and service users in England. Results: The research identified key HRM challenges during the pandemic, including staff shortages, high turnover, ineffective communication, occupational stress for front-line carers, and lack of training, all adversely affecting the safety of homecare patients. In response, homecare providers employed strategies like opportunistic recruitment, digital technology for training and communication, and flexible work arrangements to mitigate these issues. Conclusions: Several implications are proposed, with the over-riding aim of ensuring effective management of HRM practices in responding to address key areas: staffing, performance management, and training. Homecare providers should utilise short-term adaptive recruitment strategies, while also focusing on long-term workforce development and resilience to effectively respond to current and future care needs. Prioritising staff well-being for retention and care quality are crucial. Homecare providers are encouraged to offer flexible work arrangements and digital communication methods, all while being mindful of preventing technostress and digital exhaustion among their staff. They also need to bridge training gaps and employ effective delivery methods to equip healthcare workers with essential skills, thereby enhancing resilience and adaptability in homecare. HR practices homecare social care COVID-19 safety care quality Figures Figure 1 1. INTRODUCTION Extensive human resource management (HRM) research has consistently shown a strong link between effective human resource (HR) practices and beneficial outcomes for both employees and organisations [1]. In healthcare, ample evidence supports the implementation of HR practices to promote organisational performance outcomes, particularly in preventing adverse events, enhancing care quality, and improving patient safety [2–6]. However, since COVID-19, the pressure on health and social care organisations has intensified, highlighting HRM's crucial role in ensuring the continuity of the care service, managing staff, helping them to cope with the crisis, and safeguarding the safety of patients and staff [7, 8]. While effective HRM practice management is key for organisational functioning and workforce adaptation during crises [9, 10], many health and social care providers struggled to efficiently implement HRM practices in response to the major disruptions of the pandemic. There has been a scarcity of research focusing on the role of HRM and HRM-related challenges within healthcare organisations, with an even more pronounced lack of attention to the social care sector during the COVID-19 crisis, despite it being severely impacted by the pandemic [11, 12]. Social care has been on the receiving end of many of the policy and organisational changes made to cope with the pandemic, with staff, patients and access to resources affected in the push to shore up acute care [13]. Particularly striking is the limited number of studies on homecare or domiciliary care services. Therefore, in this article, we aim to address this gap by focusing on the homecare sector and looking into its HRM challenges during the COVID-19 crisis. In England, homecare, which encompasses a variety of care and support services designed to assist individuals in living independently within their own homes [14], has become a significant aspect of the healthcare sector. In recent years, HRM has been a key focus in homecare research literature, recognised for its important role in ensuring high-quality care and improving patient safety [15, 16]. Prior to the COVID-19 pandemic, reports and studies on patient safety in homecare found HRM challenges as major barriers to care quality and patient safety [15, 17–19]. These HRM challenges are related to a wide range of issues including workforce well-being, staff recruitment and retention [20], performance management [21], training and development [22], compensations and recognition [23], and employment relations [24]. The pandemic has brought long-present challenges in HRM in homecare to the fore, while adding a host of new ones. In this study, we explored the emerging HRM issues that are associated with the patient safety in homecare in England during the COVID-19 crisis and examined how homecare organisations have adapted their HRM strategies to ensure the safety of patients amidst the challenges posed by the pandemic. 2. BACKGROUND 2.1. HRM challenges during the COVID-19 pandemic The effective management of HRM practices plays a key role in an organisation’s efforts to operate businesses and help their workforce adapt to disruptive changes and crisis [ 9 , 10 ]. Despite this significance, many organisations have struggled to efficiently implement HRM practices in response to major disruptions, exemplified by the COVID-19 pandemic [ 25 ]. Recent research has highlighted a range of HRM challenges during this period including staff turnover and job loss [ 26 , 27 ], concerns over employee wellbeing [ 28 – 30 ], difficulties in training delivery and addressing skills gaps [ 7 , 8 ], as well as a decline in employee performance and productivity [ 31 ]. HR practitioners, therefore, have been under considerable pressure to adapt and transform HRM processes in response to the difficulties intensified by the COVID-19 crisis [ 32 , 33 ]. COVID-19 has also brought further HRM challenges which organisations have been struggling to overcome. One of the most noticeable difficulties involves shifting to remote work environment or altering workplace conditions during the time of crisis [ 28 , 34 ]. Managers and HR practitioners had to find new ways to ensure their staff having suitable equipment and digital skills to work from home, support employees’ wellbeing, keeping them motivated, and maintain social connections and communication [ 29 , 35 ]. Nevertheless, for other industries such as manufacturing, construction, or healthcare support, remote working is not a viable option [ 35 ]. As a result, health and social care organisations face significant obstacles in alternating and adapting new work arrangements. 2.2. Impact of HRM on healthcare organisational performance Within the health and social care, the effective management of HRM practices and initiatives is critically important for individual and organisational performance [ 20 , 36 ]. Key components of performance outcomes in healthcare organisations typically include financial results and costs, individual job performance, and quality of care (e.g., adherence to evidence-based practices, positive patient outcomes and experiences) [ 37 ]. In recent years, an important trend we observed in research within healthcare and organisational studies is the increasing emphasis on the quality-of-care services and patient safety. This focus has only been an important priority for organisations since the early 2000s [ 38 ], following a significant number of preventable incidents resulting from unsafe care practices, as reported by the U.S. Institute of Medicine (IOM) and the World Health Organization (WHO) [ 39 , 40 ]. Since then, improving care quality and patient safety emerged as a key objective in healthcare organisational performance. Consequently, the important link between HRM and quality and safety of care has gained increased attention in the fields of organisational science and healthcare [ 41 – 43 ]. In the context of acute care settings, there has been an abundance of evidence supporting the use of HRM practices in hospitals to promote healthcare organisation’s performance outcomes, particularly in areas like quality of care and patient safety [ 2 – 6 ]. These studies demonstrated common findings that HRM is one of the crucial determinants to achieve successful healthcare quality programs through appropriate staffing levels, retaining highly skilled employees, ensuring high job satisfaction, empowering staff in the workplace, supporting employee well-being, establishing effective team structures, and fostering strong communication and leadership. Nevertheless, a significant amount of research has tended to focus on acute hospitals, whereas other care settings such as domiciliary care or homecare have been overlooked [ 15 ]. Critics have also pointed out that much research in HRM and patient safety has been specifically and predominantly directed at registered nurses in hospital settings and does not pay sufficient attention to other healthcare professions [ 37 ]. Therefore, research into HRM practices, patient safety, and care quality in homecare is critical to fill the gaps in the literature. 2.3. The role of HRM in responding to COVID-19 in health and social care sector The COVID-19 pandemic has exacerbated HRM issues in health and social care sector, placing considerable pressure on care providers. During this period, the major HRM challenges in healthcare were related to staff turnover and retention [ 44 , 45 ], training and skill gaps [ 7 ], communication [ 46 ], managing staff and supporting their well-being [ 47 , 48 ]. Nevertheless, despite the health and social care sector being heavily impacted by COVID-19, there have been limited studies exploring the role of HRM and HRM-related issues in health organisations. Furthermore, most of these studies have merely reported the HRM challenges encountered during the crisis, without investigating further about how these challenges can act as barriers to care quality and impact patient safety. Other research has also been calling for further qualitative studies looking into the impacts of HRM challenges to patient’s experience [ 49 ]. Therefore, we aim to fill in this literature gap by investigating how HRM challenges influence homecare patient safety and discovering the responses of homecare providers during the pandemic. HRM within healthcare organisations is crucial in effectively responding to the pandemic [ 50 ]. Health and social care providers have developed a number of HRM innovations, focusing on new ways of managing, ways of working, and work roles [ 36 ]. One of the most salient approaches has been using digital technology to transition to virtual forms of recruitment, selection, training, and online meetings [ 8 , 51 , 52 ]. COVID-19 might have brought the opportunities for changing work arrangements and skill upgrades with respect to the use of technology [ 51 ]; however, the digital transition approach has been seen to create difficulties concerning technology-related stress and exhaustion, as employees can be constantly expected to be available and respond to emails or online meetings [ 53 ]. Workload and working hours can be increased, resulting in stress and burnout among staff [ 46 ]; therefore, organisations must take into consideration of how their employees experience and feel about the virtual tools in times of the pandemic [ 28 ]. Besides using digital technology, care providers have responded to the HRM challenges through a mix of adaptation measures. For example, to increase care staff capacity, organisations recruited and redirected staff from other areas, including hiring and training unemployed individuals, encouraging retired carers to return to work, and recruiting the military, medical students and civilian nurses [ 7 ]. Nonetheless, there might be a potential limitation of adopting non-standard employment, which is that the staff might not be familiar with the new roles due to their lack of experience in incident response [ 54 ]. Furthermore, relocating staff to work during COVID-19 might pose potential risks, cause distress and conflicts, and raise other ethical concerns for professionals [ 55 – 57 ]. As a result, healthcare providers must be able to justify the process of staff reallocation and carefully prepare guidelines for non-standard employees [ 54 , 56 ]. Once again, it is noteworthy that most studies investigating HRM issues in healthcare organisations during COVID-19 have been conducted primarily in acute care hospitals and very little research is focusing on homecare, revealing a significant gap in the literature. Additionally, a majority of these research have only explored the issues in HRM but did not investigate further the impact of these issues on care quality and patient safety. Such an extensive list of emerging HRM-related issues caused by the pandemic requires further discussion regarding their influence on the quality-of-care service and patient experience, especially in homecare settings. 3. METHODOLOGY The research took an inductive approach using the qualitative strategy of narrative inquiry which involved gathering information in the form of storytelling by the research participants [ 58 ]. 3.1. Data collection methods The data were collected between February 2021 and December 2021 by using semi-structured individual interviews. 