Ariel C. Avgar

From the Firm to the Network: Global Value Chains and Employment Relations Theory

We posit that traditional employment relations theories that focus on individual firms embedded in distinct national institutional contexts are no longer adequate for the analysis of employment relations in a globalized era where production and services are increasingly coordinated across countries and firms. Building on global value chain theory, we introduce a configurational framework that explicitly addresses the employment relations implications of the interconnections within and between firms in the global economy. We argue that different value chain configurations will evidence different employment relations patterns, and we validate our framework by applying it to the study of three contemporary global issues. In sum, the framework permits a shift in the focus of employment relations scholarship away from the individual firm to the global networks in which they belong, and hence provides a new theoretical lens for the analysis of employment relations in the global economy.

The Importance of a High-Performance Work Environment in Hospitals

OBJECTIVE To examine the benefits of a high-performance work environment (HPWE) for employees, patients, and hospitals. STUDY SETTING Forty-five adult, medical-surgical units in nine hospitals in upstate New York. STUDY DESIGN Cross-sectional study. DATA COLLECTION Surveys were collected from 1,527 unit-based hospital providers (68.5 percent response rate). Hospitals provided unit turnover and patient data (16,459 discharge records and 2,920 patient surveys). PRINCIPAL FINDINGS HPWE, as perceived by multiple occupational groups on a unit, is significantly associated with desirable work processes, retention indicators, and care quality. CONCLUSION Our findings underscore the potential benefits for providers, patients, and health care organizations of designing work environments that value and support a broad range of employees as having essential contributions to make to the care process and their organizations.

Drivers and Barriers in Health IT Adoption: A Proposed Framework

Despite near (and rare) consensus that the adoption and diffusion of health information technology (health IT) will bolster outcomes for organizations, individuals, and the healthcare system as a whole, there has been surprisingly little consideration of the structures and processes within organizations that might drive the adoption and effective use of the technology. Management research provides a useful lens through which to analyze both the determinants of investment and the benefits that can ultimately be derived from these investments. This paper provides a conceptual framework for understanding health IT adoption. In doing so, this paper highlights specific organizational barriers or enablers at different stages of the adoption process - investment, implementation, and use - and at different levels of organizational decision-making - strategic, operational, and frontline. This framework will aid both policymakers and organizational actors as they make sense of the transition from paper-based to electronic systems.

HAVING YOUR CAKE AND EATING IT TOO? THE RELATIONSHIP BETWEEN HR AND ORGANIZATIONAL PERFORMANCE IN HEALTHCARE

This paper examines the relationship between human resource practices in 173 hospitals in the United Kingdom and four organizational outcome categories – clinical, financial, employee attitudes and perceptions, and patient attitudes and perceptions. The overarching proposition set forth and examined in this paper is that human resource management (HRM) practices and delivery of care practices have varied effects on each of these outcomes. More specifically, the authors set forth the proposition that specific practices will have positive effects on one outcome category while simultaneously having a negative effect on other performance outcomes, broadly defined. The paper introduces a broader stakeholder framework for assessing the HR–performance relationship in the healthcare setting. This multi-dimensional framework incorporates the effects of human resource practices on customers (patients), management, and frontline staff and can also be applied to other sectors such as manufacturing. This approach acknowledges the potential for incompatibilities between stakeholder performance objectives. In the healthcare industry specifically, our framework broadens the notion of performance. Overall, our results provide support for the proposition that different stakeholders will be affected differently by the use of managerial practices. We believe that the findings reported in this paper highlight the importance of examining multiple stakeholder outcomes associated with managerial practices and the need to identify the inherent trade-offs associated with their adoption.

Negotiated capital: Conflict, its resolution, and workplace social capital

Purpose – The purpose of this paper is to examine the effects of conflict and conflict resolution on employee perceptions of unit social capital. The paper aims to test the overarching proposition that social capital is affected by different types of conflict and by organizational methods used to manage them.Design/methodology/approach – The papers hypotheses were tested using survey data collected as part of a case study conducted in a large Ohio hospital that had adopted a conflict management system. Survey data from 791 hospital employees were used to test hypotheses regarding the relationship between conflict and its management and social capital.Findings – Analysis of the data supports the papers proposition that different forms of conflict affect perceptions of social capital differently. Relationship and task conflict were significantly and negatively related to employee perceptions of social capital. Conflict regarding patient care issues, on the other hand, was significantly and positively rela...

