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

Authors

  • Emmeline Chuang Ph.D.,

    Corresponding author
    • Division of Health Management and Policy, Graduate School of Public Health, San Diego State University, San Diego, CA
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  • Janette Dill Ph.D.,

    1. Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, NC
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  • Jennifer Craft Morgan Ph.D.,

    1. UNC Institute on Aging and Department of Allied Health Sciences, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC
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  • Thomas R. Konrad Ph.D.

    1. UNC Institute on Aging and Cecil G. Sheps Center for Health Services Research, University of North Carolina-Chapel Hill, Chapel Hill, NC
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Address correspondence to Emmeline Chuang, Ph.D., Associate Professor, Division of Health Management and Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182-4162; e-mail: echuang@mail.sdsu.edu.

Abstract

Objective

To identify high-performance work practices (HPWP) associated with high frontline health care worker (FLW) job satisfaction and perceived quality of care.

Methods

Cross-sectional survey data from 661 FLWs in 13 large health care employers were collected between 2007 and 2008 and analyzed using both regression and fuzzy-set qualitative comparative analysis.

Principal Findings

Supervisor support and team-based work practices were identified as necessary for high job satisfaction and high quality of care but not sufficient to achieve these outcomes unless implemented in tandem with other HPWP. Several configurations of HPWP were associated with either high job satisfaction or high quality of care. However, only one configuration of HPWP was sufficient for both: the combination of supervisor support, performance-based incentives, team-based work, and flexible work. These findings were consistent even after controlling for FLW demographics and employer type. Additional research is needed to clarify whether HPWP have differential effects on quality of care in direct care versus administrative workers.

Conclusions

High-performance work practices that integrate FLWs in health care teams and provide FLWs with opportunities for participative decision making can positively influence job satisfaction and perceived quality of care, but only when implemented as bundles of complementary policies and practices.

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