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Gitte Dalgaard Hansen


Master of Science in Sociology,
1
st
year Ph.D. student
Department of Sociology and Social Work
University of Aalborg, Denmark
Email: gdh@socsci.aau.dk
Paper, September 7
th
, 2011
Case Study Research Methods
Oslo Summer School 2011
Prof. Andrew Bennett

Research Design for the Ph.D. thesis on:
Human Resource and Working Life
- Efficient Manpower Planning at a Public Hospital -

Introduction (explaining the field)
The Ph.D. thesis entitled Efficient Manpower Planning at a Public Hospital seeks to examine how
the management at a Danish hospital has created and use their manpower planning for recruitment
and maintenance among hospital nurses. I wish in my Ph.D. to examine which work values the
management has compared to the work values of the nurses. If there is no agreement between the
values it can indicate that the manpower planning is not working in correlation to the nurses and
therefore the manpower planning should be evaluated and changed (strategy development). Work
values can indicate what kind of human beings the nurses are what they priorities in their lives
and therefore what they priorities in their work.
In my Ph.D. I have described the staffing challenges that characterize the Danish labor market as a
way to illustrate the relevance of the thesis. More specifically a clarification of the recruitment- and
maintenance problems that have existed in the hospital organization in the recent years (despite the
existing financial crisis) and will continue to influence the organization in the upcoming years. The
focus will be on the shortage of the nurses that have influenced the Danish labor market (and as a
result, the hospitals) in the recent years and will continue to do so in the future. Furthermore, the
thesis will focus on the importance of an efficient manpower planning so these staffing challenges
can be met and processed. These focus areas have the purpose to document and clarify that the
challenges of the manpower planning in relation to nurses not only applies to the selected ward
(Heart-Lung Surgical Ward) at a Danish hospital (Aalborg Hospital), but are issues that can and has
affected the entire Danish healthcare system. Challenges, which must be taken seriously if the
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consequences in the future is not to be crucial. This has been chosen to demonstrate the thesis
relevance both for society in general and for the chosen hospital.

The research problem
In my Ph.D. there are three aspects (or explanations) which demonstrate why the research problem
(the puzzle) of my Ph.D. is relevant and important to study. These three aspect will be presented
in the following section below (however in this paper in an abbreviated version why some of the
explanation and elaboration are left out). However, the reader should know that the research
problem will be studied in a theory testing case with a deductive approach, as pointed out in George
and Bennett (74-79:2005).

A) The first aspect a problematic population development
Today one of the most crucial staff tasks and challenges for the employers are recruitment and
maintenance of employees and forecasts indicates that it will be an even more important and
meaningful staff challenge in the future. The imbalance of the increase in the population is the
reason why employers should and must prioritize these challenges highly. This is because all
projections indicate that this increase only will become smaller over the years to come. Danish
Statistics
1
has produced a population projection, which proves that the increase in the population
will have a big change in the age structure from year 2009 to 2050
2
. The older population aged 65
and more will increase by a massive of 76 percent until the year 2042, which means that there will
be 1.54 million people in this group as against only 875 500 today. The older population will still
make demands to society even though they are no longer an active labor force and contribute to the
society in terms of manpower. This means that the remaining working force must be able to replace
the hands that are no longer available for work. For this to become a success it will require that
the number of people who are working can match the proportion of the elderly (which are not
working) so the labor market is not to be affected by the elderlys retirement. However, according
to Danish Statistics the problem also concerns that the employed population in Denmark (defined to

1
Name of the company who produces statistics in Denmark.
2
The increase in the population takes the people who have died, given birth, immigration to and out of Denmark and
settlement and moving between region and council into account (www.dst.dk/nytudg/12321).
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be 25 to 64 years old) will fall in the future from 2.97 million to 2.71 million, corresponding to a
decrease of 8.7 percent (NEWS from the Danish Statistics). The figure below illustrates this
projection which clearly shows that the increase in the population diminishes.
Figure 1: The increase in the population divided into age group from year 2009 to 2050.

