Systematic Review of The Links Between Human Resource Management Practices and Performance

Health Technology Assessment 2010; Vol. 14: No.
51
Systematic review of the links between

human resource management
practices and performance
M Patterson, J Rick, S Wood, C Carroll,

S Balain and A Booth
October 2010
10.3310/hta14510
Health Technology Assessment

NIHR HTA programme
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Systematic review of the links between
human resource management
practices and performance
M Patterson,1* J Rick,2 S Wood,3 C Carroll,4

S Balain5 and A Booth4
1
Institute of Work Psychology, University of Sheffield, Sheffield, UK
2
Health Services Research Group – Primary Care, University of
Manchester, Manchester, UK
3
School of Management, University of Leicester, Leicester, UK
4
School of Health and Related Research (ScHARR), University of Sheffield,
Sheffield, UK
5
Management School, University of Lancaster, Lancaster, UK
*Corresponding author
Declared competing interests of authors: none
Published October 2010

DOI: 10.3310/hta14510
This report should be referenced as follows:
Patterson M, Rick J, Wood S, Carroll C, Balain S, Booth A. Systematic review of the links
between human resource management practices and performance. Health Technol Assess
2010;14(51).
Health Technology Assessment is indexed and abstracted in Index Medicus/MEDLINE,

Excerpta Medica/EMBASE, Science Citation Index Expanded (SciSearch) and Current
Contents /Clinical Medicine.
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DOI: 10.3310/hta14510 Health Technology Assessment 2010; Vol. 14: No. 51
Abstract
Systematic review of the links between human
resource management practices and performance
M Patterson,1* J Rick,2 S Wood,3 C Carroll,4 S Balain5 and A Booth4
1
Institute of Work Psychology, University of Sheffield, Sheffield, UK
2
Health Services Research Group – Primary Care, University of Manchester, Manchester, UK
3
School of Management, University of Leicester, Leicester, UK
4
School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
5
Management School, Lancaster University, Lancaster, UK
*Corresponding author
Background: In recent years human resource were derived from the NHS Performance Indicators
management (HRM) has been seen as an important and the NHS Improvement Plan. The quality criteria
factor in the successful realisation of organisational used to select papers incorporated a longitudinal
change programmes. The UK NHS is undergoing study design filter to provide evidence of the causal
substantial organisational change and there is a need to direction of relationships between HRM and relevant
establish which human resource (HR) initiatives may be outcomes. Single HRM practices were considered.
most effective. Within the health-specific literature, focus was on the
Objectives: To assess the results from a wide-ranging impact of HRM on patient outcomes. Information is
series of systematic reviews of the evidence on HRM presented on the reliability of measures in each of the
and performance. The first part assesses evidence intermediate outcome areas.
on use of HRM in the UK and fidelity of practice Results: Work design practices that enhance
implemented. The second part considers evidence employee autonomy and control influenced a number
for the impact of HRM practices on intermediate of outcomes and there was consistent evidence
outcomes, which can impact on final outcomes, such for the positive impact of increased job control
as organisational performance or patient care. on employee outcomes, such as job satisfaction,
Data sources: The following databases were absence and health. For employee participation, the
searched: Applied Social Sciences Index and Abstracts small number of studies reviewed supported the
(ASSIA), British Nursing Index (BNI), Business Source involvement of employees in design/implementation
Premier, Campbell Collaboration, Cochrane Central of changes that affect their work. In health literature
Register of Controlled Trials (CENTRAL), Cochrane in particular, employee involvement through quality
Database of Systematic Reviews (CDSR), Cumulative improvement teams resulted in improved patient
Index to Nursing and Allied Health Literature outcomes. Findings were positive for the impact of
(CINAHL), Database of Abstracts of Reviews of training on the intended outcomes of the initiatives.
Effectiveness (DARE), DH-Data, EMBASE, Health Support for the impact of performance management
Management Information Consortium (HMIC), practices was apparent, in particular feedback on
International Bibliography of the Social Sciences (IBSS), performance outcomes and the use of participative
King’s Fund database, MEDLINE, NHS Economic goal setting. Strong associations were found among all
Evaluation Database (NHS EED), National Research intermediate outcomes, and the relationship between
Register (NRR), PREMEDLINE, PsycINFO, ReFeR, most intermediate behaviours and outcomes were
Social Sciences Citation Index (SSCI) and Science significant.
Citation Index (SCI). The searches were conducted in Limitations: Limited evidence was available on the
May/June 2006. use of HRM and on the implementation of policy.
Review methods: Broad categories of HRM Also, the specific practices studied within each HRM
interventions and intermediate outcomes were category differ so there was little evidence to show
generated: 10 HRM categories and 12 intermediate whether similar practices have the same effects in
outcome categories. Seven patient final outcomes health and non-health settings.
iii
© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

Abstract
Conclusions: Some potentially effective practices is highlighted. However, future multilevel studies that
for both health and non-health areas were identified, embrace the individual, team and organisational level
and HRM methods could be used to support change are needed. Studies should look into interventions
processes within the NHS; the findings relating to aimed at improving HR outcomes and performance,
work organisation are particularly promising with and allow for pre- and post-intervention measurement
regard to changes in methods of service delivery. of practices and outcomes.
Using training to support the implementation of change
iv
Contents
List of abbreviations ................................. vii Definitions of selected intermediate
outcomes ................................................. 69
Executive summary .................................. ix Distinguishing final outcomes and
intermediate outcomes ........................... 74
1 Introduction .............................................. 1
Context for the review: overview of the 6 The impact of HRM practices on
literature on HRM and organisational intermediate outcomes among health
performance ........................................... 1 professionals .............................................. 75
Review aim, scope and objectives ............... 4 Introduction ............................................... 75
Report ......................................................... 4 Review methodology .................................. 75
Results ......................................................... 76
2 Methodology ............................................. 7 Conclusions ................................................. 82
Introduction ............................................... 7
Applying systematic review methodology 7 The impact of HRM practices on final
within the HRM literature ..................... 7 outcomes in the health sector ................ 85
Overview of systematic review Introduction ............................................... 85
methodology .......................................... 8 Patient outcomes ......................................... 85
Applying the systematic review Review methodology .................................. 87
methodology .......................................... 8 Results ......................................................... 88
Summary of specific research questions Conclusions ................................................. 124
and methodological approaches ............ 14
8 Impact of HRM practices in non-health
3 HRM practices and their reported use settings ....................................................... 129
in the UK ................................................... 17 Introduction ............................................... 129
Introduction ............................................... 17 Review methodology .................................. 129
What HRM practices are described in the Conclusions ................................................. 207
literature? ............................................... 17
How widespread is the use of these HRM 9 Intermediate and final outcomes:
practices in the UK? ............................... 19 correlations and effects ........................... 209
Summary .................................................... 21 Introduction ............................................... 209
Conclusion .................................................. 49 Review methodology .................................. 209
Findings for Objective 3.1 .......................... 211
4 Implementation fidelity in HRM ............. 51 Findings for Objective 4.2 .......................... 217
Introduction ............................................... 51 Findings for Objective 4.1 .......................... 218
Policy–practice link and implementation Conclusions ................................................. 222
fidelity ..................................................... 51
Dimensions of fidelity ................................. 52 10 Measuring the intermediate outcomes
Overview of findings from fidelity studies of HRM: the reliability of measures ........ 223
in social policy ........................................ 52 Introduction ............................................... 223
Fidelity of HR policy .................................. 59 What is measurement reliability? ............... 223
A framework for implementation fidelity ... 64 Which intermediate outcomes is it valid
Conclusion .................................................. 65 to measure in this context? .................... 224
Reliability of intermediate outcome
5 Identifying linkages between HRM measures ................................................. 225
practices and performance outcomes ... 67 Conclusions ................................................. 234
Introduction ............................................... 67
Intermediate outcomes linking HRM and 11 Conclusions and recommendations ....... 237
performance ........................................... 67 Introduction ............................................... 237
Selecting intermediate outcomes ............... 68 Systematic review methodology .................. 237
v

Contents
Identification of HRM practices ................. 237 Appendix 4 Guidance on monitoring

Range and fidelity of use of HRM implementation fidelity .............................. 301
practices in the UK ................................ 238
Evidence for the link between HRM Appendix 5 Implementation fidelity
practices and intermediate outcomes checklist ...................................................... 303
in the health sector ................................ 239
Impact of HRM practices on patient Appendix 6 Patient outcomes search
outcomes ................................................. 239 strategy ....................................................... 311
Impact of HRM on intermediate and
final outcomes in the non-health Appendix 7 Typical HRM and
literature ................................................. 240 longitudinal search filters .......................... 313
Broad emergent themes from the health
and non-health literature ....................... 241 Appendix 8 Example Business Source
Relationship between intermediate Premier and PsycInfo search filters ........... 315
outcomes and final outcomes ................. 242
Measures of intermediate outcomes ........... 243 Appendix 9 Discussion of bias in meta-
Conclusions ................................................. 244 analyses ....................................................... 317
Future research .......................................... 244
Concluding comments ................................ 246 Appendix 10 Checklist to assess bias in
meta-analyses .............................................. 319
.................................. 247
Acknowledgements
Appendix 11 Assessment of bias for
................................................. 249
References included meta-analyses .............................. 321
Appendix 1 Taken from original Health Technology Assessment

proposal to NCCSDO ................................. 281 reports published to date ........................ 335
Appendix 2 HRM practice categories Health Technology Assessment

and definitions ............................................ 295 programme ............................................... 359
Appendix 3 HRM practice categories

and associated terms from the literature ... 299
vi
List of abbreviations
BSI bloodstream infection NA nursing aide

CCM Critical Care Medicine NP nurse practitioner
CIPD Chartered Institute of Personnel OCB organisational citizenship
and Development behaviour
EPOC Employee Direct Participation in OCQ Organisational Commitment
Organisational Change Questionnaire
ESOP employee stock option plan OM outcomes manager
ESWT European Survey on Working OSQ Occupational Stress Questionnaire
Time and Work–Life Balance PDP personal development plan
FFS fee for service PMS performance management system
FTE full-time equivalent PPM participative productivity
GHQ General Health Questionnaire management
GP general practitioner QICC quality indicator for client care
HCC Healthcare Commission R&D research and development
HR human resource RBSE role breadth self-efficacy
HRM human resource management RCT randomised controlled trial
HPWP high-performance work practice RN registered nurse
ICC intraclass correlation SDO Service Delivery and Organisation
ICU intensive care unit SOC sense of coherence
IPCC Intensive Psychiatric Community TQM total quality management
Care PNP paediatric nurse practitioner
JDI job descriptive index ProMES Productivity Measurement and
JDS Job Diagnostic Survey Enhancement System
JIT just-in-time UTI urinary tract infection
LOC locus of control WAB weighted application blank
LOS length of stay WAS Ward Atmosphere Scale
MPS motivating potential score
WERS Workplace Employment Relations
MSQ Minnesota Satisfaction Survey
Questionnaire
All abbreviations that have been used in this report are listed here unless the abbreviation is well
known (e.g. NHS), or it has been used only once, or it is a non-standard abbreviation used only in
figures/tables/appendices, in which case the abbreviation is defined in the figure legend or in the
notes at the end of the table.
vii

Executive summary
Context for this review longitudinal study design filter, as this may
provide evidence about the causal direction
The UK NHS is the largest employer in Europe, of relationships between HRM and relevant
involving complex and diverse services and work outcomes in a way that cross-sectional data
roles. The NHS continues to undergo substantial cannot.
organisational change, as indicated by increased • The review considers single HRM practices
emphasis on performance targets representing and is not confined to collectivities of them,
drivers at local, national and clinical level. or ‘bundles’ as they are known in the high-
performance management literature.
Human resource management (HRM) is being • The review covers issues around the
seen as a vital element in the successful realisation implementation of HRM in practice and
of these change programmes and is being given the measurement of relevant intermediate
a greater prominence than it has traditionally. It outcomes in the HRM performance chain.
is therefore timely to assess the evidence we have • Within the health-specific literature, the review
on what human resource (HR) initiatives are most is focused, in particular, on the impact of HRM
effective. on patient outcomes.
How widespread is the use of

HRM in the UK HRM practices in the UK?
Over the past two decades, growing research The first part of this review is concerned with
attention has been given to exploring the links evidence on the use of HRM in the UK and the
between organisational performance and HRM fidelity or accuracy with which HRM practices
systems and processes, and especially the much- are implemented. Limited evidence on the use of
touted modern, high-involvement management HRM is available. A review of national survey data
approach. This has generated a large body of identified some evidence on the use of specific
literature, largely cross-sectional in nature, i.e. HRM practices in 10 broad practice categories,
measures of performance and systems are taken at although very little was disaggregated to the health
the same time, so it is not possible to determine sector level. The most commonly cited practices
cause and effect. Reviews of this literature have were family-friendly and work organisation ones,
given rise to the perception that the significance of which were used in 70% of workplaces. The data
HRM in determining organisational performance do not always indicate the precise extent of the
has largely been proven. Increasingly, however, a use practices within organisations, i.e. whether
number of researchers are questioning whether practices apply to all, or some, of the workforce.
the claims for evidence of a universal link between
HRM and performance are overstated – while they Little is known, therefore, about what HRM
endorse the importance of this line of research, practices are used within the NHS at the present
they particularly draw attention to methodological time. A more detailed picture could be achieved
limitations of the studies and the heterogeneity of through further analysis of the Workplace
the measures of HRM used across the studies. Employment Relations Survey (WERS) or through
bespoke future surveys.
This report presents the results from a wide-
ranging series of systematic reviews of the evidence How well implemented are
on HRM and performance. The searches included HRM practices?
literature published up to June 2006 and covered
the general HRM literature, not simply the health A further important consideration in assessing
literature. It is distinctive in a number of ways: the impact of HRM practices is implementation
fidelity, i.e. the accuracy with which policies
• The quality criteria that were used to are implemented by organisations in practice.
select papers for inclusion incorporated a Research from social policy, where the concept ix

Executive summary
of implementation fidelity is more established, –– staffing

indicates that the fidelity with which a practice –– training and development
in implemented is related to its efficacy. Within –– compensation and rewards
HRM, this review found only a few studies that –– communication
had collected data on the implementation of –– family friendly
a policy and this appeared to be an area that –– single status/status harmonisation
was largely ignored in the HRM literature. –– employee representation and participation
The majority of research focuses on policy or –– appraisal/performance management
intended HRM practices rather than actual –– bundles of practices
or implemented practices. This finding has • intermediate outcomes:
considerable implications for interpretation of the –– motivation
research and understanding why a study might –– job satisfaction
find a weak, or no, relationship between a practice –– organisational commitment
and its intended outcome. This review proposes –– occupational commitment
a framework for understanding and explaining –– engagement
processes at work in evaluating and achieving –– burnout
implementation fidelity, within the context of HRM –– job involvement
and policy. Appendices 3 and 4 present guidance –– turnover intentions
and a checklist for evaluating fidelity, based on –– psychological contract
these findings. –– organisational justice
–– organisational support
For all new HRM practices, the process of –– organisational climate
implementation should be clearly stated and • final outcomes:
adherence to the implementation needs to be –– patient safety
evaluated as well as any intended outcomes. –– patient-centred care
–– patient waiting times
Impact of HRM –– patient satisfaction
–– health-related quality of life
The remit for the second part of this review –– patient mortality
was to consider the evidence for the impact of –– patient stay
HRM practices on intermediate outcomes (the –– re-admissions.
intended outcomes of HRM) that may ultimately
impact on final outcomes such as organisational Overall findings on impact
performance or patient care. In other words, the
focus was on HRM interventions and employee HRM in health and non-health settings
mental, emotional and attitudinal states (and There is an imbalance in the practices covered,
their measurement), thought to influence so in both health and non-health areas certain
employee behaviours that are salient to effective domains of HRM are covered disproportionately
organisational performance. more than in others. This highlights areas of HRM
that have yet to be researched, including in an
HRM practices and outcomes NHS context. Additionally, very few replication
considered in the review studies were found, so many of the findings in this
report are based on only a small number of studies
Broad categories of HRM interventions and that precludes the development of generalisable
intermediate outcomes were generated through conclusions.
the literature. This list was refined over the course
of the study to produce 10 HRM categories and Some HRM practices have been the subject of
12 intermediate outcome categories. Seven patient research in both the health and the non-health
(final) outcomes were derived from the NHS sectors. However, the specific practices that have
Performance Indicators (Healthcare Commission been studied within each HRM category do differ,
2005) and the NHS Improvement Plan (NHS so there is little evidence to show whether similar
2005). No final outcomes were specified in the non- HRM practices have the same effects in health and
health-care literature (i.e. any longitudinal studies non-health settings. An implication of this finding
of HRM practices were considered for inclusion): is that care needs to be taken when adopting HRM
practices from outwith the NHS – it cannot be
• HRM practices: assumed that the same practices are appropriate in
x –– work design both settings or that the same effects will accrue.
No single HRM practices or bundle of practices conclude that each of the intermediate outcomes
were found to be a panacea. However, our review identified in this review may contribute uniquely
does enable us to identify some potentially effective to efforts to understand and manage employee
practices for both health and non-health areas. behaviours.
• In the area of work design, practices that The review also explored the correlations between
enhance employee autonomy and control are intermediate outcomes and productivity-enhancing
influential in relation to a number of outcomes behaviours (e.g. individual job performance,
and there is consistent evidence for the positive employee turnover). The relationships between
impact of increased job control (in various most intermediate outcomes and behaviours
forms) on employee outcomes such as job were significant and of small to moderate
satisfaction, absence and health. strength. The premise here is that intermediate
• In the parallel field of employee participation, outcomes are determinants of salient employee
the small number of studies reviewed here behaviours, which, in turn, enhance organisational
supports the widely advocated principle performance. These data do not prove a causal link
of involving employees in the design and but do demonstrate associations.
implementation of changes (e.g. job redesign)
that affect their work. Specifically in the health Impact of intermediate
literature, employee involvement through outcomes on final outcomes
quality improvement teams was found to
be effective in terms of improved patient This review was unable to identify any longitudinal
outcomes. evidence to assess whether intermediate outcomes,
• In the area of training, findings are consistently such as job satisfaction or burnout, impact
positive for the impact of training on the on patient-care outcomes. In the non-health
specific intended outcomes of the training field, a small number of longitudinal studies
initiatives. were identified that examined the impact of
• Support for the impact of performance intermediate outcomes (mostly average employee
management practices is found and job satisfaction) on organisational performance.
particularly the importance of feedback While the studies in this review show associations,
on performance outcomes and the use of the evidence on the casual direction of this
participative goal setting. relationship is mixed. This relationship is a
crucial link for the premise that HRM influences
Such evidence points to the HRM methods that final outcomes partially through its impact on
can be used to support and enhance change employee outcomes such as job satisfaction, and
processes within the NHS. The findings in the we clearly need more substantial data sets for surer
work organisation area are particularly promising interpretation.
in the light of considerable changes in methods
of service delivery that are ongoing in the NHS. Measuring intermediate
Opportunities for job and service redesign within outcomes in the NHS
the NHS offer great scope for future exploration.
The use of training to support the implementation The report presents information on the reliability
of change is also highlighted in the good practice of measures in each of the intermediate outcome
around implementation fidelity identified by this areas identified for review. Where possible, the
review, and therefore is important evidence on the specific measures used in the included studies were
process of HRM policy development and practice. reported on. Where an intermediate outcome area
was not covered by the studies included in this
Relationships between review, the subject experts on the research team
intermediate outcomes identified an appropriate measure for inclusion.
Details of the measures, their items and reliabilities
The relationships amongst intermediate outcomes are presented in Chapter 10.
were also examined. Moderate to high correlations
were found between all of the intermediate These measures represent a basic toolkit that could
outcomes for which data were available. The be used or adapted for future NHS-based research
associations, although strong, do not suggest of the HRM performance link.
construct redundancy and it is reasonable to
xi

Executive summary
Future research foci could be usefully revised to take account of some of

the learning from this and other overviews. More
Many of the problems of the studies taken attention needs to be given to the intermediate
collectively arise from the small-scale funding variables between HR practices and organisational
that characterises social science. Developing a performance. Thus, multilevel studies that
‘big science’ project that permits repeat surveys, a embrace the individual, team and organisational
broad coverage of practices, independent audits level (and, in the case of the NHS, Trust level) are
of practices, and reliable and valid performance needed. Finally, studies of interventions aimed at
measures would be desirable. Smaller-scale projects improving HR outcomes and performance should
would still be useful, for example, to delve into the be encouraged, together with a mechanism for
fidelity of implementation issue, but they would bringing together researchers and organisations
have more value if set in the context of bigger before the interventions take place. This would
studies. Existing data sets, for example, the WERS allow pre- and post-intervention measurement of
and Healthcare Commission (HCC) staff survey, relevant HRM practices and outcomes.
xii
Chapter 1
Introduction
A ppropriate human resource management

(HRM) policies and practices are vital if the
UK NHS is to change the process of health care
that patient mortality rates improve in acute
hospitals where an HRM director is a member
of the Trust Board. In this, the Department of
and improve outcomes for patients. The key issue Health is mirroring a more general emphasis
is what ‘appropriate’ means in this context, and on employee development and involvement as
the evidence on which this can be based. This key to maximising the human resource (HR)
report presents findings from a series of systematic contribution to strategic objectives of organisations.
reviews of the literature linking HRM practices This high-involvement management and human
to performance outcomes in the NHS and wider capital approach to HRM, sometimes referred to
organisational settings. It was commissioned by as ‘the HRM approach’, has been at the centre
the National Coordinating Centre for Reseach of the literature for the past two decades. For
Methodology (now part of the NIHR HTA consistency, we refer to it as ‘the high-involvement
programme under the NIHR Methodology Panel) management approach’, while acknowledging
and the NIHR Service Delivery and Organisation that not all of those who are referring to modern
(SDO) Research and Development (R&D) HRM necessarily place empowerment at its core,
Programme, and the reviews were undertaken but rather emphasise the development of human
between September 2005 and July 2007. skills and knowledge. The term ‘HRM’ is used
whenever a potentially more all-embracing concept
First, this chapter provides an overview of research of personnel management is being considered.
in the field of HRM, exploring current debates
and the rationale for the review. It then goes on to The past 20 years have seen increasing attention
explain the research brief and detail the specific given to both the general notion of HRM and
objectives for the review. Finally, the structure the more specific high-involvement management
of the report and presentation of findings are approach as a major contributor to organisation
described. performance, even in capital or technologically
intensive industries. High-involvement
management is assumed to contribute both in its
Context for the review: own right and as a support for such other modern
overview of the literature management practices as total quality management
(TQM) and just-in-time (JIT). So, in the health
on HRM and organisational context, high-involvement management adds to
performance the human capital of the workforce and helps
support new modes of organisation, technology
Focus on high involvement and
and patient delivery. Its importance derives from
skill acquisition an assumption that some forms of personnel
The Department of Health (www.dh.gov.uk/en/ management – and, particularly in the current
index.htm) repeatedly singles out the crucial role context, approaches founded on involvement
of skill development, involvement, team working and development – have greater effects on the
and morale to the modernisation of the NHS. In development, skills and motivation of employees
the words of the Department of Health’s website, than others.
‘Successful human resources management improves
efficiency through a culture that supports and Much of the attention given to the high-
develops its staff, allowing the workforce to share involvement or commitment HRM system has
in the organisation’s objectives’ (www.dh.gov.uk/en/ been advocatory. Contrasting it with a traditional
Policyandguidance/Humanresourcesandtraining/ control approach (sometimes known as Taylorist
Buildingpeoplemanagementskills/index.htm). or Fordist), academics1–3 have championed high-
involvement management as a progressive form
The evidence offered to support the Department’s of management that can remove past restrictions
view that HRM is vital to the NHS is the finding to both economic efficiency and the achievement
1

Introduction
of high-quality performance, thereby sharpening approach and performance, i.e. that the impact
the competitive edge of Western organisations of human capital will vary between contexts. In
and improving public sector delivery. They the past few years, more studies have either been
contend that there is a unique set of practices or conducted singly in the service sector or included
approaches to management that will, regardless that sector within the scope of the study,15,25–27 and
of the context, outperform all others. Within the the results have been mixed. Studies specifically
strategy literature, the resource-based theory of the on health care are emerging, for example West et
firm4–6 highlights how human resources, and the al.28 have investigated the link between HRM and
knowledge embodied in them, may be decisive for patient mortality.
long-term competitive advantage. In the operations
management literature7–10 the emphasis is on how Assessing the evidence
HRM practices and the knowledge and skills of
workers are decisive in exploiting lean production11 Notwithstanding the above, an increasing number
and other modern management methods (e.g. see of writers question whether the portrayal of the
Dean and Bowen12 on TQM). studies as providing conclusive evidence for a
universal link between HRM and performance is
Research evidence premature, and that there is a clear need to delve
more deeply – both into the studies and into the
The last decade has witnessed a stream of research reality of high-involvement management and its
assessing high-involvement management and links to other aspects and methods of management.
its associated concepts. The basic hypothesis There are a number of reasons for extending the
underlying this work is that high-involvement debate.
HRM systems will have positive effects on
organisational performance. As academics First, the results of the various studies are neither
have sought to move beyond advocacy of high- as clear-cut nor as uniform as some have concluded
involvement systems, they have focused on testing (see Wood,29 particularly table 1 for a summary of
this hypothesis. A spate of research studies in the the main results; and Wall and Wood30,31). Within
1990s were motivated by this, with many surmising studies, there is unevenness in the findings between
that high-involvement HRM systems do perform performance measures; while some results point
best.13–20 Several overviews21,22 concluded that, on to universal effects, others do not. Moreover, in
the basis of the first few studies, the universalistic many studies only the universal hypothesis has
hypothesis is supported. The increasing use of the been tested so one cannot rule out the contingency
term ‘high-performance’ model to describe the set argument that the effects of high-involvement
of practices may imply that the matter is indeed management on performance are contingent
settled, much as a drug might be named by the on a third factor, either a dimension of the
disease it is known to cure. context or the strategy of the organisation, even
when a positive link between high-performance
The initial overviews of these studies22,23 tended management and performance has been found.
to present them in a homogeneous way, taking
for granted that they are studying the same Second, it is not always clear whether high
phenomenon and that the results are broadly involvement or performance management is being
the same, concluding they had successfully defined simply as the combined use of best practice
demonstrated the link between the human capital in each domain of human resources, as a synergistic
approach and key organisational outcomes. These set of practices, or by a more fundamental
reviews have led some to conclude that the main managerial orientation.32 In fact, the discussion so
issue now is to explain the link between high- far has begged the question of how we define and
involvement management and performance, i.e. identify a system. Most studies have defined an
to assess the mechanisms between them or get HRM system a priori, often with little theoretical
inside the ‘black box’ between the HRM system justification, as the emphasis has been on testing
and outcomes. A second issue might be the extent the high involvement–performance link, rather
to which the link will be found in all contexts, and than first investigating the relationship between
particularly in service industries such as health practices or the nature of any systems. Researchers
care. The majority of the early studies were in have measured HRM on the basis of differentiating
manufacturing, and it is significant that one of the organisations by their usage of a set of practices,
few early studies in services24 found evidence of a the precise means varying between studies. Then
contingent relationship between the human capital they correlate these differences with performance
2
measures. The problem of simply aggregating systems, with some studies treating them as part
practices to provide an overall measure of HRM is of high-involvement management or at least
that each practice is treated implicitly as if it were performance management, whereas others do not.
equally important. With only a few exceptions,33,34
studies have provided insufficient information Fourth, there has been insufficient empirical
about which individual or subset of practices has exploration of the mechanisms or intervening
the strongest effects and which may be marginal variables that might explain any link between
or even irrelevant. In one case13 where this was HRM and performance. Of course it must be
done, and it was shown that only some of the acknowledged that there is little point in investing
practices affect performance, and, moreover, that resources in exploring the reasons for a link
their strength varied between industrial context, until it has been established. Yet, labels such
though the authors still framed their conclusions as ‘high commitment’ and ‘involvement’ imply
in terms of an overall (high-performance work) certain mechanisms that are concerned with the
system yielding superior performance. Aggregating extent of commitment or engagement on the
practices does not allow one to test whether the part of the work force, which is mirrored in the
effects of one practice are enhanced by the use importance given to morale in statements about
of another, i.e. whether they are synergistically the modernisation of health care, and these could
related, and begs the question of whether they tend be explored more than they have been. Much
to be used together.32,35 of the theoretical justification that precedes the
empirical studies also implies that skills, knowledge
Third, there is considerable variability across and learning might have an independent effect on
studies in the practices included either in the performance as important as employees’ attitudes.
model of high-involvement management or the
set of practices used to test its link to performance. Some studies have included intervening variables,
Some of the differences are terminological, which have either centred on intermediate HR
perhaps reflecting disciplinary biases or a quest outcomes (e.g. labour turnover in Huselid18)
to differentiate one’s wares. But a core difference or on commitment and satisfaction.36,37 Several
within the literature can be identified. On the authors hint at, but do not explore in depth, other
one hand are those authors who see the core mechanisms; for example, Guest and Conway38
of high-involvement management as changes imply that procedural justice may be important.
in work organisation, job design and employee In addition to morale and staff development,
involvement methods (particularly idea capturing), an important emphasis in statements on the
with the other practices acting as supports to modernisation of health care is what might be
help motivate and equip people to work in a termed the strategic integration of individuals into
new, more flexible and proactive way. On the the organisation, so that they both understand
other hand are those who do not prioritise the and share the goals that achieving patient
task system. They may then concentrate more on care entails and, consequently, orientate their
skill acquisition, following an emphasis on the behaviour towards common visions. Studies
resource-based theory of the firm, according to outside the narrow confines of the HRM studies,
which genuine competitive advantage reflects an particularly building on the job redesign and lean
organisation having a unique capability or set of production literature, point to the importance
resources. Therefore, primacy is placed on the of the kinds of attitudes that advocates of
competencies of individuals, rather than whether total quality management and other modern
they are empowered. Alternatively, they may treat management methods highlight, including
high-involvement management as entailing the quality consciousness,39 continuous improvement
use of the whole gamut of sophisticated personnel orientation40 or flexible work orientation.41
management methods, and conceive them as
primarily operating through people’s commitment Finally, the majority of studies have concentrated
or sense of whether they are being treated fairly on a narrow range of HRM practices in isolation,
and consistent with their psychological contract. the exception being those that have included
The different approaches need not affect TQM in their analysis,20,31,34 but there is a general
greatly the practices researchers include in their failure to assess the effectiveness of HRM and
studies, but the inclusion of job design and work related practices relative to both key elements of
organisation practices is one major source of management, such as leadership, and practices
diversity between the studies, as Wood and Wall31 further afield, such as R&D expenditure.
show. The other major difference is incentive
3

Introduction
In addition, despite the differences in focus and assess the reliability of measures of some outcomes
measures, most of the studies share a basic research of HRM.
design, which has a number of weaknesses. These
include: The brief for the review was that its scope should
be broad, covering, where feasible, evidence from
• The use of cross-sectional designs, which limits non-health sectors, although evidence from the
the ability to make causal inferences (e.g. health sector should be emphasised.
to decide whether HRM practices promote
performance, or rather better performance The objectives of the review (source: NHS/SDO
encourages greater investment in HRM). Invitation to Tender 2004) are to:
• A reliance on a single data source (e.g. a chief
executive or HRM director) for information 1. describe HRM practices and measure the
on HRM practices and performance, which fidelity with which they may be implemented
may result in measures of unknown reliability 2. review the reliability of methods of measuring
and common-method bias (see, for example, particular intermediate outcomes (intended
the debate between Huselid and Becker42 and outcomes of HRM that may affect patient care,
Gerhart et al.43 on the reliability of measures e.g. morale)
based on single respondents). 3. review the literature on the correlation of
• Many have small samples, low response rates intermediate outcomes to each other
and concentrate on a limited range of sectors. 4. investigate the correlation of intermediate
outcomes with final outcomes
However, even the most searching reviews that 5. investigate the sensitivity of intermediate
have highlighted problems in the studies have outcomes to individual HRM practices.
concluded that there is nonetheless sufficient
promise in the body of evidence to consider major A pictorial summary of the project and its
investments in the area.30 It is thus timely to invest objectives (adapted from that provided in the
in detailed assessment of what we know. original brief) is shown in Figure 1 (for details of the
full proposal see Appendix 1).
Review aim, scope and

objectives Report
The overall aim of this series of related systematic This report presents findings from a series of
reviews is to provide a picture of HRM practices systematic reviews of the relationship between
in use in the UK, to identify evidence on the HRM practices and performance. The reviews
relationships between HRM practices and a variety presented two principal challenges to the
of individual and organisational outcomes, and to research team. First, the literature on HRM and
Objective 1: Objective 3:
Describe HRM Links between
methods intermediate outcomes
Intermediate
Intermediate
outcomes:
HRM outcomes: Final
Policy Staff
practice Staff behaviour outcomes
psychological
outcomes
outcomes
Objective 1: Objective 5: Objective 2: Objective 4:

Fidelity of Sensitivity of outcomes Reliability of outcome Links between
implementation to HRM practices measures intermediate and final
outcomes
4 FIGURE 1 Human resource management policy, performance model and project objectives.
performance, and possible intervening variables outcomes. It outlines the identification of

linking the two, is diffuse, considerable and intermediate and final outcomes, and provides a
complex. For example, the research literature context for interpreting the review findings.
contains contributions from several disciplines,
using different types of research designs, and Chapters 6–8 investigate the sensitivity of
what constitutes HRM and performance can intermediate outcomes to individual HRM policies
vary considerably from study to study. Second, (Objective 5) and present findings from a series of
systematic review methodology has not been systematic reviews of the evidence on the impact of
used much in the HRM field. As the literature is HRM practices on intermediate and final outcomes
heterogeneous on a number of dimensions, we use in the general and health literature:
a reflective approach, adapting and developing
the review methodology to meet the particular Chapters 6 and 7 focus on evidence from the
demands of each research objective rather than health sector:
using an identical methodology throughout the
project. • Chapter 6 presents a synthesis of evidence
on the extent to which HRM practices affect
Chapter 2 of the report describes the intermediate outcomes in the health sector.
methodological context for the review, detailing • Chapter 7 outlines the findings of a systematic
recent developments in thinking and methodology review of the impact of HRM practices on
that we have drawn upon. It then provides a health sector outcomes.
methodological summary, including a description
of the systematic review methodologies used in this Chapter 8 reports on findings from a systematic
research, the process by which research objectives review in the general HRM literature to identify
were translated into specific research questions and synthesise evidence on the links between
and an overview of the range of methods used in HRM practices and both intermediate and final
relation to each research question. outcomes. It details specific search strategies and
presents a narrative synthesis of results.
Chapter 3 addresses some of the research questions
relating to Objective 1 of the review, specifically Chapter 9 describes the pattern of intercorrelations
detailing: found in the literature both between intermediate
outcomes (Objective 3) and between intermediate
• the range of HRM practices described in the and final outcomes (Objective 4).
literature
• evidence on the extent to which these practices Chapter 10 presents evidence on the reliability
are used in UK organisations. and validity of measures of intermediate outcomes
(Objective 2). Generic and health sector-specific
Chapter 4 considers implementation fidelity measures of intermediate outcomes are identified,
(Objective 1), i.e. the extent to which HRM and the best available evidence on their reliability
practices are actually put into practice, and the is presented.
extent to which this is measured and how it could
be measured, based on a critical review of the Chapter 11 comprises the conclusions and
literature. recommendations, based on the evidence in this
report.
Chapter 5 explores current understanding of the
linkages between HRM practices and performance

Chapter 2
Methodology
Introduction is examined in this review is multidisciplinary and
heterogeneous. Finally, the review is composed
Chapter 2 provides a broad description of the of five (subsequently six) distinct and yet related
methodological approaches used at different objectives – not a single well-focused research
stages in the review. First, the research context question but rather a series of separate and equally
is considered and the challenges of applying elusive questions.
systematic review methodology to the HRM
literature are discussed. Next, the systematic Systematic review was the method of choice
review approaches used are explained and the because the methodology offers a number of
specific questions for the review established. The models to be applied or modified depending
combinations of search terms and databases used on the questions being asked. Systematic review
are detailed and a summary of the methodological is an evolving methodology, primarily designed
approaches used in addressing each of the specific to answer questions regarding the effectiveness
research questions is presented. of interventions by synthesising findings from
large numbers of studies. As such systematic
reviews are ‘a scientific tool which can be used to
Applying systematic review summarise, appraise and communicate the results
methodology within the and implications of otherwise unmanageable
quantities of research. They differ from traditional
HRM literature reviews and commentaries produced by “content
Systematic review methodology has a very experts” in that they use a replicable, scientific and
limited pedigree within HRM, which has only transparent approach that seeks to minimise bias.’47
comparatively recently begun to adopt some of the Systematic reviews follow a process of constructing
tools of evidence-based practice.44 Nevertheless, a clearly defined research question with inclusion
some key studies do exist. For example, Levy and exclusion criteria, comprehensive searching to
and Williams45 conducted a systematic review identify all relevant literature, quality assessment
of 300 studies examining the social context of of selected studies, extraction of relevant data from
performance appraisal and Taris46 examined 16 these studies, and synthesis of the study results. In
studies dealing with the burnout–performance cases where there is sufficient similarity in the focus
relationship. The lack of a significant body of of studies, in terms of interventions and outcomes
exemplars within HRM has limited the capacity of researched, a meta-analysis may be performed: a
this particular field to develop tailored methods of quantitative synthesis. The final result of the review
systematic review and to stimulate methodological is thus a conclusion based on a critical synthesis
innovation in the identification, assessment and of the comprehensive, unbiased selection and
synthesis of this type of data. As a consequence, appraisal of the best available research examining
there are very few instances of methodological the topic under consideration, which typically, in
papers on conducting systematic reviews within the health area, is an intervention.
HRM. The review team, therefore, faced a
number of challenges in conducting this series of This methodology was originally developed for
systematic reviews and in leading the adaptation analysing the effectiveness of pharmaceutical
and development of methods to tackle practical interventions in medicine, based on quantitative
problems generated by these review questions. data from randomised controlled trials (RCTs).
The challenges were compounded by a corpus of Systematic reviews in the medical field now have
literature that conceives the concepts of both HRM an accepted, standardised methodology.47,48 In
and performance (and indeed their intersection) recent years, the advantages of systematic review
in different ways, asking comparable but not over more conventional forms of literature review
identical questions, and using different types of have been recognised and examples have appeared
research design. Furthermore, the literature that in other fields.49,50 This has led to the piloting and

Methodology
development of methodologies for the review of Applying the systematic

qualitative research and the review of literature review methodology
in disciplines, such as the social sciences,51 where
there is no accepted hierarchy of study design or As described in Chapter 1, the five primary
accepted criteria for quality assessment.52–57 research objectives are concerned with the
evidence at each stage in a model of HRM and
Despite the challenges presented by heterogeneous performance. The model identifies final outcomes
types of research, systematic review methods (such as patient care and performance) as well as
are characterised by transparency of approach, intermediate outcomes – conceptualised as the
along with comprehensiveness, reliability and factors that link HRM practices to final outcomes.
reproducibility of methods and techniques. Hence, the review aims to identify evidence on
the nature of the causal links between, on the one
Recent commentators on systematic review hand, HRM practices and intermediate outcomes
methods endorse the adoption of flexible, and, on the other, intermediate and final outcomes.
exploratory and reflective approaches, especially However, this clear-cut distinction between final
(as is the case here) when the fields of evidence and intermediate outcomes is not reflected in
being considered are both complex and the literature. The team identified that evidence
multidisciplinary.56,58,59 The team therefore generated from studies falling outside the five
decided that rather than adhere strictly to any one stated objectives would also be informative, namely:
systematic review methodology in answering the
different questions posed by this review a more • studies that attempt to examine the whole
reflective approach should be taken, which would HRM to performance chain, and
allow the development of the methodology as new • studies that examine the impact of HRM on
challenges within the literature were encountered. final outcomes.
As a result, a sixth objective was added to the list:

Overview of systematic
review methodology • to review the literature investigating the impact
of HRM on final outcomes.
Each systematic review attempts to follow the
standard model: Developing research questions
• consultation exercise to define research Getting the question right is ‘the most important
question(s) step in doing a review … [because] poorly focused
• scoping exercise to define elements of research questions lead to unclear decisions about what
question (population, intervention, outcomes) research to include and how to summarise it’.48 The
and establish inclusion criteria first stage is to develop specific research questions
• production of protocol document specifying for the review.
population, intervention, outcomes, and
inclusion/exclusion criteria (study design, The initial steps for this project involved breaking
quality assessment, language, date) down the research objectives into their specific
• identification of potentially relevant literature component questions. The aim was to provide
(literature search) questions that would form the basis of the series
• study selection and quality assessment of systematic reviews that followed. The process
• data extraction of formulating precise, answerable questions from
• data synthesis. the research objectives was achieved through
consultation within the team and with the expert
This chapter goes on to describe the broad advisers.
systematic review approach adopted by this
research. It outlines how each stage of the review The six research objectives (that is, the five that
was conducted for the series of reviews that were were originally commissioned and the sixth added
undertaken, and ultimately presents a summary of following consultation with experts) were broken
the review questions and methodologies. down into 10 specific questions, as shown in Table 1.
8
TABLE 1 Research objectives and specific research questions
Research objectives Research questions

Describe HRM methods and measure the What HRM practices are described in the literature?
fidelity with which they may be implemented How widespread is the use of HRM practices in UK organisations?
How can the fidelity with which an HRM practice is implemented be
measured?
Review the reliability of measures of What is the evidence on the reliability of measures of intermediate
particular intermediate outcomes (intended outcomes covered by this review?
outcomes of HRM)
Review the literature on the correlation of What is the evidence on the intercorrelation of intermediate outcomes
intermediate outcomes to each other with each other?
Review the literature investigating What is the evidence for the impact of intermediate outcomes on non-
intermediate outcomes with final outcomes health final outcomes?
(be these business or patient centred) What is the evidence for the impact of intermediate outcomes on patient
care outcomes?
Investigate the sensitivity of intermediate What is the evidence for the impact of HRM practices on the intermediate
outcomes to individual HRM methods alone outcomes identified for this review?
or in conjunction with each other
Review the literature investigating the impact Which HRM practices have an impact on performance outcomes?
of HR methods on final outcomes Which HRM practices have an impact on patient outcomes?
Once this had been done, each research challenging. Chapter 3 details the process of
question was then typically broken down into identifying HRM practice terms, and the specific
the components of ‘population’, ‘intervention’, intervention and outcome terms used by the
‘comparators’ and ‘outcome’; this ‘PICO model’ respective reviews are given in Chapters 6–8.
provides a structure for devising research questions,
constructing search strategies and defining the Developing the protocol
inclusion and exclusion criteria for the review.47 It
is not necessary for all of the elements of the PICO The protocol provides an explicit outline and
model to be present in every question. Where a plan to be followed by the review. Conventional
PICO model has been used in these reviews, it systematic review methods require that a protocol
is detailed in the specific methodology for that describe clearly defined populations, interventions
chapter. and outcomes for the review, and provide details
of the literature-searching procedure, quality
Scoping exercise assessment, and data extraction and synthesis to
be conducted.47 As the outcome of the scoping
The scoping exercise defines key issues for a review process, the protocol specifies the exact content and
as clearly as possible in terms of the population, processes of the review, from which there should be
interventions and outcomes to be studied, and no deviations. It facilitates the performance of the
the inclusion and exclusion criteria to be applied. review by itemising exactly what the review does
Together with the definition of the research and does not include, and specifying the methods
question, this constitutes the ‘problem formulation of quality assessment and synthesis. It should also
stage, which involves the development of key state any language or geographical restrictions that
research questions, construction of the definitions might lead to bias in the review.61,62
of the key concepts … and the establishment of
inclusion and exclusion criteria for the review’.60 It is increasingly recognised that protocols for
reviews in disciplines where the literature is a less
For each review, a series of scoping exercises was known quantity, i.e. potentially heterogeneous,
undertaken to identify the best search terms with qualitative, and lacking the tradition of a
regard to the balance of specificity (relevance) recognised hierarchy of study design and quality
and sensitivity (inclusivity). The nature of the assessment criteria,54,55,60,63 may be required to be
HRM literature made the identification of specific broad, flexible and open to change. In short, as
intervention and outcome terms particularly Eakin and Mykhalovskiy64 suggest, the question is

Methodology
to be viewed as a compass rather than an anchor, Identifying longitudinal studies

continually being enhanced and refined until A further component of the review was restriction
completion of the review. Management is typical by study design. This was used for sections of
of such a discipline.56 In such cases, it may be the review that sought to establish a causal link
necessary to revisit and redefine interventions and between interventions, in this case HRM practices,
outcomes in response to findings, and conduct and either intermediate or final outcomes. While
iterative and purposive searching of the literature longitudinal studies in themselves do not prove
to address questions that arise or gaps identified in causality, it is widely recognised that longitudinal
the literature.52,58,60,63 This is often the case where analyses do provide better evidence for causation
the overall intent of the review is interpretive, than cross-sectional analyses that use the same
not aggregative, and where the terminology and variables.67,68 Indeed, contemporaneous systematic
concepts are neither secure nor predefined.65 reviews of HRM have reported that they are
The starting point, defined by the protocol, can limited in their ability to draw conclusions by their
therefore be broad and inclusive, rather than dependence on cross-sectional data.69 The project
narrow and exclusive, in contrast with that required team decided to limit the searches to longitudinal
by more traditional systematic reviews. study designs only, as the intention was to identify
those studies that could demonstrate causal links
In order to manage the diffuse HRM literature, between HRM practices and outcomes, rather than
simple, broad protocols were developed for each simple associations. It is believed that this literature
search. Protocols were reviewed regularly during would offer evidence with greater capacity for
the search process to help shape the eventual body answering the questions set by this review. No
of literature included in the data synthesis. limitations of language were applied in order to
avoid known biases produced by language and
Identifying literature location.61,62 There were no limitations by date
other than those of the databases themselves.
After the scoping exercise, which is naturally
exploratory, imaginative and purposive, the Operationalising the search
approach adopted is required to become more
systematic, transparent and reproducible. A For much of this particular review, only terms
literature search for a review aims ‘to provide pre-specifying an intervention and an outcome
as comprehensive a list as possible of primary were required. Searches aimed to optimise use of
studies, both published and unpublished, which free-text searching and keyword terms, along with
may be suitable for answering the question posed synonyms and variant spellings. This improves the
by the review’.47 Systematic review methods chances of identifying all literature relevant to a
almost unequivocally advocate an extensive and topic, and is particularly necessary within social
multimethod approach to identifying relevant sciences where indexing and abstracting quality
literature. The intention is to identify all published falls short of standards encountered within health
and unpublished literature of relevance to the care.70
review that satisfies the review’s inclusion criteria.
The principal means for achieving this is the Literature searching requires more than
searching of electronic databases. Search strategies interrogation of electronic databases with search
follow the PICO model, which, as mentioned strategies based on the protocol. It should use
previously, breaks a search query down into four other formal methods, such as citation tracking
separate elements: population, intervention, and scanning the reference lists of selected
comparator and outcome, a now-standard papers, and hand searching of relevant journals.
approach within health care.66 Critical in this, was Informal methods of study identification can also
a time-consuming process designed to identify be utilised, such as personal communications from
both the interventions (HRM practices) and the peer reviewers or expert advisors and serendipity.
outcomes (whether intermediate outcomes, such Supplementary formal and informal methods may
as job satisfaction or final outcomes, such as account for many, or even a majority, of studies
reduction in mortality). The resulting lists and included in non-quantitative reviews.52,53,60,63 Such
classifications inform most of the subsequent additional approaches are especially valuable if
questions. This process is described in more detail concepts are imprecise or if the literature is widely
in Chapter 3 (HRM practices) and Chapters 5 and dispersed and inconsistently indexed.
7 (intermediate and final outcomes).
10
In conventional review methodology, literature from three databases using standard and more
searching is refined by the scoping process and sensitive versions of the pay and training filters.
then carried out once.47 However, where concepts The number of potential HRM categories and
or interventions are evolving or cannot be easily practices was very large. A complete and formal
defined, supplementary, purposive literature process of reciprocal translation to produce a
searches may be performed. This may reflect more clearly defined list would have been an
an increasing understanding of the topic or the extremely resource-intensive task and would have
subsequent identification of specific questions produced an unmanageable number of results
raised by the findings of the review.52,63 Searching from any searches performed. On account of the
becomes an iterative rather than one-off process, multifaceted nature of our study, with its multiple
the so-called ‘spiral approach’ as described by questions, it was decided that the approach of
Grant et al.71 This was often how we had to proceed leading the review by specific HRM interventions
in this review, where pre-defining outcomes was not viable. The original idea of structuring this
could have limited the findings. However, such a review by HR intervention was therefore rejected.
process is still systematic and consistent with the
principles of systematic review methods. All search Problems encountered using particular HRM
strategies and sources for all included papers are terms required an alternative approach to the
documented to make the process transparent, intervention terminology. The team tested the
auditable and reproducible. viability of constructing an intervention search
filter using only generic HRM terms, such as
Developing the search terms human resource, HRM, HR and high-performance
work practices or management, and database
Scoping searches were performed using two of keywords, such as ‘personnel management’. This
the less ambiguous categories from the list of removed the problem posed by constructing
HRM practices generated for the review: pay and strategies using potentially non-HRM-related
training. Even relatively non-sensitive scoping terms, such as ‘training’, ‘communication’ or ‘pay’,
searches of the principal health and psychology which retrieved large numbers of studies and
databases (MEDLINE and CINAHL) produced were, arguably, as generic and non-specific as this
large numbers of research studies, which, although overarching terminology. Scoping searches using
they used these terms, were not the focus of this approach produced manageable numbers of
the review and would provide no data on HR potentially more relevant studies and, therefore,
performance linkages. Additionally, the scoping this method was adopted. The resulting HRM
searches indicated that even larger numbers of search strategy is discussed more fully in Chapters
citations would be retrieved by the more sensitive 5–7, and example searches are provided in
searches planned for the full review. Table 2 Appendices 6 and 7.
provides an illustration of the number of hits
TABLE 2 Results of scoping searches for two HR practices with patient outcomes
– Comments,
HR + Patient editorials, letters,
practice Database Hits outcomes reviews English only + Longitudinal
Pay systems a
MEDLINE 1350 417 379 367 55
Pay MEDLINE 58,126 7443 6387 5572 1385
EMBASE 40,179 5882 4873 4213 914
CINAHL 13,909 1344 1283 1247 209
Traininga MEDLINE 11,607 939 823 793 163
Training MEDLINE 178,806 10,028 8804 8269 1341
EMBASE 209,317 28,908 21,084 19,283 4001
CINAHL 9968 1274 1219 1198 160
a Denotes the less sensitive, more specific version of the filter.
11

Methodology
Search process reliability score is achieved.47 Where a question

Literature search strategies were developed and remains over whether or not to include a study it
performed by a systematic review information is referred to a third reviewer (or a consensus is
specialist on the following databases: Applied reached by two reviewers).
Social Sciences Index and Abstracts (ASSIA),
British Nursing Index (BNI), Business Source Conventional systematic review methods
Premier, Campbell Collaboration, Cochrane advocate the application of a quality threshold
Central Register of Controlled Trials (CENTRAL), in determining study inclusion.47 The aim is to
Cochrane Database of Systematic Reviews (CDSR), evaluate the internal validity of studies by assessing
Cumulative Index to Nursing and Allied Health selection, performance, measurement and attrition
Literature (CINAHL), Database of Abstracts bias. The intention is to include only those studies
of Reviews of Effectiveness (DARE), DH-Data, that achieve the highest standards of methodology
EMBASE, Health Management Information and reporting. Many tools or checklists have been
Consortium (HMIC), International Bibliography of developed for the critical appraisal of study quality
the Social Sciences (IBSS), King’s Fund database, based on study design, but each has limitations
MEDLINE, NHS Economic Evaluation Database and there is no accepted standard set of tools.72
(NHS EED), National Research Register (NRR), Nevertheless, such tools are principally designed
PREMEDLINE, PsycINFO, ReFeR, Social Sciences for specific types of medical research; surveys and
Citation Index (SSCI) and Science Citation case studies, for example, are less easily assessed,
Index (SCI). Search strings were modified for the although quality assessment checklists have been
different databases to take account of the different developed.58
keywords and thesauri they use. Searching of
electronic databases using pre-designed search However, there is a case for not excluding studies
filters was supplemented by reference tracking of on the basis of quality, but simply to use assessment
selected studies. Searches were conducted in May/ criteria to weight the findings of the studies in the
June 2006. Table 3 provides details of the search review.52,54,55,63,73 Quality assessment may act as a
filters and databases used for different areas of the guide to interpreting findings and determining
review. the strength of inferences, as well as enabling
weighting of study results. It has been argued
Use of generic HRM terms is not ideal in that qualitative studies cannot and should not be
identifying relevant studies. Papers that examined appraised formally,54,57 and that quality assessments
an HRM practice, such as employee feedback, may be evaluating limitations of reporting rather
could be missed if no mention of human than methodology.74 Quality assessment thus
resources, personnel or a synonym is made in the depends on the type of studies being reviewed.
title, abstract or database designated keywords. Controversy remains on whether or not to exclude
However, this was the only way to operationalise ‘weak papers’.75 In this review assessment of quality
HRM as a search strategy, given the extensive is used to moderate the messages from included
problems of using single practice terms. This research, and not as a quality threshold.
search string was modified for different databases
recognising the different keywords and thesauri This review had already imposed a longitudinal
they utilise. Additionally, the ‘HRM’ searches were criterion on the studies selected for review – a
supplemented by reference tracking and citation fairly high threshold for studies in the HRM field
searching. (in which cross-sectional, self-report design is
common). Further weighting of studies by study
Study selection design was applied and this is reflected in the
relative weight given to the various studies in the
This stage aims to identify articles that ‘help to data synthesis.
answer the questions being addressed by the
review’.47 Study selection should be systematic, Data extraction
replicable and free from bias. Sifting is informed
by criteria reflecting the population, intervention, This is the process ‘by which reviewers obtain the
outcome, study design, language and other criteria information they need from what is reported by
defined in the protocol. Titles and abstracts of primary investigators’.47 The aim is to collect from
retrieved articles are sifted by two reviewers or the selected studies the most important data for
by one reviewer after an acceptable inter-rater answering the research question. A data extraction
12
DOI: 10.3310/hta14510
TABLE 3 Search filters and databases used by report chapter
Search filter Database
HRM
IOs
POs
Longitudinal
Meta-analysis/review
IO measures
MEDLINE, CINAHL
PsycINFO
Business Source
Premier
SSCI
ASSIA, SCI,
EMBASE, Cochrane
library
HMIC, King’s Funda
IBSS,a BNI
DH-Data, NRR,
ReFeR
PREMEDLINE
Report chapter

Linking HRM practices to    
outcomes (Chs 7 and 8)
HRM practices to patient            
outcomes (POs) (Ch. 6)
Linking IOs to IOs (Ch. 8)           
Linking IOs to FOs (Ch. 8)     
Linking IOs to POs (Ch. 8)       
Reliability of IO measures      a a
(Ch. 9)
FO, final outcome; IO, intermediate outcome; PO, patient outcome; ReFer, Research Findings Register.
a Of the two databases listed, only this database was searched.
Health Technology Assessment 2010; Vol. 14: No. 51
13
Methodology
form is piloted on several studies to ensure that Objective 1

reviewers are recording the same data and to Objective 1 is a mapping exercise involving
develop forms of optimal length so that all key data both the identification of the range of HRM
are recorded.47 In this review, data are primarily practices documented in the literature and the
extracted and presented in the form of evidence HRM practices actively reported in use reported
tables. by management practitioners. It is necessary to
triangulate findings from these two sources in order
Data synthesis to identify any gaps between research and practice.
Synthesis aims to ‘draw together, contextualise • Question 1.1 What HRM practices are described
and interpret the findings from the separate in the literature?
[studies]’.53 Methods of synthesis are determined
by whether data are qualitative or quantitative, Method Content analysis was performed on
and by the questions being asked of the data.75 six, recent major reviews of HRM practices,
Meta-analysis is ‘the quantitative synthesis of supplemented by additional literature identified
data, in which evidence is pooled using statistical for Objective 6. Practices were then categorised
techniques’.75 A narrative review seeks to ‘capture under broad headings of HRM, using accepted
and describe, rather than “average out” the definitions of these categories, for example work
heterogeneity between studies’, and its choice as design, performance management.
a method of synthesis may be ‘predicated on the
diversity and complexity of the field’.53 Several • Question 1.2 How widespread is the use of
methods of synthesising qualitative data are being HRM practices in UK organisations?
developed, such as thematic analysis, grounded
theory, meta-ethnography and realist synthesis.75 Method Evidence was drawn from the best available
The method applied to each review is determined surveys of HRM practices in the UK. These
by the heterogeneity of the included studies and surveys were identified from the expert knowledge
their data. In this review, synthesis is primarily of members of the project team, personal
descriptive and quantitative in recording the communications from colleagues, and systematic
studies that meet specific characteristics, and is searching of electronic databases and relevant
accompanied by a narrative synthesis.76 There websites. Surveys were included if they contained
were very few studies in this review that addressed UK data. They were then weighted according to
the same basic research question (i.e. examining specific criteria. Results were tabulated.
the same relationship or set of relationships)
precluding the use of meta-analysis for most • Question 1.3 How can the fidelity with which an
intervention groups. Narrative synthesis was HRM practice is implemented be measured?
retained to ensure consistent synthesis across all
interventions and enabling comparisons to be Method A critical review was undertaken of research
made. on implementation fidelity and relevant studies
from the field of HRM. Studies were identified
by systematic searching of electronic databases
Summary of specific and informal methods, such as serendipity. A
research questions and model, a measure and a guidance document were
developed, based on this literature review.
methodological approaches
The review team drew on the most recent Objective 2
developments in systematic review methodology
in identifying and then resolving the challenges of • Question 2.1 What are the most reliable
this evidence base. measures of the intermediate outcomes
identified for this review?
A number of different research methods were
used to identify evidence in relation to each of the Method The intermediate outcomes to be assessed
specific research questions. This section provides a by this review were identified by content analysis
summary of the methodological approaches used of the relevant literature and a Delphi process
in relation to each of the objectives and specific involving HRM experts. The existing review
research questions. and theory literature on the measures of these
14
intermediate outcomes was examined to identify Objective 5

candidate measures. This literature was identified • Question 5.1 Do any HRM practices have
from a combination of systematic searching of a significant impact on the intermediate
electronic databases and informal methods, such as outcomes identified for this review?
expert knowledge.
Method Again, each intermediate outcome
Objective 3 identified under Objective 2 was examined in
a systematic review of the longitudinal HRM
• Question 3.1 What is the evidence on the literature. This literature was identified from
intercorrelation of intermediate outcomes with Objective 6, Questions 6.1 and 6.2, which included
each other? longitudinal research examining the impact of
HRM practices on various intermediate outcomes.
Method Intermediate outcomes covered by this A qualitative, narrative synthesis of the literature
question were identified as described under was produced.
Objective 2. The existing review and meta-analysis
literature was reviewed to identify correlations Objective 6
between individual intermediate outcomes. This
literature was identified by a combination of • Question 6.1 Which HRM practices have an
systematic searching of electronic databases and impact on performance outcomes?
reference tracking.
Method A systematic review was undertaken of
Objective 4 longitudinal research examining HRM practices
and both intermediate and final outcomes. Studies
• Question 4.1 What is the evidence for the were identified by the systematic searching of
impact of intermediate outcomes on non- electronic databases and reference tracking, and
health final outcomes? by informal methods such as expert advice. The
literature was mapped to the category framework
Method Once again, the intermediate outcomes developed in response to Question 1.1 and a
covered by this question were devised as for qualitative, narrative synthesis of the literature was
Objective 2. The existing review and meta-analysis produced.
literature was identified and reviewed to evaluate
correlations between individual intermediate • Question 6.2 Which HRM practices have an
outcomes and final outcomes, such as performance, impact on patient care outcomes?
turnover and absenteeism. This literature was
identified by a combination of systematic searching Method A systematic review was undertaken of
of electronic databases and reference tracking. longitudinal research examining HRM practices
and their impact on patient-care outcomes. Studies
• Question 4.2 What is the evidence for the were identified by the systematic searching of
impact of intermediate outcomes on patient electronic databases and reference tracking, and
care outcomes? by informal methods, such as serendipity. The
literature was mapped to the category framework
Method Intermediate outcomes were again developed in response to Question 1.1 and a
identified as for Objective 2. The aim was to qualitative, narrative synthesis of the literature was
produce a synthesis of the longitudinal literature produced.
for each intermediate outcome as it relates to the
patient care outcomes identified for this review. Against this methodological backdrop, the
This literature was identified by a combination of specific details of each review are described in
formal methods, such as systematic searching of the corresponding section of the report and
electronic databases and reference tracking. justification is given for methods used.
15

