Talent management practices and other factors affecting employee performance in the public healthcare sector in poland: an empirical study using structural equation modelling

Abstract

Background

In the healthcare sector, the quality of medical services largely depends on the work of medical staff. Improving employee performance can impact the efficiency and productivity of a healthcare entity. Therefore, proper talent management practices are needed to achieve good outcomes. It is also worth answering what other factors affect this performance. The aim of the study was to investigate the impact of talent management practices and other factors on employee performance in the public healthcare sector.

Methods

Data was collected using a questionnaire method with a Likert scale. The study population consisted of 558 employees in the public Polish healthcare sector. The research instrument's structure, reliability, and validity were assessed using exploratory and confirmatory factor analysis. Descriptive analysis was used to analyze the structure of respondents, and a covariance-based structural equation modelling (CB-SEM) was used to test the model and verify hypotheses. Survey data were analyzed using SPSS v8 and AMOS v. 29 (Predictive Solution Poland).

Results

In the structural equation model, CFI = 0.997, GFI = 0.992, AGFI = 0.973, and RMSEA = 0.033, showing the model has a good fit. Significant relationships were found between job mobility and employee performance (β = 0.195, p < 0.001) between talent management practices and employee performance (β = 0.246, p < 0.001). This analysis also showed a positive, significant and strong relationship between age and employee performance (β = 0.230; ρ value < 0.001).

Conclusions

The structural equation model showed that talent management practices consisting of talent attraction, talent development, and talent evaluation had a significant and positive impact on medical staff performance. We also found that, in addition to these three talent management practices, such factors as job mobility, and age were significant predictors of employee performance. It is, therefore, important to create formal talent management processes that support personal development and appreciate the individual performance of employees.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-024-12169-4.

Introduction

General background

Employees are the heart and backbone of every organization. Therefore, it is important to find a way to increase their performance. Researchers have become increasingly interested in employee performance (EP) in the healthcare sector in recent years. This refers to the quantity and quality of work employees perform in carrying out their tasks, duties and responsibilities [1]. EP is of key importance for the efficiency of medical entities because it directly affects the quality of health services. A promising and innovative way to improve EP may be the use of appropriate talent management practices (TMP) [2], which include talent acquisition, talent development (including improving human resource competencies and capabilities), talent motivation, talent appraisal (including rewards and recognition), and retention of talented employees who are valuable to the organization [3].

Talented employees are resources that drive organizations to achieve excellence and sustainable growth through their optimal use [4]. Appropriate talent management can encourage improvements in the quality of human resources, which in turn can promote employee performance.

This study focuses on three TMPs: talent acquisition (TA), talent development (TD), and talent evaluation (TE). The use of these practices in the study can be justified by three key theories of support: talent-based theory, social identity theory, and human capital theory, which provide a clear case for including these three TMPs and provide a solid research foundation.

Talent-based theory states that talent is the only resource that allows an organization to compete effectively with other organizations [5]. Therefore, organizations must focus on acquiring, attracting and retaining a talented workforce [6]. The social identity theory proposed by Tajfel and Turner [7] argues that an individual's social identity is formed by viewing oneself in relation to the group. The formation of this identity is facilitated by the evaluation of employees [8]. In turn, according to the human capital theory, employees have valuable skills and knowledge that make them valuable resources for the organization [9, 10]. Therefore, organizations should focus on developing talented employees.

Moreover, this study draws human capital theory, social exchange theory, and Herzberg's two-factor theory to explain the perceptions of healthcare professionals towards the application of talent management practices and their consequences regarding employee performance. Human capital theory has been used in many studies to examine the relationship between human resource management practices and employee performance [10, 11]. It basically aims to rationally explain the key decisions that an organization or an individual makes in the context of managing employees in an organization [12]. From the perspective of human capital theory, when organizations value employees, they invest in them, and in return, employees strive to improve their performance [13]. Similarly, Herzberg's two-factor theory emphasizes that if motivational factors are met, an employee becomes motivated and, therefore, performs better and achieves better results [14]. The factors that truly motivate employees to do their jobs and inspire them to better performance are aspects of work that are considered intrinsic, and these include achievements, recognition of good performance, advancement, and career development opportunities [15]. The authors of this paper argue that the use of talent management practices is one way to provide employees with developmental factors to truly motivate and inspire them to perform better. Social exchange theory is a dominant theory in the TM literature, especially in the context of employee reactions to TM practices [16]. Previous studies have used social exchange theory to predict the impact of TM practices on employee outcomes. Social exchange theory assumes that people are rational beings who seek to avoid losses and gain rewards during social interactions [17]. For example, the employer-employee relationship is a social interaction. When an organization invests in its employees, employees may reciprocate with positive behaviours and attitudes in return.

An employee who manages his talents well can develop his competencies, improving his results and demonstrating higher efficiency [18].

The significance of the study

In most countries, public healthcare entities face a crisis every year, as a result of which every fifth healthcare worker resigns from their job. This may be particularly due to difficult working conditions that undermine their well-being. Therefore, talent management is seen as an essential tool to promote the well-being of healthcare personnel and thus improve their performance. These results are of great significance as they play an important role in the delivery of healthcare services as they are required to provide people with the necessary high-quality services [19].

