A configurational approach to the relationship between high-performance work practices and frontline health care worker outcomes.
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.


RESULTS
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.
Division of Health Management and Policy, Graduate School of Public Health, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182-4162, USA. echuang@mail.sdsu.edu
Emmeline
E
Chuang
Janette
J
Dill
Jennifer Craft
JC
Morgan
Thomas R
TR
Konrad
D000488:Allied Health Personnel; D003430:Cross-Sectional Studies; D017598:Efficiency, Organizational; D017143:Fuzzy Logic; D006302:Health Services Research; D006801:Humans; D007588:Job Satisfaction; D015279:Organizational Culture; D016134:Organizational Policy; D010348:Patient Care Team / Q000458:organization & administration*; D017009:Professional Autonomy; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014481:United States; D016526:Workload