Unit-level Performance Research Articles

If the Body Keeps the Score, What Happens When You Bring the Body to Work? Exploring the Health Effects of Trauma on Human Capital

Data reveal that the physical effects of trauma exposure increasingly surface in business, social, and other settings. Exposure to trauma at any point in life can cause employee health concerns, yet many firms do not acknowledge or address this. Herein, we combine trauma theory with human capital theory to explain how manifestations of trauma exposure— hyperarousal, intrusion, and constriction—impact employee health and performance. This article outlines how each manifestation affects human capital deployment, and thus employee performance. It further demonstrates how these human capital deployment issues have individual- and unit-level performance implications. This article offers a theory linking health effects of trauma to performance outcomes at work. It suggests how managerial awareness of trauma manifestations is a necessary step toward workplaces becoming supportive or healing. Our model offers new explanations related to why some individuals behave as they do at work and connects trauma to employee behavior and value creation.

Multiple case study of processes used by hospitals to select performance indicators: do they align with best practices?

Several health policy institutes recommend reducing the number of indicators monitored by hospitals to better focus on indicators most relevant to local contexts. To determine which indicators are the most appropriate to eliminate, one must understand how indicator selection processes are undertaken. This study classifies hospital indicator selection processes and analyzes how they align with practices outlined in the 5-P Indicator Selection Process Framework. This qualitative, multiple case study examined indicator selection processes used by four large acute care hospitals in Ontario, Canada. Data were collected through 13 semistructured interviews and document analysis. A thematic analysis compared processes to the 5-P Indicator Selection Process Framework. Two types of hospital indicator selection processes were identified. Hospitals deployed most elements found within the 5-P Indicator Selection Process Framework including setting clear aims, having governance structures, considering indicators required by health agencies, and categorizing indicators into strategic themes. Framework elements largely absent included: adopting evidence-based selection criteria; incorporating finance and human resources indicators; considering if indicators measure structures, processes, or outcomes; and engaging a broader set of end users in the selection process. Hospitals have difficulty in balancing how to monitor government-mandated indicators with indicators more relevant to local operations. Hospitals often do not involve frontline managers in indicator selection processes. Not engaging frontline managers in selecting indicators may risk hospitals only choosing government-mandated indicators that are not reflective of frontline operations or valued by those managers accountable for improving unit-level performance.

Relational Coordination Among Service Providers

This paper seeks to identify a potential mechanism over which HPWS influences performance. Using relational coordination theory, this paper assesses communication and relational ties of relational coordination as a potential link over which HPWS can affect unit-level performance in banks which are characterized as highly uncertain, interdependent, as well as time-bound. Primary data were collected from bank officers about the strength of HPWS and relational coordination among employees. Results indicate that HPWS was significantly associated with bank performance outcomes, including branch levels of deposits, loans, and net profit. Results also indicate that RC significantly mediated the linkages between HPWS and unit-level performance outcomes. These results suggest new insights for top management and HR leaders in the banking industry regarding the design of HPWS.

ORGANIZATIONAL CONTEXT AND QUALITY INDICATORS IN NURSING HOMES: A MICROSYSTEM LOOK

Abstract This cross-sectional quantitative sub-project assessed the association of organizational context (modifiable elements of work environments) with quality indicators (QIs) at the clinical microsystem (care unit) level. We used TREC data collected 09/2019-03/2020. The sample included 285 care units within 91 Western Canadian nursing homes. Outcomes included thirteen practice-sensitive QIs derived from the Minimum Data Set 2.0. Results from random-intercept logistic regression for each dichotomized QI showed that higher unit-aggregated scores on contextual elements as identified by the Alberta Context Tool, specifically care aide participation in decision-making (OR=3.7-8.4, p<.05), care aide perceived staffing (OR=2.6, p<.05) and time for completing tasks (OR=5.1-7.0, p<.05), and care aide rated unit-level leadership (OR=20.1, p<.05), were associated with a better unit-level performance on delirium symptoms, indwelling catheter use, behavioral symptoms, pain, and late-loss physical function. The findings suggest that targeting modifiable contextual elements is an important avenue for quality improvement interventions in nursing homes.