The Polish healthcare sector faces several challenges, such as a serious shortage of employees, drain and outflow of talent and students abroad, low quality of graduates, low quality of research, inadequate allocation of budget funds, and poor position in global rankings. These problems have led to the need to implement appropriate TMP at the central level in order to restructure the approach to education and talent development to fill the competency gap and ensure a qualified workforce for the future [20].

The literature argues that developing staff with key competencies necessary for the effective provision of public services is crucial because decisions made in the public sector affect the credibility of the government and society [21]. Public organizations in Poland realize that attracting and retaining employees from diverse backgrounds can improve their performance and improve the quality of medical services. Because public sector staff form the basis for effective public service delivery, individual employee-level action can improve overall organizational performance [22, 23].

Research gaps

Talent management (TM) has been more widely known in the private sector for many years. Although previous research has examined the relationship between TMP and EP, most research in this area has been conducted in for-profit business organizations. However, over the last few decades, more and more management concepts, including TM, have been adopted and replicated in the public sector. Only a few studies have attempted to analyze the application of TM in the public healthcare sector [24]. In this sector, employees play an important role in meeting the health needs of patients and ensuring the quality of medical services. Therefore, healthcare entities must maintain and develop talented employees to meet the increasingly stringent requirements of patients. Furthermore, in the context of healthcare, research has undeniably shown that there is a growing awareness of the underdeveloped scope and scarcity of empirical research on talent management [19, 25].

Moreover, most of the research on talent management has been conducted in Western organizational contexts [26, 27]. To date, there has been no research on TM and EP in the healthcare sector in Poland, which is an obvious research gap that needs to be filled. TM is considered an urgent challenge in this country and is essential for the development of the Polish healthcare system, which has not yet been able to develop solid TM strategies.

The literature does not provide a solid framework for integrating different talent management practices to improve employee performance [28–31]. Previous studies have mainly focused on examining talent management practices and performance from an organizational perspective, focusing on how TM affects the improvement of organizational performance [32–34]. Little research has focused on TMP at the individual level from the employees' perspective [35]. This article fills these gaps. This paper also considers job mobility and age as new variables that have not been tested in talent management in previous studies.

There are basically two approaches to talent management, namely inclusive and exclusive [36, 37]. Most studies are based on the inclusive approach to talent management because it focuses on the talents of all employees in order to improve the performance of the entire organization [38, 39]. Our study is based on the exclusive approach to talent management because it focuses on a selected group of employees (medical workers) and examines its impact on employee performance rather than the entire organization.

The objectives of the study

In view of the above research gaps, the aim of the study is to examine the impact of TMP and other factors on the performance of medical staff in the public healthcare system in Poland. The following specific objectives were set in this study: 1. Measuring the impact of TMP consisting of TA, TD and TE on EP in the Polish healthcare system. 2. Research the impact of other factors, such as job mobility (JM) and age of employees on EP in the Polish healthcare system.

The results of this study can help decision-makers in talent management, especially among managers of public healthcare entities, as Poland has difficulty retaining talent in this sector. The remainder of the article includes a literature review, methodology, data analysis, discussions and conclusions. Theoretically, it is expected that this research will contribute to the development of literature on EP in general and, in particular, in the healthcare sector, with particular emphasis on the context of Poland. In this country, no research has focused on the impact of TMP and other factors on EP so far.

Background

Talent management practices and employee performance

Talent Management is viewed as an interconnected set of activities an organization uses to attract, retain, motivate and develop the capabilities and skills of talented people who are required to perform organizational functions [40]. Recruitment, onboarding, selection, mentoring, performance improvement, learning and development, career development, replacement planning, leadership development, job preparation, reward and recognition are different aspects of TM [41]. The purpose of TM is to protect long-standing practices that aim to provide the right person with the right job, place, and time [42]. In a broader scope, talent management also means how a company manages its resources, starting from the recruitment process, job placement, job evaluation, training and career development, up to the departure of employees from the company, in order to ultimately achieve the goals of companies [43]. This study considers three important TMPs: talent attraction, development, and evaluation.

First, talent management begins with talent attraction, in which suitably qualified candidates are attracted and employed in specific positions based on their skills and required experience as per the entity's needs [44]. TA is defined as the activities undertaken to identify internal talent and attract external talent to complement the organization's essential skills and meet organizational needs [45].

Secondly, the organization should focus on talent development so employees can perform their work according to management expectations. Therefore, new and existing employees are offered various training based on their needs, roles and responsibilities in specific organizational functions [46]. TD is defined as a way to improve the skills, knowledge and competencies that employees need to perform their tasks well and achieve the highest level of achievement in the organization. TD includes activities that allow organizational members to acquire strategically valuable knowledge, skills and abilities that positively contribute to the growth and success of the organization.

Finally, an important part of talent management is talent evaluation, which involves exploring the actual results achieved by employees within those areas where they are held accountable and examining the level of skills or competencies deemed critical to their current job. TE will include not only the examination of performance but also, inevitably, a forecast of potential. When the feedback from the talent review sessions is effective and timely, it can give individuals a clear idea about what their future in the organization can be, what kind of skills they need in order to achieve their career goals, and what they can do to develop their skills [47].

Employee performance is defined as the result or contribution of employees to achieving goals or specific tasks measured according to previously established or identified performance indicators. The performance of medical staff may manifest itself in improving the quality of services, ease of using new medical technologies, and high employee motivation [48]. EP is an illustration of an organization's level of achievement in implementing an activity, program or policy and meeting performance standards to achieve the organization's vision, goals, objectives and mission [49].

