Strategic Human Resource Management in Health Care: Volume 9

The five articles in this section focus on topics such as pay-for-performance (P4P), high-commitment/high-involvement work practices, and safety culture. Interestingly, the link among all of these articles is in understanding and translating best practices in HRM from manufacturing organizations to health care organizations.

Evidence continues to accumulate that human resource management (HRM) practices associated with a commitment-based management approach can generate more energy, initiative, and engagement among workers and meaningful performance gains for an organization. Despite the business case for adoption, many organizations still fail to implement commitment-based HRM practices, or even refuse to attempt such a transition. The health care industry, in particular, has been resistant to moving away from a control-based management philosophy. We identify a potential enabling factor in making the transition as the willingness and ability of senior leadership to establish fair process and a climate of procedural justice throughout the organization, and we examine the lessons offered by a high-performing pharmaceutical plant organized according to commitment-based principles.

The relationship between organization strategy and a high-involvement work system (HIWS) in the accumulation of social capital is investigated in nursing subunits in a large sample of Canadian long-term care organizations. Results suggest that strategic orientation of nursing homes has a differential impact on the ability of these organizations to accumulate social capital in its nursing staff. Using a competing values framework to characterize strategic orientation, long-term care establishments pursuing an employee-focused strategy are able to accumulate higher levels of social capital in their nursing units through the adoption of a high-involvement human resource management (HRM) work system. By contrast, long-term care organizations pursuing an operational efficiency strategy, in tandem with the adoption of a high-involvement HRM system, produce no additional accumulation in nursing unit social capital.

Human resources management (HRM) has evolved from primarily focusing on monetary incentives toward incorporating other nonmonetary aspects for managing professionals’ motivation. However, in health care organizations, paying professionals for performance persists although evidence for its return on investment is scant. This raises the question whether monetary incentives are, in fact, the (only) motivator for health care professionals or whether other incentives could substitute or complement them in the future. This chapter reviews the basic ideas of pay for performance (P4P) and its current challenges. Taking into account HRM's experience (and evolution) in other industries, I discuss the interdependence and the impact of extrinsic and intrinsic motivators in health care. On the basis of the health care market's standing as a knowledge-intensive industry in which multiple actors contribute their knowledge to multiple tasks, I will offer suggestions how to manage motivation based on individuals’ intrinsic needs instead of relying solely on extrinsic motivators.

In an era of increasing demand for healthcare coupled with decreasing availability of highly skilled healthcare professionals, healthcare administrators are increasingly concerned with how they might recruit and retain talent. Increasingly, they are focusing on compensation strategies to support their recruitment and retention objectives. This article investigates the organizational efficiency and financial performance implications for hospitals of using a hybrid relative wage strategy to compensate their nursing professionals. Considering three types of nursing professionals, registered nurses (RNs), licensed practical nurses (LPNs), and nurse assistants (NAs), we investigated the effectiveness of paying market leading wages to higher skilled nurses and market lagging wages to lower skilled nurses. On the basis of prior utility analyses of the importance of pay practices at particular organizational levels, we hypothesize positive performance consequences as a result of pursuing these relative wage strategies. Using data from 352 short-term stay acute care hospitals in California, we found that a lead pay policy among RNs and a lag pay policies among LPNs and NAs were associated with higher Return on Assets (ROA) (i.e., financial performance) and shorter Average Length of Stay (ALOS) (i.e., organizational efficiency).