31 interview participants were selected, including homecare staff (homecare transition practitioners, homecare social workers, and carers), family members, and service users (Table 1 ). In this paper, homecare staff were also referred as care workers, support workers, carers, and caregivers. Participants were recruited by using opportunistic and snowball sampling methods. Informed consent was obtained. The interviews were conducted online and/or by phone due to the COVID-19 restrictions in face-to-face meetings. Each interview lasted between 45 and 60 minutes and were audio recorded then transcribed. Table 1 List of interview participants Interviews (I) Roles Regions Types of care provided / received I.01 Homecare Transition Practitioner Yorkshire & the Humber Hospital-to-home transition I.02 Homecare Transition Practitioner Yorkshire & the Humber Hospital-to-home transition I.03 Homecare worker (Carer) London Basic supportive care I.04 Homecare worker (Carer) South West Basic supportive care I.05 Homecare worker (Carer) Yorkshire & the Humber Basic supportive care I.06 Homecare worker (Carer) East Midlands Basic supportive care I.07 Homecare worker (Carer) London Basic supportive care I.08 Homecare worker (Carer) North West Basic supportive care I.09 Homecare worker (Carer) East Midlands Basic supportive care I.10 Homecare worker (Carer) Yorkshire & the Humber Basic supportive care I.11 Homecare worker (Carer) West Midlands Basic supportive care I.12 Homecare worker (Social worker) East Midlands Care services coordination I.13 Family member West Midlands Supportive care, assistance I.14 Service user London Basic supportive care I.15 Homecare worker (Carer) West Midlands Basic supportive care I.16 Service user East Midlands Basic supportive care I.17 Homecare worker (Carer) South West Basic supportive care I.18 Homecare worker (Carer) East of England Basic supportive care I.19 Homecare worker (Carer) East of England Basic supportive care I.20 Homecare worker (Carer) Yorkshire & the Humber Basic supportive care I.21 Homecare worker (Carer) Yorkshire & the Humber Basic supportive care I.22 Homecare worker (Carer) Yorkshire & the Humber Basic supportive care I.23 Homecare worker (Carer) East Midlands Basic supportive care I.24 Homecare worker (Carer) North East Basic supportive care I.25 Homecare worker (Carer) North East Basic supportive care I.26 Homecare worker (Carer) London Basic supportive care I.27 Service user Yorkshire & the Humber Basic supportive care I.28 Homecare worker (Social worker) East Midlands Care services coordination I.29 Homecare worker (Carer) London Basic supportive care I.30 Family member East Midlands Supportive care, assistance I.31 Service user London Basic supportive care 3.2. Data Analysis In this research, thematic analysis was used for analysing the data. The interviews were transcribed and identifying information were pseudonymised. The analysis was performed in English and the software NVivo 11 was used to organise, manage, and analyse data. The thematic analysis began after the first interview, with repeated reading of the first transcripts to identify key themes related to the review of the literature. Then, the data was coded and there were three forms of coding: open coding, axial coding, and selective coding. These core themes or central categories were linked and presented to develop a theoretical framework to better understand the research topics and answer research questions [ 59 ]. 4. FINDINGS The findings revealed three dominant themes highlighting the HRM challenges that can negatively affect the safety of service users in homecare and how homecare providers responded to these challenges (Fig. 1 ). 4.1. Making do: Staffing Home Care in Crisis Shortage of staff has been a significant challenge to homecare providers during the time of crisis. Data from the research participants reveal that homecare workplaces experienced high turnover and staff shortages during the pandemic due to staff burn-out, fear of virus, lack of support from the care providers, and staff isolating with confirmed COVID-19 or with suspected infection. For example, one homecare social worker said: There’s obviously a certain number of people working in homecare would have had COVID as well, but at that time, it obviously posed challenges to them. […] They would need to self-isolate and wouldn’t be able to go into people’s homes (I.12, Social worker). Since COVID-19, homecare providers have experienced additional staffing hurdles related to recruitment and retention of staff. In recent years, a significant number of social care staff have been leaving the sector, presenting significant challenges for providers in recruiting care workers, directly affecting care service. For example, research respondents reported that because there was not enough staff, service users might have to receive less care than normal: There was one time when many clients needed services, and we faced a challenge because many team members, especially the older ones, were not available or had resigned. This created a shortage of staff for client care, making service delivery more difficult (I.03, Carer). Before the pandemic, my doctor used to visit five days a week. During the pandemic, this was reduced to three days a week, and currently, we are considering reducing it further to two days a week (I.27, Service user). In addition, if an excessive number of staff members fall ill and are unable to work, the amount of care and support provided to certain individuals would be reduced. The service users will receive fewer hours of care than are currently funded for them due to the shortage of available staff to deliver the required services: In the event that too many staff became ill with COVID and there wasn’t anyone there to support, certain individuals will be given less care, less hours than what they are being funded (I.20, Carer). Furthermore, high turnover can lead to the inconsistency in the care workforce. It can potentially impact the performance of the team and patient’s psychological safety by causing distress for patients who do not like to have many different caregivers coming to their homes: The inconsistency with staff members can cause a lot of distress and anxiety for the individual. Some individuals like to know when people are coming home, and if the individual doesn’t know who’s coming on, getting someone that they don’t like or not very keen on for that day, it can cause a lot of anxieties for the individual (I.06, Carer). Although shortage of staff is not a new phenomenon in healthcare sector, COVID-19 has put a lot more pressure and extra constraint on healthcare organisations to change their HR strategies. All homecare managers in this study reported that their organisations had to adopt an ad-hoc, opportunistic and ‘all hands-on deck’ approach in the recruitment and selection processes during the time of crisis. For example, all interviews must be conducted online, work experience criteria were reduced, fewer reference checks, and fewer shadowing shifts for new employees to lessen in-person interaction. Respondents also expressed difficulty in recruiting and retaining support workers due to high turnover rates, inconsistent care provision, and low wages in the healthcare and social care sectors: One challenge I had was to interview and select twenty-two applicants for the support worker positions (I.19, Carer). The turnover in the sector can sometimes mean that people won’t have a consistent person coming into their homes, so this challenge for the home carers and the providers themselves will be relatively short periods of time to work with people from the amount that they’re paid as well, so I think it can be a challenge of recruiting people into the sector, then retaining them (I.12, Social worker). In addition, to address staffing challenges, homecare providers had to relocate staff from different areas to undertake care duties or recruit more temporary care staff. For example, some participants, including managers and homecare transition practitioners, were asked to perform care duties at service users’ homes, which were not part of their responsibilities before COVID-19. Additionally, care providers had to recruit more temporary carers and agency staff to cope with staff shortages: I remember applying for the job and then getting a call from a woman at the agency. She seemed eager for me to start working immediately. […]. We had a Zoom interview. I met with the woman from the agency and, I believe, her boss. The manager of the agency was also there. They seemed to like me and offered me the job (I.23, Carer). 4.2. Managing people through any means possible The second theme focused on how homecare providers had to find as many different ways as possible to manage their care staff. Given the extreme pressures of the pandemic, homecare organisations could be seen to adopt a highly ad-hoc approach to HRM in order to deal with the rapidly growing problems with which they were presented. This could be seen across a number of issues. For instance, communication was highly disrupted as many carers expressed that they struggled to communicate effectively with their managers. Some said there were slow email replies or no responses from phone calls; others reported they did not have as many supervision meetings as before: I have occasions where you’re required an immediate response from your line managers, especially nowadays where it’s working from home, and it can be quite difficult sometimes to get in contact with them. I’ve had incidents that required on call but there’s been no answer from on calls (I.06, Carer). In homecare, individuals often work alone, so not being able to reach a manager can be problematic for the service users. […] During summer, I faced a delay in response when inquiring about shifts, which was a bit frustrating, especially when I was readily available. Prompt communication is key in this field, and such lapses, even if rare, can be inconvenient (I.17, Carer). Usually, I have one supervision meeting per month but now I only meet my line manager online once in every three or even four months because she’s always busy since COVID (I.29, Carer). The challenges in communication such as delayed responses can create obstacles for homecare workers in delivering timely and appropriate services to service users. Caregivers described difficulties in communicating with their managers can hinder their ability to perform duties effectively and may impact the safety and well-being of service users: Communication with the head office can be challenging due to delayed responses or being passed between departments. […] Delayed responses can hinder my ability to do my job effectively, which might indirectly impact service user safety (I.10, Carer). From the interviews, carers also indicated that they experienced occupational stress attributed by poor communication and management. For example, two homecare transition practitioners in this study expressed their frustrations when their transition tasks were suspended, and they were required to take on-call shifts and deliver care to service users, which are not their duties before COVID-19. One of them, who decided to leave the role soon after due to this reason, said: I feel overwhelmed with workload, especially when asked to perform tasks not part of my job (I.02, Homecare Transition Practitioner). These are significant issues which can negatively impact the care quality. One carer expressed that “fatigue can hinder your ability to perform well” and emphasised the importance of maintaining sound well-being to deliver high-quality service (I.03, Carer). In response to these challenges in staff management, homecare providers and managers had to find ways of improvising approaches to communication, safety, and managing performance. Organisations have altered their management of staff by adopting technologies to organise meetings online, enabling remote work for admin staff, and allowing flexible work arrangements: All meetings with my staff are now on Teams. Often, we had to video call after midnight after the individual went to bed (I.07, Carer). Communication is mainly through WhatsApp. They inform me about available shifts, and sometimes they call if there's an urgent need (I.18, Carer). Before COVID, staff members had to attend in person for handovers, but now I can only email or text my colleagues because we are not allowed to meet in person (I.11, Carer). The data suggested that homecare staff have had to adapt their lives around the pandemic and co-ordinate work through any means possible, which detrimentally affected their mental health. For instance, some carers said they were under pressure and stressed when being expected to answer calls or emails instantly, even during late hours or during their days off. Participants also found it difficult to provide or receive emotional support and build relationships with their colleagues or service users virtually, especially during the challenging time of COVID-19. A transition practitioner said: The pandemic restricted the amount of time or visit that I could go see the individuals that required support in person, and it was all restricted to online, slash zoom calls and that had an impact on the rapport built with the individual. I feel like it didn’t build up the same level of trust (I.01, Homecare transition practitioner). 