Talent management at the organizational level can improve or reduce the performance of individual employees [50]. Previous research has already found that talent management practices positively and significantly impact employee performance [51]. However, it is said that the impact of TMP on EP depends on the industry studied [24], indicating a research gap. Moreover, the results of previous studies on the impact of different TMPs on EP are not consistent and further research is needed to obtain more accurate and reliable results. TMP influence EP separately and sometimes jointly. In the latter case, however, all TMPs are considered together. Talent management connected with the assessment of employee performance has been recognized as a best practice in the management of performance-related human resources in the UK National Health Service (NHS) [52].

Researchers have found that employees obtain economic or socio-economic benefits from TMP due to their mutual relationship with the employer [53]. They gain these benefits through development opportunities and performance assessments that lead to their promotions. One way employees can give back these benefits to their organization will be through higher levels of EP [54]. Despite the considerable amount of research on talent management in the healthcare industry worldwide, however, no studies have been conducted on the application of talent management in the healthcare sector in the context of Poland. Moreover, after conducting in-depth research, we were unable to find any academic empirical studies that demonstrate the impact of talent management practices on EP in the public healthcare sector in Poland. Therefore, this paper investigates this impact in Polish public healthcare entities. Therefore, we propose the following hypothesis:

• H1. Talent management practices in public healthcare entities in Poland have a significant impact on employee performance.

Other factors affecting employee performance

An important element of an effective talent management strategy is job mobility. Job mobility is defined as a built-in talent management procedure that supports talent movement, focusing on an organization's ability to effectively understand, develop and deploy its existing talent in line with its needs [55]. It can occur in various ways, e.g., deploying people in different areas of expertise or professions, geographical mobility, and delegating people to another place of employment [56]. Previous empirical studies have not tested the role of JM in TMP-EP relationship models. However, we found studies that showed that the rotation of talented employees in various positions and tasks allows them to develop skills and competencies, increasing employee commitment and providing challenging work that motivates them to achieve better achievements [57]. Transferring talent to different positions eliminates the monotonous work schedule and allows talent to pursue their interests per the organization's needs. Effective talent mobility allows employees to build new skills and see themselves as organizational assets [55]. In this way, the job mobility of talents promotes their development and improvement of professional skills and thus may increase their effectiveness. Additionally, it improves the flow of information among employees and streamlines operations by ensuring that the right talent is in the perfect place at the perfect time [55]. However, the above literature does not provide an adequate conceptual framework to explain the interaction of TMP, JM, and EP, especially in healthcare entities. Taking into account the above considerations, we propose the following hypothesis:

• H2. Job mobility of medical staff has a significant impact on employee performance

One of the most disturbing problems of the healthcare sector in Poland is the increasing age of medical staff. According to the Central Statistical Office, the average age of a physician in 2017 was 52, with 22.7% of physicians practising beyond the traditional retirement age of 65. The problem of the ageing medical staff in Poland is so important that it should be included in research on employee performance [58].

So far, no relationship has been demonstrated between age and EP of medical staff [59]. On the one hand, the most experienced staff is an invaluable source of knowledge and experience. More qualified physicians can demonstrate higher efficiency and quality of care. Many studies show that older employees are as productive and skilled as younger ones. Any decline in job performance with age may be offset by improved performance in other areas, such as an individual's work experience and problem-solving skills [60]. We disagree with this opinion due to the risk to patient safety associated with the deterioration of abilities and competencies in old age. Although knowledge and skills can be retained into old age, decision-making, processing speed, working memory, and executive functions decline [61]. While crucial to the healthcare system, senior physicians can pose a risk if such a decline in competence goes unnoticed. The values that different age groups have can complement each other. Research results show that different age groups provide companies with different values, which can complement each other and improve employee performance [62]. Thus, the next research hypothesis has been proposed:

• H3. Age of medical staff has a positive impact on employee performance

Material and methods

Data collection and respondent characteristics

A cross-sectional survey was conducted from December 2021 to March 2022 among medical personnel of healthcare entities in Poland. The study selected entities providing (1) inpatient and 24-h hospital health services, (2) treatment within primary healthcare (3) specialist outpatient treatment. Healthcare entities meeting these criteria constitute the backbone of every healthcare system, and they face extreme difficulties in coping with the challenges associated with managing medical personnel in Poland. The sample of entities for the study was selected from the Register of Entities Performing Medical Activity database, an electronic register maintained in accordance with the Act on Medical Activity in Poland. This database contains comprehensive information on all Polish medical facilities. Computer-assisted Internet Interviewing (CAWI) and Computer-assisted Telephone Interviewing (CATI) were used. Identical questionnaires were used in both situations.

Participation in the study was voluntary. Participants were assured confidentiality and anonymity. Of the 14882 facilities meeting the given criteria, 2177 (15%) were selected for the study, with each of them represented by one medical staff representative. The sample was limited to 1 respondent from each entity selected for the study. This approach was adopted for several reasons. Conducting a survey that included many respondents from each facility would have significantly increased the scale and complexity of the study. Given resource constraints such as funding, time and staff, limiting the number of participants while still obtaining a representative sample was more feasible. The aim was to obtain a broad overview of talent management practices in a wide range of medical entities in Poland. By selecting one employee from each facility, we ensured a diverse and statistically representative sample of the entire population of facilities, which might not have been possible with a more concentrated sample from a smaller number of facilities. The exclusion criteria included incomplete questionnaire responses, omitted information and inconsistent responses. We excluded questionnaires that did not provide answers to key questions or contained obvious logical errors. After applying these criteria, 747 valid questionnaires were obtained. Ultimately, for the objective of this study, it was decided to exclude 189 medical workers employed in non-public healthcare entities from the sample. Finally, 558 data have been coded for later data analysis. This data was divided into two sets. The first dataset (n = 206) was used for the purpose of performing exploratory factor analysis, and the second dataset (n = 352) was used for confirmatory factor analysis (CFA) and further structural equation modelling.