Chapter 3
HRM practices and their
reported use in the UK
Introduction too broad to be influenced by HR policies/
practices alone, but were of potential interest
This chapter of the report presents findings in to the review for their impact on organisational
relation to Objective 1. Specifically, it addresses or individual performance. Examples include
the first two research questions identified under bullying/harassment, socialisation, etc.
Objective 1 (Question 1.3, on implementation • A sizeable number of HR policies/practices,
fidelity, is dealt with in Chapter 11): 29 in total, were considered to be part of HR
maintenance functions (i.e. administration)
• Objective 1: 1.1 What HRM practices are rather than proactive HR practices aimed at
described in the literature? enhancing performance. Examples include
• Objective 1: 1.2 How widespread is the use of equal opportunity, dispute resolution policies,
HRM practices in UK organisations? and health and safety policies.
The chapter first describes the process by which The classification of HRM practices into broad
HRM practices were identified, and then goes on categories was reviewed by the expert advisers. As a
to report findings on the extent of use of these result, the terms were refined according to the most
practices in the UK. appropriate HR category as defined and used in
the literature and additional HRM practice terms
were suggested, which had not been identified in
What HRM practices are the review of reviews:
described in the literature?
• The higher level concepts category was
This phase of the research sought to audit the main renamed ‘bundles’ of practices. Over the last
HRM practices described in the literature. The aim 10–15 years there has been a growing body
was to identify a complete list of HRM practices of research on ‘bundles’ of practices. This
to be developed into a search strategy. Data from
three sources were used to develop the list.
TABLE 4 Initial categorisation of HRM
Step 1
1 Work design
The research team and expert advisers generated 2 Training and development
a list of 13 headings. Eleven of these were broad
3 Communication
HRM categories under which it was anticipated
that the majority of individual HRM practices 4 Single status/harmonisation/status differentials
could be grouped, which could then be used as 5 Appraisal/performance management
a framework to shape the reviews. Initial HRM 6 Higher-level concepts (HPWPs, HI, HC, etc.)
practice terms are presented in Table 4. 7 Administration
8 Recruitment and selection (including placements)
It was recognised from the outset that HRM
9 Compensation and reward systems
practices were unlikely to all fall into neat
categories. In addition to the 11 broad categories 10 Family friendly
of HRM practice identified, two further categories 11 Employee representation/involvement/participation
were used to group individual practices: 12 Total quality management
13 Miscellaneous
• The ‘Miscellaneous’ category was used to
group practices that were not subject to direct HC, high commitment; HI, high involvement; HPWP,
manipulation by the HR department, or were high-performance work practice.
17

HRM practices and their reported use in the UK
category was therefore intended to capture particular the inconsistency of terminology and the
research that focused on combinations of HRM blurred boundaries of some of the concepts, meant
practices that were intentionally designed to be that the broad categories identified through this
used in concert as well as for multiple practices process would not be a suitable as the sole basis
opportunistically used together. for the subsequent review of evidence. Ultimately,
• Articles in the ‘Miscellaneous’ category were a combination of broader search terms and study
reappraised and either recategorised under design criteria were used (which are described in
one of the main headings or excluded from Chapters 2, 5 and 6).
this assessment of the main HRM practices
described in the literature. Step 3
Step 2 The systematic reviews undertaken to meet
Objectives 3–5 generated over 450 papers (see
In a parallel process, a list of HRM practices was Chapter 5 for a description of these searches). The
compiled from six major recent reviews of the individual HR practices, policies or interventions
HRM literature.30,35,77–80 This process identified 245 that had been the focus of these studies were
practices. mapped on to the list of HR practices generated by
Steps 1 and 2. This was done in order to identify
A process of reciprocal translation81 was applied any gaps in the list of HR practice terms and
to the 245 practices identified by the review of further refine the categories. The exercise revealed
reviews, with the intention of building a consensus that:
about the main HRM practices covered in the
literature. Reciprocal translation involves the • A large body of literature in the health
comparison of themes across papers and an sector focused on specific HR practices not
attempt to establish whether there is equivalence commanding much attention in the non-health
in the themes of one paper with those from sector – specifically ‘working hours’, ‘staff
another. The aim is to ensure that a key theme levels’ and ‘skill mix’. These practices were
captures similar policies or practices from different included under the ‘staffing’ practice category
papers. In this exercise, the reciprocal translation along with selection and recruitment.
was approached by two of the researchers • All TQM practices identified (a separate
independently attempting to compare HRM category on the original list) were, in fact,
practice terms across review papers and group training interventions, so were included under
them under one of the broad HRM categories the broad ‘training’ heading.
listed in Table 4.
The final list of 10 broad HRM categories is as
Initially, a substantial number of practices did follows:
not appear in any of the categories or could be
allocated to more than one. For example, appraisal- 1. work design
based pay can be seen as a part of the broad HRM 2. staffing
category of appraisal/performance management 3. training and development
and of compensation and reward systems. Likewise, 4. compensation and rewards
introducing autonomous work teams can be seen as 5. communication
both an employee involvement strategy and a work 6. family friendly
design approach. 7. single status/status harmonisation
8. employee representation, involvement and
The process of reciprocal translation made it participation
apparent that the same term could be used to 9. appraisal/performance management
describe different practices in different papers (e.g. 10. bundles.
‘goal setting’ to mean performance management
in one context and employee involvement in Appendix 2 contains a list of these broad HRM
another). categories with definitions. Appendix 3 presents
the specific HRM practices identified in the
At this stage in the research, it became apparent literature grouped under these 10 broad categories.
that the diffuse nature of the HRM literature, in
18
How widespread is the use 1. were weighted and representative of UK

of these HRM practices in workplaces (i.e. data were collected or adjusted
so that the resulting figures do not simply
the UK? represent large organisations or organisations
Aim from particular sectors or industries)
2. were based on the unit of the workplace (this
As part of Objective 1, the review sought to can be a self-contained entity or a unit of a
document evidence on the extent of use of HRM larger organisation) rather than an individual
practices within UK organisations or workplaces. employee
The intention is to: 3. included the UK public sector and/or health
sector.
• provide a comprehensive report of the
percentage of organisations using the HRM Data from surveys that were weighted were
practices identified for this review and to preferred to data from surveys that were not
identify gaps in the survey literature representative of UK workplaces but simply
• relate findings of the review of the research reported data based on the unit of the workplace.
literature to actual practices used within UK Data from such surveys were, in turn, preferred to
organisations. For example, research may those that simply reported UK private or public
demonstrate that a practice has a significant sector data. If data on a practice were available in a
beneficial impact on job satisfaction or patient survey that was weighted and representative of UK
outcomes, while survey data may indicate that workplaces then these data were used in preference
this practice is not actually widespread. to data on that practice from a more limited survey.
The first aim is addressed in this chapter and the Results

implications for the overall conclusions of the
review are considered in Chapter 11. Surveys: a comparison
Searches identified 18 surveys from 1996 to 2006
Methods that satisfied the criteria. A comparison of included
surveys is seen in Table 5. The best available survey
Findings from the highest-quality and most is the 2004 WERS:82 WERS data were ‘weighted
up-to-date HR surveys were used to generate and are representative of [workplaces with 10 or
these data. Surveys were identified using several more employees], which accounts for 18% of all
strategies. The Workplace Employment Relations workplaces and 80% of all employees in Britain’.
Survey (WERS) and other survey organisations With the exception of the Chartered Institute of
were identified by members of the project team. Personnel and Development (CIPD) surveys on
Searches were conducted to identify appropriate performance pay or rewards, this was also the only
publications on the websites of relevant major survey to record data from the public sector,
organisations, including: Community Innovation and the only survey to compile specific health
Survey (CIS), Continuing Vocational Training sector data. Therefore, if WERS covered a practice,
Survey (CVTS), European Survey on Working then only WERS data were used, even if other
Time and Work–Life Balance (ESWT), PASO surveys provided data on the same practice; WERS
(Panel Survey of Organisations), Employee Direct was considered the best evidence. Where duplicate
Participation in Organisational Change (EPOC data existed, those from only the best survey were
Project), and Workplace and Employee Survey reported.
(WES) Canada. Searches of the SSCI and King’s
Fund electronic databases were used to identify Three further surveys also claimed to be
additional surveys, particularly for the UK health representative, although they did not acknowledge
sector. Search strategies used combinations of the weighting of these data. For example, the ESWT
following terms and their variants: survey(s) and survey stated that ‘the survey data in the ESWT
practice(s) and either human resource(s), staffing, are representative of establishments with 10 or
work or personnel. To be included, the survey data more employees from all sectors of activity’ 86 and
had to relate to UK workplaces. the EPOC survey88 claimed to be ‘representative
of workplaces in ten countries of the European
Surveys were ordered in a hierarchy, based on the Union’. The remaining surveys were not
following quality assessment criteria. The survey representative, although several did offer public
reported data that: sector or health sector data, which were absent
from the representative surveys. 19

TABLE 5 Comparison of included surveys
Representative of Unit = workplace Public sector Health sector

Survey UK data UK workplaces or equivalent data data
WERS     
(1998, 2004, 2006)82–85
ESWT (2006)86   
CVTS (2001) 87
  
EPOC (1996)88   
Newton et al. (1996) 102
   
CIPD (2006) 89
  
IPD (1999)90
  
NESS (2005)91  
CIPD surveys  a
(2002–6)92–98
Wood et al. (2004)99  
CRANET (2003) 100
 
IPD (1999)101

CRANET, Cranfield Network on International Human Resource Management; IPD, Institute of Personnel and
Development; NESS, National Employers Skills Survey.
a Some of the CIPD surveys contain these data, but others do not.
Seven surveys sampled the workplace, all of which information about staff experiences of working
reported UK data (although three surveys were within the NHS, the annual staff survey differs
Europe wide). In the remaining surveys, CIPD considerably from the HR surveys reviewed here in
members were being surveyed rather than actual that:
workplaces, limiting the potential value of these
sources. Only one specific health sector survey of • It is targeted at the individual employee, rather
HRM practices was identified by this review.102 The than the HR function.
study reported on a non-representative sample of • It asks questions about individual staff
general practices in the UK. Some HRM practices, perceptions or experiences rather than the
which duplicate those covered by other surveys, are absence or presence of specific HR practices.
included because this was the only specific health • The nature of the data means that findings are
service survey. reported at the individual level (i.e. percentage
of all staff responses to a particular item)
This section examines evidence on the extent of for the NHS as a whole, or by type of Trust
use of HRM practices among UK employers. As [e.g. all Primary Care Trusts; all Ambulance
a result, the focus is on the most recent data for Trusts, etc.], or by Strategic Health Authority,
any practice rather than on all available data. or by individual Trust, rather than at the
For example, only the most recent WERS82 data organisational level (i.e. percentage of Trusts/
were recorded here. Data from an earlier WERS83 organisations reporting the presence of an HR
survey were recorded only if the information was practice).
not collected for the subsequent survey. Also, it
was outwith the remit of this review to examine Comparing such data with HR practice measures
developments in coverage of practices over time. is extremely problematic. For example, the
proportion of employees reporting that they have
Health sector-specific surveys had an appraisal in the last 12 months may not
bear a strong relation to the proportion of NHS
The most comprehensive surveys within the health organisations with appraisal policies in place, or to
sector are those conducted by the Healthcare the existence of an appraisal policy in any specific
Commission (HCC). Whilst providing extensive organisation. Accepting these limitations, it is
20
possible to interpret some of the NHS Staff Survey at least some of the workforce. However, the
findings as a proxy indicator for staff experience of figures for companies where the entire workforce
particular HR practices in the NHS. is covered by the practice would be considerably
lower. For example, in the Wood et al.99 study of
Analysis of data from the NHS Staff Survey focuses UK manufacturing firms, 70% of responding
on 26 key areas (key scores). These are a mixture organisations had team working but only 38% used
of attitudinal and experiential measures, the it for the majority of the workforce.
latter providing an indication of the percentage of
NHS staff who have experienced a particular HR The information on staffing is mainly confined
practice (i.e. a proxy indicator). to whether selection tests are used and whether
specific recruitment procedures are used to
Where a proxy indicator for staff experience of attract minority or discriminated groups, for
an HR policy is available from the National NHS example disabled or elder workers or whether exit
Survey 2007,103 this has been indicated in the right- interviews are used. None of these practices shows
hand column of Table 6. Findings from the survey particularly widespread coverage, with none of
are summarised later (see Table 17) and discussed the practices being used in more than 50% of the
below (see Data from the NHS Staff Survey 2007, units. Competence tests are used in 46% of the
below). workplaces.
Categorisation of practices There is more information on training where a

Practices recorded by HR practice surveys are variety of practices are measured. Most units use
reported using our categories of HRM practices the practices that are studied, if only partially. The
(as presented above: see What HRM practices are provision of general training for at least some of
described in the literature?). These groupings are the workforce is, as expected, nearly ubiquitous,
used to structure the following tables reporting the whereas specific forms of training are used
survey data (Tables 7–16). Figures in these tables somewhat less.
represent the percentage of workplaces that report
using a particular practice. Data are from the In the case of compensation and rewards, we have
National NHS Staff Survey 2007103 as presented information on types of pay systems and types
later in the chapter (Table 17). of employee benefits. The pay systems measures
concentrate on types of incentive or performance-
Index of tables related pay, ranging from a general performance
• Table 6 Survey coverage of HRM practice use. pay measure to specific ones, such as team-based
• Table 7 Work design. or profit-related pay. Some form of performance-
• Table 8 Staffing: recruitment and selection. related pay is used in 40% of workplaces, whereas
• Table 9 Training and development. team-based pay is the least used. Employee
• Table 10 Compensation and rewards. benefits, such as pension schemes and sick pay, are
• Table 11 Communication. more widely used, although health insurance is not
• Table 12 Family friendly/work–life balance. so frequently used.
• Table 13 Single status/status harmonisation.
• Table 14 Employee involvement. Communication practices concentrate on forms of
• Table 15 Performance management. direct communication, the mechanisms for this,
• Table 16 ‘Bundles’ of practices/HPWPs. and the type of economic information disseminated
• Table 17 Summary of proxy indicators from to employees. A large majority of workplaces
National NHS Staff Survey 2007.103 used some form of team briefing, and just over
50% disclose key information about the financial
Summary position of the organisation or investments.
These surveys provide information on the extent Family-friendly practices are covered well in WERS
to which different HRM practices are used. The and their use varies considerably between practices.
results for work organisation practices (team In the cases of practices where there is a statutory
working, job rotation, role empowerment and the right to provide leave, for example maternity and
formality of job descriptions) show that for all of paternity leave, the study focused on the provisions
these practices over 70% of the units surveyed, beyond the statutory minimum, for example paid
the workplace or company had the practice for leave. Aside from these practices, the ability to
21

22
TABLE 6 Coverage of categories of work practices by surveys
NHS103 Staff
Survey
WERS ESWT CVTS EPOC CIPD IPD NESS CIPD CIPD CIPD CIPD CIPD CIPD CIPD 2007 proxy
200682 200686 200187 199688 200689 199990 200591 200292 200393 200594 200595 200696 200697 200698 indicator
Work design    
Staffing:   
recruitment and
selection
Training and       
development
Compensation    
and rewards
Communication   
Family friendly/     
work–life balance
Single status/    
harmonisation
Employee   
involvement
Performance     
management
Bundles of 
practices/HPWPs
DOI: 10.3310/hta14510
TABLE 7 Reported use of HRM practices: work design
Percentage of workplaces
Practice: interview or survey with practice [overall Data collection Sample size;
Category question/report definition, where available (public/private/health)] method workplace size Source
Job characteristics Formal job description 72 (na/na/na) Manager telephone 27,172 managers/ NESS (2005:
Percentage of workplaces answering ‘yes’ to the survey establishments 84)91
question, ‘What percentage of your staff has a formal
written job description?’
Job rotation Job rotation (used frequently, occasionally or rarely) 77 (na/na/na) Postal survey 635 CIPD members in UK CIPD (2006: 6)97
organisations; no limit

Team working Some use of team-based working na (80/na/79) Manager telephone 1115 UK organisations; Wood et al.
survey more than 150 employees (2004: 426)99
Team working Any employees working in teams 72 (88/68/na) Manager interviews 2050 managers; 10 or WERS (2006:
Percentage of workplaces with some or all staff in more employees 90)82
teams answering the question, ‘What proportion,
if any, of the [largest occupational group] in this
workplace work in formally designated teams?’
Empowerment Empowerment na (70/na/73) Manager telephone 1115 UK organisations; Wood et al.
survey more than 150 employees (2004: 426)99
na, data not available.

23
24
TABLE 8 Reported use of HRM practices: recruitment and selection
Practice: interview or survey question/report with practice [overall (public/ Data collection Sample size;
Category definition, where available private/health)] method workplaces size Source
Selection Personality tests used routinely for some occupations 19 (18/20/17) Manager interviews 2024 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to the question, more employees (2006: 77)82
‘When filling vacancies at this workplace do you ever
conduct any type of personality or attitude test?’
Performance tests used routinely for some occupations 46 (63/42/50) Manager interviews 2024 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to the question, more employees (2006: 77)82
‘When filling vacancies at this workplace do you ever
conduct any type of performance or competency test?’
Preference for internal applicants 22 (12/25/na) Manager interviews 2024 managers; 10 or WERS
Percentage of workplaces specifying the answer to the more employees (2004) p. 984
question, ‘Which of these statements best describes your
approach to filling vacancies as internal applicants are
given preference, other things being equal, over external

applicants?’
Open internal job market 93 (na/na/na) Postal survey 732 HR and career CIPD
management (2003: 19)95
practitioners; no limit
Formal promotion policies 18 (na/na/na) Postal survey to 477 general practices Newton et al.
practice manager (1996: 83)102
Recruitment Special recruitment procedures to attract women returning 8 (12/8/na) Manager interviews 2056 managers; 10 or WERS
to work after having a child more employees (2006: 243)82
Percentage of workplaces answering ‘yes’ to this choice
in the question, ‘When filling vacancies do you have any
special procedures to encourage applications from the
following groups?’
Special recruitment procedures to attract women in 6 (10/5/na) Manager interviews 2056 managers; 10 or WERS
general more employees (2006: 243)82
Special recruitment procedures to attract members from 9 (21/6/na) Manager interviews 2056 managers; 10 or WERS
minority ethnic groups more employees (2006: 243)82
in the question, ‘When filling vacancies does you have any
Practice: interview or survey question/report with practice [overall (public/ Data collection Sample size;
Special recruitment procedures to attract older workers 5 (6/5/na) Manager interviews 2056 managers WERS
Percentage of workplaces answering ‘yes’ to this choice (2006: 243)82
DOI: 10.3310/hta14510

Special recruitment procedures to attract disabled workers 10 (29/5/na) Manager interviews 2056 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to this choice more employees (2006: 243)82
Special recruitment procedures to attract people who have 5 (8/5/na) Manager interviews 2056 managers; 10 or WERS
been unemployed for 12 months or more more employees (2006: 243)82

Advertising in different sources to widen interest from 41 (65/33/na) Postal survey 659 HR professionals; CIPD
under-represented groups no limit (2006: 15)98
Using images and words that appeal to a wider audience 39 (45/37/na) Postal survey 659 HR professionals; CIPD
no limit (2006: 15)98
Checking tests used are culture free and tested on diverse 37 (44/33/na) Postal survey 659 HR professionals; CIPD
norm groups no limit (2006: 15)98
Recruitment documents in other formats (e.g. large print) 23 (53/9/na) Postal survey 659 HR professionals; CIPD
no limit (2006: 15)98
Formal recruitment policies 40 (na/na/na) Postal survey to 477 general practices Newton et al.
Formal resourcing strategies 53 (na/na/na) Postal survey 804 HR professionals; CIPD
no limit (2006: 3)98
Exit interviews 91 (na/na/na) Postal survey 750 HR professionals; CIPD
no limit (2006: 29)98
Exit postal surveys 32 (na/na/na) Postal survey 750 HR professionals; CIPD
no limit (2006: 29)98

25
26
TABLE 9 Reported use of HRM practices: training and development
Percentage workplaces with

Practice: interview or survey question/report definition, practice [overall (public/ Data collection Sample size;
Category where available private/health)] method workplaces size Source
General Off-the-job training for experienced core employees 84 (98/82/94) Manager interviews 2024 managers; 10 or WERS
training Percentage of workplaces answering ‘some’, ‘a lot’ or ‘all’ of more employees (2006: 83)82
time to the question, ‘What proportion of experienced [largest
occupational group of staff] have been given time off from their
normal daily work duties to undertake training over the past 12
months?’
Training 64 (na/na/na) Manager telephone 27,172 managers/ NESS
Percentage of workplaces answering ‘yes’ to the question, ‘Have survey establishments (2005: 65)91
you funded or arranged any training over the last 12 months?’
Staff development 19 (na/na/na) Postal survey to 477 general practices Newton et al.
Skills training Some core employees trained to be functionally flexible 66 (64/67/na) Manager interviews 2012 managers; 10 or WERS
Percentage of workplaces answering ‘some’, ‘a lot’ or ‘all’ of time more employees (2006: 92)82
to the question, ‘What proportion of [the largest occupational
group of staff] is formally trained to be able to do jobs other
than their own?’
Some core employees trained in team working, communication 48 (65/45/na) Manager interviews 2012 managers; 10 or WERS
or problem-solving more employees (2004: 11)84
Percentage of workplaces answering ‘yes’ to this choice in the
question, ‘Does the training cover any of the matters listed
[here]?’
Job-specific training 81 (percentage of the 64% of Manager telephone 27,172 managers/ NESS
Percentage of workplaces answering ‘yes’ to this choice in the employers who offer training) survey establishments (2005: 73)91
question, ‘Over the past 12 months which, if any, of the following (na/na/na)
types of training and development has this establishment funded
or arranged for staff employed at this location?’
Health and safety training 80 (percentage of the 64% of Manager telephone 27,172 managers/ NESS
Training in new technology 59 (percentage of the 64% of Manager telephone 27,172 managers/ NESS
Supervisory 42 (percentage of the 64% of Manager telephone 27,172 managers/ NESS
DOI: 10.3310/hta14510

Management training 41 (percentage of the 64% of Manager telephone 27,172 managers/ NESS
Personal development plans 62 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
In-house development programmes (used frequently, 96 (na/na/na) Postal survey 635 CIPD members CIPD
occasionally or rarely) in UK organisations; (2006: 6)97
no limit

Coaching (used frequently, occasionally or rarely) 94 (na/na/na) Postal survey 635 CIPD members CIPD
in UK organisations (2006: 6)97
no limit
Succession planning 92 (na/na/na) Postal survey 635 CIPD members CIPD
Percentage of workplaces reporting that they use this practice in UK organisations; (2006: 6)97
frequently, occasionally or rarely no limit
‘Planning and shaping the progression or movement of
individuals within an organisation by aligning employee
preferences and potential with organisational resourcing needs’
p. ii (CIPD 2005, p. 3)
Career coaching 52 (na/na/na) Postal survey 732 HR and career CIPD
‘A process which enables an employee to have focused attention management (2003: 26)93
on their individual career concerns, leading to increased clarity, practitioners; no limit
personal change and forward action’ (p. 26)
Career planning advice 34 (na/na/na) Postal survey 2029 IPD members; IPD (1999: 2)101
no limit
Mentoring and buddying 87 (na/na/na) Postal survey 635 CIPD members CIPD
Percentage of workplaces reporting they use this practice in UK organisations; (2006: 6)97
continued
27
28
TABLE 9 Reported use of HRM practices: training and development (continued)

Cross-functional project assignments 78 (na/na/na) Postal survey 635 CIPD members CIPD
Percentage of workplaces reporting they use this practice in UK organisations; (2006: 6)97
High-potential development schemes 76 (na/na/na) Postal survey 635 CIPD members CIPD
Graduate development programmes 55 (na/na/na) Postal survey 635 CIPD members CIPD
Assessment centres 59 (na/na/na) Postal survey 635 CIPD members CIPD
Development centres 56 (na/na/na) Postal survey 635 CIPD members CIPD
MBAs 86 (na/na/na) Postal survey 635 CIPD members CIPD
Action learning sets 56 (na/na/na) Postal survey 635 CIPD members CIPD
DOI: 10.3310/hta14510

Induction Induction 66 (percentage of the 64% of Manager telephone 27,172 managers/ NESS
Needs Skill gap assessment 54 (na/na/na) Manager telephone 27,172 managers/ NESS (2005:
assessment Percentage of workplaces answering more than zero to survey establishments 84)91

the question, ‘What percentage of your staff has a skill gap
assessment?’
Secondment Internal secondments 88 (na/na/na) Postal survey 635 CIPD members CIPD (2006:
Percentage of workplaces reporting that they use this practice in UK organisations; 6)97
External secondments 57 (na/na/na) Postal survey 635 CIPD members CIPD (2006:
Percentage of workplaces reporting that they use this practice in UK organisations; 6)97

29
30
TABLE 10 Reported use of HRM practices: compensation and reward

Practice: interview or survey question/report practice [overall (public/private/ Data collection Sample size;
Category definition, where available health)] method workplaces size Source
Payment system Performance-related pay 40 (19/44/na) Manager 1994 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to this choice in interviews more employees (2006: 190)82
the question, ‘Are … employees paid in this way?’
Profit-related payments or bonuses 30 (15/37/na) Manager 1994 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to the question, interviews more employees (2006: 192)82
‘Do any employees at this workplace receive profit-related
payments or profit-related bonuses?’
Employee share scheme na (na/21/na) Manager 1994 managers; 10 or WERS
‘Does this company operate any of the employee share
schemes listed on this card for any employees at this
workplace?’
Cash bonus or incentive plans 66 (32/88/na) Postal survey 535 organisations; no CIPD
limit (2006: 22)89
Team performance-related pay for managers 8 (4/11/na) Postal survey 1158 organisations; IPD
na (1999: 3)90
Team performance-related pay for non-managers 8 (2/12/na) Postal survey 1158 organisations; IPD
na (1999: 3)90
Skill- or competency-related pay for managers 6 (4/7/na) Postal survey 1158 organisations; IPD
na (1999: 3)90
Skill- or competency-related pay for non-managers 11 (9/14/na) Postal survey 1158 organisations; IPD
na (1999: 3)90
Job evaluation scheme 20 (42/16/28) Manager 2059 managers; 10 or WERS
‘Are there any formal job evaluation schemes here? These
are schemes for comparing systematically the relative
value of different jobs in order to settle their relative rates
of pay’
Employee Employer provision of child-care assistance 8 (18/5/na) Manager 2054 managers; 10 or WERS
benefits Percentage of workplaces answering ‘yes’ to the question interviews more employees (2006: 255)82
DOI: 10.3310/hta14510
whether they offer nursery or financial assistance to aid

child care
Access to company car for managerial employees 45 (na/na/na) Manager 1994 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to this choice interviews more employees (2004: 21)84
in the question, ‘What about managers at this workplace,
are they entitled to any of these non-pay terms and
conditions?’
Access to company car for non-managerial employees 15 (na/na/na) Manager 1994 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to this choice interviews more employees (2004: 21)84
in the question, ‘Is the largest occupational group at this
workplace entitled to any of these non-pay terms and
conditions?’
Access to private health insurance for managerial 38 (na/na/na) Manager 1994 managers; 10 or WERS

employees interviews more employees (2004: 21)84
conditions?’
Access to private health insurance for non-managerial 16 (na/na/na) Manager 1994 managers; 10 or WERS
employees interviews more employees (2004: 21)84
conditions?’
Entitlement to an employee pension scheme for 71 (na/na/na) Manager 1994 managers; 10 or WERS
managerial employees interviews more employees (2004: 21)84
conditions?’
continued
31
32
TABLE 10 Reported use of HRM practices: compensation and reward (continued)

Entitlement to an employee pension scheme for non- 64 (na/na/na) Manager 1994 managers; 10 or WERS
conditions?’
Entitlement to more than 4 weeks’ annual leave for 67 (na/na/na) Manager 1994 managers; 10 or WERS
conditions?’
Entitlement to more than 4 weeks’ annual leave for non- 59 (na/na/na) Manager 1994 managers; 10 or WERS
conditions?’
Entitlement to sick pay in excess of statutory 62 (na/na/na) Manager 1994 managers; 10 or WERS
requirements for managerial employees interviews more employees (2004: 21)84
conditions?’
Entitlement to sick pay in excess of statutory 54 (na/na/na) Manager 1994 managers; 10 or WERS
requirements for non-managerial employees interviews more employees (2004: 21)84
conditions?’
Occupational sick pay 83 (95/83/na) Postal survey 535 organisations; no CIPD
limit (2006: 29)89
na, data not available

TABLE 11 Reported use of HRM practices: communication

Practice: interview or survey question/report practice [overall (public/ Data collection Sample size;
DOI: 10.3310/hta14510
Face to face Meetings between senior management and the entire 79 (89/77/na) Manager 2057 managers; 10 or WERS
workforce interviews more employees (2006: 135)82
Team briefings or meetings with entire workforce 71 (81/68/na) Manager 2057 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to the question, ‘Do interviews more employees (2006: 135)82
you have meetings between line managers or supervisors and
all the people for whom they are responsible? … these are
sometimes known as “briefing groups” or “team briefings” ’
Regular meetings with feedback 63 (81/59/na) Manager 2017 managers WERS
Percentage of workplaces answering ‘some’ or ‘a lot’ of time interviews (overall) – 554 (2006: 139)82
to the question, ‘What proportion of the time at meetings managers (public),
is usually available for questions from employees or for 1463 managers
employees to offer their views?’ (private); 10 or more
employees

Other meetings or written or 2-way communication 30 (17/33/na) Manager 2017 managers WERS
Percentage of workplaces answering ‘some’ or ‘a lot’ of time interviews (overall) – 554 (2006: 139)82
to the question, ‘Other meetings … What proportion of managers (public),
the time at meetings is usually available for questions from 1463 managers
employees or for employees to offer their views?’ (private); 10 or more
employees
Systematic use of management chain/cascading of information 64 (91/60/na) Manager 2057 managers; 10 or WERS
the question, ‘Are there other ways in which management
communicates or consults with employees at this
establishment?’
Return-to-work interviews/short-term absence management 81 (89/78/na) HR postal and 1083 HR CIPD
online survey professionals; na (2006: 29)96
Return-to-work interviews/long-term absence management 73 (83/70/na) HR postal survey 1083 HR CIPD
professionals in (2006: 32)96
organisations; na
continued
33
34
TABLE 11 Reported use of HRM practices: communication (continued)

Impersonal Direct communication only 4 (1/5/na) Manager 2017 managers WERS
communication Percentage of workplaces answering ‘yes’ to this choice in interviews (overall) – 554 (2006: 139)82
the question, ‘Are there other ways in which management managers (public),
communicates or consults with employees at this 1463 managers
establishment?’ (private); 10 or more
employees
Regular newsletters 45 (63/41/na) Manager 2057 managers; 10 or WERS
interviews more employees (2006: 135)82
Percentage of workplaces answering ‘yes’ to this choice in

establishment?’
Notice boards 74 (86/72/na) Manager 2057 managers; 10 or WERS
establishment?’
E-mail 38 (48/36/na) Manager 2057 managers; 10 or WERS
establishment?’
Intranet 34 (48/31/na) Manager 2057 managers; 10 or WERS
establishment?’
DOI: 10.3310/hta14510

Information Information disclosure over investment plans 41 (50/40/na) Manager 2047 managers; 10 or WERS
sharing Percentage of workplaces answering ‘yes’ to this choice in interviews more employees (2004: 18)84
the question, ‘Does management regularly give employees, or
their representatives, any information about … ?’
Information disclosure over financial position of workplace 55 (76/51/na) Manager 2047 managers; 10 or WERS
Percentage of workplaces specifying an answer to the interviews more employees (2004: 18)84
question, ‘Does management regularly give employees, or
Information disclosure over financial position of organisation 51 (53/51/na) Manager 2047 managers; 10 or WERS

Information disclosure over staffing plans 64 (81/61/na) Manager 2047 managers; 10 or WERS
Guaranteed job security or no compulsory redundancies 14 (na/na/na) Manager 1926 managers WERS
policy interviews Workplaces with 25 (2004: 18)84
employees or more
na No formal arrangements 2 (0/3/na) Manager 2017 managers WERS
Percentage of workplaces answering ‘yes’ to this choice in interviews (overall) – 554 (2006: 139)82
the question, ‘Are there other ways in which management managers (public),
communicates or consults with employees at this 1463 managers
establishment?’ (private); 10 or more
employees

35
36
TABLE 12 Reported use of HRM practices (family friendly/work–life balance)

Category definition, where available private/health)] method workplace size Source
Hours Permanent non-standard hours – any employees (includes 90 (99/92/na) Manager 1879 managers; 10 or WERS
reduced hours, increased hours, job sharing, etc.) interviews more employees (2006: 269)82
Reduced hours 70 (na/na/na) Manager 2050 managers; 10 or WERS
you have any of the following working time arrangements for
any employees at this workplace … Ability to reduce working
hours e.g. switching from full-time to part-time employment?’
Increased hours 57 (na/na/na) Manager 2050 managers; 10 or WERS
any employees at this workplace … Ability to increase working
hours e.g. switching from part-time to full-time employment?’
Job sharing 31 (na/na/na) Manager 2050 managers; 10 or WERS

any employees at this workplace … Job sharing schemes, e.g.
sharing a full-time job with another employee?’
Term time only 20 (na/na/na) Manager 2050 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to the question, ‘Are interviews more employees (2006: 250)82
any employees here entitled to any of the following? Working
only during school term time?’
Compressed hours 16 (na/na/na) Manager 2050 managers; 10 or WERS
any employees at this workplace, e.g. a 9-day fortnight or 4- to
5-day week?’
Annualised hours 6 (na/na/na) Manager 2050 managers; 10 or WERS
employees at this workplace: … Annualised hours?’
Zero-hour contracts 5 (na/na/na) Manager 2050 managers; 10 or WERS
the question, ‘Do you have any of the following working time
arrangements for employees at this workplace: … Zero-hour
contracts?’
Shift working 54 (48/55/na) Manager 1879 managers; 10 or WERS
DOI: 10.3310/hta14510

Change working pattern 45 (na/na/na) Manager 2050 managers; 10 or WERS
‘Do you have any of the following working time arrangements
for any employees at this workplace … Ability to change shift
patterns?’
Overtime 80 (na/na/na) Manager postal 1507 managers ESWT
‘Overtime hours refer to those hours worked beyond the survey responsible for HR; 10 (2006: 15)86
normal agreed (weekly or monthly) working hours’ or more employees
Non-standard or ‘unusual’ working hours 53 (Saturday) Manager postal 1507 managers ESWT
‘those types of working hours that are regarded as ‘unusual’ in 41 (Sunday) survey responsible for HR; 10 (2006: 31)86
… most countries … i.e. night work from 22.00 to 06.00, and or more employees
21 (night)
work on Saturdays or on Sundays’
(na/na/na)

Flexitime 35 (na/na/na) Manager 2050 managers; 10 or WERS
‘Do you have any of the following working time arrangements
for any employees at this workplace … Flexitime [where an
employee has no set start or finish time but an agreement to
work a set number of hours per week or per month]?’
Hours, Flexibility over location or hours of work (e.g. home working, 46 (56/43/na) Manager 1879 managers; 10 or WERS
location of flexitime) interviews more employees (2006: 269)82
work
Location of Home working 26 (na/na/na) Manager 2050 managers; 10 or WERS
work Percentage of workplaces answering ‘yes’ to the question, ‘Do interviews more employees (2006: 250)82
any employees at this workplace … Working at, or from, home
in normal working hours?’
Mobile working: total availability 27 (na/na/na) Postal survey 585 HR professionals; CIPD
no limit (2005: 6)94
continued
37
38
TABLE 12 Reported use of HRM practices (family friendly/work–life balance) (continued)

Leave Extrastatutory leave at time of birth (e.g. maternity or 82 (98/77/na) Manager 1879 managers; 10 or WERS
paternity leave on full pay) interviews more employees (2006: 269)82
Fully paid maternity leave 57 (84/51/na) Manager 1907 managers; 10 or WERS
‘Would any female employees going on maternity leave from
this workplace receive their normal, full rate of pay?’
Maternity leave 73 (na/na/na) Postal survey to 477 general practices Newton et al.
Fully paid paternity or fully paid discretionary leave for fathers 55 (84/49/na) Manager 1863 managers; 10 or WERS
‘Would any fathers taking (paternity or fully paid discretionary
leave) from this workplace receive their normal, full rate of
pay?’
Extrastatutory leave for carers (e.g. paid parental leave, 82 (98/77/na) Manager 1879 managers; 10 or WERS
emergency leave, etc.) interviews more employees (2006: 269)82
Paid parental leave or special paid leave for parents 25 (47/21/na) Manager 1975 managers; 10 or WERS
‘With the exception of maternity leave, paternity leave and
time off for emergencies, how do mothers and fathers usually
take time off to look after their children? Paid parental leave …
take special paid leave’
Special paid leave for family emergencies 49 (80/43/na) Manager 1988 managers; 10 or WERS
‘With the exception of maternity leave, paternity leave and
time off for emergencies, how do mothers and fathers usually
take time off to look after their children? Take special paid
leave?’
Leave for carers of older adults 6 (16/4/na) Manager 1985 managers; 10 or WERS
DOI: 10.3310/hta14510
‘Are any employees entitled to any of the following? A specific
period of leave for carers of older adults?’
Career breaks/sabbatical: total availability 42 (na/na/na) Postal survey 585 HR professionals; CIPD
no limit (2005: 6)94
Career break schemes 20 (na/na/na) Postal survey 453 CIPD members CIPD
whose organisations (2005: 6)94
offer working from
home; no limit
Retirement Sabbaticals 17 (na/na/na) Postal survey 453 CIPD members CIPD
whose organisations (2005: 6)94
offer working from
home; no limit

Phased retirement 53 (na/na/na) Manager postal 1507 managers ESWT
‘Employees beyond a certain age threshold have the possibility survey responsible for HR; 10 (2006: 44)86
of gradually reducing the number of hours worked as they or more employees
approach retirement age’
Early retirement 59 (na/na/na) Manager postal 1507 managers ESWT
‘Older employees are allowed to fully exit the labour market, survey responsible for HR; 10 (2006: 45)86
either a few years or months before they reach the statutory or more employees
retirement age’
Employee Workplace nursery/child-care subsidy 10 (na/na/na) Postal survey 2029 IPD members; no IPD
benefits limit (1999: 2)101
Child-care subsidies 9 (na/na/na) Postal survey 2029 IPD members; no IPD
limit (1999: 2)101
Assistance with nanny /au pair selection 4 (na/na/na) Postal survey 2029 IPD members; no IPD
limit (1999: 2)101
After-school care 2 (na/na/na) Postal survey 2029 IPD members; no IPD
limit (1999: 2)101

39
40
TABLE 13 Reported use of HRM practices: single status/status harmonisation

Single status Single status: ‘both groups [managers and non-managers] 48 (73/48/na) Manager interviews 1994 managers; 10 or WERS
in a given workplace had the same entitlements (including more employees (2004a: 21)84
where neither of them were entitled to a given benefit)’
Equal opportunities Formal equal opportunity policy 73 (98/68/89) Manager interviews 2053 managers; 10 or WERS
more employees (2006: 238)82
Gender-monitoring recruitment and selection 24 (na/na/na) Manager interviews 2030 managers; 10 or WERS
Percentage of workplaces answering ‘yes’ to this choice in more employees (2006: 248)82
the question, ‘Do you monitor recruitment and selection
by any of these characteristics?’
Review procedures for recruitment and selection 19 (na/na/na) Manager interviews 2030 managers; 10 or WERS
regarding gender more employees (2006: 248)82

the question, ‘Do you review recruitment and selection
procedures to identify indirect discrimination by any of
these characteristics?’
Gender monitoring on promotion 10 (na/na/na) Manager interviews 2030 managers; 10 or WERS
the question, ‘Do you monitor promotions by any of these
characteristics?’
Review procedures for promotion regarding gender 11 (na/na/na) Manager interviews 2030 managers; 10 or WERS
in the question, ‘Do you review promotion procedures
to identify indirect discrimination by any of these
characteristics?’
Review of relative pay rates regarding gender 7 (na/na/na) Manager interviews 2030 managers; 10 or WERS
the question, ‘Do you review relative pay rates by any of
Ethnicity monitoring recruitment and selection 24 (na/na/na) Manager interviews 2030 managers; 10 or WERS
regarding ethnicity more employees (2006: 248)82
DOI: 10.3310/hta14510

Ethnicity monitoring on promotion 10 (na/na/na) Manager interviews 2030 managers; 10 or WERS
characteristics?’
Review procedures for promotion ethnicity 11 (na/na/na) Manager interviews 2030 managers; 10 or WERS
characteristics?’

Review of relative pay rates regarding ethnicity 5 (na/na/na) Manager interviews 2030 managers; 10 or WERS
Disability monitoring recruitment and selection 23 (na/na/na) Manager interviews 2030 managers; 10 or WERS
regarding disability more employees (2006: 248)82
Disability monitoring on promotion 9 (na/na/na) Manager interviews 2030 managers; 10 or WERS
characteristics?’
continued
41
42
TABLE 13 Reported use of HRM practices: single status/status harmonisation (continued)

Review procedures for promotion disability 10 (na/na/na) Manager interviews 2030 managers; 10 or WERS
characteristics?’
Review of relative pay rates regarding disability 4 (na/na/na) Manager interviews 2030 managers; 10 or WERS
Age monitoring recruitment and selection 20 (na/na/na) Manager interviews 2030 managers; 10 or WERS
regarding age more employees (2006: 248)82
Age monitoring on promotion 7 (na/na/na) Manager interviews 2030 managers; 10 or WERS
characteristics?’
Review procedures for promotion regarding age 9 (na/na/na) Manager interviews 2030 managers; 10 or WERS
characteristics?’
Review of relative pay rates regarding age 6 (na/na/na) Manager interviews 2030 managers; 10 or WERS
Training interviewers in diversity 53 (72/49/na) Postal survey 659 HR professionals CIPD
DOI: 10.3310/hta14510
in UK organisations; (2006c: 15)98

no limit
Advertising in different sources to widen interest from 41 (65/33/na) Postal survey 659 HR professionals CIPD
under-represented groups in UK organisations; (2006c: 15)98
no limit
Using images and words that appeal to a wider audience 39 (45/37/na) Postal survey 659 HR professionals CIPD
no limit
Checking tests used are culture free and tested on diverse 37 (44/33/na) Postal survey 659 HR professionals CIPD
norm groups in UK organisations; (2006c: 15)98
no limit
Recruitment documents in other formats (e.g. large print) 23 (53/9/na) Postal survey 659 HR professionals CIPD

no limit
Setting recruitment targets to correct workforce 11 (20/6/na) Postal survey 659 HR professionals CIPD
imbalance in UK organisations; (2006c: 15)98
no limit
Formal equal opportunities policies 73 (na/na/na) Postal survey to 477 general practices Newton et al.
Appraisal Subordinate feedback 11 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
Continuous assessment 14 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
Competence assessment 31 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
Objective setting and review 62 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
Staff appraisal 27 (na/na/na) Postal survey to 477 general practices Newton et al.
practice manager (1996),102 p. 83

43
44
TABLE 14 Reported Use of HRM Practices (Employee Involvement)
Percentage workplaces with Data

Practice: interview or survey question/report practice [overall (public/ collection Sample size;
Involvement Problem-solving groups involving non-managerial 21 (33/19/na) Manager 2048 managers; 10 or WERS (2006: 94)82
employees interviews more employees
Suggestion schemes 30 (30/30/na) Manager 2057 managers; 10 or WERS (2006: 135)82
interviews more employees
Employee surveys 42 (66/37/na) Manager 2057 managers; 10 or WERS (2006: 135)82
Direct participation 83 (na/na/na) Manager postal 5800 workplaces European
‘Opportunities which management provide, or initiatives survey across 10 EU countries Foundation for the
to which they lend their support, at workplace level, for (including UK); 25 or Improvement of
consultation with and/or delegation of responsibilities and more employees for Living and Working
authority for decision-making to their subordinates either smaller countries and Conditions (1996)
as individuals or as groups of employees, relating to the 50 for larger countries

immediate work tasks, work organisation and/or working
conditions’. European Foundation for the Improvement of
Living and Working Conditions (2006)
Representation Joint consultative committees: workplace level committees 14 (28/11/13) Manager 2020 managers; 10 or WERS (2006: 127)82
Joint consultative committees: higher level committees 25 (46/20/25) Manager 2020 managers; 10 or WERS (2006: 127)82
Joint consultative committees: no committees at all 62 (26/69/62) Manager 2020 managers; 10 or WERS (2006: 127)82
Aggregate union density 34 (64/22/44) Employee 21,540 employees; 10 WERS (2006: 110)82
Percentage of employees answering ‘yes’ to the question, postal survey or more employees
‘Are you a member of a trade union or staff association?’
No union members 64 (7/77/na) Manager 1973 managers; 10 or WERS (2004a: 12)82
Union density of 50% or more 18 (62/8/22) Manager 1973 managers; 10 or WERS (2006: 110)82
Recognised unions 30 (90/16/41) Manager 1992 managers; 10 or WERS (2006: 119)82

a European Foundation for the Improvement of Living and Working Conditions. Fifteen years of working conditions in the EU: Charting trends. Dublin: European Foundation for the
Improvement of Living and Working Conditions; 2006.
TABLE 15 Reported use of HRM practices: performance management
Percentage workplaces with Data

Practice: interview or survey question/report practice [overall (public/private/ collection Sample size;
DOI: 10.3310/hta14510

Appraisal Performance appraisals 71 (68/86/89) Manager 2025 managers; 10 or WERS
Percentage of workplaces answering ‘some’, ‘a lot’ or ‘all’
to the question, ‘What proportion of non-management
employees at this workplace have their performance formally
appraised?’
Annual performance review 62 (na/na/na) Manager 27,172 managers/ NESS
telephone survey establishments (2005: 84)91
Percentage of workplaces answering ‘some’, ‘a lot’ or ‘all’ to
the question, ‘What percentage of your staff have an annual
performance review?’
Twice-yearly appraisal 27 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95

Rolling appraisal 10 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
360° appraisal 70 (na/na/na) Postal survey 635 CIPD members in CIPD
UK organisations; no (2006: 6)97
Percentage of workplaces reporting they use this practice limit on organisation
frequently, occasionally or rarely size
360° appraisal 13 (na/na/na) Postal survey 1115 organisations; 100 CRANET
or more employees (2003: 13)100
Peer appraisal 8 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
Self-appraisal 30 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95
Team appraisal 6 (na/na/na) Postal survey 506 HR practitioners; CIPD
no limit (2005: 3)95

45
46
TABLE 16 Reported use of operational practices associated with HRM
Practice: interview or survey question/ Percentage workplaces with practice Data collection Sample size;
Category report definition, where available [overall (public/private/health)] method workplaces size Source
Just-in-time (JIT) JIT system of inventory control 29 (na/na/na) Manager 1926 managers; 25 WERS (1998:
interviews employees or more 10)83
JIT na (78/na/45) Manager 1115 UK manufacturing Wood et al.
telephone survey or health organisations; (2004: 426)99
more than 150;
employees
Total quality TQM na (88/na/73) Manager 1115 UK manufacturing Wood et al.
management telephone survey or health organisations; (2004: 426)99
(TQM) more than 150
employees
TABLE 17 Proxy indicators of the experience of HR practices in the NHSa,b

Employee response (%)

Category HR practice (Tables 7–16) Survey question/definition where available (KS where applicable)
Work design Team working Percentage of staff working in a well-structured team environment 39 (KS8)
Job design Quality of job design – clear job content, feedback and staff involvement (scale 3.30 (range: minimum + 1 – maximum + 5)
score) (KS9)
Training and General training Percentage of staff saying that they had taken part in at least one form of 94
development employer supported training, learning or development in the last 12 months
Job relevant training Percentage of staff receiving job relevant training, learning or development in 77 (KS7)
the last 12 months
Health and safety Percentage of staff who had received health and safety training paid for or 71 (KS12)
provided by the Trust in the last 12 months
PDPs Percentage of staff receiving the training, learning and development identified 50 (i.e. one-quarter of all staff)
in their PDP (percentage of all with a PDP in place – see Performance
management, below)
Communication Unspecified Communication between senior management and staff is effective 23
Family friendly/ Total – all forms of flexible Staff using flexible working options 73 (KS3)
work–life balance working
Flexitime ‘I work flexitime’ 31
Reduced hours ‘I work reduced hours (e.g. part time)’ 32
Flexibility over location ‘I work from home in normal working hours’ 7
Employee response (%)
Category HR practice (Tables 7–16) Survey question/definition where available (KS where applicable)
Annualised hours ‘I work annualised hours’ 21
DOI: 10.3310/hta14510
Term time only ‘I work during school term only’ 2

Job sharing ‘I job share with someone else’ 4
Single status/ Equal opportunities Training in diversity (all) 39
harmonisation
Percentage of staff receiving training in age-related equality/diversity in last 12 17
months
Percentage of staff receiving training in disability-related equality/diversity in 18
last 12 months
Percentage of staff receiving training in gender-related equality/diversity in last 15
12 months
Percentage of staff receiving training in race-related equality/diversity in last 12 17
months
Percentage of staff receiving training in sexual orientation-related equality/ 14

diversity in last 12 months
Percentage of staff receiving training in religion-related equality/diversity in last 17
12 months
Employee Suggestion schemes ‘Senior managers here try to involve staff in important decisions’ 23
involvement ‘Senior managers encourage staff to suggest new ideas for improving services’ 31
Direct participation ‘I am involved in deciding on the changes introduced that affect my work area/ 48
team/department’
‘I am consulted about changes that affect my work area/team/department’ 48
Performance Performance appraisals Percentage of staff reporting that they had received a performance appraisal or 61 (KS4)
management a performance development review in the previous 12 months
Percentage of staff receiving well-structured performance appraisal review in 24 (KS5)
the previous 12 months
PDP Percentage of staff with an agreed PDP as part of their appraisal 52 (KS6)
KS, key score; PDP, personal development plan.

a These data are not comparable with the data in Tables 7–16 – see Health sector-specific surveys, above.
b All data taken from the HCC National NHS Staff Survey 2007.103
47
reduce hours, for example to switch from full- to Data from the NHS Staff Survey
part-time work, is the most frequently provided 2007
practice, with 70% of workplaces having it, while Data from the NHS Staff Survey103 is presented
the provision of child-care facilities is the least in Table 17. Caution is needed when considering
used. these data in relation to the data on HR practices
in general. The NHS data shows the proportion
The Workplace Employment Relations Survey of NHS staff who report work experiences that
offers the only information that there is on single are consistent with the HR practices considered
status, revealing that 48% of workplaces provide here. It is not, however, indicative of the number
the same level of benefits for all staff (i.e. they of Trusts in which such HR policies/practices exist,
provide or do not provide a particular benefit nor does it help address other important questions
for managers and non-managerial staff alike). raised in this section, such as the percentage of the
Five surveys are questions on this specifically. workforce covered by a particular HR practice in a
The nearest proxy is equal opportunities, which given organisation.
is covered extensively in surveys, although only a
minority of organisations go beyond a formal equal Accepting the limitations of the NHS Staff Survey103
opportunities policy (73%) or training interviewers data in relation to the focus of this chapter, it can
in diversity (53%). be considered as providing proxy indicators of staff
experiences in areas. This is of particular interest
Information on employee involvement methods where organisational level HR practice data are not
covers union representation, consultation, available.
suggestion schemes and employee surveys. The
usage of such practices varies considerably but in Specifically the NHS Staff Survey103 data indicate
no case are they used in a majority of workplaces. that 39% of NHS employees work in a well-
structured team environment. This contrasts
Information on performance management with data from the survey of HR practices, which
focuses exclusively on appraisal. The majority of indicate that 72% of all organisations surveyed
workplaces have some form of appraisal, but only have some employees working in teams and 79% of
a minority (27% in WERS) do it more than once a health sector organisations make some use of team
year. working.
Separate figures for the health sector are available With regard to training, 54% of employers
for only a small number of the practices (Tables surveyed on HR practices had funded or arranged
7–16, column 3), and indeed for the majority of some training over the previous 12 months.
HRM categories (e.g. family-friendly practices) we No breakdown is available for health sector
have no such data. For those for which we have organisations, but 94% of NHS employees report
data, in the majority of cases the frequency of taking part in some form of training over the
use in the health sector is not that different from previous 12 months. Eighty-one per cent of
the overall use, and in most cases is even more employers from the HR practice surveys provided
similar to the use in the public sector. The two job specific training and 80% health and safety
exceptions are related to trade unions. The first is training. From the NHS Staff Survey, 77% of staff
the determination of pay by collective bargaining, reported receiving job relevant training, 71%
as this exists in 82% of public workplaces but only health and safety training.
in 36% of health sector workplaces and 14% of the
private sector. The second is union recognition, There are no health sector-specific breakdowns
which is granted in 90% of public workplaces, available for the wide range of communication
41% of health sector workplaces, and only 16% of practices covered by the HR practice surveys.
private sector workplaces. The NHS staff survey indicates that 23% of
NHS employees feel that senior management
Although evidence is reported on some HRM communicate effectively with staff.
practices within each of the broad categories
included in this review, the survey coverage is by no No breakdown is available for the percentage of
means comprehensive. It is clear from these results health sector employers offering family friendly/
that crucial elements of the HRM system are not work–life balance HR practice; however, the NHS
covered by a lot of the surveys. Staff Survey103 indicates that between 2% and 32%
48
of NHS employees make use of one of a range appraisal in the previous 12 months. Interestingly,
of specific practices in this area, with 73% of all this drops to 24% when factors indicating a well-
employees reporting that they use flexible working structured performance appraisal were taken into
options. account. Fifty-two per cent of staff (as measured by
the NHS Staff Survey103) reported that they agreed
Eighty-nine per cent of health sector organisations a personal development plan (PDP) as part of their
report having an equal opportunities policy in appraisal.
place, but no further breakdown of specific HR
practices in this area is available. Thirty-nine per
cent of NHS employees report receiving some Conclusion
form of diversity training. Levels of training in
age, disability, gender, race, sexual orientation or Human resource practice surveys and the NHS
religion-related equality/diversity range from 14% Staff Survey cover some common themes. NHS
to 18% of employees surveyed. Staff Survey103 data help to supplement the picture
provided by organisational level surveys of HR
With regard to employee involvement, there is practices by demonstrating the degree to which
some evidence from HR practice surveys in relation NHS employees in general may experience the
to health sector organisations. This mainly relates results of HR practices in place in organisations.
to union membership and joint consultative Some of the NHS Staff Survey data provide better
committees (Table 14). No breakdown is available proxy indicators than others (e.g. evidence of a
for the percentage of health sector organisations PDP) and receiving training identified in a PDP
using other employee involvement HR practices are arguably stronger indicators of the existence
(such as suggestion schemes or problem-solving of a specific HR practice in relation to appraisal
groups). Findings from the NHS Staff Survey103 and development than, say, the extent to which
indicate that 23% of NHS employees feel that perceptions of the quality of communication
senior managers try to involve staff in important between senior managers and staff indicate the
decisions and 31% feel that senior managers existence of an HR communication practice.
encourage staff to make suggestions to improve
services. Responses to the NHS Staff Survey103 at an
individual Trust level can help that Trust to assess
With regard to direct participation, 48% of NHS the effectiveness of a range of HR practices within
staff surveyed felt that they were involved in the organisation. Further breakdown of WERS
decision-making, and/or consulted about decisions data to reveal the extent of HR practices in the
that affected them. health sector would enable more meaningful
comparisons to be made between data collected at
Finally, with regard to performance management, the organisational level and individual data such as
89% of health sector employers reported using the NHS Staff Survey. Equally, systematic collection
performance appraisals (compared with 71% for of HR practice data at Trust level would enable
all organisations). From the NHS Staff Survey, more detailed analysis to identify the presence and
61% of respondents said that they had received an effectiveness of such practices.
49

Chapter 4
Implementation fidelity in HRM
Introduction This section reviews the literature on
‘implementation fidelity’, develops a framework for
This report seeks to provide as requested in the understanding and explaining processes at work in
invitation to tender (ITT) ‘an account of the evaluating and achieving implementation fidelity,
different human relations policies and methods and places this evidence and framework within the
to determine the fidelity with which they were context of HRM and policy. Subsequent guidance
implemented’. Implementation fidelity relates to outlines questions to be asked when implementing
the fidelity with which both policies and research- a policy. A checklist is presented for evaluating
based interventions are implemented by those and explaining the degree of fidelity achieved in
responsible for delivering them. In this case, the implementation of any such policy.
concern was for the fidelity with which real-world
HRM policies are implemented as practices. The
aim was to understand better how knowledge about Policy–practice link and
the effectiveness of HRM practices, evaluated implementation fidelity
and reported in previous sections, may best be
transferred into practice. There is no shortage of research evaluating the
impact of HRM practices on performance amid
Certain practices have been found by this report growing awareness of the need for evidence-based
to be effective, for example in reducing mortality practice.57 However, if a practice of demonstrated
rates or patient waiting times, but these practices effectiveness is to have a positive impact it needs
may only have the same potential effect when to be implemented faithfully. This idea is captured
reproduced by policy-makers and practitioners if by the concept of implementation fidelity: ‘the
they are implemented properly, as they should be, degree to which … programs are implemented
i.e. with high fidelity to the original practices or … as intended by the program developers’.104
interventions examined in the research. Unless an evaluation assesses whether a policy
has been implemented properly, it is not possible
This section reviews existing literature on this to know whether lack of impact is due to poor
concept and measurement of fidelity, with the aim implementation, (a so-called ‘Type III error’),105
of understanding the process of implementation and covered by the ‘thesis of comprehensiveness’,106
fidelity and thus informing and improving or inadequacies of the policy itself. Also, it would
the success with which HRM policies may be be unclear whether positive outcomes produced
implemented. With this in mind, the report by a policy could be improved still further, if the
was also required to provide guidance on how policy had in fact not been implemented fully.
fidelity could be measured, and to produce
a ‘checklist of actions, which an auditor for a Monitoring of fidelity is of particular concern
resource management method, such as Investors in HRM because of a long-standing concern
in People, would use’, i.e. a checklist to be followed about the gap between organisational HR policy
by those seeking to evaluate fidelity (ITT). The prescriptions and actual practice.107 Several scholars
guidance was intended to inform implementation ascribe to poor implementation the divide between
by outlining questions that need to be asked at espoused people-management policies and the
every stage in the process if high fidelity is to be reality experienced by employees subject to the
achieved. A tool to evaluate the fidelity with which policies.107–110
policies have been implemented is provided as
a checklist. This evaluation could be undertaken This section critically reviews the literature on
by researchers, policy-makers or practitioners, or implementation fidelity and considers the concept
anyone seeking to assess whether a policy has been in relation to the implementation of policies in
implemented properly in practice, i.e. as intended HRM. It begins by examining existing descriptions
by those designing and seeking to deliver the of a model of implementation fidelity. This is
policy. followed by a review of research that specifically
51

uses the term ‘implementation fidelity’ and uses an HRM policy may not be a simple one-stage
this concept to evaluate the implementation and process; it may take time to be implemented
effect of interventions. This literature focuses on fully and, once it has been implemented, this
interventions to help and support people with level of implementation needs to be sustained.
mental health problems, criminal behaviour or Implementation therefore requires ongoing
addiction issues. This research provides examples monitoring and support.54 Few studies examine
of how to measure implementation, describes how to sustain implementation over time. The
how to achieve high levels of fidelity and, in some second issue concerns the appropriateness
cases, evaluates associations between level of of adaptations to fit ‘local’ conditions. Some
implementation fidelity and the actual impact of an specifications allow for local adaptation or, even
intervention. The concept of fidelity is then applied if they do not explicitly do this, local adaptations
to HRM policy, both as a model and with reference may aim to improve a practice so that it fits more
to existing HRM ‘rhetoric versus reality’ literature, with the local context. Indeed, Blakely et al.115 refer
which deals with some elements of implementation to a proadaptation perspective that implies that
fidelity, although it is less sophisticated and uses successful interventions are those that adapt to
different terms. Finally, a new framework for local needs. Yet, others argue that the case for local
understanding the process of evaluating fidelity is adaptation may well have been exaggerated, where
proposed. This framework is then used to develop the evidence does not necessarily support it.116
guidance on evaluating fidelity, and a checklist for The intermediate position is that implementation
assessing the degree of fidelity with which a policy can be flexible as long as there is fidelity to the
has been implemented. essential elements, the absence of which would
adversely affect the capacity of the practice to
achieve its goals, and without which the policy
Dimensions of fidelity cannot be said to have been implemented in any
meaningful fashion.104,111,112 However, the question
In the literature that specifically names and remains about how to identify such essential
discusses the concept, implementation fidelity elements. Possible options are either canvassing
is described in terms of ‘five dimensions’ or opinions of the practice designers themselves, or
‘components’.104,111–113 These are adherence to a conducting a sensitivity analysis or evaluation to
policy or intervention, dose, quality of delivery, determine which components are most vital to its
participant responsiveness, and programme effectiveness. To date only the more unreliable
differentiation. former method has been used to identify such
elements, and limitations of this approach are
Within this framework, adherence is defined as acknowledged.116–118 What is more, there is a
whether a policy, practice, service or intervention growing appreciation that implementation data
is being delivered as it was designed or written’.111 should accompany research on the effectiveness
Dosage refers to the amount of a practice received of interventions to facilitate their proper
by participants, in other words, whether the implementation.119,120 This involves specification
frequency and duration of the practice is as full as of the essential components of an intervention or
intended.104,111 It may be, for example, that not all HRM practice because this defines exactly what
of the aspects of a HRM practice are delivered or needs to be implemented.
are delivered but not as often as required. Quality
of delivery has been defined as ‘the manner
in which a teacher, volunteer or staff member Overview of findings from
delivers a program’.111 Participant responsiveness fidelity studies in social
is ‘the extent to which participants are engaged
by and involved in the activities and content of
policy
a program’.104 Programme differentiation, the There is a growing body of literature on
fifth dimension, is defined as ‘identifying unique implementation fidelity. Studies summarised
features of different components or programs’ and in Table 18 are a sample of those published
‘which elements of … programs are essential’.104 since the reviews conducted by Dusenbury et
There are certain overlaps here with the concept of al.104 and Mihalic.111,112 This literature focuses on
process evaluation.114 interventions to help and support people with
physical and mental health problems, criminal or
Two other issues need to be addressed. The first antisocial behaviour, or addiction issues.
is implementation over time. Implementation of
52
TABLE 18 Studies addressing implementation fidelity: 2004 to present
Strategies to support Source of data 1, ‘Core’ elements only?

