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Purpose: Personnel costs typically account for 60% or more of total operating expenses in health systems, and as such become 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., Design/methodology/approach: 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., Findings: 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., Value/originality: 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.