This sample size is sufficient for structural equation modelling (SEM) according to the principles of (a) a minimum sample size of 100 or 200, (b) 5 or 10 observations for each parameter being estimated, and (c) 10 cases per variable [63]. In general, sample sizes of 200 tend to meet acceptable thresholds for structural equation modelling [64].

The socio-demographic characteristics were assessed in the study to determine the respondents' description and whether they were well suited for the study (Table 1).

Table 1.

Response by gender, age, seniority in the profession and educational stage

Biographical variable		Frequency (N)	Percentage (%)
Gender	Male	187	33.5
	Female	371	66.5
	Total	558	100.0
Age category	Less than 30 years	59	10.6
	Between 30–40 years	113	20.3
	Between 41–50 years	179	32.1
	Between 51–60 years	181	32.4
	Above 60 years	26	4.7
	Total	558	100.0
Years of experience	Between 1–5 years	80	14.3
	Between 6–10 years	37	6.6
	Between 11–15 years	81	14.5
	Between 16–25 years	104	18.6
	Above 25 years	256	45.9
	Total	558	100.0
Educational stage	Secondary education	55	9.9
	Master's degree	455	81.5
	Doctoral degree and professor	48	8.6
	Total	558	100.0

Survey instruments and measures

The questionnaire used in the study was divided into two parts. Part I consisted of questions to obtain information on the characteristics of medical personnel, including socio-demographic data (age, gender, education, years of professional experience, and information on TMP. Part II contained questions aimed at obtaining detailed information on the studied constructs, such as employee performance (EP), job mobility (JM) and talent management practices (TMP). The scale items of the questionnaire for all dimensions were adapted based on a thorough literature review.

The scale items for all three dimensions of TMP are compiled after thoroughly reviewing the literature on talent management. TD construct includes items taken from the works of El Dahshan et al. [65] and R. Behera [66], TA from the studies of B. Obeidat et al. [67], El Dahshan et al. [65] and K.S. Goves [68] and finally, TE from the studies of M. Misztal [69], El Dahshan et al. [65], R. Behera [70], and W. Nafei [71]. Items regarding EP were taken from the works of M. Paliga [72] and W. Nafei [71]. Finally, items regarding JM were taken from the studies of M. Juchnowicz [73] and K. Uklańska [74]. Each response was rated on a 5-point Likert scale, from 1 (strongly disagree) to 5 (strongly agree).

To improve the validity of the initial selection of items, we organized a focus group discussion with eight experts to confirm the items and assess the apparent and content validity. Based on the feedback received, we removed redundant items and changed the wording of incomprehensible items to make the questionnaire understandable in important respects by medical staff and adapted to the specifics of Polish medical entities.

In order to eliminate methodological bias, a methodological separation of measurement was used, consisting of mixing test items measuring various constructs regarding independent and dependent variables [75]. This allowed to eliminate the consistency effect and follow implicit theories in participants.

We conducted a pilot study using the modified questionnaire on a random sample of 206 medical staff to further define the final list of items. Data from this initial test were analyzed, and items with a correlation value of less than (0.3) indicating a weak association with the studied constructs were removed. The final version of the effort questionnaire contained five constructs and 20 items. The summary of the items and the corresponding constructs are presented in Table 2.

Table 2.

Summary of the items and the corresponding constructs

Constructs	Sources	Items
Employee performance (EP)	(Nafei, 2015 [71]; Paliga, 2021 [72])	EP1. I evaluate my previous professional achievements positively
		EP2. I am able to make an accurate diagnosis at the right time
		EP3. I have gained recognition from my colleagues and friends
		EP4. My current position aligns with my vision of career aspirations
Talent Evaluation (TE)	(Misztal, 2020 [69]; El Dahshan et al., 2018 [65]; Behera et al., 2019 [70]; Nafei, 2015 [71])	TE1. The organization has a transparent and objective way of appraising staff
		TE2. Surveys to evaluate my work are carried out periodically
		TE3. The evaluation takes place in the form of a discussion, and the reasons for the employee's bad, but also good, performance is addressed
		TE4. Managers provide feedback to staff-on-staff appraisals carried out
Talent development (TD)	(Dahshan et al.., 2018 [65]; Behera et al., 2019 [70]	TD1. The healthcare entity allocates funds for staff development
		TD2. Managers organize internal training
		TD3. My employer has learning and development programs to develop talent
		TD4. The facility offers opportunities for professional advancement
Talent acquisition (TA)	(Obeidat et al., 2018 [67]; El Dahshan et al., 2018 [65]; Groves, 2013 [68])	TA1. The organization undertakes long-term human resource planning
		TA2. The medical entity is able to recruit the needed staff
		TA3. The reputation of the facility attracts talented medical professionals
		TA4. High-potential employees are identified in the context of our organization's strategic priorities
Job mobility (JM)	(Juchnowicz M. [73]; Uklańska, 2018 [74])	JM1. For the sake of gaining attractive employment, I am able to go abroad
		JM2. For the sake of gaining attractive employment, I am able to change my place of residence in the country
		JM3. For the sake of gaining attractive employment, I am able to postpone plans for starting/expanding a family
		JM4. For the sake of gaining attractive employment, I am able to accept long commutes to work

