Malcolm Patterson

A conceptual framework for implementation fidelity.

BackgroundImplementation fidelity refers to the degree to which an intervention or programme is delivered as intended. Only by understanding and measuring whether an intervention has been implemented with fidelity can researchers and practitioners gain a better understanding of how and why an intervention works, and the extent to which outcomes can be improved.DiscussionThe authors undertook a critical review of existing conceptualisations of implementation fidelity and developed a new conceptual framework for understanding and measuring the process. The resulting theoretical framework requires testing by empirical research.SummaryImplementation fidelity is an important source of variation affecting the credibility and utility of research. The conceptual framework presented here offers a means for measuring this variable and understanding its place in the process of intervention implementation.

The link between the management of employees and patient mortality in acute hospitals

The relationship between human resource management practices and organizational performance (including quality of care in health-care organizations) is an important topic in the organizational sciences but little research has been conducted examining this relationship in hospital settings. Human resource (HR) directors from sixty-one acute hospitals in England (Hospital Trusts) completed questionnaires or interviews exploring HR practices and procedures. The interviews probed for information about the extensiveness and sophistication of appraisal for employees, the extent and sophistication of training for employees and the percentage of staff working in teams. Data on patient mortality were also gathered. The findings revealed strong associations between HR practices and patient mortality generally. The extent and sophistication of appraisal in the hospitals was particularly strongly related, but there were links too with the sophistication of training for staff, and also with the percentages of staff working in teams.

Do Organizational Climate and Competitive Strategy Moderate the Relationship Between Human Resource Management and Productivity

This study examined whether the effectiveness of human resource management (HRM) practices is contingent on organizational climate and competitive strategy. The concepts of internal and external fit suggest that the positive relationship between HRM and subsequent productivity will be stronger for firms with a positive organizational climate and for firms using differentiation strategies. Resource allocation theories of motivation, on the other hand, predict that the relationship between HRM and productivity will be stronger for firms with a poor climate because employees working in these firms should have the greatest amount of spare capacity. The results supported the resource allocation argument.

When promoting positive feelings pays: Aggregate job satisfaction, work design features, and innovation in manufacturing organizations

This study investigates the relationship between aggregate job satisfaction and organizational innovation. In a sample of manufacturing companies, data were gathered from 3717 employees in 28 UK manufacturing organizations about their job satisfaction and aggregated to the organizational level. Data on innovation in technology/processes were gathered from multiple respondents in the same organizations 24 months later. The results revealed that aggregate job satisfaction was a significant predictor of subsequent organizational innovation, even after controlling for prior organizational innovation and profitability. Moreover the data indicated that the relationship between aggregate job satisfaction and innovation in production technology/processes was moderated by two factors: job variety and a commitment to “single status”. Unlike previous studies, we conceptualize job satisfaction at the aggregate rather than the individual level and examine innovation rather than creativity. We propose that where the majority of employees experience job satisfaction, they will endorse rather than resist innovation and work collaboratively to implement as well as to generate creative ideas.

Use of a safety climate questionnaire in UK health care: factor structure, reliability and usability

Aim: To explore the factor structure, reliability, and potential usefulness of a patient safety climate questionnaire in UK health care. Setting: Four acute hospital trusts and nine primary care trusts in England. Methods: The questionnaire used was the 27 item Teamwork and Safety Climate Survey. Thirty three healthcare staff commented on the wording and relevance. The questionnaire was then sent to 3650 staff within the 13 NHS trusts, seeking to achieve at least 600 responses as the basis for the factor analysis. 1307 questionnaires were returned (36% response). Factor analyses and reliability analyses were carried out on 897 responses from staff involved in direct patient care, to explore how consistently the questions measured the underlying constructs of safety climate and teamwork. Results: Some questionnaire items related to multiple factors or did not relate strongly to any factor. Five items were discarded. Two teamwork factors were derived from the remaining 11 teamwork items and three safety climate factors were derived from the remaining 11 safety items. Internal consistency reliabilities were satisfactory to good (Cronbach’s alpha ⩾0.69 for all five factors). Conclusions: This is one of the few studies to undertake a detailed evaluation of a patient safety climate questionnaire in UK health care and possibly the first to do so in primary as well as secondary care. The results indicate that a 22 item version of this safety climate questionnaire is useable as a research instrument in both settings, but also demonstrates a more general need for thorough validation of safety climate questionnaires before widespread usage.

