This study investigates the mediation effects of the four components of psychological empowerment on the relationship between high performance work systems (HPWS) and perceptions of patient care quality among hospital employees. To test this relationship 541 hospital employees in a large regional Australian health service were surveyed. Regression analysis findings demonstrated that psychological empowerment fully mediated the relationship between HPWS and the perception of the quality of patient care. Three of the four individual components of psychological empowerment — autonomy, competence and meaning — fully mediated the relationship between HPWS and the perception of quality of care; the fourth — impact — was non-significant. This study demonstrates the need to recognise that the quality of patient care is influenced not only by clinicians but also by allowing all hospital employees to exercise concern through their work. Healthcare managers need to focus on ensuring HRM strategy, policy and processes support the implementation of HPWS at the unit level.
Adinolfi P. ( 2003) Total quality management in public healthcare: A study of and Italian and Irish hospitals. Total Quality Management14(2): 141-150.
2.
Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Busse R., Clarke H., et al. (2001) Nurses’ reports on hospital care in five countries. Health Affairs30(3): 43-53.
3.
Aiken LH, Smith A. and Lake ET ( 1994) Lower Medicare mortality among a set of hospitals known for good nursing care. Medical Care32: 771-787.
4.
Alreck PL, Settle RB ( 1995) The Survey Research Handbook: Guidelines and Strategies for Conducting a Survey, 2nd edition. New York: Irwin Press.
5.
Arthur JB ( 1994) Effects of human resource systems on manufacturing performance and turnover. Academy of Management Journal37(3): 670-687.
6.
Avolio BJ, Zhu W., Koh W. and Bhatia P. ( 2004) Transformational leadership and organisational commitment: mediating role of psychological empowerment and moderating role of structural distance. Journal of Organisational Behaviour25(8): 951-968.
7.
Baker GR, Flintoff V. ( 2004) The Canadian Adverse Events Study: The incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal170(11): 1678-1686.
8.
Baron R., Kenny D. ( 1986) The motivator-mediator variable distinction in social psychology research: Conceptual, strategic and statistical consideration . Journal of Personality and Social Psychology51: 1173-1182.
9.
Barraud-Didier V., Guerrero S. ( 2002) Impact of social innovations on French companies’ performance. Measuring Business Excellence6(2): 42-48.
10.
Bartram T. ( 2005) Small firms, big ideas: The adoption of human resource management in Australian small firms. Asia Pacific Journal of Human Resources43(1): 137-154.
11.
Bartram T., Stanton P., Leggat SG, Casimir G. and Fraser B. ( 2007) Lost in translation: Making the link between HRM and performance in healthcare. Human Resource Management Journal17(1): 21-41.
12.
Batt R. ( 2002) Managing customer services: Human resource practices, turnover, and sales growth. Academy of Management Journal45(3): 587-598.
13.
Becker BE, Gerhart B. ( 1996) The impact of human resource management on organizational performance: progress and prospects. Academy of Management Journal39(4): 779-801.
14.
Becker BE, Hueslid MA ( 1998) High performance work systems and firm performance: A synthesis of research and managerial implications. Research in Personnel and Human Resources Management16: 53-101.
15.
Boxall P. ( 2003) HR Strategy and competitive advantage in the service sector . Human Resource Management Journal13(3): 5-15.
16.
Boxall P., Macky K. ( 2007) High-performance work systems and organisational performance: Bridging theory and practice. Asia Pacific Journal of Human Resources45(3): 261-270.
17.
Buenger V., Daft RL, Conlon EJ and Austin J. ( 1996) Competing values in organizations: contextual influences and structural consequences. Organization Science7(5): 557-576.
18.
Coff RW ( 1997) Human assests and management dilemmas: Coping with hazards on the road to resource-based theory. Academy of Management Review22(2): 374-403.
19.
Conger JA, Kanungo RN ( 1988) The empowerment process: Integrating theory and practice . Academy of Management Review13(3): 471-482.
