Organisational behaviour - Literature
Reducing patient mortality in hospitals: The role of human resource management – West et al.
Aim:
To build upon and extend previous work on strategic human resource management (SHRM) to
examine the influence of a bundle or system of HR policies and practices on a critically important
organizational level healthcare outcome: patient mortality in acute hospitals in England.
In the health services research literature, there is a growing sense that structural and organizational
aspects of hospitals are important factors in care giving quality and that is not just the qualifications
and experience of attending physicians that matter. Therefore, we adopted a powerful OB paradigm
for understanding organizational performance and applied this to the study of hospital inpatient
mortality. Human resource policies are likely to influence patient care quality by impacting both
technical and interpersonal aspects of quality care. Technical aspects of care: the appropriate
application of knowledge and skills to promote healthcare. Interpersonal aspects of care: both the
relationship between patients and healthcare professionals as well as the contextual aspects of care.
Strategic human resource management: the pattern of planned human resource deployments and
activities intended to enable an organization to achieve its goals, bundle of specific HRM
interventions
Hypotheses:
Greater use of a system of high performance HRM policies and practices will be associated with
lower rates of patient mortality
Focus on HRM practices related to:
- Performance appraisal/management: clarify individual’s roles and objectives in their work, to
provide them with feedback on performance, determine their development and to
communicate to them their value and importance to the organization
o Staff who are clear about their roles are likely to perform their roles more effectively
and thereby provide better patient care, thus influencing patient mortality
- Training: provide employees with skills they need to perform their jobs and to improve their
performance over time
o Effective training will give staff the skills to provide a higher quality of patient care
and potentially reduces levels of patient mortality
- Decentralization
- Participatory mechanisms
- Team-based structures:
o Team working enables shared knowledge and understanding about patient needs,
good decision making, lower error rates and more effective patient recovery
- Employment security: likely to enhance commitment and to ensure the retention of skills
developed through training and appraisal and to maintain effective teamwork as a result of
not disrupting established relationships
o Associated with higher levels of employee job satisfaction
- Staffing (recruitment/selection): staff involvement attempts by employers to find more
participative ways in which to manage staff, utilize the entire capacity of workers and
encourage employee commitment
o Decentralization of decision making and enabling employees to exert influence over
their work are strategies to encourage staff involvement
o Not involving staff is a loss of potential
How would individual practices theoretically be likely to affect in-patient mortality in hospitals?
,Methods:
Cross-sectional approach. Sample and data collection: HRM directors from 137 acute hospitals were
identified as potential study participants. 81 hospitals agreed to participate. The final sample size was
52 hospitals. HR directors were given the option to complete the survey in a telephone interview or
by post. Conducted from 1999 to 2000.
Measures:
- HRM system
o Hospital policy and practice with respect to training, performance management,
participation, decentralization, involvement, use of teams, employment security and
investor in people (IiP) status
Reflective of high involvement or high commitment HR systems
- Hospital healthcare performance
o Standardized mortality ratio (SMR/Jarman Index)
Beginning April 1 of each year
= the ratio of actual deaths to expected number of deaths, multiplied by 100
100 exactly as many deaths as expected
> 100 more patients died than would be expected
< 100 fewer than expected died
Expected is based on characteristics of the hospital (different patient groups)
which makes it more reliable
- Control variables
o Controlling for a number of variables that might influence hospitality mortality rates,
like the ratio of doctors per bed and hospital’s prior healthcare performance
- Adjusting for prior mortality, because they want to say something about causality.
Findings:
After adjusting for prior mortality, there was a smaller effect. Therefore, they did a post hoc analysis.
HRM practices have a statistically significant negative effect on mortality rate. More HRM, less
people who die.
Strategy, HRM, and performance: a contextual approach – Paauwe & Farndale
Chapter 5: HRM and performance
HRM systems: bundles of HRM practices rather than individual practices
Common method bias: when both the independent and dependent variables are collected from the
same respondents, as well as potentially being collected at a single point in time
A black box can be defined as an
unclear mechanism going on
between the input and the output of
a relationship. If we want to say
something about the HRM
performance relationship and the
black box that occurs in between,
we must distinguish between micro,
meso and macro levels of analysis.
