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High-performance work systems in health care management, Part 2: Qualitative evidence from five case studies

McAlearney, Ann Scheck; Garman, Andrew N.; Song, Paula H.; McHugh, Megan; Robbins, Julie; Harrison, Michael I.

doi: 10.1097/HMR.0b013e3182100dc4

Background: A capable workforce is central to the delivery of high-quality care. Research from other industries suggests that the methodical use of evidence-based management practices (also known as high-performance work practices [HPWPs]), such as systematic personnel selection and incentive compensation, serves to attract and retain well-qualified health care staff and that HPWPs may represent an important and underutilized strategy for improving quality of care and patient safety.

Purpose: The aims of this study were to improve our understanding about the use of HPWPs in health care organizations and to learn about their contribution to quality of care and patient safety improvements.

Methodology/Approach: Guided by a model of HPWPs developed through an extensive literature review and synthesis, we conducted a series of interviews with key informants from five U.S. health care organizations that had been identified based on their exemplary use of HPWPs. We sought to explore the applicability of our model and learn whether and how HPWPs were related to quality and safety. All interviews were recorded, transcribed, and subjected to qualitative analysis.

Findings: In each of the five organizations, we found emphasis on all four HPWP subsystems in our conceptual model-engagement, staff acquisition/development, frontline empowerment, and leadership alignment/development. Although some HPWPs were common, there were also practices that were distinctive to a single organization. Our informants reported links between HPWPs and employee outcomes (e.g., turnover and higher satisfaction/engagement) and indicated that HPWPs made important contributions to system- and organization-level outcomes (e.g., improved recruitment, improved ability to address safety concerns, and lower turnover).

Practice Implications: These case studies suggest that the systematic use of HPWPs may improve performance in health care organizations and provide examples of how HPWPs can impact quality and safety in health care. Further research is needed to specify which HPWPs and systems are of greatest potential for health care management.

Ann Scheck McAlearney, ScD, MS, is Associate Professor, Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus. E-mail:

Andrew N. Garman, PsyD, MS, is Associate Professor and Associate Chair, Department of Health Systems Management, Rush University Medical Center, Chicago, Illinois.

Paula H. Song, PhD, is Assistant Professor, Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus.

Megan McHugh, PhD, is Director, Research, Health Research and Educational Trust/AHA, Chicago, Illinois, and Research Assistant Professor, Institute for Healthcare Studies and Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, Chigaco, Illinois.

Julie Robbins, MHA, is Research Associate, Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus.

Michael I. Harrison, PhD, is Sr. Social Scientist, Organizations and Systems, Center for Delivery, Organization, and Markets, Agency for Healthcare Research and Quality, Washington, DC.

Funding source: Agency for Healthcare Research and Quality.

The content of this article is solely the responsibility of the authors and does not represent the official views or recommendations of the Agency for Healthcare Research and Quality (AHRQ) or the Department of Health and Human Services.

An earlier version of this article received a "Best Paper" designation from the Health Care Management Division of the Academy of Management and was accepted for presentation at the 70th Annual Academy of Management Meeting in Montreal, Canada, in August 2010. Highlights of these results were also presented at the 2010 AcademyHealth Meeting in Boston, Massachusetts, in June 2010.

© 2011 Lippincott Williams & Wilkins, Inc.