4.3. Compounding skills and training gaps The crisis both presented large challenges with maintaining training and development activities, while also present a large number of new training needs. A significant challenge emerged from data is the lack of training provided by care providers during the COVID-19 pandemic. A support worker described she only received one brief training session online about how to use personal protective equipment (PPE). Another care worker expressed how his care agency only sent out government guidelines, newsletters, and online resources through emails but offered no specific training: They were sending out weekly newsletters informing staff about mental health or looking after yourself, then some updates on the government guidelines, and other things, and they’re kind of expected us to read through and learn it by ourselves (I.26, Carer). Some homecare team leaders and managers suggested that care providers did not know much about the virus and therefore, were slow to respond. Additionally, providers faced significant difficulties in interpreting and keeping up with the rapidly changing sector-specific guidance. The frequent updates and sheer volume of information posed substantial challenges, which make it hard for homecare providers to stay current and compliant with the latest guidelines: I think there’s been a lot for providers to interpret. My observation is that the guidance has changed fairly quickly […] I think no matter what sector we’ve worked in, the sheer amount of guidance that has come through has been absolutely challenging to keep up with (I.12, Social worker). This lack of clarity about PPE requirements could increase infection risks among homecare service users, seriously affecting their safety. Furthermore, without appropriate training, homecare staff might find it difficult handling challenging situations, which could potentially lead to errors and cause harm to service users. For instance, a member of care staff expressed that they were not guided by her employer on how to handle the situation when the service users feeling stressed and wanting to go out during the national lockdown, raising concerns about emotional, social, and functional safety: There is the challenge of helping them understand why they can’t, for instance, going to the cinema, or go to a recreational activity within the community. If they feel like they cannot go out or they cannot go to shop or cinema, it could affect their emotional health or mental health (I.22, Carer). […] the service user can get quite frightened, can get quite scared when something that’s not been explained to them (I.21, Carer). In response to skills and training gaps, a few homecare organisations have tried and adopted digital tools to provide some trainings for their care workers during COVID-19. For example, one care support worker mentioned that they had to watch online videos about COVID-19, while a homecare manager reported using Zoom for training. However, some carers said they found it difficult to use digital tools and some methods of online training were not very engaging. Overall, there were still significant issues in compounding skills and training gaps when homecare providers struggled to find ways to train their staff. A lack of clarity about guidance also raised serious concerns about homecare patient safety. 5. DISCUSSION Our study explored the emerging HRM challenges that are associated with homecare patient safety in England and how homecare providers have responded to these challenges during the COVID-19 pandemic. The aim of this is to explore the role of HRM practices in helping care organisations operate efficiently and supporting their workforce to adapt to future disruptive changes and crises. There were three key themes identified: staffing homecare in crisis, managing staff through any means possible, and compounding skills and training gaps. Each theme has presented a number of HRM issues during the pandemic: staff shortages, high turnover, ineffective communication, employee occupational stress, and the lack of training. These issues are significant barriers to homecare patient safety as highlighted by previous research and reports [ 15 , 17 – 19 ]. In the first theme, the data revealed that homecare organisations had to take on ad-hoc opportunistic recruitment and selection, redirect staff from other areas to take care duties, and hire temporary agency staff, in response to staff shortages and high turnover. During the pandemic, many care providers experienced challenges in recruiting, retaining, and maintaining staff morale [ 44 , 45 , 49 ]. Data from this study showed similar findings of homecare providers struggling to retain and recruit care employees. A number of reasons for this issue include staff burn-out, fear of virus, lack of support from the care providers, and staff isolating with confirmed COVID-19 or with suspected infection. Without sufficient number of care workers, service users receive less care than normal because the providers facing challenges in maintaining continuity of care. Some service users also feel stressed and anxious when they keep receiving care from different people due to high turnover of staff. These findings reflect the importance of HR practices in recruitment and retention to ensure safety and well-being of service users [ 6 , 20 , 27 ]. Responding to staff shortages and high turnover, homecare providers have adopted ad-hoc opportunistic recruitment and selection (e.g., online interviews, fewer reference checks, fewer shadowing shifts for new employees), mass recruitment, hiring temporary agency carers, and redirecting staff from other areas. Previous studies have shown that other organisations including healthcare providers had similar approaches [ 8 , 29 , 51 , 52 , 57 ]. However, these measures have also created new challenges to HR managers in terms of dealing with inexperience non-standard care staff [ 54 ], and ensuring there are no potential risks and ethical concerns to those who are relocated to work during COVID-19 [ 56 ]. In this research, two transition practitioners described their frustration in the way their managers required them to deliver care at people’s homes, which was not part of their duties before the pandemic. Although task allocation can be a quick solution for capacity problem, it can raise conflicts and cause distress for care workers [ 57 ]. Previous research has also discovered the negative feelings of health professionals who were reallocated to COVID-19 unit at hospitals [ 55 ]. The second theme of this paper has shown how homecare providers had to manage their staff through any means possible by using digital technologies or adopting flexible work arrangements. Data from this study revealed the majority of carers experienced a lack of responses from their managers during the time of crisis. Leadership communication has strong influence on staff work performance [ 37 , 43 , 46 ] and the lack of communication can be a major of stress and contribute to employee burnout [ 29 ]. Indeed, COVID-19 has made a serious impact on healthcare professionals’ health and wellbeing as they are at high risk of stress, burnout, fear, and anxiety [ 44 , 47 , 48 ]. In this research, data have shown the feeling of burnout or stress can adversely impact the performance and commitment of staff to their jobs, which leads to service users receiving less care or poor-quality care. These findings are consistent with previous research of how communication issues and occupational stress during COVID-19 can negatively affect the performance of carers, potentially leading to poor quality care services [ 7 , 45 ]. This study has shown homecare providers had to find new ways to improve communication and manage their performance. However, there was a lack of wellbeing support from homecare team leaders to their staff, whereas in hospital settings, there have been evidence of how effective leadership and communication can improve performance of health professionals during the time of COVID-19 [ 50 ]. To maintain communication and managing staff performance, homecare organisations’ approaches have included using digital technologies to organise meetings online, enabling remote work for admin staff, and allowing flexible work arrangements such as online handovers or late-night video calls for night shift care workers. These adaptation measures corroborate findings from previous research on organisations adopting digital tools and remote work to maintain communication with their staff [ 8 , 51 , 52 ]. Nevertheless, even with digital tools, some respondents in this study still expressed their struggles in communicating with their managers. This finding is in accordance with previous research showing difficulties in communication among healthcare workers during the pandemic despite the implementation of digital technology [ 46 ]. Interestingly, this paper also found an opposite result of some other participants describing their feeling of pressure while being constantly expected to answer calls or emails. This emerging issue was similarly discussed in prior research on technostress and digital exhaustion [ 28 , 53 ]. Regarding the third theme of compounding skills and training gaps, the research found that all homecare providers used digital tools as an effort to provide training for staff; however, it was challenging for them to effectively identify the training needs, develop the training programs, and implement appropriate training methods. During the time of crisis, training on knowledge related to COVID-19 and contagion control methods are essentials to the safety of staff and patients [ 50 ]. Nevertheless, most participants reported there was a lack of training on knowledge related to COVID-19. It was explained by the uncertain situation of COVID-19 and the inconsistency in official national guidance in preventing transmission and protecting workers from the virus. Although previous studies have reported challenges in training delivery and skills gaps during COVID-19 [ 7 , 8 ], training arrangements have been highly focused and prioritised in hospital settings [ 50 ]. Scholars even consider COVID-19 pandemic as an opportunity for organisation to eventually upgrade skills and competencies [ 51 ]. However, in homecare sector, lack of training still is a major HR challenge. Without proper training, homecare support staff might not know how to handle PPE requirements, or they might struggle in dealing with challenging circumstances, all of which could potentially cause harm to service users physically and mentally. In line with these findings, prior studies provided evidence of how lack of training and unskilled care staff can negatively impact the safety of patients [ 21 ]. The COVID-19 has further exacerbated this HR challenge, adversely impacting the quality of care [ 7 , 45 ]. Consequently, it is imperative for homecare providers to develop relevant training strategies, ensuring their staff receive adequate knowledge and skills to perform their roles effectively and deliver high-quality care. The only adaptation approach which all homecare providers in this study took was to use online training tools such as videos, newsletters, and virtual training courses. Nonetheless, some care workers expressed the methods of passive online training were not very engaging. This research also found very little evidence of homecare managers providing training on the use of digital tools. As a result, homecare providers must not overlook this type of challenge among employees so that they can also train them on the utilisation of technology to facilitate their work and communication [ 8 ]. Although using digital technology is a popular measure among organisations during the time of pandemic [ 51 , 52 ], this study has shown that homecare organisations still face major HRM challenges related to identifying the needs for technological training, the development of training program, and the utilisation of proper training methods. Therefore, homecare managers need to explore innovative training methods and programmes, ensuring that staff members are equipped with all the essential knowledge to effectively prepare for future crises. 