Source: NEW from Danish Statistics, no. 228, 18th of May 2009.
Therefore, the conclusion will be that there will become a reduction of the working population
meanwhile the number of the non-working population will increases. It appears clearly from the
above, that the Danish labor market is facing some major challenges in relation to labor shortages,
which are the consequence of the unbalance in the increase of the population.
All sectors in the Danish labor market is effected by this increased pressure, that is
why it is crucial that the working force can be both recruited and maintained. As a result there will
be increasing pressure on the public sector and especially in the hospital organization due to the
increased elderly population which will require more services. As the working population increases
it will mean that there will be fewer people to produce the health benefits contemporary with
several people in need for these benefits. This is because it is especially the aging population which
will need and use the benefits. Therefore, it is essential for the Danish healthcare system to get
enough employees who are educated to work in the healthcare system (especially nurses) if the
service level is to be maintained. This means that the older staff increasingly needs to be maintained
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while the unused resources (for example foreigners who are educated in the healthcare system) also
must be used (Ministry of Finance, May 2010). The Hospital organization must continue to recruit
and maintain the skilled workers (such as doctors and nurses), if the public hospitals are to continue
to deliver a proper and satisfactory service. The focus of the thesis will be on how this future
absence of nurses can be met and the importance of recruitment- and maintenance strategies that
may ensure that nurses choose to work in the public hospitals and stay there (Ministry of Finance,
May 2010). I will examine this by analyzing the nurses work values, as I assume that the nurses
work values can be found, analyzed and documented. This knowledge of values can be beneficial
for management to know in relation to recruiting and maintaining this staff group. This is because
values can be an indicator of what the nurses prioritize (and therefore are looking for) in their
professional lives. The study of the values must therefore also include the management, as it is
important to examine the work values, which the manager assume that the nurses have. By having
this knowledge of values, I am able to analyze if there is a match between the values of the nurses
and the values that the management think the nurses have/prioritize. This value knowledge can then
be used in the manpower planning of the nurses in relation to recruitment and maintenance.
Therefore, the public hospitals must make a thorough effort if the nurses and thus the
public service must be maintained. In relation to the recruitment effort it is important that the
hospitals can attract the nurses, so the nurses for example do not choose the private health area.
Furthermore, it is important that they attract the student nurses as well so they do not choose to
continue to study further after graduation (example study for a Masters degree). In relation to the
maintenance effort the hospitals have to offer an attractive work environment and an attractive
politics for the seniors so the older nurses choose to stay longer in employment and thus in the
profession. The public hospitals must formulate some attractive staffing initiatives if the staffing
levels are to be similar to the patient approach.

B) The second aspect a critical profession
It is emphasized in several studies that nurses are difficult to recruit and maintain (example Jensen
et al. 2009). It is clarified in these studies, that the hospital organization faces a major problem
because of the many opportunities among nurses and the much discussed reputation in the field.
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There are a number of problems in the area of recruitment that increase the difficulty
significantly when attracting nurses. First of all, hospitals are competing against other educations to
get enough students where the tendency shows that there still are seats available in the many
nursing schools in Denmark. This is in spite of more students applying to the schools and more
enrollments year after year. All numbers shows that there has been an increase of 18.1 percent from
1996 to 2010 in students that have applied to a nursing school and an increase of 20.2 percent in the
enrollments in the same period of time (KOT2010). However, there has also been seen a negative
development in the number of student nurses that graduates. This problem is compounded by the
fact that the average age for graduated nurses has increased, which means that the nurses are not
working the same number of years as previously (Jensen et al. 2009:25-26; Wang et al. 2010). The
problem is intensified by the choice of city the graduated nurses choose to live in because most
choose to live in the same city as they have graduated from. The consequence is, that the cities
where the nursing schools are located have a higher population of nurses whereas cities without has
great difficulty attracting nurses. In this case 80 percent of the graduated nurses will live the first
two to four years in the city where they graduated from. Thus, the smaller cities find it difficult to
attract especially the graduated nurses why these cities (typically) have the biggest recruitment
problems (Jensen et al. 2009:13, 60-62). Finally, the bad reputation of the nursing profession is a
big problem when hospitals have to recruit nurses. The nurses feel that the poor staffing and high
absenteeism due to too much work pressure and -stress are some of the aspects which result in a
difficult recruitment process in general and to the public hospital in particular. A survey from the
Danish Nursing Council indicates that the nurses sickness absence per year can be compared to
1900 full-time nursing jobs
3
. The Danish Nursing Organization is worried about this comparison as
it shows that the nurses are exposed to a bad working environment which affects the nurses health
(Forkant 2008:19). The above mentioned examples illustrate that the recruitment problem has
several dimensions. Therefore, the public hospitals must in their recruitment strategies take this into
account if they in the future want to overcome the battle for employees.
There are also some problematic issues in the maintenance area which increase the
difficulty in maintaining nurses in their jobs and especially in the profession (this will be outlined in
the following section). More and more nurses choose to find work outside the public sector. The
public hospitals thus have to compete to maintain the health professional staff against the private
sector where especially the private hospitals, employment agencies and the pharmaceutical industry