Statistical analysis

SPSS v27.0 was used to conduct descriptive analysis, correlation analysis, and exploratory factor analysis of the collected data, and structural equation modelling was performed using AMOS v7.0. In all tests, p-values ​​less than 0.05 were interpreted as statistically significant. The scale's reliability was examined based on Cronbach's Alpha coefficient, indicating whether the questions were answered consistently [76]. The value of Cronbach's Alpha between 0.6 to 0.8 is deemed acceptable. While Alpha Cronbach's in the ranges of 0.8 and up to 1.00 is considered very good [77]. We used the McDonald's Omega coefficient to determine the internal consistency of the items and how they relate to each other on a global scale. McDonald's Omega will be between 0 and 1 [78]. Internal consistency is usually considered acceptable if the estimate is 0.70 or higher [79]. Other researchers believe the instrument demonstrates acceptable reliability when the omega coefficients are greater than 0.6 [80, 81].

In order to determine the appropriateness of factor analysis, the Kaiser–Meyer–Olkin (KMO) test and Bartlett's test of sphericity were performed. In this study, 206 questionnaires were randomly selected for exploratory factor analysis (EFA), and the remaining questionnaires were used for confirmatory factor analysis (CFA). EFA was performed using principal component analysis, and Varimax rotation was used to select the final variables for the structural model. We also assessed the reliability of our scale by calculating its composite reliability (CR), considering a CR value greater than 0.60 as an indicator of strong consistency of latent construct indicators [82]. In order to assess convergent validity, the average variance extracted (AVE) was used as an indicator of the average level of precision for each item in the scale. The AVE of each construct and all standard loadings should be greater than 0.50 [83]. Discriminant validity is evident if the AVEs exceed the squared values ​​of the correlations between this construct and other constructs. We tested the construct validity of the model using fit indices such as χ 2 /df, goodness of fit index (GFI), adjusted goodness of finding index (AGFI), comparative fit index (CFI), root mean square error of approximation (RMSEA) and p-close. Generally, if CMIN/DF (between 1 and 5), CFI > 0.80, GFI > 0.95, AGFI > 0.90, RMSEA < 0.1, p-close > 0.05, it means that the fit index is reasonable and acceptable [84].

Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy was used to apply factor analysis. It was equal to 0.873, which specified the goodness of the sample greater than 0.6 of the acceptable limit. Bartlett's test of sphericity was applied: χ2 = 2094.458; DF = 190, p − value < 0.0001. The obtained values are highly reliable, the whole model is consistent, and factor analysis can be used. EFA was performed on 20 items to condense them into factors. The items are condensed into five factors with an eigenvalue greater than 1, shown in Table 3. The model explains 67.56% of data variance.

Table 3.

Factor loading values of the variables, item mean, standard deviation AVE, CR and Cronbach's Alpha and McDonald's Omega values

Variable	Componenta					Mean	Standard deviation	AVE	CR	Cronbach's Alpha (α)	McDonald's Omega (ω)
	1 (TE)	2 (TD)	3 (TA)	4 (JM)	5 (EP)
TE2	0.804					2.96	1.463	0.548	0.920	0.867	0.868
TE3	0.774					2.47	1.447
TE4	0.711					2.67	1.519
TE1	0.664					3.00	1.395
TD4		0.793				2.92	1.419	0.558	0.922	0.873	0.874
TD3		0.780				2.47	1.409
TD1		0.719				2.84	1.579
TD2		0.692				3.59	1.448
TA2			0.814			3.20	1.437	0.537	0.917	0.832	0.836
TA3			0.768			3.25	1.362
TA4			0.671			2.98	1.359
TA1			0.668			3.02	1.303
JM2				0.812		2.26	1.467	0.559	0.923	0.765	0.759
JM1				0.758		2.10	1.443
JM3				0.730		2.09	1.333
JM4				0.685		2.52	1.454
EP2					0.778	4.10	0.749	0.515	0.911	0.722	0.719
EP3					0.758	4.06	0.856
EP1					0.722	4.33	0.764
EP4					0.599	3.84	1.111

CR Composite Reliability, AVE Average Variance Extracted

^a Extraction Method: Principal Component Analysis, Rotation Method: Varimax and Kaiser Normalization

The questionnaire used in the study included variables to assess employee performance (EP = 4 items) and three talent management practices: talent acquisition (TA = 4 items), talent development (TD = 4 items) and talent evaluation (TE = 4 items). In addition, the following dimensions were included in the questionnaire: development needs (DN = 4 items) and job mobility (JM = 4 items). In this study, all constructs satisfactorily fulfilled the requirements since the values of CR and AVE were greater than the recommended values. Specifically, the range value for CR was between 0.911 and 0.923, and the value of AVE for each construct was between 0.515 and 0.559.

