The relationship between work-life balance, the need for achievement, and intention to leave: Mixed-method study.

AIMS: To examine the mediating role of employee well-being on the relationship between work-life balance practices, the need for achievement and intention to leave among nurses in Malaysia. BACKGROUND: Work-life balance practices are associated with employee perceptions of the need for achievement and well-being which subsequently influence their intention to leave the organization. This study contributes new knowledge to nursing studies on work-life balance in an Asian and Islamic society where the expectations for women are to focus on family rather than career. DESIGN: A cross-sectional, explanatory mixed methodology. METHODS: This is a two-phase study conducted between 2015-2017 with 401 nurses in East Malaysia. In Phase 1, researchers surveyed 379 nurses to test eight hypotheses and in Phase 2 researchers interviewed 22 nurses to explore the results of Phase 1. RESULTS: Phase 1 revealed job satisfaction mediates the relationship between work-life balance practices (e.g. flexibility and choice in working hours, supportive supervision), financial success, and intention to leave. However, life satisfaction and money as a motivator did not mediate such relationships. Phase 2 identified four important factors that cast light on survey results: working conditions of Malaysian nurses; inadequate compensation in the public healthcare sector; team-based practices; and pressure on senior nurses in both administrative and clinical roles. CONCLUSION: This is one of the first studies to investigate work-life balance issues among nurses in Malaysia. Outcomes of this study extend the debates on work-life balance and employee well-being in an Asian Islamic social context. IMPACT: The use of flexible working arrangements and collectivist teamwork approaches, improving compensation and employment benefits and eliminating the 'time-based job promotion' policy may help to mitigate work-life balance issues and intention to leave among nurses in Malaysia.

Process redesign for time-based emergency admission targets.

Purpose Hospitals have used process redesign to increase the efficiency of the emergency department (ED) to cope with increasing demand. While there are published studies suggesting a positive outcome, recent reviews have reported that it is difficult to conclude that these approaches are effective as a result of substandard research methodology. The purpose of this paper is to explore the perceptions of hospital staff on the impact of a process redesign initiative on quality of care. Design/methodology/approach A retrospective qualitative case study examining a Lean Six Sigma (LSS) initiative in a large metropolitan hospital from 2009 to 2010. Non-probability sampling identified interview subjects who, through their participation in the redesign initiative, had a detailed understanding of the implementation and outcomes of the initiative. Between April 2012 and January 2013 26 in-depth semi-structured interviews were conducted and analysed with thematic content analysis. Findings There were four important findings. First, when asked to comment on the impact of the LSS implementation, without prompting the staff spoke of quality of care. Second, there was little agreement among the participants as to whether the project had been successful. Third, despite the recognition of the need for a coordinated effort across the hospital to improve ED access, the redesign process was not successful in reducing existing divides among clinicians and among managers and clinicians. Finally, staff expressed tension between production processes to move patients more quickly and their duty of care to their patients as individuals. Originality/value One of the first studies to explore the impact of process redesign through in-depth interviews with participating staff, this study adds further evidence that organisations implementing process redesign must ensure the supporting management practices are in place.

Organisational development in a rural hospital in Australia.

OBJECTIVE: This paper analyses an organisational development project that aimed to change the organisational culture and improve people management systems and processes. The questions addressed were: was the change process a success; how was success defined; and what were the barriers to its progress? METHODS: We examined the process of change over a 3-year period. The organisational development intervention is described and analysed. Qualitative methods, including document review, in-depth interviews and focus groups, participant observation, newsletters and diary entries were used to gather the data. A variant of competing values was used to analyse the data. RESULTS: We sought to build trust with all managers and encouraged reflection by conducting feedback sessions, presentations, workshops and one-on-one and group discussions. A cross-site action group was established to encourage organisation-wide participation in the project. However, it was clear that stakeholders had different understandings and perceptions of the problems facing the organisation. The project faltered when a leadership development intervention was organised. CONCLUSIONS: The existence of at least four different organisational 'worlds' and identities, according to different professional groupings with different goals, languages and values, was evident. The relationship between the researcher and subjects was key in terms of whether the researcher is seen as an 'expert' or as a 'facilitator'. In bringing about change, we need to work with the Chief Executive Officer in empowering others. Hence, the researchers need to engage in continual dialogue across boundaries and within groups as well as at individual levels to provide support for organisational change.

Do perceived high performance work systems influence the relationship between emotional labour, burnout and intention to leave? A study of Australian nurses.