6. CONCLUSIONS, IMPLICATIONS, AND FUTURE RESEARCH This research found several HRM challenges that emerged during the COVID-19 pandemic and could harmfully influence the safety of patients in homecare in England: staff shortages, high turnover, ineffective communication, occupational stress, and the lack of training. These issues could lead to patients’ inability to access care, patients receiving less care or getting poor quality care, also cause potential risks and harm to service users. This study also provided evidence of how homecare organisations have responded to the difficulties through huge individual and collective efforts, from increasing care staff capacity by adopting ad-hoc opportunistic recruitment and selection, and redirecting staff from other areas, to embracing digital technologies and allowing flexible work arrangements. Nevertheless, some of the HRM issues including staff shortages and training gaps persist without definite solutions, and COVID-19 even brought further challenges in how to deal with non-standard employment, redirect and reallocate staff appropriately, and maintain effective communication while making sure there are no technostress or digital exhaustion among staff. Therefore, homecare organisations in England are still facing many major HRM challenges, and at the same time have to ensure to protect the wellbeing of both carers and service users. A number of implications are proposed, with the over-riding aim of ensuring effective management of HRM practices in responding to address key areas: staffing, performance management, and training. In response to staff shortages and high turnover, while short-term adaptive recruitment strategies (ad-hoc opportunistic recruitment and selection, redirecting existing staff to different roles) can be effective, it is important for homecare providers to consider the second-order side effects of the responses [ 48 ], and ensure that staff are adequately prepared before assigning them to care roles. Providing relevant training to temporary support workers and agency staff is key to maintain the quality and continuity of care [ 60 ]. For a long-term approach, we encourage homecare providers to focus on long-term workforce planning, investing in skill development, and creating a stable, competent workforce that is not only aligned with evolving care needs but also equipped and resilient in responding to future crises [ 10 ]. In terms of management challenges, flexible working arrangements and digital methods can are important to maintain communication and performance. However, staff well-being and mental health should be prioritised to enhance retention and care quality [ 35 ]. Homecare providers should provide comprehensive support and protect the wellbeing of their staff [ 10 ], improve communication and demonstrate strong leadership [ 8 , 37 ], and be mindful of avoiding technostress and digital exhaustion while adopting digital technologies for communication and training. Maximising the benefits of flexible work requires aligning it with employee autonomy and establishing a trust-based employment environment [ 61 ]. Addressing training gaps, we recommend that homecare providers identify training needs, develop relevant training programs, and use proper methods for training delivery [ 22 ]. This approach not only address current challenges but also prepares healthcare workers for future crises, ensuring they are equipped with the necessary skills and knowledge to respond effectively to similar situations [ 8 ]. The proactive training and development are crucial for resilience and adaptability in homecare during unforeseen events. This study contributes to the literature in a number of ways: (1) examining the HRM challenges emerged from COVID-19 in the context of homecare settings, (2) providing evidence of how homecare providers have developed responses to these challenges, and (3) investigating how these HRM challenges can adversely affect the safety of patients in homecare. The study used a strong theoretical approach to explain the purposes of the research and the importance of the research questions. Another strength of this paper is using the data source triangulation that involves interviews with diverse participant groups, including homecare workers, service users, and family members. This strategy helps enhance the depth and reliability of the findings. However, this research was limited due to small sample. Also, while writing this paper, the pandemic is still present and therefore, it is not possible to capture accurately the long-term challenges. Future research could include larger sample sizes, along with involving mixed methods and directing toward longitudinal analysis to explore further HRM issues and providing implications for the effectiveness of HRM in homecare settings. Abbreviations COVID-19: Coronavirus Disease 2019 HRM: Human Resource Management HR: Human Resource PPE: Personal Protective Equipment Declarations Ethics approval and consent to participate: Ethical approval was obtained from the Nottingham University Business School Ethics Committee on 05/02/2021. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Funding statement: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors. Acknowledgements: The authors would like to thank all participants who contributed to this study. 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BMC Primary Care. https://doi.org/10.1186/s12875-022-01705-y Aleksić D, Černe M, Batistič S (2024) Understanding meaningful work in the context of technostress, COVID-19, frustration, and corporate social responsibility. Human Relations. https://doi.org/10.1177/00187267221139776 Tekeli-Yesil S, Kiran S (2020) A neglected issue in hospital emergency and disaster planning: Non-standard employment in hospitals. International Journal of Disaster Risk Reduction. https://doi.org/10.1016/j.ijdrr.2020.101823 Danielis M, Peressoni L, Piani T, Colaetta T, Mesaglio M, Mattiussi E, Palese A (2021) Nurses’ experiences of being recruited and transferred to a new sub-intensive care unit devoted to COVID-19 patients. J Nurs Manag. https://doi.org/10.1111/jonm.13253 Dunn M, Sheehan M, Hordern J, Turnham HL, Wilkinson D (2020) “Your country needs you”: The ethics of allocating staff to high-risk clinical roles in the management of patients with COVID-19. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4875799","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":338124991,"identity":"5836b225-c088-4903-920a-a056fb069161","order_by":0,"name":"Thoai Le","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCUlEQVRIiWNgGAWjYBAC+xtAIoHhAAM/mGsARhAggUMLmwRUi2QDA2PDAaK1MAC1GBwAaWEgRot088EPDxgOyBnfbj7++EPBHbvt7KcTGH7UMCTObMChReZYsgTQYcZmd44lAh32LHlnT+4Gxp5jDImzcTosxwCkJXHbjRxDoJbDyQYHcjcw8DYwJM7DrcX4B1BL/eYZMC3n325g/ItfixnIlgQDCYgWO4MbuRuYQbbgdlhamkWCwQHDGTfSEmecMTicYHDj7YbDMsckjHF6XyL58M0fFf/k+WckH/hQ8eewvcH53I0P39TYyM44gMMaMDBAMBNBZh/AHStYgD3xSkfBKBgFo2CkAADofmTthKP9WAAAAABJRU5ErkJggg==","orcid":"","institution":"University of Nottingham","correspondingAuthor":true,"prefix":"","firstName":"Thoai","middleName":"","lastName":"Le","suffix":""},{"id":338124992,"identity":"e0add09c-487d-44d2-a528-88004af48aa8","order_by":1,"name":"Simon Bishop","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Bishop","suffix":""},{"id":338124993,"identity":"ab8ecc64-09d2-46ca-a477-8e2bba1eaeb9","order_by":2,"name":"Carl Macrae","email":"","orcid":"","institution":"University of Nottingham","correspondingAuthor":false,"prefix":"","firstName":"Carl","middleName":"","lastName":"Macrae","suffix":""}],"badges":[],"createdAt":"2024-08-07 15:22:50","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4875799/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4875799/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-024-11842-y","type":"published","date":"2024-12-18T15:58:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64709758,"identity":"9f3fd67d-fa19-4910-8836-08a27dc7c204","added_by":"auto","created_at":"2024-09-18 01:48:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":43803,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eHRM challenges impacting homecare patient safety, and responses from homecare providers during the COVID-19 pandemic in England\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4875799/v1/ce1748af02ceecb0c8216588.png"},{"id":72202638,"identity":"40575780-8255-4880-9f52-33d296810a66","added_by":"auto","created_at":"2024-12-23 16:15:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":604690,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4875799/v1/a6fa886b-bd99-4c41-a969-a500a9d5b2bb.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Human Resource Management in Homecare in England: Managing People for Safe Care During Crisis","fulltext":[{"header":"1.\tINTRODUCTION","content":"\u003cp\u003eExtensive human resource management (HRM) research has consistently shown a strong link between effective human resource (HR) practices and beneficial outcomes for both employees and organisations [1]. In healthcare, ample evidence supports the implementation of HR practices to promote organisational performance outcomes, particularly in preventing adverse events, enhancing care quality, and improving patient safety [2–6]. However, since COVID-19, the pressure on health and social care organisations has intensified, highlighting HRM's crucial role in ensuring the continuity of the care service, managing staff, helping them to cope with the crisis, and safeguarding the safety of patients and staff \u0026nbsp;[7, 8]. While effective HRM practice management is key for organisational functioning and workforce adaptation during crises [9, 10], many health and social care providers struggled to efficiently implement HRM practices in response to the major disruptions of the pandemic.\u003c/p\u003e\n\u003cp\u003eThere has been a scarcity of research focusing on the role of HRM and HRM-related challenges within healthcare organisations, with an even more pronounced lack of attention to the social care sector during the COVID-19 crisis, despite it being severely impacted by the pandemic [11, 12]. Social care has been on the receiving end of many of the policy and organisational changes made to cope with the pandemic, with staff, patients and access to resources affected in the push to shore up acute care [13]. Particularly striking is the limited number of studies on homecare or domiciliary care services. Therefore, in this article, we aim to address this gap by focusing on the homecare sector and looking into its HRM challenges during the COVID-19 crisis.\u003c/p\u003e\n\u003cp\u003eIn England, homecare, which encompasses a variety of care and support services designed to assist individuals in living independently within their own homes [14], has become a significant aspect of the healthcare sector. In recent years, HRM has been a key focus in homecare research literature, recognised for its important role in ensuring high-quality care and improving patient safety [15, 16]. Prior to the COVID-19 pandemic, reports and studies on patient safety in homecare found HRM challenges as major barriers to care quality and patient safety [15, 17–19]. These HRM challenges are related to a wide range of issues including workforce well-being, staff recruitment and retention [20], performance management [21], training and development [22], compensations and recognition [23], and employment relations [24]. The pandemic has brought long-present challenges in HRM in homecare to the fore, while adding a host of new ones. In this study, we explored the emerging HRM issues that are associated with the patient safety in homecare in England during the COVID-19 crisis and examined how homecare organisations have adapted their HRM strategies to ensure the safety of patients amidst the challenges posed by the pandemic.\u003c/p\u003e"},{"header":"2. BACKGROUND","content":"\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e2.1. HRM challenges during the COVID-19 pandemic\u003c/h2\u003e \u003cp\u003eThe effective management of HRM practices plays a key role in an organisation\u0026rsquo;s efforts to operate businesses and help their workforce adapt to disruptive changes and crisis [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite this significance, many organisations have struggled to efficiently implement HRM practices in response to major disruptions, exemplified by the COVID-19 pandemic [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Recent research has highlighted a range of HRM challenges during this period including staff turnover and job loss [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], concerns over employee wellbeing [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], difficulties in training delivery and addressing skills gaps [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], as well as a decline in employee performance and productivity [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. HR practitioners, therefore, have been under considerable pressure to adapt and transform HRM processes in response to the difficulties intensified by the COVID-19 crisis [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCOVID-19 has also brought further HRM challenges which organisations have been struggling to overcome. One of the most noticeable difficulties involves shifting to remote work environment or altering workplace conditions during the time of crisis [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Managers and HR practitioners had to find new ways to ensure their staff having suitable equipment and digital skills to work from home, support employees\u0026rsquo; wellbeing, keeping them motivated, and maintain social connections and communication [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Nevertheless, for other industries such as manufacturing, construction, or healthcare support, remote working is not a viable option [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. As a result, health and social care organisations face significant obstacles in alternating and adapting new work arrangements.