Study Definition of fidelity Domain Intervention implementation fidelity programme How identified?
Forgatch et al. (p. 3) ‘whether or not the Prevention MAPS: MAPS manual PMTO Five ‘core’ components and
(2005)117 programs are practised as A preventive intervention for processes
intended’ recently married stepfamilies Based on SIL model (p. 3 and
DOI: 10.3310/hta14510
p. 11)
O’Brien (p. 244) ‘the extent to Prevention Nurse–Family Partnership Site development, guidelines, Unclear Unknown
(2005)121 which the program is programme: training, an information
replicated with fidelity to the Nurse home visits to support system to record data for
intervention tested’ young mothers on low measures, ongoing quality
incomes improvement assessment and
feedback
Resnick et al. (p. 140) ‘Treatment fidelity Health and Exercise plus vs exercise-only Training manuals, standardised Programme All elements
(2005)122 impacts the internal and medicine intervention programme: training program, ongoing description (p. 140)
external validity of a study, Exercise intervention for direct observation of
as well as the effect size of women, post hip fracture. interventions with feedback,
a tested intervention … If Individualised programme and ongoing training
the treatment being tested involving weekly or monthly
does not adhere to the stated exercise, education,

protocol, then … the results motivation and goal-setting
may not be truly informative sessions
as to the utility of the
treatment’ 1 year
Elliott and None given Prevention Blueprint VP programme and Capacity building/site Initiatives described in Core only
Mihalic LST programme development, training, published reports ‘… judged by program
(2004)116 ongoing technical assistance developers as essential for
program effectiveness … not
established by experimental
manipulation or other formal
tests’ (p. 49)
Rinaldi et al. (p. 282) ‘Fidelity refers to the Health and ETHOS team vs ETHOS None given IPS model (Bond et al. Core only
(2004)118 degree of implementation of social care plus part-time vocational 1997)129 ‘… critical ingredients of
an evidence-based practice’ specialist: evidence-based supported
To support education and employment for people with
employment of young people severe mental illness’ (p. 282)
(aged 17–30) with mental Items identified by
illness ‘brainstorming sessions
1 year among the authors’ (Bond et
al. 1997: 271)129
continued
53
54
TABLE 18 Studies addressing implementation fidelity: 2004 to present (continued)
Strategies to support Source of data 1, ‘Core’ elements only?

Study Definition of fidelity Domain Intervention implementation fidelity programme How identified?
Penuel (p. 294) ‘the extent to which Education GLOBE data reporting Teacher’s guide/protocol GLOBE data reporting na
and Means teachers enact innovations programme: on data collection, training and education
(2004)123 in ways that either follow 2 years in GLOBE resources and programme described
designers’ intentions or learning activities, follow-up in a published
replicate practices developed training, mentoring, ongoing teachers’ guide
elsewhere’ communications
Cash and (p. 66) ‘examine treatment Prevention Family- and home-based Training, incentives (pp. 82–3) Principles of an Unclear
Berry fidelity by comparing actual programme to prevent child ecologically and

(2003)124 practices to the proposed removal and the recurrence structural model of
principles of a service model’ of child maltreatment a family- and home-
based intervention
(Whittaker et al.
1986)130
Resnick et al. (p. 141): ‘fidelity scale Health and IPCC model (ACT) vs No information given ACT (Mueser et al. Unknown
(2003)125 … to measure program social care Standard Care (p. 140) 1998):131 this is the
implementation …with higher basis of the IPCC
numbers indicating greater model
fidelity to the model’
Herzog Study addresses ‘the fidelity Prevention PSRM in a 20-lesson martial No information given PSRM (Steinhardt Unknown
and Wright model of implementation arts programme 1992)132
(2005)126 … a methodology for Five elements
analysing the fidelity of PSRM (respecting the rights
implementation’ and feelings of others,
effort, self-direction,
caring and transfer)
McGrew (p. 42): ‘ensuring accurate, Health and Supported employment Training (p. 43) Benchmark provided Unknown
and Griss consistent implementation social care programmes by ratings of the
(2005)127 and maintenance of the (SECT) Center
model program … to assess
implementation of the model’
Faw et al. (p. 78): ‘the degree to which Prevention ATP: No information given Prescriptions outlined Unknown
(2005)128 a service is delivered as A residential treatment by the theory of
intended by the program programme for adolescent Holland (1986)133
theory’ substance abuse
ACT, Assertive Community Treatment; ATP, Adolescent Treatment Programme; ETHOS, Early Treatment and Home-based Outreach Service; IPCC, Intensive Psychiatric
Community Care; IPS, Individual Placement and Support; LST, Life Skills Training; MAPS, Marriage and Parenting for Stepfamilies; na, data not available; PMTO, Oregon Model of
Parent Management Training; PSRM, Personal and Social Responsibility Model; SECT, Supported Employment Consultation and Training; SIL, social interaction learning; VP, violence
prevention.
Elliott and Mihalic116 report that ‘the available and clear recommendations were almost twice
research demonstrates that fidelity is related as likely to be followed as vague and complex
to effectiveness’, a finding echoed by other recommendations.137 Generally, research indicates
reviews111,112,114 and the primary research.117,127,127,136 that simple but specific policies or interventions
Much of this research, summarised in Table 19, are more likely to be implemented with high
seeks only to measure implementation fidelity, fidelity than complex or vague ones. As such,
but some studies do aim to analyse findings about the comprehensiveness and nature of an HRM
fidelity in relation to the interventions’ outcomes policy’s description may moderate how far the
too. Forgatch et al.117 have demonstrated how the implemented practice actually adheres to the
level of implementation fidelity to a parent training policy.
programme, designed to improve interaction
between parents and stepchildren, predicted the Two further points are raised by this research.
level of improvement in parenting practices. Firstly, the level of implementation fidelity is not
determined purely by the simplicity or specificity
Resnick et al.125 found that employment outcomes of a policy or intervention, strategies are usually
among people with mental health issues ‘were employed to facilitate the achievement of the
weakest for those in poorly implemented Intensive highest possible fidelity. Seven of the studies
Psychiatric Community Care (IPCC) programs’ reviewed here report the employment of strategies
(p. 142). The same correlation was found in a to support adherence to the policy or intervention
similar study by McGrew and Griss,127 which also as it was designed, and to ensure high quality of
looked at supported employment programmes. delivery. In some cases, these strategies include
Resnick et al.122 also found that participant ongoing monitoring and feedback to ensure
outcomes were good when fidelity to an exercise continuing adherence and quality of delivery
programme was high, but no cases of low fidelity over time.116,121,122 Monitoring such as this exists
were present in this study, so a positive correlation not only to optimise, but also to standardise
could not be confirmed. The number of studies implementation fidelity, i.e. to ensure that everyone
evaluating this association is small, but this research is receiving not only the most effective training or
does indicate that the degree of fidelity with which support to aid implementation, but also exactly
a policy or intervention is implemented will be a the same training.138 These studies aim not only
factor in its achievement of successful outcomes. to evaluate fidelity, but also to achieve the highest
fidelity possible. However, the potential role of
Research has also found that detailed or specific these strategies in implementation fidelity has
policies are more likely to be implemented not been considered by research. It is possible
with high fidelity than those that are vague. that these strategies, like the nature of a policy
For example, well-planned violence protection or intervention’s description, may potentially
interventions, where all the key components moderate the degree of adherence: the more that is
are identified in advance, have been found to done to help implementation, through guidelines,
produce higher levels of adherence than less well- training, support and monitoring, the higher
structured interventions.112 Specificity enhances the level of fidelity achieved. This is especially
delivery. Indeed, by far the majority of policies and the case for complex interventions, which can be
interventions implemented in our sample are very multifaceted and more vulnerable to variation
detailed and are based on published models (Table in their implementation.139 The role of such
18: Source of data 1). In one case where the source strategies in optimising fidelity and standardising
is unclear,121 strategies to support implementation what is being implemented arguably is even more
fidelity, for example guidelines, suggest that a important in this case, and even more likely to
highly specific model is behind the intervention. influence the level of fidelity achieved. However,
High specificity may be prerequisite to meaningful there is currently no research to confirm the
measurement. potentially important role of facilitation strategies
as moderators of the relationship between policies
Specificity does not mean complexity. A policy and actual implemented practices, but they should
or intervention can be specific but simple, and be considered as such.
there is evidence that it is easier to achieve high
fidelity of simple guidelines or policies with Secondly, there is no generic measure of fidelity.
fewer ‘response barriers’ than complex ones.54,104 All of the studies used different measures. In each
For example, a study of guidelines intended for case the content of measures is determined by the
general practitioners (GPs) found that detailed content or description of the HRM practice or
55

56
TABLE 19 Studies measuring implementation fidelity
Dimensions of fidelity Validity and reliability of

Study How fidelity is measured Source of data 2 (Dusenbury et al. 2003)104 measures Results
Forgatch et al. FIMP Independent observation Adherence Predictive validity High implementation fidelity
(2005)117 by FIMP raters of video- Quality of delivery (‘competent Inter-rater reliability for associated with more effective
taped sessions execution’) (p. 3) FIMP parenting independent of specified
variables
See also Knutson et al.
(2003)134
O’Brien Outcomes Data collected by local Unclear Only given for 1 of the Good implementation fidelity
(2005)121 Outcomes are perceived programme staff Dose is acknowledged (p. measures Indicators ‘in expected direction’ but
to be indicative of level of 251) based on frequency and ‘weaker’ than RCTs (p. 251)
implementation fidelity (p. duration of nurse home visits, Reduction in maternal smoking and
246) but no formal measure is given drug use, but below target levels
Measures relate to maternal Positive impact on immunisation rates
and child functioning. Results
compared to national Positive impact on language
benchmark standards development
Positive impact on maternal education
Resnick et al. Checklists, logbooks, Checklists completed Delivery (adherence) No information given Good implementation fidelity
(2005)122 calendars by direct observation of Receipt ‘that the treatment has 90%+ score for delivery, receipt and
random sessions been received’ (p. 142) (dose) enactment
Logbooks of staff Enactment ‘that the treatment
delivering the has been … understood …
intervention (self-report) that the individual performs
Calendars of patients treatment-related … skills and
receiving the strategies’ (p. 142) (participant
intervention (self-report) responsiveness)
Elliott and Fidelity score (%) VP: Not clear how these Adherence No information given Good implementation fidelity
Mihalic No. of core components data are collected Dose: lessons taught ‘at Adherence levels high
(2004)116 ‘correctly and fully LST: Checklist rated by recommended levels … dosage Dosage levels for LST low
implemented’ (p. 49) divided classroom observers elements in the prescribed
by total number of core amounts’ (p. 50)
components to give fidelity
score
Rinaldi et al. Supported EFS ‘Independent Adherence Bond et al. (1997) (cited) Good implementation fidelity
(2004)118 15-item scale; items use 1–5 assessment’ (p. 282) provide validity and reliability 71 out of possible 75 on fidelity score
Likert scale information on the Fidelity
Scale
DOI: 10.3310/hta14510

Penuel Outcomes GLOBE student data Unclear No information given Low implementation fidelity
and Means Persistence and consistency archive: objective, Less than half of the schools report
(2004)123 of data reporting. ‘If reported data data consistently (p. 309)
students report high
quality environmental data
consistently over time, the
program can judge teachers’
implementation fidelity to be
adequate’ (p. 311)
Cash and Service delivery tracking log Caseworkers’ complete Adherence No information given Low implementation fidelity
Berry (2003)124 This covers: structure log Low percentage of family- and home-

of service, service time, based contact, and low service time
ecological forms of service; compared with model
compared with principles of
model
Resnick et al. DACTS Self-report by interview Unclear Bond et al. (2001)135 (cited) Four sites demonstrate adequate
(2003)125 Items use 1–5 Likert scale; Baseline and 1 year provides validity and fidelity (4.04–4.30); three sites
the higher the score, the reliability information on the demonstrate inadequate fidelity
higher the fidelity DACTS Fidelity Scale (2.39–3.09) (p. 141)
Mean score 4.5 or above High fidelity associated with improved
(high fidelity), 4.0–4.5 participant outcomes (employment)
(moderate), 3.5–4.0 (low), (pp. 142–143)
3.5 and below (not ACT) Low fidelity associated with poor
outcomes (pp. 142–143)
continued
57
58
TABLE 19 Studies measuring implementation fidelity (continued)

Adherence (items 1–5) Reliability: interparticipant High implementation fidelity of two of
Herzog Nine-item log Self-report of

and Wright Five items address participants Participant responsiveness agreement (80%); five elements
(2005)126 programme leader’s Self-report of (items 6–9) programme leader– Low implementation fidelity of one of
promotion of PSRM; four programme leader participant agreement (75%) five elements
items address the degree to Low implementation fidelity increasing
which participants accept to high implementation fidelity of two
these responsibilities of five elements
McGrew and IPS Fidelity Scale (IPS scale) Phone interviews with Adherence (SECT Center QSEIS has adequate validity Adequate implementation fidelity for
Griss (2005)127 15-item scale; items use 1–5 SE providers at multiple Adherence Rating) (p. 43) and reliability, but internal QSEIS and higher levels of fidelity
Likert scale sites consistency reliability was associated with outcomes (pp. 45–6)
low (p. 45) Low implementation fidelity for IPS
QSEIS:
QSEIS good predictive and levels of fidelity not associated
33-item scale; items use 1–5 validity with outcomes (pp. 45–6)
Likert scale
IPS low reliability, validity
Faw et al. ATP daily activity logs, ATP Completed by staff Adherence (do reported levels Reliability scores given for 50% adherence (authors claim this
(2005)128 environment scale Completed by reach prescribed levels of ATP Environment Scale; is difficult to interpret regarding
participants hours for specified activities?) scores good whether this level is adequate or not)
Participant responsiveness (p. 89)
(therapeutic milieu) High levels of quality of delivery
(p. 86)
ATP, Adolescent Treatment Programme; DACTS, Dartmouth Assertive Community Treatment Scale; EFS, Employment Fidelity Scale; FIMPY, Fidelity of Implementation Rating
System; IPS, Individual Placement and Support; LST, Life Skills Training; QSEIS, Quality of Supported Employment Implementation Scale; SE, supported employment; SECT,
Supported Employment Consultation and Training; VP, violence prevention.
intervention as it appears in the policy document embedded in policy. Typically, such policies and
or as espoused by the designers of the intervention. programmes involve installing new practices or
Nine of the studies collected data on fidelity maintaining central activities or approaches within
using measures that were developed specifically core areas of HRM, for example recruitment and
for the intervention being studied. For example, selection, training, employee involvement, and
the Individual Placement and Support Scale (IPS equal opportunities. Assessing their fidelity is about
Fidelity Scale) was developed to measure fidelity gauging whether policies are implemented fully as
to interventions that were designed to help people practices.
with mental health issues into employment,127 and
the service delivery tracking log, completed by Adherence is then about assessing whether
social workers, was used to monitor implementation practices are implemented in accordance with
of an intervention to protect children potentially policy. ‘Dosage’ refers to ensuring that all aspects
at risk.124 Two other studies evaluated fidelity using of the policy are covered, and all employees and
outcomes: they assumed that positive outcomes are sites to be covered by a particular element are
a proxy for high fidelity of implementation,121,123 actually involved in it. They must also be exposed
which, in effect, negates the primary reason for to it as frequently, and for as long, as prescribed
assessing fidelity, i.e. to see if it moderates the link by policy. ‘Quality of delivery’ refers to how well
between policy and outcomes. the practice is delivered or performed by those
responsible for doing so. For example, a policy may
Data collection on fidelity involves independent prescribe that training is delivered by specialist
observation or reporting in four of the studies, and trainers and involve feedback on quality from
the self-report of staff delivering or participants participants. In this sense, quality of delivery is
receiving the intervention in the remaining seven part of implementation adherence. Alternatively,
studies. The measurement of fidelity in two studies a policy may simply state that training in a
combines data from independent observers with particular skill should be given to all new members
data from staff and participants. Independent of staff but make no specific prescriptions to
observation of delivery offers the best source of guarantee the quality of the training. Quality of
data about both adherence and quality of delivery. delivery is therefore no longer a dimension of
Six of the eleven studies give validity and reliability implementation fidelity, an element of adherence,
information on the scales used. Three studies aim but rather a moderator of the relationship
to measure whether the ‘essential’ elements of the between a policy and successful implementation.
intervention or practice have been implemented, Participant responsiveness concerns the reaction
with the opinions of experts being used to identify of employees to the practices. It may involve
these elements.116–118 assessing whether employees are engaged in each
element of the practice to the extent that they
The implementation fidelity measures applied by should be, and as such may also moderate the
this research literature are intervention specific and implementation–outcome relationship. Programme
heterogeneous in their data collection methods, differentiation is relevant if certain components
but they all seek to measure implementation are core. For example, if employee involvement is
fidelity by measuring adherence, and have as their key to an HRM policy we would naturally expect
starting point highly specific descriptions of their practices associated with the high-involvement
interventions. They also aim to achieve high levels model to be used. Other practices may include
of fidelity by employing similar support strategies, supporting training programmes. A ‘programme
and seek to provide accurate measurement differentiation’ analysis, to use the earlier
of implementation fidelity. However, none terminology, may reveal that supporting practices
examines whether any of the following may have are just as important as core practices, or that
a moderating effect; the complexity or simplicity their delivery is a vital adjunct if the core practices
of the interventions’ descriptions; strategies to are to have an impact. Indeed, within employee
facilitate implementation, quality of delivery; or the involvement it is widely recognised that the not-
responsiveness of participants. so-essential practices support the essential ones,
and hence are necessary if the performance effects
of the policy are to be realised. In effect they are
Fidelity of HR policy practices that ensure the quality of its delivery.
Organisations establish HRM policies, and As with all evaluations, an assessment of the fidelity
occasional change programmes, which may become of policies is an important complement to the
59

evaluation of its impact. However, there are several This implies that the effect of fidelity on outcomes
other reasons why it is important to assess the of policies will be moderated by the level of
fidelity of HRM policies and practices. specificity of a policy. Alternatively, it may be the
case that low specificity leads to non-adherence,
First, the issue of policy implementation may because if policies are vague they can be easily
contain interesting questions in its own right neglected, even allowing for the implied ease at
precisely because adherence is not such a which it might be met. In the extreme, policies may
straightforward matter. Policy-makers themselves be so vague as to contain no clear intentions in
would no doubt value understanding the which case assessing the policy against intentions
organisational processes through which policies are is not possible. In less extreme cases, where some
implemented and the factors (organisational, group intentions can be inferred, little of interest may
and individual) that may facilitate and impede emerge from an assessment of the implementation
implementation fidelity. For example, Cunningham fidelity of a vague policy.
et al.107 in an analysis of four case studies, identified
a range of factors that militated against the In HRM, policies are often not clearly specified if
implementation of a policy on job security for they exist at all. They are often not self-contained,
ill workers. These included contradictory policy have evolved incrementally and statements only
requirements, weakness in training, and various refer to the most salient, perhaps most novel,
work and budgetary pressures. Implementation features. Other elements are taken for granted
fidelity is therefore inherently important in or left unspecified. Modern managerialism may
understanding and evaluating how HRM policies encourage policy-makers and managers to develop
are implemented. policy statements that simply convey homilies and
exhortations to go in a particular direction.141
Second, non-adherence to a policy may adversely
affect employees. For example, if an organisation Certainly, the presence of a policy should not be
has a policy of paying high wages but does not give inferred from HR practices, and, in the same way,
out wage increases, employees’ pay satisfaction and the presence of practices should not be inferred
perception of trust in their employer may decline from the existence of a policy. Indeed, this is a
and affect their performance or commitment to the recognised issue in HRM research.142–144 As a result
organisation. It is often claimed that management research increasingly looks to measure practices by
espouses policies that they do not operationalise collecting data from multiple sources rather than
fully, or even at all, precisely because the policies relying on a single managerial respondent, whose
are designed to make them appear employee- response about uptake may be determined by their
centred but their implementation falls considerably knowledge of policy rather than practice.
short of the implied aspiration. This claim often
falls under the rhetoric-versus-reality label107,140 As a consequence, most recent HRM research
and is applied especially to employee involvement concentrates on practices and not policies or
and equal opportunities, but also sometimes to programmes. More specifically, attempts to link
TQM. For some employees, perhaps especially HRM to performance, i.e. gauge its impact, focus
management, this policy infidelity may affect their on practices, perhaps because of the problems of
morale and commitment. Indeed, the disparity vagueness surrounding policies or because small
between an organisation’s practice and its professed and medium firms may well not have formal
values may be one possible cause of burnout or policies, or simply because they want to focus
disengagement amongst employees. on what organisations do rather than what they
profess to do. Some studies measure HR practices
Finally, policies are important because they drive by coverage, i.e. the proportion of staff covered
and shape practices, and should be accompanied by a practice, but if we do not have information
by strategies to achieve adherence. As a result, about the level of coverage stated in any policy
policies may also ensure that a practice is then we cannot use it as a measure of dosage. For
implemented well, i.e. the quality of delivery is example, a practice may cover 60% of staff. This is
high. One problem that has to be faced, however, the measure of the coverage of a practice, typically
is that the lower the level of specificity the greater assessed by surveys, such as the figures reported
the possibility that the policy will be adhered to, above. However, if a practice is found to cover
on the grounds that it is easier for practice to fall 60% of staff but should in fact cover 100%, i.e. all
within parameters that are broad, or at least to staff then it becomes a measure of implementation
appear to be within them when they are opaque. fidelity because this suggests that the organisation
60
has an acknowledged benchmark for the practice, the HR studies sought to evaluate whether policy
perhaps provided by written policy. is being implemented rather than to do so while
also trying to achieve high levels of fidelity or
It may even be possible to employ theoretical evaluate its relationship with performance, the
or model benchmarks against which to measure need for support strategies is recognised: three
adherence. For example, if an organisation studies report how such strategies had been used by
claims to be using TQM then seeing whether organisations.107,140,147 Like much implementation
reported practices adhere to the accepted model fidelity research, they focused entirely on
of TQM could offer a measure of implementation adherence (including dose). The principal
fidelity.34,144 However, the danger is that the difference between the two literatures concerns
benchmark is a pure ‘textbook’ model that is data collection: the HR literature used only self-
unlikely ever to be implemented in this form. report of participants rather than independent
Nonetheless, Patterson et al.34 successfully audited observation – employee experience rather than the
companies against pre-determined definitions report of quantitative data.
of ‘good practice’ for advanced manufacturing
technologies, TQM, JIT, job enrichment and skill In many cases, studies compare details about
enhancement, and, in so doing, circumnavigated policy given by HR managers or documents, with
the implementation problem by assuming that the report of employees. Disparities between
the measures reflected both the existence and the the two are highlighted. In most cases, greater
effective use of a practice. weight is given to the report of the employees,
even though self-report of employees can be
Finally, the question that naturally follows an unreliable measure of a practice and its
an assessment of how fully a policy has been implementation.110,143,148,149 No validity or reliability
implemented concerns the effectiveness of the information was given about any measures.
resulting practice. Only two studies have sought Measures used were basic by comparison with
to measure effective implementation in the HRM the fidelity scales, logs and checklists used in the
field.145,146 Khilji and Wang145 argued that high fidelity literature (Table 21). HR studies reported
levels of implementation of practices correlate little more than employees’ opinions about whether
with high levels of performance, with satisfaction or not a policy has been implemented; fidelity
as a mediator. However, this study only compared studies often reported percentages or exact fidelity
manager and employee perceptions rather than scores. Also, none of the HR studies sought to
actual implementation fidelity and assumed relate fidelity to outcomes.
that satisfaction was a recognised mediator of
the relationship between implemented practice Research needs to test whether specificity of HRM
and performance, the practices being the prior policy aids or hinders implementation fidelity
variable. The study was also unable to determine (adherence and quality), and to ascertain if this
the direction of causality in these relationships. effect varies according to context. This is a gap
Another study aimed to measure how well HRM in the HR literature and implementation fidelity
practices were implemented by measuring research. Research also fails to address adequately
outcomes: successful outcomes implied successful the issue of local adaptation, which in HR is
implementation or practices.146 This relationship particularly pronounced in multinationals and
cannot be assumed, however. On the whole, large public bodies where adaptations to local
studies have ignored whether how well practices demands and differing cultures is acknowledged as
are implemented affects outcomes, and simply legitimate, and may be incorporated in the policy
concentrated instead on studying the effects of the or may be implicit in management’s approach
adoption of practices, regardless of how well they to it. The effect of specificity may in fact be
are implemented. moderated by the extent to which local adaptation
is allowed or more importantly vital for successful
In the field of HRM, few studies have collected performance.
and evaluated data on the implementation
of policy (Table 20), the equivalent of the The sophisticated knowledge of the concept and
interventions described in the implementation measurement of fidelity apparent in the specific
fidelity literature (Table 18). Despite a lack of implementation fidelity research and associated
concern about implementation fidelity within the literature is clearly lacking in the field of policy
HRM literature, there are similarities between the implementation research in HRM.
literature described in Tables 18 and 20. Although
61

62
TABLE 20 HRM studies measuring implementation
‘Core’
Definition of Strategies to support elements only?
Study fidelity Domain Intervention implementation fidelity Source of data 1, programme How identified?
Cunningham None HRM Management of long-term Training: pp. 283–4 Policy documents Unknown
et al. (2004)107 absence: p. 278
Currie and None HRM Teamworking: pp. 588–9 Selection of managers, Semi-structured interviews with all Unknown
Procter Six offices in one Allocation of work to groups training of managers, grades of staff (including HR staff)
(2003)147 UK organisation rather than individuals. Change training of employees, team
in management style development activities (e.g.
Team Development Pack)

Hutchinson None HRM Appraisal: p. 26 None ‘Information on company HR Unknown
and Purcell Units in 12 UK Employee Involvement: p. 35 policies’ (p. 4)
(2003)108 organisations (These were the only HR
practices covered by the study
which make explicit reference
to policy)
Truss None HRM Policy (the HR department): p. None The HP Way (document) Unknown
(2001)110 Recognition of the Single UK 1128 Focus group (HR department)
need to analyse ‘how organisation Interviews (HR department)
policy is translated
into practice’ (p. 1146)
McGovern None HRM Performance appraisal Institutional Company handbooks Unknown
(1997)140 Eight UK reinforcements:
organisations Performance objectives for
managers; training
Cunningham Interviews Line managers Adherence: pp. 282–83 No information given Medium implementation fidelity
et al. (2004)107 Return to work Returnees ‘a number of employees reported
record sheets Occupational health positively … at the same time … a
Relevant letters and marked gap was apparent between
HR staff policy prescriptions … and the
memos
Trade union treatment [employees] actually
representatives received’ (p. 287)
Currie and Semi-structured All grades of staff Adherence: p. 589 No information given High implementation fidelity
Procter interviews (including HR staff) Dose: Take-up of team ‘clerical worker and management
(2003)147 Employee experience development activities (pp. responses suggest that
591–2) teamworking was successfully
Participant responsiveness: implemented’ … regardless of
Outcomes of team development ‘the uneven take-up of team
activities (pp. 591–2) development activity’ (p. 593)
DOI: 10.3310/hta14510
TABLE 21 Method of measuring fidelity in HRM studies
How fidelity is Dimensions of fidelity Validity and reliability of

Study measured Source of data 2 (Dusenbury et al. 2003)104 measures Results
Hutchinson and Face-to-face interviews Front-line employees Adherence, dosage: presence, No information given Low implementation fidelity
Purcell (2003)108 Structured questionnaires frequency and purpose ‘gaps between policy and practice
employees views on the purpose
of the appraisal scheme differed
from company policy’ (p. 28); ‘policy
practice gap’ in EI initiatives (p. 35)
Truss (2001)110 Interviews Senior managers Adherence: (p. 1135: I receive the No information given Low implementation fidelity
Questionnaires Line managers training I need to do my job) ‘discrepancies between rhetoric and

Focus groups Non-managerial staff Dose: (p. 1135: days training this reality … problems of implementation
year) and interpretation occur’ (pp. 1145–6)
Documentary evidence HR staff (p. 1128)
The enactment of HR
policies: employee
experiences (p. 1134)
McGovern et al. Semi-structured Staff (all grades) Adherence, dosage: presence/ No information given Low implementation fidelity
(1997)140 interviews frequency ‘in the case of frequency …
Surveys Quality of delivery: ‘the actual implementation was uneven within
Focus groups conduct of the appraisals’ (p. 17) organisations and the actual quality
of the practice was also subject to
significant variations’ (p. 26)
63
A framework for process, how well the policy is delivered in practice,

implementation fidelity and how receptive managers and employees are to
the new practice.
Current models and descriptions of
implementation fidelity are therefore inadequate. An example of this might be the introduction of
A new framework is presented here (Figure 2), teamworking: questions relating to adherence need
informed by the discussions and limitations of the to be asked: are people now performing a task as
existing review and research literature, which seeks a team rather than individuals; is the composition
to describe and clarify more fully the function of of the team as required (both ‘content’). Then,
the various components and processes involved in however, there may be an issue about whether the
the relationship between a policy or intervention people in the team are actually working in the
and the fidelity with which it is implemented in way required, such as all team members being
practice. This model is designed primarily for the involved in decision-making (‘coverage’, ‘dose’
evaluation of implementation fidelity in the area of and ‘frequency’). However, the level of adherence
HRM policy and practice, but applies equally to the or implementation fidelity achieved may be
evaluation of any intervention. moderated by participants’ understanding of their
new roles (determined by the quality of the training
The framework begins with a written policy. delivered by those charged with explaining and
Measurement of implementation fidelity is basically implementing the new practice, which, in turn, may
measurement of adherence, i.e. has the policy be affected by the complexity of the practice), and/
been implemented fully in practice, as intended. or whether their managers or they themselves are
This requires that an evaluation assesses how far committed to the new way of working (participant
the policy has been implemented as a practice, responsiveness). The degree of adherence or
preferably by independent observation to reduce fidelity achieved may thus be influenced by all of
bias.138,150 The degree to which it is successfully the potential moderators in the framework.
implemented may, in turn, be moderated, i.e.
influenced, by the complexity of the practice’s Another example might be training in a skill; for
description, the adequacy of the strategies ‘adherence’ we would ask: Have all those been
employed (if any) to facilitate the implementation trained who are eligible?; Did the training take
Potential moderators:
1. Comprehensiveness of policy
description
2. Strategies to facilitate
implementation
3. Quality of delivery
4. Participant responsiveness
Adherence in practice:
Details of content
Policy Coverage Performance outcome
Frequency
Duration
Evaluation of
implementation Evaluation
fidelity
Component analysis to identify

‘essential’ components
64 FIGURE 2 Conceptual framework for fidelity of implementation.

place as often as it should?; Did it last as long evaluate the fidelity with which policies have been
as it should?; and Did it contain what it should implemented. This evaluation could be undertaken
have done? However, implementation fidelity by researchers, policy-makers or practitioners,
might also require that the participants actually indeed anyone seeking to assess whether a policy
acquire knowledge of a new skill as a result of the had been implemented properly in practice, i.e. as
training. Whether or not they did so might again intended by those designing and seeking to deliver
be influenced by the complexity of the training the policy.
programme, the quality with which the training
was delivered (quality of delivery), the strategies
that were in place to support the delivery and Conclusion
implementation of the training (such as a manual
or guidelines), and whether the participants Introduction of new practices, or the revision of
themselves were actually receptive to the training existing practices, requires formulation of policy or
(participant responsiveness). programmes. There is a growing interest in data
for assessing the quality of implementation.119,120,151
Whether the new knowledge acquired affects However, even if the requisite data are provided
outcomes or performance is a separate question, within examples of effective HRM interventions,
beyond fidelity. This is the remit of measures it is still necessary to measure fidelity to
of the practice–performance relationship. gauge whether evidence-based policies are
Implementation fidelity is therefore a potential being implemented properly, in accordance
moderator of this relationship, as represented with a specific policy. Achievement of high
by the broken line in Figure 2. A sensitivity implementation fidelity is one way of replicating
analysis based on performance outcomes could the success achieved by original research.
then determine which, if any, components or Obviously, the successful development and
combination of components are essential if the implementation of policy is governed by more than
practice is to have its desired effect. The scope for the principles of evidence-based practice,152 but the
adaptability would then be known, and the issue of above framework helps to understand why and how
external validity addressed more fully. policy implementation should be evaluated.
Finally, the fidelity with which apparently less This review concerns the entire HRM performance
complex HRM practices are implemented may chain, from HR policy through to performance
still be affected by the moderators described here. outcomes. This chain has several stages, from
For example, appraisals: Have all those who are policy to practice, from practices to intermediate
eligible been covered? Are they appraised as often outcomes, and from intermediate outcomes to
as they should be? Does the appraisal last the set final outcomes. The link between HRM practices
amount of time? Are the required elements of the and intermediate outcomes (e.g. job satisfaction,
process covered? The description of the process, burnout), and the link between such intermediate
the support provided for its implementation, the outcomes and final outcomes (e.g. productivity/
quality of any training given to the managers patient care outcomes), are often measured by the
delivering the appraisals, their own delivery of the research and are analysed in depth elsewhere in
new practice, and the enthusiasm of both managers this review. The HR policy to practice link, called
and employees for the practice may all affect how here implementation fidelity, is measured much
far the policy is adhered to in practice, i.e. the level less if at all. This section therefore considered
of implementation fidelity achieved. the first stage in the HR policy to performance
chain, critically examined current literature on the
The framework in Figure 2 outlines and clarifies concept, outlined its importance, described how it
processes to be taken into account in any evaluation can be measured and the problems presented by
of implementation fidelity. This framework measuring it. The relevance of this lies in how it
informs the guidance presented at Appendix 4 and highlights the processes involved in implementing
checklist in Appendix 5. The guidance outlines practices of demonstrable effectiveness and how
the questions that need to be asked at every stage the implementation process may be evaluated.
in the process if high levels of implementation As such, it is of value to policy-makers and those
fidelity are to be achieved. The checklist is a tool to seeking to develop evidence-based practice.
65

Chapter 5
Identifying linkages between HRM
practices and performance outcomes
Introduction be the mediating path between HRM and final
organisational performance outcomes, although
This chapter provides context and theoretical we would expect HRM practices to also directly
background for Objectives 2–6. Specifically, it influence performance outcomes by creating
discusses current thinking about intermediate operational and structural efficiencies. It is a short
outcomes of HRM. First, the links between HRM step to specify the HRM practices that promote
and performance are considered. The chapter high knowledge, skills and abilities,22 for example
then goes on to describe the method used for through careful attention to recruitment, selection,
identifying the intermediate outcomes considered appraisals and investment in training. Less
in the review and provides conceptual definitions straightforward is the series of mental, emotional
for each intermediate outcome. and attitudinal processes156 that are frequently
proposed to link HRM and performance,
and which are implied by labels such as high-
Intermediate outcomes commitment and high-involvement HRM.
linking HRM and
performance Intermediate outcomes
Two of the principal aims of this review are to Although there are a multitude of variables
evaluate the research evidence linking HRM that are implicated in this process, some of the
practices and organisational performance and more important proposed mental, emotional
also the evidence for mechanisms or intermediate and attitudinal states are employee well-being,
outcomes of HRM that may explain any link an effective psychological contract, perceived
between HRM and performance; specifically, organisational support, fairness and justice,
how and why HRM practices may impact on motivation, job satisfaction, commitment job
performance. While researchers have devoted a involvement and organisational climate.156 An
great deal of attention to examining the linkage organisation’s HR architecture will be closely
between HRM practices and firm performance, tied to these states. For example, satisfaction of
there has been less empirical work attempting to employees, perceptions of fairness and trusting
better understand possible causal mechanisms. management–employee relationships may be
Without examining intervening variables or influenced by HR practices that provide employees
intermediate outcomes of HRM, it is difficult to with opportunities for participation and autonomy.
rule out alternative explanations for an association Intrinsic motivation could well be influenced by
between HRM and performance.23 work design interventions, such as job enrichment
and empowerment. Firms offering job security
There are a number of rationales and and organisation pay programmes, such as profit-
models explaining a link between HRM and related pay, can engender employee perceptions’
performance,13,22,153,154 and while there are of organisational support, and their identification
differences there are also constant themes that with, and commitment to, the organisation.
are shared across the approaches. At a general
level, most models are based on the assumption However, a lack of clarity remains about the degree
that superior HRM practices are believed to result of overlap between the constructs describing
in more skilled, motivated, satisfied, committed, employee states and their causal ordering (e.g.
and hence productive, employees, who, in turn, Does satisfaction precede commitment, and
promote a more effective firm.155 That is, employee under what circumstances?; Is job satisfaction
skills, psychological states (such as attitudes and a consequence of job involvement or is the
motivation) and specific behaviours (such as job relationship reciprocal?). Also the relationships
performance and absenteeism) are purported to between any one individual’s feelings,
67

Identifying linkages between HRM practices and performance outcomes
attitudes, motives and performance will not be most popular conceptualisation of OCB is a five-
straightforward.157 As Ostroff and Bowen155 point dimension model proposed by Organ,159 consisting
out, ‘Lower performance is only one possible of altruism, courtesy, conscientiousness, civic virtue
response to dissatisfaction. A dissatisfied employee and sportsmanship.
could file a grievance, engage in sabotage, ask for a
transfer, try to improve performance or fail to pass Although much of the work on OCB takes the
on important information.158 In contrast, a satisfied position that there is a clear boundary between in-
employee could work harder, engage in more role and extra-role behaviour, the distinction is not
citizenship behaviours, improve skills or make as clear as much of the literature suggests.161
suggestions for improvements in work procedures’
(p. 228). But although the relationship between Research has suggested that employees who are
satisfaction and performance at the individual level satisfied with their jobs and committed to their
may be not be large, the collective effects for the organisation, and feel that they are treated fairly,
organisation as a whole may be enhanced due to are more likely to engage in OCBs.162 Consequently,
the overall cumulative impact of the responses of OCBs have recently emerged as a potential
satisfied or dissatisfied employees.155 important linking mechanism between employee
attitudes, such as commitment and satisfaction, and
Productivity-related employee organisational outcomes. Any single incidence of
behaviours citizenship may have a minor or moderate effect –
‘however, across multiple acts of citizenship from a
How do employee mental, emotional and single employee, and across multiple employees,
attitudinal states get converted into organisational the aggregate impact should be more substantial’
performance? The assumption is through their (Ostroff and Bowen:155 227). However, so far,
influence on employee behaviours salient to arguments for an association between employee
effective organisational performance, i.e. when OCB and organisational performance are
these mental, emotional and attitudinal states are conceptual rather than empirical.
favourably directed then employees are more likely
to display performance-orientated behaviours.156 In summary, despite the paucity of evidence on
Three pertinent sorts of employee behaviour are these relationships (evidence that will be reviewed
task performance, withdrawal behaviours and in later chapters), it has been consistently theorised
organisational citizenship behaviour (OCB).154 that satisfaction, motivation and other mental,
emotional and attitudinal states of employees
Task performance behaviours include job-related tasks are key factors in determining appropriate
and activities comprising the employee’s formal productivity-related employee behaviour,
role. which ultimately contribute to organisational
performance.
Withdrawal behaviours refer to absenteeism and
turnover. A large number of variables may serve as
intermediate outcomes linking HRM practices and
Organisational citizenship behaviours include final performance outcomes, from job satisfaction
components of so-called prosocial behaviours, to organisational commitment, and from burnout
and refer to constructive or cooperative gestures to organisational support. Given the vast range of
that are not mandatory, but which contribute potential intermediate outcomes available from
to organisational effectiveness.159 OCB refers to the research, and the limitations of project time
work-related behaviour that is outside traditional and resources, it was necessary to select a limited
task performance, in-role job performance and number of intermediate outcomes.
the formal organisational reward system, but
is beneficial to the organisation.160 Typically,
employees who engage in OCBs are those who Selecting intermediate
go the extra mile for their organisations and outcomes
therefore contribute to its effective functioning.
This discretionary work performance has been It is important to state at this stage that while we
conceptualised in a number of ways (e.g. contextual support the notion that HR practices have a direct
performance, prosocial organisational behaviour, impact on the knowledge and skills of employees
extra role performance), but the research literature that may translate to improved organisational
has focused most prominently on OCB. The performance, here, and in line with the research
68
brief, we concentrate on the role of employee a newer concept in the literature but is increasingly
mental, emotional and attitudinal states as seen as important employee orientation for
intermediate outcomes of HRM practices. performance, and organisational climate and
organisational support play a prominent role in
The intention was to select only those variables for some models of HRM and performance.
which high-quality data were available, and which
were likely to prove most instructive about the Selected intermediate outcomes
relationships being examined by this report. • Motivation.
• Job satisfaction.
For this reason, a list of potential intermediate • Organisational commitment.
outcomes was compiled from the following sources: • Occupational/professional commitment.
• Engagement.
• The longitudinal research examining the link • Burnout.
between HRM practices and their outcomes • Job involvement.
(Chapters 6–8). • Turnover intentions.
• A list of 40 systematic reviews identified • Psychological contract.
by a search of electronic databases (ASSIA, • Organisational justice (distributive,
MEDLINE, EMBASE, CINAHL, PsycINFO, procedural).
Cochrane Library, Emerald, King’s Fund, • Organisational support.
DH-Data, HMIC, SSCI, SCI) using the search • Organisational climate.
terms ‘human resource’ or ‘HRM’ or ‘high
performance’ or ‘high involvement’ or ‘high Excluded intermediate outcomes
commitment’ and ‘systematic review’ or ‘meta- The following potential intermediate outcomes
analysis’. were in the initial list identified from the sources
• Six recent major HRM reviews (Hyde et al.,77 above, but were excluded because they were only
Boselie et al.,78 Wall and Wood,30 Michie and cited by a single source:
West,79 National Institute of Clinical Studies,80
Wood35). • work-related irritation
• Literature modelling the mediators and • job anxiety/tension
moderators of the HRM practice–performance • job exhaustion
relationship).153,154,163–167 • health complaints
• psychosomatic complaints
This produced a comprehensive list of the • psychophysiological stress reactions
intermediate outcomes cited by both secondary • somatic complaints
research and primary longitudinal research into • physical symptoms
HRM. If two or more of the above sources cited an • psychological well-being
intermediate outcome then it was included. • depression
• strain (depression /anxiety)
In addition, intermediate outcomes that would be • occupational stress
otherwise excluded were included, nevertheless, if • frustration
they were present in a meta-analysis that reported • life distress
correlations between this intermediate outcome • life satisfaction
and three or more selected intermediate outcomes • self-esteem
identified specifically to address Objectives 2 and 3 • conscientiousness
(see Chapter 9). For example, job involvement was • level of participation
originally excluded as an intermediate outcome • transfer of learning
because it was only mentioned by one of the • overflow.
four sources described above, but meta-analyses
reported correlations between organisational
commitment, professional commitment, burnout Definitions of selected
and OCB and this variable. It was then included intermediate outcomes
as an additional intermediate outcome of interest.
Finally, a decision was made in consultation Motivation
with the expert panel to include three ‘wildcard’ Work motivation can be generally defined as
variables – employee engagement, organisational the direction, intensity and persistence of work
support and organisational climate. Engagement is behaviour;168 i.e. what drives a person’s choice
69

of what to do, how hard they try and how long itself. In addition, the concept is sometimes
they keep trying. Motivation is clearly critical to separated into intrinsic satisfaction, which involves
performance. Indeed, work performance is often satisfaction with supervision, co-workers and the
used as a measure of a person’s motivation,169 work itself, and extrinsic satisfaction that targets
although there are many other factors that features extrinsic to task activities, such as pay and
influence performance other than motivation (e.g. promotion.
ability, resources, employee collaboration and
cooperation). There are many motivation theories Organisational commitment
that have been advanced to help understand
behaviour at work but it is often difficult to know Employee commitment to an organisation has been
which theory is helpful in any individual case.169 defined in a variety of ways but is most popularly
Some theories are more relevant to the notion that operationalised as the level of attachment and
HRM practices effect employee motivation, such loyalty to an organisation among its employees.172
as goal-setting theory, equity theory and job design The concept has been particularly popular in the
theory. HRM literature as many scholars advocate that
the traditional relationship between employer and
Job satisfaction employee, based on control, must be replaced by a
high-commitment approach.1
Job satisfaction is the most widely researched
concept in organisational psychology and Mowday et al.173 who were influential in the early
organisational behaviour. Locke170 estimated work on commitment, characterised it as a strong
that over 3300 studies on job satisfaction had belief in and acceptance of the organisation’s goals
been conducted up to 1973. Judge et al.171 then and values, a willingness to exert considerable
identified a further 7856 studies on job satisfaction effort on behalf of the organisation, and a strong
since 1973 using the PsycINFO database. Studies desire to maintain membership in an organisation.
and papers have been written about its definition, They have developed a widely used scale, the
meaning, specific dimensions of job satisfaction, its Organisational Commitment Questionnaire (OCQ),
antecedents and its consequences. Its popularity to measure these elements. But the definition and
stems from the key role it plays in many theories the measure have been criticised for conflating
and models of organisational practices and commitment with outcomes such as effort and
processes, individual attitudes and behaviours. propensity to stay.
Job satisfaction is important as an end in itself
for employees and also because of proposed Meyer and Allen174 have suggested definitions and
relationships with individual and organisational measures based on three broad themes. Affective
effectiveness (e.g. turnover and performance). It commitment describes an employee’s liking for an
is a widely held belief that ‘a happy worker is a organisation and emphasised identification and
productive worker’ (although there is considerable involvement in the organisation. Employees with a
debate about the validity of this statement), and job strong affective commitment continue employment
satisfaction is one way of measuring happiness at with the organisation because they want to do so.175
work. Continuance commitment refers to an awareness of
the costs associated with leaving the organisation.
Locke170 defined job satisfaction as ‘a pleasurable Employees whose primary link to the organisation
or positive emotional state resulting from the is based on continuance commitment remain with
appraisal of one’s job or job experiences’. Thus the employer because they need to do so. Finally,
job satisfaction involves affective (emotional) states normative commitment reflects a feeling of obligation
or how one feels about one’s job, and cognition, to continue employment. Employees with a high
deriving from appraisal of the situation. Although level of normative commitment feel that they ought
there is some debate about the emphasis placed to remain with the organisation.
on affect and cognition, it is probably most helpful
to think of job satisfaction as the interplay of The HRM literature has, not surprisingly,
cognition and affect, or thoughts and feelings.171 concentrated on the affective aspect of
commitment because of the assumed associated
Job satisfaction can be thought of as an overall positive organisational gains. The general theory
assessment of one’s job but which comprises various of organisational commitment predicts that high
job facets, such as satisfaction with pay, recognition, commitment should result in greater motivation
promotion, co-workers, supervision and the work and performance, lower absenteeism and lower
70
labour turnover,172 with consequent organisational Although the concept is relatively new, work
benefits. engagement does overlap with established concepts
also included in this review as intermediate
Occupational/professional outcomes. Vigour is conceptually similar to
commitment motivation, and the dimension of dedication shares
conceptual space with those of job involvement
Much of the theoretical and empirical work on and commitment.180 Engagement has been
commitment has focused on the organisation; defined as the opposite of burnout,181 as, contrary
however, it is clear that workers have multiple to employees suffering from burnout, engaged
commitments at work (such as work itself) and the employees are energetically and effectively
organisational unit (such as the team, department connected to their work, and able to cope well with
or branch). An important commitment domain the demands of the job.182
outside the employing organisation is commitment
to the profession or occupation as well as the Engagement is influenced by the availability
family. of job resources that reduce job demands, help
achieve work goals and stimulate learning and
As with organisational commitment it is the state development.183 Examples of possible resources are
of psychological attachment that is important training and coaching, performance feedback and
in the occupational commitment literature.176 participative management.
Occupational commitment is the individual’s
psychological attachment to, and identification Burnout
with, his/her occupation, based on an affective
reaction to that occupation.177 Burnout is defined as ‘a persistent, negative, work-
related state in normal individuals that is primarily
The strength of employees’ occupational characterised by exhaustion, which is accompanied
commitment may have important consequences by distress, a sense of reduced effectiveness,
for organisations because of its potential links to decreased motivation and the development of
retention and work performance. Also, the salience dysfunctional attitudes and behaviours at work’.184
of occupational commitment may be on the rise as It is a psychological strain resulting from chronic
a means of coping with the uncertainty of extensive work stress, such as job demands.
organisational change.178 Workers may increase
their identification with their occupation on the The concept of burnout was initially associated
basis that they retain more control over that aspect with human services work such as health care
of their working life. and social work, where employees are engaged in
‘people’ work, for example, providing patient care.
Although there has been debate over the It is usually characterised as a three-dimensional
possible inherent conflict between occupational syndrome. Le Blanc et al.185 describe the
commitment and organisational commitment, dimensions in relation to burnout in nursing staff
more recent work argues that the two forms of in three stages:
commitment are not incompatible, but rather they
are positively associated.177 • First, high emotional demands in interpersonal
relationships with patients lead workers to feel
Work engagement emotionally exhausted.
• Second, as a coping strategy they may try
Work engagement refers to ‘a positive, fulfilling, to protect themselves by detaching from
work-related state of mind characterized by their patients by treating their patients in
vigour, dedication and absorption’.179 Vigour is an indifferent and cynical way.186,187 This
characterised by high levels of energy and mental detached attitude towards patients is called
resilience while working, a desire to invest effort in depersonalisation.
one’s work and persistence in the face of adversity. • Finally, as a result of this dysfunctional attitude,
Dedication refers to a strong psychological workers are unable to perform adequately, and
involvement in one’s work, together with feelings the quality of their care is impaired. In turn,
of pride, significance, enthusiasm and inspiration. this may lead to a decline in their feelings
Finally, absorption refers to total concentration on, of personal accomplishment or professional
and pleasant immersion in, work. efficacy.
71

More recent research has argued that burnout by describing the mutual obligations or exchange
exists outside the realm of human services. relationship perceived by the employee to bind him
Consequently, the concept has been adapted or her with the organisation.197 The individual’s
to apply to all employees, by replacing the psychological contract reflects his of her
depersonalisation dimension with cynicism, which understanding of each party’s obligations, derived
reflects indifference towards work in general, not in part from HRM practices, and also verbal
necessarily towards other people.188 statements and actions each party has made.
Burnout may have negative consequences not just Psychological contracts have important implications
for the individual (such as health problems), but for employee attitudes and behaviours, especially
also in relation to organisational outcomes such as when employees perceive that obligations
absenteeism and performance. or promises explicitly or implicitly made by
an employer have been unfulfilled. Contract
Job involvement perceptions are associated with attitudes such as
mistrust, employee behaviour (including effort and
The concept of job involvement has been the contribution), frequency of absence, and intention
subject of a large volume of research for over to stay or leave.198
40 years. Although it is subject to some definitional
confusion, Brown189 notes that most research Organisational justice
has followed Lawler and Hall’s190 definition of
job involvement as ‘psychological identification Organisational justice is one of the most popular
with one’s work’ and ‘the degree to which the job research topics in HRM, organisational psychology
situation is central to the person and his [or her] and organisational behaviour.199 The literature
identity’. The more recent concept of employee has ‘grown around attempts to describe and
engagement treads on similar territory. explain the role of fairness as a consideration in
the workplace’,200 and much of the research in
Multiple outcomes are often attributed to high this area starts from the premise that employees’
job involvement. Job involvement has been judgements of fairness are important in
considered important for promoting employee determining organisational outcomes such as job
motivation,191 goal-directed behaviour, personal satisfaction, organisational commitment, intention
growth and satisfaction, and consequently to quit and OCB.201 What is just or unjust is based
performance.190,192,193 For example, Janssen194 on individuals’ perceptions of fairness.
describes it as ‘the key that unlocks motivation’
to exert extra effort. Increasing job involvement Organisational justice research has primarily been
has been advocated as a means to ‘enhance concerned with distributive justice and procedural
organisational effectiveness and productivity by justice. Distributive justice deals with perceived
engaging employees more completely in their fairness of the distribution of outcomes, such as
work and making work a more meaningful and pay and promotion decisions, whereas procedural
fulfilling experience’.189 Developing enriched jobs justice focuses on the fairness of the process by
is regarded as an important means for stimulating which outcomes are determined.202 The process for
job involvement.192,195 making organisational decisions may be equally or
more important to employees as their perception
Turnover intentions of outcome fairness.
Morrell et al.196 describe turnover as ‘voluntary Interactional justice,203 as more recently advanced
cessation of membership of an organisation by an in the justice literature, relates to the quality of
employee of that organisation’. Turnover intention the interpersonal treatment people receive when
or intention to quit is the psychological state that procedures are implemented, and can be seen as
precedes this cessation. taking two forms.204,205 First, interpersonal justice,
which pertains to the degree to individuals feel
Psychological contract they are treated with respect, politeness and
honesty in the process. The second, informational
The relationship between employees and justice, reflects employees’ perceptions about
employers is central to HRM. The concept of the whether they feel that they are provided with
psychological contract explores this relationship adequate explanations for the use of procedures or
for outcome distribution.
72
Organisational support An initial assumption of theory and research in

Perceived organisational support refers to this area was that social environments could be
employees’ global beliefs concerning the extent to characterised by a limited number of dimensions.
which the organisation values their contributions Typical dimensions were role stress and lack of
and cares about their well-being.206,207 Employees harmony; job challenge and autonomy; reward
view their favourable or unfavourable treatment orientation; leadership facilitation and support;
as in indication that the organisation favours work group cooperation, friendliness and
or disfavours them. Perceived favourable warmth.211,212 However, over the years the number
treatment can be around issues such as fairness, of climate dimensions identified as targets of
organisational rewards and favourable job assessment has proliferated to cover numerous
conditions (e.g. pay, promotions, participation). dimensions of organisational life. Confusingly,
Favourable treatment contributes more towards some of the dimensions that are frequently used in
perceived organisational support if the employee climate research overlap or match other constructs
believes that they result from the organisation’s considered in this review, such as perceived
voluntary actions, as opposed to external pressures organisational support, and work design variables,
such as government regulations.206,207 such as autonomy and role conflict.
Employees who perceive themselves to be An important distinction has been made between
supported and valued are more likely to respond psychological climate and organisational
in a favourable manner. Organisational support climate.213 Psychological climate is based on
theory proposes three psychological mechanisms individuals’ perceptions of the organisation, but
underpinning the consequences of support.208 when individuals in the same unit (e.g. team,
First, on the basis of reciprocity, organisational department) or organisation agree or share their
support should produce an obligation in employees perceptions, organisational climate emerges,
to care about the organisation’s welfare and goal represented by the mean score across all employees
attainment. Second, the support and respect within a particular unit or organisation. The
provided by the organisation should satisfy rationale behind aggregating individual data to
socioemotional needs, leading to employees a unit level is the assumption that organisational
psychologically identifying with the organisation. collectives have their own distinct climate.
Third, perceived organisational support should
increase employees’ beliefs that the organisation Culture and climate are similar concepts since
recognises increased performance. These processes both describe employees’ experiences of their
should result in positive attitudes (e.g. commitment organisations. Organisational climate, according
and satisfaction) and behaviours (e.g. reduced to Schneider,214 represents the descriptions
turnover, increased performance). of the things that happen to employees in an
organisation, they tell us what is happening,
Perceived organisational support has been found whereas culture comes to light when employees
to be related to, but distinct from, organisational are asked why these patterns exist. The question
commitment, procedural justice and job is answered in relation to shared values, common
satisfaction.208 assumptions, and patterns of beliefs held by
organisational members and it is these which
Organisational climate define organisational culture.
Central to most, if not all, models of organisational Schneider214–216 eschews the use of general
behaviour are employee perceptions of the work multidimensional measures of climate and argues
environment, referred to generally as organisational for a facet-specific climate approach where
climate.209 Primarily understood as an intervening climate has a focus and is tied to something of
variable between the context of an organisation interest. Schneider suggests that the dimensions
and the behaviour of its members, and attempting of organisational climate will differ depending on
to understand how employees experience their the purpose of the investigation and that general
organisations, the concept has inspired many measures of organisational climate will contain
descriptions and operationalisations. The dimensions that are not relevant for each specific
dominant approach conceptualises climate as study. This line of argument has encouraged the
employees’ perceptions of what their organisation development of measures with a particular strategic
is like in terms of its routines, practices, procedures focus such as service217 and safety,218 which are
and rewards.210
73

predictive of relevant outcomes (e.g. customer Distinguishing final outcomes

service, safe behaviours). and intermediate outcomes
Research has suggested that climate perceptions Various organisational stakeholders may consider
are associated with a variety of important outcomes organisational effectiveness quite differently. For
at the individual, group and organisational example, employees may well consider some of
levels. These include leader behaviour,209,219 the intermediate outcomes identified above, such
absenteeism and turnover,220 job satisfaction,221–223 as job satisfaction, to be their goal, rather than
commitment,224 individual job performance,225,226 organisational performance. This has led to the
and organisational performance.36 use of the ‘balanced scorecard’ approach227 to
reflect the objectives of all major stakeholders
For the purposes of this review, the focus was (e.g. shareholders, managers, customers and
initially on general multidimensional measures and employees). However, the brief for this review
performance outcomes. However, very little was clearly focuses on organisational performance as
found in this area so the criteria were expanded to the final outcomes in a framework linking HRM
include facet-specific measures. and performance. In the health sector we have
defined the final outcomes, in accordance with
Within HRM and performance models, climate is the review brief, as patient outcomes. Outside the
often conceived as a linking mechanism between health sector, we view final performance outcomes
the HR system and collective employee thoughts, as financial outcomes (e.g. profits, sales revenue,
emotions and attitudes.154 That is, the HR system market share) and organisational outcomes (e.g.
influences climate, which shapes employee customer satisfaction, output measures such as
states, such as satisfaction and motivation, productivity). This approach has determined the
and subsequently employee behaviours and remainder of this report.
performance.
74
Chapter 6
The impact of HRM practices on intermediate
outcomes among health professionals
Introduction comparison was specified, but a longitudinal
filter was developed and used in the search. No
One objective of this review is to evaluate whether specific outcomes were stipulated.
HRM practices have an impact on intermediate • The second, a more specific search for HRM
outcomes, such as job satisfaction. The findings and patient outcomes (reported fully in
presented in Chapter 6 focus exclusively on Chapter 7) used a more focused search strategy
evidence from the health sector and examine the in which the population was working adults,
extent to which HRM practices have an impact on the intervention was fixed as one of the broad
intermediate outcomes. Specifically, it addresses: categories of HRM practice (see Chapter 3 for
details) and the outcomes identified as a range
• Objective 5: 5.1 What is the evidence for the of patient outcomes (again, described fully in
impact of HRM practices on the intermediate Chapter 7).
outcomes identified for this review?
In both searches there was no exclusion of studies
This chapter provides a narrative summary for based on formal quality assessment. However,
relevant longitudinal research relating specifically longitudinal study design was a criterion for
to the health sector and health professionals. This inclusion in the review and served as a form of
synthesis also enables a comparison of this research quality assessment. This ensured that the search
and its findings with that of the non-health sector. was focused on causal relationships.
This chapter first summarises the specific method The search strategies and methodology used for
for this part of the review then gives an overview of identifying longitudinal studies in Chapters 7 and
the intermediate outcomes for which evidence was 8 therefore apply here also; only the inclusion
found. Finally, narrative syntheses and data tables criteria are different. To be included in this part
are presented for each intermediate outcome. of the review, studies had to satisfy the following
criteria.
Review methodology Inclusion criteria