20.
Committee on Quality of Healthcare in America ( 2001) Crossing the Quality Chasm: A New Health System for the 21st Century. Washington DC: National Academy Press.
21.
Datta DK, Guthrie JP and Wright PM ( 2005) Human resource management and labour productivity: Does industry matter? Academy of Management Journal48(1): 135-145.
22.
Delaney JT, Huselid MA ( 1996) The impact of human resource management practices on perceptions of organizational performance. Academy of Management Journal39(4): 949-969.
23.
Donabedian A. ( 1980) The Definition of Quality and Approaches to its Assessment: Explorations in Quality Assessment and Monitoring. Ann Arbor: Health Administration Press.
24.
Dwyer J., Leggat SG ( 2002) Innovation in hospital care. Australian Health Review25(5): 19-31.
25.
Flood AB ( 1994) The impact of organizational and managerial factors on the quality of care in healthcare organizations. Medical Care Review51: 318-428.
26.
Gaba DM ( 2000) Structural and organisational issues in patient safety: A comparison of healthcare to other high-hazard industries. California Management Review43(1): 83-102.
27.
Godard J. ( 2004) A critical assessment of the high-performance paradigm . British Journal of Industrial Relations42(2): 349-378.
28.
Gorton C., Jones JL and Arke DL ( 2005) Patient characteristics and the impact of mortality indicator definition on provider performance measurement. Academy Health Meeting . Boston: Academy Health.
29.
Greenglass ER, Burke RJ ( 2001) Stress and the effects of hospital restructuring in nurses . Canadian Journal of Nursing Research33: 93-108.
30.
Guthrie JP ( 2001) High-involvement work practices, turnover, and productivity: evidence from New Zealand. Academy of Management Journal44(1): 180-190.
31.
Hair JF, Anderson RE, Tatham RL and Black WC ( 1998) Multivariate Data Analysis, 5th edition. Englewood Cliffs, NJ: Prentice Hall.
32.
Harmon J., Scotti DJ, Behson B., Farias G., et al. (2003) Effects of high-involvement work systems on employee satisfaction and service costs in veterans’ healthcare. Journal of Healthcare Management48(6): 393-406.
33.
Harris C., Cortvriend P. and Hyde P. ( 2007) Human resource management and performance in healthcare organisations. Journal of Health Organization and Management21(4/5): 448-459.
34.
Huselid M. ( 1995) The impact of human resource management practices on turnover, productivity and corporate financial performance. Academy of Management Journal38(3): 635-672.
35.
Hyde P., McBride A., Young R. and Walshe K. ( 2005) Role redesign: New ways of working in the NHS. Personnel Review34(6): 697-712.
36.
Ibrahim J., Majoor J. ( 2002) Corruption in the healthcare system: The circumstantial evidence. Australian Health Review25(2): 20-26.
37.
Joiner TA, Bartram T. ( 2004) How empowerment and social support affect Australian nurses’ work stressors. Australian Health Review28(1): 56-64.
38.
Kane RL, Maciejewski M. and Finch M. ( 1997) The relationship of patient satisfaction with care and clinical outcomes. Medical Care35(7): 714-730.
39.
Karasek R. ( 1990) Lower health risk with increased job control among white collar workers. Journal of Organisational Behavior11: 171-185.
40.
Khatri N. ( 2006) Building HR capability in healthcare organizations . Health Care Management Review31(1): 45-54.
41.
Khatri N., Brown GD and Hicks LL (2009) From a blame culture to a just culture in healthcare . Healthcare Management Review34(4): 312-322.
42.
Koberg CS, Boss RW, Senjem JC and Goodman EA ( 1999) Antecedents and outcomes of empowerment. Group and Organization Management24(1): 71-91.
43.
Larrabee JH, Withrow ML, Janney MA, Hobbs GR, Ostrow CL and Burant C. ( 2003) Predicting registered nurse job satisfaction and intent to leave. Journal of Nursing Administration33(5): 271-283.