Through a number of comprehensive reviews, the Institute of Medicine (IOM) has recommended that healthcare organizations develop safety cultures to align delivery system processes with the workforce requirements to improve patient outcomes. Until health systems can provide safer care environments, patients remain at risk for suboptimal care and adverse outcomes. Health science researchers have begun to explore how safety cultures might act as an essential system feature to improve organizational outcomes. Since safety cultures are established through modification in employee safety perspective and work behavior, human resource (HR) professionals need to contribute to this developing organizational domain. The IOM indicates individual employee behaviors cumulatively provide the primary antecedent for organizational safety and quality outcomes. Yet, many safety culture scholars indicate the concept is neither theoretically defined nor consistently applied and researched as the terms safety culture, safety climate, and safety attitude are interchangeably used to represent the same concept. As such, this paper examines the intersection of organizational culture and healthcare safety by analyzing the theoretical underpinnings of safety culture, exploring the constructs for measurement, and assessing the current state of safety culture research. Safety culture draws from the theoretical perspectives of sociology (represented by normal accident theory), organizational psychology (represented by high reliability theory), and human factors (represented by the aviation framework). By understanding not only the origins but also the empirical safety culture research and the associated intervention initiatives, healthcare professionals can design appropriate HR strategies to address the system characteristics that adversely affect patient outcomes. Increased emphasis on human resource management research is particularly important to the development of safety cultures. This paper contributes to the existing healthcare literature by providing the first comprehensive critical analysis of the theory, research, and practice that comprise contemporary safety culture science.

Retail clinics in health care have been characterized as a “low-cost disruptive innovation” (Christensen, Anthony, & Roth, 2004). This article examines the retail clinic innovation, how it has grown and evolved over time, and the human resource implications of this phenomenon. The article provides a comprehensive literature review of both academic research and practitioner perspectives. Data regarding how retail clinics have impacted consumer access to health services, cost of health services, clinical outcomes, and customer satisfaction are examined. Even though retail clinics use lower cost staffing patterns than do traditional providers, data indicate positive outcomes and high levels of customer satisfaction with retail clinics. The evolution of retail clinics through multiple models and staffing patterns are discussed. The article concludes with implications for theory, health administration practice, public policy, and future research.

Numerous studies have identified various unintended adverse consequences (UACs) of implementing health information technology (HIT). For example, UACs identified in the context of Computerized Physician Order Entry (CPOE) implementation include unfavorable workflow issues, generation of new types of errors, untoward changes in communication patterns, and problems of paper persistence.

However, gaps remain in understanding why UACs from HIT implementation occur, and how they may be overcome. The technology-in-practice (TIP) framework emphasizes the role of human agency (or individual action) in enacting structures of technology use (or technologies-in-practice) and other social structures within the organization. As such, given a set of UACs from HIT implementation, the TIP framework can help trace them back to specific actions (types of HIT-in-practice) and institutional conditions (social structures).

However, insofar as the TIP framework can help understand causes of UACs, it does not shed light on how they may be overcome through strategic action. By contrast, the knowledge-in-practice (KIP) framework, which emanates from both human resource and knowledge management literatures, helps understand how information and communication technologies (ICTs) such as “Intranets” and the “Virtual Office” can be used alongside existing HIT systems (e.g., CPOE) to create new social structures, generate new KIP, and transform HIT-in-practice.

This chapter integrates the TIP and KIP literatures to develop an integrated framework for understanding and overcoming the UACs from HIT implementation. The framework is applied to existing evidence on UACs from CPOE implementation, to explain why they occur, and how they may be overcome. The application and ensuing discussion provide insight into strategies for successful HIT implementation in healthcare organizations, as well as recommendations for future research.

Health care organizations are facing the dual challenge of providing high-quality patient care at an affordable price. In this article, we argue that the role of people, or human resource management (HRM), and information, or health information technologies (HIT), is crucial in surmounting the above challenge. Specifically, we contend that HRM and HIT in health care are fundamental rather than support functions, and health care organizations need to build internal capabilities in both HRM and HIT to manage these resources effectively. Health care organizations vary in their levels of HRM and HIT capabilities. A few exceptional health care organizations have built both of these capabilities and have derived significant complementarities between HRM and HIT that, in turn, have allowed them to be leaders in value-based health care delivery. Several health care organizations have developed capabilities in either HRM or HIT but not in both, and still others have developed capabilities in neither function. Outsourcing of HRM and HIT by health care organizations is likely to hamper the integration and embedding of these functions in organizational operations. Although HIT has attracted significant attention from policy makers and health care organizations alike, it is not so with HRM. Most large-scale HIT initiatives that proceed without strong HRM capabilities are likely to result in disappointing outcomes. This occurs because the organizational change and development embodied in major HIT initiatives often cannot be sustained without strong HRM capabilities.