A Configurational Approach to the Relationship Between High-Performance Work Practices and Frontline Health Care Worker Outcomes

Frontline health care workers—a category that includes nursing assistants and several types of technicians—are more satisfied at work when they receive supervisor support and participate in team-based work practices.

Health care organizations traditionally see their frontline workers (FLWs) as expendable. However, as the U.S. population ages and demand for health services climbs, FLWs’ cost-effectiveness makes them increasingly valuable.

High-performance work practices (HPWP) are bundles of mutually reinforcing work policies that promote worker satisfaction and increase organizational performance. The study presented here examined two “subsystems” of HPWP: staff motivation and frontline empowerment. Specifically, the authors hypothesized that when health care organizations instituted the two subsystems, there would be higher job satisfaction among FLWs and perceived quality of care among patients.

Key Findings:

  • Both job satisfaction and quality of care were simultaneously better only in health care organizations that had adopted both subsystems.
  • Bundling HPWPs may be more effective than implementing individual practices.

A limitation of this study was its use of perceived, rather than clinically measured, quality of care. The authors gathered data from Jobs to Careers: Transforming the Front Lines of Health Care, a program commissioned by the Robert Wood Johnson Foundation.

Evaluation of the Jobs to Careers Program

This evaluation assesses work-based learning systems and partnerships, and articulates the successes and challenges of the Jobs to Careers program in achieving its objectives.

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