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Impact of HRM on healthcare organisational performance\u003c/h2\u003e \u003cp\u003eWithin the health and social care, the effective management of HRM practices and initiatives is critically important for individual and organisational performance [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Key components of performance outcomes in healthcare organisations typically include financial results and costs, individual job performance, and quality of care (e.g., adherence to evidence-based practices, positive patient outcomes and experiences) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In recent years, an important trend we observed in research within healthcare and organisational studies is the increasing emphasis on the quality-of-care services and patient safety. This focus has only been an important priority for organisations since the early 2000s [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], following a significant number of preventable incidents resulting from unsafe care practices, as reported by the U.S. Institute of Medicine (IOM) and the World Health Organization (WHO) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Since then, improving care quality and patient safety emerged as a key objective in healthcare organisational performance. Consequently, the important link between HRM and quality and safety of care has gained increased attention in the fields of organisational science and healthcare [\u003cspan additionalcitationids=\"CR42\" citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the context of acute care settings, there has been an abundance of evidence supporting the use of HRM practices in hospitals to promote healthcare organisation\u0026rsquo;s performance outcomes, particularly in areas like quality of care and patient safety [\u003cspan additionalcitationids=\"CR3 CR4 CR5\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These studies demonstrated common findings that HRM is one of the crucial determinants to achieve successful healthcare quality programs through appropriate staffing levels, retaining highly skilled employees, ensuring high job satisfaction, empowering staff in the workplace, supporting employee well-being, establishing effective team structures, and fostering strong communication and leadership. Nevertheless, a significant amount of research has tended to focus on acute hospitals, whereas other care settings such as domiciliary care or homecare have been overlooked [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Critics have also pointed out that much research in HRM and patient safety has been specifically and predominantly directed at registered nurses in hospital settings and does not pay sufficient attention to other healthcare professions [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Therefore, research into HRM practices, patient safety, and care quality in homecare is critical to fill the gaps in the literature.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.3. The role of HRM in responding to COVID-19 in health and social care sector\u003c/h2\u003e \u003cp\u003eThe COVID-19 pandemic has exacerbated HRM issues in health and social care sector, placing considerable pressure on care providers. During this period, the major HRM challenges in healthcare were related to staff turnover and retention [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], training and skill gaps [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], communication [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], managing staff and supporting their well-being [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Nevertheless, despite the health and social care sector being heavily impacted by COVID-19, there have been limited studies exploring the role of HRM and HRM-related issues in health organisations. Furthermore, most of these studies have merely reported the HRM challenges encountered during the crisis, without investigating further about how these challenges can act as barriers to care quality and impact patient safety. Other research has also been calling for further qualitative studies looking into the impacts of HRM challenges to patient\u0026rsquo;s experience [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Therefore, we aim to fill in this literature gap by investigating how HRM challenges influence homecare patient safety and discovering the responses of homecare providers during the pandemic.\u003c/p\u003e \u003cp\u003eHRM within healthcare organisations is crucial in effectively responding to the pandemic [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Health and social care providers have developed a number of HRM innovations, focusing on new ways of managing, ways of working, and work roles [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. One of the most salient approaches has been using digital technology to transition to virtual forms of recruitment, selection, training, and online meetings [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. COVID-19 might have brought the opportunities for changing work arrangements and skill upgrades with respect to the use of technology [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]; however, the digital transition approach has been seen to create difficulties concerning technology-related stress and exhaustion, as employees can be constantly expected to be available and respond to emails or online meetings [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. Workload and working hours can be increased, resulting in stress and burnout among staff [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]; therefore, organisations must take into consideration of how their employees experience and feel about the virtual tools in times of the pandemic [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBesides using digital technology, care providers have responded to the HRM challenges through a mix of adaptation measures. For example, to increase care staff capacity, organisations recruited and redirected staff from other areas, including hiring and training unemployed individuals, encouraging retired carers to return to work, and recruiting the military, medical students and civilian nurses [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Nonetheless, there might be a potential limitation of adopting non-standard employment, which is that the staff might not be familiar with the new roles due to their lack of experience in incident response [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Furthermore, relocating staff to work during COVID-19 might pose potential risks, cause distress and conflicts, and raise other ethical concerns for professionals [\u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. As a result, healthcare providers must be able to justify the process of staff reallocation and carefully prepare guidelines for non-standard employees [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. Once again, it is noteworthy that most studies investigating HRM issues in healthcare organisations during COVID-19 have been conducted primarily in acute care hospitals and very little research is focusing on homecare, revealing a significant gap in the literature. Additionally, a majority of these research have only explored the issues in HRM but did not investigate further the impact of these issues on care quality and patient safety. Such an extensive list of emerging HRM-related issues caused by the pandemic requires further discussion regarding their influence on the quality-of-care service and patient experience, especially in homecare settings.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. METHODOLOGY","content":"\u003cp\u003eThe research took an inductive approach using the qualitative strategy of narrative inquiry which involved gathering information in the form of storytelling by the research participants [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Data collection methods\u003c/h2\u003e \u003cp\u003eThe data were collected between February 2021 and December 2021 by using semi-structured individual interviews. 31 interview participants were selected, including homecare staff (homecare transition practitioners, homecare social workers, and carers), family members, and service users (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In this paper, homecare staff were also referred as care workers, support workers, carers, and caregivers. Participants were recruited by using opportunistic and snowball sampling methods. Informed consent was obtained. The interviews were conducted online and/or by phone due to the COVID-19 restrictions in face-to-face meetings. Each interview lasted between 45 and 60 minutes and were audio recorded then transcribed.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eList of interview participants\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterviews (I)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRoles\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRegions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTypes of care provided / received\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare Transition Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHospital-to-home transition\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare Transition Practitioner\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eHospital-to-home transition\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSouth West\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNorth West\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWest Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Social worker)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCare services coordination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWest Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupportive care, assistance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eService user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWest Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eService user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSouth West\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast of England\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast of England\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNorth East\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNorth East\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eService user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYorkshire \u0026amp; the Humber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Social worker)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCare services coordination\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHomecare worker (Carer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily member\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEast Midlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSupportive care, assistance\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eService user\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLondon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBasic supportive care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Data Analysis\u003c/h2\u003e \u003cp\u003eIn this research, thematic analysis was used for analysing the data. The interviews were transcribed and identifying information were pseudonymised. The analysis was performed in English and the software NVivo 11 was used to organise, manage, and analyse data. The thematic analysis began after the first interview, with repeated reading of the first transcripts to identify key themes related to the review of the literature. Then, the data was coded and there were three forms of coding: open coding, axial coding, and selective coding. These core themes or central categories were linked and presented to develop a theoretical framework to better understand the research topics and answer research questions [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"4. FINDINGS","content":"\u003cp\u003eThe findings revealed three dominant themes highlighting the HRM challenges that can negatively affect the safety of service users in homecare and how homecare providers responded to these challenges (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1. Making do: Staffing Home Care in Crisis\u003c/h2\u003e \u003cp\u003eShortage of staff has been a significant challenge to homecare providers during the time of crisis. Data from the research participants reveal that homecare workplaces experienced high turnover and staff shortages during the pandemic due to staff burn-out, fear of virus, lack of support from the care providers, and staff isolating with confirmed COVID-19 or with suspected infection. For example, one homecare social worker said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThere\u0026rsquo;s obviously a certain number of people working in homecare would have had COVID as well, but at that time, it obviously posed challenges to them. [\u0026hellip;] They would need to self-isolate and wouldn\u0026rsquo;t be able to go into people\u0026rsquo;s homes (I.12, Social worker).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSince COVID-19, homecare providers have experienced additional staffing hurdles related to recruitment and retention of staff. In recent years, a significant number of social care staff have been leaving the sector, presenting significant challenges for providers in recruiting care workers, directly affecting care service. For example, research respondents reported that because there was not enough staff, service users might have to receive less care than normal:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThere was one time when many clients needed services, and we faced a challenge because many team members, especially the older ones, were not available or had resigned. This created a shortage of staff for client care, making service delivery more difficult (I.03, Carer).