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Engaging Employees: The Importance of High-Performance Work Systems for Patient Safety

Etchegaray, Jason M. PhD; Thomas, Eric J. MD, MPH

doi: 10.1097/PTS.0000000000000076
Original Articles
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Objectives To develop and test survey items that measure high-performance work systems (HPWSs), report psychometric characteristics of the survey, and examine associations between HPWSs and teamwork culture, safety culture, and overall patient safety grade.

Method We reviewed literature to determine dimensions of HPWSs and then asked executives to tell us which dimensions they viewed as most important for safety and quality. We then created a HPWSs survey to measure the most important HPWSs dimensions. We administered an anonymous, electronic survey to employees with direct patient care working at a large hospital system in the Southern United States and looked for linkages between HPWSs, culture, and outcomes.

Results Similarities existed for the HPWS practices viewed as most important by previous researchers and health-care executives. The HPWSs survey was found to be reliable, distinct from safety culture and teamwork culture based on a confirmatory factor analysis, and was the strongest predictor of the extent to which employees felt comfortable speaking up about patient safety problems as well as patient safety grade.

Conclusions We used information from a literature review and executive input to create a reliable and valid HPWSs survey. Future research needs to examine whether HPWSs is associated with additional safety and quality outcomes.

From the The University of Texas Medical School at Houston, The University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, Texas.

Correspondence: Jason Michel Etchegaray, PhD, The University of Texas Medical School at Houston and The University of Texas at Houston-Memorial Hermann Center for Healthcare Quality and Safety, Houston, TX (e-mail: jason.etchegaray@uth.tmc.edu).

The authors disclose no conflict of interest.

Funding: This work was supported by the Agency for Healthcare Research and Quality [Grant no. K02HS017145] as well as The University of Texas at Houston–Memorial Hermann Center for Healthcare Quality and Safety.

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