Kent V. Rondeau

Emergency department overcrowding: the impact of resource scarcity on physician job satisfaction.

EXECUTIVE SUMMARY Emergency departments in most developed countries have been experiencing significant overcrowding under a regime of severe resource constraints. Physicians in emergency departments increasingly find themselves toiling in workplaces that are characterized by diminished availability of, limited access to, and decreased stability of critical resources. Severe resource constraints have the potential to greatly weaken the overall job satisfaction of emergency physicians. This article examines the impact of hospital resource constraints on the job satisfaction of a large sample of emergency physicians in Canada. After controlling for workflow and patient characteristics and for various institutional and physician characteristics, institutional resource constraints are found to be major contributors to emergency physician job dissatisfaction. Resource factors that have the greatest impact on job satisfaction include availability of emergency room physicians, access to hospital technology and emergency beds, and stability of financial (investment) resources.

Developing human capital: what is the impact on nurse turnover?

AIM To investigate the impact that increasing human capital through staff training makes on the voluntary turnover of registered nurses. BACKGROUND Healthcare organizations in Canada, the United Kingdom, the United States, and Australia are experiencing turbulent nursing labour markets characterized by extreme staff shortages and high levels of turnover. Organizations that invest in the development of their nursing human resources may be able to mitigate high turnover through the creation of conditions that more effectively develop and utilize their existing human capital. METHODS A questionnaire was sent to the chief nursing officers of 2208 hospitals and long-term care facilities in every province and territory of Canada yielding a response rate of 32.3%. The analysis featured a three-step hierarchical regression with two sets of control variables. RESULTS After controlling for establishment demographics and local labour market conditions, perceptions of nursing human capital and the level of staff training provided were modestly associated with lower levels of establishment turnover. CONCLUSIONS and implications for Nursing Management The results suggest that healthcare organizations that have made greater investments in their nursing human capital are more likely to demonstrate lower levels of turnover of their registered nursing personnel.

Managing the clinic wait: an important quality of care challenge.

Patients spend a substantial amount of time in clinics waiting for services to be delivered by nursing and other allied health professionals. The degree to which health consumers are satisfied with the care received is strongly related to the quality of the wait experience. Health care organizations that strive to deliver exceptional service must effectively manage their clinic wait. Failure to incorporate consumer-driven features into the design of the wait experience will lead to patient and provider dissatisfaction.

Heavy physician workloads: impact on physician attitudes and outcomes:

The intensity of physician workload has been increasing with the well-documented changes in the financing, organization and delivery of care. It is possible that these stressors have reached a point where they pose a serious policy issue for the entire healthcare system through their diminution of physicians ability to effectively interact with patients as they are burned out, stressed and dissatisfied. This policy question is framed in a conceptual model linking workloads with five key outcomes (patient care quality, individual performance, absenteeism, turnover and organizational performance) mediated by physician stress and satisfaction. This model showed a good fit to the data in a structural equation analysis. Ten of the 12 hypothesized pathways between variables were significant and supported the mediating role of stress and satisfaction. These results suggest that workloads, stress and satisfaction have significant and material impacts on patient care quality, individual performance, absenteeism, turnover and organizational performance. Implications of these results and directions for future research are discussed.

Organizational Learning and Continuous Quality Improvement: Examining the Impact on Nursing Home Performance

Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organizations culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporate culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.

Impact of culture on commitment, satisfaction, and extra‐role behaviors among Canadian ER physicians

PURPOSE The purpose of this paper is to explore the impact of hospital emergency department culture on the job satisfaction, patient commitment, and extra-role performance of Canadian emergency physicians. The conceptual model related four cultural archetypes from the competing valued model to the three outcome variables. DESIGN/METHODOLOGY/APPROACH In total, 428 Canadian emergency physicians responded to a national survey. The conceptual model was tested via structural equation modeling via LISREL 8. FINDINGS Culture had a relatively weak impact on the outcomes. Human resources culture related positively to job satisfaction while bureaucratic culture related positively to patient commitment. Patient commitment, but not job satisfaction strongly and positively related to extra-role behavior. A direct relationship between entrepreneurial culture and extra-role behavior emerged from an extended analysis. PRACTICAL IMPLICATIONS Organizational culture seems to have more distal relationships with outcome variables and its influence is likely to be mediated by more proximal workplace variables. ORIGINALITY/VALUE Of value by showing that a key modern leadership challenge is to create the kind of work culture that can become a source of competitive advantage through generating particular organizational outcomes valued by stakeholders.