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eBefore the pandemic, my doctor used to visit five days a week. During the pandemic, this was reduced to three days a week, and currently, we are considering reducing it further to two days a week (I.27, Service user).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn addition, if an excessive number of staff members fall ill and are unable to work, the amount of care and support provided to certain individuals would be reduced. The service users will receive fewer hours of care than are currently funded for them due to the shortage of available staff to deliver the required services:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIn the event that too many staff became ill with COVID and there wasn\u0026rsquo;t anyone there to support, certain individuals will be given less care, less hours than what they are being funded (I.20, Carer).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFurthermore, high turnover can lead to the inconsistency in the care workforce. It can potentially impact the performance of the team and patient\u0026rsquo;s psychological safety by causing distress for patients who do not like to have many different caregivers coming to their homes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe inconsistency with staff members can cause a lot of distress and anxiety for the individual. Some individuals like to know when people are coming home, and if the individual doesn\u0026rsquo;t know who\u0026rsquo;s coming on, getting someone that they don\u0026rsquo;t like or not very keen on for that day, it can cause a lot of anxieties for the individual (I.06, Carer).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAlthough shortage of staff is not a new phenomenon in healthcare sector, COVID-19 has put a lot more pressure and extra constraint on healthcare organisations to change their HR strategies. All homecare managers in this study reported that their organisations had to adopt an ad-hoc, opportunistic and \u0026lsquo;all hands-on deck\u0026rsquo; approach in the recruitment and selection processes during the time of crisis. For example, all interviews must be conducted online, work experience criteria were reduced, fewer reference checks, and fewer shadowing shifts for new employees to lessen in-person interaction. Respondents also expressed difficulty in recruiting and retaining support workers due to high turnover rates, inconsistent care provision, and low wages in the healthcare and social care sectors:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eOne challenge I had was to interview and select twenty-two applicants for the support worker positions (I.19, Carer).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eThe turnover in the sector can sometimes mean that people won\u0026rsquo;t have a consistent person coming into their homes, so this challenge for the home carers and the providers themselves will be relatively short periods of time to work with people from the amount that they\u0026rsquo;re paid as well, so I think it can be a challenge of recruiting people into the sector, then retaining them (I.12, Social worker).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn addition, to address staffing challenges, homecare providers had to relocate staff from different areas to undertake care duties or recruit more temporary care staff. For example, some participants, including managers and homecare transition practitioners, were asked to perform care duties at service users\u0026rsquo; homes, which were not part of their responsibilities before COVID-19. Additionally, care providers had to recruit more temporary carers and agency staff to cope with staff shortages:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI remember applying for the job and then getting a call from a woman at the agency. She seemed eager for me to start working immediately. [\u0026hellip;]. We had a Zoom interview. I met with the woman from the agency and, I believe, her boss. The manager of the agency was also there. They seemed to like me and offered me the job (I.23, Carer).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e4.2. Managing people through any means possible\u003c/h2\u003e \u003cp\u003eThe second theme focused on how homecare providers had to find as many different ways as possible to manage their care staff. Given the extreme pressures of the pandemic, homecare organisations could be seen to adopt a highly ad-hoc approach to HRM in order to deal with the rapidly growing problems with which they were presented. This could be seen across a number of issues. For instance, communication was highly disrupted as many carers expressed that they struggled to communicate effectively with their managers. Some said there were slow email replies or no responses from phone calls; others reported they did not have as many supervision meetings as before:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI have occasions where you\u0026rsquo;re required an immediate response from your line managers, especially nowadays where it\u0026rsquo;s working from home, and it can be quite difficult sometimes to get in contact with them. I\u0026rsquo;ve had incidents that required on call but there\u0026rsquo;s been no answer from on calls (I.06, Carer).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eIn homecare, individuals often work alone, so not being able to reach a manager can be problematic for the service users. [\u0026hellip;] During summer, I faced a delay in response when inquiring about shifts, which was a bit frustrating, especially when I was readily available. Prompt communication is key in this field, and such lapses, even if rare, can be inconvenient (I.17, Carer).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eUsually, I have one supervision meeting per month but now I only meet my line manager online once in every three or even four months because she\u0026rsquo;s always busy since COVID (I.29, Carer).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe challenges in communication such as delayed responses can create obstacles for homecare workers in delivering timely and appropriate services to service users. Caregivers described difficulties in communicating with their managers can hinder their ability to perform duties effectively and may impact the safety and well-being of service users:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eCommunication with the head office can be challenging due to delayed responses or being passed between departments. [\u0026hellip;] Delayed responses can hinder my ability to do my job effectively, which might indirectly impact service user safety (I.10, Carer).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFrom the interviews, carers also indicated that they experienced occupational stress attributed by poor communication and management. For example, two homecare transition practitioners in this study expressed their frustrations when their transition tasks were suspended, and they were required to take on-call shifts and deliver care to service users, which are not their duties before COVID-19. One of them, who decided to leave the role soon after due to this reason, said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI feel overwhelmed with workload, especially when asked to perform tasks not part of my job (I.02, Homecare Transition Practitioner).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThese are significant issues which can negatively impact the care quality. One carer expressed that \u003cem\u003e\u0026ldquo;fatigue can hinder your ability to perform well\u0026rdquo;\u003c/em\u003e and emphasised the importance of maintaining sound well-being to deliver high-quality service (I.03, Carer).\u003c/p\u003e \u003cp\u003eIn response to these challenges in staff management, homecare providers and managers had to find ways of improvising approaches to communication, safety, and managing performance. Organisations have altered their management of staff by adopting technologies to organise meetings online, enabling remote work for admin staff, and allowing flexible work arrangements:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eAll meetings with my staff are now on Teams. Often, we had to video call after midnight after the individual went to bed (I.07, Carer).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eCommunication is mainly through WhatsApp. They inform me about available shifts, and sometimes they call if there's an urgent need (I.18, Carer).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003eBefore COVID, staff members had to attend in person for handovers, but now I can only email or text my colleagues because we are not allowed to meet in person (I.11, Carer).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe data suggested that homecare staff have had to adapt their lives around the pandemic and co-ordinate work through any means possible, which detrimentally affected their mental health. For instance, some carers said they were under pressure and stressed when being expected to answer calls or emails instantly, even during late hours or during their days off. Participants also found it difficult to provide or receive emotional support and build relationships with their colleagues or service users virtually, especially during the challenging time of COVID-19. A transition practitioner said:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThe pandemic restricted the amount of time or visit that I could go see the individuals that required support in person, and it was all restricted to online, slash zoom calls and that had an impact on the rapport built with the individual. I feel like it didn\u0026rsquo;t build up the same level of trust (I.01, Homecare transition practitioner).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.3. Compounding skills and training gaps\u003c/h2\u003e \u003cp\u003eThe crisis both presented large challenges with maintaining training and development activities, while also present a large number of new training needs. A significant challenge emerged from data is the lack of training provided by care providers during the COVID-19 pandemic. A support worker described she only received one brief training session online about how to use personal protective equipment (PPE). Another care worker expressed how his care agency only sent out government guidelines, newsletters, and online resources through emails but offered no specific training:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThey were sending out weekly newsletters informing staff about mental health or looking after yourself, then some updates on the government guidelines, and other things, and they\u0026rsquo;re kind of expected us to read through and learn it by ourselves (I.26, Carer).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome homecare team leaders and managers suggested that care providers did not know much about the virus and therefore, were slow to respond. Additionally, providers faced significant difficulties in interpreting and keeping up with the rapidly changing sector-specific guidance. The frequent updates and sheer volume of information posed substantial challenges, which make it hard for homecare providers to stay current and compliant with the latest guidelines:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI think there\u0026rsquo;s been a lot for providers to interpret. My observation is that the guidance has changed fairly quickly [\u0026hellip;] I think no matter what sector we\u0026rsquo;ve worked in, the sheer amount of guidance that has come through has been absolutely challenging to keep up with (I.12, Social worker).\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis lack of clarity about PPE requirements could increase infection risks among homecare service users, seriously affecting their safety. Furthermore, without appropriate training, homecare staff might find it difficult handling challenging situations, which could potentially lead to errors and cause harm to service users. For instance, a member of care staff expressed that they were not guided by her employer on how to handle the situation when the service users feeling stressed and wanting to go out during the national lockdown, raising concerns about emotional, social, and functional safety:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThere is the challenge of helping them understand why they can\u0026rsquo;t, for instance, going to the cinema, or go to a recreational activity within the community. If they feel like they cannot go out or they cannot go to shop or cinema, it could affect their emotional health or mental health (I.22, Carer).\u003c/em\u003e \u003c/p\u003e\u003cp\u003e \u003cem\u003e[\u0026hellip;] the service user can get quite frightened, can get quite scared when something that\u0026rsquo;s not been explained to them (I.21, Carer).