The broad approach to systematic review • Longitudinal study design.
methodology adopted to identify the evidence • HRM practice (e.g. work design, training,
presented in Chapters 6–8 is described in Chapter appraisal).
2. This section describes aspects of the review • One of the intermediate outcomes identified
methodology specific to this search. in Chapter 5 (e.g. job satisfaction, burnout,
organisational commitment).
Studies in this section are a drawn from two • The intermediate outcome must apply to
systematic reviews of longitudinal studies: health professionals.
• The study must test the causal relationship
• The first, a broad review of HRM practices and between the practice and the intermediate
intermediate and/or final outcomes (reported outcome.
fully in Chapter 8), used a simple protocol to
identify relevant papers. The population for Exclusion criteria
the searches was identified as working adults
and the intervention was determined as any • Unpublished dissertations.
HRM or personnel management practice. No
75

The impact of HRM practices on health professionals
Results who performed certain functions or how a certain

task was performed.228,230–232 Five studies examined
Summary of evidence
the impact of job characteristics on various
References identified by the search were scanned by outcomes. Job characteristics were evaluated in
two reviewers for studies that satisfied the inclusion several different ways. Two studies considered
criteria. Intermediate outcomes are categorised them from the perspective of job demand and
with the corresponding numbers of studies as control,229,233 two from the perspective of role
shown in Table 22, below. conflict or ambiguity,234,235 and one considered task
complexity.236 Two of these studies also considered
Job satisfaction the impact of pay on job satisfaction234,236 and
one evaluated the causal relationship between
All of these studies consider the impact of HRM employee participation in decision-making and
interventions or practices on job satisfaction job satisfaction.235 Finally, one study evaluated the
among health professionals. A narrative synthesis impact of the implementation of a new care policy
is preferred here despite the homogeneity of some – work reorganisation generally, rather than a
clusters of studies in this sample. No systematic specific element of work design.237
reviews of this relationship in the health sector
have been found. Outcomes
Most studies measured a range of outcomes in
Details of studies addition to job satisfaction, including burnout,
Ten studies met the inclusion criteria (Table 23). organisational commitment, collaboration, costs,
All were published in English between 1982 and climate, and patient care outcomes, such as length
2002. Five studies were conducted in the USA, two of stay and patient satisfaction. Only two studies
in the UK, and one each in Denmark, Sweden and measured job satisfaction alone.234,236 Each study
the Netherlands. Two studies had experimental in this set of 10 used a different instrument to
designs,228,229 but the remainder were all measure job satisfaction, ranging from specific job
prospective in design. Studies varied in duration, satisfaction scales such as Sandman’s238 Job Stress
from 13 weeks to 5 years, and sample sizes ranged Index, to broader work psychology measures,
from 24 staff to over 2000. for example the Job Diagnostic Survey (JDS)195
or health scales, such as the General Health
HRM practice Questionnaire (GHQ).239 Two studies developed
Nine of the 10 studies examined work design or a their own instrument.
facet of work design. Four studies considered re-
allocation of work in some form, such as changing Results
All four of the work re-engineering and task
reallocation studies found some form of positive
TABLE 22 Number of studies satisfying inclusion criteria
outcome for job satisfaction. The move to greater
No. of studies satisfying
team working/collaboration in two of these
Intermediate outcomes inclusion criteria studies had a positive effect on job satisfaction,
and significant improvement was found for all
Motivation 0
but two of the additional outcomes measured by
Job satisfaction 10 these studies also.230,231 In the third such study, the
Burnout 3 performance of tasks in certain settings (surgical
Job involvement 0 and male wards) was found to be associated with
Occupational commitment 0 improved satisfaction,228 and the reorganisation of
work, involving an increase in workload, was found
Turnover intentions 1
not to have an adverse effect on satisfaction by the
Organisational commitment 1 fourth study.232
Engagement 0
Organisational justice 0 The sample of studies evaluating the relationship
Organisational climate 1 between job characteristics and job satisfaction
found more inconsistent results. In terms of
Psychological contract 0
job demands and control, one study found that
Perceived organisational 0 levels of demand or control had no effect on job
support
satisfaction,229 whereas the second found that social
76
support was positively related to improved job Details of studies

satisfaction, while high demands were associated Three studies met the inclusion criteria237,248,249
with low job satisfaction,233 The former study used (Table 24). All studies were published in English,
a superior study design and a much larger sample, with the earliest dating from 1999. Each study
suggesting that this job characteristics model may was conducted in a different country: the UK,
not significantly predict job satisfaction in the Australia and Sweden. Two studies were of the same
health sector. Role conflict or ambiguity was also duration, i.e. 3 years; the other was 15 months.
found to have no effect on job satisfaction,234,235 The sample design was between 200 and 900
although task complexity did demonstrate health-care staff; in one case the sample size was
a significant association: complex tasks were not given.
associated with high job satisfaction, routine tasks
with low job satisfaction.236 HRM practice
Two studies examined either team working248
Studies of payment practices found different or new forms of team working as part of the
results. Blau236 found that high wages increased intervention:249 the former affected nurses only and
job satisfaction, but Agho et al.234 found no causal the latter all staff. The third study examined a very
relationship between salary and this outcome. different type of work reorganisation intervention:
Both studies used the same study design. Also, the introduction of a new patient care policy.237
Bateman and Strasser235 found that participation in
decision-making did not impact on job satisfaction. Outcomes
Finally, the introduction of a new care policy had a Two of these studies examined morale, an inverse
significant negative effect on job satisfaction. measure of burnout,248,249 and both measured this
by evaluating sickness absence rates and turnover.
Omissions These studies also measured several patient and
These studies only focused on the HRM practices performance outcomes. The third study evaluated
of pay, employee involvement and work design, burnout using the Pines et al.250 measure of this
especially job characteristics. Longitudinal studies dimension of psychological well-being.237
of the impact of other HRM practices on health
professionals’ job satisfaction were not identified by Results
this review. The two team-working studies both found that the
introduction of team working had a positive effect
Summary on staff morale.248,249 In fact, a positive effect was
There is little consistency in the findings of this found on almost all outcomes measured by these
group of studies. Most studies examined either two studies. The two studies used different, but
some aspect of work design or pay, and its impact relatively strong (experimental and prospective
on job satisfaction, but only reallocation of roles cohort) study designs. The third study also used
or tasks consistently demonstrated a positive effect a prospective cohort design but found that the
on job satisfaction, and role conflict consistently HRM practice – the introduction of a new policy –
showed no effect at all. In both cases, results were increased burnout and thus had a negative effect.237
found across two studies only. The remaining
studies found some positive effects, some absence Omissions
of effect, and, in one case, the intervention These studies only focused on the impact of a
produced a negative effect. However, there are single element of work design on morale and
substantial gaps in the literature and the potential burnout. The effect of no other type of practice
relationship between many practices and job was found in this review of the longitudinal HRM
satisfaction in the health sector has not been tested literature.
by longitudinal research.
Summary
Burnout and morale Two of the three studies found were quite
homogeneous in terms of their intervention and
All studies consider the impact of HRM outcome, and found very similar results: team
interventions or practices on burnout and morale working can improve morale. The third study was
among health professionals. No systematic reviews quite different in terms of both the intervention
of this relationship in the health sector have been and outcome, and found that the introduction of
found. a particular care policy had a significant negative
effect in terms of increased burnout.
77

78
TABLE 23 Job satisfaction
Study, Design, sample size, Fidelity

country duration Intervention(s) measure Outcomes Outcome measure(s) Results +ve/–ve
Jones et al. Prospective cohort with Re-engineered work No Employee satisfaction; Attitude survey Positive effect: Employee satisfaction,
(1997)230 historical controls design for patient patient satisfaction; programme for health patient satisfaction, length of stay
USA 119 staff focused care; use collaboration; cost of care; care (1985)240 Negative effect: Collaboration
of multidisciplinary length of stay decreased
Patient numbers collaboration
unknown No effect: Costs
15 months
O’Connor Prospective cohort with Daily patient allocation No Job satisfaction; activity Job satisfaction: 20-item Positive effect: All
(1993)231 historical controls (old system) vs team analysis; QICC scale (own scale)
UK 38 patients nursing (continuity of
care) (new system)
10 staff: activity
24 staff: satisfaction
6 months
Parkes Prospective cohort with Practices No Work satisfaction; work Affective states: GHQ, Surgical wards were higher in
(1982)228 concurrent controls Medical vs surgical ward performance; affective Goldberg (1978)239 satisfaction than medical wards, and
UK 164 student nurses duty states; somatic symptoms; male wards were higher than female
social dysfunctions; wards
13 weeks Male vs female ward depression; anxiety;
duty Other outcomes mixed
sickness/absence
Jung et al. Prospective cohort with Workload No Job satisfaction; nurses Job satisfaction: Price and No effect: Work delegated increased
(1994)232 historical controls redistribution ability to supervise nursing Mueller (1986)241 with no significant effect on
USA 265 nurses programme: decrease assistants, coordination outcomes
nurse workload, of care; quality of nursing
21 months increase use and care; workload; patient
productivity of nursing satisfaction
assistants, educate
nurses to direct and
supervise ancillary staff
Nielsen et Prospective cohort with Psychological demands No Job satisfaction; self-rated Marmot et al. (1991)242 No effect: Job satisfaction
al. (2002)229 concurrent controls Control (decision health; perceived stress; Positive effect: Decision authority
Denmark 2068 employees authority and skill absence from work; labour had positive impact on self-rated
discretion) turnover health, perceived stress and
5 years
Social support absence. Skill discretion had positive
impact on health and absence but
Meaning of work no impact on perceived stress
Predictability Negative effect: Psychological
demands had a negative impact on
self-rated health
de Jonge et Prospective cohort with Job demand No Job satisfaction Scale for job satisfaction Positive effect: Workplace social
al. (2001)233 historical controls Job autonomy Emotional exhaustion, work was constructed by the support was positively related to
Netherlands 261 employees motivation authors job satisfaction
Workplace social
12 months support Negative effect: Job demand was
DOI: 10.3310/hta14510
found to be negatively related to job

satisfaction
Bateman Prospective cohort with Job tension (role No Job satisfaction; Job satisfaction: JDI (Smith Positive effect: MPS has a positive
and Strasser historical controls conflict/ambiguity/ organisational commitment et al. 1969)243 impact on job satisfaction
(1984)235 129 employees overload) Organisational No effect: Neither role conflict nor
USA 5 months MPS: measured as a commitment: Porter et al. centralisation had significant effect
cumulative score from (1974)244 on job satisfaction or organisational
administration JDS commitment
Centralisation:
a measure of
participation/autonomy
in decision-making
Agho et al. Prospective cohort with Pay; role ambiguity; No Job satisfaction Job satisfaction: Six No effect: After controlling for
(1993)234 historical controls role conflict; role items selected from 18- effects of other variables, role

USA 405 employees overload; autonomy; item index developed ambiguity, role conflict and role
supervisory support; by Brayfield and Rothe overload had no effect on job
3 months task significance; (1951)245 satisfaction
routinisation
Blau Prospective cohort with Wages; task No Job satisfaction Job satisfaction: JDS Positive effect: Higher wages and
(1999)236 historical controls responsibility (measured (Hackman and Oldham satisfaction with performance
USA 672 medical as a continuum ranging 1975)195 appraisal also had positive impact on
technologists from routine/simple to job satisfaction
complex tasks) Task complexity had a significantly
4 years
Performance appraisal positive impact on job satisfaction
satisfaction Negative effect: Routine task had a
significantly negative impact on job
satisfaction
Lovgren et Prospective cohort with Introduction of a new No – but Job satisfaction Sandman 1992;238 Karasek Negative effect: Significant reduction
al. (2002)237 historical controls care policy, which strategies such Burnout; creative and and Theorell 1990;246 in satisfaction, increase in burnout
Sweden 225 health staff made statements as training were innovative climate Rasmussen 1996247 and decrease in climate on 2–3 of
about greater work put in place to aid the wards studied
3 years (1995 and 1998) satisfaction and an open implementation
climate
JDI, job descriptive index; JDS, Job Diagnostic Survey; MPS, motivating potential score; QICC, quality indicator for client care.
79
80
TABLE 24 Burnout and morale

MacDonald Experimental Self-managing day surgery No Morale; patient Morale Positive effect: Staff morale
and Bodzak 100 patients nurse-led team – expanded satisfaction; day-case Sickness absence rates (team vs Patient satisfaction also
(1999)248 nurse role activity; financial all hospital personnel) high but not reported as
879 staff performance
UK Source: hospital personnel a significant improvement.
15 months Financial performance within
record system
targets
Browne et al. Prospective cohort with Seamless model of ED No Staff morale; patient Turnover rate and sick leave of 2 Positive effect: Significant
(2000)249 historical controls management: designed by a waiting times; critical days or less positive effects on all
Australia Unknown strategic planning committee care performance; Average waiting time (against outcomes
consisting of physicians patient satisfaction benchmark)
3 years and nursing staff reviewing
working practice. Areas in Time to craniotomy for patients
ED defined by function, staff with acute head injuries
work in functional teams, Patient and relative satisfaction
staff redeployed to functional judged by number of complaints
area (acute, emergency,
observation) of greatest need
Lovgren et al. Prospective cohort with Introduction of a new No – but Burnout; job Pines et al. 1981 (p. 204), 250 Negative effect: Increase in
(2002)237 historical controls care policy, which made strategies such satisfaction; creative Sandman 1992;238 Karasek and burnout
Sweden 225 health staff statements about greater as training were and innovative climate Theorell 1990;246 Rasmussen Significant reduction in
work satisfaction and an open put in place to aid 1996;247 Ekvall et al. 1983 (p. satisfaction, and decrease in
1995–8 climate implementation 204)251 climate on 2–3 of the wards
studied
ED, emergency department.

Turnover intentions Details of studies

All studies considered the impact of HRM One study met the inclusion criteria (Table 26).235
interventions or practices on health professionals’ This study was conducted in the USA, was
turnover intentions or intention to withdraw or prospective in design, and the study lasted
quit. No systematic reviews of this relationship in 5 months. The study’s sample was 129 health
the health sector have been found. sector employees.
Details of studies HRM practice

Only one study met the inclusion criteria The study examined a facet of work design, role
(Table 25),252 published in English and conducted conflict or ambiguity, and employee participation
in Israel. It used a prospective longitudinal design in decision-making.
over 12 months. The sample consisted of 146
health professionals. Outcomes
The study measured organisational commitment
HRM practice using the Porter et al.244 OCQ.
The study examined the effect of job scope (job
variety) on intention to leave among health Results
professionals in an Israeli hospital. Neither role conflict nor employee involvement
was found to have any effect on organisational
Outcomes commitment.
It examined health professionals’ intentions to
leave, and used its own scale to measure this staff Omissions
attitude. This study only focused on the HRM practices
of employee involvement and a particular
Results job characteristic. The impact of other HRM
The study found that greater scope for variation practices on health professionals’ organisational
within the job made it less likely that the health commitment does not appear to have been tested
professionals would seek to leave their current by longitudinal research.
position.
Summary
Omissions The only study that examined any potential
This study focused on a very specific facet of work causal relationship between an HRM practice and
design. No longitudinal research was identified that organisational commitment found that neither role
examined the impact of any other HRM practices, conflict nor employee participation in decision-
such as training, pay, performance management or making had any impact. However, this is the
selection, on an individual’s intention to leave. finding of a single study only and must be treated
with caution. There is very little longitudinal
Summary research in this field in the health area.
One study has found that the job characteristic of
having scope for variation within a job is positive Climate
in relation to turnover intentions among health
professionals, i.e. such personnel were less likely A single study considered the impact on HRM
to leave if there was good scope for variety within intervention or practice on the cultural or working
their work. However, this was a finding of only a climate among health professionals. No systematic
single, small-scale study. No other dimensions of reviews of this relationship in the health sector were
work design, or any other HRM practices, have found.
been examined for their impact on turnover
intentions using longitudinal research. Details of studies
The one study that met the inclusion criteria
Organisational commitment (Table 27)237 was conducted in Sweden, written
in English in 2002, and lasted 3 years. The
A single study considered the impact of HRM population was 225 health-care staff.
interventions or practices on organisational
commitment among health professionals. No HRM practice
systematic reviews of this relationship in the health The study examined the introduction of a new
sector have been found. care policy, which included a call for a more open
climate and greater work satisfaction. 81

TABLE 25 Turnover intentions
Study, Design, sample Outcome

country size, duration Intervention(s) FM Outcomes measure(s) Results +ve/–ve
Krausz et al. Prospective Job scope No 1. Intention to Own scale Positive effect: High
(1995)252 longitudinal [measured using leave job scope led to low
Israel 146 employees a 10-item scale, 2. None intention to leave
based on Hackman
12 months and Oldham’s 3. None
(1975)195 JDS scale]
TABLE 26 Organisational commitment

Bateman Prospective Job tension (role No Job satisfaction; Job Positive effect: MPS
and cohort with conflict/ambiguity/ organisational satisfaction: has a positive impact
Strasser historical controls overload); MPS, commitment JDI (Smith et on job satisfaction
(1984)235 129 employees measured as a al. 1969243) No effect: Neither
USA cumulative score Organisational role conflict nor
5 months from administration commitment: centralisation had
of JDS Porter et al. significant effect
Centralisation: (1974)244 on job satisfaction
A measure of or organisational
participation/ commitment
autonomy in
decision-making
JDI, Job Descriptive Index; JDS, Job Diagnostic Survey; MPS, motivating potential score.
Outcomes Conclusions
The study evaluated creative and innovative climate
in the setting using Ekvall et al.’s251 instrument Thirteen different studies from the longitudinal
for creative organisational climate. The study also literature identified for Chapters 7 and 8 examined
measured the outcomes of job satisfaction and the relationship between an HRM practice or
burnout. job characteristic and one of the intermediate
outcomes selected by this review within the health
Results sector. All studies examined some facet of work
The introduction of this particular new care policy design, such as teamworking,248,249 reallocation or
had a significant negative effect on all the staff reorganisation of work,228,230–232,237 job demands and
outcomes studied, including creative organisational control,229,233 role conflict,234,235 and variation252 or
climate. task complexity.236 A subset assessed the impact of
additional practices on intermediate outcomes.
Omissions These practices were pay234,236 and employee
Although widely studied in other settings, involvement.235 Consequently, most HRM practices
longitudinal research on climate in the health we have considered in this review, i.e. recruitment
sector is rare. and selection, staffing, training and development,
communication, family friendly, harmonisation and
Summary performance management have not been subject
The included study found that the introduction of to longitudinal research in the health sector that
a new care policy had a significant negative effect has examined their relationship with the relatively
in terms of a decrease in climate scores across most common intermediate outcomes described above.
of the wards studied within this setting of a Swedish
hospital, contrary to expectations. Very few intermediate outcomes of potential
relevance were studied: job satisfaction, burnout,
82
TABLE 27 Climate

Lovgren et Prospective Introduction of a No – but 1. Creative and Ekvall et al. Negative effect:
al. (2002)237 cohort with new care policy, strategies such innovative (1983);251 Decrease in
Sweden historical which made as training climate Pines et al. climate on 2–3
controls statements about were put in 2. Burnout, job (1981);250 of the wards
225 health staff greater work place to aid satisfaction Sandman studied; increase
satisfaction and implementation (1992)238 in burnout;
1995–8 an open climate 3. None significant
reduction in
satisfaction
organisational commitment, organisational climate longitudinal research is highly recommended. This

and turnover intentions. The following outcomes section is limited because the sample of included
were not addressed by any longitudinal studies: studies is small. This could be partly because the
professional commitment, job involvement, sample was a broad search on HRM and a specific
motivation, justice and psychological contract. search on patient outcomes. An explicit search for
Some outcomes were only evaluated by one study; longitudinal studies examining specific practices
only job satisfaction was examined by more than and staff outcomes may find additional material;
three. however, such an approach would have to surmount
the associated problems identified in Chapter 2.
Other longitudinal studies did consider potential
intermediate outcomes, but were excluded from Overall, the findings are far from conclusive.
this current analysis because the particular Positive effects were found for team working on
outcomes studied were not included in the shortlist morale and job satisfaction, for job variety on
of intermediate outcomes selected for this report. turnover intentions, and for job complexity on
Such outcomes included staff perceptions of care,253 job satisfaction. However, these findings were
staff attitude or beliefs,254,255 staff knowledge,256–259 only demonstrated by a small number of studies,
numbers of hours slept by residents260 and, and job demand and control, task reallocation,
rather than a measure of an individual’s own job role ambiguity, pay and employee involvement
satisfaction, co-worker satisfaction with waiting were not found to have a consistent impact on job
times261 and staff satisfaction with a service.262 satisfaction, climate or organisational commitment.
Firmer conclusions may be drawn on account of
the greater homogeneity of relationships studied Although cross-sectional studies consistently
within, and across, sections. find relationships between these variables, more
stringent longitudinal research is far more limited
Given the number of gaps in the research linking and it is therefore difficult to draw generalisable
HRM practices and staff outcomes, further conclusions from this body of evidence.
83

Chapter 7
The impact of HRM practices on final
outcomes in the health sector
Introduction The tender specified ‘patient’ outcome variously as
patient care and patient outcomes, which include
This chapter presents findings from a systematic patient satisfaction, mortality rates, hospital acute
review of the evidence on the impact of HRM infection rates, clinical quality standards, and
practices on final outcomes in the health sector. patient safety and well-being. However, a more
The findings reported here relate to objective six of specific definition of patient care outcomes is not
the overall review, specifically: given. An earlier report commissioned by the
SDO on the impact of HRM in the health sector77
• Objective 6: 6.2 Which HRM practices have an failed to examine the relationship between HRM
impact on patient care outcomes? practices and clearly defined patient care outcomes.
The type and nature of the patient care outcomes
Chapter 7 describes aspects of the methodology therefore lacked definition. Scoping exercises were
specific to the health sector systematic review. It undertaken to examine a broad spectrum of patient
then presents the narrative syntheses and data outcomes that appear in the medical and health
tables summarising the evidence for the impact of literature, including clinical outcomes, which are
HRM outcomes on patient care outcomes. treatment- or condition-specific. This literature was
vast and unmanageable, and outcomes were diverse
The narrative syntheses and data tables drawing and heterogeneous. It was decided to prioritise a
together evidence for the impact of HRM on set of patient outcomes based on Department of
intermediate outcomes in the health sector are Health and NHS performance literature.
presented in Chapter 6.
Policy-makers and practitioners want information
Chapter 2 of this report outlines the systematic that is locally applicable, timely and relevant.52,263
review methodology approaches used to guide all Given that the invitation to tender for this
the reviews. The search strategies for this review research described the target audience as ‘NHS
were based on the broad HRM categories described managers, HR practitioners and researchers, …
in Chapter 3 and on patient outcomes. commissioners, … and the NHS HR community
as a whole’, it was decided to focus on patient
In this chapter, the classification of patient care outcomes of relevance to these groups.
outcomes is described first then the specific The Healthcare Commission NHS Performance
methodology is described. The chapter then goes Indicators264 and the NHS Improvement Plan265
on to describe the results. therefore provided a potentially good rationale
for examining a limited, but specific, list of patient
care outcomes.
Patient outcomes
This review focused on seven patient outcomes
One of two principal questions to be addressed is derived from the Healthcare Commission
whether there is any demonstrable link between NHS Performance Indicators264 and the NHS
HRM practices and final performance outcomes in Improvement Plan265 (Table 28). There are no
health, and between intermediate outcomes (such standard definitions for any of these outcomes.
as morale and motivation) and final performance Definitions used in this review are either those
outcomes in health. A clear definition of this provided by the Healthcare Commission264
particular outcome offers the only viable approach and NHS Improvement Plan265 or the terms
to dealing with this question and reducing the as they appear in the health services research
number of outcomes to be investigated. literature. For example, patient satisfaction has
85

The impact of HRM practices in the health sector
TABLE 28 Sources of patient care outcomes
Patient care outcome Source

Patient safety 1. NHS Improvement Plan Standards (Domains 1 and 6): Safety and Care Environment and
(includes infection/HAI/ Amenities
MRSA) 2. Healthcare Commission Performance Indicators: MRSA
3. ITT
Patient-centred care 1. NHS Improvement Plan Standards (Domains 4 and 5): Patient Focus and Accessible and
Responsive Care
2. Healthcare Commission Performance Indicators
3. Appleby 2003266 (Manchester report)
Patient waiting times 1. NHS Improvement Plan Standards (Domain 5): Accessible and Responsive Care
(includes delays and 2. Healthcare Commission Performance Indicators: Waiting; delays; cancellations
cancellations)
Patient satisfaction 1. Healthcare Commission Performance Indicators: Patient complaints; patient surveys
2. ITT
Patient health-related 1. Healthcare Commission Performance Indicators
quality of life 2. ITT
3. Appleby 2005267 (Manchester report)
Patient mortality 1. Healthcare Commission Performance Indicators: Deaths related to certain operations
2. ITT
Patient stay and re- 1. Healthcare Commission Performance Indicators: Emergency re-admissions
admission
no standardised measure, but is a self-explanatory help maintain the profile of infection control.’
term widely used in the literature. Definitions This outcome does not include adverse events or
appearing in this review’s protocols relating to medication errors.
patient care outcomes, and the related literature
searching, are perhaps broader and more vague Patient centred-care refers to ‘health care that is
than would be required by standard systematic provided in partnership with patients, their carers
review methodology, but this reflects the non- and relatives, respecting their diverse needs,
standardised nature of the outcomes being preferences and choices’ (NHS 4). This involves
measured. Further research may add to this list, giving ‘patients and carers information when
but it provides a sound starting point for looking they want or need it, seeking their feedback and
at specific patient care outcomes of demonstrable consulting them regarding their care, and treating
relevance to the target audience. their choices regarding their care or food with
respect’ (NHS 4). This also includes taking into
Patient care outcomes considered by the review are: account their views and choices regarding access to
services and treatments (NHS 5). It is measured in
Patient safety refers to ‘activities that prevent or two indicators under the Patient Focus standards
reduce the risk of harm to patients’ (NHS 1). This for Acute Trusts. These are the ‘Outpatient and
includes activities to reduce ‘the risk of hospital A&E patient surveys: better information, more
acquired infection’ and MRSA, and to achieve choice’ and ‘Outpatient and A&E patient surveys:
high standards of hygiene and cleanliness (NHS 1 building closer relationships’ indicators. The
and 6). MRSA is also a standards indicator under former measures ‘patients’ experience of these
the Clinical Focus element of the Healthcare aspects of care, such as information about care and
Commission Performance Indicators, which treatment, and involvement in care’, and the latter,
states, ‘Infection control (IC) is an integral part ‘feedback from patients … taking account of their
of healthcare and the NHS is working to improve views and priorities … and placing the patient at
hospital cleanliness and reduce infection rates. the centre of health services’.
Rates of infection with MRSA are an increasing
public concern and reducing them is a key priority Patient waiting times refers to ‘delay at … [the]
for the Government. Including this indicator will stage of service delivery’ (NHS 5). It is an
86
integral element of the Healthcare Commission have their limitations.278 For example, Mitchell
Performance Indicators. Waiting times makes and Shortell279 point out that mortality may be
up five of the eight Key Targets and 10 of the a good ‘bottom-line outcome’, but it is arguably
16 Patient Focus Targets for Acute Trusts. These more dependent on patient characteristics than
targets range from standards regarding waiting organisational factors, such as HRM practices.
times in A&E and waiting times from GP referral to
consultation, to the number of cancelled operations
and delays in transfers. They also constitute three Review methodology
of the eight Key Targets and 3 of the 13 Access to
Protocol development
Quality Services indicators for Primary Care Trusts.
Protocols were produced for the review question
Patient quality of life is a common measure in ‘Which HRM practices have an impact on patient
the health services research literature.268,269 It care outcomes?’ but much was left open because
is measured in the Healthcare Commission of the lack of clear definitions and because the
Performance Indicators using ‘feedback from literature itself was an unknown quantity. The
patients … taking account of their views and literature was so diverse and heterogeneous that
priorities’. Patient surveys and complaints nothing was fixed beyond the broad categories
constitute 5 of the 16 Patient Focus Targets for of HRM practice (Chapter 3) and the patient
Acute Trusts, and 5 of the 13 Access to Quality outcomes described above, and the plan for the
Services indicators for Primary Care Trusts. systematic search of the literature by various
methods. There was to be no exclusion of studies
Patient satisfaction is a common measure in based on formal quality assessment. However,
health services research270–273 and is covered by a longitudinal study design was a criterion for
substantial number of the Healthcare Commission inclusion in the review and served as a form
Performance Indicators. These indicators measure of quality assessment. The details of the data
‘feedback from patients … taking account of their extraction and synthesis remained open and
views and priorities’. Satisfaction, as with patient flexible. Such flexibility is permitted by evolving
quality of life, makes up 5 of the 16 Patient Focus systematic review methods, especially when dealing
Targets for Acute Trusts, and 5 of the 13 Access to with complex literatures.52,56,58,60,63
Quality Services indicators for Primary Care Trusts.
Search strategy
Patient mortality rates is a common measure in
the health services research literature274,275 and is Literature search strategies were developed and
covered by 2 of the 10 Clinical Focus standards performed on the following electronic databases:
of the Healthcare Commission Performance ASSIA, BNI, Business Source Premier, Campbell
Indicators for Acute Trusts, and two of the nine Collaboration, CENTRAL, CDSR, CINAHL,
Improving Health indicators for Primary Care DARE, DH-Data, EMBASE, HMIC, IBSS, King’s
Trusts. Fund database, MEDLINE, NHS EED, NRR,
PREMEDLINE, PsycINFO, ReFeR, SSCI and SCI.
Patients’ length of stay and re-admission rates Search strings were modified for the different
are common measures in the health services databases to take account of the different keywords
research literature.274,276,277 Re-admissions that are and thesauri they use. Examples of the search
‘potentially avoidable’ are also covered by 2 of filters and strategies can be found in Appendices 6
the 10 Clinical Focus standards of the Healthcare and 7. The searching of electronic databases using
Commission Performance Indicators for Acute pre-designed search filters was supplemented by
Trusts. reference tracking of selected studies.
An example of the resulting patient outcomes Study selection

search strategy is given in Appendix 6. This search
string was modified for the different databases to A pilot sift was conducted by two reviewers to test
take account of the different keywords and thesauri the study selection criteria form and to assess
they use. inter-rater reliability. Titles and abstracts of studies
identified by both electronic database searching
Many of these outcomes are acknowledged proxies and reference tracking were sifted using the
for patient care, although it is also true that they following inclusion criteria.
87

Studies that: Data synthesis

Despite the apparent heterogeneity of the studies,
• were longitudinal in design a second stage of data extraction was then
• examined an intervention which could be undertaken by the research associate leading on
described as an HRM practice, such as this question (CC) when it became apparent that
training, work design or performance appraisal some studies demonstrated sufficient homogeneity
• evaluated the impact of this intervention on a to be grouped together for synthesis. This
patient care outcome. additional data extraction compiled information
on country, the unit of analysis, staff involved in
Studies were excluded if they were unpublished the intervention, sample size, length of the study,
theses. bottom-line results, staff outcomes and whether
staff variables had been used as moderators or
All of the identified articles were sifted by mediators.
one of the research associates and half by a
second reviewer. The k-statistic for inter-rater Study design was the principal method of quality
reliability across the double-sifted articles was weighting studies in the synthesis. RCTs were
0.9. This complies with the standards required considered to be the best-quality studies because
by conventional systematic review methodology.47 this design limits the scope for bias in the study.48
In cases where there was disagreement, the two The next best studies had a quasi-experimental
reviewers attempted to reach a consensus. If they design: a research design that resembles a RCT but
could not, a third reviewer took the decision about has no random assignment. These were followed
inclusion. There was no formal quality assessment by prospective studies and, finally, retrospective
of the studies at this stage. The only quality studies were considered to be the longitudinal
criterion applied was that the study needed to be design most vulnerable to bias. This hierarchy was
longitudinal. Papers were included only if they had applied in the synthesis. For example, the findings
a longitudinal study design, an HR intervention of a RCT are given greater weight than those
and a stated outcome. Papers were excluded if they of all other study designs examining the same
did not satisfy these criteria or if they were student intervention or outcomes, and the findings of a
theses or dissertations. quasi-experimental study are given greater weight
than a prospective or retrospective study. As far as
Data extraction possible, the review used authors’ own descriptions
of their study’s design in order to limit potential
A data extraction form was piloted by two bias in the labelling of studies as particular designs
reviewers. This process indicated the high degree by reviewers in the project team.
of heterogeneity between the studies. As a result,
the team designed a first-level form to extract only This provided all the data required for a
the minimal amount of key data: study design, worthwhile summary and synthesis of the studies.
intervention, fidelity measure, outcome(s), outcome
measure(s), and to identify any potentially relevant
additional studies. This form served two purposes. Results
First, it enabled the team to gain a quick overview
of the studies’ interventions and outcomes in After the removal of duplicates, a total of 1277
order to test their potential for synthesis. Given citations were identified by the searches of the
the number and apparent heterogeneity of the electronic databases and grey literature sources.
studies, more in-depth data extraction would have The titles and abstracts of retrieved citations were
been time-consuming and potentially of little then screened using the stated inclusion and
added value. Second, reference tracking was used exclusion criteria. At this stage, 1083 citations were
to identify additional potentially relevant studies. rejected because they did not meet the required
The new forms were piloted by all six members criteria. Attempts were made to retrieve the full
of the team and questions were resolved at team papers of the remaining 106 references. When
meetings. The data extraction was then completed examining the full paper, 29 papers were rejected
for each study by a single reviewer. Double data because they did not meet the inclusion criteria.
extraction was rejected because of the number Reference tracking was then performed on the
of selected studies and the limited potential for remaining 77 papers, as well as any included
synthesis. This process provided a necessary papers resulting from the reference tracking
overview of the available literature. process. This process yielded 33 papers, 12 of
88
which were rejected when the full paper was the health sector and is not used to describe any
retrieved because they did not meet the inclusion of the interventions in this sample of longitudinal
criteria. Therefore, in total, reference tracking research. However, the interventions fall under the
yielded 21 additional references. A member of heading of ‘work or job design’ because they all
the project team also encountered a relevant involve the redesign or extension of job content.
paper while working on another project. Overall, The absence of any existing systematic review or
therefore, 99 studies were identified (Table 29). meta-analysis of health sector studies described
The QUOROM flow chart280 in Figure 3 explains as work design may be explained by difficulties
how many studies were rejected and at which stage, in creating a clear, structured definition of work
and the means by which included studies were design or operationalising the concept as a search
identified. strategy. It may also have been prevented by the
potentially limited number of relevant studies
Data extraction was performed on the resulting and the heterogeneity of their interventions and
99 studies, which were then categorised by outcomes, as demonstrated by this sample. In
intervention following the framework of broad fact, there is only one meta-analysis covering job
HRM practices (developed earlier in the review and enrichment, an element of work design, in the non-
described in Chapter 3). The tables below describe health sector.281
the key data for the studies and the accompanying
narrative offers a basic synthesis of these data. Details of studies
Some studies appear under more than one Fourteen studies met the inclusion criteria (Table
category, either because the interventions being 30). All studies were published in English, with
examined have a number of different components the earliest being published in 1992. Eight studies
or because the nature of the intervention means it were conducted in the USA, four in the UK, one in
can be justifiably categorised under more than one Hong Kong and one in Australia. One study used
heading, for example education and feedback. an experimental design, but most of the studies
used a prospective longitudinal design, and there
Work design were also three retrospective studies. The studies
varied in duration, from 6 weeks to 3 years. The
All of these studies consider interventions or sample sizes ranged from as few as 10 staff or 38
practices changing or affecting the content of a job patients to 879 staff or 5037 patients, depending
or the way it is to be done. The term ‘work design’ on the outcomes being studied. In three studies
is rarely used in the literature relating to HRM in the relevant patient sample size was not given.
TABLE 29 Summary of studies included by HRM practice
Systematic reviews:
HRM practice Subcategories No. of studies health sector
Work design 14 0
Staffing Staffing levels and working 19 2
hours
Innovation 13 5
Substitution 23 5
Transfer 8 5
Training and development 16 5
Compensation and rewards 3 7
Communication 0 0
Family friendly 0 0
Single status 0 0
Employee involvement 5 0
Performance management, 7 0
appraisal
Bundles 0 0
89

Total citations from

electronic database
searches (n = 1277)
Application of
inclusion criteria to
titles and abstracts by
three reviewers
Total studies after first
sift (n = 106)
Application of
full papers by three
reviewers
Total studies after
second sift (n = 77)
References satisfying
inclusion criteria from
Serendipity (n = 1)
reference tracking of
included papers (n = 21)
Final total of studies
satisfying inclusion
criteria (n = 99)
FIGURE 3 QUOROM flow chart for patient outcomes review.
In all cases the unit of analysis consisted of units staff members to facilitate the revision or extension
or specific services or departments in hospitals, of roles.232,248
including emergency departments.
The remaining studies all involved elements of
HRM practice job redesign, including within the interventions
All of the interventions considered here involved components such as team working231,286 and
the introduction of new systems or programmes redesigned task allocation.231,287,288 One study
affecting either who performed what tasks within a measured the fidelity with which the new systems
team or how work was allocated to team members. were implemented by recording when protocols
However, analysis of the literature reveals that some required by the new system were activated.284
of the interventions studied may be placed into two However, none of the other studies reported any
groups, each containing three studies. measures of implementation fidelity for the systems
or programmes being examined.
In the first group, three studies, two by the
same authors, examined the implementation Outcomes
of an outcomes management model of working The three outcomes management studies all
developed from quality circles: jobs were researched the impact of this model on patient
redesigned with the intention of achieving outcome length of stay, but had no other outcomes in
benchmarks.282–284 common. Two of the three studies evaluating skill
enhancement for NPs measured both patient
In the second group of three studies, the satisfaction and staff satisfaction. One study used
intervention focused on skill enhancement of nurse validated scales for both of these outcomes,232 but
practitioners (NPs), i.e. nurses taking on expanded the other study used its own instruments.248 The
roles. This involved an increase in workload and remaining seven outcomes measured by these
the assumption of more duties by these staff, studies were all different. The latter study also
or a redistribution of workload combined with assessed other staff psychological and behavioural
increased supervision of more junior members outcomes, including the ability to supervise staff
of staff.232,248,285 In two of these studies, this job and workload.
90 redesign was accompanied by education of relevant
The remaining studies measured a wide variety and retrospective designs all produced the same
of patient care outcomes. Patient satisfaction was inconsistent results.
measured by five studies and waiting times by four.
Overall, unlike the majority of other interventions Omissions
considered by the longitudinal research included The unit of analysis used by these studies did not
in this review, several work design studies did include the hospital or primary or community
examine staff psychological outcomes. Six studies care. Several staff outcomes were measured
measured job satisfaction, employee satisfaction or by these studies, but no study controlled for
morale. None of these outcomes was analysed as a any staff variables and none examined these
moderator or mediator but only as direct outcomes, staff psychological or behavioural variables as
and the job and employee satisfaction measures moderators or mediators of the relationships
used by these studies were all different. being evaluated. Unlike many other interventions
considered by this review, only two patient safety
Results indicators were examined as an outcome by any
Two of the three studies evaluating the outcomes of these studies: errors and urinary tract infection
management model found that this intervention (UTI) rates; and only one study considered
had a positive effect on all outcomes, which mortality rates.
included length of stay and patient mortality
rates.282,283 However, the third study found that the Summary
impact of this intervention on outcomes such as The job design interventions considered here had
length of stay was positive, but not significant.284 All certain basic elements in common, but they also
three studies used a prospective cohort design with differed markedly in parts of their content. Neither
historical controls. outcomes management nor skill enhancement
interventions demonstrated consistent results,
In the group of skills enhancement studies, one but other job and work design interventions all
intervention (workload redistribution) had no had positive effects on staff satisfaction, patient
significant positive or adverse effect on staff or satisfaction and patient waiting times.
patient satisfaction.232 A second study, using a
superior experimental design, also examining the Staffing level and working hours
relationship between increased role responsibility
and these outcomes, found that the intervention These studies consider research into two elements
had a positive effect on morale, but no significant of staffing practice: staffing level and staff working
impact on patient satisfaction.248 The weakest hours. The staffing level literature considers
study in this group in terms of study design only whether increased ratios of staff–patients improve
measured the impact of the intervention on length patient care outcomes or whether decreased
of stay, and found a significant positive effect.285 ratios have an adverse effect on these outcomes.
This ratio may relate either to numbers of staff
In the remaining studies, the work redesign or to grades of staff, such as registered nurses
intervention significantly improved patient (RNs). There is one systematic review of studies
satisfaction in almost every study that measured of staffing levels in the health sector.295 Two of the
this outcome,230,249,287,289 although one study longitudinal studies described below have been
found that the provision of continuity of care included in this previous systematic review.296,297
by physicians, as opposed to their rotation, However, the majority have not been included in
made no difference to patient satisfaction or existing systematic reviews and therefore add to
patients’ perception of the atmosphere in a the review literature on this topic. There are no
ward.288 However, all three studies examining the systematic reviews or meta-analyses on staffing
impact of interventions on staff psychological levels in the non-health sector HRM literature.
outcomes found a significant positive impact
on these outcomes,230,231,249 and all four studies The working hours literature considers both
examining waiting times found significant positive the variable of total numbers of hours worked
outcomes.249,286,287,290 In the four studies examining and interventions that affect the number of
financial performance or cost as an outcome, the hours worked by health professionals, especially
results were positive for three of the interventions, reductions or rescheduling. There are two meta-
and only had no effect in the case of re-engineering analyses that include studies of health sector
work design for patient-focused care.230 Prospective working hours, reflecting the sizeable number of
91

92
TABLE 30 Work design
Design, sample
Study, country size, duration Intervention(s) FM Outcomes Outcome measure(s) Results +ve/–ve
Burns et al. Prospective cohort Outcomes No Ventilator duration Ventilator duration: Data collection by OMs Positive effect: All
(2003)282 with historical management: developed ICU length of stay ICU length of stay: Data collection by OMs outcomes
USA controls from quality circles:
pathway, protocols, Hospital length of stay; Hospital length of stay: Data collection by
1105 patients mortality; costs OMs
four nurses as OMs
30 months Mortality: Data collection by OMs
Costs: Routine collection
Russell et al. Prospective cohort Outcomes No details Length of stay; rates of Length of stay: Routine data collection Positive effect:
(2002)283 with historical management: UTI and skin breakdown; Rates of UTI and skin breakdown: Routine Significant
USA controls (generated from quality discontinuation of catheter data collection improvements on all
524 patients circle): and mobilisation; cost savings outcomes
Discontinuation of catheter and
OM (NPs), pathway and
18 months mobilisation: Routine data collection

protocol
Cost savings: Routine data collection
Burns et al. Prospective cohort Outcomes Yes: Duration of mechanical Duration of mechanical ventilation: Routine No effect: Outcomes
(1998)284 with historical management: recorded ventilation data collection management better
USA controls (generated from quality when Hospital length of stay Hospital length of stay: Routine data but not significant
305 patients circle): protocols collection
were Cost per case
24 months OM, pathway and Cost per case: Routine data collection
protocol activated
Macdonald and Experimental study Self-managing day No Morale; patient satisfaction; Morale Positive effect: Staff
Bodzak (1999)248 100 patients surgery nurse-led team day case activity; final Sickness absence rates (team vs all hospital morale. Patient
UK – expanded nurse role outcome personnel); source: hospital personnel satisfaction also high
879 staff but not reported
record system
15 months as a significant
Self-completion survey questionnaire (p. improvement. Financial
860) performance within
Patient satisfaction survey targets
Day-case activity performance vs national
performance indicators on 15 procedures
Financial performance
Performance against budget
Cash-releasing efficiency savings (comparing
savings against total budget)
Design, sample
Jung et al. Prospective cohort Workload No Nurses ability to supervise Nurses ability to supervise nursing No effect: Work
(1994)232 with historical redistribution nursing assistants; job assistants: own scale delegated increased
DOI: 10.3310/hta14510
USA controls programme: decrease satisfaction; coordination Job satisfaction: Price and Mueller (1986)241 with no significant
265 nurses nurse workload, of care; quality of nursing effect on outcomes
increase use and care; workload; patient Coordination of care: Price and Mueller
21 months productivity of nursing satisfaction; final outcomes: (1986)241
assistants, educate job satisfaction Quality of nursing care: Atwood and
nurses to direct and Hinshaw (1988)291
supervise ancillary staff Workload: Atwood and Hinshaw (1988)291
Patient satisfaction: Press–Ganey Survey
Schweer et al. Retrospective Role of trauma No Length of stay Positive effect:
(2004)285 Unknown paediatric NPs Significant decrease
USA (trauma PNP) was re- in LOS
3 years engineered to a joint
practice model with
trauma PNP assuming

increased responsibility
Sakr et al. Prospective cohort A&E vs NP staffed MIU No Waiting times; no. of errors in No. of errors in clinical assessment, No effect: No
(2003)290 with historical clinical assessment, treatment treatment and disposal: Pre-designed forms difference in safety
UK controls and disposal; costs of ideal vs what happened between MIU and A&E
2760 patients Costs: Obtained from trust Positive effect: MIU
10 months shorter waiting times
Negative effect: MIU
greater costs, more
outpatient referrals
Barry et al. Prospective cohort Implementation of No Financial performance Financial performance: No details Positive effect: Cost
(2002)289 with historical ‘Case Management’ Family-centred care/ Family-centred care/satisfaction: No details savings, improved
USA controls programme satisfaction; clinical process patient satisfaction,
Clinical process improvement: No details improved length of
245 patients Use of CCCs and case improvement
managers stay and re-admission
3 months rates for patients with
diabetes
continued
93
94
TABLE 30 Work design (continued)
Design, sample
Browne et al. Prospective cohort Seamless model of ED No Patient waiting times Average waiting time (against benchmark) Positive effect:
(2000)249 with historical management: designed Critical care performance Time to craniotomy for patients with acute Significant positive
Australia controls by a strategic planning head injuries effects on all outcomes
committee consisting of Patient satisfaction
Unknown Patient and relative satisfaction judged by
physicians and nursing Staff morale; final outcome:
3 years staff reviewing working staff morale number of complaints
practice. Areas in ED Turnover rate and sick leave of 2 days or less
defined by function,
staff work in functional
teams, staff redeployed
to functional area
(acute, emergency,
observation) of greatest
need
Jones et al. Prospective cohort Re-engineered work No Patient satisfaction; employee Press–Ganey Survey Positive effect:
(1997)230 with historical design for patient satisfaction; collaboration; Attitude survey programme for Health Care Employee satisfaction,
USA controls focused care; use cost of care; length of stay; (1985)240 patient satisfaction,
119 staff of multidisciplinary final outcome: employee length of stay
collaboration satisfaction Routine data collection
Patient numbers No effect: Costs
unknown Negative effect:
15 months Collaboration
decreased
O’Connor Prospective cohort Daily patient allocation No Staff perception of changes; Staff perception of changes: job satisfaction: Positive effect: All
(1993)231 with historical (old system) vs team activity analysis; QICC; final 20-item scale (own scale)
UK controls nursing (continuity of outcomes: job satisfaction; Activity analysis: observation exercise
38 patients care) (new system) staff activities
QICC: 85-item questionnaire based on
10 staff: activity Goldstone et al. (1984)292
24 staff: satisfaction
6 months
DOI: 10.3310/hta14510
Design, sample
Lau and Leung Prospective cohort Small team consultation No Waiting times Interval between registration and being seen Positive effect:
(1997)286 with historical vs common patient pool by doctor Significant reduction in
Hong Kong controls waiting times
2583 patients
8 months
Sparr et al. Retrospective House officer rotation No Patient satisfaction; Patient satisfaction questionnaire (PSS) No effect
(1994)288 120 patients vs no rotation patient perception of ward (Speedling et al. 1983);293 revised version of
USA atmosphere Ward Atmosphere Scale (WAS) (1974)294
6 weeks

George et al. Retrospective Formal nurse triage vs No Waiting times Waiting times: routine data collection Positive effect: Informal
(1992)287 5037 patients informal prioritisation Patient satisfaction Patient satisfaction: 14-item questionnaire prioritisation more
UK process (own) effective than formal
6 weeks triage for most urgent
category waiting times
No effect: Patient
satisfaction
CCC, clinical care coordinators; ED, emergency department; ICU, intensive care unit; LOS, length of stay; MIU, Minor Injuries Unit; OM, outcomes manager; QICC, quality
indicator for client care; trauma PNP, trauma paediatric NP.
95
studies in this field.298,299 However, none of the measured the patient safety variable ‘unplanned
studies described below has been included in these extubations’. The remaining study from this cluster
existing reviews. This sample therefore adds to considered the staff outcome: medically certified
the review literature on this topic. There is only sick leave.
one meta-analysis in the non-health sector HRM
literature reviewing studies on a similar subject.300 The studies comparing different lengths of working
hours can be separated further into several smaller
Details of studies groups examining three or more of the same
Nineteen studies met the inclusion criteria (Table or similar outcomes. Four studies investigated
31). All were published in English, with the earliest the relationship between this intervention and
being published in 1988, and all but three of the mortality rates. In only one study was this the only
studies were conducted in North America. Most outcome; the remainder all evaluated multiple
of the studies used a retrospective or prospective outcomes. Three examined the relationship with
longitudinal design, but there was one RCT.301 length of stay, medication errors and adverse
The studies varied in duration, from 3 months events, although these last-named outcomes were
to 7 years. The sample sizes ranged from 347 to only nominally the same. In total, an additional 15
more than 300,000 patients, although in five cases different outcomes were also examined by these
the study’s sample size was not given. In terms of studies. Five of the seven studies assessed multiple
units of analysis, seven studies used the hospital as outcomes rather than a single outcome.
the unit and 12 used units or specific services or
departments in hospitals. Results
Two of the studies examining the impact of total
HRM practice number of hours worked found that this variable
Analysis of the literature reveals that these had no impact on patient satisfaction,297,305 and
longitudinal studies may be examined in two others found no significant relationship with
three separate groups: six studies examine the mortality or prescribing errors.296,306 Only one study
relationship between patient care outcomes and found lower numbers of hours to be associated with
the total number of hours worked by staff; six lower satisfaction among patients, and one study
studies look at how nurse or medical staff–patient found that higher nurse intensity, that is, more
ratios impact on patient care outcomes; and seven hours, led to decreased length of stay.307 All of these
studies compare the effect of shifts of different studies used either retrospective or prospective
lengths being worked by physicians, for example study designs.
long hours compared with an overall reduced
total numbers of hours or shifts of shorter hours. The results for the four nurse–patient ratio studies
In the case of this last grouping of studies, the examining the outcome of mortality rates were
intervention was often introduced as a consequence inconsistent. The two prospective studies found
of new working hour limits. The fidelity with which that there was no significant association with
these interventions were implemented was clearly mortality rates regardless of the ratio,308,309 while
measured in only one study,302 but there was also the two studies using a less powerful retrospective
some monitoring of compliance in another.303 design did find that higher ratios of staff–patient
produced lower mortality rates.310,311 The results
Outcomes of these latter two studies may also have been
In the first two groups, all but one of the studies determined by their patient population of newborn
examined the relationship between staffing or children, which was very different from the adult
working hours and a single patient care outcome. populations of the two studies that reported no
Three of the studies that examined total number of effect. A lower nurse–patient ratio was found to
hours worked all looked at the outcome of patient have the negative effect of increased unplanned
satisfaction. These three studies used two different extubations and increased sick leave absences by
measures and the two studies which used the same head nurses.312,313
patient satisfaction measure reported different
findings.297,304 The three other studies examining Two of the seven studies examining reduced
total number of hours worked looked at three very working hours recorded some negative outcomes,
different outcomes; length of stay, mortality and such as an increase in certain complications,
prescribing errors. Four of the nurse–patient ratio negative patient safety indicators and delays in
studies looked at the same outcome: in-hospital the provision of some diagnostic tests. However,
mortality. One of the nurse–patient ratio studies reduction in working hours consistently appears
96
not to have any adverse effect on the patient liaison (using specialists in one sector to educate
outcomes of mortality rates, length of stay, transfers and support staff in another)’.318 The following
to intensive care, discharge disposition, prescribing synthesis focuses on studies researching innovation:
or medication errors, complications, re-admissions, the introduction of a new type of worker to existing
reinterventions, cost per patient, adverse events or teams or services. There are five recent systematic
perception of care.302,303,314–316 In some cases, this reviews or meta-analyses on staffing in the health
intervention was associated with positive outcomes sector workforce, reflecting both the sizeable
regarding length of stay, medication errors and number of studies and the growing interest in this
maternal and neonatal health outcomes.260,301,314 field.295,319–322 However, only one of the studies
This was the same across study designs: RCTs described below has been included in any of these
generated the same outcomes as simple prospective systematic reviews.323 There is no meta-analysis in
or retrospective designs. In fact, some of the the non-health sector HRM literature reviewing
positive outcomes were found by the more powerful studies on a similar subject.
RCT.301
Details of studies
Omissions Thirteen studies met the inclusion criteria (Table
None of the studies reported here took emergency 32). All were published in English, with the earliest
departments or primary or community care being published in 1988. Eight studies were
as its unit of analysis. Also, staff psychological conducted in the USA, two from Australia, and
or behavioural outcome (sick leave) was only one each in the UK, Switzerland and Turkey. Of
measured by one of these studies, but no study the 13 studies, one was experimental,324 nine were
controlled for any staff variables and none prospective in design and three were retrospective.
examined these variables as moderators or The studies varied in duration, from 1 month to
mediators of the relationships being evaluated. 5 years, and the sample sizes ranged from 203 to
6909 patients. However, no sample size was given
Summary by five studies. Almost all of these studies were
According to this sample of longitudinal research, conducted on units, wards or specific hospital
neither lower numbers of hours worked nor the services or departments. There was one study of a
reduction of working hours appears to have an community nursing home.
adverse effect on mortality rates, length of stay,
transfers to intensive care, discharge disposition, HRM practice
prescribing or medication errors, complications, Analysis of the literature reveals that the
re-admissions, reinterventions, cost per patient or interventions studied may be examined in
adverse events. These variables may potentially three groups. Five studies look at whether the
have a negative effect on patient satisfaction, introduction of physicians with specific training
although they may equally have some positive or skills has any impact on patient care outcomes.
effect on some patient outcomes. The evidence on Five studies compare the impact on patient care of
staff–patient ratios is inconsistent for mortality as teams made up of physicians alone versus teams
a patient outcome, although those studies with a composed of physicians and newly introduced
superior design suggest there is no adverse effect. NPs. Finally, three studies examine the impact of
However, the research also indicates that lower the creation of new NP or senior nurse services.
nurse–patient ratios may lead to adverse events The units of analysis were all either emergency
and increased absences among senior nursing staff. departments or intensive care units (ICUs). None
of the studies made any attempt to measure the
Introduction of a new type of fidelity with which the new staffing practice was
worker to existing teams or being implemented.
services
Outcomes
The staffing category includes skill mix at work, The five studies which looked at the introduction
which involves ‘practices affecting enhancement of new types of physicians assessed a small number
(increasing depth of job by extending roles of of consistent outcomes. Four of the five studies
skills), substitution (working across professional assessed one outcome only, either length of stay,
divides or exchanging one type of worker for mortality or discharge rates. Length of stay was
another), delegation, innovation (creating new evaluated by three of the five studies and mortality
jobs by introducing a new type of worker), transfer by two. There were only two additional patient
of services, relocation of staff and services, and outcomes.
97

98
TABLE 31 Staffing level and working hours
Study Design, sample size,

country duration Intervention(s) FM Outcomes Outcome measure(s) Results +ve/–ve
Bolton et al. Prospective cohort with Total hours of nursing care No Patient perceptions Picker Institute Inpatient Positive effect: Lower number
(2003)304 historical controls per patient-day (p. 610) of care Questionnaire (p. 609) of total nursing hours per
USA Unknown patient, less satisfaction
18 months
Potter et al. Prospective cohort with Nurse staffing No Patient satisfaction Patient satisfaction No effect
(2003)305 historical controls Measures: (post discharge) (p. measure (Burroughs et al.
USA Unknown 159) 1999)317
Average number of hours of
12 months nursing care per patient per
day on the day shift (p. 161)
Davydov et al. Prospective cohort with No. of hours worked No Errors in prescribing Errors per hour worked No effect: No significant
(2004)306 historical controls association between errors
USA Unknown and numbers of hours worked
3 months
Beglinger Retrospective No. of hours worked by No Length of stay Routine data collection Positive effect: Decreased
(2006)307 Unknown nurses length of stay
USA 13 years
Tourangeau et Retrospective Predictors: No 30-day mortality 30-day risk-adjusted No effect: All other predictors
al. (2002)296 46,941 patients Higher dose of nurse staffing rates mortality rates: Routine had no significant effect
Canada (greater number of nursing data collection
12 months
hours)
Sovie and Jawad Retrospective No. of hours worked per No Patient satisfaction Picker Institute Inpatient No effect
(2001)297 12 hospitals (1997) patient-day Questionnaire
USA 16 hospitals (1998) Press–Ganey Survey
24 months
Amaravadi et al. Prospective cohort with Different night time No ‘Clinical and In-hospital mortality No effect
(2000)309 concurrent controls nurse–patient ratios in ICU economic outcomes’
USA 366 patients (postoperative care)
5 years (1994–8)
Dimick et al. Prospective cohort with Nurse–patient ratio (night- No In-hospital mortality Routine data collection No effect: No association with
(2001)308 historical controls time in ICU) mortality regardless of ratio
USA 569 patients
5 years (1994–8)
Marcin et al. Retrospective Nurse–patient ratio No Unplanned Routine data collection Negative effect: Lower nurse–
(2005)312 1004 patients extubations patient ratio significantly
USA associated with increased
4 years unplanned extubations
DOI: 10.3310/hta14510
Callaghan et al. Retrospective Nurse–patient ratio No Mortality (survival to Mortality (survival to Positive effect: Highest infant–
(2003)310 692 patients hospital discharge) hospital discharge): staff ratio (I.71+) produced
Australia routine data collection significantly lower mortality
4 years
Bourbonnais et Retrospective Nurse–patient ratio No Medically certified Routine data collection Negative effect: Lower nurse–
al. (1992)313 1165 nurses sick leave patient ratio significantly
Canada associated with increased
41 months taking of sick leave by head
nurses (not all nurses)
Stilwell et al. Retrospective Level of staffing/all staff– No Mortality Mortality per 1000 births Positive effect: Lower staff
(1988)311 Unknown patient ratio (medical, ratio, higher mortality
UK nursing, midwives)
7 years (1977–83)
Landrigan et al. RCT Traditional schedule No Medical errors; Routine data collection Positive effect: Intervention

(2004)301 Unknown (normal working hours) adverse events schedule had lower rates of
USA vs intervention schedule errors and adverse events
(2203 patient-days) (reduced working hours)
12 months
Bollschweiler et Prospective cohort with Daily working hours (as a No Mortality: Routine data collection No effect: Only ICU length
al. (2000)315 concurrent controls result of limits): 2 x 12-hour Complications; of stay showed a significant
Germany 347 patients shifts vs 3 x 8-hr shifts re-admissions; difference, 3-shift model was
reinterventions; longer
4 months
ICU length of stay;
hospital length of
stay; APACHE II
score
Bailit and Prospective cohort with Reduction in working hours No Medication errors; All routine data collection No effect: Medication errors,
Blanchard historical controls maternal and neonatal Patient perception patient perceptions
(2004)314 Unknown outcomes; patient measured by numbers of Positive effect: Some maternal
USA perception complaints and neonatal outcomes
24 months
significantly improved
continued
99
100
TABLE 31 Staffing level and working hours (continued)