44.
Laschinger HKS, Finegan J., Shamian J. and Wilk P. ( 2001a) Impact of structural and psychological empowerment on job strain in nursing work settings: Expanding Kanter’s model. Journal of Nursing Administration31: 260-272.
45.
Laschinger HKS, Shamian J. and Thomson D. ( 2001b) Impact of magnet hospital characteristics on nurses’ perceptions of hospital burnout, quality of care and work satisfaction. Nursing Economics19: 209-219.
46.
Laschinger HKS, Finegan J., Shamian J. and Wilk P. ( 2004) A longitudinal analysis of the impact of workplace empowerment on work satisfaction. Journal of Organizational Behavior25(4): 527-545.
47.
Laschinger HKS, Wong D. ( 1999) Staff nurse empowerment and collective accountability: Effects on perceived accountability and self-rated work effectiveness. Nursing Economics17(6): 308-316.
48.
Leggat SG, Bartram T., Casimir G. and Stanton P. (forthcoming) Nurse perceptions of the quality of patient care: Confirming the importance of empowerment and job satisfaction. Health Care Management Review.
49.
Leggat SG, Dwyer J. ( 2005) Improving hospital performance: Culture change is not the answer. Healthcare Quarterly8(2): 60-66.
50.
Lepak DP, Liao H., Chung Y. and Harden E. ( 2006) A conceptual review of human resource management systems in strategic human resource management systems. Research in Personnel and Human Resource Management25: 217-271.
51.
Lohr KN, Schroeder SA ( 1990) A strategy for quality assurance in Medicare. New England Journal of Medicine322: 707-712.
52.
MacDuffie JP ( 1995) Human resource bundles and manufacturing performance: Organisational logic and flexible production systems in the world auto industry . Industrial and Labor Relations Review48(2): 197-221.
53.
Macky K., Boxall P. ( 2007) The relationship between ‘high performance work practices’ and employee attitudes and investigation of additive and interaction effects. International Journal of Human Resource Management18(4): 537-567.
54.
Macky K., Boxall P. ( 2008) High involvement work processes, work intensification and employee well being: A study of New Zealand worker experiences. Asia Pacific Journal of Human Resources46(1): 38-55.
55.
Mannion R., Davies HTO and Marshall MN ( 2005) Cultural characteristics of ‘high’ and ‘low’ performing hospitals. Journal of Health Organization and Management19(6): 431-439.
56.
McLean J., Walsh M. ( 2003) Lessons into the inquiry into obstetrics and gynaecology services at King Edward Memorial Hospital 1990-2000. Australian Health Review26(1): 12-23.
57.
Metocchi M. ( 2002) The influence of leadership and member attitudes in understanding the nature of union participation. British Journal of Industrial Relations40: 87-111.
58.
Mishra AK, Spreitzer GM ( 1998) Explaining how survivors respond to downsizing: The role of trust, empowerment, justice, and work redesign. Academy of management Review23(3): 568-588.
59.
Mitchell PH, Shortell SM ( 1997) Adverse outcomes and variations in organization of care delivery. Medical Care35(11): NS19-NS32.
60.
Morrison RS, Jones L. and Fuller B. ( 1997) The relation between leadership style and empowerment on job satisfaction of nurses. Journal of Nursing Administration27(5): 27-34.
61.
Nishii LH, Lepak DP and Schneider B. ( 2008) Employee attributions of the ‘why’ of HR practices: Their effects on customer attitudes and behaviours, and customer satisfaction . Personnel Psychology61: 503-545.
62.
Nunally JC ( 1978) Psychometric Theory. New York : McGraw-Hill.
63.
Oecd (2004) Towards High-Performing Health Systems. Paris: OECD.
64.
Oldham GR, Hackman JR and Pearce JL ( 1976) Conditions under which employees respond positively to enriched work. Journal of Applied Psychology61(4): 395-403.
