NABH 6th Edition HRM Chapter: Human Resource Management Explained

What the HRM chapter is about

NABH's intent for HRM starts from the idea that staff are the hospital's most important resource. Management plans the right number and skill mix of staff for safe care, recruits through a uniform system, orients everyone (including outsourced staff, volunteers, students and trainees), trains them continually, appraises them in a structured way, looks after their physical and mental well-being, handles grievances and discipline fairly, and credentials and privileges its clinical professionals.

One definition matters throughout: NABH uses "employee" for salaried personnel and "staff" for everyone who works in the hospital, including fee-for-service doctors, part-time and contractual workers and volunteers. Most HRM requirements apply to staff.

HRM has more Core elements than any other chapter, and every Core element must score at least 4 out of 5 at every assessment. Our 6th Edition overview explains the scoring. NABH marks nine HRM elements with an asterisk, meaning they must be documented: HRM.1.b, 1.f, 2.a, 2.d, 4.a, 7.a, 8.a, 9.a and 9.d.

The 13 standards at a glance

Staffing and recruitment (HRM.1–HRM.2)

The hospital maintains an adequate number and mix of staff for its patients' needs (HRM.1.b, Core). Human resource planning supports current and future needs (moved down from Excellence to Commitment in this edition), every category of staff has a job specification, job description and reporting relationships, and new staff get a background check. Contingency plans for short and long-term shortages and exit interviews used to improve HR practice are Achievement elements.

Recruitment follows written guidance (HRM.2.a, Core), new staff have a pre-employment medical examination, the hospital defines and implements a code of conduct (HRM.2.c, Core) and HR administrative procedures are documented.

Evidence that works: a staffing plan with nurse-to-patient ratios by area; job descriptions signed by the staff member; background and reference check records; a recruitment policy; a code of conduct acknowledged by every staff member.

Induction (HRM.3)

Induction training is Core (HRM.3.a). It covers the hospital's vision, mission and values; staff and patient rights and responsibilities; safety (the interpretation now stresses emergency codes); CPR; infection prevention and control; service standards; administrative procedures; the department's own policies; and, new in the 6th Edition, information systems, information security and information use (HRM.3.j).

Evidence that works: an induction programme with a session list; attendance records with dates and durations; post-induction tests; induction records for outsourced staff, students and volunteers too.

Ongoing and job-specific training (HRM.4–HRM.5)

Written guidance governs training and development (HRM.4.a, Core); NABH's change notes say the interpretation now includes learning management systems and e-learning. Training records are maintained (with dates and durations, and digital records accepted), training also happens when duties change or new equipment arrives, and feedback improves the programme. Evaluating training effectiveness and supporting continuing professional development are Achievement elements.

HRM.5 covers job-specific training: handling blood and blood products for transfusion staff, vulnerable patients, restraint techniques, healthcare communication, infection prevention (now with emphasis on the antimicrobial policy and stewardship) and periodic CPR training for staff in direct patient care (HRM.5.e, Core).

Evidence that works: an annual training calendar; individual training records; competency checks after training; BLS and ACLS certificates with renewal dates.

Safety and quality training (HRM.6)

Staff are trained in the hospital's safety programme, in detecting and handling risks (including chemicals and cytotoxic drugs), in what to do after an incident, in occupational safety (such as laser exposure and medical gases) and in the quality improvement programme. Two elements are Core: training on the disaster management plan (HRM.6.e) and on handling fire and non-fire emergencies (HRM.6.f). These link directly to the drills required in the FMS chapter.

Appraisal, discipline and grievances (HRM.7–HRM.8)

Performance appraisal is done for staff at defined intervals, against predetermined criteria, explained at induction, documented and used for development (HRM.7.d, moved up from Achievement to Commitment).

Discipline and grievances follow written guidance known to all staff, are based on natural justice, allow appeals in every disciplinary case and lead to action on grievances. The Core element is that the procedure is in line with prevailing laws (HRM.8.d).

Staff health and safety (HRM.9)

Staff health problems, including occupational hazards, are managed under a policy that the interpretation now says should cover physical and mental health and support for the "second victim": a staff member affected by an unanticipated adverse event. Staff in direct patient care get a health check at least once a year, staff injured at work are treated, and the hospital has measures to prevent and handle workplace violence (HRM.9.d, Core).

Evidence that works: an occupational health policy; annual health check records; staff immunisation records; needle-stick injury records with follow-up; a workplace violence policy with security measures and a reporting route.

Personal files (HRM.10)

Every staff member has a confidential personal file, which may now be kept electronically. It holds qualifications, job description, verification of credentials, health status, in-service training records and the results of all evaluations.

Credentialing and privileging (HRM.11–HRM.13)

These three standards usually get the closest look in HRM, and they carry six Core elements. For medical, nursing and para-clinical professionals who are allowed to work without supervision, the hospital:

• identifies who is permitted by law, regulation and the hospital to do so (Core for all three groups);
• documents and periodically updates their education, registration, training and experience, and verifies it with the issuing body where possible (the interpretation now refers to the National Medical Commission rather than the MCI);
• grants privileges matched to qualification, training, experience and registration (Core for all three groups);
• makes sure the professionals and the departments know what each person may do, and that they work within their privileges.

Evidence that works: a credentialing committee with minutes; verified copies of degrees and current council registrations; a privilege list for each doctor (which procedures they may perform); the same for nurses and para-clinical staff; OT and procedure records that match the privilege lists.

What changed from the 5th Edition

• New: information systems and information security training at induction (HRM.3.j).
• Level changes: HR planning (HRM.1.a) moved from Excellence to Commitment, training effectiveness (HRM.4.e) from Excellence to Achievement, and using appraisal for development (HRM.7.d) from Achievement to Commitment. HRM no longer has any Excellence elements.
• Interpretations now cover e-learning and digital training records, emergency codes and role-based CPR training, antimicrobial stewardship, cytotoxic drugs, laser and medical gas safety, non-fire emergencies, mental health, second victims, electronic personal files and the National Medical Commission.
• The intent now makes clear that outsourced staff, volunteers, students and trainees are oriented too.

How assessors test HRM

Assessors pick names from the duty roster, including a contractual worker and a visiting consultant, and ask for their personal files. They check registration certificates against the council's records, compare a surgeon's privilege list with what the OT register shows he performed, look for induction and CPR training dates, and ask for the annual health check. On the wards they ask staff what the code for fire is and what to do when a relative turns violent. Our list of NABH questions for staff, with model answers covers what each role is usually asked.

Getting HRM ready

1. Audit every personal file against HRM.10, including outsourced and fee-for-service staff.
2. Set up a credentialing and privileging committee and issue privilege lists to doctors, nurses and para-clinical staff.
3. Rebuild the induction programme around HRM.3 and train every current staff member who missed it.
4. Publish an annual training calendar with CPR, disaster, fire and non-fire emergency training.
5. Start annual health checks and put a workplace violence policy in place.

Our staff training service runs induction and safety training programmes, the NABH documents checklist lists the HRM policies, and we run 6th Edition gap analyses scored the way assessors score.

All ten NABH 6th Edition chapter guides: AAC · COP · MOM · PRE · IPC · PSQ · ROM · FMS · HRM · IMS