Hospital accreditation and HRM: a likely pair?

"...effective HRM systems and processes significantly influence[d] the quality of patient care,” says Associate Professor Keith Townsend.

In 2013, the Australian Institute of Health and Welfare (AIHW) reported more than one quarter of a million full-time equivalent persons to be employed in Australia’s public hospitals. As the most resource-intensive element of the healthcare system (with about 62 per cent of recurrent expenditure), the sector is under constant pressure to implement organisational change that delivers further efficiencies and effectiveness.

A team of Centre for Work, Organisation and Wellbeing (WOW) and University of New South Wales (NSW) researchers is in the final year of a three year Australian Research Council (ARC) Linkage grant with independent not-for-profit accreditation and training funding partner, the Australian Council on Healthcare Standards (ACHS), to develop a body of evidence around the contribution that human resource management (HRM) makes to clinical health effectiveness and performance.

Project partner, ACHS, has an important role in systematically assessing Australian hospitals’ implementation of accreditation processes, and although necessary for the majority, they are still expensive and time consuming for organisations to participate in.

But the research team are closing in on reasons why accreditation is important. They have developed a model which groups otherwise individually-assessed HRM systems within the accreditation process as they interact, to look, in particular, at how health sector accreditation and clinical performance assessment criteria work together to predict positive change in clinical performance over time.

Project (lead) Chief Investigator, Associate Professor Keith Townsend
Project (lead) Chief Investigator, Associate Professor Keith Townsend

“Using…industry-based hospital accreditation data relating to 465 acute hospitals between 2003 and 2006 (inclusive)…we found that effective HRM systems and processes significantly influenced the quality of patient care,” notes the project’s lead Chief Investigator, Associate Professor Keith Townsend.

Generally, the team has found that the higher the HRM accreditation ratings, the higher the level of continuity in the organisation’s quality patient care (or clinical performance).

A second stage of the study considers the accreditation processes’ effect on motivating 311 of the 465 original hospitals surveyed to make improvements to their quality patient care and HRM processes. And the results? Those hospitals with ‘below moderate’ ratings in the mandatory accreditation categories showed the greatest change over the two assessment periods (being four years apart). Interestingly, there was also improvement by those organisations with ‘moderate’ and ‘above moderate’ ratings, challenging critics’ claims that the value of accreditation programs lay only in its function as a tool for regulatory and industry compliance.

A third element of the study has focussed on training for front line managers (FLMs), and how the effective application of HR policy can be achieved through learning and development (L&D) initiatives. In hospitals, highly qualified nurses typically fill this management role. Targeting those with ACHS accredited HRM system ratings, 50 hospitals were chosen. Twenty-four of the twenty-five hospitals classified as ‘high performers’ from this sample reported the inclusion of L&D initiatives (despite a non-mandatory status), of which a majority specifically targeted the development of FLM’s leadership, management or HRM capabilities. And the motivation for organisations to do so? Although implied, the project team suggest that the potential benefits for quality of patient care may be the reason:

“This is a very different finding from the bottom twenty-five performers that have substantially lower L&D systems, particularly in the areas of succession planning and financial support for external training”, says Keith.

Whilst collective findings of the grant to date highlight the importance of establishing, maintaining and improving strategic and operations management processes to reach such goals as quality patient care; locating, storing and using information in a performance enhancing manner; the positive compensatory effect that successful HRM processes have on clinical performance when other sub-systems are working less effectively; and the same positive effect that synergised HRM and health and safety processes have:

“… it is unlikely that a magic bullet will be found with HRM. We are talking about managing people, and context is vitally important”, comments Keith. “Transferring policy into reality is a process that is at the heart of improving HR scholarship and practice…This research contributes to understanding what is more likely to work and what is less likely to work. HRM is not one thing and doesn’t lead to one result.”

The project team includes Keith, fellow WOW researchers Dr Sandra Lawrence, Professor Adrian Wilkinson and Dr Ashlea Kellner, and the University of NSW’s, Associate Professor David Greenfield.