THE ROLE OF HUMAN RESOURCE MANAGEMENT IN HEALTH WORKERS’ INTENTION TO MOBILE: EVIDENCE FROM KOSOVO’S PUBLIC HOSPITALS

Abstract

Human resource management (HRM) is widely regarded as the central lever for sustaining health workers’ motivation, satisfaction and retention, yet in transition health systems such as Kosovo’s, dedicated HRM departments are frequently absent from public hospitals. This paper examines the relationship between health workers’ job satisfaction, motivation, work-related problems and loyalty, and their intention to mobile (migrate) to other countries, and assesses the extent to which weak institutional HRM contributes to that intention. A mixed-methods case study was conducted at two regional hospitals in Kosovo. Quantitative data were collected through a structured online questionnaire (7-point Likert scale) completed by 40 medical professionals: doctors, nurses and technicians – and analysed in SPSS using linear regression and independent-samples t-tests; qualitative data were obtained through ten semi-structured remote interviews with hospital top and middle management. The first regression model showed that 69% of the variance in health workers’ job satisfaction and motivation is explained by the support received from top and middle management, with standardized beta coefficients of .478 for job motivation and .450 for job loyalty. The second model showed that 61% of the variance in health workers’ intention to mobile is explained by work-related problems, with job satisfaction (β = -.462), motivation (β = -.402) and loyalty (β = -.394) each exerting a significant negative effect. Sixty-five percent of the surveyed workers, predominantly aged 20-40, reported an intention to mobile, 80% of them naming Germany as their preferred destination and citing salary, working conditions and family prospects as leading motives. Independent-samples t-tests revealed significant gender differences in work-related problems and intention to mobile, both higher among male respondents, but not in job satisfaction or motivation. The qualitative interviews confirmed that neither hospital operates a dedicated HRM department; personnel functions are instead handled by a generalist administrative officer alongside unrelated duties. The findings indicate that the absence of a functioning HRM structure is strongly associated with unresolved work-related problems, reduced job satisfaction and motivation, and elevated migration intention among Kosovo’s public-hospital health workforce, quantifying a relationship the literature has so far described mainly in qualitative terms. The paper recommends that Kosovo’s health institutions establish dedicated HRM departments with defined reward, promotion, and training and development policies; adopt a structured HR-development monitoring tool, such as the modified Human Development Index for the health sector proposed in this study; and expand cost-free retention approaches, including staff-exchange agreements with international hospitals, while advocating for a national law on health-sector salaries. The study is based on a two-hospital case design, and replication across Kosovo’s remaining public hospitals is recommended to support a national HR action plan for the health workforce.