Opening the 'black box' of human resource management’s association with team characteristics and performance in healthcare : lessons from rehabilitation services in public hospitals

摘要

How does Human Resource Management (HRM) contribute to organisations and their functioning? What is the relationship between HRM, teamwork and clinical performance? We know that organisations deploy Human Resources (HR) departments and initiate HRM with the express purpose of improving performance, yet little is known about their associations, especially in the healthcare setting. HRM is essentially a ‘black box’ which needs to be understood, thereby informing organisations on how to maximise the benefits of the HR function. This thesis contributes to this deficit in knowledge, examining team characteristics, job satisfaction and clinical performance and how these relate to HRM policy and practice. Specifically, it investigates the links between aspects of HRM with teamwork and performance. A mixed method cross sectional study was conducted focusing on full service category rehabilitation services from public hospitals in Australia. This setting was selected for investigation because of the strong teamwork orientation and the lack of research comprehensively evaluating the contribution of HRM in this medical field. A total of 163 participants, comprising 152 rehabilitation clinicians and 11 managerial staff from seven hospitals were enrolled. A semi-structured questionnaire was administered to clinicians to determine their individual and team characteristics. Two measures of team performance were employed, namely: self reported job satisfaction, and compliance with clinical indicators defined by the Australian Council of Healthcare Standards. Twenty four focus groups and 18 interviews were conducted with clinicians and HR managers to investigate HRM policy and practice. Quantitative input from survey and clinical indicator data were analysed using descriptive and inferential statistics while qualitative data from focus groups and interviews were thematically analysed.The results show that a holistic approach to HRM is related to teamwork and facets of performance. Influenced by local context, HRM has the potential to either positively or negatively affect teamwork, job satisfaction and clinical performance. HRM’s links to teamwork and performance were found to be significantly mediated by elements of efficiency, effectiveness, change, structure, service constraints, leadership, staffing, specialisation and research. The tailoring of HRM approaches to take account of local organisational circumstances could contribute positively to desirable teamwork and performance outcomes.