Gottlieb et al. Prospective cohort with Change in work schedule/ No Hours slept by Routine data collection Positive effect: Length of stay,
(1999)260 historical controls rotation, which reduced house staff; no. of medication errors, number of
USA 445 patients hours of typical longest shifts patients admitted; laboratory tests
length of stay; no. No effect: All other outcomes
2 months of laboratory tests;
no. of consultations;
medication errors;
mortality; nosocomial
fever (adverse event);
re-admissions;
discharge to nursing
home; final outcome:
no. of hours slept by
residents
Laine et al. Prospective cohort with Limitation placed on No In-hospital mortality; No details on measure and No effect: On mortality,
(1993)316 historical controls residents’ working hours transfers to ICUs; its reliability or validity transfer to intensive care,
USA 526 patients cardiopulmonary discharge disposition and
resuscitation length of stay
13 months attempts; discharge Negative effect: More patients
disposition; length of suffered complications or had
stay; diagnostic test delays
In-hospital medical
complications; delays
in ordering and
performing diagnostic
tests
Poulose et al. Retrospective Resident work hours limit Yes: surveillance PSIs Rates per 1000 discharges No effect: For three of five
(2005)302 85,000+ patients performed to per quarter of: APL, patient safety indicators
USA evaluate compliance PEDVT, FB, PTX, Negative effect: For two of five
7 years (1995–2001) with limit (p. 848) postoperative WD patient safety indicators
Howard et al. Retrospective Residents’ work hours limits Some monitoring In-hospital mortality In-hospital mortality for No effect: Mortality rates
(2004)303 300,000+ patients of compliance, the following diagnoses: declined but no different
USA but authors CHF, AMI and iatrogenic between experiment and
4 years (1988–91) recognise this was PNU control
not universal, and Source: New York
therefore cite this SPARCS database (p. 2)
as a limitation of
the study
AMI, acute myocardial infarction; APL, accidental puncture or laceration; CHF, congestive heart failure; FB, foreign body left during procedure; ICU, intensive care unit; PEDVT,
postoperative pulmonary embolus or deep vein thrombosis; PNU, pneumonia; PSI, patient safety indicators; PTX, pneumothorax; SPARCS, Statewide Planning and Research Co-
operative System; WD, wound dehiscence.
Length of stay was the only outcome examined by Summary

more than one of the five studies examining the This sample describes longitudinal research
introduction of NPs or senior nurses into physician relating to innovation in the skill mix of staff
teams. This outcome was evaluated in four of these members. The small samples of studies examining
studies. The remaining 15 outcomes evaluated by the introduction of new specially trained physicians
these studies were all different. Only one of these and new nurse services both found that these
studies evaluated any staff psychological outcomes: interventions had positive effects on most of the
staff satisfaction with the new service.262 outcomes being tested, especially length of stay,
mortality and patient satisfaction. However, the
In the grouping of three studies examining the results were far less consistent for the introduction
new introduction of a new nurse service, length of of NPs or their equivalent into teams with
stay and patient satisfaction were both measured physicians, when this new team was compared with
in two studies. The two patient satisfaction studies teams of physicians alone.
used different scales and none was an established
measure. Four other outcomes were also evaluated Substitution of one type of staff
by these studies. for another
Results The following synthesis focuses on studies
The results of those studies that examined the researching substitution. There are five recent
introduction of new types of physicians were systematic reviews or meta-analyses on staffing in
consistently positive. This intervention was found the health sector workforce, reflecting both the
to reduce mortality rates significantly in both sizeable number of studies and growing interest in
studies examining this outcome,325,326 and reduce this field.295,319–322 However, only three of the studies
length of stay in two of the three studies evaluating described below have been included in any of
this variable.324,327 All other outcomes were also these systematic reviews,296,334,335 so this sample also
positively affected.328 Different study designs clearly adds to the review literature on this topic.
produced the same outcomes. There is no meta-analysis in the non-health sector
HRM literature reviewing studies on a similar
Results for the studies examining innovative joint subject.
working between physicians and NPs were very
inconsistent. A positive effect was found in three of Details of studies
the four studies examining length of stay,285,329,330 Twenty-three studies met the inclusion criteria
but many of the remaining diverse outcomes being (Table 33). All studies were published in English,
measured showed no effect at all, regardless of with the earliest being published in 1982. Nineteen
quality of study design.262,331 studies were conducted in the USA. Most of the
studies employed a prospective or retrospective
Two of the three studies examining the longitudinal design, but there was one RCT and
introduction of a new nurse service found three studies used a quasi-experimental design.
consistently positive outcomes for length of stay, The studies varied in duration, from 6 weeks to
waiting times and patient satisfaction,323,332 but the 6 years, and the sample sizes ranged from 96 to
third study, which was of much longer duration, more than 100,000 patients. The studies focused
found no effect on the outcomes of length of on different units of analysis. In 15 cases, the unit
stay and re-admission rates.333 All of the studies was a hospital unit, ward or specific service or
employed a similar prospective design. department; in seven cases a hospital; and in one
case a primary care practice.
Omissions
None of the studies reported here took primary HRM practice
care or the hospital as its unit of analysis. Only Analysis of the literature reveals that the
one study measured any staff psychological or interventions studied may be examined in three
behavioural outcomes, and no study controlled groups. The largest group of 14 studies compared
for any of these variables or examined them as results found for the substitution of RNs, regular
moderators or mediators of the relationships being or employed nurses with other nursing grades or
evaluated. The key patient outcome of patient members of staff. Substitute staff included pool or
safety was not considered by longitudinal studies bank staff, nursing aides (NAs), contract nurses,
looking at this type of innovative intervention. patient care associates, licensed practice nurses,
101

102
TABLE 32 Innovation
Study, Design, sample size,

Partovi et al. Experimental Faculty (additional staff No Length of stay Routine data collection: Nurse Positive effect: Faculty
(2001)324 Unknown member) vs no faculty triage triage time to nurse discharge triage significantly
USA (skill mix) time reduced LOS
16 weeks
Topeli et al. Prospective cohort with New staff: an intensivist No – Mortality; length of Mortality: Routine record Positive effect: Better
(2005)325 historical controls plus closed ICU policy vs no implementation stay in ICU; length collection mortality rates
Turkey 559 patients intensivist plus open policy more than just of stay in hospital Level of sickness of admitted No effect: Length of stay
a new staff patients: APACHE II score
23 months member
Length of stay in ICU: In days
Length of stay in hospital: In days
Bucheli and Prospective cohort with Addition of medical Length of stay Positive effect: Significantly
Martina historical controls personnel to the existing reduced LOS for

(2004)327 360 patients staff (staffing) outpatients; No effect: ED
Switzerland LOS of those admitted to
5 weeks hospital
Pepe et al. Prospective cohort with Comparison of existing No Hospital discharge Positive effect: Significant
(1993)328 historical controls hospital discharge rates rates improvement in discharge
USA 352 patients pre- and post recruitment rates
of specialised emergency
5 years medical services system
physician
Reynolds et al. Retrospective CCM physician staffing No Impact on patients Positive effect: Significant
(1988)326 212 patients with septic shock: reduction in mortality
USA Mortality rates post-designated
24 months CCM staffing
McMullen et al. Prospective cohort with Physician vs NP/physician No Patient health status Patient health status: SF-12 Positive effect: Patients
(2001)262 concurrent controls service (skill mix) Patient satisfaction Patient satisfaction: Picker more healthy, better
USA 701 patients Commonwealth Institute mental health at
Physician and other admission, better
12 months staff satisfaction Questionnaire
communication; high staff
with service Physician satisfaction with service: satisfaction
Final outcomes: University Health Consortium
Referring Physician Survey Negative effect: Traditional
Physician and other service better at
staff satisfaction Other staff satisfaction with explaining tests
with service service: Own two-item scale
Grouse and Prospective cohort with Normal ED staffing vs No Waiting times; Arrival at triage to time first seen Positive effect: Significant
Bishop (2001)330 concurrent controls normal ED staffing plus length of stay by doctor reductions in waiting
DOI: 10.3310/hta14510
Australia 6909 patients nurses trained to perform Arrival at triage to time first seen times for most frequent
ED clinicians’ role (non- by doctor categories and numbers
12 weeks medical technicians) who leave without being
seen
Christmas et al. Prospective cohort with Surgical residents with No No. of patients No details of measure No effect (positive): on
(2005)329 historical controls no work hour limitations admitted to trauma mortality and cost per
USA Unknown vs surgical residents with service patient
limited working hours plus Hospital length of Positive effect: Reduction
3 years NPs (p. 918) stay in all lengths of stay
Intensive care stay
Floor length of stay
Mortality
Direct cost per

patient
Aigner et al. Retrospective NPs and physicians vs No Acute visits; no. of Acute visits: routine data Small effect: NP/physician
(2004)331 203 nursing home physicians only treatments given; collection team did more acute visits
USA residents ED visits; No. of treatments given: routine and gave more treatments
12 months ED costs; data collection
hospitalisations; ED visits: routine data collection
LOS; hospital costs;
performance of ED costs: routine data collection
progress visits; Hospitalisations: routine data
performance of collection
annual history LOS: routine data collection
Hospital costs: routine data
collection
Performance of progress visits:
routine data collection
Performance of annual history:
routine data collection
continued
103
104
TABLE 32 Innovation (continued)

Schweer et al. Retrospective Role of trauma PNP was No Length of stay Positive effect: Significant
(2004)285 Unknown re-engineered to a joint decrease in LOS
USA practice model with
3 years physicians and surgeons
Green and Prospective cohort with Developing and introducing n/a Length of stay in No effect
Edmonds historical controls an ‘advanced practice ICU; re-admission
(2004)333 Unknown nursing position’ (ICU liaison rates in ICU
Australia nurse)
6 years
Spisso et al. Prospective cohort with Introduction of NPs No Cost–benefit Cost–benefit: FISCAL and routine Positive effect: Length
(1990)323 historical controls Quality of care: collected patient data of stay, waiting times
USA Unknown waiting times/length Quality of care: Waiting times/ and patient complaints
of stay; patient length of stay (routine data decrease; time saved for
24 months team increased; costs
satisfaction collection); patient satisfaction:
number of patient complaints offset
Impact of healthcare
team: time spent Impact of health-care team: team
doing certain tasks spent doing certain tasks: 30-day
review
Barr et al. Prospective cohort with NP services to cope with No Patient satisfaction Patient satisfaction Positive effect: High
(2000)332 historical controls increased demand patient satisfaction, but
UK (NI) 241 patients not a comparison with a
control
1 month
CCM, Critical Care Medicine; ED, emergency department; LOS, length of stay; PNP, paediatric nurse practitioner.
unlicensed assistive personnel, unregulated staff and adverse events. Unlike the studies focusing
and nursing assistants. Therefore, despite the almost exclusively on nurses, there was little
apparent homogeneity of the intervention, the consideration of patient satisfaction or patient
substitutes were not always the same. However, 13 safety.
of these 14 studies focused exclusively on nursing
staff. Mortality was the only outcome to be examined by
more than one study in the group examining the
In the same way, the second largest group (a group replacement of physicians by NPs or senior nurses.
of five studies) examined the substitution of one The remaining eight outcomes were all different.
type of physician for another, such as part-time for Patient satisfaction was measured by one study;
full-time physicians. However, in each case both once again the researchers used their own scale.
the physician being replaced and his/her substitute
were different. Results
Results for interventions examining the
The final group of four studies examined the substitution of one type of nurse for another, or
replacement of physicians by NPs or senior for a more junior member of health staff, were
nurses. Once again, however, the details of each inconsistent. Two prospective studies found that
intervention were different. None of the studies the higher the ratio of RNs, the higher the patient
made any attempt to measure the fidelity with satisfaction,305,337 but another study, using a higher-
which the intervention was being implemented. quality experimental design, found that using
RNs alone was less effective at improving patient
Outcomes satisfaction than replacing some RNs with NAs.338
In the group of 14 studies examining the The use of more RNs or regular nurses compared
substitution of one type of nurse for another, or to other grades was also positively associated
for a more junior member of health staff, only with lower mortality rates by all five studies that
four patient outcome measures were examined examined this outcome, although all of these
by more than one study: patient satisfaction, studies were retrospective, which is the weakest
mortality, quality of nursing care and length of form of longitudinal study design. All-RN staffing
stay. Six studies considered the outcome of patient versus staffing by temporary nurses or other grades
satisfaction and all used different measures or was found to have a positive impact on length of
tools, only three of which were named scales (Press– stay, and, in a study of a burns unit, infection rates
Ganey Survey; Burroughs Patient Satisfaction among patients. Employee nurses were also found
Measure; Patient Judgement of Hospital Quality to have a better impact on quality of nursing care
Questionnaire). Quality of nursing care was and patient satisfaction than contract nurses.339
also only measured by a recognised instrument However, the remaining three studies found that
(Hinshaw and Atwood336 scale) in one of the two the substitution of RNs with others generally had
studies examining this outcome. Four studies no effect on outcomes.232,340,341
evaluated mortality rates as an outcome and three
length of stay. Cost was the only other outcome to Results from those studies examining the
be measured by more than one study. These twelve substitution of one physician for another were
studies also measured an additional 13 different again inconsistent. In two cases there was no effect
outcomes, several of which related to patient safety, on mortality rates,342,343 but one did have a positive
such as patient falls. Jung et al.232 also measured effect.344 However, the latter was a retrospective
a number of staff psychological and behavioural study344 and one of the studies that found no effect
outcomes, including job satisfaction, ability to was a RCT,343 the results of which may be more
supervise staff and workload. This was the only one robust. Cross-coverage by physicians was found
of the 23 substitution studies to measure any staff to have a negative effect on adverse events when
outcomes. compared to residency345 but otherwise there was
no significant effect, either positive or negative, on
The group of five studies examining the almost any of the remaining outcomes.342,343,346 Only
substitution of one physician for another made a the study of full- versus part-time primary care
more limited but consistent choice of outcomes. physicians controlled for any staff variables, but
Mortality was measured as an outcome by three these were purely demographic.346
studies, and was the only outcome examined by two
of these studies. Other outcomes measured were The studies examining the replacement of
length of stay, transfer time, patient satisfaction physicians by NPs or senior nurses generally found
105

that such a substitution had no adverse effect patients. All eight studies were conducted on units,
on the outcomes measured, regardless of study wards or specific services.
design.290,347–349 Two studies in this group also
indicated that this intervention had a positive effect HRM practice
on patient satisfaction and some waiting times, Analysis of the literature reveals that the
although these studies used less reliable prospective interventions studied may be examined in two
designs.290,348 groups.335,355–357 Four studies all examine the same
intervention: the specific transfer of services to a
Omissions particular team of physicians, to the exclusion of
All of the principal patient care outcomes were physicians who were previously involved in the care
covered by this sample of studies. However, only under a different model. These studies examined
one study measured any staff psychological or the impact of a move from open ICUs, in which the
behavioural outcome, and no study controlled physician responsible for admission retained some
for any of these variables or examined them as input into a patient’s care, to closed units in which
moderators or mediators of the relationships being care was controlled exclusively by the intensive unit
evaluated. critical care team. The remaining four studies may
also be grouped together because they examine
Summary the effect on patient care outcomes of the presence
This sample describes longitudinal research or absence of certain physicians, although in each
relating to substitution of staff members in the case the unit of analysis, and, therefore, the type
health sector literature. This research suggests that of physician, was different. None of these studies
staffing by RNs only, rather than their replacement made any attempt to measure the fidelity with
with other grades of staff, is better for mortality which the intervention was being implemented.
rates, length of stay and some infection rates
but has limited impact on other outcomes. The Outcomes
replacement of one type of physician with another The group of studies evaluating open versus closed
was also shown to have neither an adverse nor ICUs all considered mortality as an outcome. In
positive impact on patient outcomes. The most one study it was the only outcome measured, but
consistent results were found for the replacement in the remainder it was one of multiple outcomes:
of physicians with senior nursing staff: there were length of stay and duration of mechanical
no adverse effects as a result of this substitution. ventilation were examined as outcomes by two of
these studies, but eight further different outcomes
Transfer or relocation of staff were also studied.
and services
In the same way, in the remaining four studies, two
The following synthesis focuses on studies outcomes were examined by two studies: mortality
researching transfer or relocation of services. There rates and length of stay.253,358 Mortality was the only
are five recent systematic reviews or meta-analyses outcome measured by one study.359 The remaining
on staffing in the health sector workforce, reflecting studies measured an additional nine different
the sizeable number of studies in this field and outcomes. Only one study focused on patients’
the growing interest in this field.295,319–322 However, perceptions of quality of care and used the Picker
only one of the studies described below has been Commonwealth Institute Questionnaire.253
included in any of these systematic reviews.335
There is no meta-analysis in the non-health sector Results
HRM literature reviewing studies on a similar The studies examining the impact of the presence
subject. or absence of a physician found inconsistent results
regarding mortality rates and waiting times,335,355,357
Details of studies and found that the practice had no effect at all
Eight studies met the inclusion criteria (Table 34). on length of stay.356,357 These studies all used a
All were published in English, with the earliest retrospective study design.
being published in 1984. Six of the studies were
conducted in the USA, one in the UK and one in In the group of four studies examining open
Australia. The studies used either a prospective versus closed ICUs, three found that the
or a retrospective design. The studies varied practice of closing the unit significantly reduced
in duration, from 6 months to 3 years, and the mortality.253,359,360 However, one of the two studies
sample sizes ranged from 274 to more than 22,000
106
TABLE 33 Substitution
Study, Design, sample

country size, duration Intervention(s) FM Outcomes Outcome measure(s) Results +ve/–ve
Lee et al. Experimental The skill mix practice model of No Patient satisfaction 16-item questionnaire Positive effect: Skill mix
(2005)338 nursing ‘the practice of using (p. 408) practice model vs non-
DOI: 10.3310/hta14510
100 patients
Taiwan both nurses and NAs to carry skill mix model
12 months out nursing activities’ (p. 408)
An NA is ‘anyone who was
qualified to assist in nursing tasks
through obtaining a nursing care
training certification’ (p. 408)
Fontaine Experimental Two different models of after- No Cost; quality of nursing care Cost: No. of hospital days Positive effect: Employee
and Rositani 373 patients hours nursing care: nurse Patient/family satisfaction Quality of nursing care: nurses produce
(2000)339 employees vs contract nurses Own scale significantly better
8 months outcomes than contract
USA Patient/family satisfaction: nurses
Own questionnaire
Hall et al. Prospective ‘Nurse staff mix’ (p. 1099): No Patient functional health FIM; Medical Outcome Positive effect: Better
(2003)337 with concurrent All RN outcomes; pain; patient Study SF-36 (acute form) FIM, social function

Canada controls perceptions of nursing care BPI-SF and patient satisfaction
RN/RPN scores with higher
2046 patients PJHQ (nursing subscale)
RN/unregulated staff proportion of RNs. RNs
6 weeks+ and unregulated staff had
better pain outcomes for
patients than RNs/RPN
mix and unregulated staff
Barkell et al. Prospective cohort Staffing models: Low ratio vs No LOS; variable cost; patient LOS: Routine data collection No effect: Only pain
(2002)340 with historical high ratio of RNs to PCAs satisfaction; UTI rates; pneumonia Variable cost: Routine data management outcome
USA controls rates; pain management collection showed a significant
96 patients difference
Patient satisfaction: Routine
12 months data collection
UTI rates: Routine data
collection
Pneumonia rates: Routine
data collection
Pain management: Routine
data collection
continued
107
108
TABLE 33 Substitution (continued)

Bolton et al. Prospective cohort Ratio of RNs to other staff No Patient falls; hospital-acquired Routine data collection No effect: Regardless
(2001)341 with historical pressure ulcers of nurse grade–patient
USA controls staffing ratio
257 units
(1,253,892 patient
days)
12 months
Jung et al. Prospective cohort Workload redistribution No Nurses ability to supervise Nurses ability to supervise No effect: Work
(1994)232 with historical programme: Decrease nurse nursing assistants; job nursing assistants: Own delegated increased with
USA controls workload, increase use and satisfaction; coordination of care; scale no significant effect on
265 nurses productivity of nursing assistants, quality of nursing care; Job satisfaction: Price and outcomes
educate nurses to direct and workload; patient satisfaction; Mueller (1986)241
21 months supervise ancillary staff final outcomes: job satisfaction Coordination of care: Price
and Mueller (1986)241
Quality of nursing care:

Atwood and Hinshaw
(1988)291
Workload: Atwood and
Hinshaw (1988)291
Patient satisfaction: Press-
Ganey Survey
McCausland Prospective cohort All RN-primary nursing model vs Yes: hours Length of stay Routine data collection Positive effect: Change to
et al. (1988)350 with historical RN overtime, as-needed nurses worked all-RN primary nursing
USA controls and part-time nurses by nurses model led to decreased
Unknown checked length of stay
5 years
Mark et al. Retrospective RN FTE staffing/1000 inpatient- No Mortality Mortality: risk adjusted Positive effect: Lower
(2005)351 422 hospitals days ratio of observed/expected mortality rates for
USA LPN FTE staffing/1000 inpatient- mortality increased RN staffing for
6 years (1990–5) high HMO penetration
days
hospitals
Non-nurse FTE staffing/1000
inpatient-days
Mark et al. Retrospective Staffing (pp. 282–3): No Quality of care Mortality Positive effect: Lower
(2004)352 422 hospitals RN FTEs/1000 inpatient-days mortality rates for
USA increased RN staffing
6 years (1990–5) LPN FTEs/1000 inpatient-days
Non-nurse FTEs/1000
inpatient-days
Person et al. Retrospective RN staffing: Ratio of FTE RNs to No In-hospital mortality of patients In-hospital mortality Positive effect: Lower
(2004)334 118,000+ patients ADC (p. 5) with AMI mortality rates for higher
RN staffing levels
DOI: 10.3310/hta14510
USA 2 years LPN staffing: Ratio of FTE LPNs

to average daily census (p. 5)
Potter et al. Retrospective Average percentage RN and No Patient satisfaction (post Patient satisfaction measure Positive effect: Higher
(2003)305 Unknown average percentage UAP hours discharge) (p. 159) (Burroughs et al. 1999)317 percentage of hours
USA of direct care (p. 161) by RNs, higher post-
12 months discharge satisfaction
Average float percentage or
mean percentage of nursing care
on day shift that is provided by
float nurses from other units or
outside the hospital (p. 161)
Tourangeau et Retrospective Richer RN skill mix: RN inpatient No 30-day mortality rates 30-day risk-adjusted Positive effect: Richer RN
al. (2002)296 46,941 patients hours vs inpatient hours by mortality rates: routine data skill mix, more years
Canada other nurses collection experience on unit, larger
12 months number of shifts missed
Increased opportunities for

continuity of care (more full-time predicts lower mortality
RNs) No effect: All other
predictors had no
significant effect
Robert et al. Retrospective Low regular and high-pool No BSI; length of stay; duration of Routine data collection Positive effect: Higher
(2000)353 127 patients nurse–patient ratio vs high mechanical ventilation; assisted regular nurse–pool
USA regular and low-pool nurse– nutrition; mortality nurse ratio led to better
13 months patient ratios outcomes
Arnow et al. Retrospective Regular burns unit nurses vs No Infection rates Routine data collection Positive effect: Use
(1982)354 101 patients temporary nursing staff of regular nurses
USA significantly associated
8 months with lower infection rates
than temporary staff
Simmer et al. RCT Resident (teaching) vs staff (non- 554 In-hospital mortality and No effect: No difference
(1991)343 1151 patients teaching) staffing model mortality within 6 months of between the two models
USA admission
12 months
continued
109
110
TABLE 33 Substitution (continued)

Oswanski et Prospective cohort Resident assisted vs physician No Mortality; length of stay; transfer Routine data collection Positive effect: Length
al. (2004)342 with historical assistant only time of stay significantly
USA controls reduced from ED to
769 patients trauma centre (1 of
5 components of this
12 months variable)
No effect: All other
outcomes
Tenner et al. Retrospective Hospitalist vs resident No, but Survival Survival rates Positive effect: Staffing by
(2003)344 1211 patients different ‘hospitalists’ has lower
USA settings mortality rates than
12 months resident staffing
Fairchild et al. Retrospective Part-time vs full-time PCPs No Patient satisfaction; controls; staff No difference full-time vs
(2001)346 132 primary care gender; staff years in practice; part-time primary care
USA physicians staff location physicians
Unclear
Rudy et al. Experimental Residents vs acute care NPs and No Length of stay; mortality; adverse Length of stay: Routine data No effect
(1998)349 389 patients physician assistants drug reaction; completeness of collection
USA admission notes; re-admission Mortality: Routine data
14 months
collection
Adverse drug reaction:
Routine data collection
Completeness of admission
notes: Examination by
researchers
Re-admission: Routine data
collection
Hoffman et al. Prospective cohort ACNP and attending physician No Mortality rates No. of deaths of patients No effect
(2005)347 with concurrent vs critical care/pulmonary fellow who did or did not have
USA controls and attending physician in an ICU treatment limitations
526 patients (skill mix)
31 months
ACNP, acute care nurse practitioner; BSI, bloodstream infection; FTE, full-time equivalent; PCA, patient care associate; PCP, primary care physician; RPN, registered practical
nurses.
that used a superior prospective design found no impact on physician performance and health-care
such positive effect.358 The impact of this practice outcomes.363–365 The two other reviews examine
on all other outcomes was also inconsistent. For systems of continuing professional development to
example, two studies examined length of stay and enhance the recruitment and retention of specific
found differing results.253,358 The different results health professionals.299,366 There are also three
were not related to quality of study design as both meta-analyses of training practices from the non-
studies employed a form of prospective design. health sector. These focus on elements of training
that are very different from those examined for
These eight studies covered all of the key patient health, such as altering organisational behaviour,367
outcomes, although the patient safety variables mentoring368 and evaluating the effectiveness of
were limited. organisational training.369 None of the studies
reviewed below appear in any of these systematic
Omissions reviews. A narrative synthesis has been undertaken
None of the studies reported here took the hospital due to the general heterogeneity of the studies in
or primary or community care practices as their this sample.
unit of analysis, and none controlled for any staff
variables or examined them as moderators or Details of studies
mediators of the relationships being evaluated. Sixteen studies met the inclusion criteria (Table
35). All studies were published in English, with the
Summary earliest being published in 1988. Eight studies were
This sample describes longitudinal research conducted in the USA, two in Argentina, and one
relating to the transfer or relocation of staff and each in the UK, the Netherlands, Sweden, Pakistan,
services. Despite the apparent homogeneity of Taiwan and Macedonia. Most of the studies
such practices or interventions, there is still a great employed a prospective longitudinal design, but
deal of heterogeneity between these studies in there were two RCTs256,370 and one experimental
terms of outcomes and units of analysis. Also, only study.371
one study232 measured any staff psychological or
behavioural outcome. The studies varied in duration, from 6 months
to more than 6 years. The length of the study
The results derived from similar interventions period was not given by one paper. The sample
(such as the move to closed from open ICUs) either sizes ranged from as few as 35 patients or 76 staff
had a positive effect, or no effect at all, in equal to 1411 patients or 649 staff, depending on the
measure. These findings, in combination with outcomes being studied. The relevant patient
the small number of studies, means that no firm sample size was not given in two studies. The unit
conclusions can be reached about the relationship of analysis was a hospital unit or ward in 13 of
between patient outcomes and the location of the studies. In one study the unit of analysis was
physicians on- or off-site, or the transfer of services a primary care practice and in two others it was a
to exclude certain types of physician. hospital.
Training HRM practice

Analysis of the literature reveals that seven studies
All of these studies consider interventions that all examine the same intervention and outcome:
involve some form of training or education for the impact of specific training on infection rates
health staff and its impact on patient and staff within ICUs.372,373 In five of these studies the
outcomes. Studies have only been included if education or training element was conducted in
the entire practice was training or if training conjunction with evaluation feedback.
was a primary element of an HRM practice. A
number of studies have been excluded because The remaining nine studies also examined
education or training was only one element of a interventions specifically to improve staff
multifaceted intervention in which none of the knowledge and skills in particular fields, but these
other components could be described as falling studies do not form a similar homogeneous body
within the field of HRM.361,362 There are five of literature. The training in two studies aimed to
existing systematic reviews or meta-analyses of improve communication and collaboration within
training and development interventions in the teams,256,370 and two had elements specifically
health sector. Three examine forms of continuing designed to improve communication and working
medical education for physicians and their with patients.256,371 Despite these potential
111

112
TABLE 34 Transfer

country size, duration Intervention(s) FM Outcomes Outcome measure(s) Results ±
O’Connor et al. Retrospective ED with ED physician No Waiting time by triage category; Waiting time by triage category: Routine Positive effect: For waiting
(2004)355 11,999 patients present vs ED with ED waiting time by access block data collection time by triage category
Australia physician not present Waiting time by access block: Routine 4. Not significant for all
6 months other categories
data collection
French et al. Retrospective Two different staffing n/a Length of stay; decision to No effect
(2002)356 22,527 patients models: admit time; laboratory tests and
USA 1. ED was staffed with radiographic studies ordered;
6 months specialist consultations obtained;
EM residents under the
unscheduled return visits within 72
direct supervision of the

faculty hours; overall patient satisfaction
2. ED was staffed with
absent EM residents
Porter and Retrospective Attending vs non-attending No Resuscitation room time; time Resuscitation room time: Routine data No effect: Except
Ursic (2001)357 943 patients surgeon in a trauma centre to operating room; time to CT collection different for time to
USA scan; length of stay; complications; Time to operating room: Routine data OR – attending surgeon
6 months mortality significantly better
collection
Time to CT scan: Routine data collection
Length of stay: Routine data collection
Complications: Routine data collection
Mortality: Routine data collection
Li et al. Retrospective On-site vs off-site physician No Mortality Positive effect: Significant
(1984)335 954 patients staffing in ICU reduction in mortality
USA rates post introduction of
20 months on-site staffing
country size, duration Intervention(s) FM Outcomes Outcome measure(s) Results ±
Multz et al. Prospective Change from ‘open’ to No Mortality; length of stay in Routine data collection Positive effect: Significantly
(1998)358 cohort with ‘closed’ ICU: mix of staff ICU; length of stay in hospital; lower LOS and MV when
DOI: 10.3310/hta14510
USA concurrent changes from non-ICU mechanical ventilation closed

controls physicians (admitting No effect: Mortality
280 patients physicians) having input into
care, plus critical care team,
8 months to critical care team alone
Carson et al. Prospective Change from ‘open’ to No Patient outcomes: 1–6. Routine data collection Positive effect: Significantly
(1996)253 cohort with ‘closed’ ICU work team: Hospital mortality; duration of 7. Adapted version of Picker reduced mortality
USA historical controls mix of staff changes mechanical ventilation; length Commonwealth Foundation No effect: On all other
245 patients from non-ICU physicians of stay; patient charges for Questionnaire outcomes
(admitting physicians) having radiology, laboratory and pharmacy
6 months input into care, plus critical Nurses show increased
departments; catheter use; perceived satisfaction
care team, to critical care interruptions of formal teaching
team alone with the care delivered
rounds; patient, family and staff
perceptions of quality of care;

staff perceptions of care as a final
outcome
Baldock et al. Retrospective Change from ‘open’ to No Mortality Routine data collection Positive effect: Reduced
(2001)359 1134 patients ‘closed’ ICU work team: mortality rates for
UK mix of staff changes ‘closed’ unit
3 years from non-ICU physicians
(admitting physicians) having
input into care, plus critical
care team, to critical care
team alone
Ghorra et al. Retrospective Change from ‘open’ to No Clinical outcomes: Routine data collection Positive effect: Reduced
(1999)360 274 patients ‘closed’ SICU team: mix Mortality; overall complications; mortality, complications,
USA of staff changes from non- rate of occurrence of renal failure; consults and renal failure
12 months ICU physicians (admitting in closed ICU
no. of consultations
physicians) having input into
care, plus critical care team,
to critical care team alone
MV, mechanical ventilation; OR, operating room.

113
similarities, however, the type of training used was one study,258 but in another study, with a superior
different for each study and ranged from leaflets to design, the combination of improved knowledge
formal lectures and seminars. The majority of these and improved patient satisfaction was not found.256
studies concerned both nurses and physicians. The latter was a RCT.
Other than the group of training and feedback
studies, no study clearly measured the fidelity with Five studies found that training led to a significant
which the training programmes were implemented, reduction in mortality rates. This was the case not
although two studies did acknowledge barriers to only for studies using the prospective cohort and
full implementation. retrospective case–control research designs,254,259,379
but also for high-quality longitudinal designs, such
Outcomes as RCTs370 and quasi-experimental designs.371 Two
Almost one-half of the studies focused on a single studies examined length of stay as an outcome,
specific outcome: infection rates. Three of these with differing results. The more powerful quasi-
studies looked at ventilator-associated pneumonia, experimental study found that the training
two at bloodstream infections (BSIs), one at UTIs intervention had a positive effect on length of
and one at nosocomial infections generally. In each stay,371 whereas the more limited prospective
case, the measure was the number of infections per cohort design of Lawrence et al.379 found no such
1000 days of the relevant device. positive outcome. However, the interventions and
populations of the two studies were different.
Unlike many of the other interventions considered
by HRM studies in the health sector, several Omissions
training studies did examine staff outcomes, Several staff outcomes were measured by
usually knowledge or beliefs. In each case, this these studies, but no study controlled for any
outcome was measured in conjunction with at least staff variables and none examined these staff
one other outcome, usually patient satisfaction. psychological or behavioural variables as
In three studies, increased staff knowledge was moderators or mediators of the relationships
a specific and primary outcome of the training being evaluated. Unlike many other studies of
intervention. However, in each case the knowledge HRM practices in the health sector, there are
being assessed was different, so the scales used to no longitudinal studies here looking at whether
measure this knowledge were different. In the same training or education can have an impact on
way, three studies measured patient satisfaction waiting times or patient safety indicators other
or perceptions of care, and all three studies used than infection rates.
different measures.
Summary
Results The training interventions considered here have
With a single exception – Cohran et al.’s study372 certain basic elements in common, but they also
– the training interventions designed to address differ in elements of their content and delivery.
the specific outcome of infection rates all had The training ranged from leaflets to formal lectures
a significant positive effect on infection rates. and seminars. The primary outcomes examined by
Four of the five studies that combined training most of these studies were also different.
with some form of performance monitoring,
such as evaluation and feedback, had positive A group of seven studies all examined the impact
outcomes,373–376 and both studies examining of some form of infection control training on
education alone had positive outcomes.377,378 All of infection rates, and six of these studies found
the studies used a prospective cohort design with that training significantly reduced infection rates.
historical controls. However, none of these studies used a high-quality,
powerful form of longitudinal study design.
For the remaining studies, the results of those
training interventions that aimed to increase staff Several studies also found that training had a
knowledge were consistently positive.256,257,259 All positive effect on staff knowledge and mortality
four studies used a full range of study designs, rates. These studies not only used simple
from a RCT to a retrospective case–control study. prospective and retrospective designs, but also
Where staff knowledge was measured, significant superior longitudinal study designs, such as RCTs
improvements were found in two instances. and quasi-experimental design. The effect of
Improved knowledge was also reported in training from those studies is, overall, positive.
conjunction with greater patient satisfaction by
114
TABLE 35 Training

Cohran et al. Prospective cohort with Training: No Rates of nosocomial BSIs Routine data collection No effect
DOI: 10.3310/hta14510
(2006)372 historical controls IVSP

USA 432 patients
6 years 6 months
Rosenthal et al. Prospective cohort with Education Yes – compliance Catheter-associated UTI Catheter-associated UTI Positive effect: Significant
(2004)374 historical controls Performance feedback is measured rate rate: Number per 1000 decrease in infection
Argentina 1301 patients catheter-days (p. 49) rates (compliance is a
moderator)
12 months
Salahuddin et al. Prospective cohort with ‘Educational programme No VAP infection rates VAP infection rates per 1000 Positive effect: Significant
(2004)377 historical controls focusing on preventive device-days: reduction in infection
Pakistan 677 patients practices for VAP’ (p. 223) Survey of hospital infection rates
24 months Weekly lectures, departmental control team (p. 224)
presentations, reinforcement at VAP must fulfil CDCP-
the bedside, visual aids posted

defined criteria for VAP
in the ICU (p. 224)
Won et al. Prospective cohort with Education: Formal lectures, Yes – compliance Nosocomial infection rate Nosocomial infection rate: Positive effect: Significant
(2004)375 historical controls written instructions, informal is measured Report by hospital infection decrease in infection
Taiwan 1411 patients instruction control team rates (compliance is a
Posting of visual reminders moderator)
5 years
Performance feedback: Routine
monitoring and feedback
Penalties and incentives
Rosenthal et al. Prospective cohort with ‘Education and training with Yes – active Rates of IVD BSI BSIs per 1000 IVD-days Positive effect: Significant
(2003)376 historical controls CVC care’ (p. 406) surveillance (p.408) decrease in infection
Argentina 840 patients ‘Performance feedback and feedback rates after education, and
provided on a monthly (p. 409) further after feedback
26 months
basis documenting rates of
compliance with [infection
control practices]’ (p. 406)
continued
115
116
TABLE 35 Training (continued)

Zack et al. Prospective cohort with Education programme: Self- No measure Reduction in VAP Reduction in VAP: Routine Positive effect: All
(2002)378 historical controls study module, in-services at – but issue is data collection of cases per
USA Unknown staff meetings, formal lectures acknowledged 1000 ventilator-days
24 months
Kelleghan et al. Prospective cohort with Feedback to physicians Yes – monitoring Reduction in VAP Reduction in VAP: Routine Positive effect
(1993)373 historical controls Education programme and surveillance data collection of cases per
USA Unknown of compliance 1000 ventilator-days
4 years
Fidler et al. RCT Managerial-based intervention: No ORMs: BP, heart rate, etc.; Routine data collection Positive effect: Significant
(2004)370 mortality for all outcomes
10,137 patients Training and instruction in

Netherlands 9 months collaborative practice; use of
protocols
Campbell et al. RCT Two-day training and planning No – but does Staff knowledge of Staff knowledge of and Positive effect: Significantly
(2001)256 649 ED staff programme that addresses: acknowledge and attitude towards attitude towards IPV: SAS improved staff knowledge
USA System change barriers to IPV; Culture of the ED based on Saunders et al. of and attitude towards
123 patients the successful regarding IPV (1987)380 IPV, culture of the ED
24 months Coalition building implementation regarding IPV, and patient
Patient satisfaction; Culture of the ED regarding
Attitudes and skill building of the IPV: System change indicator satisfaction
intervention Final outcome: Staff
Aim: To improve effectiveness attitudes and knowledge Patient satisfaction: PSSS
of ED response to IPV post-training
adapted from Soeken et al.
(1998)381
Lundstrom et Experimental study Staff education (training) No Duration of delirium in Duration of delirium in older Positive effect: Significantly
al. (2005)371 400 patients (aged focusing on assessment, older patients patients: DSM IV reduced duration of
Sweden 70 years+) prevention and treatment Ward length of stay Ward length of stay: Routine delirium, length of stay
of delirium and staff–patient data collection and mortality
8 months interaction vs no training Mortality
Mortality: Routine data
Patient allocation vs task collection
allocation system
DOI: 10.3310/hta14510

Jeffery et al. Prospective cohort with Educational intervention: No Perinatal mortality rates; Perinatal mortality rates: Positive effect
(2004)254 historical controls Placements (p. 438) staff response to training Routine data collection
Australia and 115 doctors and nurses programme
Formal teaching (p. 439)
Macedonia 4 years (1999–2002) Workshops (p. 439)
Lawrence et al. Prospective cohort with Multidisciplinary in-service No Time to antibiotic DDD Time to antibiotic door-to- Positive effect: Reduction
(2002)379 historical controls team-based education Mortality drug delivery: Time from in DDD time
USA 119 patients administered to ED physicians presentation on ED triage No effect: Mortality and
and nurses and medicine house Length of stay sheet to administration of
9 months length of stay
staff antibiotics
Feedback on time to antibiotic Mortality: Routine data
DDD collection
Length of stay: Routine data

collection
Barnason et al. Prospective cohort with ‘Educational retooling’: No Patient perception of Patient perception of Positive effect: Patient
(1998)257 historical controls – Self-study pain management pain assessment and pain pain assessment and pain satisfaction and ability to
USA 47 patients module management effectiveness; management effectiveness: rate pain (not reported
pain management; 11-item tool: PMIG as significant); nurse’s
125 nurses – 1-hour seminar using critical experience evaluation knowledge significantly
thinking exercises Pain management experience
8 months Nurse cognitive; evaluation: PMEE tool improved
assessment of pain Nurse cognitive assessment
management; final of pain management: 18-item
outcome: significant tool
improvement nurses’
level of knowledge of pain
management tool
continued
117
118
TABLE 35 Training (continued)

Ogden and Prospective cohort with Educational packages to change No Practice nurses’ beliefs and Practice nurses’ beliefs and Positive effect: Patient
Hoppe historical controls PNs’ beliefs about obesity and behaviours behaviours: Questionnaire perception of nurses’
(1998)255 240 practice nurses behaviour towards patients: Patient perceptions of the (p. 250) satisfaction with
UK Expert educational package nurse consultation Patient perceptions of consultation for learner
179 patients (T1) group only; patient
(leaflet only) (p. 251) VS Practice nurse consultation the nurse consultation:
35 patients (T2) Questionnaire (p. 250) confidence significantly
Learner-centred educational style higher in expert group;
6 months package (leaflet and interactive Practice nurse consultation
Patient reports of weight no other differences
seminar) (p. 251) VS change; beliefs; behaviour; style: Questionnaire (p. 250)
No education = control group Consultation style Patient reports of weight
change: Questionnaire
(p. 250)
Harrison and Prospective cohort with CEP for nurses on knowledge No Nurses’ attitude and Miller–Dodder revision of Positive effect: Significant
Novak (1988)258 historical controls of and attitudes towards the knowledge; patient Palmore’s Facts on Aging improvement in nurses’
USA 76 nurses elderly satisfaction and Quiz knowledge and attitudes
perceptions of nursing Kogan’s Attitude Toward Old No effect: Patient
63 patients care; final outcome only: People Scale satisfaction
Unclear nurses’ knowledge and
attitudes LaMonica–Oberst Patient
Satisfaction Scale
Birnbaum et al. Retrospective Training in advanced cardiac life No Specific medical knowledge Range of specific behaviours/ Positive effect: Significant
(1994)259 869 patients (ischaemic support gains knowledge of staff reduction in mortality
USA heart disease) Mortality rates Mortality rates from rates
24 months Quality of care ischemic heart disease
Enhancement of Explicit measures of quality
knowledge and skills of care (e.g. number with
intravenous line in first hour
post training vs pre-training)
CEP, Continuing Education Program; CDCP, Centers for Disease Control and Prevention; CVC, central venous catheter; DDD, door-to-drug delivery; DSM IV, Diagnostic and Statistical
Manual of Mental Disorders-Fourth Edition; IPV, intimate partner’s violence; IVD, intravascular device; IVSP, Intravascular Surveillance and Education Programme; ORM, out-of-range
measurement; PMEE, pain management experience evaluation; PMIG, patient’s pain management interview guide; PN, practice nurse; PSSS, Patient Safety and Satisfaction Survey; SAS,
Staff Attitudinal Survey;
Compensation and payment perceived quality of care, and physicians’ cost

These studies consider payment systems, awareness as a result of the intervention.
compensation and reward practices that seek to
affect patient and service outcomes. A narrative Results
synthesis is preferred because of the very small The findings of the study on performance-based
sample of studies identified. However, this topic reimbursement were mixed: length of stay and
has been the subject of seven systematic reviews. physicians’ cost awareness improved, but quality
Five of these reviews have compared the impact of care worsened.393 The results of the two
of different types of remuneration for physicians retrospective studies were similarly inconsistent. In
on a range of patient and service outcomes.382–386 the first case, the different payment systems, fee or
The remaining reviews consider the impact of salary, had no effect on the measured outcomes,394
target payments on immunisation rates and which included mortality and length of stay, but the
financial incentives on retention rates among rural second study did find that bonuses increased the
physicians.387–388 No health professionals other than likelihood of referral.395
physicians have been considered by these reviews.
None of the studies described below appears in Omissions
any of these systematic reviews. There are also five These studies examine only three types of
reviews focusing on compensation and rewards in payment system or financial incentive; others,
the non-health sector, such as financial rewards, such as personal performance-related pay, merit
social rewards and profit sharing.367,389–392 pay or gain-sharing schemes, were not evaluated.
There were no studies of acute care wards, units
Details of studies or departments. Also, due to the small number
Three studies met the inclusion criteria (Table of studies, many patient outcomes have not
36). All studies were published in English, with been examined in relation to this intervention,
the earliest being published in 1999. One study such as waiting times, patient satisfaction and
was a good quality prospective design undertaken patient safety. The only staff outcome measured
in Sweden, and two studies were retrospective in by any of these studies was cost awareness; no
design and were conducted in North America. study controlled for any staff variables and none
The duration of the studies ranged from 24 to examined staff psychological or behavioural
48 months. The sample sizes ranged from 418 variables as moderators or mediators of the
physicians, or 582 to 6749 patients. Two studies relationships being evaluated.
were undertaken in primary care practices, and one
in hospitals.393 Summary
The studies identified for this review considered
HRM practice several different compensation and reward
The studies examined different interventions. One interventions and three sets of very different
study compared salary with fee for service (FFS) for outcomes. The literature examining the causal
primary care physicians; one evaluated the impact relationship between compensation and rewards
of bonuses on the number of referrals by primary and various patient outcomes is, therefore,
care physicians to colorectal cancer screening, and extremely limited. These studies suggest that the
one examined a broad incentive, performance- method of payment to physicians does not always
based reimbursement. Like all financial positively affect the small number of patient
interventions examined by the review literature, outcomes examined, but bonuses may affect certain
these interventions were aimed only at physicians. other outcomes. However, the very small number
None of these studies evaluated whether the and heterogeneity of the studies prevents any firm
stated intervention was being implemented in full conclusions from being drawn.
accordance with policy.
Employee involvement
Outcomes
The outcomes examined by the three studies All of these studies consider interventions or
varied. The first study examined the intervention’s practices that seek to involve staff in decision-
impact on multiple outcomes: mortality and length making. The absence of any systematic review or
of stay, and a service delivery outcome. The second meta-analysis of studies of this intervention in
study only examined numbers of patients referred the health sector may be explained by difficulties
for screening. The third, like the first, examined in operationalising the concept of employee
length of stay, but also measured physician- involvement for the purposes of systematic review.
119

120
TABLE 36 Pay

Forsberg et al. Prospective Performance-based No Quality of care; length Own index; hospital Positive effect: Length of stay; cost
(2001)393 cohort with reimbursement of stay; job satisfaction register awareness
Sweden concurrent cost awareness Own questionnaire Negative effect: Quality of care
controls
418 physicians
4 years
Armour et al. Retrospective Influence of bonuses on No Increased chance of Increased chance of Positive effect: Bonus eligibility
(2004)395 6749 patients Colorectal Cancer Screening referring patient for referring patient for significantly associated with
USA colorectal cancer colorectal cancer physicians asking for more
24 months screening screening: Routine data colorectal screening tests for
collection patients
Lee et al. Retrospective Primary care physician No Number and cost of Number and cost of No effect
(1999)394 582 patients payment: Salary vs FFS specialist diagnostic specialist diagnostic
Canada services and medicines services and medicines:
3 years Routine data collection
No. of days in hospital
Causes of death No. of days in hospital:
Routine data collection
Causes of death: Routine
data collection
It may also have been prevented by the potentially Omissions

limited number of relevant studies and the None of the studies reported here took primary
heterogeneity of their interventions and outcomes, or community care practices as its unit of analysis
as demonstrated by this sample. Tellingly, there and only one staff outcome was measured by any
are also no distinct meta-analyses of employee of these studies. No study controlled for any staff
involvement in the HRM literature of the non- variables and none examined staff psychological or
health sector. behavioural variables as moderators or mediators
of the relationships being evaluated. Waiting times
Details of studies was the only principal patient care outcome not
Five studies met the inclusion criteria (Table 37). considered by one or more of these studies.
Three studies were published in English and two in
German. The earliest was published in 1999. Two Summary
studies were conducted in the USA and three in There is a distinct grouping of employee
Germany. All of the studies in this sample used a involvement studies in the longitudinal literature
prospective design. The studies varied in duration, relating to the health sector: quality circles. This
from 6 months to 5 years. The sample sizes ranged intervention was found to have a consistently
from 97 to 826 patients. However, in one study significant and positive effect on a range of
the sample size was not given. In all but one case, different patient outcomes.
the studies focused on a similar unit of analysis,
either an ICU or an equivalent ward or medical Performance management
department.
All of these studies consider interventions or
HRM practice practices that evaluate and feed back on the
These five studies all examined quality circles or performance of health professionals. A narrative
an equivalent body, such as a continuing quality synthesis is preferred here despite the homogeneity
improvement committee. In four cases this was of some clusters of studies in this sample. No
the only intervention and, in the fifth, quality systematic reviews of performance management
circles constituted one component of a broader in the health sector were found, but there are
quality management system. All but one of the several meta-analyses of performance management
interventions was aimed at both physicians and in the non-health sector HRM literature. These
nurses. These studies have much in common with cover feedback,400,401 goal setting401 and supervisor
the research examining performance management ratings.402,403
interventions because three of the five monitor or
measure compliance with designated practices. In Details of studies
one study, the specific function of the quality circle Seven studies met the inclusion criteria (Table 38).
was to monitor implementation and pursue actions All of the studies were published in English, with
to improve it.396 the earliest being published in 1991. Four studies
were conducted in the USA, two in Argentina
Outcomes and one in Taiwan. All studies used prospective
With the exception of mortality and length of stay, designs. The studies varied in duration, from
which were considered by two papers, the outcomes 12 months to 5 years. The sample sizes ranged
considered by the five studies of quality circles from 300 physicians or 800 to 1411 patients, with
were all different, and ranged from co-worker the sample population being determined by the
satisfaction to treatment outcomes such as patient study outcome. However, in three cases the sample
complications. size was not given. All of the studies focused on
a similar unit of analysis, either an ICU or an
Results equivalent ward or medical department.
These quality circles consistently led to significant
positive outcomes in four of the five studies.396–399 HRM practice
In the other study, the intervention had no The seven studies all examined feedback. Five of
significant effect on the majority of the outcomes the seven studies examined this in combination
and a small positive effect on one only: satisfaction with some form of education or training, while
with service provided by the receptionist.261 All two concentrated solely on the practice of
of the studies used a prospective cohort design, feedback to staff. The type of training differed
mostly with historical controls, so there is nothing between the different studies. It ranged from
to choose between them in terms of study formal education programmes focusing on
methodology. technical skills, such as catheter care, to informal 121

122
TABLE 37 Employee involvement

Forster et al. Prospective cohort with Continuous quality Reports on Infection rates Routine data collection Positive effect:
(2000)397 concurrent controls improvement strategy: partial or full Infection rates reduced
Germany Unknown Quality circles implementation
but no details of
20 months measure
Fischer et al. Prospective cohort with Quality circles Yes, gives Patient satisfaction Patient satisfaction (p. 362): No effect:
(2002)261 historical controls percentage (p. 362); co-worker Survey, ordinal scale: Care at In three or four
Germany 200 patients implementation satisfaction with waiting reception, acceptability of waiting measures, only
of quality times but not significant time, care by investigating health difference in care by
6 months measures personnel, overall impression of stay receptionist
decided at in the department

quality circles,
but no details Co-worker satisfaction (p. 362):
about the Survey, ordinal scale: Acceptability of
measurement appointment allocation, waiting time
of patients in department, waiting
time for written results
Ruchholtz et Prospective cohort with Ongoing quality Yes – no formal Time needed for Time needed for radiological and Positive effect:
al. (2001)396 historical controls management system measure but radiological and sonographic check-up: No details Significant reductions
Germany 447 patients comprising: quality circles sonographic check-up Duration until performance of cranial in waiting times for
Protocol for meet at four Duration until computerised tomography: No details processes and in
16 months points during
documentation performance of Delayed diagnoses: No details mortality rates
study to evaluate cranial computerised
Criteria for assessment of and suggest Times for transfusion, emergency
teaching quality tomography
improvements – operations and, haemorraghic shock,
Regular analysis of a form of fidelity Delayed diagnoses craniotomies: No details
teaching quality implementation Times for transfusion, Mortality: No details
Quality circles monitoring for emergency operations
routine practices and, haemorrhagic
shock, craniotomies
Mortality
DOI: 10.3310/hta14510

Kyriacou et Prospective cohort with Administrative No Patient care efficiency On-site data collection Positive effect:
al. (1999)398 historical controls interventions (length of stay) Administrative
USA 826 patients implemented by a special interventions
interdepartmental significantly reduce
5 years continuous quality length of stay
improvement committee
Leiniger Prospective cohort with Quality circles: No No. of consultations; No. of consultations: Routine data Positive effect:
(1999)399 historical controls Multidisciplinary team mortality; length of collection Reduced mortality,
USA 97 patients meeting to discuss stay; no. of days from Mortality: Routine data collection LOS, appropriate use
patients and address admission to operating of consulting services,
12 months problems room; discharge Length of stay: Routine data
collection increase in numbers
status; re-admissions; returning home
complications; No. of days from admission to

comorbidities operating room: Routine data
collection
Discharge status: Routine data
collection
Re-admissions: Routine data
collection
Complications: Routine data
collection
Comorbidities: Routine data
collection
None
LOS, length of stay.

123
instruction, handouts or monthly presentations. outcomes have not been considered by the research
Each of these studies viewed this combination of in relation to this type of HRM intervention or
interventions as additive rather than synergistic, practice, such as waiting times, mortality and
and therefore not a bundle as understood by length of stay, as well as patient safety indicators
current HRM research.20,404,405 In only one study other than nosocomial infection rates. No staff
did the intervention have additional components, outcome was measured by any of these studies,
which included the posting of visual reminders and no study controlled for any staff variables, and
the use of penalties and incentives.375 However, none examined staff psychological or behavioural
the interventions were not all aimed at the same variables as moderators or mediators of the
population of health staff: physicians and nurses relationships being evaluated.
were the target of the intervention in three studies,
and either nurses or physicians alone were affected Summary
by the intervention in the two remaining studies. The interventions and outcomes considered by
Of the two studies that examined the practice of these studies were quite homogeneous and, even
feedback alone, one examined the outcome of though the number of outcomes researched in
infection rates, just like the education and feedback relation to this intervention was extremely limited,
studies, but the other examined the impact on this sample does suggest that the practice of
patient satisfaction of feedback to physicians. This feedback, both alone and in conjunction with
is the only study of this type. education or instruction, can have a significant
positive effect on infection rates, as well as patient
These studies are unusual because only one satisfaction.
does not measure compliance with the practices
described by the educational component of the
intervention. The majority, therefore, seek to Conclusions
measure the fidelity with which at least part of the
intervention or practice is being implemented. Longitudinal studies identified by the broad
This is because this monitoring or surveillance HRM and patient care outcomes literature search
is also part of the intervention: the feedback conducted for this review focus on a small number
component is informed by the measurement of of distinct HRM practices.
compliance. This is not a requirement for most
HRM interventions. These are:
Outcomes • work design

In all cases, these studies measure only a single • staffing
outcome. Six of the seven studies all examine in- • compensation and rewards
hospital infection rates.373–376,406,407 However, only • training
two studies examine the same type of infection, • employee involvement
catheter-related UTIs.374,406 The types of infection • performance management.
studied by the remaining papers are all different,
although measurement rates are usually the same Practices relating to staffing, especially the
or very similar. The one study that looks at a introduction, substitution or transfer of staff, as
different outcome examined patient satisfaction.408 well as staff–patient ratios and working hours,
account for more than one-half of the retrieved
Results longitudinal studies of HRM and patient outcomes
In all cases, the interventions were found to have a in the health sector. The systematic review and
significant positive impact on infection rates. All of meta-analysis literature on the health sector reflects
these studies used a prospective cohort design with this balance, with the vast majority of such reviews
historical controls. examining research covering these practices.
Omissions There are several possible reasons for this focus on

These studies only focused on the performance staffing and hours. It may be because a very high
management practice of feedback; other practices proportion of expenditure in health goes on staff,
such as staff appraisals and goal setting were not so policy-makers and researchers want to see how
evaluated. None of the studies were in emergency this resource is performing295 and, related to this,
departments, primary or community care, or because the increasing pressure to contain costs
the local hospital. Also, other possible patient generates interest in reducing staff expenditure,
124
TABLE 38 Performance management

DOI: 10.3310/hta14510

Rosenthal et al. Prospective cohort Education Yes – Catheter-associated Catheter-associated UTI Positive effect:
(2004)374 with historical Performance feedback compliance is UTI rate rate: Number per 1000 Significant decrease
Argentina controls measured catheter-days (p. 49) in infection rates
1301 patients (compliance is a
12 months moderator)
Won et al. Prospective cohort Education: Formal lectures, written Yes – Nosocomial infection Nosocomial infection rate: Positive effect:
(2004)375 with historical instructions, informal instruction compliance is rate Report by hospital infection Significant decrease
Taiwan controls Posting of visual reminders measured control team in infection rates
1411 patients Performance feedback: Routine (compliance is a
5 years monitoring and feedback moderator)
Penalties and incentives

Rosenthal et al. Prospective cohort ‘Education and training with CVC Yes – active Rates of IVD BSI BSIs per 1000 IVD-days Positive effect: Significant
(2003)376 with historical care’ (p. 406) surveillance (p. 408) decrease in infection
Argentina controls ‘Performance feedback provided on and feedback rates after education, and
840 patients a monthly basis documenting rates (p. 409) further after feedback
26 months of compliance with [infection control
practices]’ (p. 406)
Goetz et al. Prospective cohort Feedback: ‘quarterly report Yes – active Catheter-related UTIs UTIs per catheter patient- Positive effect: Significant
(1999)406 with historical of catheter-related UTI rates’ surveillance days decrease in number of
USA controls monitored by an infection control and feedback UTIs
Unknown (number professional; nurse manager reviews (p. 402)
of catheter patient- results with staff (p. 402)
days)
24 months
continued
125
126
TABLE 38 Performance management (continued)

Speirer et al. Prospective cohort Patient satisfaction survey (feedback) No Improvement in patient Patient satisfaction survey: Positive effect: Significant
(1994)408 with historical as a part of physician evaluation satisfaction with Fallon Survey improvement in patient
USA controls process participating doctors satisfaction across all
14,519 patients (T1) The overall quality of departments
5259 patients (T2) care
24 months The likeliness of the
patient to recommend
the physician to others
Kelleghan et al. Prospective cohort Feedback to physicians Yes – Reduction in VAP Reduction in VAP: Routine Positive effect
(1993)373 with historical Education programme monitoring data collection of cases per
USA controls and 1000 ventilator-days
Unknown surveillance of
compliance
4 years
Nettleman et Prospective cohort Feedback to physicians Yes – MRSA rates MRSA rates per 1000 Positive effect
al. (1991)407 with historical Handouts monitoring of patient-days
USA controls compliance
Monitoring
Unknown
Monthly presentations
27 months
CVC, central venous catheter; IVD, intravascular device; VAP, ventilator-associated pneumonia.
(for example by replacing one type of worker with interest among health sector researchers in a small
another who costs less).321 Alternatively, this focus number of practices relating to staff skill mix
may be because the increasing numbers of patients and working hours. In some cases, these small
using UK health services have an impact on staff groupings also measure the same outcomes (albeit
workload, which may, in turn, affect the quality of rarely using the same or equivalent measures).
patient care.320 However, with the exception of practices relating
to skill enhancement, or the skill mix variables
This differs markedly from the non-health sector involving the introduction or substitution of staff,
HRM review and meta-analysis literature, which the number of studies contained in these groupings
has almost no meta-analyses at all on the skill mix is often small, rarely larger than four or five. There
of teams, staffing ratios or working hours. Instead, are also often differences between these studies in
it focuses principally on practices that are covered terms of location, unit of analysis and study length.
much less by literature on the health sector, such as Such heterogeneity precludes the pooling of data
employee involvement391,401,409 and recruitment and for quantitative synthesis and means we must add
selection.281,410,411 This review found only a small a strong caveat to the drawing of conclusions from
number of longitudinal studies looking at quality any narrative synthesis of these studies.
circles (employee involvement) in relation to
patient outcomes. HRM practices or interventions Interestingly, almost all of the studies identified
relating to communication, family friendly working in this review report neither negative nor adverse
and harmonisation are other major categories effects for any of the practices evaluated, which
for which no longitudinal studies from the health may suggest a degree of publication bias affecting
sector were identified by this review. the results. The interventions that appear to report
the most consistent positive impact on patient
There is a great deal of heterogeneity among and staff outcomes are training, performance
the studies reviewed in all of the categories. For management (feedback) and employee
example, the studies placed within the categories involvement (quality circles). Beneficial effects were
of pay, employee involvement and training are found on infection rates, mortality, length of stay,
all very different in terms of both practices and patient satisfaction and staff knowledge. The many
outcomes, and this prevents anything but the work design variables, such as the substitution or
most basic narrative synthesis. There is a greater introduction of staff, skill enhancement, reduced
degree of homogeneity among the studies under working hours and the relocation of staff or
the categories of work design, performance services, produced more inconsistent results. In
management and staffing. Within these categories, some studies these interventions had no effect (or
some of the studies examine the same or very no adverse effect), and only in a few cases were
similar practices and may be grouped together. the effects positive, such as for the addition of new
Once again, this probably reflects the greater nurses or physicians.
127