The power of knowledge management: how top management team bricolage boosts ambidexterity and performance

Purpose This paper aims to explore the relationship between top management team bricolage and performance and also examines unit ambidexterity's mediating role. More essentially, to understand the black box of organizational knowledge dynamism, a multilevel moderated mediating model is established by exploring the effects of two firm-level moderators, namely, potential absorptive capacity and realized absorptive capacity. Design/methodology/approach To test the cross-level moderated mediation model, this study used multisource data from 90 R&D units in 45 Taiwanese manufacturing firms through two-wave surveys and retrieving the archival data for assessing unit performance. Findings This study’s evidence revealed that unit-level ambidexterity mediates the effect between firm-level top management teams’ (TMT) bricolage and unit-level performance. This study also found that firm-level potential absorptive capacity positively moderates the effect between firm-level TMT bricolage and unit-level ambidexterity. Moreover, firm-level realized absorptive capacity strengthens the indirect relationships between firm-level TMT bricolage and unit-level performance via unit-level ambidexterity. The findings shed light on how and why TMT bricolage influences unit ambidexterity and performance in knowledge-intensive sectors. Originality/value This paper adds to the existing knowledge-based theory literature by disentangling the association between top management team bricolage and unit performance and identifying the pivotal role of absorptive capacity at both the firm and unit levels.

The impact of manager recognition training on performance: a quasi-experimental field study

PurposeEmployee recognition programs are ubiquitous, and recognition is a multibillion-dollar industry. Yet, very little research has tested the utility of recognition-based interventions. The purpose of this paper was to examine the impact of managerial training for employee recognition on the occurrence of recognition and unit-level performance.Design/methodology/approachThe design was a quasi-experimental field study of branches within a financial services company. Differences between a recognition training group and a no-training control group were examined using objective unit-level performance and recognition data before and after the training intervention.FindingsResults indicated that the training program led to more recognition and improved unit performance compared to control.Research limitations/implicationsThe sample size was small, but the research demonstrates that managerial recognition training is effective.Practical implicationsThis research establishes the effectiveness of recognition training and describes its effects on important business outcomes, supporting the notion that recognition programs may be a worthwhile investment for organizations.Originality/valueThis study is one of the first to demonstrate the benefit of training managers on effective recognition practices on recognition behavior and unit performance.

Gender’s moderating role in the relationship between organisational form and performance in the Spanish supermarket industry

This research seeks to discover how the organisational form (franchising vs. vertical integration) of 305 supermarkets belonging to a Spanish franchise chain influences unit-level performance measured through three key performance indicators commonly used in the retail literature: sales per square metre, sales per employee, and service quality scores. Additionally, we assess the moderating role of the manager's gender in each individual supermarket. We have analysed the research questions using multivariate analyses, with a panel dataset that includes quarterly establishment-level data covering the period from January 2017 to December 2019. We have found that franchised supermarkets record higher sales both per square metre and per employee than vertically integrated ones. This positive effect of franchising is lower in establishments run by females than in those run by males. The findings also reveal that franchised supermarkets record lower service quality scores than their company-owned counterparts, and this negative effect is again lower in establishments managed by females than in those managed by males.

When leaders are marketers: a duality perspective on the effect of openness to experience on marketing behaviors and the moderating role of bottom-line mentality.

While research has considered the effects of CEO and top-management team members’ characteristics on strategic initiatives (e.g. marketing), less research has examined when non-executive leaders directly contribute to these initiatives. In this research, drawing from the duality framework on leader characteristics, we examine how leader openness to experience is associated with their increased engagement in marketing behaviors (e.g. recruiting new customers). Across two field studies, including an exploratory sample of small business owners and a sample of non-executive leaders in the outpatient physical therapy industry, we find that openness to experience was related to leaders’ likelihood of executing marketing functions. Additionally, this relationship was weakened when leaders had a primary focus on short-term financial outcomes (i.e., high bottom-line mentality). We further link marketing to unit-level performance in a subsample of Study 2, suggesting that non-executive leaders’ marketing behaviors can impact objective organizational performance.