Five statements (EP1, EP2, EP3, EP4) were assigned to the employee performance dimension (EP) in the developed survey questionnaire (Table 2). The measures of the correctness of the representation of the EP dimension were correct, so it was assumed that the variables correctly represent the EP dimension. Kaiser–Meyer–Olkin Measure of Sampling Adequacy: KMO = 0.681; Bartlett's Test of Sphericity: χ2 = 189.41; DF = 6, p − value < 0.001. In this dimension, the value of Cronbach's Alpha is 0.722, and the value of McDonald's Omega is 0.719.

Based on the EFA, the TMP dimension was finally divided into three separate factors (Table 2). The first factor, Talent Evaluation (TE), comprised four items (TE1, TE2, TE3, TE4); the second factor, Talent Development (TD), comprised four items (TD1, TD2, TD3, TD4); the third-factor talent acquisition (TA) comprised of 4 items (TA1, TA2, TA3, TA4). In this dimension, Cronbach's Alpha scored 0.873 (TD), 0.867 (TE) and 0.832 (TA), while McDonald's Omega scored 0.874 (TD), 0.868 (TE) and 0.836 (TA). The model was adequate since all variables correlated sufficiently, forming a reliable solution. Two tests confirmed the adequacy of the TMP dimension: the Kaiser–Meyer–Olkin test (KMO coefficient) (KMO = 0.902) and the Bartlett's test of sphericity (χ2 = 1456.523, df = 66, p < 0.0001).

Four statements (JM1, JM2, JM3, JM4) were assigned to the Job Mobility dimension (JM) in the survey questionnaire (Table 2). Mean values of the job mobility (JM) dimension ranged from 2.09 to 2.52, and the dimension was consistent. Based on reliability analysis and factor analysis, it was assessed that statements JM1 to JM4 describing the JM dimension measure it correctly. Cronbach's Alpha (α) = 0.765; McDonald's Omega (ω) = 0.759; Kaiser–Meyer–Olkin Measure of Sampling Adequacy: KMO = 0.695; Bartlett's Test of Sphericity: χ2 = 242.494; DF = 6, p − value < 0.001.

On the basis of the EFA model, the Confirmatory Factor Analysis model was prepared (Fig. 1). The strengths of the variables' correlations described the Average Variance Extracted (AVE) coefficient and composite reliability coefficient (CR). On the basis of those coefficients, the convergent validity of the model could be confirmed. AVE values should be greater than 0.5, and CR values should be greater than 0.7. For JM and EP variables, convergent validity was confirmed only on the basis of the CR coefficient (Table 4). On the basis of the CR factor, reliability was also confirmed. Discriminant validity of the model—using the Fornell Larcker criterion since the square root of AVE for each factor is higher than the correlation between factors (apart from TA, but in this case, AVE = 0.540).

Fig. 1.

Confirmatory Factor Analysis model, standardized values

Table 4.

Convergent validity measures

	AVE	CR	√AVE
TE	0.667	0.947	0.817
TA	0.540	0.918	0.735
TD	0.626	0.938	0.791
JM	0.494	0.906	0.703
EP	0.402	0.876	0.634

Results and discussion

The study findings indicate that over half (66.5%) of the respondents in the study were female, and 33.5% were male. The findings, therefore, show that there was no relative gender balance among the staff of Polish healthcare entities. The age category of the respondents was also sought in this study. Over half (64.5%) of respondents were between 41 and 60. The mean age was 46 years.

The study findings indicate that 45.9% of the respondents in the study had a working experience of above 25 years, 18.6% had a working experience of between 16 to 25 years, 14.5% had a working experience of between 11 to 15 years, 14.3% had a working experience of between 1 to 5 years, 6.6% had a working experience of between 6 to 10 years. The fact that respondents had worked between 1 and 5 years and above illustrated that they were able to articulate the issues in this study. The educational stage of the respondents was also sought in this study. Most respondents had master's degrees (81.5% of respondents). Medical doctoral and higher-level staff accounted for 8.6% of all respondents.

The relationship among the variables has been checked through correlation analysis to determine whether the variables are highly correlated. The findings are shown in following Table 5.

Table 5.

Cross-correlations matrix

Correlations	EP	TMP	JM	Age
EP	1
TMP	0.424*	1
JM	0.521*	0.423*	1
Age	0.412*	0.413*	0.412*	1

^*Refers to p < 0.01

A positive correlation indicates a positive linear association in all cases. There is sufficient evidence to conclude that there is a significant linear relationship between EP and other constructs (TMP, JM and AGE) because the correlation coefficient is significantly different from zero.

In the next analysis stage, the research hypotheses (H1 – H3) were tested using structural equation modelling (SEM) in AMOS v. 27 software. The measurement model was constructed with employee performance (EP) as the dependent variable, talent management practices (TMP), job mobility (JM) and age as the independent variables. The final model has six items with one latent variable (Fig. 2).

Fig. 2.

The structural model with the determined standard path loadings

Before testing the hypothesized structural model, we also checked whether the measurement model had a good fit. The values of the model evaluation coefficients, CFI = 0.997, GFI = 0.992, AGFI = 0.973, CMIN/DF = 1.382, RMSEA = 0.033, p-close = 0.656 confirmed the reliability of the model. The model was considered correct regarding the requirements for structural models. It was found that the model is very well-fit, and all values are within the acceptable range.

The results of the hypothesis tests using SEM can be seen in Fig. 2 and Table 6. The results showed that each path coefficient was statistically significant.