Chapter 8
Impact of HRM practices in non-health settings
Introduction Search strategy
Literature search strategies were developed
This chapter reports on findings from a systematic and performed on Business Source Premier
review of the impact of HRM practices on and PsycINFO; these two electronic databases
intermediate and final outcomes in non-health have the most comprehensive coverage of peer-
sector settings. The findings address research reviewed journals in the field of psychology and
questions under Objectives 5 and 6 of the review, management. Search strings were modified for the
specifically: different databases to take account of the different
keywords and thesauri they use. Examples of
• Objective 5: 5.1 What is the evidence for the the search filters and strategies can be found in
impact of HRM practices on the intermediate Appendix 8.
outcomes identified for this review?
• Objective 6: 6.1 Which HRM practices have an The searching of electronic databases using pre-
impact on performance outcomes? designed search filters was supplemented by
reference tracking of selected studies. The titles,
This chapter gives details of the aspects of the abstracts and full papers of studies identified by
review methodology specific to this review. both electronic database searching and reference
Narrative syntheses for each of the HRM categories tracking were sifted using the following inclusion
and data tables are then presented. criteria.
Study selection
Review methodology
Sift criteria were developed by the team and
The broad approach to systematic review piloted on a sample of titles and abstracts.
methodology adopted to identify the evidence Adjustments were made to improve specificity, and
presented in Chapters 6–8 is described in Chapter all titles and abstracts identified by the electronic
2. This section describes aspects of the review searches and reference tracking were sifted by one
methodology specific to this search. team member, with 50% being sifted by a second
reviewer. The inter-rater reliability, using k-statistic,
Protocol development for the double-sifted articles was 0.92.
Simple protocols were developed to guide the Unclear articles went to another team member for
search, although some parameters were left open a second opinion. If still unclear, the full paper was
due to the lack of consistent definition/use of retrieved for sifting.
HRM terms in the literature. The population for
the searches was identified as working adults and The criteria identified papers as relevant to the
the intervention was determined as any HRM or review on the basis that they:
personnel management practice. No comparison
was specified, but a longitudinal filter was • were longitudinal in design
developed and used in the search. This ensured • included an intervention which could be
that the search was focused on causal relationships. described as some form of HRM practice, and
No specific outcomes were stipulated. • evaluated the intervention on some form of
outcome measure.
The data extraction and synthesis was left open
at this stage to allow development of a synthesis Studies were excluded if they were unpublished
framework most fitting to the data retrieved. This theses.
approach is consistent with the latest developments
in applying systematic review methodology to This not only acknowledged potential difficulties
complex literatures.52,56,58,60,63 in obtaining these materials, but also, more
129

TABLE 39 HRM categories and subclusters of studies in the

importantly, recognised that as these are not non-health literature
subject to peer review prior to publication they
are likely to be small-scale and of generally poorer HRM category No. of studies
quality than those conducted by research teams.
1 Work design: 52
Teamwork
Data extraction
Job complexity
A data extraction form was developed by the team Job demands and control
and piloted on a sample of papers. Due to the Job rotation, enlargement and
heterogeneity of the literature the form focused enrichment
on key data [e.g. study design, HRM practice, Role conflict/clarity
fidelity measure, outcome(s), specific outcome(s) 2 Staffing: 23
measure(s)] and any additional references to be Recruitment/selection
included in the sifting process. Data extraction was Socialisation
then completed by one reviewer. The first round Working schedule
of data extraction allowed the team to build a
3 Training and development: 25
clear overview of the evidence base and assess its
Performance and skill
suitability for synthesis. enhancement training
Career or employee
Data synthesis development training
Cultural sensitivity training
As anticipated, there was much heterogeneity
Socialisation training to
across the studies. However, it was concluded that understand organisational
narrative synthesis could be performed for most culture
of the broad categories of HRM identified in TQM training
Chapter 3. In some cases, the studies identified in a 4 Compensation and rewards 29
category clearly fell into distinct subthemes. Where
5 Communication 5
this was the case, syntheses were performed on the
smaller, more homogeneous group of studies. 6 Family friendly 9
7 Single status/status 0
The broad categories of HRM and subthemes are harmonisation/status differential
presented in Table 39. 8 Employee representation/ 8
involvement/participation
Further data extraction was undertaken to support 9 Appraisal/performance 25
this synthesis including: sample size; study management
duration; moderators or mediators; and results. 10 Bundles/HPWPs 10
Papers included in the review were assigned

different categories based on the HRM practices rejection of 119 papers. Data was extracted from
that they investigated. Some papers have the remaining 129 papers and these papers were
researched on more than one HRM practice also scanned for any potentially relevant references.
and therefore such studies occur across different This process of reference tracking led to the
categories. Outcomes in these papers are both identification of 105 more papers of which 70
intermediate and final outcomes. were rejected as they failed to meet the inclusion
criteria. Data was extracted from the remaining 35
Results research papers and added to the data obtained
from the 129 papers obtained through electronic
A total of 1622 citations were identified from database searches. Thus, the final synthesis is based
searches of electronic databases after de- on these 164 research papers.
duplication. Following screening for relevance,
1374 citations were rejected on the basis that they Table 39 provides a summary of the studies
did not meet the sift criteria. Full papers were included in the review. The QUOROM flow chart280
obtained for the remaining 248 citations. These in Figure 4 explains how many studies were rejected
248 full papers were again subjected to inclusion and at which stage, and the means by which
criteria by three reviewers, which led to a further included studies were identified.
130
Total from electronic

database searches
(n = 1622)
Application of
titles and abstracts by
three reviewers
Total after first

sift (n = 248)
Application of
full papers by three
reviewers
Total after second

sift (n = 129)
References satisfying
inclusion criteria from
reference tracking of
included papers (n = 35)
Final total of studies
satisfying inclusion
criteria (n = 164)
FIGURE 4 QUOROM flow chart for the review.
The remainder of the chapter presents the is conceptually similar to the job characteristics
narrative synthesis of findings for each of the main approach to job design proposed by Hackman and
HRM categories (or subclusters). Oldham.412 The difference in the two approaches
is the level at which the concepts of variety,
Work design identity, significance, autonomy and feedback are
applied. The job characteristic model proposes the
A total of 49 studies were identified under the application of these principles at the individual
broad HRM category of work design. The studies work level; the autonomous teamwork model tries
fell into distinct, heterogeneous clusters and to implement the same variables at a group or team
syntheses under work design are presented as level in a bid to influence work-related outcomes.
follows:
Details of studies
• teamwork Eight studies met the inclusion criteria (Table 40).
• job complexity All the studies were published in English, with
• job demands and control three conducted in UK, two each in Australia and
• job rotation, enlargement and enrichment Canada, and one in USA. There were five studies
• role conflict/clarity. with quasi-experimental methods, and three
studies with a prospective longitudinal research
Teamwork design. The shortest time duration for a study
Studies on teamwork largely look at how was just 2 months, whereas the longest study was
autonomous or semi-autonomous teams can carried out over a period of 8 years. The sample
have a significant impact on certain work-related size of these eight studies varied from 34 to 545
outcomes. Autonomous teamwork approaches employees.
propose that increases in work factors (e.g. variety,
identity, significance, autonomy and feedback) are HRM practice/intervention
causally linked to work-related outcomes, such as Four research papers investigated the impact of
motivation, job satisfaction and productivity. It semi-autonomous or autonomous work groups.
131

132
TABLE 40 Work design (teamwork)
Design, sample Practice(s)/intervention(s);

Study, country size, duration moderators/mediators (if any) FM Outcomes Outcome measure(s) Results +ve/–ve
Wall and Clegg Quasi- Practices: Yes Performance JDS for work motivation and Job Positive effect:
(1981)413 experimental Semi-autonomous work groups Work motivation; job satisfaction (Hackman and Oldham All positive
UK 34 employees satisfaction; mental 1975)195
Moderators/mediators:
18 months health; labour turnover GHQ, for mental health (Goldberg
None 1972)420
Company records for performance and
turnover data
Wall et al. Quasi- Practices: Yes Group performance Work attitudes (Clegg and Wall 1981)421 Positive effect:
(1986)415 experimental Autonomous work group Work motivation; GHQ (Goldberg 1972)420 Job satisfaction (Intrinsic)
UK 545 employees Moderators/mediators: job satisfaction; Labour turnover and performance: No effect:
2.5 years organisational Factory records

None commitment; labour Work motivation
turnover; mental health Organisational commitment;
Performance;
Mental health
Negative effect:
Labour turnover
Cordery et al. Quasi- Practices: No Job satisfaction;
(1991)418 experimental Work design: organisational
Australia 302 employees commitment; trust
Autonomous group working in management;
20 months Multiskilling and appropriate absenteeism; employee
training for additional skill turnover
acquisition
Job rotation
Compensation and rewards:
A payment system based on
number of multiple skills possessed
rather than work performed
None
416 Quasi- Practices: No Productivity JDS for work motivation and Job Positive effect:
Pearson (1992)
Australia experimental Semi-autonomous group working Job motivation; job satisfaction (Hackman and Oldham Substantial impact of semi-
327 employees satisfaction; accidents 1975)195 autonomous working group
DOI: 10.3310/hta14510
2 months Employee turnover; Productivity, accidents and absenteeism: practices on all the outcomes
None Company data
absenteeism
Banker et al. Quasi- Practices: (as a result of relocation) No Quality; labour Quality: Percentage of total units Positive effect:
(1996)417 experimental High-performance work teams productivity produced that were defective labour Both, quality and labour
USA 41 employees (characterised by decision- Productivity: Ratio of the number of units productivity improved
21 months making authority, mandated team produced to total production hours
membership, information rich and
expanded problem-solving domain)
Managerial policies:
Workforce policies (overtime,
headcount additions, headcount
deletions)

Policies affecting confusion in the
factory (product diversity, product
complexity, capacity utilisation,
engineering change orders,
adhesive experiment period on the
gear train line)
Kirchmeyer Prospective Practices: No Organisational OCQ (Mowday et al. 1982)173 Positive effect:
(1995)419 longitudinal Demographic (gender, age, minority commitment; turnover; A better work group fit
Canada 141 employees status) similarity to work group promotion had a positive impact on
14 months Work group fit organisational commitment
and led to reduced turnover
Supervisor support
Negative effect:
Mentor
Dissimilarity in terms of age,
Moderators/mediators: education, and lifestyle led
None to poor integration with the
work group, which in turn
led to poor organisational
commitment and high job
turnover
continued
133
134
TABLE 40 Work design (teamwork) (continued)

Armstrong- Prospective Practices: No Job performance Job satisfaction: Part developed from Positive effect:
Stassen et al. longitudinal Work group membership stability Job satisfaction; Hackman and Oldham (1974),422 JDS Survivors in the moderate
(2004)414 159 employees job security; job Job security: Jick’s Job Security Index change group reported a
Downsizing
Canada 2 years involvement; perceived (1979)423 significant increase in job
Moderators/mediators: justice; employee morale satisfaction, job performance,
Job involvement: Lodahl and Kejner
None (1965)424 and employee morale at the
completion of downsizing
Perceived Justice: Moorman et al. (1998)425
Perceived Justice Scale Negative effect:
Employee morale: Scale devised by the Survivors in the intact
authors for the study work-groups (stable)

reported lowest levels of job
satisfaction, and perceived
job security,
Coupland et al. Prospective Practices: No Change of attitude Discourse analysis Positive effect:
(2005)426 longitudinal Team working (us-and-them work New working role did
UK 401 employees relationship) undermine traditional ‘then’
8 years and ‘us’ loyalties to some
None extent
Negative effect:
Despite of the observed
positive effects, overall
the whole team working
initiative was looked upon
with cynicism as the workers
felt that little substantial had
been done in reality
GHQ, General Health Questionnaire; OCQ, Organisational Commitment Questionnaire; JDS, Job Diagnostic Survey.
Other practices investigated in this section were the in turn, led to poor organisational commitment
impact of work group fit, high-performance work and high job turnover. A similar finding was
teams, work group stability, and team working, as reported for the link between organisational
opposed to individual work arrangements. commitment and work teams, with employees
showing high commitment if they worked in teams
Outcomes with similar demographics.419
A range of outcome variables was measured in
these studies. The most frequently studied type of Mixed results were found for the relationship
outcome variable in relation to teamwork was some between team working and absenteeism. One
form of performance measure (e.g. individual/team study found work teams to exert a positive impact
performance, quality or productivity), with five of on absenteeism,416 but the study by Cordery et
the eight studies investigating at least one of these. al.418 found a negative impact of teamwork on
absenteeism.
All other outcome variables in the studies included
here were employee centric, such as motivation, job Omissions
satisfaction, organisational commitment, employee The longitudinal studies on work teams largely
turnover, absenteeism, morale, change in employee concentrated on performance outcomes or
attitude and mental health. employee-centric outcomes. There were virtually
no longitudinal studies that investigated how, or
Job satisfaction was the most studied employee- if, team working can lead to learning outcomes for
centric outcome, with five of the eight studies employees. There are also no longitudinal studies
measuring how it changed with the implementation included here that explore the impact of working
of one form of teamwork or another. Job turnover in teams on the financial bottom line of a firm or
was the next most commonly studied outcome, with business unit.
four studies investigating it as an outcome of group
work. Other variables were studied by one or two Summary
papers. There were eight studies on teamwork and its
impact on various work-related outcomes, with
Results one-half of the papers concentrating on semi-
There was some support for improved team and autonomous or autonomous teams. Most of these
individual performance under autonomous or studies have explored the impact of autonomous
semi-autonomous teamwork, with two out of three team working on performance, quality or
studies arriving at this conclusion.413,414 One study productivity issues. Almost all the studies found
failed to find any such significant relationship.415 these two variables to be positively linked.
Both quality and labour productivity were also
found to have improved as a result of introducing The relationships of work teams with job turnover
high-performance work teams, characterised and absenteeism were not so straightforward. Some
by decision-making authority, mandated team studies found teamwork to have a positive impact
membership, and an expanded, information rich, on both factors, whereas others found them to
problem-solving domain.416,417 have a negative impact. There was some evidence
of this relationship being moderated by group and
There was very strong support for the positive demographic fit.
impact of work teams on job satisfaction, with all
five studies coming to this conclusion.413–415,418 The studies in this area mostly focused on
performance and employee-centric outcomes and
Five studies investigated the impact of work teams there were no longitudinal studies investigating the
on job turnover and the results were equivocal, impact of work groups on learning and growth of
with three studies finding support for the positive employees.
impact of team working on job turnover,413,416,419
whereas two other studies found team working to Job/task complexity
have a negative impact on employee turnover.415,418 Studies of job/task complexity focused on two
Kirchmeyer419 found that a better work group aspects of complexity:
fit had a positive impact on organisational
commitment and led to reduced turnover, whereas • Psychological complexity refers to the
dissimilarity in terms of age, education and lifestyle psychological dimensions of tasks, for example
led to poor integration with the work group, which, variety and perceived job scope. It is a more
135

subjective measure of job complexity and routine or simple tasks to complex tasks – on job
has been measured using tools such as the satisfaction. Other than task complexity, this study
JDS developed by Hackman and Oldham.195 also included wages and performance appraisal
Such an approach to job/task complexity has satisfaction as predictors for the given outcome.
often been equated with the concept of job
enrichment.427 Outcomes
• Task–person job complexity refers to tasks All three studies used different employee-centric
that can be objectively classified as simple or outcomes, for example employee burnout,
complex, based on the mental demands that a employee cardiovascular health, and employee job
given job places on the person and the extent satisfaction, as dependent variables.
of education, skill or training required on the
part of the person to do that job.428 Results
None of the three studies investigated the impact
Details of studies of job/task complexity directly. The studies all
Three studies met the inclusion criteria (Table 41). examined the interaction of job/task complexity
All of the studies were published in English, with with other variables, or study job/task complexity as
two being conducted in the USA and the one in a moderator in the analysis.
Finland. The first study was quasi-experimental,
with retrospective analysis of the impact of The studies by Kalimo et al.429 and Schaubroeck et
certain HRM practices on the given outcome. al.428 concluded that the impact of job complexity
The remaining two studies used a prospective was moderated by, or interacted with, the personal
longitudinal design. The quasi-experimental study resources and personality type of an individual to
was conducted over 10 years, whereas the other determine how it would impact on an individual’s
two studies were conducted over 7 and 4 years, health. The study by Kalimo et al.429 found that
respectively. The sample sizes of the three studies higher job complexity was associated with lower
were 174, 110 and 672 employees, respectively. burnout. The other variables that helped prevent
burnout were appreciation of work, feedback
HRM practice/intervention and role clarity. They concluded that sense of
The three studies in this synthesis had distinct coherence (SOC) was the most important personal
concepts of job/task complexity. However, the determinant of burnout and individuals with high
studies can be broadly classified as using either SOC were significantly more resistant to burnout
psychological or task–person complexity as than those with low SOC. Schaubroeck et al.428
a variable in their investigations. One study found that job complexity (both types) interacted
examined only task–person complexity, one study with employee personality type (types A and B) to
used only psychological complexity, and one study impact on cardiovascular health. They concluded
looked at both task–person and psychological that high job complexity for type B individuals
complexity. leads to low cardiovascular disorders, whereas high
job complexity for type A individuals leads to high
In the first study, by Kalimo et al.429 psychological cardiovascular disorders.
task complexity was studied as one of the many
variables, measured using the Occupational The study by Blau236 used task responsibility as a
Stress Questionnaire (OSQ).430 This study used construct and measured it as a continuum ranging
personal resources (sense of coherence, self-esteem from routine to complex tasks. He concluded that
and sense of competence) as moderators of the task complexity was significantly positively related
impact of task complexity and other predictors on to job satisfaction. Besides task complexity, he
employee burnout. found both higher wages and satisfaction with
supervisory performance appraisal to be significant
The second study, by Schaubroeck et al.,428 determinants of employee job satisfaction.
investigated the impact of both psychological task
and task–person complexity, as moderated by the Omissions
impact of an individual’s personality (type A or All studies have focused on employee-centric
type B) on his/her cardiovascular health. The third health-related outcomes, for example burnout
study in this analysis, Blau,236 investigated the and cardiovascular health, or on psychological
impact of task complexity – varying on a scale from outcomes, such as job satisfaction.
136
TABLE 41 Work design (job complexity)
Design,
Study, sample size, Practice(s)/intervention(s);
country duration moderators/mediators (if any) FM Outcomes Outcome measure(s) Results +ve/–ve
Kalimo et al. Quasi- The following work characteristics were No Employee MBI–GS; Schaufeli et al. Positive effect:
(2003)429 experimental studied using the OSQa) burnout 1996)188
DOI: 10.3310/hta14510
Higher job complexity was found to be

Finland 174 Job complexity associated with lower burnout
employees Autonomy; role clarity; support from Other variables that helped prevent burnout
10 years supervisor; organisational climate; were appreciation of work, feedback and role
cooperation; work appreciation; work clarity
hazards; feedback; time pressure Negative effect:
Moderators/mediators: Best predictors of burnout were:
Personal resources: Changes in support from superior
SOC; self-esteem; sense of competence Changes in cooperation
Changes in work appreciation
Schaubroeck Prospective Practices: No Cardiovascular Cardiovascular disorder Job complexity (both types) interacted with
et al. (1994)428 longitudinal Job complexity disorder was measured using the employee personality type (type A and B)
USA 110 cardiovascular system to have an impact on his/her cardiovascular

Psychological complexity subscale of the medical health
employees of
fire and police Task–person job complexity (DOT history instrument Positive effect:
departments complexity) developed by House
(1980)432 High job complexity for type B individuals
7 years Moderators/mediators: leads to low cardiovascular disorders
Personality (type A vs type B) Negative effect:
High job complexity for type A individuals
leads to high cardiovascular disorders
Blau (1999)236 Prospective Practices: No Job satisfaction Job satisfaction: Positive effect:
USA longitudinal Task responsibility (measured as a JDS (Hackman and Oldham Task complexity had a significantly positive
672 medical continuum ranging from routine/simple 1975)195 impact on job satisfaction
technologists to complex tasks) Higher wages and satisfaction with
4 years Wages performance appraisal also had positive
Performance appraisal satisfaction impact on job satisfaction
Moderators/mediators: Negative effect:
None Routine task had a significantly negative
impact on job satisfaction
DOT, Dictionary of Occupational Titles; MBI, Maslach Burnout Inventory – General Scale.
a Elo A-L, Leppanen A, Lindstrom K, Ropponen T. OSQ. Occupational Stress Questionnaire: User’s Instructions. Helsinki: Institute of Occupational Health; 1992.
137
Summary Outcomes
These studies used the concept of job/task All 13 studies have used employee-centric
complexity in two ways: psychological complexity outcomes (e.g. job satisfaction, absenteeism,
of jobs, i.e. jobs higher or lower on the five turnover and work motivation) as dependent
dimensions of job scope, as defined by Hackman variables. The majority of studies also measured
and Oldham,431 or jobs higher or lower on employee health-related outcomes, including
task–person complexity, as determined by some mental health, occupational stress, psychological
objective criteria of a job being simple or complex. well-being, self-rated health, perceived strain,
Overall, the studies seem to suggest that either: emotional exhaustion, anxiety, depression, immune
functions and cardiovascular health.
• Task complexity interacts with other variables,
for example, individual personality factors, to Job satisfaction was the most frequently studied
have impact on given outcomes; or, outcome, with five studies investigating how
• The effects of task complexity are moderated demands and control have an impact on employee
by variables, such as an individual’s personal job or work satisfaction.
resources including SOC, self-esteem and sense
of competence. Two studies investigated the impact of demands
and control on employee learning outcomes, such
Job demands and control as skill utilisation, self-efficacy and motivation to
The studies in this section investigated how learn.
demands and control at work can have important
consequences for various work-related outcomes. Results
Most of these studies have tested Karasek’s The studies on job demands and control have used
demand–control model433 in one form or another. Karasek’s433 demand–control model as a starting
Studies examined various aspects of job demands: point to investigate how various combinations of
physical, psychological, workload, monitoring and demand and control impact on given outcomes.
complexity. Control has been studied as decision
control, skill discretion, degree of autonomy and Of the five studies that investigated the impacts
predictability. of demands and control on job satisfaction, two
concluded that high demands and low control lead
Details of studies to poor job satisfaction,233,434 two studies found that
Thirteen studies met the inclusion criteria (Table high control led to higher job satisfaction,435,436 and
42). All of the studies were published in English. one study failed to find any impact for high control
Five were conducted in the Netherlands, four in on job satisfaction.229
the UK, two in Denmark and one each in Sweden
and Hong Kong. Five of the 13 studies had a Absence was another outcome that was found to
quasi-experimental design and the remaining respond well to high job control. Three studies
eight studies were of prospective longitudinal concluded that high job control leads to lower
design. The majority of studies (8 out of 13) were absence.229,437,438 The study by Smulders and
conducted over a 12-month period or less. The Nijhuis437 concluded that high job demands, when
shortest time duration for a study was just 1 month, coupled with high control, can lead to low absence.
whereas the longest was carried out over 5 years.
Sample size varied from 144 to 11,799 employees. Job turnover was found to be negatively associated
with high demands, but high control was not found
HRM practice/intervention to have any significant relationship with employee
All of the studies in this section investigated the turnover.229,439
impact of work demands and individual levels
of control. The majority of studies (8 out of 13) All of the health and psychophysiological outcomes
measured some form of social support at work were found to be negatively related to high job
as a potential moderator of the demand–control demands with low control, and to respond well to
relationship. Locus of control (LOC)/personality enhanced job control.
was used as moderator by two studies, and one
study each used work values (traditional versus Two studies that explored the relationship of
modern) and extent of predictability (being demands and control on employee learning and
informed of future events at work) as moderating self-efficacy concluded that increased control leads
variables.
138
TABLE 42 Work design (job demands and control)

DOI: 10.3310/hta14510
Johnson et al. Quasi-experimental Practices: No Cardiovascular Mortality data were Positive effect:
(1996)442 11,799 employees Work control (a 12-item scale disease mortality or obtained from National Higher psychological demands were found
Sweden measuring decision authority and risk Death Registry to be associated with lower cardiovascular
4 years
skill discretion on the job) disease morality or risk of it
Psychological demands (time Negative effect:
pressure and extent to which the Men exposed to lower control jobs had a
job was mentally strenuous) substantially elevated risk for cardiovascular
Physical job demands; job hazards; disease mortality relative to men with a work
work social support history of high-control jobs
Moderators/mediators: None
Moyle and Parkes Quasi-experimental Practices: (as a result of relocation) No Strain indicators: Job satisfaction: 10-item Positive effect:
(1999)436 175 employees Demand and control (an 1. Job satisfaction measure Perceived control and high managerial
UK 7 months adaptation from Karasek (1979),433 2. Psychological Psychological distress: 12- support buffered the negative impact of work

the scale had seven items distress item GHQ-12 (Goldberg relocation
concerning pace and challenge of 1978)239 No effect:
work demands and eight items 3. Physical symptoms
of strain Physical symptoms: Job demand had no effect on perceived strain
concerning decision latitude and Seven-item symptom
discretion at work scale
Managerial support
Extraversion, neuroticism and
social desirability; personality
(type A/B); LOC
Holman and Wall Quasi-experimental Practices: No Learning-related Skill utilisation: O’Brien Positive effect:
(2002)440 144 employees Work characteristics: Job control; outcomes: Skill (1986)443 An increase in control is associated with
UK job demands utilisation; self Self-efficacy: Axtell et al. decrease in depression; this effect is
12 months efficacy
Moderators/mediators: (2000)444 mediated through skill utilisation such that
Strain: Anxiety; Strain: Warr (1990)445 higher control leads to better skill utilisation,
None depression which, in turn, reduces depression
continued
139
140
TABLE 42 Work design (job demands and control) (continued)

Nielsen et al. Quasi-experimental Practices: No Self-rated health; Job satisfaction: Marmot Positive effect:
(2002)229 2068 employees Psychological demands perceived stress; et al. (1991)242 Decision authority had positive impact
Denmark absence from work; Health: Setterlind and on self-rated health, perceived stress and
5 years Control (decision authority and job satisfaction;
skill discretion) Larsson (1995)446 absence. Skill discretion had positive impact
labour turnover on health and absence but no impact on
Social support; meaning of work; Absence: Company data
perceived stress
predictability
Negative effect:
Psychological demands had a negative impact
None on self-rated health
Nielsen et al. Quasi-experimental Practices: No Absence Company records Positive effect:
(2004)438 1919 employees Psychosocial workplace factors: High level of decision authority and high
Denmark (psychological demands; decision predictability (being informed on future
2 years
authority; predictability of work; events at work) predicted lower absence rate
skills; support from colleagues;
supervisory support; meaning of
work)
None
Daniels and Guppy Prospective Practices: No Occupational stress; Occupational stress was Positive effect:
(1994)447 longitudinal Job control (job autonomy and psychological well- measured using a 18-item High job control and high social support had
UK 244 employees participative decision-making) being questionnaire, designed a positive impact on psychological well-being
for the study by the
1 month Social support authors Interaction effect:
Moderators/mediators: Psychological well-being LOC moderated the impact of job control
LOC (Warr 1990;445 and and social support on psychological well-
GHQ12 by Goldberg and being in such a way that persons with internal
Williams 1988 448) LOC benefited more from high job control
than persons with external LOC
Moyle (1998)435 Prospective Practices: No Mental health and job Mental health: GHQ Positive effect:
UK longitudinal Demand and control satisfaction (used as (Goldberg 1978)239 High control had a direct positive impact on
148 employees indices of strain) Job satisfaction: 10- job satisfaction
Managerial support
12 months item scale adapted from Managerial support has a positive impact on
Role ambiguity Parkes (1993)449 job satisfaction and mental health
Negative effect:
None
High demand and low control had a negative
impact on both concurrent and future mental
health
Smulders and Prospective Practices: No Absence Two measures of absence Positive effect:
Nijhuis (1999)437 longitudinal Job demands were used: Job control was significantly associated with
Netherlands 1755 employees Job control 1. Absence rate: Days low absence rate
11 months absent/100 calendar Job demands was also associated with low
Physical working conditions days
DOI: 10.3310/hta14510
absence rate
Moderators/mediators: 2. Absence frequency: No effect:
None No. of spells of
absence/per year per Neither job control nor job demand was
person (irrespective of associated with absence frequency
their duration)
Jia et al. (2000)450 Prospective Practices: No Immune function; Blood test Interaction effect:
Hong Kong longitudinal Worker control: Includes job symptoms of The relationship between decision control
492 employees control and decision control; respiratory illness and poor health was stronger for more
12 months Measures: Smith et al. (1997)451 Job traditional employees than for less traditional
complexity: House (1980);432 Job employees. Also, job control interacted with
demands: Includes job complexity, job demands and job self-efficacy to predict
responsibility for others, workload health outcomes
and monitory pressure

1. Traditionality (a cultural value
where there is an acceptance of
hierarchical orientation among
people)
2. Job self-efficacy
de Jonge et al. Prospective Practices: No Psychological well- MBI (Dutch version Positive effect:
(2001)233 longitudinal Job demand being: Emotional 1993)a Workplace social support was positively
Netherlands 261 employees exhaustion; job Scales for job satisfaction related to job satisfaction
Job autonomy satisfaction; work
12 months and work motivation Negative effect:
Workplace social support motivation were constructed by the
Moderators/mediators: authors Job demand was found to be negatively
related to job satisfaction
None
There was some weak but significant
reverse causality between time 1 emotional
exhaustion and time 2 perception of job
demands such that higher exhaustion was
related to perception of higher job demands
No effect:
Autonomy was not found to be related to the
outcome variables
continued
141
142
TABLE 42 Work design (job demands and control) (continued)

Taris et al. Prospective Practices: No Active learning: Self-efficacy scale: Dutch Positive effect:
(2003)441 longitudinal Work characteristics: Perceptions 1. Self-efficacy adaptation of Personal Job control had a lagged positive impact on
Netherlands 876 employees of job control and job demands Accomplishment scale by active learning
2. Motivation to learn Maslach et al. (1996)452
12 months Moderators/mediators: Negative effect:
Learning motivation scale
None was developed by the Job demand had a lagged negative impact on
authors for this study active learning
de Croon et al. Prospective Practices: No Voluntary turnover Voluntary turnover data Negative effect:
(2004)439 longitudinal taken from company
Job demands and control (with Jobs high on demands and low on controls
Netherlands 564 employees jobs high on demands and low on records (defined in the study as stressful work) had a
2 years controls being defined as ‘stressful negative impact on voluntary turnover
work’) Mediation analysis revealed that this
Moderators/mediators: relationship between stressful work and
Strain (defined in this study as turnover was mediated through psychological
‘need for recovery after work’ and fatigue
‘fatigue’)
de Langeff et al. Prospective Practices: No Mental health: Mental health Negative effect:
(2004)434 longitudinal Job demands and Job control Defined in the Depression:11-item High level of demand with low job control
Netherlands 668 employees current study as version of the CES-D and poor social support led to poor mental
Social support from supervisors comprising three
4 years scale health (higher depression, low job satisfaction
Moderators/mediators: variables: and high emotional exhaustion)
Job satisfaction: New
None 1. Depression single-item measure; Also, there was a reciprocal relationship
2. Job satisfaction Burnout: Seven-item between job demands, social support and
3. Emotional dichotomous subscale of emotional exhaustion
exhaustion the MBI
CES-D, Center for Epidemiologic Studies Depression Scale; LOC, locus of control; MBI, Maslach Burnout Inventory.
a Schaufeli WB, Van Dierendonck D. The construct validity of two burnout measures. Journal of Organizational Behavior 1993;14:631–47.
to better skill utilisation and also has a positive engaged in.454 It refers to horizontal expansion
impact on active learning.440,441 of the jobs, increasing the role responsibilities
and range of activities being carried out by an
Later adaptations of Karasek’s433 model of employee.453
demands and control include support as a third • Job enrichment leads to more holistic changes
strand. This is reflected in the use of managerial in job roles and responsibilities. In contrast
support or social support measures in eight of the with the horizontal expansion involved in
13 studies. There was clear evidence in this set of job enlargement, job enrichment involves
studies for the positive impact of social support on vertical expansion.412 An enriched work design
all given outcomes when used in conditions of high means that employees have discretion to take
job control. on broader and more proactive tasks as and
when required. It can be done by increasing
Omissions employee responsibility, autonomy and regular
These 13 studies have covered a wide variety of feedback.
health and employee-centric outcomes. However,
there were no studies exploring how job demands Details of studies
and job control, in their various combinations, Twenty-one studies met the inclusion criteria
influence job performance, productivity or (Table 43). All the studies were published in English,
customer/client outcomes. with eleven being conducted in USA, three in the
UK, three in Canada, two in the Netherlands, and
Summary one each in Sweden and Israel. There were four
The results of the 13 studies meeting the criteria studies with RCT designs, six studies used quasi-
for inclusion in this review provided consistent experimental methods, and eleven studies had a
evidence for the positive impact of increased job prospective longitudinal research design. There
control and the negative impact of high demands was huge variation in the duration of the studies in
on the given outcomes. Job satisfaction, absence this section, with the shortest being just 2 months
behaviour and health outcomes in particular were and the longest being 4.5 years. The sample size
positively influenced by higher control. A large of these 21 studies varied from 31 employees to
proportion of these studies (5 out of 13) were 80 manufacturing firms with between 60 and 1150
quasi-experimental in design. Over one-half of the employees.
studies investigated the influence of managerial or
social support as a variable alongside demands and HRM practice/intervention
control. Authors used the terms job enlargement and
job enrichment in their own distinct ways.
The studies in this area mostly focused on health Campion and McClelland455 used the terms ‘task
and employee-centric outcomes and there were enlargement’ and ‘knowledge enlargement’ as
no longitudinal studies investigating the impact two types of job enlargement, with knowledge
of demand and control on performance or enlargement being conceptually similar to
productivity. job enrichment. Therefore, the Campion and
McClelland455 study has been included as a study
Job rotation, enlargement and of both job enlargement and enrichment. Parker454
enrichment used job enlargement as horizontal enlargement
The concepts of job rotation, enlargement and and job enrichment for jobs that were high on
enrichment are all suggested answers to the autonomy and control. Other variations of the
problems posed by job simplification. use of the term job enrichment included high job
stimulation, high motivating potential score (MPS),
• Job rotation involves doing more than a single high authority and control, high job quality, high
type of repetitive task. The inherent logic of job scope, and high intrinsic motivating properties
job rotation is to help break the monotony of the job.
arising out of doing the same task repeatedly,
also making the employee more versatile as There were two studies on job rotation:
he/she learns various other tasks. It does not, one analysed the impact of job rotation on
however, change the content of the job.453 psychophysiological stress reactions and
• Job enlargement is intended to increase musculoskeletal symptoms456 and one explored the
the breadth of activities that employees are impact on performance.457
143

144
TABLE 43 Work design (job rotation, enlargement and enrichment)
Study, Design, sample Practice(s)/intervention(s);

country size, duration moderators/mediators (if any) FM Outcomes Outcome measure(s) Results +ve/–ve
Rissen et al. Experimental Practices: No Psychophysiological SBP and DBP; heart rate; Positive effect:
(2002)456 design Job rotation stress reactions; subjective experience Job rotation had positive effects on muscle
Sweden 31 women muscle activity of questionnaire (self-report) – activity in the neck and shoulders; DBP was
Moderators/mediators: the trapezius muscle; positive and negative arousal;
employees also significantly lowered; and self-report
None musculoskeletal urine samples questionnaire indicated that job rotation was
3–4.5 years symptoms in the neck EMG positively experienced by the employees
and shoulders
Use of surface electrodes No effect:
Job rotation has no effect on several
psychophysiological variables for example SBP,
heart-rate, perceived negative arousal, and
epinephrine; pain was only partially affected
Campion Quasi- Practices: No Customer service Positive effect:
and experimental Task enlargement; knowledge Errors (as a measure Knowledge enlargement (akin to job enrichment)
McClelland 515 employees enlargement of performance); job had positive impact on satisfaction, mental
(1993)455 efficiency workload, errors and led to better customer
2 years Moderators/mediators:
USA Satisfaction; mental service
None
load Negative effect:
Task enlargement led to more mental overload,
greater chance of making errors, and lower job
efficiency
Parker Prospective Practices: No RBSE RBSE scale was designed by Positive effect:
(1998)454 longitudinal Job enlargement (measured as the the author Job enrichment was positively associated with
UK 459 employees horizontal range of the jobs) RBSE
18 months Job enrichment (measured as jobs
high on autonomy and control)
Communication; training (on
quality management)
None
Axtell and Prospective Practices: No RBSE RBSE scale was designed by Positive effect:
Parker longitudinal Job enlargement (measured as the the author Job enrichment was positively associated with
(2003)458 94 employees horizontal range of the jobs) RBSE
UK 18 months Job enrichment (measured as jobs Negative effect:
high on autonomy and control) Job enlargement had a lagged negative impact on
Communication; training (on RBSE
quality management)
None
Locke et al. Experimental Practices: No Productivity; Outcomes for example Positive effect:
(1976)466 design Job enrichment absenteeism; absenteeism, turnover, Absenteeism, turnover and productivity were
USA 95 employees turnover; complaints complains and disciplinary positively influenced by job enrichment
Moderators/mediators: and disciplinary actions and productivity
14 months None actions; attitudes were taken from company No effect:
records. Attitudes were No changes were observed in attitudes of the
DOI: 10.3310/hta14510
measured using a 134-item workers toward the work or the workplace

questionnaire, which was
designed for the study by the
authors
Orpen Experimental Practices: No Performance; Performance and productivity: Positive effect:
(1979)460 design Job enrichment productivity; work Supervisory ratings and actual Job enrichment had significant positive impact
USA 72 employees satisfaction; employee company records on each of the personal outcomes of job
Moderators/mediators: motivation; employee
6 months Work satisfaction: Work satisfaction, job involvement, and intrinsic
GNS; contextual satisfaction involvement; subscales of Smith et al. motivation
absenteeism; turnover 1969243 JDI Rates of absenteeism and turnover also were
Employee motivation: Six significantly reduced following job enrichment
items of JDS: Hackman and Both, GNS and contextual satisfaction
Oldham (1975)195 significantly moderated the relationship between
Job involvement: Short six- Job enrichment and personal outcomes. These

item scale (Lodahl and Kejner two variables, however, were not significant
1965)424 moderators between job characteristics and
Absenteeism and turnover: work outcomes, i.e. job performance
Company records No effect:
The results did not indicate significant effects for
enrichment on work outcomes of performance
and productivity
Hall et al. Quasi- Practices: No Perceived Perceived effort, perceived Negative effect:
(1978)461 experimental Change in job characteristics (job performance; performance and psychological A decrease in job stimulation leads to decreased
Canada 153 employees stimulation: a cumulative score for perceived effort; success were measured using job involvement
variety, identity, autonomy and psychological success; scales constructed by the
10 months work satisfaction; job authors for this study; work Organisational change (irrespective of it
feedback) due to organisational being perceived as resulting in high or low job
change involvement; higher satisfaction was measured
order need strength using JDI (Smith et al. 1969);243 stimulation) had negative impact on all outcomes
Moderators/mediators: job involvement was measured No effect:
None using scales developed by Change in Job stimulation has no effect on
Lodahl and Kejner (1965)424 perceived effort, perceived performance,
Higher order need strength psychological success, work satisfaction or higher
was measured using the scale order need strength
devised by Hackman and
Lawler (1971)192
continued
145
146
TABLE 43 Work design (job rotation, enlargement and enrichment) (continued)

Bhagat and Quasi- Practices: No Attitudinal outcomes: Psychological states: JDS Positive effect:
Chassie experimental Change in work week from Experienced (Hackman and Oldham Enrichment (higher MPS) led to higher general
(1980)462 65 employees 5 days to 4 days a week to meaningfulness of 1975)195 satisfaction, growth satisfaction, internal work
USA induce changes in perceived job work; experienced Affective responses: JDS motivation, increased meaningfulness and
2 months responsibility for
characteristics as measured by the responsibility for work
MPS of the job work outcomes;
knowledge of results No effect:
Moderators/mediators: Context satisfaction was unaffected by changes
Affective responses:
Individual GNS General satisfaction; in MPS
intend work Interaction effect:
motivation; growth High GNS employees responded more
satisfaction; context
sensitively to changes in MPS

satisfaction
Griffin Experimental Practices: No Productivity: Core task attributes and Positive effect:
(1983)463 design Objective changes in task Core task attributes; interpersonal task attributes: Both objective task attributes and supervisory
USA 274 employees attributes to enhance job interpersonal task Job Characteristic Inventory cues influenced perception of core task
enrichment (task redesign); attributes; affective (Sims et al. 1976)472 attributes, interpersonal task attributes, and
3 years
informational cues from reactions: Intrinsic Affective reactions: Minnesota affective reactions to task attributes
supervisors: Feedback, variety, satisfaction; extrinsic Satisfaction Questionnaire Objective task changes (towards enriched jobs)
autonomy and identity satisfaction; overall (Weiss et al. 1967)473 had a positive impact on productivity
Moderators/mediators: satisfaction Productivity: Average daily No effect:
None output
Supervisory cues had no effect on productivity
Bateman Prospective Practices: No Job satisfaction Job satisfaction: JDI (Smith et Positive effect:
and Strasser longitudinal MPS: Measured as a cumulative and organisational al. 1969)243 MPS has a positive impact on job satisfaction
(1984)235 129 employees score from administration of JDS commitment Organisational commitment: No effect:
USA 5 months Job tension: Measured as Porter et al. (1974)244
MPS (enrichment) has no significant effect on
comprising role conflict/ambiguity/ organisational commitment
overload
Centralisation: A measure
of participation/autonomy in
decision-making
None
Griffin Quasi- Practices: No Performance: JDS (Hackman and Oldham, Positive effect:
(1991)464 experimental 1975)195
DOI: 10.3310/hta14510
Job enrichment (through Task perceptions Time 3 and 4 measures of performance were
USA 564 employees enhancement of responsibility, (MPS score); Minnesota Satisfaction significantly (positive) related with the time 1 and
4 years authority and accountability; job satisfaction; Questionnaire (Weiss et al. 2 MPS of the job
increased feedback) organisational 1967)473 There was a significant increase in MPS,
Moderators/mediators: commitment; Organisational commitment satisfaction, commitment, and performance over
absenteeism; (Porter et al. 1974)244 time
None propensity to quit
Propensity to quit (Seashore No effect:
et al. 1982)474 There was no significant change in absenteeism
Performance was assessed and propensity to quit as a result of increased
through supervisor scores job enrichment
Absenteeism was taken from
company records
Morgeson Quasi- Practices: No Overall job Positive effect:
and experimental satisfaction; training

Motivational job redesign (through Motivational job design was positively related
Campion 96 employees increasing the identity and requirement; work with job satisfaction and training requirements
(2002)465 feedback properties of the job) simplicity and negatively correlated with work simplicity
2 years
USA Mechanistic job redesign (simple, Higher mechanistic job design led to less training
uncomplicated, and repetitive) requirement and made the work simpler
Moderators/mediators: Negative effect:
None Higher motivational design led to more training
requirement and decreased work simplicity
Houkes et al. Quasi- Practices: No Intrinsic work Intrinsic work motivation: Positive effect:
(2003)467 experimental Task characteristics (MPS of the motivation; emotional Warr et al. (1979)475 MPS was found to have a positive impact on
Netherlands 148 employees job) exhaustion; turnover Emotional exhaustion: MBI intrinsic work motivation
intention (Schaufeli et al. 1996)188
12 months Workload; social support; career
expectations Turnover intention – four-item
Moderators/mediators: scale (Van Veldhoven and
Meijman 1994)476
None
continued
147
148
TABLE 43 Work design (job rotation, enlargement and enrichment) (continued)

Hammer et Prospective Practices: No Absenteeism Company records No effect:
al. (1981)469 longitudinal Various job situation (voluntary and There was no significant impact of job
USA 112 employees characteristics for example: Job involuntary) involvement on any form of absenteeism
2.5 years involvement (high score indicating
interest and involvement in
job and a sense of pride and
accomplishment: a concept, as
per the authors, theoretically
similar to enrichment); change
of the financial ownership of the
plant from private hands to the
employees
None
Meyer et al. Prospective Practices: No Organisational Organisational commitment: Positive effect:
(1991)468 longitudinal Job quality: Comprising a commitment Meyer and Allen (1984)477 Job quality had a significant effect on affective
Canada 104 employees composite score from the (affective and commitment
following variables: Job challenge, continuance
11 months commitment) No effect:
participation, self-expression,
personal importance, role Job quality had no effect on continuance
clarity, feedback, confirmation of commitment
expectations
None
Barnett et al. Prospective Practices: No Psychological distress Used items from 2 scales Negative effect:
(1995)470 longitudinal Job role quality on psychological distress: A decrease in job quality over time was related
USA 210 employees Derogatis, (1975),478 Barnett with an increase in psychological distress but this
Moderators/mediators: et al. (1993)479
2 years relationship was not affected by the gender
Gender
Krausz et al. Prospective Practices: No Intention to leave Self-made scale Positive effect:
(1995)252 longitudinal Job scope [measured using a -tem High job scope led to low intention to leave
Israel 146 employees scale based on Hackman and
12 months Oldham’s (1975)195 JDS scale]
None
Taris et al. Prospective Practices: No Depression Translation of Depression Negative effect:
(1998)471 longitudinal Intrinsic job characteristics Adjective Checklist (Rooijen Intrinsic job characteristics and depression had
DOI: 10.3310/hta14510
Netherlands 593 employees (comprising jobs high on variety, 1979480 and Lubin 1965)481 a significant reciprocal negative effect on each
4 years autonomy, opportunity to engage other
in meaningful tasks, and feedback) Job change did moderate the effect between
Moderators/mediators: time 1 depression and time 2 job characteristics
Job change
Blocher Prospective Practices: No Performance Reviewer’s overall evaluation Negative effect:
(1979)457 longitudinal Job rotation of workers’ performance, A lapse in performance in consecutive
USA 58 employees rated on an ordinal scale assignments was observed for employees within
Moderators/mediators: from ‘superior’ to ‘needs
5 years the same industry
None improvement’
No effect:
No change in performance was observed for
employees who rotated between assignments in
different industries

Patterson et Prospective Practices: Yes Performance Audited government records Positive effect:
al. (2004)34 longitudinal Integrated manufacturing and (productivity and Productivity – measured Job enrichment and skill enhancement have
UK 80 firms (varying empowerment (job enrichment, profitability) as the logarithm of the a positive impact on both productivity and
in size between skill enhancement advanced financial value of net sales per profitability
60 and 1150 manufacturing technology, total employee (see Huselid 1995)18 Productivity is a mediator of the relationship
employees) quality management, JIT inventory Profit: Measured as the between job enrichment and profitability and
2 years control) financial value of sales less skill enhancement and profitability
Moderators/mediators: costs per employee, before
Productivity profits tax
Laschinger et Prospective Practices: No Satisfaction Four-item global measure Positive effect:
al. (2004)459 longitudinal Structural empowerment of job satisfaction adapted Perceptions of increased structural
Canada 185 employees from Hackman and Oldham’s empowerment resulted in improved job
Moderators/mediators: (1975)195 JDS
4 years satisfaction and increased perceptions of
Psychological empowerment psychological empowerment
Psychological empowerment did not mediate the
relationship between structural empowerment
and job satisfaction
DBP, diastolic blood pressure; GNS, growth need strength; MBI, Maslach Burnout Inventory; SBP, systolic blood pressure.
149
Three studies investigated the combined effect level if the seniors were assigned consecutively
of job enlargement and job enrichment.454,455,458 within a particular industry, whereas no lapse
Sixteen studies investigated the sole impact of job in performance was observed for those seniors
enrichment on various outcomes. who rotated between assignments in different
industries.
Outcomes
All of the studies on job rotation, enlargement and Studies investigating job enlargement and
enrichment studied outcomes that can be broadly enrichment found a positive impact on RBSE454,458
classified in three categories: outcomes related to but a negative impact on workload, i.e. workload
customer service/satisfaction, outcomes related to increased.455
both individual and organisational performance/
productivity, and employee-centric outcomes, Knowledge enlargement was found to have a
including absenteeism, turnover, motivation, positive relationship with customer services.455
involvement, organisational commitment, job
satisfaction, effort, depression, role breadth self- Researchers investigating the impact of job
efficacy (RBSE) and other employee attitudes. enrichment on various outcomes were unanimous
in their conclusion that it is a desirable
• The studies on job rotation had physiological, intervention, which works quite well for some
psychophysiological and performance outcomes but has less straightforward results
outcomes as their predicted variables.456,457 for others. Of the nine studies that investigated
• There was only one study that investigated job satisfaction, eight found it to be positively
the impact of job enlargement (knowledge influenced by job enrichment235,455,459,460,462–465
enlargement) on customer service.455 and only one study had a no-effect result.461 Job
• The studies on job enrichment looked at a enrichment was also found to enhance employee
relatively large number of outcome variables. motivation and involvement by all the studies that
Job satisfaction was the most frequently investigated these links.460,462,467
studied, with nine studies investigating it as a
predicted outcome.235,450,459–465 Lack of enriched job has also been found to lead
• Employee turnover or intention to leave was to increased levels of psychological distress and
investigated by four studies.252,460,464,466 depression.470,471
• Individual performance, productivity,
motivation, absenteeism and commitment were Two studies found employee performance to be
studied by five studies each.34,235,455,460–464,466–469 positively influenced by job enrichment,455,464
One study34 examined the impact of job whereas two other studies failed to reach any
enrichment on organisational performance such conclusion.460,461 With regards employee
(company productivity and profitability). productivity, two research papers concluded that
• Two studies studied the impact of job it is positively related with job enrichment463,466
enlargement and job enrichment on whereas Orpen460 found productivity to be
RBSE.454,458 unaffected by job enrichment. The study by
• Two studies explored the impact of job Patterson et al.34 concluded that the extent of
enrichment on job involvement and positive empowerment within companies predicted the
employee attitudes.461,462 subsequent level of company performance (both
• Effort, psychological distress and depression productivity and profitability) controlling for prior
were investigated by one study each.461,470,471 performance, the association between enrichment
and profitability was mediated by productivity,
Results suggesting that enrichment affected profitability
Job rotation was found to have a clearly beneficial through its effects on productivity.
impact on certain psychophysiological stress
reactions, for example diastolic blood pressure and More definitive results were obtained for the
self-reported positive experience of the job. It also relationship between job enrichment and
had a positive impact on muscle activities in the turnover, with three studies favouring a positive
neck and shoulder. However, job rotation had no impact252,460,466 and one study failing to come to any
impact on other psychophysiological reactions of such conclusion.461
systolic blood pressure, heart rate and perceived
negative arousal.456 Blocher457 found a lapse in Of the three studies on absenteeism and job
performance over time for audit staff at senior enrichment, two found a positive impact of
150
enriched jobs on absenteeism460,466 but one study Details of studies

failed to find any definitive relationship.469 Seven studies met the inclusion criteria (Table 44).
All studies were published in English. Four
Omissions were conducted in the USA and the other three
The studies on job rotation, enlargement and were conducted in the UK, Israel and Finland,
enrichment covered multiple outcome variables. respectively. The first six studies used a prospective
The only significant omissions were the impact of longitudinal design and the seventh study was
job enrichment on outcomes related to learning a quasi-experimental study using retrospective
and growth of employees. One would expect longitudinal analysis. Five of the studies in this
more research on these variables given both job category were conducted over a period of 1 year or
enlargement and enrichment are conceptually less, one was carried out over 2 years, and one over
proposed to enhance the skills and abilities of a period of 10 years. The sample size of the studies
employees. However, no longitudinal research varied from 111 to 661 employees.
explored such tasks.
HRM practice/intervention
Summary Most studies in this synthesis treated role ambiguity
The 21 studies in this review investigated as a stressor, with some even labelling it as such.
the impact of job rotation, enlargement and Bateman and Strasser235 used a measure of role
enrichment on various outcomes. There were two conflict and role ambiguity (along with role
studies on job rotation, both of which find it to be overload) as a measure of job tension, whereas
beneficial. The three studies on job enlargement Saks and Ashforth482 and Kalimo et al.429 used it
were consistent in their conclusion that job as a measure of an occupational stressor. None of
enlargement by itself has a negative impact on the seven studies investigated the impact of role
employees. The 16 studies on job enrichment and conflict or role clarity per se. Most of the studies
three on job enrichment and job enlargement considered it as one of a range of occupational
indicated that job enrichment largely has a positive role characteristics. Three studies investigated role
impact on all the outcomes, especially on job conflict or role clarity in conjunction with other key
satisfaction, employee motivation, involvement characteristics of the job, for example the MPS for
and commitment. Some studies also found job the job (as measured by JDS) or some components
enrichment to have a positive impact on other of MPS, such as autonomy or task significance.
outcomes, for example, individual performance, Other studies explored the impact of role conflict
customer service, job turnover or intention to leave, in conjunction with colleagues’ or supervisors’
and depression. The impact of job enrichment support. Though these studies attempted some
on absenteeism was found to be positive by two form of statistical control to understand the
studies but one study failed to find any such link. unique effects of role clarity or role ambiguity,
The role of job enrichment on job turnover or only two studies presented moderated analysis of
intention to quit was clearer, with three out of four role conflict and role clarity with other variables.
studies indicating that enriched jobs lead to lower The study by Saks and Ashfort482 investigated the
job turnover. One study found job enrichment to moderating role of predispositions in the form of
predict company productivity and profitability. general self-efficacy (GSE) on role conflict, whereas
the study by Fried et al.483 studied the role of job
Overall, research in this field is dominated by security as a moderator of role clarity.
investigation of the impact of job enrichment.
There is comparatively little longitudinal research Outcomes
on job rotation or job enlargement per se. Job satisfaction was the most commonly measured
outcome variable, used in four out of seven
Role ambiguity, role conflict and role studies. Two studies investigated organisational
clarity commitment and two studies used individual
Studies of role conflict and role ambiguity have employee performance as the predicted variable.
typically treated these variables as dimensions The other outcome variables studied in relation
of role stress, focusing on whether, for example, to role conflict or role clarity were mental health,
increased levels of role conflict or role ambiguity intention to quit, frustration, stress symptoms and
lead to increased role stress and, conversely, employee burnout.
whether higher levels of role clarity lead to
decreased role stress.
151

152
TABLE 44 Work design (role conflict/clarity)

Bateman Prospective Practices: No Job satisfaction and Job satisfaction: Job Descriptive Negative effect:
and Strasser longitudinal Job tension: Measured as organisational commitment Index (JDI; Smith et al. 1969)243 Job tension has a negative
(1984)235 129 employees comprising role conflict/ambiguity/ Organisational commitment: Porter impact on Job satisfaction
USA 5 months overload et al. (1974)244 No effect:
Motivating potential score: Job tension has no significant
Measured as a cumulative score effect on organisational
from administration JDS commitment
Centralisation: A measure of
participation/autonomy in decision-
making
None
Agho et al. Prospective Practices: No Job satisfaction Job satisfaction: 6 items selected No effect:
(1993)234 longitudinal Role ambiguity; role conflict; role from 18 item index developed by After controlling for effects
USA 405 employees overload; autonomy; supervisory Brayfield and Rothe (1951)245 of other variables, role
3 months support; task significance; ambiguity, role conflict and
routinisation; pay role overload had no effect on
Moderators/mediators: job satisfaction
None
Moyle Prospective Practices: No Mental health and job Mental health: GHQ (Goldberg, Negative effect:
(1998)435 longitudinal Role ambiguity; demand and satisfaction 1978)239 Role ambiguity had a direct
UK 148 employees control; managerial support Job satisfaction: 10-item scale negative impact on job
12 months Moderators/mediators: adapted from Parkes (1993)449 satisfaction
None No effect:
Role ambiguity had no effect
on mental health
Saks and Prospective Practices: No Individual job performance Job satisfaction: Cammann et al. Positive effect:
Ashforth longitudinal Stressors: Role conflict, role details Adjustment to work: (1983)485 Stressors significantly
(2000)482 231 employees ambiguity and role overload Measured by the following Organisational commitment: Allen predicted all outcomes
USA 10 months Moderators/mediators: components: and Meyer (1990)486 Interaction effect:
Predispositions (GSE) Job satisfaction Organisational identification: Mael Role conflict interacted with
Organisational commitment and Ashforth (1992)487 GSE in a manner that person
Organisational Intentions to quit: Colarelli (1984)488 with high GSE had higher
identification Frustration: Ashforth (1989)489 organisational commitment and
organisational identification
Intentions to quit Stress symptoms: Patchen (1970)490 under conditions of high role
Frustration Performance: House et al. (1982)491 conflict, whereas the opposite
Stress symptoms was true for persons with low
GSE
Performance
Bravo et al. Prospective Practices: No Immediate and intermediate Used items from two scales: Positive effect:
(2003)492 longitudinal Role conflict and role ambiguity; adaptive strategies Bachman et al. (1978)493 Role conflict had a positive
USA 661 employees institutional socialisation tactics; Career strategies inventory: Penley impact on immediate career-
DOI: 10.3310/hta14510
24 months co-worker relations; superior and Gould (1981)494 enhancing strategies

relations Negative effect:
Moderators/mediators: Role conflict and role
None ambiguity were negatively
related with intermediate
career-enhancing strategies
Fried et al. Prospective Practices: No Individual job performance Supervisor ratings Positive effect:
(2003)483 longitudinal Role clarity Role clarity had a positive
Israel 111 employees Moderators/mediators: impact on employee job
10 months performance
Job security
Interaction effect:
Role clarity and job security
interacted in a manner that

increase in performance was
maximised when both role
clarity and job security were
high, whereas deterioration in
performance was maximum
under conditions of high job
security and low clarity
Kalimo et al. Quasi- The following work characteristics No Employee burnout MBI-GS; Schaufeli et al. (1996)188 Positive effect:
(2003)429 experimental were studied using the OSQa Increase in role clarity had a
Finland design Role clarity; job complexity; positive impact on employee
(retrospective autonomy; support from burnout. Other variables
analysis) supervisor; that helped prevent burnout
174 employees Organisational climate; were appreciation of work,
10 years cooperation; work appreciation; feedback, and task complexity
work hazards; feedback; time
pressure
None
GSE, general self-efficacy; MBI-GS, Maslach-Burnout Inventory – General Scale.

a Elo et al. 1992.
153
Results ambiguity on clients, customer-centric outcomes

Three out of the four studies measuring job or outcomes related to learning and growth of
satisfaction reported role ambiguity to act as a employees seem to have been largely omitted.
stressor and decrease job satisfaction. However, one
study234 concluded that after controlling for the Summary
effects of other factors (e.g. autonomy, supervisory The seven studies on role conflict/ambiguity
support, task significance, task routinisation and or role conflict were fairly homogeneous in
pay) there was no unique predictive power in role their definitions and use of terminology. Most
conflict or ambiguity in accounting for levels of job of the studies investigated the impact of role
satisfaction. conflict or role clarity on employee-centric
psychological outcomes, with job satisfaction again
Two studies used individual job performance as being the most studied variable. Overall, the
a predicted variable.483,484 Both found that role studies concurred that role conflict reduced job
conflict reduced job performance, whereas role satisfaction and increased burnout but its impact
clarity increased it. on organisational commitment was unclear. The
studies also highlighted that role clarity may
Studies on the impact of role conflict/ambiguity interact significantly with some dispositional or
on organisational commitment reported mixed job environment variables (e.g. self-efficacy or
results. Saks and Ashforth482 found role conflict to workplace support) to influence key outcome
be a significant predictor of poor organisational variables. The majority of studies considered
commitment. In contrast, Bateman and Strasser235 role conflict or role clarity in combination with
found no significant impact of job tension other work design variables, especially those that
(measured as a combination of role conflict, role constitute the Hackman and Oldham412 JDS, such
ambiguity and role overload) on organisational as task autonomy and task significance.
commitment. There were also mixed findings in
relation to the impact of role conflict on mental Staffing
health. Saks and Ashfort482 found a negative impact
of role conflict, ambiguity and overload on stress Twenty-three papers were categorised under the
symptoms, whereas Moyle435 found no significant broad HRM area of staffing. The studies fell into
relationship between role ambiguity and mental three distinct areas of focus and syntheses are
health. presented for each area as follows:
The interaction effect of two moderators of role • recruitment and selection

conflict was investigated by two studies, both of • induction/orientation
which reported significant findings. Role conflict • work scheduling.
interacted with GSE such that those with high
GSE reported higher organisational commitment Recruitment/selection
and identification under conditions of high Employee selection is a two-way interaction, where
role conflict, whereas the opposite was true for applicants and organisations gather information
individuals with low GSE.482 Role clarity was about one another and react to this information
found to significantly interact with job security;483 while making employment decisions.495 The
increases in performance were maximised when longitudinal studies in this section looked at a
both role clarity and job security were high, while range of factors in the recruitment and selection
deterioration in performance was greatest under process, and considered how they have an impact
conditions of high job security and low clarity. on various employee and organisational outcomes.
Role clarity was also found to be instrumental in
preventing job burnout. Details of studies
Seven studies met the inclusion criteria (Table 45),
Omissions all of which were conducted in the USA. One study
Only two studies investigated the impact of role used experimental design with full randomisation,
clarity or role conflict/ambiguity on variables other two studies used quasi-experimental methods,
than employee-centric outcomes, for example and four had a prospective longitudinal research
individual job performance. Most of the studies design. The duration of the studies varied from
only focused on employee-centric psychological 1 hour to 8 years. The sample size of these seven
outcomes, such as job satisfaction. Outcomes studies varied from 30 to 533 employees.
including the impact of role clarity or role
154
HRM practice/intervention role ambiguity. Previews were more effective in