3
Note from DSR analysis, 2006
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are the high takers of employees. The private sector is found more attractive for the nurses due to
better professional development, self-organizing work scheduling, day shifts, freedom from
organizational problems, better working hours because of the freedom to choose when to work,
higher salary, more recognition, better work environment and -conditions and better perks
4
. Among
other things the bad working conditions is the reason why many nurses choose to leave the public
hospitals. Especially because the quality of work is declining and they experience a feeling of
demotivation. For example, the employees fled from the public hospitals are due because the nurses
are curious in relation to working in different departments and areas, the need in change of air,
escape from mismanagement and cutbacks, too high workload, the burden of shifts, bad image and
an increased documentation burden. At the same time the nurses must train the new (and possibly
inexperienced) nurses because of the continuous high replacements of nurses. This is because of the
difficulty of maintaining (especially experienced) nurses. Therefore, the new staff will not get the
adequate training and introduction as required and this will as well affect the probability to maintain
this group (Jensen et al. 2009:17-20). New data from the University of Aarhus establish a new trend
which shows that more and more of the graduated nurses choose to continue to study at a higher
level after graduating from nursing school. The number of applicants has increased by 59.6 percent
from 2008 to 2010. Counselors from the various University Colleges (nursing schools) confirms
these numbers, as they express that the student nurses now (in 2010) compared to just a few years
ago both have an increased interest and seek out more information about further education
5
. Earlier
the trend was that the student nurses wanted a few years out in practice before they wanted to study
further (source: interviews with counselors from different University Colleges). The reason for this
new trend may be due to unemployment as one out of four graduated nurses did not have a job in
2010. Because of this trend the hospitals can experience a situation where it will be difficult to
maintain the nurses in the jobs. This is because the further education gives other possibilities
(example management positions) for the nurses then the ordinary employment as a basic nurse
(www.kandidat.au.com). Therefore, in the future there will be more graduated nurses who will
choose to study further immediately after graduation which will mean that there will be fewer
nurses available for the hospitals. This supports my idea (theory) in relation to study the nurses
work values because the nurses these years are becoming interested in other areas than the hospital
why their priorities are changing in a way we have not seen before. I have a presumption which

4
However, it seems that many nurses return to the public hospitals again, as the private sector not always can
accommodate the nurses expectations (Jensen et al. 2009:71ff).
5
This is primary because of difficulty in finding jobs due to the financial crisis.
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states that the student nurses and the graduated nurses especially have a different work-value-
orientation
6
because of their interest in further education than the nurses who already work in the
hospitals. This is just an assumption on my part as there are no currently studies which state what
kind of work-value-orientation the student nurses and the graduated nurses have (which can
support my assumption) in relation to recruiting this staff group.
A survey conducted by DSR
7
Analysis indicates that over half of the nurses aged 50 to
59 do not hesitate to stay in the profession longer than absolutely necessary. This analysis points out
that the nurses retirement age is low which strengthen the maintenance problems even more
(Forkant 2008:18). This situation can cause problems if it is linked to the fact that older nurses are
overrepresented in the profession. The problem will become effective when the older nurses leave
the labor market because the patient volume cannot accommodate the number of nurses there are
left (confer the earlier argument in relation to the increase in the population). Therefore, it is
essential to maintain these older, experienced nurses. The maintenance problems are partly due to a
bad work environment, to a tough work burden both physical and mental, the experience of the
impact of changing shifts, the older nurses choice of early retirement and the fact that the older
nurses generally are financially better off, why the need to work is not present if the work do not
enriches their life sufficient (Bjerre et al. 2008:2). However, the older nurses have a suggestion to
how the hospitals can maintain their labor force. They can for example get an extra week of
vacation, higher wages, shorter working hours but with the same salary, bonuses for extra shifts and
a smaller shift burden. These solutions could lure the older nurses to stay longer in the profession,
where several of the older nurses point out that they actually want to continue to work (Forkant
2008:20). One nurse formulated it in this following way; (editors note: I) feel a certain sadness
(editors note: compared to retire) for whom am I when I do not have a working life? (Forkant
2008:21). This underlines an employee resource that can be used and would like to be used if the
right offer otherwise is obtainable. Consequently, the aspects of maintaining the nurses are many,
why the public hospitals have to produce some attractive initiatives if they wish to avoid an
employee escape especially in the upcoming years.
It is now up to the management at the hospitals to find a solution to both the
recruitment- and maintenance problems, so these can be minimalized. As before stated I think this

6
A concept I have developed together with a student coworker. The operationalization behind the concept will be
outlined later in the paper.
7
DSR is the Danish Nursing Council.
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can be helped if the management can study, find and use the nurses work values. To investigate the
(nurses) work values is a (new) method that can be used in manpower planning, which has not
previously been used in hospitals and/or in the work of managers manpower planning.