Table 6.

Standardized and unstandardized model path loading

Hypothesis	Path	Unstandardized estimate	Standardized estimate	S.E	C.R	Value of p	Hypothesis acceptance
H1	TMP to EP	0.144	0.246	0.035	4.098	< 0.001	Accepted
H2	JM to EP	0.112	0.195	0.031	3.656	< 0.001	Accepted
H3	AGE to EP	0.047	0.230	0.011	4.335	< 0.001	Accepted

S.E Standard Error, C.R Critical Ratio, P p-value

Hypotheses H1, H2 and H3 were confirmed. The analysis shows a strong, positive and significant impact of talent management (TMP) (β = 0.246; ρ value < 0.001) and age (β = 0.230, ρ value < 0.001) on employee performance (EP). The analysis results also showed a positive, significant and strong relationship between job mobility (JM) and EP (β = 0.195; ρ value < 0.001).

Hypothesis H1 stated that TMP, consisting of TA, TD, and TE, significantly affects EP. The results of the study presented in Table 6 supported this hypothesis. An effective TMP system significantly impacts EP if it can appropriately match job descriptions or requirements to employees' knowledge and skills [85]. In such a situation, appropriate talent acquisition enables the staff to achieve effective results. These conclusions are supported by previous studies showing that TA positively impacts EP [35, 86, 87]. Our results also mean that when employees are provided with development opportunities, they become motivated and gain confidence, enabling them to perform exceptionally at work. It confirms the research results that have focused on norms of social reciprocity. Employees tend to demonstrate positive individual outcomes when they believe that their employer respects and supports employees by providing appropriate development opportunities [87–90]. The results also mean that a well-organized and effective TE encourages employees to perform effectively. For example, in previous research regarding university staff, TE is an effective indicator of high employee performance [91]. Many studies suggest that a transparent and fair performance evaluation system appears to have a beneficial effect on positive staff attitudes and motivates employees to make efforts to achieve positive results [92]. Moreover, employees who perceive the talent evaluation system as transparent and fair are much more likely to perform successfully and contribute to improving their performance [93].

The results also show a positive relationship between job mobility and the employee performance of medical staff in Poland, which confirmed hypothesis H2. Previous research has shown that human resource practices, such as systematic job mobility, positively influence employee attitudes such as commitment and motivation [94–96] and, as a result, hence, on employee performance [97, 98]. From a theoretical perspective, the impact of job mobility on employee performance can be explained by the employee motivation hypothesis [99]. According to this hypothesis, job mobility can make work life more interesting for employees by reducing boredom, monotony and fatigue associated with higher stress levels and lower productivity, thereby increasing job motivation [100]. Particularly for employees who are in a plateau phase, with low levels of performance or poor work attitudes, job mobility can help improve the quality of the job-person fit by enabling new interpersonal relationships or a better-working climate in the new job, thus improving employee performance [101].

The analysis of the impact of age on employee performance suggests a positive relationship. The results showed that more mature employees demonstrate higher performance levels, which confirms H3. This finding refutes the stereotype of declining performance in an ageing workforce [102] and strengthens the argument that employee performance should increase with age [103]. It is worth emphasizing that most empirical research has not shown a clear relationship between age and employee performance [104, 105]. Many age studies have indicated negative relationships between these two variables [106]. According to the literature, older people seem poor at focusing attention, using analytical reasoning [107] and multitasking [108]. However, several studies indicate that performance does not decline with age [109, 110]. Older workers can perform as well as their younger colleagues due to the accumulation of specialized knowledge, experience and the ability to acquire new skills, which increases their performance [111]. The human capital theory can justify the positive relationship between employee performance and the age of medical workers. In the light of this theory, experience and specialist knowledge that increase during an individual's life cycle enrich and increase the value of the human capital of medical workers. As a result, deepening the knowledge, skills and experience of an individual employee over the course of his or her life can positively impact elements of human capital, including employee performance. As employees mature, the effect of investment in employees also pays off (training, incentive pay), which increases their knowledge, skills, abilities, values and social assets and then generates value related to individual results [112, 113].

Conclusion

General conclusions

The study developed and tested three research hypotheses, confirming direct relationships between TMP, JM, age and EP in the Polish healthcare system. All factors had a significant and positive impact on employees' performance. The main aim of this study was to analyze the impact of TMP on EP in the context of the Polish healthcare system. This work provided evidence that the use of TMP, including three practices (TA, TD, TE), is directly related to EP. Identifying and acquiring top talents is important, but developing, assessing and nurturing that talent to increase employee engagement and optimize performance is equally important. The results of this study also showed the positive impact of talent mobility on the achievements of medical workers. This means that the chances of improving performance may increase significantly as the conditions and attractiveness of work improve, which motivates talented employees to take up employment in a given place.

This study also confirmed the positive impact of age on employee performance. The positive relationship between age and EP is fully consistent with human capital theory, given that over the lifespan, human capital improves through on-the-job training and work experience, increasing employee maturity and productivity. The positive effect of age on employee performance highlights the need for targeted TMP practices attractive to an ageing workforce.