A Balancing Act: Work–Life Balance and Multiple Stakeholder Outcomes in Hospitals

This article examines the direct and indirect effects of work–life balance (WLB) practices on multiple stakeholder outcomes in hospitals. The authors examine the direct and indirect effects of WLB practices in 173 hospitals in the United Kingdom on organizational, patient care and employee outcomes. The article proposes a model in which the effects of WLB practices on patient care outcomes and financial performance are mediated by employee turnover intentions. The authors provide strong support for the potential vested in WLB practices in the healthcare setting. Results indicate that greater use of WLB practices enhances outcomes for hospitals, their employees and the patients they care for.

Conflict in context: Perceptions of conflict, employee outcomes and the moderating role of discretion and social capital

Purpose – The purpose of this paper is to examine the moderating effect of discretion and social capital on the relationship between individual perceptions of team conflict and employee-level outcomes. The authors propose that both employee discretion and unit-level social capital influence the negative effects of perceived conflict on employee stress and turnover intentions. They argue that an individual’s perceptions of these central organizational characteristics are likely to alter the consequences associated with conflict and the manner in which individuals respond to it. Design/methodology/approach – This study empirically tests the moderating effects of discretion and unit-level social capital on the relationship between individual’s perception of team conflict and employee-level outcomes. Analysis was conducted with survey data from a sample of health care care providers in 90 units across 20 nursing home organizations. We applied hierarchical linear modeling analyses to test our hypotheses. Findi...

Measurement Error in Performance Studies of Health Information Technology: Lessons from the Management Literature

Just as researchers and clinicians struggle to pin down the benefits attendant to health information technology (IT), management scholars have long labored to identify the performance effects arising from new technologies and from other organizational innovations, namely the reorganization of work and the devolution of decision-making authority. This paper applies lessons from that literature to theorize the likely sources of measurement error that yield the weak statistical relationship between measures of health IT and various performance outcomes. In so doing, it complements the evaluation literatures more conceptual examination of health ITs limited performance impact. The paper focuses on seven issues, in particular, that likely bias downward the estimated performance effects of health IT. They are 1.) negative self-selection, 2.) omitted or unobserved variables, 3.) mis-measured contextual variables, 4.) mismeasured health IT variables, 5.) lack of attention to the specific stage of the adoption-to-use continuum being examined, 6.) too short of a time horizon, and 7.) inappropriate units-of-analysis. The authors offer ways to counter these challenges. Looking forward more broadly, they suggest that researchers take an organizationally-grounded approach that privileges internal validity over generalizability. This focus on statistical and empirical issues in health IT-performance studies should be complemented by a focus on theoretical issues, in particular, the ways that health IT creates value and apportions it to various stakeholders.

The Effects of Organizational Factors on Healthcare IT Adoption Costs: Evidence from New York Nursing Homes

We investigate how organizational factors influence healthcare IT adoption costs, using new data collected from an EMR adoption experiment conducted in a sample of New York State nursing homes. We find that workplaces characterized by higher levels of employee satisfaction and employee discretion incur lower EMR implementation costs. Our estimates suggest that nursing homes that are one standard deviation above the mean in terms of employee satisfaction and employee discretion measures incur about 10% lower EMR adoption costs than average facilities. Implications for policy makers and managers are discussed.

Caregivers and Computers: Key Lessons from the Adoption and Implementation of EMR in New York State Nursing Homes

This chapter presents an overview of our evaluation of the introduction of electronic medical records (EMR) in 20 nursing homes located in the New York City region. These organizations were part of an EMR demonstration project cosponsored by the for-profit segment of the nursing home industry in the region and 1199SEIU United Health Care Workers East, the union that represented frontline staff in these organizations. We report central lessons from our evaluation, which took place over the course of four years and included multiple data sources. The primary purpose of our research was to examine the effects of EMR adoption on employment and labor relations in the participating organizations. Findings are based on a longitudinal study of EMR adoption in 15 of the 20 organizations that received the EMR technology and five “control” organizations, which did not receive the technology, employing a mixed methodological design with both quantitative and qualitative data collection methods. Results from our research inform the existing EMR adoption discussion in two ways. First, we find mixed evidence associated with EMR implementation. The adoption of this new technology enhances certain organizational outcomes, but it seems to hinder others. Second, findings from our research highlight the importance of preexisting organizational factors as predictors of EMR-associated outcomes. EMR-associated outcomes, positive or negative, are likely to be contingent on key organizational characteristics and on managerial adoption strategies. Our studys findings imply that the meaningful use of EMR needs to take into account not only the technical specifications of EMR but also the organizational characteristics of the physician practices and healthcare facilities adopting the technology. Healthcare organizations vary in their capacity and ability to make optimal use of health information technology, which should be incorporated into public policy and organizational practices designed to increase adoption.