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Personnel costs typically account for 60% or more of total operating expenses in health systems, and as such beome a necessary focus in most if not all substantive health reform adaptations. This study sought to assess whether strategic alignment of the human resource (HR) and learning functions was associated with greater adaptive capacity in U.S. health systems.

Data were gathered using a survey that was distributed electronically to chief human resource officers from two U.S.-based associations. The survey included questions about organizational structure, strategic human resource management, strategic learning, and organizational response to health reform.

Significant correlations were found between strategic alignment of HR and HR’s involvement in responses related to cost control (r=0.46, p<0.01); quality improvement (r=0.45, p<0.01), and patient access (r=0.39, p<0.01). However, no significant relationships were found between strategic alignment of organizational learning and HR involvement with these responses.

Results suggest that HR structure may affect an organization’s capacity for adaptive response. Top-management teams in health systems should consider positioning HR as part of the core leadership team, with a reporting relationship that allows HR to maximally participate in formulating and implementing organizational adaptation.

The purpose of this paper is to articulate the results of a comprehensive literature review and grassroots outreach with first responder organizations to present an operationalized framework for organizations to utilize as a blueprint in developing customized behavioral health access program (BHAP) programs.

Historically, authorities having jurisdiction (AHJ)over fire service organizations have primarily offered behavioral health interventions through Employee Assistance Programs (EAPs) or commercial insurance carriers. These programs are necessary but may prove insufficient to meet the scope and needs of trauma-exposed firefighters and the firefighters' families.

A BHAP is a comprehensive and operationalized plan which clearly specifies the mental health services fire department members and families need, where those services are available within their communities and levels and standards of care that are expected in the provision of these services.

The BHAP is becoming a world standard of behavioral health care for first responders. While some fire service agencies are beginning to create BHAP guides, developing and implementing a BHAP can be time consuming and overwhelming, particularly for departments with limited internal and external resources. While the results of this review focus on BHAP within the fire service, this framework is applicable across all first responder professions.