Implementing high-performance work practices in healthcare organizations: qualitative and conceptual evidence.

Ann Scheck McAleamey, ScD, professor and mce chair, Department of Family Medicine, The Ohio State University, Columbus; Julie Robbins, PhD, post-doctoral researcher, Department of Family Medicine, The Ohio State University; Andrew N. Garman, PsyD, professor, Department of Flealth Systems Management, Rush University, and CEO, National Center for Healthcare Leadership, Chicago, Illinois; and Paula H. Song, PhD, associate professor, FFealth Services Management and Policy, College of Public Health, The Ohio State UniversityEXECUTIVE SUMMARYStudies across industries suggest that the systematic use of high-performance work practices (HPWPs) may be an effective but underused strategy to improve quality of care in healthcare organizations. Optimal use of HPWPs depends on how they are implemented, yet we know little about their implementation in healthcare.We conducted 67 key informant interviews in five healthcare organizations, each considered to have exemplary work practices in place and to deliver high-quality care, as part of an extensive study of HPWP use in healthcare. We analyzed interview transcripts inductively and deductively to examine why and how organizations implement HPWPs. We used an evidence-based model of complex innovation adoption to guide our exploration of factors that facilitate HPWP implementation.We found considerable variability in interviewees' reasons for implementing HPWPs, including macro-organizational (strategic level) and micro-organizational (individual level) reasons. This variability highlighted the complex context for HPWP implementation in many organizations. We also found that our application of an innovation implementation model helped clarify and categorize facilitators of HPWP implementation, thus providing insight on how these factors can contribute to implementation effectiveness. Focusing efforts on clarifying definitions, building commitment, and ensuring consistency in the application of work practices may be particularly important elements of successful implementation.For more information about the concepts in this article, please contact Dr. McAleamey at ann.mcaleamey@osumc.edu.INTRODUCTIONIncreasing evidence suggests that a link exists between a capable workforce and the delivery of high-quality patient care across healthcare settings (Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; McCue, Mark, & Harless, 2003; Tang, 2003). In healthcare organizations challenged to address issues associated with suboptimal care quality and patient safety (e.g., IOM, 2001; Kohn, Corrigan, & Donaldson, 1999; McGlynn et al., 2003), the use of innovative management practices-or high-performance work practices-may be an important strategic opportunity to consider (Garman, McAlearney, Harrison, Song, & McHugh, 2011).High-performance work practices (HPWPs) include a set of human resource (HR) practices-for example, performance appraisal, training, and teamwork-that, when implemented together, show a positive relationship with organizational outcomes (e.g., Becker & Huselid, 1998, 2006; Combs, Ketchen, Hall,