C) The third aspect a crucial manpower planning
Today, a clear manpower planning should be a natural part in companies (which should be
implemented systematically). This planning must take labor regulations, staffing requirements and
the employees values and attitudes into account so that the right staff is employed in the
company. This is the only way companies can have success, as good employees is an important part
in a positive developments of the company. Therefore, it is extremely important that the manpower
planning is handled proactive, as this will make sure that the company has the qualified staff as
required (Gold 2007). Manpower planning should not be performed ad hoc (or altogether be
missing) as the consequences can be that the wrong staff is recruited and that the remaining staff
can be difficult to maintain. An ad hoc manpower planning can be very expensive for the company
financially but also for the candidate (as recruited) personally. The expenses obviously depends on
which person is to be employed (e.g. if the person is a manager or not). But no matter what the job
function is, it is expensive to produce advertisements and profile the company contemporary with
making induction- and educational programs, pay salaries without e.g. the similar productivity and
performance and conduct layoff dialogues. Similarly, it is expensive to lose good and qualified
employees because of the failure to maintain these by the company (Abildgaard 2008:138-139).
Consequently, there are many unnecessary expenses associated with an unprofessional, ad hoc or
missing manpower planning.
Therefore, in the shortest sense manpower planning regards to prepare and have a plan
for how supply and labor demands is and how it should be met, so the company have the staff
required (Abildgaard 2008:139-140; Gold 2007:199-200). The purpose of manpower planning thus
becomes in the following way:
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to estimate the chancing and future needs for different types of labor and provide instructions
for action or alternatives that ensure that the company always has and can use a work force of
adequate size and power equipment (Jrgensen et al. 1994:176)
8
.

Manpower planning can have an influence on whether companies have recruitment- and
maintenance problems as the manpower planning contains the four main areas in the work of
human resources; recruitment, maintenance, development and layoffs of employees (the focus in the
thesis will only be recruitment and maintenance). In relation to this there are also four flexibility
types (which are the typical way to regulate staff); numerical flexibility, functional flexibility,
temporary flexibility and intensive flexibility (which rarely occur in the pure forms and exclusive
from each other) (Jrgensen et al. 1994:177).

In the Ph.D. I will further describe the following areas, although in this paper (due to lack of space)
it will only be presented through bullet points:
Difference in planning (business planning versus manpower planning where both are
pointed out in relation to three levels: strategic term (10-15 years), tactical term (3-5
years) and operative term (under 1 year)). Source: Nordhaug et al. 2004.
Job analysis (the content of the job is being studied, operationalized and evaluated). Source:
Nordhaug et al. 2004; Abildgaard 2008.
Analysis of the candidate (to get knowledge of the target group, who are
recruited/maintained through values and attitudes. It is all about making an analysis of the
future employees and the existing employees which will give a concrete knowledge of the
staff). Source: Seldorf 2008.
To ensure that the hospital has a manpower planning that works, it is important to know whether
this planning is working as intended. The purpose of the manpower planning is to have some
strategies regarding how to recruit and maintain the staff. Therefore, in my Ph.D. I wish to examine
whether a manpower planning based on work-value-orientation (from a deductive approach) is

8
Translated by me.
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more successful than a manpower planning how is not based upon this
9
. From this knowledge it is
possible to evaluate and analyze the manpower planning (see if the strategies work as intended). To
examine and use the employees work-value-orientation in manpower planning is not widespread
or used, as methods in manpower planning typically is more quantitatively oriented than
qualitatively. However, I find that it is important to add qualitative methods because I believe that
the employees values, attitudes and views can be extremely beneficial and useful when strategies
are formulated
10
. This is because I believe that the work values may indicate how the employees
prioritize in their working lives. It is most common in the hospital (management) to use
quantitatively methods regarding manpower planning, to analyze supply and demand in relation to
the employees (source: interview with Aalborg Hospital). What I have tried to point out is that there
is an inadequate manpower planning when it comes to the in-depth, qualitative method. That is why
I will examine the new methods in the Ph.D. and hopefully contribute to new knowledge.

The case to be studied and specification of variables
In this section I will in a shorten version describe the case to be studied and outline the independent
(the work values of the nurses) and dependent (the manpower planning amongst managers)
variables and how the variables have been operationalized (process tracing), as pointed out in
George and Bennett (79-83:2005)
11
.
The two main research questions addressed in this thesis are:
1) Which works values do nurses and student nurses have?
2) How does the work values among nurses influence the manpower planning among managers
in relation to recruitment and maintenance?