AIMS: The purpose of this article was to explore the relationships between perceived high performance work systems, emotional labour, burnout and intention to leave among nurses in Australia. BACKGROUND: Previous studies show that emotional labour and burnout are associated with an increase in intention to leave of nurses. There is evidence that high performance work systems are in association with a decrease in turnover. There are no previous studies that examine the relationship between high performance work systems and emotional labour. DESIGN: A cross-sectional, correlational survey. METHODS: The study was conducted in Australia in 2008 with 183 nurses. Three hypotheses were tested with validated measures of emotional labour, burnout, intention to leave, and perceived high performance work systems. Principal component analysis was used to examine the structure of the measures. The mediation hypothesis was tested using Baron and Kenny's procedure and the moderation hypothesis was tested using hierarchical regression and the product-term. RESULTS: Emotional labour is positively associated with both burnout and intention to leave. Burnout mediates the relationship between emotional labour and intention to leave. Perceived high performance work systems negatively moderates the relationship between emotional labour and burnout. Perceived high performance work systems not only reduces the strength of the negative effect of emotional labour on burnout but also has a unique negative effect on intention to leave. CONCLUSION: Ensuring effective human resource management practice through the implementation of high performance work systems may reduce the burnout associated with emotional labour. This may assist healthcare organizations to reduce nurse turnover.

High performance work systems: the gap between policy and practice in health care reform.

PURPOSE: 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. FINDINGS: 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.

Nurse perceptions of the quality of patient care: Confirming the importance of empowerment and job satisfaction.

AIM: This aim of this study was to investigate the interactive effects of psychological empowerment and job satisfaction on the relationship between high-performance work systems (HPWS) and nurses' perceptions of the quality of patient care they provide. BACKGROUND: Studies of high-performing organizations in a variety of industries have consistently reported a positive relationship between 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 patient outcomes have been reported in international health care studies. METHOD: We used regression analysis with tests of mediation and moderation to analyze survey responses collected in March 2008 of 201 nurses in a large regional Australian health service. FINDINGS: Psychological empowerment fully mediated the relationship between HPWS and perceptions of quality of patient care. Job satisfaction moderated the relationship between HPWS and perceptions of quality of patient care. CONCLUSION: Hospital managers should focus on promoting HPWS and ensuring that nurse unit managers have the competencies to empower and to enhance the job satisfaction of their staff.

High performance work systems and employee well-being: a two stage study of a rural Australian hospital.

PURPOSE: This paper aims to explore the attitudes of managers and employees to high performance work practices (HPWS) in a medium sized rural Australian hospital. DESIGN/METHODOLOGY/APPROACH: The study consists of two stages. Stage one involved a qualitative investigation consisting of interviews and focus group sessions with senior, middle and line management at the hospital. Bowen and Ostroffs framework was used to examine how strategic HRM was understood, interpreted and operationalised across the management hierarchy. Stage one investigates the views of managers concerning the implementation of strategic HRM/HPWS. Stage two consisted of a questionnaire administered to all hospital employees. The mediation effects of social identification on the relationship between high performance work systems and affective commitment and job satisfaction are examined. The purpose of stage two was to investigate the views and effects of SHRM/HPWS on employees. It should be noted that HPWS and strategic HRM are used inter-changeably in this paper. FINDINGS: At the management level the importance of distinctiveness, consistency and consensus in the interpretation of strategic HRM/HPWS practices across the organization was discovered. Findings indicate that social identification mediates the relationship between HPWS and affective commitment and also mediates the relationship between HPWS and job satisfaction. PRACTICAL IMPLICATIONS: High performance work systems may play a crucial role facilitating social identification at the unit level. Such practices and management support is likely to provide benefits in terms of high performing committed employees. ORIGINALITY/VALUE: The paper argues that team leaders and managers play a key role in building social identification within the team and that organizations need to understand this role and provide recognition, reward, education and support to their middle and lower managers.

Will "common" work environment measures lead to "common" health service performance?

The establishment of common work environment measures has the potential to increase the focus on and potentially improve human resource management (HRM) practice throughout the Canadian healthcare system. However, based on research evidence, we suggest that successful execution cannot be achieved through top-down implementation of a set of "lag" indicators. We also stress that without accompanying management training in HRM, it is unlikely that the potential benefits of an indicator set will be realized.

Exploring the lack of progress in improving patient safety in Australian hospitals.

