Pakistan is a developing country under severe pressure to provide efficient and effective healthcare to its population owing to inadequate financial and human resources and limited management capabilities. This study explores the role and practice of human resource management (HRM) in three Pakistani public teaching tertiary hospitals. We interviewed leaders and managers in these hospitals to gain a better understanding of the context, challenges and opportunities for HRM. Our thematic analysis revealed that a lack of specialised human resource (HR) departments staffed by HR professionals in these hospitals negatively impacted HRM functions and practices and created confusion and complexity. This was exacerbated by centralised decision-making at the provincial level and limited managerial autonomy over key HR issues. However, despite the enormous challenges facing the Pakistani public healthcare sector the informants believed that HR could play a significant role in influencing employees' attitudes and behaviours to provide quality healthcare to more patients.

Key points 

1. There were no specialised HR departments in the three hospitals.
2. Some HRM functions and practices were carried out by hospital administrative departments.
3. Most were centralised at the provincial level leading to limited autonomy over decision-making.
4. HRM practices could influence employees' attitudes and behaviours to provide better quality healthcare to Pakistani patients.