\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn response to skills and training gaps, a few homecare organisations have tried and adopted digital tools to provide some trainings for their care workers during COVID-19. For example, one care support worker mentioned that they had to watch online videos about COVID-19, while a homecare manager reported using Zoom for training. However, some carers said they found it difficult to use digital tools and some methods of online training were not very engaging. Overall, there were still significant issues in compounding skills and training gaps when homecare providers struggled to find ways to train their staff. A lack of clarity about guidance also raised serious concerns about homecare patient safety.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. DISCUSSION","content":"\u003cp\u003eOur study explored the emerging HRM challenges that are associated with homecare patient safety in England and how homecare providers have responded to these challenges during the COVID-19 pandemic. The aim of this is to explore the role of HRM practices in helping care organisations operate efficiently and supporting their workforce to adapt to future disruptive changes and crises. There were three key themes identified: staffing homecare in crisis, managing staff through any means possible, and compounding skills and training gaps. Each theme has presented a number of HRM issues during the pandemic: staff shortages, high turnover, ineffective communication, employee occupational stress, and the lack of training. These issues are significant barriers to homecare patient safety as highlighted by previous research and reports [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the first theme, the data revealed that homecare organisations had to take on ad-hoc opportunistic recruitment and selection, redirect staff from other areas to take care duties, and hire temporary agency staff, in response to staff shortages and high turnover. During the pandemic, many care providers experienced challenges in recruiting, retaining, and maintaining staff morale [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Data from this study showed similar findings of homecare providers struggling to retain and recruit care employees. A number of reasons for this issue include staff burn-out, fear of virus, lack of support from the care providers, and staff isolating with confirmed COVID-19 or with suspected infection. Without sufficient number of care workers, service users receive less care than normal because the providers facing challenges in maintaining continuity of care. Some service users also feel stressed and anxious when they keep receiving care from different people due to high turnover of staff. These findings reflect the importance of HR practices in recruitment and retention to ensure safety and well-being of service users [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eResponding to staff shortages and high turnover, homecare providers have adopted ad-hoc opportunistic recruitment and selection (e.g., online interviews, fewer reference checks, fewer shadowing shifts for new employees), mass recruitment, hiring temporary agency carers, and redirecting staff from other areas. Previous studies have shown that other organisations including healthcare providers had similar approaches [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. However, these measures have also created new challenges to HR managers in terms of dealing with inexperience non-standard care staff [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e], and ensuring there are no potential risks and ethical concerns to those who are relocated to work during COVID-19 [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. In this research, two transition practitioners described their frustration in the way their managers required them to deliver care at people\u0026rsquo;s homes, which was not part of their duties before the pandemic. Although task allocation can be a quick solution for capacity problem, it can raise conflicts and cause distress for care workers [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. Previous research has also discovered the negative feelings of health professionals who were reallocated to COVID-19 unit at hospitals [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe second theme of this paper has shown how homecare providers had to manage their staff through any means possible by using digital technologies or adopting flexible work arrangements. Data from this study revealed the majority of carers experienced a lack of responses from their managers during the time of crisis. Leadership communication has strong influence on staff work performance [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] and the lack of communication can be a major of stress and contribute to employee burnout [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Indeed, COVID-19 has made a serious impact on healthcare professionals\u0026rsquo; health and wellbeing as they are at high risk of stress, burnout, fear, and anxiety [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. In this research, data have shown the feeling of burnout or stress can adversely impact the performance and commitment of staff to their jobs, which leads to service users receiving less care or poor-quality care. These findings are consistent with previous research of how communication issues and occupational stress during COVID-19 can negatively affect the performance of carers, potentially leading to poor quality care services [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has shown homecare providers had to find new ways to improve communication and manage their performance. However, there was a lack of wellbeing support from homecare team leaders to their staff, whereas in hospital settings, there have been evidence of how effective leadership and communication can improve performance of health professionals during the time of COVID-19 [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. To maintain communication and managing staff performance, homecare organisations\u0026rsquo; approaches have included using digital technologies to organise meetings online, enabling remote work for admin staff, and allowing flexible work arrangements such as online handovers or late-night video calls for night shift care workers. These adaptation measures corroborate findings from previous research on organisations adopting digital tools and remote work to maintain communication with their staff [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Nevertheless, even with digital tools, some respondents in this study still expressed their struggles in communicating with their managers. This finding is in accordance with previous research showing difficulties in communication among healthcare workers during the pandemic despite the implementation of digital technology [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Interestingly, this paper also found an opposite result of some other participants describing their feeling of pressure while being constantly expected to answer calls or emails. This emerging issue was similarly discussed in prior research on technostress and digital exhaustion [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRegarding the third theme of compounding skills and training gaps, the research found that all homecare providers used digital tools as an effort to provide training for staff; however, it was challenging for them to effectively identify the training needs, develop the training programs, and implement appropriate training methods. During the time of crisis, training on knowledge related to COVID-19 and contagion control methods are essentials to the safety of staff and patients [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Nevertheless, most participants reported there was a lack of training on knowledge related to COVID-19. It was explained by the uncertain situation of COVID-19 and the inconsistency in official national guidance in preventing transmission and protecting workers from the virus. Although previous studies have reported challenges in training delivery and skills gaps during COVID-19 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], training arrangements have been highly focused and prioritised in hospital settings [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Scholars even consider COVID-19 pandemic as an opportunity for organisation to eventually upgrade skills and competencies [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. However, in homecare sector, lack of training still is a major HR challenge. Without proper training, homecare support staff might not know how to handle PPE requirements, or they might struggle in dealing with challenging circumstances, all of which could potentially cause harm to service users physically and mentally. In line with these findings, prior studies provided evidence of how lack of training and unskilled care staff can negatively impact the safety of patients [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The COVID-19 has further exacerbated this HR challenge, adversely impacting the quality of care [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Consequently, it is imperative for homecare providers to develop relevant training strategies, ensuring their staff receive adequate knowledge and skills to perform their roles effectively and deliver high-quality care.\u003c/p\u003e \u003cp\u003eThe only adaptation approach which all homecare providers in this study took was to use online training tools such as videos, newsletters, and virtual training courses. Nonetheless, some care workers expressed the methods of passive online training were not very engaging. This research also found very little evidence of homecare managers providing training on the use of digital tools. As a result, homecare providers must not overlook this type of challenge among employees so that they can also train them on the utilisation of technology to facilitate their work and communication [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Although using digital technology is a popular measure among organisations during the time of pandemic [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e], this study has shown that homecare organisations still face major HRM challenges related to identifying the needs for technological training, the development of training program, and the utilisation of proper training methods. Therefore, homecare managers need to explore innovative training methods and programmes, ensuring that staff members are equipped with all the essential knowledge to effectively prepare for future crises.\u003c/p\u003e"},{"header":"6. CONCLUSIONS, IMPLICATIONS, AND FUTURE RESEARCH","content":"\u003cp\u003eThis research found several HRM challenges that emerged during the COVID-19 pandemic and could harmfully influence the safety of patients in homecare in England: staff shortages, high turnover, ineffective communication, occupational stress, and the lack of training. These issues could lead to patients\u0026rsquo; inability to access care, patients receiving less care or getting poor quality care, also cause potential risks and harm to service users. This study also provided evidence of how homecare organisations have responded to the difficulties through huge individual and collective efforts, from increasing care staff capacity by adopting ad-hoc opportunistic recruitment and selection, and redirecting staff from other areas, to embracing digital technologies and allowing flexible work arrangements. Nevertheless, some of the HRM issues including staff shortages and training gaps persist without definite solutions, and COVID-19 even brought further challenges in how to deal with non-standard employment, redirect and reallocate staff appropriately, and maintain effective communication while making sure there are no technostress or digital exhaustion among staff. Therefore, homecare organisations in England are still facing many major HRM challenges, and at the same time have to ensure to protect the wellbeing of both carers and service users.