Skills-Based Human Capital Management in Latvian University Hospitals: A Qualitative Multi-Institutional Study

Health systems increasingly require workforce governance approaches that move beyond formal qualifications and make physician skills more visible for planning, education, quality management, and resource allocation. However, evidence remains limited on how physician skill information is organisationally documented and used within hospitals, particularly in small health systems. This study examined how information on physician skills is organisationally documented, interpreted, and used for workforce governance across all Latvian university hospitals, and identified organisational, cultural, and digital barriers to systematic skills monitoring.

A qualitative, exploratory, multi-institutional design was adopted. Semi-structured interviews were conducted with 12 stakeholders from human resources, education, quality, and finance across all three Latvian university hospitals. Data were analysed using reflexive thematic analysis, with reporting guided by COREQ and SRQR.

Eight interrelated themes were identified across three domains. Current practices were fragmented and primarily focused on formal qualifications rather than verifiable practical skills. Internally delivered education was partially documented, whereas externally acquired skills remained largely outside organisational systems. Skill gaps were usually identified reactively through incidents, complaints, or managerial observation. Training needs were determined through decentralised channels, and skill assessment depended heavily on local leadership judgement. Participants also highlighted financial blind spots, weak digital infrastructure, governance ambiguity, cultural resistance, and limited staffing capacity as barriers to implementation. At the same time, respondents consistently reported that improved skill visibility could support strategic workforce planning, targeted education, patient safety, better financial justification, and greater organisational transparency.

Latvian university hospitals appear to recognise the organisational value of physician skill visibility but currently lack integrated systems for capturing and using such information systematically. The findings support the need for a context-sensitive, phased approach to skills-based workforce governance and inform a data-informed conceptual framework (Three-Layer Skills Governance Model) for aligning regulatory expectations, organisational processes, and individual skill records in small health systems.