Organisational form and performance in fashion retailing

PurposeThis research seeks to discover how the organisational form (franchising vs vertical integration) of 384 fashion stores belonging to a Spanish franchise chain influences unit-level performance measured through three key indicators commonly used in the retail literature: sales per square metre, sales per employee and service quality scores.Design/methodology/approachThe authors have analysed this research question using bivariate and multivariate analyses, with a panel dataset that includes quarterly establishment-level data covering the period from January 2018 to December 2019.FindingsThe aggregated data initially reveal weaker outcomes among franchised establishments. However, after controlling for other variables related to the fashion stores and their local markets, the authors have found that franchised establishments record higher sales both per square metre and per employee than vertically integrated stores. The findings also reveal that franchised establishments record lower service quality scores than their company-owned counterparts.Originality/valueNothing has been published on the differences between franchising and company ownership in terms of establishment-level performance in fashion retailing.

Unit-Level Counterproductive Work Behavior (CWB): A Conceptual Review and Quantitative Summary

Despite assumptions that counterproductive work behavior (CWB) leads to detrimental outcomes for organizations, most of the existing CWB research focuses on outcomes for the individual employee. In the present study, we clarify fundamental issues regarding unit-level CWB, including its definition and how it is distinct from individual-level CWB. We then use social information-processing (SIP) theory as a lens to articulate our hypotheses regarding the factors associated with unit-level CWB’s emergence (e.g., collective attitudes, human resources practices, leadership) as well as its relationship with unit-level performance (e.g., profit, customer satisfaction). We use meta-analysis (representing 7,110 units and over 391,000 employees) to test our hypotheses. Our results show that unit-level CWB is significantly related to antecedents such as collective job attitudes, the use of strategic human resource management practices (e.g., staffing, training, rewards), and collective perceptions of the work environment (e.g., unit-level fairness perceptions). Moreover, we demonstrate that unit-level CWB is empirically linked to unit-level productivity (ρ = −.23), turnover (ρ = .22), customer satisfaction (ρ = −.26), and profit (ρ = −.31), which verifies the detrimental consequences of CWB at the strategic level. We conclude with a detailed discussion of the theoretical and practical implications of this study as well as a clear plan for future research.

Association Between Use of EHR-Generated Dashboards and Hospital Outcomes in 30-Day Heart Failure Readmissions.

This study examined whether usage of clinical data from the electronic health record (EHR) to create organizational- and unit-level performance dashboards and assess adherence to clinical practice guidelines is associated with hospital outcomes in risk-adjusted 30-day readmissions for patients with a principal diagnosis of heart failure (HF). It further assesses the association between the metrics of hospital financial health and the usage of those EHR-generated tools.A cross-sectional study design was used. The study used data from the 2016 American Hospital Association Annual Survey Information Technology Supplement, the Pennsylvania Health Care Cost Containment Council's (PHC4's) 2017 Hospital Performance Report, and the PHC4 General Acute Care Hospitals Financial Analysis Report for fiscal year 2017. Contingency tables, likelihood-ratio chi-square tests, and logistic regression were applied for data analysis.Usage of the EHR to assess adherence to clinical practice guidelines and create EHR-generated unit-level performance dashboards, rather than organizational performance dashboards, was more strongly associated with the hospitals' rating in risk-adjusted 30-day readmissions for HF patients. An increase in hospitals' operating margin was associated with greater odds of the usage of the discussed EHR tools, after controlling for hospital control/ownership and the total number of beds.Usage of some EHR-generated analytical tools may be more strongly associated with lower-than-expected 30-day hospital readmissions in HF patients than with other tools. Better hospital financial health is linked with greater uptake of the discussed analytical tools. Further research could help to determine which EHR-generated tools are more effective in improving hospital outcomes in HF.