The HRM practices investigated in these seven reducing turnover among more intelligent trainees
studies focus on two broad areas: and among those initially more committed to
army. These results were based on a randomised
• the tools and techniques of employee selection experimental design.
• the impact of an applicant’s perception of the
selection process on his/her decision to accept The other four studies on selection tools and
the employment offer. techniques, using prospective longitudinal designs,
also reported positive outcomes from the use of
Five of the seven studies examined selection. They their respective methods.
explored the usefulness of realistic job previews,
the predictive validity of assessment centres, Management assessment centre scores attained
person–organisation fit measures as a selection 8 years previously (at the time of recruitment) were
tool, employee referrals as a hiring practice, and found to predict the level or position attained by
the use of weighted application blanks (WABs) for employees later in their careers.498
screening potentially successful candidates.
Person–organisation fit measures, when used as
Two further studies explored how perceptions a selection tool, reliably predicted the person–
of procedural justice in the selection process organisation fit of employees 2.5 years after the
could have important consequences for both the recruitment process and were positively related to
applicant and the organisation. their job satisfaction. High person–organisation fit
also reduced intention to leave the organisation.499
Outcomes
One study496 investigated the effectiveness of a Castilla496 found that using referrals from existing
recruitment strategy on employee productivity employees for hiring new workers was an effective
and turnover. Castilla496 looked at the relationship recruitment strategy, as workers hired in this way
between the productivity and turnover of were found to be more productive and to have
employees hired through referrals from current lower turnover than workers hired without such
employees, and the productivity and turnover of referrals.
employees hired without such references. Another
study looked at the predictive validity of the Browne et al.500 reported that use of WABs
screening process. improved the screening process used in hiring
police recruits. WABs were effective predictors of
All other studies investigated the impact of various the successful applicants. However, the authors
hiring and selection practices on the employee- gave no time period over which the study was
centric outcomes of turnover, trust and honesty, carried out. Given that the study did not have an
attitudes towards other employees and the experimental design and was carried out over a
organisation, commitment, job satisfaction, role single recruitment process, it would require further
ambiguity, organisational attractiveness, intention studies on a similar sample with similar tools to
towards the organisation, achievements of the arrive at any definitive conclusion.
selected employees later in their career, person–
organisation fit achieved at a later time, and The remaining two studies explored how
intention to leave. applicants’ perceptions of procedural justice of the
selection process and the treatment they received
Results at the test site influenced their attraction toward
The five studies that investigated the relationship the organisation and their intention to accept or
between specific recruitment and selection reject the offer.495,501 The study of Bauer et al.495
techniques all reported broadly positive impacts of was conducted on white-collar workers, whereas
these tools. The study by Meglino et al.497 on army the study by Maertz et al.501 was conducted on
recruits found that trainees exposed to combined blue-collar workers. However, both studies used
previews had significantly lower turnover. Trainees’ the same intervention, studied the same outcomes
exposure to combined previews was also found to and found similar results. They concluded that
be positively related to their perceptions of the applicants’ perceptions of procedural justice after
army as more caring, trustworthy and honest; selection tests had been taken but before pass–fail
they were more committed to the army, more feedback was given, predicted organisational-
satisfied with their jobs, and experienced less related outcomes, but had marginal or no effect on
155

156
TABLE 45 Staffing (recruitment/selection)

Meglino et Experimental Practices: No Turnover; trust and Commitment: Porter and Positive effect:
al. (1988)497 533 army Realistic job preview: honesty; caring; Smith (1970) 502 Trainees exposed to combined previews
USA personnel (enhancement preview vs commitment; Satisfaction: JDI (Hackman (enhancement + reduction preview) had
trainees reduction preview) satisfaction; role and Oldham, 1974)423 significantly lower turnover
ambiguity
5 weeks Moderators/mediators: Ambiguity: Rizzo et al. Trainees exposed to combined previews
Intelligence; initial commitment to (1970) 503 were found to be positively related to the
army Other variables were trainees perceiving the army as more caring,
measured by scales trustworthy and honest; they were more
developed by the authors committed to the army and more satisfied
with their jobs; and they experienced less

role ambiguity
It was also found that the previews were
more effective in reducing turnover among
more intelligent trainees and those initially
more committed to army
Bauer et al. Quasi- Practices: No Organisational Organisational Positive effect:
(1998)495 Experimental Perception of procedural justice in attractiveness; attractiveness was measured Procedural justice did explain incremental
USA design selection process intention toward the using the Macan et al. variance in the outcomes studied but it was
144 applicants organisation (1994)504 four-item scale the pass–fail feedback that explained most
3 weeks Intentions toward the of the variance
Feedback on passing or failing the organisation was measured
test using the Smither et al.
(1993) 505 three-item scale
Maertz et al. Quasi- Practices: No Organisational Organisational Positive effect:
(2004) 501 experimental Perception of procedural justice in attractiveness; attractiveness was measured The general pattern of findings is that
USA 170 blue-collar selection process intention toward the using Macan et al. (1994)504 procedural justice perceptions predict
workers organisation four-item scale organisational-related outcomes before
1 hour Intentions toward the pass-fail feedback is given; but procedural
Feedback on passing or failing the organisation was measured justice perceptions have marginal or no
test sing Smither et al. (1993) 505 effect on applicant attraction and intention
three-item scale after the pass–fail outcome is controlled
DOI: 10.3310/hta14510

Hinrichs Prospective Practices: No Achievements of the Position or level attained Positive effect:
(1978)498 longitudinal Management assessment centres selected employees was taken from company Assessment centre scores at the time of
USA 30 employees used as method of employee later in their career records selection were good predictors of later
selection measured by the personal achievements of the employees
8 years position/level they
Moderators/mediators: attain within their
None organisation
Chatman Prospective Practices: No Person–organisation Person–organisation fit: Positive effect:
(1991)499 longitudinal Measure of person–organisation fit; intention to Organisational culture A higher person–organisation fit at the
USA 171 auditors fit used as a selection method; leave; job satisfaction profile (O’Reilly et al. time of joining resulted in better person–
socialisation 1991)506 organisation fit at a later stage in the
10–12 months

Moderators/mediators: Satisfaction: Faces Scale organisation, which led to low intention to
(Kunin 1955) 507 quit and more job satisfaction
None
Castilla Prospective Practices: No Productivity; job Both data were taken from Positive effect:
(2005)496 longitudinal Employee referrals as a hiring turnover company records New workers hired using references from
USA 290 new hires practice current employees were more productive
2 years Moderators/mediators: and had lower job turnover than other hires
None
Browne et Prospective Practices: No Improvement in Screening records Positive effect:

al. (2005)500 longitudinal Use of WABs for screening predictive validity WABs scores successfully predicted
USA 229 police potentially successful applicants for of the screening whether an applicant will be finally selected
recruits final selection process for the police training programme
2 years Moderators/mediators:
None
157
applicant attraction and intention once pass–fail socialisation (as opposed to individual, informal,
feedback had been given. This suggests that test random, variable, disjunctive and divestiture
outcome favourability (passing or failing) predicts socialisation, which characterise individualised
organisational outcomes more consistently than do socialisation tactics).
perceptions of procedural justice. The studies used
quasi-experimental design and the findings were Details of studies
replicated across both time and different samples. Nine studies met the inclusion criteria (Table 46).
All of the studies were published in English. Eight
Omissions studies were conducted in the USA and one in
One study used employee performance the UK. Three studies used quasi-experimental
(productivity) as an outcome measure of the methods and six had a prospective longitudinal
recruitment and selection techniques. All other research design. Most of the studies were
studies concentrated on employee-centric conducted over a relatively short duration, with the
outcomes. As most selection tools and techniques shortest time period being 4 weeks and the longest
are designed for, and aim to, select employees who being 2 years. The sample size of these studies
are best suited for a given job, it was expected that varied from 61 to 661.
more longitudinal studies would be available on
this theme. However, this review found a paucity of HRM practice/intervention
longitudinal research on such relationships. All of the studies investigated the benefits of some
form of induction or orientation programme
Summary implemented by various organisations to initiate
There are seven studies in this review that their new employees.
investigated how various recruitment and selection
techniques impact on a range of employee and All but one study510 used the classifications of either
organisational outcomes. All but one of the studies Van Maanen and Schein508 or Jones,509 as described
used employee-centric variables as outcomes; only above. Cooper-Thomas et al.510 investigated
one study investigated the impact of using referrals the efficacy of a computer-based orientation
from existing employees on the productivity of new programme to impact on later socialisation of
employees. The results from three of these seven employees, their job satisfaction and organisational
studies were particularly strong as they were based commitment.
on experimental and quasi-experimental research
designs. Outcomes
All but one study511 investigated the impact of
Induction/Orientation various socialisation tactics on employee-centric
Most organisations provide some form of outcomes, including level of later socialisation, job
induction, orientation, or socialisation programme satisfaction, organisational commitment, newcomer
to new recruits. These programmes may be adjustment, stress, intention to quit, intention to
conducted in various ways, depending on the remain and achievement of person–organisation
requirements of the position and the organisation. fit. Ashforth and Saks511 investigated the impact
Van Maanen and Schein508 propose that different of socialisation practices on self-appraised
socialisation tactics produce different results in performance.
newcomers’ adjustments to their new roles. They
identify six dimensions of socialisation tactics, with Results
each dimension consisting of a bipolar continuum: The results of the studies in this section largely
collective–individual, formal–informal, sequential– supported the conclusion that socialisation
random, fixed–variable, serial–disjunctive, and practices achieve their intended effects.
investiture–divestiture.
• Five studies found a positive impact of
Other authors have used this classification and institutionalised socialisation tactics on job
have proposed different combinations of these six satisfaction.499,509–512
dimensions. Jones509 grouped the six dimensions • Institutional socialisation tactics were
in two sets and classified them as ‘Institutionalized also found to have a positive impact on
socialisation tactics’ and ‘Individualized organisational commitment.492,509,510,512,513
socialisation tactics’. Organisations that scored • Wesson and Gogus514 found that a computer-
high on institutionalised tactics use orientation based orientation programme had a negative
programmes that emphasise a collective, formal, impact on job satisfaction, organisational
158 sequential, fixed, serial and investiture form of commitment and levels of later socialisation.
• Studies by Waung,512 Jones509 and Chatman499 orientation programmes on given outcomes. Most
concluded that institutionalised socialisation of the studies had employee-centric outcomes
tactics had a positive impact on intention (e.g. job satisfaction, organisational commitment,
to remain with the organisation and, thus, person–organisation fit, and intention to remain)
reduced turnover. However, Waung512 found as the predicted variables of these socialisation
that providing relevant and potentially practices. Most of the research in this field
negative information about the job during centred on the classification of socialisation tactics
the process of orientation did adversely affect proposed by Van Maanen and Schein508 and
some new recruits, who left the organisation Jones.509 There was overwhelming support for the
in the first few weeks. Those who successfully positive impact of institutionalised socialisation
coped with the initial problems, and who used tactics over individualised tactics on various
the help provided during the orientation employee-centric outcomes.
programme, were more likely to remain with
the organisation. Work scheduling
• Person–organisation fit is another variable that Organisations use various forms of work scheduling
is related to socialisation tactics. Three studies to carry out their day to day activities. Some work
found vigorous socialisation, characterised schedules are driven by function, for example
by sequential, fixed, serial and investiture round-the-clock running of hospitals and factories,
characteristics, leads to better person– necessitating the use of shifts. Other forms of
organisation fit.499,510,515 work scheduling are intended to enhance the work
• Two studies researched the impact of experience of employees by, for example, making
institutionalised socialisation tactics on a more family friendly environment through HRM
later socialisation with other employees practices, such as flexitime and compressed work
in the organisation. Both found a positive weeks.
relationship between the two.493,512 The study
by Bravo et al.492 found that institutionalised Details of studies
socialisation significantly improved the Six studies met the inclusion criteria (Table 47). Five
relationship between new and old employees, studies were conducted in the USA and one was
leading to enhanced role clarity, and had a conducted in the UK. Three studies used quasi-
positive impact on workers’ career-enhancing experimental methods, and three had a prospective
strategies. longitudinal research design. The duration of the
• One study511 investigated the impact of studies varied from 2 weeks to 2 years. Sample sizes
socialisation tactics on employee performance varied from 68 to 1325 employees.
using self-rated performance as the dependent
variable rather than objective criteria. Ashforth HRM practice/intervention
and Saks511 found that although individualised All six studies focused on HRM practices that
socialisation tactics were not related to several govern employee work schedules. Practices covered
employee-centric outcomes, when contrasted in this section were the impact of flexitime,
with institutionalised socialisation tactics they compressed work week, monitoring the time of
did have a positive impact on self-perceived employees on job, temporary versus permanent
performance. employment and perception of procedural justice
of work schedule on various outcomes.
Omissions
The studies on induction and socialisation largely Outcomes
concentrated on employee-centric outcomes. There The various outcomes measured by the studies in
were no longitudinal studies that researched the this synthesis can be grouped into four categories:
impact of socialisation tactics on employee learning
and growth behaviour. There is also a dearth of • financial outcomes, including organisational
research on the impact of socialisation tactics on effectiveness and overtime costs
performance, with this review finding only one • customer or client outcomes, with one study
study based on self-rated employee performance researching quality of client service
that met the inclusion criteria. • employee performance, for example two
studies on work performance and one each on
Summary productivity and error rates
There are nine studies in this review investigating • employee outcomes, for example affective
the impact of various socialisation tactics and states of employees, sickness absence, personal
159

160
TABLE 46 Staffing (induction/orientation)

Waung Quasi- Practices: No Intention to Intentions to remain and job Positive effect:
(1995) 512 experimental Orientation programme remain; job satisfaction were measured using The orientation programme had a
USA design (experimental group received satisfaction; scales constructed by the authors positive impact on all the outcomes
61 new hires information warning of negative organisational Organisational commitment: in the long run
aspects of job and information commitment Mowday et al. (1979) 516
4 weeks
about specific coping behaviours
plus training in cognitive
restructuring and positive self-talk
and statements to bolster self-
efficacy as a part of the orientation
programme)
None
Klein and Quasi- Practices: No Level of later Level of socialisation: Chao et al. Positive effect:
Weaver experimental Orientation programme socialisation; (1994) 517 Orientation programme had a
(2000) 513 116 new hires organisational Organisational commitment: Allen positive impact on both level of
Moderators/mediators: commitment
USA 3 months and Meyer (1990)486 later socialisation and organisational
None commitment
Wesson Quasi- Practices: No Level of later Measure of socialisation: Chao et al. Negative effect:
and Gogus experimental Computer-based orientation socialisation; (1994) 517 Computer based orientation
(2005) 514 261 new hires programme organisational Job satisfaction: Hackman and programme led was negatively
USA commitment; job Oldham (1975)195 related to all of the three outcomes
5 months Moderators/mediators: satisfaction
None Organisational commitment: Allen
and Meyer (1990)486
Jones Prospective Practices: No Custodial role Scales for custodial role orientation Positive effect:
(1986) 509 longitudinal Socialisation tactics orientation; and intention to quit were devised Institutionalised socialisation has a
USA 102 new hires (institutionalised socialisation vs organisational by the authors positive impact on all four outcomes
individualised socialisation) commitment; Organisational commitment: Porter
5 months job satisfaction; Moderation effect:
Moderators/mediators: et al. (1974)244
intention to quit The effects are more pronounced
Self-efficacy Job satisfaction: Dunham and for individuals with lower self-
Herman (1975) 518 efficacy
Chatman Prospective Practices: No Person– Person–organisation fit: Positive effect:
(1991)499 longitudinal Socialisation organisation fit; Organisational culture profile Vigorous socialisation resulted in
USA 171 auditors intention to leave; (O’Reilly et al. 1991) 506 better person–organisation fit,
Moderators/mediators: job satisfaction
14 months Satisfaction: Faces Scale (Kunin low intention to quit and more job
None 1955) 507 satisfaction
Ashforth Prospective Practices: No Self appraised 519 Positive effect:
Role innovation: West (1987)
and Saks longitudinal Socialisation tactics performance; role Role ambiguity and role conflict: Institutionalised socialisation had a
(1996) 511 222 new (institutionalised socialisation vs innovation; role Rizzo et al. (1970) 503 positive impact on all the outcomes
DOI: 10.3310/hta14510
USA employees individualised socialisation) ambiguity; role investigated in the study

conflict; stress; Stress: Patchen (1970)490
10 months Moderators/mediators: intention to quit; Intention to quit: Colarelli (1984)488 However, self-appraised
None job satisfaction performance was more influenced
Job satisfaction: Cammann et al. by Individualistic socialisation tactics
(1983)485 rather than with the institutionalised
socialisation tactics
Cable and Prospective Practices: No Perceived person– Single-item scale (Cable and Judge Positive effect:
Parsons longitudinal Socialisation tactics: organisation fit; 1997) 520 Both person–organisation fit and
(2001) 515 101 new hires organisation and Reduced version of Organisational value congruence were positively
1. Content tactics (sequential and individual values
USA 2 years fixed rather than variable and Culture Profile (Chatman 1991,499 influenced by the content and social
congruence O’Reilly et al. 1991, 506 Cable and aspect socialisation tactics
random)
Judge 1997) 520
2. Social aspects (serial and
investiture rather than

disjunctive and divestiture)
None
Bravo et al. Prospective Practices: No Career-enhancing Bachman et al. (1978)493 Positive effect:
(2003)492 longitudinal Socialisation tactics strategies; Career strategies inventory (CSI; Institutional socialisation had a
USA 661 new hires (institutionalised socialisation vs immediate and Penley and Gould 1981)494 positive impact on relations with
individualised socialisation) intermediate superiors, co-workers and enhanced
2 years adaptive strategies
Moderators/mediators: role clarity; this, in turn, had a
positive impact on the workers’
Relations with superiors; relations career enhancing strategies
with co-workers; role clarity
Cooper- Prospective Practices: No Actual person– Single-item scale (Chatman 1991)499 Positive effect:
Thomas et longitudinal Socially orientated socialisation organisation fit; Single-item scale (Cable and Judge The socialisation tactics positively
al. (2004) 510 129 employees tactics (investiture, serial and perceived person– 1997; 520 Saks and Ashforth 1997) 521 influenced perceived person–
UK mentoring) organisation fit; organisation fit, job satisfaction, and
5 months job satisfaction; Job satisfaction: Single-item scale
Moderators/mediators: organisational climate
organisational Nine-item scale from OCQ
None commitment (Mowday et al. 1979) 516 No effect:
There was no impact of socialisation
tactics on actual fit
161
leave and job satisfaction. Of the employee- The other scheduling and staffing issue
centric outcomes, there are three studies each investigated in studies was the perceived
on absence and job satisfaction. procedural justice of work schedule. Posthuma
and Campion526 found that perceived procedural
Results justice in work assignments and work schedule
Two studies of flexitime used quasi-experimental was positively related to employees giving
design. A study by Narayanan and Nath522 reported their permission for their names to be used in
that the effects of flexitime and introduction recruitment advertisements.
of time monitoring devices on employees were
moderated by the hierarchical position of Omissions
employees in the organisation. For employees at Although there were no notable omissions, it is
lower levels (non-exempt employees), flexitime had difficult in this synthesis to draw any evidence-
a beneficial impact on their social relationships and based conclusions about the impact of a given
enhanced their flexibility. However, there was no practice on a given outcome because the papers
impact of flexitime on professionals, except a trend considered are heterogeneous, focusing on
towards deterioration in superior–subordinate different aspects of the work schedule and on
relationships. The professionals resented the different outcomes. Therefore, the evidence cannot
introduction of punch cards and preferred to be synthesised into a single bottom-line conclusion.
negotiate work schedules with colleagues and Given the prevalence of the organisational use
managers on an informal basis. For managers, the of flexitime, compressed work week, and shift
introduction of flexitime had no impact on any work, it was anticipated that there would be more
of the outcomes. Job satisfaction was found to be longitudinal research on these variables. However,
unrelated to the use or non-use of flexitime in the this review found relatively few longitudinal studies
organisation. In contrast, the study by Dunham in this area.
et al.523 found that use of flexitime along with
compressed work week led to reports of greater Summary
organisational effectiveness, with employees The six studies in this review researched how
exhibiting positive reactions towards both practices. different forms of work schedules (flexitime,
compressed work week, shift work and perceived
Latack and Foster524 using quasi-experimental procedural justice of assigning work schedule)
design, suggested substantial organisational impact on various employee and organisational
gains including reduced sickness–absence costs, outcomes. Only flexitime and compressed work
overtime costs, and personal leave time, as a week were studied by two papers; all other
result of using compressed work weeks. However, practices were examined by only one study. A wide
use of a compressed work week had no effect on range of outcomes was investigated, including
either job satisfaction or error rates. The study financial outcomes in the form of overtime costs,
also investigated the interaction of participative customer outcomes such as quality of client
decision-making in the adoption of a compressed service, performance outcomes (e.g. error rates,
work week, and concluded that such participation productivity and work performance) and employee
has a positive impact on satisfaction with the outcomes in the form of affective employee states,
work schedule but not on other outcomes, such as job satisfaction and sickness–absence rates. The
sickness–absence costs, overtime costs and personal results of this section cannot be presented in an
leave. additive manner as the practices and outcomes
studied are varied. Hence, each study needs to
Markham et al.525 investigated the impact of shift be considered in isolation. More longitudinal
work on the absence behaviour of employees, research needs to be undertaken to arrive at a firm
concluding that all four factors (the shift and three conclusion as to how each of these practices can be
temporal factors of year, season and day of the reliably linked to achieving a given outcome.
week) combine to account for 17% of the variance
in absenteeism. Though no main effects were found Training and development
for the impact of shift time on absenteeism, there
were significant temporal effects on absenteeism. Studies in this section provide evidence on the
Also, temporal effects of year, season and day of various forms of training and development
the week interacted with shift timings to have practices in organisations. This review found the
significant effects on employee absenteeism. following subclusters in the longitudinal studies
conducted on these variables:
162
TABLE 47 Staffing (work scheduling)

Narayanan Quasi- Practices: No Productivity; flexibility; IJS (Brayfield and Rothe Hierarchical level moderates the impact
and Nath experimental Introduction of flexitime at three social relations at workplace; 1951)245 of flexitime on given outcomes
(1982) 522 design job satisfaction
DOI: 10.3310/hta14510
levels of management (non- For non-exempt employees:

USA 68 employees at exempt employees, i.e. lower-level 1. In case of non-exempt employees,
the three levels of employees; professionals; and flexitime had the intended effect of
management managers); introduction of time- enhancing flexibility, improvements in
9 months keeping devices (punch card) social relationships at workplace
Moderators/mediators: 2. There was no effect of flexitime on job
Hierarchical level of the employees satisfaction of non-exempt employees
For professionals:
1. There was no impact of flexitime on
professionals, except a trend towards
deterioration in superior–subordinate
relationship. The professionals
resented against introduction of punch
cards and preferred to negotiate work

schedule with colleagues and managers
on an informal basis
For managers:
1. Introduction of flexitime had no impact
on any of the outcomes
Latack Quasi- Practices: No Overtime costs; error rates; JDI (Smith et al. 1969)243 Positive effect:
and Foster experimental Compressed work week (work job satisfaction; satisfaction The data suggests substantial
(1985) 524 84 Information schedule: 3 days, 38 hours) with the work schedule; organisational pay-offs, including
USA systems absenteeism; personal leave reduction in sick time costs overtime
Participation in decision to adopt time
professionals the compressed work week costs and personal leave time
18 months Moderators/mediators: Those involved in decision to adopt
compressed work week expressed
None greater satisfaction with the work
schedule
No effect:
There was no effect of compressed work
week on either their job satisfaction or
error rates
continued
163
164
TABLE 47 Staffing (working schedule) (continued)

Dunham et al. Two quasi- Practices: No Organisational effectiveness: Dunham and Pierce (1986):527 Positive effect:
(1987) 523 experimental First Study: Compressed work work performance; work Work schedule scales Non-parametric tests showed that
USA studies week (change from 5/40 to 4/40 coordination; quality of Pierce and Newstrom compressed work week (4/40 schedule)
First study, 84 work week schedule) client service (1982):528 Work schedule led to improvement in organisational
employees; Second Study: Flexible work General worker reaction: attitudes effectiveness measures; flexible work
second study, 102 schedule general job satisfaction; Kunin (1955); 507 Dunham schedule also had similar results. The
employees leisure time satisfaction; and Herman (1975):518 Work workers under compressed work week
Moderators/mediators: organisational commitment; and flexible work schedule also exhibited
First study, 4 satisfaction faces scale
months; second None job involvement; intrinsic positive worker reactions to the changed
Minnesota Satisfaction
study, 6 months motivation; fatigue; schedule

physiological stress; and Questionnaire (Weiss et al.
1967)473 However, both studies reported a
psychological stress statistically insignificant reduction
in work coordination as a result of
compressed work week and flexible work
schedule
Markham et Prospective Practices: No Absenteeism Absenteeism data were taken Positive effect:
al. (1982) 525 longitudinal Shift work (day, afternoon, and from company records All four factors (the shift and three
USA 1325 hourly paid night); temporal effects: year; temporal factors) combine to account for
workers season (winter, spring, summer and 17% of the variance in absenteeism
2 years fall); day of the week Temporal effect:
Moderators/mediators: Temporal effects of year, season and day
None of the week interact with shift timings
to have significant effects on employee
absenteeism
No effect:
No main effects were found for the
impact of shift time on absenteeism
DOI: 10.3310/hta14510

Posthuma Prospective Practices: No Permission to use employees Survey of employees who Positive effect:
and Campion longitudinal Perceived procedural justice of: name in recruitment took part in the study Perceived procedural justice in work
(2005) 526 198 nurses work assignment; work schedule; advertisements assignments and work schedule was
USA 2 weeks pay raises positively related to giving permission
Moderators/mediators: by the employees to use their names in
recruitment advertisements
None
Parker et al. Prospective Practices: No Perceived work Perceived work Temporary employment had both
(2002) 529 longitudinal Temporary vs permanent characteristics by the characteristics: negative and positive consequences:

UK 458 employees employment employees; job strain Role overload: Caplan et al. Positive effect:
18 months Moderators/mediators: (1975) 530 Temporary workers had fewer strain-
None Role conflict: Rizzo et al. inducing role demands (in particular
(1970) 503 lower work overload)
Job strain: Warr (1990)445 Negative effect:
Temporary status reduced perceptions
of job security and participative decision-
making
IJS, Index of Job Satisfaction.

165
• performance and skill enhancement training in performance or relevant skills as outcome

• career or employee development training variables. The outcomes studied in this subcategory
• cultural sensitivity training were rating efficiency, leadership and its impact
• socialisation training to understand on subordinates’ self-efficacy, interpersonal
organisational culture discrimination and communication skills,
• total quality management training. housekeeping skills and time management.
Details of studies Six studies34,149,531–534 examined training and

Twenty-five studies met the inclusion criteria development alongside various other practices.
(Table 48). Thirteen of these studies were conducted These studies had multiple outcomes and
in the USA: seven in the UK, and one each in ranged from investigation of the impact of HRM
Sweden, France, Israel, Finland, and Canada. Two practices on organisational performance at large
studies used a complete RCT experimental design, to employee outcomes, for example employee
11 studies used quasi-experimental methods, 10 satisfaction and labour turnover.
had a prospective longitudinal research design,
and three studies used a retrospective longitudinal Studies on career or employee development
design. The duration of the studies varied from training programmes had the following variables
4 weeks to 20 years. The sample size of these as outcomes: career self-management activity,
studies varied from 20 to 1091 employees. employee career satisfaction, participation in
self-development training programmes, and
HRM practice/intervention perceptions of employee psychological contract.
Studies on the impact of training to enhance
employees’ performance or skill set were the The impact of cultural sensitivity training
single largest subcategory within the training and programmes was measured by the extent of
development category. There were 13 studies differential treatment of culturally different
that looked at how various forms of training, for individuals and effective employee mindset towards
example training on psychometric errors in ratings, acquisition.
competency-based HRD counsellor training,
teacher training programme, training in reflective Research in training for organisational socialisation
communication, time management training and looked at the following outcomes: intention
skill enhancement in general. to remain, job satisfaction, organisational
commitment, academic self-efficacy, intention to
Four longitudinal studies assessed the impact of quit the organisation and the profession, ability to
career enhancement training for employees. The cope and job performance.
specific practices investigated were career self-
management training, management support for Studies of TQM training measured outcomes such
self-development initiative (career workshops, as teamwork, quality level, financial performance
development workbooks and guides, and PDPs), and RBSE.
and lifelong learning and training programmes.
Results
There were two studies of training to increase Performance and skill enhancement
employees’ awareness of cultural issues in a training
culturally diverse work environment. Of the 13 studies in this category, 10 found that
training helped to improve the targeted skill sets
Three studies considered training employees to and employee performance. Ivancevich535 used
better understand the existing organisational a full experimental design to show that intense
culture and integrate well with the rest of the training compared with mere discussion or no
workforce. training, helped reduce errors. Similarly, studies
by Cash and Vellema,536 Rautalinko and Lisper,537
Four studies looked at training employees in Leivo,538 Green and Skinner,539 Adam,531 and Price
preparation for TQM being implemented at the and Mueller532 concluded that training leads to a
organisation. range of positive results, for example improvement
in communication skills, job performance,
Outcomes planning and prioritising. At the organisational
Studies under the subcategory of performance level, general skill enhancement was associated
and skill enhancement measured improvement with reduced labour turnover, in organisational
166
performance (e.g. productivity and profitability) satisfaction, ability to cope with the new place and
and reduced long-term costs.149,533,534 job performance.512,548,549
However, two studies reported non-effects of TQM training

training. A study by Eden et al.540 consisting of Four studies looked at TQM training, two of
seven field experiments, failed to find any evidence which looked directly at training prior to the
of the efficacy of a specific form of leadership introduction to TQM practices. The way in which
training and concluded that such training had TQM was implemented and the purpose of its
no effect on either leaders or their followers. introduction varied greatly between the studies.
Similarly, Jacob and Lefgren541 found that marginal The study by Coyle-Shapiro550 concluded that
increases in the in-service training of teachers had TQM intervention does not have a significant
no statistically or academically significant effect direct effect on changes in teamwork; employees’
on the reading or mathematical achievements of perceptions of the training are more important
elementary school children in high-poverty schools. than actual participation in the intervention.
Thus, if employees perceive the intervention to be
Career or employee development beneficial and appropriate, and their supervisors
training reinforce its importance, positive changes to
Providing training to employees for their own intermediate variables such as trust in colleagues,
career development led to positive employee supervisory satisfaction, and improvement in
reactions and better outcomes, for example general commitment to quality, are more likely.
employee career satisfaction, participation Of these hypothesised mediating variables, it
in self-development training programmes, was only trust in colleagues that was found to be
and perceptions of employee psychological further predictive of teamwork. Other than trust
contract.542–544 in colleagues, the intermediate variables that were
found to influence teamwork were satisfaction with
Kossek et al.,545 however, found that such training colleagues, and quality awareness.
efforts were not successful in increasing employees’
tendencies to engage in career self-management The study by Murray and Raffaele551 found good
activities. support for the impact of TQM training and
implementation on both quality level and dollar
Cultural sensitivity training utility value of the training programme.
Studies on the impact of training employees with
the intention of improving their sensitivity to other When these two studies are viewed together, they
cultures have mixed results. The study by Sanchez provide valuable information on the mechanism
and Medkik546 concluded that providing cultural through which TQM can influence a final outcome,
diversity training did not result in a straightforward for example quality improvement.
improvement in employees’ cultural sensitivity;
the ethnicity of the co-worker interacted with The other two studies in this category did not
the training received, such that trainees received use TQM per se but explored the impact of
higher ratings of differential treatment from training in quality management and the impact
non-white co-workers than did matched controls. of participation in improvement groups on an
Schweiger and Goulet547 reported positive individual’s RBSE.454,458 Both studies concluded
training outcomes leading to change in employee that membership of improvement groups had a
mindset by using a ‘deep-level cultural learning’, positive impact on an individual’s RBSE.
intervention, characterised by creating an ongoing
dialogue between partners on cultural awareness Omissions
and cultural introspection. Training and development of employees has
always been a much investigated area of research.
Socialisation training to understand However, the present review finds that there
organisational culture is still a very limited number of studies with
There were three longitudinal studies in this longitudinal design on the efficacy of these
section, all of which found positive impacts of training programmes. For example, organisations
socialisation training on employee outcomes, expend considerable resources on programmes
including intention to remain, organisational such as executive MBA qualifications; however,
commitment, professional commitment, job the review did not find any research on how such
167

an investment leads to better organisational or The duration of the studies varied from 2 weeks
employee performance. to 20 years. The sample size of these 29 studies
varied from 38 to 3355 employees. Six studies
Summary reported data from organisations as a whole; one
There are 26 studies in this review on training and investigated four plants, one had data from five
development. Two studies used a RCT method, federal offices of the USA, one had data from 20
10 used a quasi-experimental design, 12 used a local and regional federal offices of the USA, two
prospective longitudinal design and two used a investigated five units of a single organisation, and
retrospective longitudinal design. The studies one used organisational data from 42 different
in this section can be grouped in five major firms.
categories; performance and skill enhancement
training, career or employee development training, HRM practice/intervention
cultural sensitivity training, socialisation training All studies used one of the four types of
to understand organisational culture, and TQM compensation and reward systems intended to
training. Each study used a distinct outcome achieve various types of outcomes mentioned
relevant to the training being provided. Overall, above.
the results indicated that training predicted desired
impacts, both at the individual and organisational • Eight studies on incentive plans investigated
level, and provides worthwhile return on how various types of financial incentives,
investment. However, the review found a lack of bonuses, ESOPs and gain-sharing could achieve
longitudinal research on the efficacy of the high the desired outcomes.
expenditure training programmes, for example • Nine longitudinal studies were found on merit
executive MBA, used by organisations to up-skill pay, performance-related pay, earnings-at-risk
their employees. pay plans and employees’ perceptions of fair
pay. These studies focused on the use of pay or
Compensation and rewards rewards based on employee performance, and
showed the relative merits and demerits of the
Organisations use various types of compensation various plan types.
and reward plans as instruments for influencing • There were four studies on the impact of
numerous objectives of vital organisational interest. promotion as an incentive for achieving the
In this review, the types of compensation and desired outcomes.
reward systems that have been investigated by the • Finally, this section also contains eight studies
researchers using longitudinal design are: that used a combination of various HRM
practices along with an incentive plan to
• various types of incentive plans, bonuses, achieve given outcomes.
employee stock option plans (ESOPs) and gain-
sharing Outcomes
• merit-based pay, performance-related pay, A wide range of outcomes were measured in these
earnings-at-risk plans and perceptions of pay 29 studies. Employee performance in one form or
fairness. the other was the most studied outcome, with 14
studies investigating job performance and three
Promotions studies concentrating on productivity gains as a
Combinations of compensation and rewards with result of compensation and incentive plans. Job
various other HRM practices. turnover or intention turnover was the other major
outcome of interest in this area. Five studies had
Details of studies job turnover as an outcome and two had intent to
Twenty-nine studies met the inclusion criteria turnover as the dependent variable. Absenteeism
(Table 49). Twenty-three of these studies were was studied in three research papers.
conducted in the USA and one each in France,
Hong Kong, Ireland, India, Israel and the Other dependent variables investigated were bonus
UK. One study used experimental design with or pay satisfaction, organisational commitment,
full randomisation, eight studies used quasi- occupational commitment, intrinsic motivation, job
experimental methods, thirteen had a prospective involvement, job satisfaction, job anxiety, physical
longitudinal research design and seven used a health and mental health.
retrospective analysis of longitudinal data sets.
168
TABLE 48 Training and development
Study, Design, sample size, Practice(s)/intervention(s);

Ivancevich Experimental design Training on psychometric errors No Rating efficiency (minimise Rating efficiency Positive effect:
(1979) 535 66 supervisory in ratings (three groups: intense halo and leniency errors in measure devised by the Intense training helped reduce errors.
DOI: 10.3310/hta14510
USA engineers training, discussion group and no ratings) authors Results were more pronounced after
training group) 6–12 months of training
18 months
Eden et al. Seven field Pygmalion Leadership Training No Improvement in leadership Trainees rating of their No effect:
(2000) 540 experiments: six using Workshop (Pygmalion effect such that it will augment leader There was little evidence that
Israel experimental design being a special case of self- subordinates self-efficacy leadership training workshops
and one using quasi- fulfilling prophecy in which raising influenced either the leaders or their
experimental; sample leader expectations regarding followers
of each experiment was subordinate achievement produces
different and were very an improvement in performance)
diverse, for example
army personnel, youth
training camps, blue
collar supervisors,
school principles,

banking staff, and
service mangers in
a large government
hospital
Each experiment had a
different time duration
Cash and Quasi-experimental Different types of training No Interpersonal discrimination Communication and Positive effect:
Vellema 79 graduate and techniques: Competency based and communication skills discrimination indices Competency-based training was
(1979) 536 undergraduate students HRD counsellor training vs (Carkhuff 1971) 552 better at improving interpersonal
USA conceptual-based HRD counsellor discrimination and communication
14 weeks training skills
Jacob and Quasi-experimental In-service teacher training No Maths and reading Maths and reading: Iowa No effect:
Lefgren 461 schools programme performance of elementary Tests of Basic Skills Marginal increase in in-service
(2004) 541 students (ITBS) training of teachers has no statistically
3 years
USA or academically significant effect
on reading or math achievement of
elementary school children in high-
poverty schools
continued
169
170
TABLE 48 Training and development (continued)

Rautalinko Quasi-experimental Training in reflective No Reflective learning Observation of Positive effect:
and Lisper 21 insurance agents communication responses The training recipients’ exhibited
(2004) 537 better reflective learning, i.e.
5 months
Sweden understand what it is the sender is
feeling or what his message means;
then he puts his understanding into
his own words and feeds it back for
the sender’s verification; the learning
was transferred to real-life setting
Leivo Quasi-experimental 1. Feedback No Improvement in Objective measures of Positive effect:
(2005) 538 Three road 2. Training housekeeping house-keeping The house-keeping performance
Finland maintenance areas and improved in all units and was
one garage maintained over 3- to 4-year period
3–4 years even after gradual termination of

feedback
Green and Prospective longitudinal Time management training No Improvement in relevant Key Skill Questionnaire Positive effect:
Skinner 134 employees skill areas of the trainee (KSQ) developed by the Significant improvement in the key
(2005) 539 authors skill areas for example planning,
7 months
UK prioritising and assertiveness
Adam Quasi-experimental Behavioural and attitudinal No Change in attitudes (job Attitude: Job Mixed results:
(1981) 531 153 pick-up and change procedures introduced: 1. satisfaction) satisfaction with The training intervention led to
USA delivery truck drivers operations changes, 2. feedback Customers attitude toward various facets of improvement in work outcomes. For
of a single company sessions the driver and drivers the organisation, example lowered labour turnover,
attitude towards the modification of JDI operating efficiency and profitability;
18 months (Smith 1967) 553
customer however, the intervention failed
Labour turnover Operating efficiency: to change the employees’ negative
Costs and net Profit attitude toward the company
Absenteeism
Operating efficiency
Profitability
Price and Prospective longitudinal HR practice: Training; pay; No Labour turnover Company data Positive effects:
Mueller 1091 non-supervisory promotional opportunity Promotional and training
(1981) 532 RNs opportunities had a positive impact
USA 14 months on labour turnover
No effect:
Pay itself had no direct effect on job
turnover
D’Arcimoles Retrospective Various HR Practices: No Economic performance Return on assets Positive effect:
(1997) 533 longitudinal Compensation; training; Productivity Training had a lagged positive effect
France 42 firms recruitment and dismissals; social on a firm’s economic performance
climate
5 years No effect:
DOI: 10.3310/hta14510
Source: Social data set ERMES

Compensation by itself had no effect
on a firm’s economic performance
Cappelli and Retrospective Various HRM practices: TQM; No Sales per worker; total National Employees Positive effect:
Neurmark longitudinal self-managed or autonomous labour costs per worker; Survey (NES) data The study concludes that HPWPs
(2001)149 Survey data from teams; regular meetings to discuss inverse of unit labour costs Census Bureau’s LRD raise labour costs per employee,
USA different periods: work-related problems (quality (ratio of sales per worker data suggesting that they may raise
circles); teamwork training; job and total labour costs per employee compensation. The study
1977–93 panel: n = 433 rotation; cross-training; pay-for- worker) reports statistically weak evidence
1993–6 panel: n= 205 skill programmes; gain-sharing/ between the use of these practices
1977–96 panel: n = 666 profit-sharing; benchmarking; and productivity. The authors
computer use by employees concluded that HPWPs have little
20 years
effect on overall labour efficiency
Vogus and Prospective longitudinal Employment of skilled temporary No Financial performance Financial performance: Positive effect:
Welbourne employees Stock price

184 firms Intensity of innovation HRO firms (characterised by
(2003) 534 Positive employee relations Innovation: No. of employing skilled temporary workers,
3 years
USA Emphasis on training to innovate patents positive employee relations, and an
emphasis on training to innovate)
(the authors describe the innovated more frequently and had
combination of these three higher stock prices over time
practices as High Reliability
Organisations: HROs)
Patterson et Prospective longitudinal Practices: Yes Performance (productivity Audited government Positive effect:
al. (2004)34 80 firms (varying in size Integrated manufacturing and and profitability) records Job enrichment and skill enhancement
UK between 60 and 1150 empowerment (job enrichment, Productivity – measured have a positive impact on both
employees) skill enhancement advanced as the logarithm of the productivity and profitability
2 years manufacturing technology, total financial value of net Productivity is a mediator of the
quality management, JIT inventory sales per employee (see relationship between job enrichment/
control) Huselid 1995)18 profitability and skill enhancement/
Moderators/mediators: Profit – measured as profitability
Productivity the financial value of
sales less costs per
employee, before
profits tax
continued
171
172

Yarnall Prospective longitudinal Management support for self- No Employee career Career satisfaction: Positive effect:
(1998) 542 281 employees development initiative (career satisfaction; participation in six-item measure Employee career satisfaction was
UK workshops, development self-development training devised by the authors positively influenced by the training
20 months workbooks and guides and PDPs) programme programme, but the programme had
no impact on their participation in
this programme
Sturges et al. Prospective longitudinal Career management: Self- No Organisational commitment Organisational Positive effect:
(2001) 543 212 graduate employees management and management by is outcome of organisational commitment (Cook and Formal career management activities,
UK the organisation career management but also Wall 1980) 554 for example training and development
12 months determinants of career self- are associated with increased
management organisational commitment
Martin et al. Retrospective Lifelong learning and training No Perceptions of employee Questionnaire Positive effect:
(1999) 544 longitudinal programme psychological contract developed by the There is a positive relationship
UK 20 employees authors between lifelong learning programme

4 years and employee perceptions of careers,
fairness and certain other key
elements of psychological contract
Sanchez Quasi-experimental Cultural diversity awareness No Extent of differential Co-workers appraisals Interaction effects:
and Medkik 125 managers and training treatment of culturally of differential There was an interaction between
(2004) 546 supervisors different individuals treatment, measured training and co-worker’s ethnicity,
USA with a revised version such that trainees received higher
12 months of the discrimination ratings of differential treatment
scale (Sanchez and from non-white co-workers than did
Brock 1996) 555 matched controls
Schweiger Quasi-experimental Deep-level cultural learning No Effective employee mindset 1. Ashford et al. Positive effect:
and Goulet Six plants (236 interventions as compared with towards acquisition (1989) 556 DCL interventions were found to
(2005) 547 employees) surface and non-cultural learning (attitudes): 2. Mowday et al. develop constructive employee
USA interventions 1. Trust in combination (1979) 516 perceptions and attitudes
10 weeks
management 3. Created by the
2. Commitment to author
combined organisation 4. Chatterjee et
3. Understanding of al. (1992) 557 and
combining partner’s Lubatkin et al.
culture (1999) 558
4. Cultural differences 5. Created by the
between combining firms author
5. Communication between 6. Devised by the
combining firms authors
6. Acceptance of combining 7. Devised by the
partner’s culture authors
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7. Cooperation between
combining firms
Waung Quasi-experimental Practices: No Intention to remain; job Intentions to remain Positive effect:
(1995) 512 design Orientation programme satisfaction; organisational and job satisfaction The orientation programme had a
USA 61 new hires (experimental group received commitment were measured using positive impact on all the outcomes in
information warning of negative scales constructed by the long run
4 weeks the authors
aspects of job and information
about specific coping behaviours Organisational
plus training in cognitive commitment: Mowday
restructuring and positive self- et al. (1979) 516
talk and statements to bolster
self-efficacy as a part of the
orientation programme)

None
Tannenbaum Prospective longitudinal Socialisation type training No Organisational commitment; Mowday scale (1982);173 Positive effect:
et al. 666 military trainees academic self-efficacy; McIntire and Levine Training fulfilment was positively
(1991) 548 physical self-efficacy; (1984);559 McIntire and related to post-training attitudes
8 weeks training motivation
USA Levine (1984);559 scale
adapted from Lawler
(1981) 560
Saks Prospective longitudinal Amount of training; perceived No Job satisfaction; JS: Hackman and Positive and mediation effects:
(1996) 549 152 newly hired entry- helpfulness of the training organisational and Oldham (1980);431 The amount of training received by
Canada level accountants Mediator: Anxiety professional commitment; commitment: Mowday, newcomers was significantly related
intention to quit the et al. (1979);516 to job satisfaction, commitment,
10 months organisation and profession; intention to quit: intention to quit, ability to cope and
ability to cope; job Colarelli (1984);488 job performance. In addition, anxiety
performance ability to cope: was found to mediate the relationship
House et al. (1982); 561 between training and ability cope,
job performance: and partially mediate training
supervisor ratings relationships with job satisfaction,
commitment and intention to quit
continued
173
174

Coyle- Prospective longitudinal TQM: No Outcomes measured using Teamwork: own Positive effect:
Shapiro 165 employees Participation in the intervention questionnaires: teamwork; scale; trust in Assessment/perception of
(1995) 550 other intervening variables: colleagues (Cook intervention by the employees has
16 months Perceived benefit of the and Wall 1980);554
UK intervention Trust in colleagues positive impact on certain intervening
perceived colleague’s variables, for example supervisory
Perceived appropriateness of the Perceived colleague’s and and management’s
management’s commitment participation, and improvement in
intervention commitment to quality: general commitment to quality
to quality own scale; satisfaction
Reinforcement of intervention by Reinforcement of the intervention by
the supervisor Satisfaction with colleagues with colleagues
(Warr et al. 1979475 the supervisor has positive impact on
Supervisory participatory
– job satisfaction trust in colleagues, which, in turn, has

style positive impact on teamwork
scale); supervisory
Improvement in No effect:
participatory style: own
commitment to quality
scale; improvement Participation in the intervention has
Participation in TQM in commitment to no effect on any of the intervening
intervention quality: own scale; variables or the final outcome of
Perceived benefit and participation in TQM teamwork
appropriateness of intervention: own
intervention scale; perceived benefit
and appropriateness
of intervention: own
scale; supervisor
reinforcement of
intervention: own scale
Murray and Quasi-experimental Quality-awareness training No Quality level; dollar utility Percentage of good Positive effect:
Raffaele (interrupted times (Crosby quality training pieces following a TQM training had a positive impact
(1997) 551 series design) programme) production process; on quality level and also led to
USA Plant-level study reduction is dollar value eduction in waste
of the scrap material
5 years
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Parker Prospective longitudinal Practices: No RBSE RBSE scale was Positive effect:
(1998)454 459 employees Communication; job enlargement designed by the author Membership of improvement groups
UK 18 months (measured as the horizontal had a positive impact on RBSE
range of the jobs); job enrichment
(measured as jobs high on
autonomy and control); training
(on quality management)
None
Axtell and Prospective longitudinal Practices: No RBSE RBSE scale was Positive effect:

Parker 94 employees Communication briefs (frequency designed by the author Membership of improvement groups
(2003)458 with which communication briefs had a positive impact on RBSE
18 months
UK were given to the employees); job
enlargement (measured as the
horizontal range of the jobs); job
enrichment (measured as jobs
high on autonomy and control);
training (on quality management)
None
HRO, High Reliability Organisation; LRD, Longitudinal Research Database.

For National Employees Survey (NES) data, see Cappelli P. The National Employer Survey: employer data on employment practices. Industrial Relations 2001;40:635–47.
175
176
TABLE 49 Compensation and rewards

Fairbrother et Experimental Incentives: Financial bonus; No Immunisation Up-to-date immunisation status Positive effect:
al. (1999) 562 design enhanced fees for immunisation performance among as reflected in the patients’ Bonuses sharply and rapidly
USA 60 paediatricians Feedback: Feedback on physicians medical charts increased immunisation coverage
12 months immunisation coverage rates in Percentage of visits in the
New York city compared with previous 4 months that were
peers missed opportunities to
immunise
Percentage of vaccinations
received outside the practice
Petty et al. Quasi- Organisational incentive plan No Productivity; Company records survey Positive effect:
(1992) 563 experimental performance; designed for the authors Organisational incentives led to
employee perceptions
USA 1205 employees better performance on all dependent

of behaviour for parameters
8 months example teamwork,
trust and credibility,
performance and goals,
and organisational
functioning
Welbourne Quasi- Gainsharing: (bonus formula for No Pay satisfaction Four-factor scale (Heneman Interaction effect (gain-sharing ×
and Cable experimental the two firms differed; in firm A, 1985) 580 distribution rule):
(1995) 579 360 bank tellers bonus was conditional on achieving In firm A, where bonus was based on
USA a critical level of customer equal distribution rule, gain-sharing
18 months satisfaction and the firm employed was viewed as a benefit and in this
equal distribution rule; in firm B, firm gain-sharing was unrelated to
bonus was conditional on meeting pay satisfaction
a given level of safety standard and
it used a equity-based distribution In firm B, where bonus was based
rule, i.e. employees received bonus on equity rule and individual
as some percentage of their basic performance, thought of gain-sharing
pay rather than an equal bonus) as a part of their pay and their pay
satisfaction was affected by the gain-
sharing programme
Rusbult Prospective Rewards (high vs low) No Job satisfaction; job Job satisfaction: Quinn and Positive effect:
and Farrell longitudinal commitment; turnover Shephard (1974);582 commitment Greater rewards induce greater
(1983) 581 88 newly hired (Rusbult 1980) 583 employee satisfaction and greater
USA accountants commitment
12 months
584 Prospective Incentives No No. of recruits enlisted Organisational data Positive effect:
Asch (1990)
USA longitudinal Recruiters generally enlisted more
125 Navy recruits as the date of their eligibility
recruiters for incentives approached and the
DOI: 10.3310/hta14510
5 months number fell once the incentives had

been obtained
Buchko Prospective ESOPs No Employee attitudes; Employee satisfaction Positive effect:
(1992) 564 longitudinal employee turnover questionnaire (Rosen et al. Employees with greater perceived
USA 218 employees behaviour 1986) 585 – 15-item scale OCQ influence in the organisation as a
(Mowday et al. 1979) 516 result of the ownership programme
3 years
Two of the three items of and those with greater financial
the Michigan Organisational value in the programme were more
Questionnaire (Cammann et al. satisfied with the programme, more
1983)485 committed to the organisation, and
had lower turnover intention
Arthur and Retrospective Gainsharing: (combining of No Grievance rates Company records Positive effect:
Jelf (1999) 565 longitudinal plant-wide bonuses with a Absenteeism Adoption of Scanlon type gain-
USA 1600 employees comprehensive employee sharing plan led to improved

involvement programme) union–management relationship
7.5 years
as measured by reduction in both
grievance rates and employee
absenteeism
Bhattacherjee Retrospective Group incentives (plant level No Productivity Company records Interaction effects:
(2005) 566 longitudinal vs departmental level incentive Productivity returns to incentives
India Four Plants schemes) are non-linear and concave in shape
10 years Department level incentive scheme
is associated with significant
productivity returns, whereas plant
level incentive scheme is associated
with negative effects on worker
productivity
Yukl and Quasi- Reinforcement schedules with No Performance Piecework Positive effect:
Latham experimental incentive magnitudes (various Productivity was highest in the
(1975) 567 38 marginal contingent bonuses: continues continuous reinforcement condition
USA workers reinforcement, variable ratio)
6 month
continued
177
178
TABLE 49 Compensation and rewards (continued)

Pearce Prospective Merit pay No Employee attitudes Semi-structured interviews No effect:
and Perry longitudinal Federal managers do not appear to
(1983) 586 Five federal be more motivated under merit pay
USA government than under the previous time-in-
agencies grade compensation policies. The
18 months reasons for this, as reported by the
authors, are the lack of belief by
the managers in the performance
appraisal system on which the merit
pay is based
Pearce et al. Prospective Merit pay for managers No Performance Four objective performance No effect:
(1985) 587 longitudinal measures Merit pay programme had no effect
USA 20 local federal on organisational performance

offices
4 years and
5 months
Kahn and Prospective Contingent pay: Bonuses; merit pay No Performance Organisation’s own six-point Mixed effect:
Sherer longitudinal rating scale Bonuses: Differences across workers
(1990) 588 92 middle- to in the impact they expect their
USA upper-level performance to have on bonus
managers payments led to differences in
12 months subsequent performance levels.
Specifically, managers for whom
the impact of performance on
bonus is high have higher future
performance, even controlling for
past performance levels
No effect:
Merit pay: In contrast to bonuses,
merit pay had no relationship with
employee performance
Brown Prospective Earnings at risk No Pay outcome PSQ (Heneman and Schwab Negative effect:
and Huber longitudinal satisfaction; pay process 1985) 589 Pay outcome satisfaction and pay
(1992) 570 101 bank satisfaction process satisfaction both declined
USA employees significantly over time
6 months
Begley and Prospective Change of compensation system: No Bonus satisfaction Scales devised by the authors Moderated effects:
Lee (2005) 568 longitudinal Introduction of Pay at Risk (7%); Distributive justice Employees with low negative
Ireland 99 employees bonus plan (0%, 4%, 7%, 10% and (perceived fairness of affectivity are more sensitive to
15%) the bonus percentage) changes in bonus awards than
12 months
Moderators: employees with high negative
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Personality (high/low on negative affectivity

affectivity)
Brown Retrospective Experience-rated sick pay scheme No Absenteeism Company records Positive effect:
(1994) 571 longitudinal Sick pay scheme does exert a
UK 1263 employees significant control over absenteeism
12 months and it is more effective when the
sick pay is linked with loss of current
earnings rather than loss of future
sick pay entitlement
Lazear Retrospective Performance pay: No Productivity Charts per worker per day Positive effect:
(2000) 569 longitudinal Shift from hourly wages to piece Productivity effects associated with
USA 2755 employees rate compensation switch from hourly wages to piece
19 months rates are quite large and there are

significant productivity gains
Shaw and Prospective Pay fairness (moderated by the No Physical health; 10-item life satisfaction scale; Moderated effects:
Gupta longitudinal financial needs of the employees) psychological health; 10-item depression scale; When employees are economically
(2001) 590 272 employees work-related behaviour; 14-item somatic complaints; dependent, they are more likely
USA job performance, One-item job search intent; to experience life dissatisfaction,
2 years absenteeism, turnover supervisory rating of job depression, and somatic complaints
performance; absenteeism from as a consequence of unfair pay
company records; voluntary
turnover from company records The relationship between pay
perceptions and job performance is
strongly negative among people high
on financial need
Schwarzwald Quasi- Promotion No Equity; commitment; Commitment and OCS by Positive effect:
et al. (1992) 573 experimental behavioural outcomes Porter et al. (1974)244 Positive promotion decisions
Israel 191 employees increased commitment
6 months Negative effect:
Failure to get promotion was
associated with feeling of inequity,
a decrease in commitment and
increase in absenteeism
continued
179
180

Johnston et al. Quasi- Promotion No Organisational 244 Positive effect:
OCQ: (Porter et al. 1974;
(1993) 572 experimental commitment Lawler and Hall 1970;190 Lodahl Promoted stayers exhibited an
USA 157 sales people Intrinsic motivation and Kejner 1965;424 Bluedorn increase in satisfaction over time;
1982, 591 staying/leaving index; they were significantly more satisfied
6 months Job involvement
Smith et al. 1969, 243 JDI; than non-promoted leavers
Propensity to leave company records; House and
However, job attitudes decline over
Satisfaction with pay Rizzo 1972592
time, even for promoted employees
Turnover
Job anxiety
Lam and Quasi- Promotion No Organisational OCQ: Mowday et al. (1979) 516 Moderated effects:
Schaubroeck experimental Moderators: commitment Promoted tellers who had more
JI: Kanungo (1982);593
(2000) 574 360 bank tellers Job involvement internal LOC maintained improved
Personality LOC JS: Hoppock (1935) 594
Hong Kong 18 months Job satisfaction attitudes across 3–18 months post
ITQ: Bluedorn (1982) 591 test intervals
Intentions to quit
Performance: Organisational For external LOC individuals,
Performance rating records attitudes returned to baseline after
Absence frequency 6 months
Mixed effects:
Absenteeism and job performance
both decreased among promotees
Pergamit Retrospective Promotion No Job attachment; job Source: National Longitudinal Mixed effects:
and Veum longitudinal satisfaction Survey of Youth Promotion led to increased job
(1999) 575 3355 young men satisfaction There is no evidence that
USA and women promotion can lead to higher job
working in private attachment
sector
12 months
Pritchard et al. Quasi- ProMES: No Productivity ProMES Positive and interaction effect:
(1988) 576 experimental A system that developed Job satisfaction Job satisfaction: Seven items Results indicated that group-level
USA Five organisational productivity measurement in order Turnover intentions adapted from Minnesota feedback increased productivity on
units to provide feedback to measure Satisfaction Questionnaire average by 50%, which was raised to
productivity; comprising feedback, Morale (Weiss et al. 1967)473 76% when goal setting and incentives
2 years
goal setting, and incentives based Role clarity Turnover intention: Own were added to it
on achieved goals questionnaire Work attitudes for example job
Morale: Adapted from ISR satisfaction, turnover intentions,
instruments (Seashore et al. and morale were good or better
1983) 595 following intervention
Role clarity: Adapted from Rizzo No such changes were observed in
et al. (1970) 503 the control group
Pritchard et al. Prospective ProMES: No Productivity ProMES scale was used to Positive and Interactions effects:
(1989) 577 longitudinal measure productivity
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A system that developed Feedback alone improved

USA Five organisational productivity measurement in order productivity by 50%; when goal
units to provide feedback to measure setting and incentives were added to
2 years productivity; comprising feedback, it, productivity improved by 76%
goal setting, and incentives based
on achieved goals
Knight et al. Quasi- Practices: No Strategic risk; tactical Objective measured devised for Interaction effect:
(2001) 578 experimental Monetary incentives; goal difficulty implementation; team the experiment Teams with both difficult goals and
USA 264 students performance incentives achieved the highest
Repeated performance
measures taken
during a single
experimental
sitting

Price and Prospective HR practice: Training; pay; No Labour turnover Company data Positive effect:
Mueller longitudinal promotional opportunity Promotional and training
(1981) 532 1091 non- opportunities had a positive impact
USA supervisory RNs on labour turnover
14 months No effect:
Pay itself had no direct effect on job
turnover
Blau (1999)236 Prospective Practices: No Job satisfaction Job satisfaction: JDS (Hackman Positive effect:
USA longitudinal Task responsibility (measured as a and Oldham 1975)195 Task complexity had a significantly
672 medical continuum ranging from routine/ positive impact on job satisfaction
technologists simple to complex tasks); wages; Higher wages and satisfaction with
4 years performance appraisal satisfaction performance appraisal also had
Moderators/mediators: positive impact on job satisfaction
None Negative effect:
Routine task had a significantly
negative impact on job satisfaction
continued
181
182

Posthuma Prospective Practices: No Permission to use Survey of employees who took Positive effect:
and Campion longitudinal Perceived procedural justice of: employees name part in the study Perceived procedural justice in pay
(2005) 526 198 nurses work assignment; work schedule; in recruitment raise, work assignments and work
USA pay raises advertisements schedule was positively related to
2 weeks
Moderators/mediators: giving permission by the employees
to use their names in recruitment
None advertisements
D’Arcimoles Retrospective Various HR practices: No Economic performance Return on assets Positive effect:
(1997) 533 longitudinal Compensation; training; Productivity Training had a lagged positive effect
France 42 firms recruitment and dismissals; social on a firm’s economic performance

5 years climate No effect:
Source: Social data set ERMES Compensation by itself had no effect
on a firm’s economic performance
Cappelli and Retrospective Various HR practices: No Sales per worker; National Employees Survey The study concludes that HPWP
Neurmark longitudinal TQM; self-managed or autonomous total labour costs per (NES) data raises labour costs per employee,
(2001)149 Survey data from teams; regular meetings to discuss worker; inverse of unit Census Bureau’s LRD data suggesting that they may raise
USA different periods: work-related problems (quality labour costs (ratio of employee compensation. The study
circles); teamwork training; job sales per worker and reports statistically weak evidence
1977–93 panel: total labour costs per between the use of these practices
n = 433 rotation; cross-training; pay-for-
skill programmes; gain-sharing/ worker) and productivity. The authors
1993–6 panel: profit-sharing; benchmarking; concluded that HPWP have little
n= 205 computer use by employees effect on overall labour efficiency
1977–96 panel:
n = 666
20 years
ISR, Institute of Social Research; ITQ, intention to quit ; JI, job involvement; JS, job satisfaction; LRD, Longitudinal Research Database; OCQ, Organizational Commitment
Questionnaire; ProMES, Productivity Measurement and Enhancement System; PSQ, Pay Satisfaction Questionnaire.
For National Longitudinal Survey of Youth, see Pergamit MR, Pierret CR, Rothstein DS, Veum JR. Data watch: the national longitudinal surveys. Journal of Economic Perspectives
2001;15:239–53.
For National Employees Survey (NES) data, see Cappelli P. The National Employer Survey: employer data on employment practices. Industrial Relations 2001;40:635–47.
Results Merit-based pay, performance-related pay,