The micro level of HRM is related to
the fields of organizational behaviour and industrial and organizational psychology and is focused on
the individual employee and his/her attitude and behaviours. The meso level of HRM examines the
, impact of HRM practices at the organizational level. The macro level of HRM is concerned with issues
outside the organization and the influence of this external context.
HPWSs: bundles of HRM practices designed to improve firm performance
Chapter 6: The Contextual SHRM Framework
The Contextually Based Human Resource Theory (CBHRT)
Two predominant dimensions in a firm’s
environment are argued to dominate the
crafting of SHRM, moderated by other
internal factors. First, SHRM is determined by
competitive mechanisms, which consist of
demands arising from relevant product-
market combinations and appropriate
technology. They are aimed at achieving
certain desirable organizational capabilities
(efficiency etc.). This dimension represents
the tough economic rationality of
competition. The competitive market is
embedded in a system of institutional
mechanisms. Prevailing values and norms and
their institutionalization channel alter the
outcomes of competitive market forces. The
goal is achieving legitimacy: the acceptance of
organizations in the wider society in which they operate, to ensure access to necessary resources
from potential exchange partners (= relational rationality). The configuration dimension may be
considered the outcome of past strategic choices interacting with the organizational structure and
culture that they engendered. It is the influence of structures, methods, competencies and values
that originated in the past. We then see the role of active human agency (through the dominant
coalition) in the decision making process. All of the actors have their own values, norms and
attitudes, shared with others to a greater or lesser degree. The leeway (room for manoeuvre) is
available for the actors to make their own strategic choices. The dominant coalition is involved in
shaping and selecting an HRM strategy, based on aligning with different internal and external forces.
The shaping of the HRM strategy is aimed at generating HRM outcomes, which in turn contribute to
the performance of the organization as a whole.
The Contextual SHRM Framework
There are two sides in this
framework: the context side
and the SHRM side. The
outcomes of the three
mechanisms have been made
more explicit. These describe
how the firm is dealing with
its reality, often describing a
desired state. There are 4
types of fit:
- Organization fit: fit
between the
organizations heritage
and its SHRM system
- Strategic fit: fit
between the competitive mechanisms and the SHRM system
Reducing patient mortality in hospitals: The role of human resource management – West et al.
Aim:
To build upon and extend previous work on strategic human resource management (SHRM) to
examine the influence of a bundle or system of HR policies and practices on a critically important
organizational level healthcare outcome: patient mortality in acute hospitals in England.
In the health services research literature, there is a growing sense that structural and organizational
aspects of hospitals are important factors in care giving quality and that is not just the qualifications
and experience of attending physicians that matter. Therefore, we adopted a powerful OB paradigm
for understanding organizational performance and applied this to the study of hospital inpatient
mortality. Human resource policies are likely to influence patient care quality by impacting both
technical and interpersonal aspects of quality care. Technical aspects of care: the appropriate
application of knowledge and skills to promote healthcare. Interpersonal aspects of care: both the
relationship between patients and healthcare professionals as well as the contextual aspects of care.
Strategic human resource management: the pattern of planned human resource deployments and
activities intended to enable an organization to achieve its goals, bundle of specific HRM
interventions
Hypotheses:
Greater use of a system of high performance HRM policies and practices will be associated with
lower rates of patient mortality
Focus on HRM practices related to:
- Performance appraisal/management: clarify individual’s roles and objectives in their work, to
provide them with feedback on performance, determine their development and to
communicate to them their value and importance to the organization
o Staff who are clear about their roles are likely to perform their roles more effectively
and thereby provide better patient care, thus influencing patient mortality
- Training: provide employees with skills they need to perform their jobs and to improve their
performance over time
o Effective training will give staff the skills to provide a higher quality of patient care
and potentially reduces levels of patient mortality
- Decentralization
- Participatory mechanisms
- Team-based structures:
o Team working enables shared knowledge and understanding about patient needs,
good decision making, lower error rates and more effective patient recovery
- Employment security: likely to enhance commitment and to ensure the retention of skills
developed through training and appraisal and to maintain effective teamwork as a result of
not disrupting established relationships
o Associated with higher levels of employee job satisfaction
- Staffing (recruitment/selection): staff involvement attempts by employers to find more
participative ways in which to manage staff, utilize the entire capacity of workers and
encourage employee commitment
o Decentralization of decision making and enabling employees to exert influence over
their work are strategies to encourage staff involvement
o Not involving staff is a loss of potential
How would individual practices theoretically be likely to affect in-patient mortality in hospitals?