Human Resource Management Systems and Attachment Styles: A Multi-Level Conceptual Model

The purpose of this paper is to develop a multi-level conceptual model outlining the interplay between human resource management and leader-follower adult attachment styles. The paper aims to further elucidate the HR systems-firm performance relationship by theorizing relational mediating mechanisms, namely the interplay between leader and follower attachment styles. We focus specifically on relationship-oriented HR systems, defined as synergized HR practices required to help employees build interpersonal relationships, and offer propositions about their role in activating leaders’ individual-level attachment style and followers’ group-level attachment style. Further, we theorize an indirect relationship between a leader’s contextually-activated attachment style and followers’ group attachment style through LMX exchange, meaning the quality of relationship between leader and followers. Drawing on social contagion theory, we posit the dispersion of group attachment as a collective mechanism. Finally, the role of discretionary work behaviors, including positive behaviors such as organizational citizenship behavior (OCB) and detrimental behaviors such as counter-productive work behaviors (CWB) are considered in predicting followers’ unit-level performance outcomes. Theoretical and practical implications, as well as the avenues for future research, are discussed.

Increased Business Value for Positive Job Attitudes during Economic Recessions: A Meta-Analysis and SEM Analysis

ABSTRACT Using a database of 171 studies across 62,965 organizational units with job attitude data and business performance outcomes ranging from 1994 to 2015, we tested the hypothesis that positive employee job attitudes relate more strongly to business unit success during bad economic times than during favorable economic times. Results showed that although the relationship between favorable job attitudes and unit-level performance is positive and generalizable across all time periods, the relationships between job attitudes and all business success outcomes studied (profitability, productivity, turnover, and customer perceptions) were substantially stronger during the recession years of 2001, 2002, 2008, and 2009 in comparison to other years. Favorable employee job attitudes may provide extra assistance that helps business units continue to achieve under challenging economic conditions.

Participative leadership and unit performance: evidence for intermediate linkages

ABSTRACT This study aims to examine the intermediate links and boundary conditions between unit-level participative leadership and unit-level unit performance. The study collects multiple resource data from 174 units in 75 high, medium, and low technology firms. In particular, unit-level co-worker knowledge sharing is found to partially mediate the relationship between unit-level participative leadership and unit-level performance. Unit-level absorptive capacity also positively moderates the positive relationship between unit-level participative leadership and unit-level co-worker knowledge sharing, as well as positively moderating the concept that unit-level co-worker knowledge sharing mediates the positive relationship between unit-level participative leadership and unit-level performance. The theoretical contributions of this study are in its attempts to use organisational learning theory to comprehensively understand the intermediate links and boundary conditions between participative leadership and performance. This study has two practical implications: 1) human resources practitioners in each firm should arrange specific educational trainings for each unit; and 2) firms should establish a knowledge exchange platform for every unit.

Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study

Concerns have been raised about variation in care quality and outcomes among children and young people with epilepsies in England. We aimed to investigate the association between quality of paediatric care, hospital admissions, and all-cause deaths among epilepsy patients. In this longitudinal data linkage study of paediatric epilepsy services in England, we linked unit-level data from round 1 (2009-11) and round 2 (2013-14) of the Epilepsy12 national clinical audit, with death registrations from the UK Office for National Statistics and data for unplanned hospital admissions from Hospital Episode Statistics. We investigated the association between unit-level performance in involving a paediatrician with epilepsy expertise, an epilepsy specialist nurse, and a paediatric neurologist (where appropriate) in round 1 and the proportion of adolescents (aged 10-18 years) with epilepsy admitted to each unit who subsequently died during the study period (April 1, 2009, to March 31, 2015). We also investigated whether change in Epilepsy12 performance between the two audit rounds was associated with changes in the standardised ratio of observed-to-expected unplanned epilepsy admissions over the same period. In 99 units with data for the analyses relating to paediatricians with epilepsy expertise and epilepsy specialist nurses, 134 (7%) of 1795 patients died during the study period, 88 (5%) of whom died after the transition to adult service. In 55 units with data for the analyses relating to paediatric neurologists, 79 (7%) of 1164 patients died, 54 (5%) of whom did so after the transition. In regression models adjusting for population, unit, and hospital activity characteristics, absolute reductions in total mortality risk (6·4 percentage points, 95% CI 0·1-12·7) and mortality risk after transition (5·7 percentage points, 0·6-10·8) were found when comparing units where all versus no eligible patients were seen by a paediatric neurologist. Units where all eligible patients were seen by a paediatric neurologist were estimated to have absolute reductions of 4·6 percentage points (0·3-8·9) in total mortality and of 4·6 percentage points (1·2-8·0) in post-transition mortality, compared with units where no or some eligible patients were seen by a paediatric neurologist. There was no significant association between performance on being seen by an epilepsy specialist nurse or by a paediatrician with epilepsy expertise and mortality. In units where access to an epilepsy specialist nurse decreased, the standardised ratio of epilepsy admissions increased by a mean of 0·21 (0·01-0·42). Among adolescents with epilepsy, greater involvement of tertiary specialists in paediatric care is associated with decreased all-cause mortality in the period after transition to adult services. Reduced access to an epilepsy specialist nurse was associated with an increase in paediatric epilepsy admissions. The Health Foundation.

Can You Hear Me Now? … Optimized Communication to Reduce Hospital Acquired Central Line Bloodstream Infection

BACKGROUND Effective communication that is timely, accurate, and unambiguous results in improved patient safety. Central venous catheters are the most frequent cause of healthcare-associated bloodstream infections. Central line associated blood stream infection (CLABSI) events increased during FY16. The hospital CLABSI improvement team identified uncoordinated efforts of multiple disciplines simultaneously working on central line bloodstream improvements as a significant root cause for lack of improved CLABSI performance. METHODS A unified communication strategy was created with oversight from the CLABSI committee. Essential communication building blocks included standardized metrics and data display, custom improvement tools and 24/7 access to unit level performance via a “one-stop-shop” team site. Once the team site was implemented, it was used as a regular mode to deliver consistent CLABSI information to all levels of staff and leadership. RESULTS On demand access to metrics and improvement tools enabled stakeholders to have resources available regardless of time, day or shift. Continuous availability to frontline staff created hyperawareness and urgency around CLABSI prevention. Subsequently, staff were engaged and empowered to monitor and act on their own unit's performance. Since implementing the communication strategy there has been a gradual decrease in both Standardized Infection Ratios (SIR) and Standardized Utilization Ratios (SUR). FY17 SIR of 0.80 decreased to 0.72 during FY18 and FY17 SUR of 0.98 decreased to 0.88 during FY18. CONCLUSIONS Effective communication is essential when coordinating any type of sustainable improvements. A multi-pronged communication plan around CLABSI can assist Infection Prevention with a shift towards shared ownership of unit performance.

Redesigning systems to improve teamwork and quality for hospitalized patients (RESET): study protocol evaluating the effect of mentored implementation to redesign clinical microsystems