65.
Patrick A., Laschinger HKS ( 2006) The effect of structural empowerment and perceived organisational support on middle level nurse manager’s role satisfaction . Journal of Nursing Management14: 13-22.
66.
Penfold RB, Dean S., Flemons W. and Moffatt M. ( 2008) Do hospital standardized mortality ratios measure patient safety? HSMRs in the Winnipeg Regional Health Authority. Healthcare Papers8(4): 8-24.
67.
Preuss GA ( 2003) High performance work systems and organizational outcomes: The mediating role of information quality. Industrial and Labor Relations Review56: 590-605.
68.
Schuler RS, Jackson SE ( 1987) Linking competitive strategies with human resource management practices. Academy of Management Executive1(3): 207-226.
69.
Scotti DJ, Harmon J. and Behson SJ ( 2007) Links among high-performance work environment, service quality and customer satisfaction: an extension to the healthcare sector. Journal of Healthcare Management52(2): 109-125.
70.
Shortell SM, Zimmerman JE, Rousseau DM, Gillies RR, Wagner DP, Draper EA, et al. (1994) The performance of intensive care units: Does good management make a difference? Medical Care32(5): 508-525.
71.
Snell SA, Youndt MA ( 1995) Human resource management and firm performance: Testing a contingency model of executive controls. Journal of Management21(4): 711-737.
72.
Spreitzer G. ( 1995a) An empirical test of a comprehensive model of intrapersonal empowerment in the workplace. American Journal of Community Psychology23(5): 601-629.
73.
Spreitzer G. ( 1995b) Psychological empowerment in the workplace: Dimensions, measurement and validation. Academy of Management Journal (38): 1442-1465.
74.
Spreitzer G., Kizilos MA and Nason SW ( 1997) A dimensional analysis of the relationship between psychological empowerment and effectiveness, satisfaction, and strain. Journal of Management23(5): 679-704.
75.
Stanton P., Young S., Bartram T and Leggat SG (2010) Singing the same song: Translating HRM messages across managerial hierarchies. International Journal of Human Resource Management21(4): 567-581.
76.
Upenieks VV ( 2003) The interrelationship of organizational characteristics of magnet hospitals, nursing leadership and nursing job satisfaction. Healthcare Manager22(2): 83-98.
77.
Uribe CL, Schweikhart SB, Pathak DS and Marsh GB ( 2002) Perceived barriers to medical-error reporting: An exploratory investigation. Journal of Healthcare Management47(4): 263-280.
78.
Walton RE ( 1985) From control to commitment in the workplace. Harvard Business Review63(2): 77-84.
79.
West MA, Borrill C., Dawson JF, Scully J., Carter M., Anelay S., et al. (2002) The link between the management of employees and patient mortality in acute hospitals. International Journal of Human Resource Management13(8): 1299-1310.
80.
West MA, Guthrie JP, Dawson JF, Borrill CS and Carter M. ( 2006) Reducing patient mortality in hospitals: The role of human resource management. Journal of Organizational Behaviour27: 983-1002.
81.
Wright PM, Dunford BB and Snell SA ( 2001) Human resources and the resource based view of the firm . Journal of Management27(6): 701-722.
82.
Wright PM, Kehoe RR ( 2008) Human resource practices and organizational commitment: A deeper examination. Asia Pacific Journal of Human Resources46(1): 6-20.
83.
Youndt MA, Snell SA, Dean JW and Lepak DP ( 1996) Human resources management, manufacturing strategy, and firm performance. Academy of Management Journal39(4): 836-866.
84.
Zacharatos A., Barling J. and Iverson R. ( 2005) High-performance work systems and occupational safety . Journal of Applied Psychology90(1): 77-93.
85.
Zacaratos A., Herschovis MS, Turner N. and Barling J. ( 2007) Human resource management in the North American automotive industry: A meta-analytic review. Personnel Review36(2): 231-254.