OBJECTIVES: This study aimed to build on the increasing evidence of a link between good people management practice, and organizational and patient outcomes in public health care to document the important human resource management practices in our hospitals. METHODS: The design included large scale survey of hospital managers' perceptions of the use of human resource management practices. The questionnaire included Human resource management (HRM) measures and additional questions related to the Australian hospital accreditation standards. Data were collected in December 2003 until April 2004 from a total sample of 92 hospitals/hospital organizations from the State of Victoria, Australia. The participants were Chief Executive Officers, Human Resource Directors and two other senior managers of the hospital organizations were invited to complete the questionnaire. There were no interventions. The main outcome measure, one-way analysis of variance was used to determine differences in the perceptions of the three groups of managers' concerning the use of HRM practices. Frequency and descriptive statistics were used to determine use of HRM practices. RESULTS: A 67% response rate enabled us to document human resource management practices in Victorian hospitals. The respondents reported limited strategic and organizational HRM. CONCLUSION: This study found limited evidence of sophisticated HRM practices among hospitals and hospital organizations in the State of Victoria, Australia. Despite the increasing evidence of a relationship among effective HRM and health-care outcomes, these hospitals reported limited performance management, training and development, and employee empowerment and decision-making. The authors suggest that it is unlikely that attempts to improve patient safety in this sector will be successful until the deficits in HRM are addressed.

Performance monitoring in the Victorian health care system: an exploratory study.

This paper reports on an exploratory study which aims to improve our understanding of how the Chief Executive Officers of Victorian health services monitor strategic and operational performance in their organisations. As a component of a large scale human resource management study, we surveyed 130 Chief Executive Officers (CEOs) of Victorian health sector agencies. Our findings suggest that performance monitoring was more advanced among the larger Victorian health sector organisations, and that there were areas for improvement throughout the system. Overall, the CEOs reported limited use of performance indicators related to service and clinical perspectives, with financial and volume indicators most widely used. There was little evidence that these organisations had processes in place (such as benchmarking and linking required outcomes to staff performance management) to understand the implications of the performance information and translate them into management action. The findings suggest that the sector requires technical expertise and support in data reporting, benchmarking and quality improvement in order to improve performance monitoring and ensure its relevance to strategic control, but further study is required.

Factors affecting the job stress and job satisfaction of Australian nurses: implications for recruitment and retention.

Against a background of nurse shortages in Australian hospitals, a significant challenge facing the healthcare sector is the recruitment and retention of nurses. The job stress and job satisfaction of nurses have been associated with recruitment and retention. The aim of this study is to consider two factors that may contribute to the job satisfaction and job stress of nurses: social support and empowerment. Using a sample of 157 registered nurses in a private hospital in Melbourne, Australia, we found that social support derived from the nurse's supervisor and work colleagues lowered job stress and at the same time increased job satisfaction. The presence of nurse empowerment, meaning, impact, competence and self-determination, also lowered job stress and increased job satisfaction. Finally, we discuss contributions of this study and implications for recruitment and retention of nurses in the health sector.

Improving human resource management in Chinese healthcare: identifying the obstacles to change.

Health sector reform in China has led to increasing responsibility for hospital managers in the management of staff; but constraints continue. New personnel reforms offer new opportunities but face a number of difficulties. Drawing on research in Chinese hospitals in 1997 this paper identifies two major obstacles to improved human resource management: wage policy and lack of control by local managers over staffing.

Managing the healthcare workforce: cost reduction or innovation.

Labour costs are the largest proportion of total costs in the health industry in developed countries and are a target in health sectory reform. The Kennett government in Victoria introduced policies based on competition and cost reduction and the decentralisation of industrial relations through enterprise bargaining. These policies directly impacted on the health workforce leading to work intensification, labour shortages and poor morale. The Bracks government has since returned to centralisation. This paper argues that it is time for a more innovative approach to health workforce management based on recognising staff as an asset rather than a cost.

Evaluation of the health services management training course of Jiangsu, China.

Health service management education programs emerged in the early 1980s in China as a result of changing demands on health service managers created by new directions in health policy. This paper reports on an evaluation of the Jiangsu-Victoria Health Management Training Program and discusses five of the main findings. Participants in the study believed that the Program has impacted positively on the health management practice of Jiangsu Province, and has made a significant contribution to health services management education in China. However, certain areas in teaching practice need to be improved and participants in the study provided suggestions to achieve this. The study also found that there were limitations to the impact of managerial education due to administrative and environmental factors.

Sino-Australian cooperation in health administration education / 中华医院管理杂志

With a developmental history of more than a decade, health administration education in China has resulted in the cultivation of large numbers of health administrators and played a positive role in promoting health reform in China. The paper reports a Sino Australian jointly sponsored training program in health administration and gives an account of the development, implementation and features of the program. The authors hold that the design of the program is innovative, as it well integrates Western theories of and experiences in health administration with Chinese realities, particularly the ongoing practice of health reform. The program attaches importance not only to improving the theoretical level of health administrators, but also to cultivating abilities to solve practical problems in management, to developing strategies for active involvement in the waves of the reform, and to nurturing the spirit of lifelong learning and exploration in light of the challenges facing health administrators. The program is an attempt at a new mode of health administration education in China.