BackgroundA number of challenges impede our ability to consistently provide high quality care to patients hospitalized with medical conditions. Teams are large, team membership continually evolves, and physicians are often spread across multiple units and floors. Moreover, patients and family members are generally poorly informed and lack opportunities to partner in decision making. Prior studies have tested interventions to redesign aspects of the care delivery system for hospitalized medical patients, but the majority have evaluated the effect of a single intervention. We believe these interventions represent complementary and mutually reinforcing components of a redesigned clinical microsystem. Our specific objective for this study is to implement a set of evidence-based complementary interventions across a range of clinical microsystems, identify factors and strategies associated with successful implementation, and evaluate the impact on quality.MethodsThe RESET project uses the Advanced and Integrated MicroSystems (AIMS) interventions. The AIMS interventions consist of 1) Unit-based Physician Teams, 2) Unit Nurse-Physician Co-leadership, 3) Enhanced Interprofessional Rounds, 4) Unit-level Performance Reports, and 5) Patient Engagement Activities. Four hospital sites were chosen to receive guidance and resources as they implement the AIMS interventions. Each study site has assembled a local leadership team, consisting of a physician and nurse, and receives mentorship from a physician and nurse with experience in leading similar interventions. Primary outcomes include teamwork climate, assessed using the Safety Attitudes Questionnaire, and adverse events using the Medicare Patient Safety Monitoring System (MPSMS). RESET uses a parallel group study design and two group pretest-posttest analyses for primary outcomes. We use a multi-method approach to collect and triangulate qualitative data collected during 3 visits to study sites. We will use cross-case comparisons to consider how site-specific contextual factors interact with the variation in the intensity and fidelity of implementation to affect teamwork and patient outcomes.DiscussionThe RESET study provides mentorship and resources to assist hospitals as they implement complementary and mutually reinforcing components to redesign the clinical microsystems caring for medical patients. Our findings will be of interest and directly applicable to all hospitals providing care to patients with medical conditions.Trial registrationNCT03745677. Retrospectively registered on November 19, 2018.

How Trust in One’s Employer Moderates the Relationship Between HRM and Engagement Related Performance

Trust can be seen as important element for the effectiveness of organizational engagement. In particular, in order to be engaged to their work, employees’ trust in their employer organization plays a crucial role. This study adopts Dirks and Ferrin’s somewhat neglected model of trust as a moderator on the link between human resource management (HRM) and performance. Using a Finnish data-set from a forestry company, we find that trust in the employer moderates the relationship between HRM and unit-level performance. In three out of six HRM practices studied (communication, career opportunities, and job design) the moderation effect was as expected: in a climate where the employer is highly trusted, the effect of the HRM practice on performance was enhanced. However, for three practices (learning and development, performance evaluation and rewards, participation) the effect of HRM was contrary to our hypotheses. We consider the implications of these results for both the trust and HRM literatures, and for HR practitioners.

Integrating knowledge in organizations: examining performance and integration difficulties

ABSTRACTThis paper builds a theoretical model and decision-making flow chart for optimizing the integration of knowledge from individuals to units, and predicting when the desired integration process will be relatively easy or difficult to implement. We argue that the integration process most likely to lead to higher unit-level performance depends on the degree to which knowledge is learnable, while the ease of implementation depends on the degree to which knowledge is tacit. Implementation challenges occur when there is a mismatch between these two dimensions. Organizations would benefit from targeting knowledge management investments at these mismatched situations.

Testing the Influence of Individual-Level Competency Proficiency on Unit-Level Performance

Firms worldwide increasingly use competency-based performance appraisals, and a growing proportion link competence proficiency appraisals to rewards. This “best practice”, highly disseminated by consultants and other HR pundits, is seem as a key tool to align human capital to business strategy and performance. Its main assumption is that competence mastery at the individual level would drive up unit- or organizational-level performance. Thus rewarding proficiency in individual competencies would be justified by it boosting organizational results. However, few empirical studies tested the empirical validity of this assumption. We conducted a large-scale inquiry involving “live” and consequential competence appraisal data for 682 managers in a large bank. We tested if appraised proficiency in six soft skills competencies, linked to rewards, influenced unit- level performance. Our study indicated that unit-level performance could not be significantly explained from individual-level competency, but insist that further research is needed. Based on these findings, we argue that organizations presenting similar disassociation between individual-level appraised competencies and unit-level performance should consider decoupling their behavior-based performance appraisal from their compensation and reward decisions.