Sandra G. Leggat

Effective healthcare teams require effective team members: defining teamwork competencies

BackgroundAlthough effective teamwork has been consistently identified as a requirement for enhanced clinical outcomes in the provision of healthcare, there is limited knowledge of what makes health professionals effective team members, and even less information on how to develop skills for teamwork. This study identified critical teamwork competencies for health service managers.MethodsMembers of a state branch of the professional association of Australian health service managers participated in a teamwork survey.ResultsThe 37% response rate enabled identification of a management teamwork competency set comprising leadership, knowledge of organizational goals and strategies and organizational commitment, respect for others, commitment to working collaboratively and to achieving a quality outcome.ConclusionAlthough not part of the research question the data suggested that the competencies for effective teamwork are perceived to be different for management and clinical teams, and there are differences in the perceptions of effective teamwork competencies between male and female health service managers. This study adds to the growing evidence that the focus on individual skill development and individual accountability and achievement that results from existing models of health professional training, and which is continually reinforced by human resource management practices within healthcare systems, is not consistent with the competencies required for effective teamwork.

Singing the same song: translating HRM messages across management hierarchies in Australian hospitals

This paper reports the findings of case study research exploring the strength of the HR system in three Australian public hospitals from the perspective of senior, middle and line managers, and HR practitioners. The study explored how HRM is understood, interpreted, and operationalized across the management hierarchy. The findings suggest that the role of the CEO is crucial in providing HR legitimacy, leadership and resources that create a distinctive HR system, and in nurturing within group agreement and consensus among the senior executive team on the role of HR. In turn, senior managers need to translate consistent HR messages throughout the management hierarchy and provide lower level managers with the formal and informal direction, support and empowerment to operationalize HR strategy.

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 Kennys 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.

Does psychological empowerment mediate the relationship between high performance work systems and patient care quality in hospitals

This study investigates the mediation effects of the four components of psychological empowerment on the relationship between high performance work systems (HPWS) and perceptions of patient care quality among hospital employees. To test this relationship 541 hospital employees in a large regional Australian health service were surveyed. Regression analysis findings demonstrated that psychological empowerment fully mediated the relationship between HPWS and the perception of the quality of patient care. Three of the four individual components of psychological empowerment - autonomy, competence and meaning - fully mediated the relationship between HPWS and the perception of quality of care; the fourth - impact - was non-significant. This study demonstrates the need to recognise that the quality of patient care is influenced not only by clinicians but also by allowing all hospital employees to exercise concern through their work. Healthcare managers need to focus on ensuring HRM strategy, policy and processes support the implementation of HPWS at the unit level.

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.

The role of team climate in the management of emotional labour: implications for nurse retention

AIMS This article examines the relationships among emotional labour, team climate, burnout, perceived quality of care and turnover intention among nurses in Australia, with the aim of addressing nurse retention and burnout. BACKGROUND Emotional labour refers to the regulation of emotion during interpersonal transactions. It may involve faking unfelt emotions, hiding genuine emotions and deep acting whereby the individuals attempt to influence their inner feelings to induce the appropriate outward countenance. Currently, there is a dearth of literature that investigates the link between emotional labour and perceived quality of care and ultimately turnover intention. The contribution of team climate in the relationship between emotional labour and burnout is still uncertain. DESIGN A cross-sectional quantitative study conducted with self-completed questionnaires. METHODS The study was conducted in 2011 with 201 registered nurses. Validated measures were used to measure the aforementioned constructs. Confirmatory factor analyses were used to examine the factor structure of the measured variables and hypotheses were tested using structural equation modelling. RESULTS The final model demonstrates that faking has a significant negative influence on perceived quality of care. Hiding predicts burnout, leading to an increase in turnover intention. Team climate moderates the relationship between hiding and burnout, which may subsequently influence turnover intention. CONCLUSION The establishment of a strong team climate may help nurses to manage the emotional demands of their role, promote their well-being and retention.

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.

Social identification: linking high performance work systems, psychological empowerment and patient care

This paper examines the mediating effects of social identification on the relationship between high performance work systems (HPWS) and psychological empowerment and the direct relationship between psychological empowerment and clinician perceptions of quality of patient care. We use structural equation modelling on a sample of 254 health professionals from a large regional hospital in Australia. Results demonstrate, first, a strong effect of HPWS on social identification. Second, social identification mediates the relationship between HPWS and psychological empowerment and, third, psychological empowerment has a strong effect on clinician perceptions of quality of patient care. Implications are drawn for management theory and hospital managers.

Comparing the impact of leader–member exchange, psychological empowerment and affective commitment upon Australian public and private sector nurses: implications for retention

This study uses Leader–Member Exchange (LMX) theory to test the associations between the supervisor–subordinate relationship, psychological empowerment and affective commitment amongst 1283 nurses working in Australian public and private hospitals. Both qualitative and quantitative data were collected, analysed and presented. The findings show that the quality of LMX is more important in public sector nursing contexts than in the private sector with regard to the relationship between empowerment and affective commitment. Furthermore, the relationship between empowerment and affective commitment is stronger for nurses in public sector organisations with low-quality LMX than for nurses in public sector organisations with high-quality LMX. As empowerment and affective commitment are both predictors of staff retention, the findings can assist in developing targeted current and future retention strategies for healthcare management.

Content of clinical supervision sessions for nurses and allied health professionals: A systematic review

Purpose – The purpose of this paper is to evaluate the current evidence regarding the content of clinical supervision for nursing and allied health professionals.Design/methodology/approach – The authors searched CINAHL, Medline, PsychINFO and Cochrane Database. Studies were included if the participants involved were nursing, medical or allied health practitioners, but not students, and if the studies contained discussion regarding the content of clinical supervision. Critical analysis of the articles was carried out by two independent researchers to ensure consistency and thematic analysis was applied.Findings – Twenty included articles were in three main categories: cross‐sectional studies (n=9), including interview, survey and focus group methods of data collection; literature reviews (n=2); and nine published opinion pieces. Themes related to the content of clinical supervision that were identified were reflective practice; task oriented content; diversity of content; and stress management. The result...