The adoption of high involvement work practices in Canadian nursing homes

PURPOSE The objective of the research is to assess the degree of adoption of high-involvement nursing work practices in long-term care organizations. It seeks to determine the organizational and workplace factors that are associated with the uptake/adoption of ten selected human resource high-involvement employee work practices. DESIGN/METHODOLOGY/APPROACH A survey questionnaire was sent to 300 long-term care organizations (nursing homes) in western Canada. Results from 125 nursing home establishments (43 percent response rate) are reported herein. FINDINGS Of the ten high-involvement nursing work practices examined, employee suggestion and recognition systems are the most widely adopted by homes in the sample, while shared governance and incentive/merit-base pay are used by a small minority of establishments. PRACTICAL IMPLICATIONS The uptake of high-involvement nursing work practices is not adopted in a haphazard fashion. Their uptake is variously associated with a number of establishment and workplace factors, including the presence of a supportive and enabling workplace culture. ORIGINALITY/VALUE The objective of this research is to examine the extent and degree of adoption of high involvement work practices in a sample of long-term care establishments operating in the four provinces of western Canada.

Reducing the Hospital Workforce: What is the Role of Human Resource Management Practices?

n recent years, downsizing has become a ubiquitous phenomenon of organizational life, even though an increasing body of evidence suggests that it may produce few lasting benefits (Heenan 1989; Mentzer 1996). Organizational scholars, in a burgeoning literature focusing on the downsizing process, suggest that downsizing is not merely the reverse of organizational growth and, therefore, requires a unique perspective (Cameron, Sutton, and Whetton 1988). Although downsizing is often stimulated by a change in strategy, a diminution in the availability of critical resources, or declining markets, a decline in performance is not necessarily a precursor (Cameron, Freeman, and Mishra 1993). For instance, organizations may downsize to prune an ineffective bureaucracy, lower overhead costs, hasten decision making, smooth communication, increase entrepreneurship, or improve productivity (Cascio 1993; Tomasko 1987). However, in the long run, achieving any of these benefits may stem mainly from an organizations ability to manage its human capital. The overuse and misuse of downsizing—^in a first response to environmental decline or in the pursuit of short-term, tactical objectives—have been shown to produce lasting deleterious effects on an organizations human resources (ArmstrongStassen 1993; Brockner 1988, 1992; Noer 1993). Nevertheless, how reductions are carried out may play a seminal role in mitigating the dysfunctional human consequences too often associated with organizational retrenchment (Cameron, Freeman, and Mishra 1991). Managing the workforce effectively under conditions of decline and cutback remains a unique and enduring challenge (Feldman and Leana 1994; Gilmore and Hirschhorn 1983). Progressive management of an organizations human resources has long been considered crucial to its effectiveness and, increasingly, a means by which an organization can secure strategic advantage (Lawler 1986; Pfefifer 1994, 1998; Schuler and Jackson 1987). Few researchers have examined the impact that human resource management (HRM) practices associated with higher levels of organizational performance have on an organization experiencing decline or retrenchment. However, this area of research is one of the fields most promising in recent years (Cook and Ferris 1986; Ferris, Schellenberg, and Zammuto 1984). We are only now beginning to understand how such practices afFect performance (Huselid 1995; Sheppeckand Militello 2000; Youndt et al. 1996), yet we know almost nothing about their ability to do so when the organization is undergoing significant change—including labor force displacements. Although the activities and practices identified in the literature as being high performing, high involv-

Hospital choices in times of cutback: the role of organizational culture

Organizational scholars and practitioners alike have long recognized the role of corporate culture in shaping the strategic and operational choices that organizations pursue. It is the responsibility of those who plan for change to select approaches that are compatible with the enduring elements of the organization’s dominant culture. A large sample of Canadian hospitals were surveyed to assess how organizational culture impacts the choices that organizations make in managing fiscal cutbacks. Results suggest that approaches and strategies used by Canadian hospitals in managing the change are variably influenced by CEO perceptions of the prevailing corporate culture.

Managing the workforce reduction: hospital CEO perceptions of organizational dysfunction.

EXECUTIVE SUMMARY Over the past few years many nations have undertaken activities aimed at restructuring and reengineering their health system as a means of achieving greater cost effectiveness and consumer responsiveness. Most efforts at reforming healthcare delivery have been accompanied by the downsizing of healthcare organizations. Organizations that are undergoing decline or significant workforce contractions are widely believed to experience a number of negative or dysfunctional attributes as a consequence of reductions in, or redeployments of, their labor force. For organizations undergoing planned workforce reductions, much speculation has been made in an attempt to identify a set of “best practices” that have the potential to mitigate the dysfunctional consequences associated with large permanent reductions in the workforce. This article explores the relationships among workforcereduction practices and perceptions of organizational dysfunction in a large sample of Canadian hospitals. Results of the analysis suggest that the application of certain “progressive” workforce‐reduction practices preceding, during, and subsequent to the downsizing process may play an important role in mitigating some of these dysfunctional organizational consequences. This research provides some evidence to suggest that how a workforce reduction is carried out may have a greater effect on organizational effectiveness than either the magnitude or severity of the overall workforce reduction.