Using Workforce Practices to Drive Quality Improvement: A Guide for Hospitals

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A Guide for Hospitals

The purpose of this guide is to provide hospital leaders and human resources staff a basic description of four high-performance work practices (HPWPs) that can help improve an organization's capacity to effectively attract, select, hire, develop, and retain and deploy personnel in ways that best support a high-performing health care system. It also offers approaches and recommendations for implementing HPWPs in their organizations.

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http://www.ahrq.gov/qual/workforceguide.pdf

Contents

Acknowledgments
Introduction
HPWP Category 1: Organizational Engagement Practices
HPWP Category 2: Staff Acquisition and Development Practices
HPWP Category 3: Frontline Empowerment Practices
HPWP Category 4: Leadership Alignment/Development
Facilitating the Adoption of High-Performance Work Practices
Conclusion
Organizational Assessment
Resources


Acknowledgments

The Health Research & Educational Trust (HRET), an affiliate of the American Hospital Association (AHA), is dedicated to transforming health care through research and education. The research and publication costs for this guide were funded by the Agency for Healthcare Research and Quality (Contract No. HHSA290200600022, Task Order No. 5).

We appreciate the work of the following contributors who served as advisors to this project:

Peter I. Buerhaus, Ph.D., RN, FAAN
Professor of Nursing
Vanderbilt University

Myron D. Fottler, Ph.D.
Director of Programs
University of Central Florida

Jane Grady, Ph.D.
Assistant Vice President, Human Resources
Rush University Medical Center

Stephen R. Grossbart, Ph.D.
Corporate Quality Officer
Catholic Healthcare Partners

Stephen R. Mayfield, Dr.H.A., M.B.A., M.B.B.
Senior Vice President for Quality and Performance Improvement
Quality Center Director
American Hospital Association

Nicole Morin-Scribner, M.B.A., SPHR
Director of Human Resources
St. Mary's Health System

Nancy Pratt, RN, M.S.
Senior Vice President, Clinical Effectiveness
Sharp HealthCare

Contact Information; Michael Harrison, AHRQ. E-Mail: Michael.Harrison@ahrq.hhs.gov.

The authors of this report are responsible for its content. The authors and investigators have all provided assurances to AHA and AHRQ that they did not have any affiliations or financial involvement that created a conflict of interest with respect to any of the material or conclusions presented in this publication. Funding of the Guide by the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services was provided to collect and disseminate employment practices that have yielded high quality outcomes. The contents of the Guide should not be interpreted as mandatory national standards of clinical practice or quality health care.


Introduction

There is ample evidence indicating the need to improve health care quality. Health care organizations have been investing significant resources to implement systems and processes to improve care quality, but must pursue these efforts strategically in order to maximize their effectiveness within an environment of growing resource constraints.

A considerable amount of information suggests that workforce practices may represent an important and underutilized resource for supporting quality improvement activities in health care organizations. The availability of a stable, capable health care workforce has been shown repeatedly to be critical to the efficient and effective delivery of health services. Although researchers are still investigating links between workforce practices and care quality, the findings so far suggest that several practices hold the potential to positively affect organizational outcomes.

The purpose of this guide is to provide hospital leaders and human resources staff a basic description of four high-performance work practices (HPWPs) that can help improve an organization's capacity to effectively attract, select, hire, develop, and retain and deploy personnel in ways that best support a high-performing health care system. It also offers approaches and recommendations for implementing HPWPs in their organizations. These HPWPs fall into four categories.

* HPWP Category 1: Organizational Engagement Practices:

Practices that ensure all employees' awareness, understanding, and personal stake in the organization's vision, including its current level of success in pursuing that vision.
o Communicating mission, vision, and values.
o Sharing performance information.
o Involving employees in key decisions.
o Tracking and rewarding performance.

* HPWP Category 2: Staff Acquisition and Development Practices:

Practices that build the quality of the organization's workforce through attention to attracting, selecting, and developing staff.
o Rigorous recruiting.
o Selective hiring.
o Extensive training.
o Career development.

* HPWP Category 3: Frontline Empowerment Practices:

Practices that affect the ability and motivation of frontline staff to improve the quality of care that their teams provide.
o Employment security.
o Reduced status distinctions.
o Teams/decentralized decisionmaking.

* HPWP Category 4: Leadership Alignment and Development Practices:

Practices that develop leaders and align behavior with organizational goals.
o Linking management training to organizational needs.
o Planning succession.
o Tracking and rewarding performance.

These numerous HPWPs can be facilitated by the following actions, which will be expanded upon in a later section of this guide:

* Commit to an organizational culture that focuses on quality and safety.
* Engage senior leadership support.
* Involve the human resource department in strategic planning.
* Identify opportunities for shared learning.
* Hire human resources professionals with training and experience in HPWPs.
* Involve employee representatives.
* Monitor progress.

The implementation recommendations presented below were distilled from a review of peer-reviewed and gray literature covering health care and other industries, and from findings from case studies of five health care organizations that have been recognized for their successful workforce practices (e.g., Fortune magazine's 'Best Companies to Work For,' Baldrige National Quality Award). A checklist for readers to document and assess the extent to which HPWPs are used in their organizations is available later in this guide.



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