,Methods:
Cross-sectional approach. Sample and data collection: HRM directors from 137 acute hospitals were
identified as potential study participants. 81 hospitals agreed to participate. The final sample size was
52 hospitals. HR directors were given the option to complete the survey in a telephone interview or
by post. Conducted from 1999 to 2000.
Measures:
- HRM system
o Hospital policy and practice with respect to training, performance management,
participation, decentralization, involvement, use of teams, employment security and
investor in people (IiP) status
Reflective of high involvement or high commitment HR systems
- Hospital healthcare performance
o Standardized mortality ratio (SMR/Jarman Index)
Beginning April 1 of each year
= the ratio of actual deaths to expected number of deaths, multiplied by 100
100 exactly as many deaths as expected
> 100 more patients died than would be expected
< 100 fewer than expected died
Expected is based on characteristics of the hospital (different patient groups)
which makes it more reliable
- Control variables
o Controlling for a number of variables that might influence hospitality mortality rates,
like the ratio of doctors per bed and hospital’s prior healthcare performance
- Adjusting for prior mortality, because they want to say something about causality.
Findings:
After adjusting for prior mortality, there was a smaller effect. Therefore, they did a post hoc analysis.
HRM practices have a statistically significant negative effect on mortality rate. More HRM, less
people who die.
Strategy, HRM, and performance: a contextual approach – Paauwe & Farndale
Chapter 5: HRM and performance
HRM systems: bundles of HRM practices rather than individual practices
Common method bias: when both the independent and dependent variables are collected from the
same respondents, as well as potentially being collected at a single point in time
A black box can be defined as an
unclear mechanism going on
between the input and the output of
a relationship. If we want to say
something about the HRM
performance relationship and the
black box that occurs in between,
we must distinguish between micro,
meso and macro levels of analysis.
The micro level of HRM is related to
the fields of organizational behaviour and industrial and organizational psychology and is focused on
the individual employee and his/her attitude and behaviours. The meso level of HRM examines the
, impact of HRM practices at the organizational level. The macro level of HRM is concerned with issues
outside the organization and the influence of this external context.
HPWSs: bundles of HRM practices designed to improve firm performance
Chapter 6: The Contextual SHRM Framework
The Contextually Based Human Resource Theory (CBHRT)
Two predominant dimensions in a firm’s
environment are argued to dominate the
crafting of SHRM, moderated by other
internal factors. First, SHRM is determined by
competitive mechanisms, which consist of
demands arising from relevant product-
market combinations and appropriate
technology. They are aimed at achieving
certain desirable organizational capabilities
(efficiency etc.). This dimension represents
the tough economic rationality of
competition. The competitive market is
embedded in a system of institutional
mechanisms. Prevailing values and norms and
their institutionalization channel alter the
outcomes of competitive market forces. The
goal is achieving legitimacy: the acceptance of
organizations in the wider society in which they operate, to ensure access to necessary resources
from potential exchange partners (= relational rationality). The configuration dimension may be
considered the outcome of past strategic choices interacting with the organizational structure and
culture that they engendered. It is the influence of structures, methods, competencies and values
that originated in the past. We then see the role of active human agency (through the dominant
coalition) in the decision making process. All of the actors have their own values, norms and
attitudes, shared with others to a greater or lesser degree. The leeway (room for manoeuvre) is
available for the actors to make their own strategic choices. The dominant coalition is involved in
shaping and selecting an HRM strategy, based on aligning with different internal and external forces.
The shaping of the HRM strategy is aimed at generating HRM outcomes, which in turn contribute to
the performance of the organization as a whole.
The Contextual SHRM Framework
There are two sides in this
framework: the context side
and the SHRM side. The
outcomes of the three
mechanisms have been made
more explicit. These describe
how the firm is dealing with
its reality, often describing a
desired state. There are 4
types of fit:
- Organization fit: fit
between the
organizations heritage
and its SHRM system
- Strategic fit: fit
between the competitive mechanisms and the SHRM system
