title: High-performance work systems in health care, part 3: the role of the business case.
abstract: BACKGROUND
  Growing evidence suggests the systematic use of high-performance work practices (HPWPs), or evidence-based management practices, holds promise to improve organizational performance, including improved quality and efficiency, in health care organizations. However, little is understood about the investment required for HPWP implementation, nor the business case for HPWP investment.
  
  
  OBJECTIVE
  The aim of this study is to enhance our understanding about organizations' perspectives of the business case for HPWP investment, including reasons for and approaches to evaluating that investment.
  
  
  METHODS
  We used a multicase study approach to explore the business case for HPWPs in U.S. health care organizations. We conducted semistructured interviews with 67 key informants across five sites. All interviews were recorded, transcribed, and subjected to qualitative analysis using both deductive and inductive methods.
  
  
  RESULTS
  The organizations in our study did not appear to have explicit financial return expectations for investments in HPWPs. Instead, the HPWP investment was viewed as an important factor contributing to successful execution of the organization's strategic priorities and a means for competitive differentiation in the market. Informants' characterizations of the HPWP investment did not involve financial terms; rather, descriptions of these investments as redeployment of existing resources or a shift of managerial time redirected attention from cost considerations. Evaluation efforts were rare, with organizations using broad organizational metrics to justify HPWP investment or avoiding formal evaluation altogether.
  
  
  CONCLUSIONS
  Our findings are consistent with prior studies that have found that health care organizations have not systematically evaluated the financial outcomes of their quality-related initiatives or tend to forget formal business case analysis for investments they may perceive as "inevitable." In the absence of a clearly described association between HPWPs and outcomes or some other external imperative, ongoing HPWP investment may be at risk relative to other quality-related initiatives, particularly if organizational resources are constrained.
authors.affiliation: Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, USA. psong@cph.osu.edu
authors.forename: Paula H
authors.initials: PH
authors.lastname: Song
authors.forename: Julie
authors.initials: J
authors.lastname: Robbins
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Garman
authors.forename: Ann Scheck
authors.initials: AS
authors.lastname: McAlearney
mesh_terms: D017598:Efficiency, Organizational; D055317:Evidence-Based Practice; D005260:Female; D019981:Health Care Sector / Q000592:standards; D006801:Humans; D007449:Investments; D008297:Male; D019982:Organizational Case Studies; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D012107:Research Design; D013647:Task Performance and Analysis; D014481:United States; D017132:Workplace