Learning in manufacturing organizations: what factors predict effectiveness?

This paper argues that it is possible to identify factors which pre-dispose organizations to adopt effective learning strategies and processes. It is hypothesized that effective OL is associated with: profitability, environmental uncertainty, structure, approach to HRM and quality orientation. The study focuses on forty-four manufacturing organizations, and draws on longitudinal data gathered through interviews. The findings suggest that two of these variables - approach to HRM and quality orientation - are particularly strongly correlated with measures of OL. It is concluded that effective learning mechanisms, with the potential to improve the quality of OL processes, are more likely to be established in businesses where HRM and quality initiatives are well established.

Systematic review of the links between human resource management practices and performance

BACKGROUND In recent years human resource management (HRM) has been seen as an important factor in the successful realisation of organisational change programmes. The UK NHS is undergoing substantial organisational change and there is a need to establish which human resource (HR) initiatives may be most effective. OBJECTIVES To assess the results from a wide-ranging series of systematic reviews of the evidence on HRM and performance. The first part assesses evidence on use of HRM in the UK and fidelity of practice implemented. The second part considers evidence for the impact of HRM practices on intermediate outcomes, which can impact on final outcomes, such as organisational performance or patient care. DATA SOURCES The following databases were searched: Applied Social Sciences Index and Abstracts (ASSIA), British Nursing Index (BNI), Business Source Premier, Campbell Collaboration, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Database of Abstracts of Reviews of Effectiveness (DARE), DH-Data, EMBASE, Health Management Information Consortium (HMIC), International Bibliography of the Social Sciences (IBSS), Kings Fund database, MEDLINE, NHS Economic Evaluation Database (NHS EED), National Research Register (NRR), PREMEDLINE, PsycINFO, ReFeR, Social Sciences Citation Index (SSCI) and Science Citation Index (SCI). The searches were conducted in May/June 2006. REVIEW METHODS Broad categories of HRM interventions and intermediate outcomes were generated: 10 HRM categories and 12 intermediate outcome categories. Seven patient final outcomes were derived from the NHS Performance Indicators and the NHS Improvement Plan. The quality criteria used to select papers incorporated a longitudinal study design filter to provide evidence of the causal direction of relationships between HRM and relevant outcomes. Single HRM practices were considered. Within the health-specific literature, focus was on the impact of HRM on patient outcomes. Information is presented on the reliability of measures in each of the intermediate outcome areas. RESULTS Work design practices that enhance employee autonomy and control influenced a number of outcomes and there was consistent evidence for the positive impact of increased job control on employee outcomes, such as job satisfaction, absence and health. For employee participation, the small number of studies reviewed supported the involvement of employees in design/implementation of changes that affect their work. In health literature in particular, employee involvement through quality improvement teams resulted in improved patient outcomes. Findings were positive for the impact of training on the intended outcomes of the initiatives. Support for the impact of performance management practices was apparent, in particular feedback on performance outcomes and the use of participative goal setting. Strong associations were found among all intermediate outcomes, and the relationship between most intermediate behaviours and outcomes were significant. LIMITATIONS Limited evidence was available on the use of HRM and on the implementation of policy. Also, the specific practices studied within each HRM category differ so there was little evidence to show whether similar practices have the same effects in health and non-health settings. CONCLUSIONS Some potentially effective practices for both health and non-health areas were identified, and HRM methods could be used to support change processes within the NHS; the findings relating to work organisation are particularly promising with regard to changes in methods of service delivery. Using training to support the implementation of change is highlighted. However, future multilevel studies that embrace the individual, team and organisational level are needed. Studies should look into interventions aimed at improving HR outcomes and performance, and allow for pre- and post-intervention measurement of practices and outcomes.

