Enhancing working conditions

Introduction Research in the manufacturing and retail sectors has demonstrated a link between human resource management (HRM) practices and productivity. Researchers have demonstrated that organizations that promote practices that encourage workers' abilities, motivation and opportunities achieve better outcomes. Within the health sector similar links have been proposed and used to explain variation in health outcomes and performance between organizations (West et al. 2002). The precise mechanisms responsible for improved outcomes differ. West et al. proposed a model of employee appraisal, training and team-working to account for variation in outcomes; specifically, sophistication in appraisal and teamworking were associated with lower mortality rates. American research has identified other HRM factors as being important in explaining variation; namely nurse staffing levels and nurses' educational preparation (Aiken et al. 2002b, 2003). There appears to be a growing consensus that certain HRM practices that incorporate commitment to ensure adequate staffing , investment in training, teamwork, employee autonomy and empowerment are associated with enhanced organizational outcomes and performance. The purpose of this chapter is to present some key sources of evidence on the relationship between the quality of working life and its impact upon outcomes for health care workers and patients, where possible. We have deployed a model derived from British research, which links human resource inputs with organizational and patient outcomes, to structure the chapter. In their staff survey for the United Kingdom Healthcare Commission, Michie and West (2002) propose a tripartite model that explores the relationship between the context of work, management of people, staff attitudes and organizational performance. We begin by considering the impact of the work context in terms of workload and climate, management of people in terms of management and leadership, and staff attitudes. We conclude with the challenges associated with creating healthy environments at work. Our review focuses mainly on nursing, using it as a probe to track the topics and themes within the evidence. We have adopted this approach largely for pragmatic reasons. First, although the majority of studies focus on nursing, nurses form the largest part of the health care workforce and therefore are likely to influence the experience and quality of care for patients in many significant ways. While there is disagreement about what combination of factors constitutes a perfect system for the quality of working conditions and how this should be defined, there is an emerging consensus on such measures' general effects on outcomes. In the …