This paper reports the findings of case study research exploring the strength of the HR system in three Australian public hospitals from the perspective of senior, middle and line managers, and HR practitioners. The study explored how HRM is understood, interpreted, and operationalized across the management hierarchy. The findings suggest that the role of the CEO is crucial in providing HR legitimacy, leadership and resources that create a distinctive HR system, and in nurturing within group agreement and consensus among the senior executive team on the role of HR. In turn, senior managers need to translate consistent HR messages throughout the management hierarchy and provide lower level managers with the formal and informal direction, support and empowerment to operationalize HR strategy.