The case to be studied in my Ph.D. is a multiple case study. That is because I will examine the
Heart-Lung Surgical Ward at Aalborg Hospital, where I will conduct interviews with the nurses and
managers and further interview student nurses in a nursing school in Aalborg
12
and graduated

9
The interaction between work-values- orientation and manpower planning will be outlined later in this paper.
10
I have already proved in my Masters Thesis that it can be useful to study values in the working life when it comes to
nurses.
11
However, the dependent variable will in this paper bee introduced and described in relation to the independent
variable.
12
Therefore, I also deselect doctors and social and health care assistants who also works with patients.
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nurses (which have not yet found a job) in Aalborg. My research design is a multiple case study
because I have four research units (nurses, student nurses, graduated nurses and managers).
However, I do not wish to compare the tree nursing groups with one another in relation to the
managers or generalize between the groups. On the contrary, I will study them as four individual
groups with their own work-value-orientation. The study is centralized around the manpower
planning at the Heart-Lung Surgical Ward in relation to the nurses, graduated nurses and student
nurses. Because of this choice I know that I cannot generalize further than the case why my study
only is relevant for the ward in question. Although, the Ph.D. will have a practical section where I
will outline how the manpower planning could be constructed if the work-value-orientation is to
be included. This practical section will have the effect that the study can be studied by other
wards/hospitals who wish to make their manpower planning as I have suggested.

I have in my Ph.D. outlined (constructed/designed) two ideal types which display which work-
value-orientation the nurses can have. My empirical work will document which of the two ideal
types the nurses represents today. I have previously worked with the concept of work-value-
orientation within the human resource area and specifically in relation to recruitment and
maintenance where the trade group where nurses and marine engineer students. However, the
concept was here primarily used in relation to the HR department (in the recruitment and
maintenance officers) and theoretical operationalized in relation to the general Danish labor market
(based on Max Weber, Karl Marx, Richard Sennett, Anthony Giddens, Peter Gundelach and Esther
Nrregrd-Nielsen), why the concept not specifically where used at (1) a management level, (2)
operationalized concrete according to the professional group (3) or studied specifically in relation to
manpower planning (Hansen & Hermansen 2011). Therefore, the concept has in this Ph.D. been
further developed so it can be used at management level and especially for manpower planning. The
concept will be examined as an integral part of the planning qualitatively. Finally, the theoretical
operationalization of the concept is further developed, so the understanding of the concept is related
to the nursing professional group and not superior compared to the Danish labor market. This has
occurred through the two before mentioned ideal types.
The staff amount is adjusted according to how much staff is needed in relation to how
many there are available to enter into a job function. Therefore, the tendency becomes that
employers focus on what needs the company has in relation to staff and not on (which I find
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interesting), how the workers (employees and prospective employees) are related to work, tasks and
the company in general. The manpower planning focuses primarily on the companys needs and
neglects the interaction between these needs and the employees needs. The employees needs can
involve several aspects such as, what motivates them to come to work, carry out the work and what
values they prioritize in their working life. The literature of manpower planning is very much
focused on the needs and motivation as for example Abraham Maslow, Douglas McGregor and
Frederick Herzberg (Larsen 2006:168-172). The managers focus a lot on how they can motivate
their employees to get to work and carry out the work. To look at employees work values instead of
needs and motivation is not an aspect which is discussed in the literature of manpower planning or
is something that managers focus upon. However, there is no research that indicates why this is so
and whether it is due to: (1) that needs and motivation can be associated with values, (2) that the
difference between motivation and values is difficult to distinguish or (3) that managers focus on
motivation rather than values because of the lack of the value aspect in the literature of manpower
planning. However, I find a difference between motivation/needs and values in relation to working
life
13
.
The work values of the employees can describe the criteria (characteristics) that they
put into account when they prefer one kind of a job (or tasks) rather than another. Today, since the
limit between work and private life is more or less blurred, it is important that employees feels that
their work values are fulfilled. In a way to investigate the nurses work-value-orientation I have
constructed the two ideal types which is based on two assumptions about why nurses choose to
work as a nurse. These ideal types are named work as a calling and wage labor. These two
ideal types will be tested in my empirical work to determine what work-value-orientation nurses
and student nurses have today
14
.

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13
This difference will not be discussed in this paper.
14
The operationalization of the two ideal types is not included in this paper due to lack of pace.
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