Theoretical implications

The present study offers a number of theoretical and research contributions. The results support and extend social exchange theory [16] to explain the relationship between TMP use and employee performance. This finding strengthens the argument that healthcare providers also invest in their employees by using TMP practices, and in return, employees demonstrate high engagement and high performance [114]. By confirming the positive association of talent management practices with employee performance, the study offers new evidence to the literature in this area, especially in healthcare organizations. This is one of the few research areas that has been studied in the context of the healthcare sector, especially in Poland. This study is one of the first to empirically examine the relationship between TMPs based on three practices: TA, TD, and TA and TE. Although existing research supports the impact of TMP on EP, there has been a lack of empirical evidence highlighting the impact of the three mentioned practices on employee outcomes. Moreover, by empirically dividing TMP into three key practices, we could document more precise relationships and overcome the weakness of examining only an aggregate construct that may miss practical insights related to individual dimensions. Assessing the integration of the core talent management constructs (talent attraction, talent development, and talent assessment) helps researchers and academics to generate new theories and frameworks that offer valuable theoretical insights. Moreover, including factors such as age and employee mobility in the model adds value to the literature. Finally, this study contributes to the literature on human resource management with new empirical evidence, especially in the context of the Polish healthcare system. The theoretical implications of the study, therefore, aim to offer a solid conceptual framework with a model examining factors influencing individual-level performance, which provides valuable empirical insights on healthcare entities in the context of countries facing a shortage of healthcare personnel, such as Poland.

Practical implications

Our findings have important practical implications. We have shown that public healthcare providers should include TA, TD, and TE in their TM programs. By incorporating these three TM practices, the entity's management can benefit from greater employee commitment and efficiency. Healthcare management must understand the importance of TM practices in supporting the effectiveness of healthcare workers who must continually learn and develop. Healthcare providers should develop consistent recruitment strategies to ensure that working conditions match employee development needs, which will help retain qualified employees.

Additionally, if employees are effectively placed in the right positions, they are likelier to demonstrate greater commitment and a strong attachment to the institutions that help them succeed. In addition, medical staff should be offered appropriate T&D programs to improve their skills and ensure a consistent development cycle. Therefore, public healthcare entities should implement an advanced training action plan that meets employee development needs because it builds skilled and motivated employees, leading to excellent performance. Finally, HRM departments must implement specific TM practices to meet young and mature employees' characteristics and needs. Although both mature and younger workers have many of the same needs and preferences, differentiation is necessary given the differential impact of staffing on employee performance for younger and older workers. The research results are particularly important for improving the Polish healthcare system's human resources management system. As a rule, public medical entities in Poland do not have formal human resources management systems, including tools for motivation, development, and employee evaluation criteria. These entities most often operate according to informal rules, which can hardly be considered a solid basis for making decisions related to talent management [115]. It is, therefore, important to create formal talent management processes that support personal development and appreciate the individual performance of employees.

Limitations and future directions

This study has some limitations that can be used as a reference for future research. First, the study used a cross-sectional survey design, which may weaken internal validity and limits the study from drawing causal conclusions over a long period of time. Second, we did not include all TMP in the study. Third, we did not test the effects separately for different types of healthcare providers, such as hospitals, primary care providers, or outpatient care. Furthermore, the study was conducted only in healthcare providers in one country, so the results cannot be generalized to providers in other countries. Another limitation was that the research focused exclusively on medical staff. The generalization of the findings may be more appropriate if non-medical personnel are included, as they affect the performance of medical staff.

Further research is suggested on the perception of healthcare personnel towards the current use of talent management practices. We recommend that future studies should be longitudinal and include non-medical personnel as well. Since this research paper focuses on three TM practices (TA, TD, TE), further research can include other TM practices such as talent screening, motivation, planning, and retention. Future studies should include different healthcare entities, such as hospitals' primary care entities, where talent management can play a different role in increasing employee performance. The type of entity can be considered as a moderating variable in these future studies. Other demographic factors (such as gender, work experience, marital status and job title) can also be included as moderating variables to determine how the demographic status of the respondents can affect employee performance. Therefore, the existing research paradigm can be extended by adding the proposed variables. Moreover, this study was conducted only in Poland. Therefore, future studies can expand their scope by considering other countries to obtain robust and competitive results.

Abbreviations

EP

Employee Performance

TM

Talent Management

TMP

Talent Management Practices

TA

Talent Acquisition

TD

Talent Development

TE

Talent Evaluation

CAWI

Computer-Assisted Web Interview

CATI

Computer-Assisted Telephone Interview

EFA

Exploratory Factor Analysis

KMO

Kaiser–Meyer–Olkin measure

AGFI

Adjusted goodness-of-fit

GFI

Goodness-of-fit

T&D

training and professional development

SEM

Structural Equation Model

SPSS

Statistical Package for Social Sciences

AMOS

Analysis of Moment Structure

RMR

Root Mean Square Residual

RMSEA

Root Mean Square Error of Approximation

CFI

Comparative Fit Index

GFI

Goodness-of-Fit Index

CR

Composite Reliability

AVE

Average Variance Extracted

Authors’ contributions

WP: Conceptualization, Data curation, Writing – original draft, Writing – review & editing, Visualization, Investigation, Validation, Formal analysis, Methodology. MKA: Conceptualization, Writing – original draft, Writing – review & editing, Formal analysis.

Funding

No funding was received for this study.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of the Warsaw University of Technology (certificate dated January 15, 2021). During data collection, informed verbal consent was obtained from all respondents. All participants were informed that they had the right to withdraw from the study at any time. All responses and study sites were anonymized. The study was in compliance with the Helsinki Declaration.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.