\u003c/p\u003e \u003cp\u003eA number of implications are proposed, with the over-riding aim of ensuring effective management of HRM practices in responding to address key areas: staffing, performance management, and training. In response to staff shortages and high turnover, while short-term adaptive recruitment strategies (ad-hoc opportunistic recruitment and selection, redirecting existing staff to different roles) can be effective, it is important for homecare providers to consider the second-order side effects of the responses [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and ensure that staff are adequately prepared before assigning them to care roles. Providing relevant training to temporary support workers and agency staff is key to maintain the quality and continuity of care [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. For a long-term approach, we encourage homecare providers to focus on long-term workforce planning, investing in skill development, and creating a stable, competent workforce that is not only aligned with evolving care needs but also equipped and resilient in responding to future crises [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn terms of management challenges, flexible working arrangements and digital methods can are important to maintain communication and performance. However, staff well-being and mental health should be prioritised to enhance retention and care quality [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Homecare providers should provide comprehensive support and protect the wellbeing of their staff [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], improve communication and demonstrate strong leadership [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], and be mindful of avoiding technostress and digital exhaustion while adopting digital technologies for communication and training. Maximising the benefits of flexible work requires aligning it with employee autonomy and establishing a trust-based employment environment [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAddressing training gaps, we recommend that homecare providers identify training needs, develop relevant training programs, and use proper methods for training delivery [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This approach not only address current challenges but also prepares healthcare workers for future crises, ensuring they are equipped with the necessary skills and knowledge to respond effectively to similar situations [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The proactive training and development are crucial for resilience and adaptability in homecare during unforeseen events.\u003c/p\u003e \u003cp\u003eThis study contributes to the literature in a number of ways: (1) examining the HRM challenges emerged from COVID-19 in the context of homecare settings, (2) providing evidence of how homecare providers have developed responses to these challenges, and (3) investigating how these HRM challenges can adversely affect the safety of patients in homecare. The study used a strong theoretical approach to explain the purposes of the research and the importance of the research questions. Another strength of this paper is using the data source triangulation that involves interviews with diverse participant groups, including homecare workers, service users, and family members. This strategy helps enhance the depth and reliability of the findings. However, this research was limited due to small sample. Also, while writing this paper, the pandemic is still present and therefore, it is not possible to capture accurately the long-term challenges. Future research could include larger sample sizes, along with involving mixed methods and directing toward longitudinal analysis to explore further HRM issues and providing implications for the effectiveness of HRM in homecare settings.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCOVID-19: \u0026nbsp; \u0026nbsp;\u0026nbsp;Coronavirus Disease 2019\u003c/p\u003e\n\u003cp\u003eHRM: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Human Resource Management\u003c/p\u003e\n\u003cp\u003eHR: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Human Resource\u003c/p\u003e\n\u003cp\u003ePPE: \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Personal Protective Equipment\u003c/p\u003e"},{"header":"Declarations","content":"\u003cul\u003e\n \u003cli\u003eEthics approval and consent to participate: Ethical approval was obtained from the Nottingham University Business School Ethics Committee on 05/02/2021.\u003c/li\u003e\n \u003cli\u003eConsent for publication: Not applicable.\u003c/li\u003e\n \u003cli\u003eCompeting interests: The authors declare no competing interests.\u003c/li\u003e\n \u003cli\u003eFunding statement: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.\u003c/li\u003e\n \u003cli\u003eAcknowledgements: The authors would like to thank all participants who contributed to this study.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSanders K, Guest D, Rodrigues R (2021) The role of HR attributions in the HRM \u0026ndash; Outcome relationship: Introduction to the special issue. Human Resource Management Journal. https://doi.org/10.1111/1748-8583.12358\u003c/li\u003e\n\u003cli\u003eBurgess N, Strauss K, Currie G, Wood G (2015) Organizational Ambidexterity and the Hybrid Middle Manager: The Case of Patient Safety in UK Hospitals. Hum Resour Manage. https://doi.org/10.1002/hrm.21725\u003c/li\u003e\n\u003cli\u003eKhatri N, Gupta V, Varma A (2017) The Relationship Between HR Capabilities and Quality of Patient Care: The Mediating Role of Proactive Work Behaviors. Hum Resour Manage. https://doi.org/10.1002/hrm.21794\u003c/li\u003e\n\u003cli\u003eTownsend K, Lawrence SA, Wilkinson A (2013) The role of hospitals\u0026rsquo; HRM in shaping clinical performance: A holistic approach. 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Hum Resour Manage. https://doi.org/10.1002/hrm.22162\u003c/li\u003e\n\u003cli\u003eLeonardi PM (2021) COVID-19 and the New Technologies of Organizing: Digital Exhaust, Digital Footprints, and Artificial Intelligence in the Wake of Remote Work. Journal of Management Studies. https://doi.org/10.1111/joms.12648\u003c/li\u003e\n\u003cli\u003eCollings DG, Nyberg AJ, Wright PM, McMackin J (2021) Leading through paradox in a COVID-19 world: Human resources comes of age. Human Resource Management Journal. https://doi.org/10.1111/1748-8583.12343\u003c/li\u003e\n\u003cli\u003eKessler I, Heron P, Spilsbury K (2017) Human resource management innovation in health care: the institutionalisation of new support roles. Human Resource Management Journal. https://doi.org/10.1111/1748-8583.12114\u003c/li\u003e\n\u003cli\u003eMayo AT, Myers CG, Sutcliffe KM (2021) Organizational science and health care. 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Human Resource Management Journal. https://doi.org/10.1111/j.1748-8583.2007.00018.x\u003c/li\u003e\n\u003cli\u003eGrimshaw D, Rubery J, Marchington M (2010) Managing people across hospital networks in the UK: Multiple employers and the shaping of HRM. Human Resource Management Journal. https://doi.org/10.1111/j.1748-8583.2010.00144.x\u003c/li\u003e\n\u003cli\u003eShipton H, Sanders K, Atkinson C, Frenkel S (2016) Sense-giving in health care: the relationship between the HR roles of line managers and employee commitment. Human Resource Management Journal. https://doi.org/10.1111/1748-8583.12087\u003c/li\u003e\n\u003cli\u003eNyashanu M, Pfende F, Ekpenyong M (2020) Exploring the challenges faced by frontline workers in health and social care amid the COVID-19 pandemic: experiences of frontline workers in the English Midlands region, UK. 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Work, Employment and Society. https://doi.org/10.1177/09500170211035937\u003c/li\u003e\n\u003cli\u003eRapp DJ, Hughey JM, Kreiner GE (2021) Boundary Work as a Buffer Against Burnout: Evidence From Healthcare Workers During the COVID-19 Pandemic. Journal of Applied Psychology. https://doi.org/10.1037/apl0000951\u003c/li\u003e\n\u003cli\u003eMoynihan R, Sanders S, Michaleff ZA, et al (2021) Impact of COVID-19 pandemic on utilisation of healthcare services: A systematic review. BMJ Open. https://doi.org/10.1136/bmjopen-2020-045343\u003c/li\u003e\n\u003cli\u003eLiu Y, Wang H, Chen J, Zhang X, Yue X, Ke J, Wang B, Peng C (2020) Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic. Int J Nurs Sci. https://doi.org/10.1016/j.ijnss.2020.03.011\u003c/li\u003e\n\u003cli\u003eAkkermans J, Richardson J, Kraimer ML (2020) The Covid-19 crisis as a career shock: Implications for careers and vocational behavior. J Vocat Behav. https://doi.org/10.1016/j.jvb.2020.103434\u003c/li\u003e\n\u003cli\u003eMazurenko O, Sanner L, Apathy NC, Mamlin BW, Menachemi N, Adams MCB, Hurley RW, Erazo SF, Harle CA (2022) Evaluation of electronic recruitment efforts of primary care providers as research subjects during the COVID-19 pandemic. BMC Primary Care. https://doi.org/10.1186/s12875-022-01705-y\u003c/li\u003e\n\u003cli\u003eAleksić D, Černe M, Batistič S (2024) Understanding meaningful work in the context of technostress, COVID-19, frustration, and corporate social responsibility. Human Relations. https://doi.org/10.1177/00187267221139776\u003c/li\u003e\n\u003cli\u003eTekeli-Yesil S, Kiran S (2020) A neglected issue in hospital emergency and disaster planning: Non-standard employment in hospitals. 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Sociol Health Illn 45:1560\u0026ndash;1577\u003c/li\u003e\n\u003cli\u003eEdmonds WA, Kennedy TD (2017) An Applied Reference Guide to Research Designs: Quantitative, Qualitative, and Mixed Methods, 2nd ed. SAGE, London\u003c/li\u003e\n\u003cli\u003eBenaquisto L (2008) Selective Coding. In: Given LM (ed) The SAGE Encyclopaedia of Qualitative Research Methods. SAGE, London, pp 805\u0026ndash;806\u003c/li\u003e\n\u003cli\u003eKirkpatrick I, Hoque K, Lonsdale C (2019) Client organizations and the management of professional agency work: The case of English health and social care. Hum Resour Manage 58:71\u0026ndash;84\u003c/li\u003e\n\u003cli\u003eKulik CT (2022) We need a hero: HR and the \u0026lsquo;next normal\u0026rsquo; workplace. Human Resource Management Journal 32:216\u0026ndash;231\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HR practices, homecare, social care, COVID-19, safety, care quality","lastPublishedDoi":"10.21203/rs.3.rs-4875799/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4875799/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eHuman resource management (HRM) of healthcare organisations plays an important role in improving the continuity of care, managing staff, and ensuring patient safety. During COVID-19, there were several HR-related issues, creating a significant challenging situation for health and social care institutions. This study explored the HRM issues that are associated with the patient safety in homecare, and how homecare providers have responded to these HR-related challenges during the COVID-19 pandemic. The aim of this is to explore the role of HRM practices in helping care organisations operate efficiently and supporting their workforce to adapt to future disruptive changes and crises.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eQualitative strategies include narrative inquiry involving gathering information in the form of storytelling by the research participants. Between February 2021 and December 2021, data were collected through semi-structured interviews of 31 participants, including homecare staff (homecare transition practitioners, homecare social workers, and carers), family members, and service users in England.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe research identified key HRM challenges during the pandemic, including staff shortages, high turnover, ineffective communication, occupational stress for front-line carers, and lack of training, all adversely affecting the safety of homecare patients. In response, homecare providers employed strategies like opportunistic recruitment, digital technology for training and communication, and flexible work arrangements to mitigate these issues.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eSeveral implications are proposed, with the over-riding aim of ensuring effective management of HRM practices in responding to address key areas: staffing, performance management, and training. Homecare providers should utilise short-term adaptive recruitment strategies, while also focusing on long-term workforce development and resilience to effectively respond to current and future care needs. Prioritising staff well-being for retention and care quality are crucial. Homecare providers are encouraged to offer flexible work arrangements and digital communication methods, all while being mindful of preventing technostress and digital exhaustion among their staff. They also need to bridge training gaps and employ effective delivery methods to equip healthcare workers with essential skills, thereby enhancing resilience and adaptability in homecare.\u003c/p\u003e","manuscriptTitle":"Human Resource Management in Homecare in England: Managing People for Safe Care During Crisis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-18 01:48:11","doi":"10.21203/rs.3.rs-4875799/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-09T11:08:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-09T01:22:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-09T01:22:07+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-08-07T15:21:17+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"af594662-8d2b-476d-9a9f-c4153b1a8afb","owner":[],"postedDate":"September 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-23T16:09:06+00:00","versionOfRecord":{"articleIdentity":"rs-4875799","link":"https://doi.org/10.1186/s12913-024-11842-y","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2024-12-18 15:58:21","publishedOnDateReadable":"December 18th, 2024"},"versionCreatedAt":"2024-09-18 01:48:11","video":"","vorDoi":"10.1186/s12913-024-11842-y","vorDoiUrl":"https://doi.org/10.1186/s12913-024-11842-y","workflowStages":[]},"version":"v1","identity":"rs-4875799","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4875799","identity":"rs-4875799","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}