Modeling patient care quality: an empirical high-performance work system approach
| Pages | 1176-1199 |
| DOI | https://doi.org/10.1108/PR-03-2015-0068 |
| Published date | 05 September 2016 |
| Date | 05 September 2016 |
| Author | Dimitrios M. Mihail,Panagiotis V. Kloutsiniotis |
| Subject Matter | HR & organizational behaviour,Global HRM |
Modeling patient care quality: an
empirical high-performance work
system approach
Dimitrios M. Mihail and Panagiotis V. Kloutsiniotis
Department of Business Administration,
University of Macedonia, Thessaloniki, Greece
Abstract
Purpose –Following a social identity approach focussed in the Greek healthcare sector, the purpose
of this paper is to investigate the mediating effects of social identification on the relationship between
high-performance work systems (HPWS) and psychological empowerment, and the mediating role of
psychological empowerment between HPWS and quality of patient care.
Design/methodology/approach –Partial least squares-structural equation modeling was used in a
sample of 297 nurses, doctors, and allied health professionals across seven hospitals in Greece.
Findings –The findings suggest that HPWS has a strong effect on healthcare professionals’social
identification, which in turn partially mediates the relationship between HPWS and psychological
empowerment. In addition, psychological empowerment indirectly mediates the relationship between
HPWS and quality of patient care.
Practical implications –The findings not only validate previous studies’conclusions, but also
provide evidence for the potential fruitfulness of the HPWS approach from a social identity
perspective. In addition, it is also confirmed that without the presence of psychological empowerment,
HPWS may have limited impact on the quality of patient care.
Originality/value –Although HPWS have been generally connected with positive employee
attitudes and behaviors, few studies choose to follow a social identity approach in examining these
relationships. Finally, this study confirms the argument that HPWS can be a fruitful approach even in
a country severely affected by Europe’s debt crisis over the last five years.
Keywords Quantitative, Social identification, Psychological empowerment,
High-performance work systems (HPWS), Quality of patient care
Paper type Research paper
Introduction
During the past 20 years, there has been a great deal of debate regarding the
appropriate human resource practices that should be used in an organization in order
to lead to workers’prosperity and well-being and consequently to greater efficiency
and increased financial performance for the organization. The most common term
characterizing such a relationship is known as high-performance work systems
(HPWS), also referred to as high performing work practices (HPWPs), high
involvement management (HIM), and high commitment management (HCM). Despite
the fact that many researchers use the latter notions (HIM and HCM) as being the
same and identical terms with the HPWS approach, these are not equivalent to HPWS
(Boxall and Macky, 2009). In contrast, HPWS encompasses both the high
commitment and involvement elements, and is thus broader in scope (Zacharatos
et al., 2005, p. 77). Although across the human resource management (HRM) literature
HPWS has been generally examined in the manufacturing sector (e.g. Datta et al.,
2005; Delery and Doty, 1996; Huselid, 1995; Messersmith and Guthrie, 2010; Torre and
Solari, 2012), recent empirical studies have extended to the service sector as well, and
especially in regard to healthcare.
Personnel Review
Vol. 45 No. 6, 2016
pp. 1176-1199
©Emerald Group Publishing Limited
0048-3486
DOI 10.1108/PR-03-2015-0068
Received 16 March 2015
Revised 16 August 2015
Accepted 14 September 2015
The current issue and full text archive of this journal is available on Emerald Insight at:
www.emeraldinsight.com/0048-3486.htm
1176
PR
45,6
Indeed, there is mounting evidence relating aspects of HPWS and improved
patient outcomes in numerous healthcare studies. For instance, HPWS has been
connected with cost efficiency through enhancing employee satisfaction and
service quality (Scotti et al., 2007), positive perceptions of quality of patient care and
delivery of healthcare services (Bartram et al., 2014; Leggat et al., 2010, 2011),
and improved employee reaction and service quality (Lee et al., 2012; Robbins
et al., 2012). Moreover, it has been reported that the introduction of HPWS is
positively related to employee experiences of work (Harley et al., 2007, 2010) and
benefits t o employees’well-being (Fan et al., 2014), while HPWPs focussed on career
development and extensive training are positively related to career mobility, which
in turn is a significant predictor of job satisfaction and employment intentions
(Dill et al., 2014). In addition, some researchers have suggested a negative association
of HPWS with employee burnout (Ang et al., 2013; Bartram et al., 2012; Fan et al.,
2014; Zhang et al., 2013) and, consequently, on intention to leave (Ang et al., 2013;
Bartram et al., 2012).
Despite the HPWS positive contribution, however, one fact that should not be
neglected is that HRM research is often predicted from an individual rather than on a
group perspective, whereas the HRM impact on employee attitudes and performance
can be described as a social process. For the healthcare sector especially, where
different occupational and professional groups work in multidisciplinary teams, it is
extremely important to follow a social identity approach (Bartram et al., 2014,
pp. 2401-2402). Social identification refers to the inclination of a particular individual
to perceive himself or herself as representative of a particular group, which makes the
individual perceive characteristic group features as self-descriptive and leads him or
her to adopt distinctive group norms as guidelines for his or her own behavior
(Ellemers et al., 2004, p. 462). Thus, in this study we extend previous research and
propose that HPWS will have a strong impact on the healthcare practitioners’social
identity, which in turn will enhance their psychological empowerment and ultimately
lead to higher clinician perceptions of the quality of patient care. Hence, social
identification will act as a mediator on the relationship between HPWS and
psychological empowerment, while the latter is expected to mediate the relationship
between HPWS and quality of care.
Finally, one significant issue prohibiting generalizations of the positive findings
among healthcare studies concerns the existing differences between different
contexts and countries. The context in which organizations operate may indeed limit
or enhance the HPWS usefulness and success due to differences in the culture, the
legislative frames, and other cultural and institutional factors that are considered
country-contingent, and which shape employment relationships and HR decision
making in organizations. Therefore, practices which seem to be appropriate in one
culture may be less appropriate in another (Boxall and Macky, 2009; Den Hartog and
Verburg, 2004). Thus, what makes this specific research unique is the focus on the
Greek healthcare sector. Greece has been overshadowed by a deep economic crisis
since 2008. Although the unprecedented downswing of economic activity has had
devastating consequences on the overall labor market, affecting both employment
levels and the number of enterprises operating in the country, the healthcare sector
taken together with the leisure industry form the two most promising service sectors
for the country’s future development. Hence, focussing explicitly on the health care
sector, the main goal is to examine the contribution of the HPWS approach in the
Greek social context, given the current economic turmoil.
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Modeling
patient care
quality
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