Institutional members access full text with Ovid®

Share this article on:

High-performance work systems in health care, Part 3: The role of the business case

Song, Paula H.; Robbins, Julie; Garman, Andrew N.; McAlearney, Ann Scheck

doi: 10.1097/HMR.0b013e31822e2a6b

Background: Growing evidence suggests the systematic use of high-performance work practices (HPWPs), or evidence-based management practices, holds promise to improve organizational performance, including improved quality and efficiency, in health care organizations. However, little is understood about the investment required for HPWP implementation, nor the business case for HPWP investment.

Purpose: The aim of this study is to enhance our understanding about organizations’ perspectives of the business case for HPWP investment, including reasons for and approaches to evaluating that investment.

Methodology/Approach: We used a multicase study approach to explore the business case for HPWPs in U.S. health care organizations. We conducted semistructured interviews with 67 key informants across five sites. All interviews were recorded, transcribed, and subjected to qualitative analysis using both deductive and inductive methods.

Findings: The organizations in our study did not appear to have explicit financial return expectations for investments in HPWPs. Instead, the HPWP investment was viewed as an important factor contributing to successful execution of the organization’s strategic priorities and a means for competitive differentiation in the market. Informants’ characterizations of the HPWP investment did not involve financial terms; rather, descriptions of these investments as redeployment of existing resources or a shift of managerial time redirected attention from cost considerations. Evaluation efforts were rare, with organizations using broad organizational metrics to justify HPWP investment or avoiding formal evaluation altogether.

Practice Implications: Our findings are consistent with prior studies that have found that health care organizations have not systematically evaluated the financial outcomes of their quality-related initiatives or tend to forgo formal business case analysis for investments they may perceive as “inevitable.” In the absence of a clearly described association between HPWPs and outcomes or some other external imperative, ongoing HPWP investment may be at risk relative to other quality-related initiatives, particularly if organizational resources are constrained.

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

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

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

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

Funding Source: Agency for Health Care Research and Quality.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2012 Lippincott Williams & Wilkins, Inc.