Experience and reflections of using individual work histories and events of public sector doctors to unpack Human Resource Management policies and systems: Job histories as powerful method in Human Resource for Health research

Background and methods: There is limited use of job histories in Human Resource for Health (HRH) research. This paper presents authors’ reflections of using job histories in HRH related research. In particular paper discusses how these can be useful method specifically to examine the implementation fidelity for health policy analysis of HRH and the strengths and limitations of this approach. Methods: The context of this exploration is a multiple case study research project examining the implementation of HRH policies in public health sector in two Indian States—Sikkim and Rajasthan. As the doctors were the main subjects of the study, semi-structured interviews were conducted with 33 doctors to understand their experiences and interactions with the health department in relation to four key HRH management functions: recruitment, initial posting, transfer and promotions. The interview process revealed construction of work life related chronology by the doctors as a means of structuring their responses. This emerging pattern was adapted for the subsequent interviews to formalise it in form of job histories. Key findings and reflection: Job histories constructed from the interviews gave rich descriptive accounts of doctors’ experiences with the HRM systems, and also unravelled how HRM policies and systems operate, specifically in relation to adherence and dosage aspects of implementation fidelity, represented as narrative and quantitative accounts. For instance, job histories clearly allude non-adherence to posting rules and norms. Similarly, examination of the dosage aspect suggests variable application of HRH related policies and practices, delivered inconsistently across the doctors (applied to some and not to others or not applied consistently to the same doctor across his/her work career) or not applied as often as required. The organic and fluid nature of the job histories grounded in the qualitative data presents itself as a very powerful case in narrating rich job related stories and experiences of doctors. Additionally, it offers the flexibility to collect data in a more structured way potentially demonstrating useful chronological patterns and offering valuable insights into attempts to unravel the complexities and conflicts and in unpacking the rich individual experience, conflicts and tensions that public sector rural doctors confront in interacting with HRM policies and systems. Job histories can serve as a useful method for data collection in the area of Health Policy and Systems Research implementation, especially in relation to HRH.