Organizations Driving Positive Social Change: A Review and an Integrative Framework of Change Processes

Academic and practitioner interest in how market-based organizations can drive positive social change (PSC) is steadily growing. This paper helps to recast how organizations relate to society. It integrates research on projects stimulating PSC—the transformational processes to advance societal well-being—that is fragmented across different streams of research in management and related disciplines. Focusing on the mechanisms at play in how organizations and their projects affect change in targets outside of organizational boundaries, we (1) clarify the nature of PSC as a process, (2) develop an integrative framework that specifies two distinct PSC strategies, (3) take stock of and offer a categorization scheme for change mechanisms and enabling organizational practices, and (4) outline opportunities for future research. Our conceptual framework differentiates between surface- and deep-level PSC strategies understood as distinct combinations of change mechanisms and enabling organizational practices. These strategies differ in the nature and speed of transformation experienced by the targets of change projects and the resulting quality (pervasiveness and durability), timing, and reach of social impact. Our findings provide a solid base for integrating and advancing knowledge across the largely disparate streams of management research on corporate social responsibility, social entrepreneurship, and base of the pyramid and open up important new avenues for future research on organizing for PSC and on unpacking PSC processes.

Teamwork and organizational innovation: The moderating role of the HRM context

Evidence is accumulating on the role of teams in shaping a variety of business outcomes, but our knowledge on the effect of teamwork on organizational innovation is still evolving. This study examines whether the extent to which two staff groups are organized in teams (production staff and management/administrative staff) affects organizational innovation and whether human resource management (HRM) systems, which can be of facilitating or constraining nature, enhance the teamwork/innovation relationships. Hypotheses were tested with lagged and longitudinal data derived from 18 to 45 organizations from the UK manufacturing sector. Results suggest that the more widespread the use of teamwork in organizations, the higher the level of organizational innovation. Furthermore, this effect depends, particularly for production teams, on the overall quality of the HRM systems that exist in their organizations. Teamwork/innovation relationships are further moderated (for management and administrative teams) by an HRM practice that provides teams with time for thoughtful reflection. Thus, HRM systems can be of more or less facilitating or constraining nature for teams in organizations.

How do nurses, midwives and health visitors contribute to protocol-based care? A synthesis of the UK literature

OBJECTIVES To explore how nurses, midwives and health visitors contribute to the development, implementation and audit of protocol-based care. Protocol-based care refers to the use of documents that set standards for clinical care processes with the intent of reducing unacceptable variations in practice. Documents such as protocols, clinical guidelines and care pathways underpin evidence-based practice throughout the world. METHODS An interpretative review using the five-stage systematic literature review process. The data sources were the British Nursing Index, CINAHL, EMBASE, MEDLINE and Web of Science from onset to 2005. The Journal of Integrated Care Pathways was hand searched (1997-June 2006). Thirty three studies about protocol-based care in the United Kingdom were appraised using the Qualitative Assessment and Review Instrument (QARI version 2). The literature was synthesized inductively and deductively, using an official 12-step guide for development as a framework for the deductive synthesis. RESULTS Most papers were descriptive, offering practitioner knowledge and positive findings about a locally developed and owned protocol-based care. The majority were instigated in response to clinical need or service re-design. Development of protocol-based care was a non-linear, idiosyncratic process, with steps omitted, repeated or completed in a different order. The context and the multiple purposes of protocol-based care influenced the development process. Implementation and sustainability were rarely mentioned, or theorised as a change. The roles and activities of nurses were so understated as to be almost invisible. There were notable gaps in the literature about the resource use costs, the engagement of patients in the decision-making process, leadership and the impact of formalisation and new roles on inter-professional relations. CONCLUSIONS Documents that standardise clinical care are part of the history of nursing as well as contemporary evidence-based care and expanded roles. Considering the proliferation and contested nature of protocol-based care, the dearth of literature about the contribution, experience and outcomes for nurses, midwives and health visitors is noteworthy and requires further investigation.