School of Public Health, La Trobe University, Bundoora, Australia.
J Health Organ Manag. 2011;25(3):281-97. doi: 10.1108/14777261111143536.
Studies of high-performing organisations have consistently reported a positive relationship between high performance work systems (HPWS) and performance outcomes. Although many of these studies have been conducted in manufacturing, similar findings of a positive correlation between aspects of HPWS and improved care delivery and patient outcomes have been reported in international health care studies. The purpose of this paper is to bring together the results from a series of studies conducted within Australian health care organisations. First, the authors seek to demonstrate the link found between high performance work systems and organisational performance, including the perceived quality of patient care. Second, the paper aims to show that the hospitals studied do not have the necessary aspects of HPWS in place and that there has been little consideration of HPWS in health system reform.
DESIGN/METHODOLOGY/APPROACH: The paper draws on a series of correlation studies using survey data from hospitals in Australia, supplemented by qualitative data collection and analysis. To demonstrate the link between HPWS and perceived quality of care delivery the authors conducted regression analysis with tests of mediation and moderation to analyse survey responses of 201 nurses in a large regional Australian health service and explored HRM and HPWS in detail in three casestudy organisations. To achieve the second aim, the authors surveyed human resource and other senior managers in all Victorian health sector organisations and reviewed policy documents related to health system reform planned for Australia.
The findings suggest that there is a relationship between HPWS and the perceived quality of care that is mediated by human resource management (HRM) outcomes, such as psychological empowerment. It is also found that health care organisations in Australia generally do not have the necessary aspects of HPWS in place, creating a policy and practice gap. Although the chief executive officers of health service organisations reported high levels of strategic HRM, the human resource and other managers reported a distinct lack of HPWS from their perspectives. The authors discuss why health care organisations may have difficulty in achieving HPWS.
ORIGINALITY/VALUE: Leaders in health care organisations should focus on ensuring human resource management systems, structures and processes that support HPWS. Policy makers need to consider HPWS as a necessary component of health system reform. There is a strong need to reorient organisational human resource management policies and procedures in public health care organisations towards high performing work systems.
对高绩效组织的研究一致报告了高绩效工作系统 (HPWS) 与绩效结果之间的积极关系。尽管这些研究中有许多是在制造业进行的，但在国际医疗保健研究中也报告了 HPWS 各个方面与改善护理提供和患者结果之间存在正相关的类似发现。本文的目的是汇集在澳大利亚医疗保健组织内进行的一系列研究的结果。首先，作者试图展示在高绩效工作系统和组织绩效之间发现的联系，包括对患者护理质量的感知。其次，本文旨在表明所研究的医院尚未具备高绩效工作系统的必要方面，并且在医疗体系改革中很少考虑高绩效工作系统。
设计/方法/途径：本文借鉴了一系列使用澳大利亚医院调查数据的相关性研究，辅之以定性数据收集和分析。为了展示 HPWS 与感知护理质量之间的联系，作者对 201 名澳大利亚大型地区医疗服务护士的调查结果进行了回归分析，并进行了中介和调节检验，还详细研究了三个案例研究组织中的人力资源管理和高绩效工作系统。为了实现第二个目标，作者对维多利亚州所有卫生部门组织的人力资源和其他高级管理人员进行了调查，并审查了计划在澳大利亚进行的卫生系统改革相关政策文件。
研究结果表明，HPWS 与护理质量感知之间存在关系，这种关系是通过人力资源管理 (HRM) 成果（例如心理授权）来介导的。还发现，澳大利亚的医疗保健组织通常没有必要的高绩效工作系统方面，这造成了政策和实践之间的差距。尽管卫生服务组织的首席执行官报告了高水平的战略性人力资源管理，但人力资源和其他管理人员从他们的角度报告了明显缺乏高绩效工作系统。作者讨论了为什么医疗保健组织可能难以实现高绩效工作系统。
原创性/价值：医疗保健组织的领导者应专注于确保支持高绩效工作系统的人力资源管理系统、结构和流程。政策制定者需要将高绩效工作系统视为医疗体系改革的必要组成部分。公共医疗保健组织迫切需要重新调整组织人力资源管理政策和程序，以实现高绩效工作系统。