Incentive plans, bonuses, ESOPs and gain-sharing earnings-at-risk plans and perceptions of pay
The major focus of studies in this subcategory of fairness
compensation and rewards was the use of monetary The studies on merit or performance-related pay
incentives to influence employee behaviour. The differed from those on incentives and bonuses in
main distinction between this subcategory and the that there was some component of an employee’s
next (merit pay, pay at risk, etc.) was that incentives salary that was at risk of being reduced unless
did not affect salary. The focus was rather to a particular level of performance was achieved.
encourage employees to perform better for gaining The performance-related-pay papers invariably
monetary awards over and above their base pay. found that merit-based pay was not liked by the
Largely, all studies in this category concluded that employees.567 The major point of contention in
incentives had a positive effect on the desired performance-related pay was the perceived fairness
outcome. in the performance appraisal system on which the
whole scheme rests. Though there was a general
There was only one study that used complete dissatisfaction among workers where performance-
randomisation and conducted RCTs to understand related pay or some form of earning-at-risk plans
how three interventions (financial bonus, enhanced were used, studies reported an improvement in
fees for immunisation services, and feedback on performance indicators and desired outcomes, for
their performance) helped improve immunisation example reduced absence, when these pay plans
performance among paediatricians.562 The authors are implemented.568–571
reported that of the three schemes, cash bonus
resulted in the maximum positive impact on the Promotions:
immunisation service. The quasi-experimental Use of promotion as an incentive to reward higher
study by Petty et al.563 also found that an incentive performers was quite widely used in organisations.
plan targeted at the division as a whole led to However, the results from the studies reviewed here
better performance of that division compared with found that use of promotions as an incentive can
a control group without an incentive plan. There lead to mixed outcomes.
was a significant increase in employee productivity
and other measures of job performance along Studies by Johnston et al.572 and Schwarzwald et
with improvement in employee attitudes toward al.573 reported that the impact of promotions on
the organisation. The other three studies on the given outcomes was moderated by promotion
use of financial rewards and bonuses, employing decisions. Those who were promoted as a reward
prospective longitudinal designs, also found a for good performance showed better future
positive relationship between use of rewards and performance and were more likely to stay with the
incentives and the desired outcomes, for example organisation than those who were not promoted.
productivity, job satisfaction, job commitment
and employee turnover. The study by Buchko564 However, some studies pointed out that the
reported that employees with greater perceived negative consequences of employees not being
influence as a result of an ESOP programme promoted when they feel entitled. The study by
and those with greater financial value in the Schwarzwald et al.573 found failure to get promotion
programme were more satisfied with the pay plan, was associated with feelings of inequity, decreased
more committed to the organisation, had lower commitment and increased absenteeism. Johnston
turnover intention and were less likely to leave the et al.572 found that the initial positive effects of
organisation. promotion were unsustainable in the long run
and that job attitudes declined over time, even for
Use of a gain-sharing plan, characterised by promoted employees. Similar results were found
combining a system of plant-wide bonuses with a by Lam and Schaubroeck574 and Pergamit and
comprehensive employee involvement programme, Veum.575
was reported by one study which found that it had
a positive impact on long-term grievance rates as Combination of compensation and rewards with
well as employee absenteeism.565 various other HRM practices
The eight studies in this category used rewards
Bhattacherjee566 found that group incentives were along with other HRM practices for achieving
more effective in increasing productivity when used desired employee or organisational outcomes. Five
with smaller groups than when applied to large of these studies showed that compensation and
groups, for example whole departments. rewards in interaction with various other HRM
183

practices had a positive effect. Studies by Pritchard Communication

et al.576,577 found that although feedback alone was Through communication, organisations and
instrumental in improving the performance of their members exchange information, form
employees by 50%, when feedback was used with understandings, coordinate activities, exercise
goal setting and incentives, productivity improved influence, socialise, and generate and maintain
by 76%. Similarly, a study by Knight et al.578 found systems of beliefs, symbols, and values.
that combining incentives with difficult goals Organisations have two distinct communication
achieved best results. systems; formal and informal. The formal
communications system is a part of the
However, studies by Price and Mueller532 and organisational structure and includes supervisory
D’Arcimoles533 found that pay and compensation relationships, work groups, permanent and ad hoc
by itself failed to have any direct effect on committees, and management information systems.
labour turnover and the firm’s overall economic The informal communication system emerges
performance. The compensation and pay system from day-to-day interaction among organisational
need to be combined with practices such as training members. In this section we review longitudinal
to achieve the desired impact. studies on how various forms of communication
have an impact on given or desired outcomes.
Omissions
There were no significant omissions in the Details of studies
longitudinal literature on the relationship between Five studies met the inclusion criteria (Table 50).
compensation and rewards and desirable outcomes. Two studies were conducted in the USA, two were
However, given the popularity of incentive plans, conducted in the UK, and one was conducted
for example ESOPs, it was surprising to find in Finland. One study had a quasi-experimental
only one study on how ESOPs can impact on design and four studies had a prospective
employee behaviour. There seems to be a paucity longitudinal design. The duration of the studies
of longitudinal research on the impact of ESOPs on varied from 3 to 18 months, with sample sizes
employee performance and turnover. ranging between 94 and 459 employees.
Summary HRM practice/intervention

In this review there were 29 studies that explored The five studies in this section can be grouped in
the impact of compensation and rewards systems two categories:
on given employee and organisational outcomes,
for example job performance, productivity, job • communication by the organisation to create
turnover, absence and various other employee awareness of a given programme or any
attitude variables. Nine out of the 29 studies were impending changes
experimental or quasi-experimental in design, • quality and quantity of communication briefs
with 13 studies using prospective longitudinal given to employees and the impact on their
design and seven using retrospective analysis on RBSE.
pre-existing longitudinal data sets. The studies
in this section can be grouped in four broad In the first category, three studies596–598 explored
categories depending on the type of compensation how creating an effective communication plan can
and reward plan under investigation; incentive be useful in achieving the desired outcomes.
and bonus plans, gain-sharing schemes; merit-
or performance-related pay and employee pay The second category includes the studies
fairness perceptions; promotions; and studies of Parker454 and Axtell and Parker,458 which
using compensation and rewards in combination explored the effects of the quality and quantity of
with other HRM interventions. Largely, the communication briefs on employees.
impact of incentives and bonuses was positive
whereas that of merit-based pay was negative. Outcomes
Promotions had both positive and negative impacts The three studies in the first category focused on
depending on the promotion decision. Studies the decreased dysfunctional impact of mergers on
researching combinations of compensation and employees as a result of realistic merger previews,
rewards with other HRM practices found positive satisfaction with various aspects of the workplace
and interaction effects with these other practices. as a result of an organisational benefit awareness
Overall, there seems to be a paucity of longitudinal programme, and how job insecurity and its related
research on the impact of ESOPs on organisational consequences (e.g. relationship with colleagues and
184 and employee outcomes. organisational efficiency) can be positively dealt
TABLE 50 Communication

Schweiger Quasi-experimental Practices: No Dysfunctional outcomes of Global stress: Cohen et al. Positive effect:
and DeNisi 147 employees Realistic merger preview before mergers on the employees (1983) 599 Realistic merger previews
(1991) 596 the merger of two companies for example: global stress; Job satisfaction: House et al. substantially reduced the
3 months uncertainty; job satisfaction;
USA (1979) 600 dysfunctional outcomes of the
DOI: 10.3310/hta14510
Moderators/mediators: commitment; company’s

Commitment: Porter and merger
None trustworthiness, honest and
caring; intention to remain; Smith (1970) 502
performance; absenteeism; Uncertainty: Schweiger et al.
turnover (1987) 601
Company’s trustworthiness:
Meglino et al. (1988)497
Intention to remain with the
organisation: Meglino et al.
(1988)497
Performance, absenteeism and
turnover: Company data
Henessey et Prospective Practices: No Various outcomes: Benefit All outcomes were measured Positive effect:
al. (1992) 597 longitudinal satisfaction; job satisfaction; using scales constructed by

Benefit awareness programme The awareness programme had
USA 237 employees (creating awareness among employee perceptions of the authors specifically for this a positive impact on benefit
employees the benefits available organisational effectiveness study satisfaction and employee
6 months
to them) perceptions of organisational
Moderators/mediators: satisfaction
None No effect:
The programme had no effect on
employee job satisfaction
Kinnunen et Prospective Practices: No Job insecurity and Job insecurity: Greenhalgh and Positive effect:
al. (2000) 598 longitudinal Organisational communication outcomes of job insecurity: Rosenblatt (1984) 602 Restorative strategy had a positive
Finland 210 employees (quality, quantity, and rumours Organisational commitment; Organisational commitment: influence on feeling of job security
in the general communication relationship with Cook and Wall (1980) 554 of the employees. Job security
12 months colleagues and supervisors;
occurring within the organisation) Relationship with colleagues on turn was a good predictor of
organisational efficiency relationship with the colleagues
Restorative strategy (honest and supervisors: Scale
communication with the developed by the authors and organisational efficiency
employees and to reassure them Organisational efficiency: Scale No effect:
on the security of their jobs and developed by the authors General organisational
maintain a positive atmosphere) communication had no effect
Moderators/mediators: on feeling of job security of the
Gender employees
continued
185
186
TABLE 50 Communication (continued)

Parker Prospective Practices: No RBSE RBSE scale was designed by the Positive effect:
(1998)454 longitudinal Communication; job enlargement author Increase in communication quality
UK 459 employees (measured as the horizontal was associated with increase in
18 months range of the jobs); job enrichment self-efficacy. However, it did not
(measured as jobs high on have significant beta weight in the
autonomy and control) final regression equation despite
Training (on quality management) significant zero order association,

suggesting that communication
Moderators/mediators: briefs shares variance with the
None work background or personality
factors of the employees
Axtell and Prospective Practices: No RBSE RBSE scale was designed by the No effect:
Parker longitudinal Communication briefs (frequency author Communication briefs had no
(2003)458 94 employees with which communication briefs effect on RBSE
UK 18 months were given to the employees)
Job enlargement (measured as the
horizontal range of the jobs)
Job enrichment (measured as jobs
high on autonomy and control)
Training (on quality management)
None
with by use of a restorative strategy using honest design, while four used a prospective longitudinal
communication with employees. design. The studies can be divided in to two
categories. In the first category were studies that
The outcome for the second category of dealt with communication by the organisation
communication papers discussed in this section was to create awareness of a given programme or
employee perception of RBSE. any impending changes. In the second category
were studies dealing with quality and quantity of
Results communication briefs given to employees and their
The results of the communication strategy on impact on RBSE. The results of these interventions
the desired outcomes were mixed. For the first are mixed. There was some support for the impact
category of studies, Schweiger and DeNisi596 of tailored communication strategies dealing with
found that realistic merger previews were a good specific issues as opposed to general organisational
tool for limiting the dysfunctional outcomes of a communications; however, this was based on only
merger, resulting in lower stress, job dissatisfaction, five eligible studies.
absenteeism and job turnover, and improved
commitment and employee performance. However, Family friendly
the study by Henessey et al.597 found that although
a benefit awareness programme had a positive The term ‘family friendly workplace’ (or ‘work
impact on satisfaction with benefits and the and family’) is one which recognises the non-
organisation, it had no effect on employee job workplace family responsibilities of its employees,
satisfaction. Similarly, the study by Kinnunen et and develops and implements policies that aim
al.598 found that a dedicated restorative strategy to help employees simultaneously fulfil work
using honest communication with employees, to and family commitments. Some authors extend
provide reassurance of job security and maintain the use of the term to include practices that are
a positive work atmosphere, did result in lower employee friendly and take care of the well-being
levels of job insecurity and improvements in of employees and their families (such as general
relationships with the colleagues. However, the employee assistance programmes or specific help
general communication system in the organisation for drug or alcohol addiction).
was completely unrelated to employees’ feelings of
job security. Details of studies
Four studies met the inclusion criteria (Table 51).
The studies by Parker454 and Axtell and Parker458 All studies were conducted in the USA. One study
both concluded that, although quality of had a quasi-experimental design, one study had a
communication briefings had a positive impact on prospective longitudinal design, and two studies
employees perception of their RBSE, the quantity used a retrospective longitudinal research design.
of such communication had no similar impact. The duration of the studies varied from 12 months
to 7 years. The sample size of the studies varied
Omissions from 207 employees to 60 sites encompassing
Management theory places great emphasis on 43,888 employees.
devising organisational communication plans for
internal and external stakeholders, yet it appears HRM practice/intervention
that little of that has translated in longitudinal Of the four studies in this section, three
peer-reviewed research. Five studies met the review investigated the impact of health promotion
criteria for HRM practice in this area, but they programmes or policies, elements of which
focused on a limited range of possible outcomes. included family friendly practice.603–605
There appears to be substantial scope for further
longitudinal research on the impact of different The fourth study by Hammer et al.606 investigated
communication practices. couples’ or individuals’ use of alternative work
arrangements and dependent care support.
Summary
The five studies in this section provided evidence Outcomes
on how various forms of communication can be The outcomes investigated these studies of family
used to achieve the employee outcomes of reduced friendly practices were absenteeism (two studies),
dysfunctional outcomes during a merger, feelings return on investment, medical claims made, job
of job security, job satisfaction and enhanced turnover, job satisfaction, and family–work/work–
RBSE. One study used a quasi-experimental family conflict.
187

188
TABLE 51 Family friendly

Bertera Quasi-experimental Comprehensive workplace health No Absenteeism; return Company records Positive effect:
(1990) 603 60 sites (comprising promotion programme on investment on the Health promotion programme helped
USA 43,888 blue-collar Moderator/mediator: programme in significant reduction in disability
employees) None days and provided a good return on
2 years investment
Astrup et al. Retrospective Participation in company- No Absenteeism and Company records Positive effect:
(1992) 604 longitudinal sponsored wellness programme medical claims Wellness intervention slowed the rate
USA 207 employees Moderator/mediator: of increasing claims among middle-aged

7 years Age of the employee participants
Gilleskie and Retrospective Employer provided health No Employment transition Whether an individual has No effect:
Lutz (2002) 605 longitudinal insurance changed employer Employer provided health insurance
USA 4422 individuals (all Moderator: had no impact on married employees’
males) Married/unmarried decision to change their jobs and had
12 months a very small impact on the unmarried
males
Hammer et al. Prospective Utilisation of available No Work–family conflict; Work–family conflict: Positive effect:
(2005) 606 longitudinal workplace support (couples’ or family–work conflict; (Metemeyer et al. 1996) 607 Use of alternative work arrangements
USA 234 couples individuals’ use of alternative job satisfaction Job satisfaction: JDS and dependent care supports are
work arrangement; couples’ or (Hackmann and Oldham positively related to family–work
12 months individuals’ use of dependent care 1975)195 conflict in dual-earner couples; use of
support) workplace support is positively related
Moderator: to job satisfaction over time
None No effect:
Couple level utilisation of workplace
support does not appear to have a
strong impact on individuals’ report of
work–family conflict
Results longitudinal research design. The results of these

Results from two studies indicated that health studies indicated that use of company sponsored
promotion and company sponsored wellness health and wellness programmes are value for
programmes reduced absence. The study by money and help reduce absenteeism. However,
Bertera603 used a quasi-experimental research company provided health insurance benefit has no
design and collected data from 43,888 employees effect on employees’ decisions to stay or leave from
working in 60 different sites. It concluded that the company. Use of alternative work arrangements
the company’s workplace health promotion and dependent care support is positively related
programme gave good return on investment to reduced family–work conflict in dual-earner
and led to significant reductions in employee couples but couple level use of such support is not
absence. The study by Astrup et al.604 came to a related to work–family conflict. There seemed to
similar conclusion, and the company’s wellness be substantial gaps in longitudinal research on
programme was especially effective for middle- family and employee friendly practice, with no
aged participants as it reduced their rates of peer-reviewed longitudinal research available on
medical claims. The third study in this category topics including flexible working arrangements,
measured the impact of employer provided health permanent part-time work, job-sharing, career
insurance on employee turnover. The study found break schemes, paid or unpaid family leave,
that employer provided health insurance had no and assistance with child care and elder-care
impact on married employees’ decisions to change responsibilities, which aim to help workers balance
their jobs and had a very small impact on the their work and family responsibilities.
unmarried males.605
Employee participation,
The only study on the uptake of workplace support, representation and involvement
in the form of alternate work arrangements and
employees’ use of dependent care, found mixed The terms employee participation/representation/
effects. Hammer et al.606 concluded that use of involvement have been used to describe a wide
alternative work arrangements and dependent care range of practices in organisations.511 Common
supports were positively related to reduced levels of to all of these practices is the attention paid
family–work conflict in dual-earner couples. Use of to increasing employees’ influence over how
workplace support was also positively related to job their work is carried out or over other areas of
satisfaction over time. However, the study found organisational policy and practice.511
that couples’ use of workplace support did not
appear to have an impact on individual reports of Details of studies
work–family conflict. Eight studies met the inclusion criteria for the
review (Table 52). Three of these studies were
Omissions conducted in the USA, two in Australia, and
This review found only four longitudinal studies one each in Germany, the Netherlands, and
that explored the efficacy of family-/employee- Korea. Seven studies had a quasi-experimental
friendly policies or practices as HRM interventions, research design and one study had a prospective
and these were limited in scope. Practices, longitudinal research design. The duration of the
for example flexible working arrangements, studies varied from 32 days to 22 months. The
permanent part-time work, job-sharing, career sample size of these eight studies varied from 43 to
break schemes, paid or unpaid family leave, 182 employees.
and assistance with child care and elder-care
responsibilities, which can help workers balance HRM practice/intervention
their work and family responsibilities, need to be Of these eight studies, only two studies are
examined longitudinally to establish the nature of discussed exclusively in this section.608,609
their impact. These studies researched the role of employee
participation in the process of introducing changes
Summary to their own jobs, and the impact of employee
The four studies in this category investigated participation in the job evaluation process, as HR
the impact of family and employee-friendly practices.
policies, such as health promotion programmes
and workplace support. One study used a quasi- The other six studies used employee participation
experimental research design, one used prospective in conjunction with other practices, for example
longitudinal and two others used a retrospective
189

190
TABLE 52 Employee representation/involvement/participation
Practice(s)/intervention(s);
Study, Design, sample moderators/mediators
country size, duration (if any) FM Outcomes Outcome measure(s) Results +ve/–ve
Coch and Quasi-experimental Employee participation in the No Productivity; labour Company data Positive effect:
French design process of introducing changes turnover Participation of employees in the process
(1948) 608 46 employees to the job of making changes to their jobs reduces
USA 32 days Moderator/mediator: the resistance to change and increases
None their post change productivity. It also
helps in reducing employee turnover
Morgeson et al. Quasi-experimental Employee participation in job No Pay satisfaction PSQ (Horeman and Schwab No effect:
(2001) 609 168 employees evaluation process 1985) 615 Participation in the job evaluation
USA 3 months Moderator/mediator: process made no impact on employee

None pay satisfaction
Kleinbeck and Quasi-experimental Participative productivity No Productivity Organisational productivity Positive effect:
Fuhrmann 43 employees management (PPM) system Group cohesion measure PPM led to improved productivity
(2000) 610 Group cohesion: Adapted
22 months No effect:
Germany from three scales – Widmeyer
et al. 1985;616 Luhtanen and PPM had no effect on group cohesion
Crocker (1992), 617 Wagner
and Zick (1993) 618
Pearson Quasi-experimental Participative goal setting Yes Performance; job Performance: Achievement of Positive effect:
(1987) 611 42 teams satisfaction set goals in the given time Participative goal setting has positive
Australia 12 months Job satisfaction: JDS (Hacman effects on employee performance and
and Oldham 1975)195 job satisfaction
Pearson Quasi-experimental Participative system for No Role ambiguity and 1. Rizzo et al. (1970):503 Role Positive effect:
(1991) 612 76 teams monitoring productivity role conflict; internal index Monitoring and feedback had a significant
Australia Feedback on performance work motivation; 2. JDS (Hackman and Oldham, effect on reducing role ambiguity,
5 months job satisfaction;
(productivity) 1975):195 Internal work increasing job satisfaction and increasing
productivity motivation productivity
3. Job satisfaction (Cammann
et al. 1979) 619
Practice(s)/intervention(s);
Study, Design, sample moderators/mediators
DOI: 10.3310/hta14510
country size, duration (if any) FM Outcomes Outcome measure(s) Results +ve/–ve
Kleingeld et al. Quasi-experimental PMS (ProMES): Participation in Yes Individual performance Performance data from Positive effect:
(2004) 613 182 employees implementation of a PMS data feedback reports generated Implementation of a ProMES was found
Netherlands by the PMS to be better in improving employee
18 months
performance than implementing the
system based on simply telling the
employees what was expected of them
Lee and Son Prospective Appraisal review: Employee No Satisfaction with Three-item scale made by the Positive effect:
(1998) 614 longitudinal get opportunity to participate review; performance authors Goal setting and career discussion of the
Korea 116 employees in discussion; goals are clearly Performance ratings appraisal review were positively related
set; career issues are discussed to employee satisfaction
6 months
No effect:
Overall, appraisal review had no effect

on job performance
Latack Quasi-experimental Practices: No Overtime costs; error JDI (Smith et al. 1969)243 Positive effect:
and Foster 84 information Compressed work week (work rates; job satisfaction; The data suggests substantial
(1985) 524 systems schedule: 3 days, 38 hours) satisfaction with organisational pay-offs, including
USA professionals the work schedule; reduction in sick time costs, overtime
Participation in decision to absenteeism; personal
18 months adopt the compressed work costs and personal leave time
leave time
week Those involved in decision to adopt
Moderators/mediators: compressed work week expressed
greater satisfaction with the work
None schedule
No effect:
There was no effect of compressed work
week on either their job satisfaction or
error rates
PMS, performance management system; PPM, Participative Productivity Management; ProMES, Performance Management System; PSQ, Pay Satisfaction Questionnaire.
191
performance management and staffing, and are majority supported the positive impact of using
therefore discussed in those sections as well. employee participation when making key decisions
that affect their working. There appeared to be less
Outcomes emphasis in the literature on using longitudinal
The following outcomes were studied in the research design to study the impact of participation
articles reviewed in this section: overtime practices, such as collective bargaining and
costs, productivity (three papers), performance employee involvement in strategic decision-
(three papers), error rates, labour turnover, pay making.
satisfaction, group cohesion, job satisfaction
(three papers), role ambiguity and conflict, work Performance appraisal and
motivation and absenteeism. performance management
Results Studies in this section cover performance appraisal
Results from two studies focusing exclusively and performance management practices.
on employee participation arrived at different
conclusions, possibly due to the nature of the Details of studies
outcome measure and area of participation in Twenty-five studies met the inclusion criteria (Table
which the employees were involved (one being a 53). Nineteen of these studies were conducted
very specific intervention). The study by Coch and in USA, two in Australia and one each in the
French608 found that participation of employees Netherlands, Germany, New Zealand and Korea.
in the process of introducing changes to their jobs One study used a complete RCT experimental
led to less resistance to change, improved labour design, nine studies used quasi-experimental
productivity and helped reduce labour turnover. In methods and 15 had a prospective longitudinal
contrast, the study by Morgeson et al.609 found that research design. The duration of the studies varied
employee participation in a job evaluation process from 7 weeks to 6 years. The sample size of these
had no effect on employee pay satisfaction. 25 studies varied from five teacher–student dyads
(10 persons in all) to 4413 employees.
There were five studies on the use of participation
in performance/productivity management HRM practice/intervention
practices. All five studies supported the conclusion The studies were concerned with one of the
that participation and involvement in any form following:
of performance management practice positively
impacts on outcomes, for example productivity, job • feedback
performance, job satisfaction, role ambiguity and • goal setting, alone or in combination with
role conflict.610–614 feedback and/or incentives
• performance or productivity management
The eighth study was on the use of employee systems, alone or in combination with
participation in the implementation of a feedback, goal setting, and incentives
compressed work week. It concluded that those • performance appraisal.
involved in the decision to adopt a compressed
working week expressed greater satisfaction with The largest number of the studies was on the use
their work schedule than those not involved in the of feedback systems and their ability to influence
decision.524 desired outcomes. There were 13 studies that had
feedback as their main independent variable,
Omissions focusing on how rich feedback, characterised by
For this review, two studies had a primary focus on large amounts of specific and positive information
the effects of participation. The remaining studies on one’s work behaviour, can impact on
all included participation as part of the evaluation performance and employee outcomes.
of another HRM practice.
Goal setting, either alone or in combination with
Summary feedback and/or incentives, was investigated by six
There were eight studies in this category, with six studies. The focus of these studies was on Locke’s620
also being discussed in other sections, namely theory of goal setting, exploring how performance
performance management and staffing. Seven of and attitudinal outcomes can be influenced by
these studies used quasi-experimental design and the way in which goal setting is conducted and
one used a prospective longitudinal study. The implemented.
192
TABLE 53 Appraisal/performance management

Codding et Prospective Performance feedback Yes Implementation Integrity data sheet Positive effect:
al. (2005) 627 longitudinal of antecedent Treatment integrity of intervention
DOI: 10.3310/hta14510
USA Five teacher– and consequence improved

student dyads procedures in an
(10 persons) ongoing behaviour
support plan
22 weeks
Kinicki et al. Prospective Performance appraisal feedback: No Job performance Organisation’s Positive effect:
(2004) 637 longitudinal Feedback rich environment (mediated by cognitive performance appraisal A feedback rich environment is positively
USA 102 loan officers (specific, frequent, and positive variable) forms related to perceived accuracy of feedback,
12 months feedback) which leads to better performance
Mediation: Credibility of the source Credibility of the source of feedback is also
of feedback positively related to perceived accuracy of
the feedback and recipients’ intention to act
on it
Smither et al. Prospective Sharing of multisource feedback No Performance 360° performance Positive effect:

(2004) 623 longitudinal with colleagues appraisal Though the performance improved, the
USA 4413 financial effect size of the improvement was very
services small (explained only 2% of the variance)
employees
12 months
Reilly and Prospective Upward feedback programme No Performance Performance rating Positive effect:
Smither longitudinal scale developed by the Continued administration of upward
(1996) 621 92 managers authors feedback programme results in sustained
USA 2.5 years improvement in performance
Parsons et al. Prospective Supervisor feedback No Attributions of 1. JDI (Smith et al. Positive effect:
(1985) 628 longitudinal performance: Luck or 1969)242 Positive supervisory feedback increased
USA 51 hotel staff effort; job satisfaction; 2. Attributions (Porac et internal attribution, which increased work
job turnover al. 1981) 638 satisfaction and decreased turnover
6 months
Komaki et al. Quasi- Feedback No Safety behaviour Questionnaire for Positive effect:
(1982) 626 experimental desired safety practices Feedback improved safety behaviour
USA 200 employees
11.5 months
continued
193
194
TABLE 53 Appraisal/performance management (continued)

LeBaron et Prospective Programme of measurement and No Rate of vaccination Routine record-keeping Positive effect:
al. (1997) 639 longitudinal feedback coverage Regular feedback improved immunisation of
USA 200 public clinics the target population significantly
6 years
Walker and Prospective Upward feedback No Job performance Survey of performance Positive effect:
Smither longitudinal devised by the authors Upward feedback improves managerial
(1999) 622 252 managers performance
USA 5 years
Arvey et al. Prospective Goal setting (use of MBO) No Employee satisfaction MSQ (Weiss et al. Positive effect:
(1978) 629 longitudinal 1967)473 There is a significant positive relationship
USA 245 employees between use of MBO and employee

21 months satisfaction
Ivancevich Quasi- Goal setting (participative/assigned/ No Performance; job Market potential index – Positive effect:
(1976) 630 experimental no goal setting) satisfaction total retail sales volume Both participative and assigned goal
USA 104 sales persons divided by potential setting resulted in better performance
retail sales volume (p. and job satisfaction; the effects of these
12 months 608); – two scales from interventions were only there up to
JDI (Smith et al. 1969)243 12 months and the effects dissipated after
12 months of intervention suggesting regular
training and refreshing the goal-setting
process
Pearson Quasi- Participative goal setting Yes Performance; job Performance: Positive effect:
(1987) 611 experimental satisfaction Achievement of set goals Participative goal setting has positive
Australia 42 teams in the given time effects on employee performance and job
12 months Job satisfaction: JDS satisfaction
(Hackman and Oldham
1975)195
Ludwig Quasi- Goal setting and feedback No Safety behaviour Wearing of safety belt Positive effect:
and Geller experimental Goal setting with feedback improved safety
(1997) 625 324 pizza delivery behaviour of the employees
USA persons
11 weeks
Kim and Quasi- Performance feedback (evaluative No Productivity; Performance: Positive effect:
Hamner experimental vs non-evaluative and goal setting) satisfaction Achievement of set goals Non-evaluative feedback with goal
(1976) 624 113 employees Job satisfaction: JDI setting led to higher productivity and job
DOI: 10.3310/hta14510
USA 3 months (Smith et al. 1969)242 satisfaction compared with goal setting alone
Campbell RCT Incentives: No pay; hourly pay; goal No Performance Achievement of set Positive effect:
(1984) 631 56 graduate contingent pay; goal setting targets Goal contingent payment with participative
USA students goal setting was better than hourly pay
6 weeks
Kleinbeck Quasi- PPM No Productivity; group Organisational Positive effect:
and experimental cohesion productivity measure PPM led to improved productivity
Fuhrmann 43 employees Group cohesion:
(2000) 610 No effect:
22 months Adapted from three
Germany scales: Widmeyer et PPM had no effect on group cohesion
al. 1985;616 Luhtanen
and Crocker 1992;617
Wagner and Zick 1993618

Taylor Prospective PMS No Work-related Commitment – 15-item Mixed effects (PMS in interaction with high/
and Pierce longitudinal Pay for performance (focus on goal attitudes: Satisfaction scale (Mowday et al. low performer):
(1999) 632 129 regional setting and appraisal) with supervision and 1979);516 organisation- Substantial increases in ratings of satisfaction
New environmental cooperation based self-esteem; job and cooperation with one’s supervisor was
Interaction effects with: High and satisfaction – five-item
Zealand council employees low performers found with the introduction of PMS for low
(Hackman and Oldham performers. In contrast, high performers
6 months 1975);640 satisfaction had high baseline for these attitudes towards
with supervisor – supervision, followed by substantial drops
five-item; cooperation immediately after receiving appraisal and
with supervisor – four- bonus pay
item
Pearson Quasi- Participative system for monitoring No Role ambiguity and Rizzo et al. (1970):503 Positive effect:
(1991) 612 experimental productivity; feedback on role conflict; Internal role index; JDS Monitoring and feedback had a significant
Australia 76 teams performance (productivity) work motivation; (Hackman and Oldham effect on reducing role ambiguity, increasing
job satisfaction; 1975):195 internal job satisfaction and increasing productivity
5 months productivity work motivation; job
satisfaction (Cammann
et al. 1979) 619
continued
195
196
TABLE 53 Appraisal/performance management (continued)

Pritchard et Prospective ProMES: No Productivity ProMES scale was used Positive effect:
al. (1989) 577 longitudinal A system that developed to measure productivity Feedback alone improved productivity by
USA Five organisational productivity measurement in order 50%; when goal setting and incentives were
units to provide feedback to measure added to it, productivity improved by 76%
2 years productivity; comprising feedback,
goal setting and incentives based on
achieved goals
Kleingeld et Quasi- ProMES: Participation in Yes Individual performance Performance data Positive effect:
al. (2004) 613 experimental implementation of a PMS data from feedback reports Implementation of a participative PMS
Netherlands 182 employees generated by the PMS (ProMES) was found to be better in
18 months improving employee performance than

implementing the system based on simply
telling the employees what was expected of
them
Pritchard et Quasi- ProMES No Productivity; job ProMES Positive effect:
al. (1988) 576 experimental A system that developed satisfaction; turnover Job satisfaction: Seven Results indicated that group-level feedback
USA Five organisational productivity measurement in order intentions; morale; items adapted from increased productivity on average by 50%,
units to provide feedback to measure role clarity MSQ (Weiss et al. which was raised to 76% when goal setting
2 years productivity; comprising feedback, 1967)473 and incentives were added to it. Work
goal setting and incentives based on Turnover intention: attitudes (e.g. job satisfaction, turnover
achieved goals Own questionnaire intentions and morale) were good or better
following intervention
Morale: Adapted
from ISR instruments No such changes were observed in the
(Seashore et al. 1983) 595 control group
Role clarity: Adapted
from Rizzo et al.
(1970) 503
Murray Prospective Performance appraisal: objective No Employee attitude Scale developed by the Result-orientated (MBO) performance
(1981) 633 longitudinal result orientated (MBO); subjective towards the authors appraisal was viewed more positively by
USA 87 managers trait approach performance appraisal the employees than the trait approach to
performance appraisal
2.5 years
Lee and Son Prospective Appraisal review: Employee get No Satisfaction with Three-item scale Positive effect:
DOI: 10.3310/hta14510
(1998) 614 longitudinal opportunity to participate in review; performance made by the authors; Goal setting and career discussion of the
Korea 116 employees discussion performance ratings appraisal review were positively related to
6 months Goals are clearly set; career issues employee satisfaction
are discussed No effect:
Overall, appraisal review had no effect on
job performance
Westin Prospective Electronic monitoring No Employee perceptions Focus group and survey Negative effect:
(1992) 634 longitudinal of fairness; climate of Introduction of electronic monitoring of
USA 200 customer organisational trust or employees at workplace in place of self
service agents distrust regulated or supervisory monitoring had a
Not provided negative effect on employees’ perception of
fairness and led to decrease in a climate of
organisational trust

Markham et Quasi- Positive attendance improvement Yes Improvement in Absence measure at Positive effect:
al. (2002) 635 experimental programme: Experimental group attendance the plant level (no. of A personal recognition programme resulted
USA Four plants (1100 were part of a recognition absentees/total no. of in significant decrease in employee absence
employees) programme; personal attention; the pay role on a given compared with their baseline behaviour
public celebration; use of day) before the programme
12 months mementoes; time framed
recognition; clarity of expectations; Control group showed no such
source of acknowledgement improvement
Control groups: Only information
feedback; survey only; no
intervention
Fellows and Prospective Reinforcement schedule and No Performance Calls completed per Positive effect:
Mawhinney longitudinal feedback function group per day An operant-based system of individual
(1997) 636 14 telemarketers rewards contingent on meeting group quota
USA 7 weeks produced reliable performance increases
among the telemarketers
MBO, management by objetives; MSQ, Minnesota Employee Satisfaction Questionnaire; PMS, performance management system; ProMES, Productivity Measurement and
Enhancement System.
197
There were six studies on how types of by Codding et al.627 reported that use of feedback
performance or productivity management systems can enhance the implementation integrity of an
are related to employee job performance or intervention programme. Feedback also helped
productivity. Three of these studies investigated to improve job satisfaction and reduce job
the impact of a productivity management tool turnover.612,628
[Productivity Measurement and Enhancement
System (ProMES)], on employee productivity and Goal setting, feedback and incentives
attitudinal outcomes. There were three studies on goal setting alone. Two
of these used a quasi-experimental design and one
There were two studies on how different types of used a prospective longitudinal research design.
performance appraisal or performance appraisal All three studies concluded that goal setting has
reviews can impact on given outcomes. a positive impact on job performance and job
satisfaction, and showed that participative goal
Of the remaining studies in this section, one looked setting is particularly beneficial.611,629 However, the
at electronic monitoring of employees at work, one study by Ivancevich630 found that the effects of goal
at recognition, and one at operant conditioning setting on job performance were not permanent
reinforcement schedules to boost performance or and tended to dissipate after 12 months.
other desired outcomes.
The other three studies were on goal setting in
Outcomes combination with feedback or financial incentives.
Sixteen of the 25 studies looked at job performance Two studies concluded that goal setting works
or productivity as one of their outcomes. Job best when it is participative and combined with
satisfaction was the second most investigated adequate feedback.624,625 Campbell631 used an
outcome variable, with eight studies including it as experimental design and reported that incentives
their dependent variable. Other variables that were linked to goal setting led to better performance
investigated in these studies are attendance, safety than when incentives are paid at an hourly rate.
behaviour and turnover.
Performance or productivity management systems,
Results feedback and incentives
Feedback All performance management systems used a
Of the 13 studies on feedback, eight were on combination of practices to achieve their desired
feedback alone and the rest were on feedback outcomes. Of the six studies in this category,
in combination with either goal setting or some five investigated how these systems influenced
form of performance or productivity management productivity or employee performance. All of these
system. Four studies investigated how feedback studies concluded that performance or productivity
impacts on job performance – all four used a management systems enhanced employee
prospective longitudinal design and indicated that performance or increased productivity.576,577,610,612,613
feedback leads to a significant improvement in job Three of these studies were on the use of ProMES
performance of employees. Two of these studies and all three concluded that, although feedback
used upward feedback (subordinate feedback alone improves productivity by around 50%
on supervisor performance) as an intervention when combined with goal setting and incentives,
and found that it enhanced managerial job productivity goes up by 76%.576,577 The sixth
performance.621,622 One study investigated study on the use of a performance management
how feedback sharing with raters and seeking system explored the impact of a newly installed
suggestions for improvement can influence the performance management system, along with
ratee’s performance. The study concluded that, pay for performance on employee attitudes. The
although there was a statistically significant study found that high and low performers reacted
difference between the ratees who shared their differently to use of a performance management
feedback and sought advice and those who did not, system involving pay for performance. For low
the effect size of improvement in performance was performers, the new performance management
very low and explained only 2% of the variance.623 system substantially increased ratings of satisfaction
Two studies on feedback, using quasi-experimental and cooperation with one’s supervisor. In
designs, found that a significantly positive impact contrast, high performers had a high baseline
on employee productivity.612,624 Two other studies, for these attitudes towards supervision, followed
one quasi-experimental and the other prospective by substantial drops immediately after receiving
longitudinal, concluded that feedback enhanced appraisal and bonus pay.632
198 the safety behaviour of employees.625,626 The study
Performance appraisal most studied outcomes were job performance

There were only two longitudinal studies in this and job satisfaction, with 16 and eight papers,
section that dealt with the impact of performance respectively. Feedback was found to have a positive
appraisal on given outcomes. The study by impact on job performance and job satisfaction,
Murray633 found that use of objective performance but feedback, in combination with goal setting
appraisal coming from management by objectives and incentives, had a better impact on the desired
was viewed more favourably than a trait-based outcomes. There seemed to be less emphasis by
performance appraisal system. Lee and Son614 researchers on conducting longitudinal studies on
explored the impact of performance appraisal impact of various types of performance appraisal
review on employee satisfaction and performance, systems on performance-related outcomes, as only
and concluded that goal setting and career one study explored that link.
discussion components of the appraisal review
were positively related to employee satisfaction. Integrated measures
However, overall performance appraisal review was
found to be unrelated to employee performance. In this chapter we have been examining the impact
of individual HRM practices on an outcome or
Studies on miscellaneous practices of performance plurality of outcomes, be they intermediate or
management final. It is often argued in the HRM literature
There were three papers that explored the use of that management practices work best when
various performance management techniques to used in conjunction with other practices that fit
achieve outcomes, for example attendance and together as a coherent set. Such sets of internally
job performance. The paper by Westin634 found consistent practices are typically referred to as
that the use of electronic monitoring of employees HR systems. The focus of much of the recent
attendance and working was associated with discussion has been on high-involvement systems,
decreased trust. The study by Markham et al.635 the core of which are practices designed to foster
concluded that a positive attendance management a high level of appropriate employee involvement
programme, characterised by recognition, personal and proactivity at all levels of the organisation.
attention, public celebration, use of mementoes, The term high-performance work system has
clarity of expectations and acknowledgement, can increasingly been used – ahead of any strong
significantly improve employee attendance. Fellows evidence that the title is warranted – to label such
and Mawhinney636 concluded that an operant-based a system. According to the US Department of
system of individual rewards contingent on meeting Labour (1993: 1)641 they are defined as: ‘Systems of
a group quota produced reliable performance mutually reinforcing practices [that] create multiple
increases among the telemarketers. ways to develop worker skills, to align individual
and organisational goals, and to share information
Omissions crucial to solving problems’. In a similar vein,
Although there were no significant omissions a decade later, Datta et al. (2005: 135)642 saw
on performance management, there does seem them as systems ‘of HR (human resource)
to be less longitudinal research on the use of practices designed to enhance employees’ skills,
various form of performance appraisal tools and commitment, and productivity’.
techniques, and their impact on individual, team
or organisational performance. The current section In such accounts, the concept of a high-
has only two studies on performance appraisal performance work system is clearly linked to
per se. the high-involvement management emphasis
on participation and employee commitment.1,191
Summary The argument is that high-performance systems
There are 25 studies in this review on performance give workers sizeable discretion over their work,
appraisal and performance management. One and provide the necessary skills and motivation
study used an RCT method, nine used quasi- for them to use this discretion for the benefit of
experimental methods, and 15 studies used the organisation. Work organisation practices,
prospective longitudinal design. The studies in this designed to provide opportunities for employee
section can be grouped in four major categories, participation in substantive ‘shop floor’ decisions
namely feedback, goal setting, performance (Appelbaum et al. 2000: 26),13 are thus treated by
management systems and performance appraisal some as the core high-performance practices, while
studies. Three studies used various other skill acquisition and motivational enhancement
techniques to achieve the desired outcomes. The practices are the HRM practices that are
199

‘supportive’ of this participation (Gittleman et al. it is this, and not the particular practices per se,
1998: 102).643 However, as Wood and Wall31 show, that is really yielding high performance.
the involvement aspect has increasingly been
neglected in the empirical work on HRM systems, Through our analysis of individual practices, which
at least in the stream of cross-sectional studies that has examined the connection between these and
developed in the 1980s following pioneering work outcomes, we have identified a set of practices that
by Arthur,14 MacDuffie,20 Huselid18 and others. As may be best in each domain. We could, therefore,
the resource-based theory has been increasingly create a complementary set on the basis of this.
used to justify the association of HRM systems with However, to be certain they are complementary, we
high performance, the seeds for a diminishing would need to ascertain that they have no negative
role for employee involvement were set relative impact on the effect of each other. For example,
to emphases on skills and knowledge, labour it is often argued that individual performance-
flexibility and extrinsic motivation. This theory related pay will detract from the positive effects of
stresses that organisations achieve competitive teamwork.
advantage through having distinctive, if not
unique, resources that are not easily imitated In our analysis of individual practices, we reported
or substitutable.644,645 It thus sees HRM systems any synergistic relationships between practices. For
as particularly important for generating the example, in our review of performance appraisal
competences of employees, and some even talk of studies we report two studies that show that goal
the HRM system itself becoming a unique asset of setting works best when it is participative and
the organisation, though this is not consistent with combined with adequate feedback.624,625 We have
the idea of there being a generic type (or types) of not examined, however, studies that have used
system(s) that should result of high performance. composite measures of HR practice or systems, as
those studies typically do not compare the effect of
The emphasis on the need for practices to cohere individual practices with those of their composite
if performance is to be optimised remains. The measure.
argument is, to use the words of Appelbaum et
al. (2000: 34) ‘that firms adopting a coherent In this section, we will introduce and report the
set of workplace practices designed to maximise results of studies that use composite measures
horizontal fit should have superior performance’. of the HR system. We will continue to use our
The authors take cohesion to mean that (1) the methodological selection criteria that limits our
workplace practices are complementary; (2) search to longitudinal, experimental or quasi-
synergies exist between the practices leading experimental studies.
to positive interaction effects on performance;
and (3) the practices form an integrated system. The studies are concerned with assessing the
However, these meanings are distinct and should impact of a particular system or subsystem of HRM.
not, as Appelbaum et al.13 and others do, be For example, Freeman and Kleiner649 concentrate
conflated. Following Delery646 and Wood and de on continuous flow production system, which
Menezes,647 these should be seen as distinct ways is centred on a time–rate compensation system
of conceiving a horizontal fit. As Wood and de complemented by other HR changes, for example
Menezes647 outline, a complement of practices a new safety programme. This is contrasted with
consists of all those practices that individually a piecework system in which payment is based
have a positive association with performance. As directly on output and the system of production
such, a complement of high-performance practices is highly individualised. Or in the case of Shipton
would be made up of the practices that are best et al.650 the central concept is the sophistication of
in each of the domains of HRM. Each would add HRM.
something unique and not detract from the effect
of any other. Synergistic practices are those that The studies are of two basic types: (1) ones that
enhance the effect on performance of another. A measure the system through a composite variable
high-performance synergistic set would be one in based on the extent of use of a set of practices
which all practices interact positively with each to capture a system – as in the case of Shipton et
other, so that the combined use of the practices al.’s650 sophistication of HRM – and (2) case studies
has ‘a greater effect on performance than the sum before and after the introduction of a new system,
of effects of the individual practices’ (Appelbaum as in Freeman and Kleiner’s649 study of a change
et al. 2000: 134).13 Finally, an integrated approach from piecework system to the new continuous flow
implies that the practices reflect an underlying production.
200 distinctive style648 or orientation to HRM, and that
Details of studies fulfilment of job requirements, but no fundamental

Ten studies met the inclusion criteria (Table 54). changes were made. The practices used were
All of the studies were published in English, with job rotation, aligned individual-organisational
seven being conducted in USA, two in the UK and performance systems, and merit pay and bonus
one in Germany. The majority were prospective schemes. The intermediate group (called ‘high-
longitudinal studies.21,27,645,649–652 One study37 used involvement work processes’) involved more
a prospective design, while Schuster653 used a participation, in particular, quality circles, seeded
retrospective longitudinal design. Finally, one study by mentors, were introduced and workers were
was a RCT.654 given participation training to help them adapt
to an increased level of interdependent working.
Some of the studies involved statistical A gain-sharing reward system was introduced
analysis across samples of companies or alongside the merit pay and bonus schemes used in
workplaces,21,27,645,650–652 whereas others involved the ‘alignment job design’. The final intervention
qualitative analysis supplemented by quantitative was ‘autonomous work teams’, where the team
analysis of a single company.649,652–654 was self-managed, so responsibilities for problem-
solving as well as job design itself were shared.
HRM construct Participation training was given and the group
No two studies examined the same concept. devised a team-based merit pay.
Perhaps the simplest concept used was the HR The core concept of Rauch et al. (2005: 683)645
practice of Wright et al.37 This was measured by was human development and utilisation, which
simply aggregating the use of nine practices: three is defined in terms of a set of ‘practices used
concerned with selection and staffing, one with the for enhancing employee skills through training
extent of training, three with pay for performance, and other forms of skill enhancement’. They
and two with participation – all measured by a included practices such as employee participation,
simple binary divide (have or have not). empowerment and communication in the other
forms of skill enhancement.
In a similar vein, HRM was the central concept
of Guest et al.27 It was again measured by an Ichniowski et al.21 assumed that there is a set of
index containing 48 items that covered nine innovative HR practices that are at least applicable
areas: recruitment and selection, training and to traditional manufacturing industries, for
development, appraisal, financial flexibility, job example steel. Innovative work practices are:
design, two-way communication, employment incentive pay, high screening in recruitment
security and the internal labour market, single and selection, teamwork, employment security,
status and harmonisation, and quality. flexible job assignments, high skills training and
information sharing, and line manager–worker
Shipton et al.650 considered HRM systems in meetings on production and other issues. Using
terms of their degree of sophistication, which, cluster analysis, Ichniowski et al.21 empirically
although not conceptually defined, was rated by identified four types of plants: at the two extremes,
an interviewer. Five dimensions were assessed: ‘innovative’ plants used all the labour practices,
performance management, recruitment and whereas ‘traditional’ plants used none of these
selection, induction, training, and strategy. A practices. The two intermediate types both had
high score on each represents sophistication teams, in contrast with the traditional system, but
and extensiveness, for example in the case of differed in the type of other practices they utilised.
performance management, not only is there a The more innovative of the two intermediate types
formal appraisal scheme, but also appraisals are differed from the high innovative system in that
frequent, appraisers are trained and it extends to it did not tend to have screening in recruitment,
all employees. employment security or job rotation, while the
other intermediate type tended only to have
Workman and Bommer654 focus on high- information sharing and line manager–worker
involvement work processes. Three types of meetings. It was having these that differentiated it
interventions, effectively measuring three degrees from the ‘traditional’ plants.
of high-involvement management, were designed.
The type that was the least level of involvement, Katz et al.652 reported a similar interplant study,
labelled ‘alignment job design’, entailed removing but studied only one firm and focused on a
impediments to effective motivation and the company-wide quality of work programme,
201

202
TABLE 54 Bundles

country size, duration moderators/mediators (if any) Outcomes Outcome measure(s) Results +ve/–ve
Rauch et al. Prospective HR development and utilisation: Employment growth Average yearly growth in the Owners’ human capital as well as
(2005) 645 longitudinal Training and development; number of employees during the employee HR development and
Germany 119 entrepreneurs decision-making involvement; last 3 years utilisation are positively correlated
support for personal initiative; goal with employment growth
4 years communication
Shipton et al. Prospective HRM systems: Sophistication of Organisational Respondents from the Effective HRM systems (incorporating
(2005) 650 longitudinal HRM; learning climate; appraisal- innovation in products companies gave estimates of sophisticated approaches to
UK 25–27 UK-based linked remuneration and production the number of entirely new and recruitment and selection, induction,
companies technology adapted products developed in appraisal and training) predict
the last 2 years; percentage of organisational innovation in products
2 years production workers involved and production technology
in making the new products; Organisational innovation is enhanced
current sales turnover accounted where there is a supportive learning

for by the new products; and climate, and inhibited (for innovation
the extent to which production in production processes) where
processes had been changes to there is a link between appraisal and
accommodate the new products remuneration
Freeman Prospective Individual practice of specific Productivity; profits Monthly company data Labour management policies
and Kleiner longitudinal importance: Shift from piece rate Productivity: Average number of associated with shift from piece rate
(2005) 649 Case study of a to time rate form of compensation; shoes produced per day to time rate compensation decreased
USA single company bundle of practices: HR practices productivity but still increased profits
that were required for working Profits: Total revenue minus (due to reduced labour and other
5 years in synchronisation with the new labour costs and material costs costs)
compensation system: Teamwork
(more emphasis); communication
skills
Workman RCT/full field Three interventions: Aligning Individual-level Job satisfaction: Warr et High-involvement work practices
and Bommer experiment organisational structures; increasing outcomes: Degree al. (1979),475 Intrinsic job produced the most potent effects
(2004) 654 149 call centre employee involvement; implementing of group orientation; satisfaction scale on job satisfaction and organisational
USA employees autonomous work teams job satisfaction; Organisational commitment: commitment attitudes as well as
organisational OCQ by Mowday et al. (1979) 516 performance
10 months commitment
Performance: Customer service Group work preference moderated
Group-level score; problems closed per the results between such that under
performance measures: employee; percentage of calls high involvement and in autonomous
Customer survey escalated; percentage of repeat work teams, high preferences for
scores; problems calls group work resulted in greater job
solved; escalations; satisfaction than when employees had
repeat calls lower preferences for group work
Wright et al. Predictive design HR practices: Nine items in Performance: Workers Performance: Workers The HR practices of selection, pay
(2003)37 50 business units four areas – selection; pay for compensation; quality; compensation; workers for performance and training and
USA and (5635 respondents) performance; training; participation; shrinkage; productivity; compensation/sales employee participation, along with
organisational commitment operating expenses; employee organisational commitment,
DOI: 10.3310/hta14510
Canada 6 months Quality: 100,000 pieces/error

profitability are significantly related operational
Shrinkage: Percentage of measures of performance
inventory loss
Productivity: Payroll expenses/
no. of pieces
Operating expenses: All costs
Profitability: Operating pre-tax
profits/sales percentage
Guest et al. Cross-sectional and Use of HR practices: Recruitment Interviewee estimates Manager estimates of labour Results show that greater use of
(2003)27 longitudinal and selection; training and of performance: productivity and financial the given HR practice is strongly
UK 366 firms development; appraisal; financial Turnover; absence; performance on 5-point scale, associated with both productivity and
flexibility; job design; two-way industrial conflict; compared against average for financial performance but fails to show
2 years communication; employment productivity; financial industry that HRM causes higher performance
security; single status and performance; objective

Independent financial data
harmonisation; emphasis on quality performance: Labour from Dun and Bradstreet:
productivity; financial Value of sales per employee
performance (labour productivity), company
profit per employee (financial
performance)
Gomez-Mejia Prospective International HRM Strategy: Higher Export performance Company records The results of this study find
(1988) 651 longitudinal status for employees engaged in significant impact of international
USA 388 firms international activities; higher HRM practices on export
rewards for those engaged in performance
2.5 years international activities; international
experience as a requirement for new
hires; international experience as a
requirement for promotion; training
and development for engaging in
international activities; international
activities as a part of middle and
upper management performance
review
continued
203
204
TABLE 54 Bundles (continued)

Ichniowski et al. Prospective HRM practices bundle: Incentive pay Productivity – labour Production – increasing up-time The study finds that lines that use
(1997)21 longitudinal (line incentive) these set of innovative work practices
USA 36 homogeneous Recruiting and selection (high achieve substantially higher levels of
steel production screening); teamwork (high productivity than lines that use a more
lines owned by participation, multiple teams, traditional approach
17 companies formal team practice); employment
2190 observations security; flexible job assignment
(job rotation); skills training;
communication (information sharing,

meet workers)
Schuster Retrospective Single intervention: Scanlon Plan Productivity (output/ On monthly basis; average The results of this study find that
(1983) 653 longitudinal – seemingly tailor-made to plants; hour); level of number of workers employed on use of cooperative programmes led
USA Nine firms labour and management committees employment 12th day of each month to increase in productivity in six of
the eight firms in which it could be
5 years measured and level of employment
remained stable in eight out of the
nine firms
Katz et al. Prospective Various practices: QWL Economic outcomes: Quality: No. of faults or The study reports limited support for
(1983) 652 longitudinal programmes involving direct quality index; efficiency demands appearing in the QWL intervention in improving
USA 18 plants within a communication and ‘shop floor Industrial relations inspections either the economic or industrial
division of General decision-making’ outcomes: Grievance Efficiency: Direct labour hours/ relations performance
Motors rates; absenteeism; standardised hours calculated
9 years disruption; contract by industrial engineers; contract
demand; negotiation demands – no. of demands
time; climate – often IR outcomes – self-
explanatory
IR, industrial relations; QWL, quality of work life.

which, in Ichniowski et al.’s21 terms, was aimed at studies were economic; productivity was included
innovative practice. The practices used to measure in six and profitability or financial performance
the intensity of the quality-of-work programme in four. Workers’ compensation, a measure of the
were specific to the programme, ranging from wages bill over sales revenue, was more a measure
upward communication programmes to alcohol- or of efficiency than compensation. The other
drug-abuse programmes, and also included some economic outcomes used in the studies, mainly
procedural elements, for example the use of an in one only, were: quality, shrinkage, operating
outside consultant or quality-of-work specialist. expenses, employment growth, employment
stability, innovation in product, processes or
Schuster653 focused on unionised plants where the technology, and export performance. Workman
union and management had explicitly developed and Bommer654 used performance measures
a cooperative relationship. The concept of that were primarily specific to call centres, for
union–management cooperation, the impact of example percentage of calls escalated, but also
which Schuster653 assessed, reflects the notions of used a customer service measure. The other
Kochan about the changes in industrial relations in outcome measures used were concerned with HR
unionised settings in the early 1980s, also reflected or industrial relations measures – again mainly in
in Katz et al.’s652 study above, and culminated one study only – and included: labour turnover,
in Kochan’s655 book with Katz and MacKersie, absenteeism, organisational commitment, job
The Transformation of Industrial Relations. In satisfaction, industrial conflict or disruption,
Schuster’s653 study there were differences between contract demands, negotiation time, employment
the novel practices, which varied across the nine climate and grievance rate.
manufacturing plants, but they most commonly
involved plant-wide productivity-sharing plans, Results
labour-management committees and work redesign Wright et al.37 showed that HR practices lower
projects. operating expenses and increase profitability,
and are also associated with organisational
Freeman and Kleiner649 contrasted continuous commitment, which Wright et al.37 took to be
flow production with a piecework system, and suggestive of commitment mediating the link
conceptualised both primarily on the basis of their between HR practices and outcomes, although this
compensation systems, as these were, for them, is not formally tested.
‘a central element to any set of human resource
policies’ (ibid: 308). Nonetheless, the systems The results of Guest et al.’s27 study showed a
entailed complementary practices: piece rates positive association between HRM and profitability
were similar to supervisors who monitored the and a negative relationship between HRM and
quality output and set rates, while the change to labour turnover. It was not, however, related to
a continuous flow system included a change in productivity. Moreover, when prior profit was
the production system, teamwork, a new safety included in the profitability equation, profit was
programme, as well as time rates. Such a contrast no longer significantly associated with HRM.
in systems is most applicable to shoe and apparel This suggests that profits may well lead to the
manufacturing, where piece rates have continued introduction of HRM not vice versa, this conclusion
to be extensively used. being enhanced by the lack of association between
HRM and productivity.
Gomez-Mejia’s651 focus was specifically on
international HR strategy. The measure used was a Shipton et al.650 revealed a positive link between
seven-item scale that focused on how HR practice sophisticated HRM and innovation in product
is geared to international elements, for example and production technology, but not in process
international experience is highly desirable when technology.
managers are hired or promoted, whereas some
of the practices included reflect those in the other Workman and Bommer654 showed that the
studies, for example inventive pay, intensive introduction of alignment job design, high-
training. involvement work processes, and autonomous work
teams all increased job satisfaction. However, in
Outcomes the case of autonomous work teams, the effect was
The range of the outcomes used to test the impact moderated by the individual’s preference for group
of the various core HR constructs was equally large. working, so autonomous teams were only potent
The only two outcomes assessed in more than two for those with such a preference. In the case of
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high-involvement work processes, this preference monitoring costs or costs involved in changing
intensified the positive impact of the processes on styles, were greater than those associated with the
job satisfaction. Hence, while the job satisfaction newly implemented time-based compensation and
of all individuals increased, the satisfaction of continuous flow method. These costs outweighed
those with a strong preference for group working the productivity gains to be made from piece work,
increased to a greater extent. However, only high- so, on balance, the new continuous flow system led
involvement work processes were associated with to an overall better performance.
organisational commitment. Tests of performance
showed that all three systems improved the four Gomez-Mejia’s651 study of international human
performance measures over and above the pre-test resources strategy showed that the extent to which
and control group measures, with the exception the firm had a strategy was positively associated
of one test, which showed that the number of with export performance.
problems resolved by employees was lower in
autonomous work groups than for any other groups Omissions
(including the control group). The main omission within the studies that directly
purport to examine the impact of a HR system is
The core concept of Rauch et al.,645 i.e. human that they did not specify, in any precise way, the
development and utilisation, was positively concept of HRM underlying their work nor did
associated with the only outcome measure they they develop a clear rationale for the inclusion
used, namely employment growth. The effect was of the practices by which HRM was measured.
also shown to be enhanced by the extent of the Consequently the main omission from the set of
human capital of employees in the firm, measured studies is research that systematically defines its
by the owner’s perception of whether employees core concept and in which the correspondence
were qualified to do the job. between this and its measure is precise. There
is also an absence of studies that first examine
Ichniowski et al.21 showed that the productivity the association between the practices before
of steel plants was progressively greater as they constructing measures and as part of the
moved through each of the four categories, from understanding of the reality of the HRM they are
traditional to innovative systems. Innovative studying.
systems were the most productive, while the limited
use of innovative practices had some pay-offs. There is also a lack of studies that test mediation
effects, for example whether organisational
The results of Katz’s et al.’s652 analysis of the commitment or job satisfaction mediates the
performance effects of ‘the quality of work life impact of HRM on performance.
programme’ revealed that the extent of the
programme’s adoption was related to product In the case studies, the practices are determined
quality but not to higher productivity. Its effects by the situation and in broad terms correspond to
on quality may have been partially mediated by the concept of the underlying programme that the
its impact on grievance and absence rates (the researcher is examining, although again in these
two main effects for HR outcomes), which were cases more articulation of this concept would have
negatively related to the extent of adoption. been useful.
Schuster653 showed that in six of the nine plants All studies are in the private sector and are mainly
studied, the introduction of the cooperative found in manufacturing settings. Studies of public
programme increased productivity without the sector and voluntary organisations were not
employment level being cut. The employment identified by this review.
level was reduced in only one of the plants, and,
unfortunately, this was the one plant where no Summary
productivity data were provided. The studies taken together showed that HR
practices do make a difference to performance.
In contrast, Freeman and Kleiner’s649 case study However, limitations in the methods and
showed no productivity effects in the change particularly the measures meant that, in many
from the traditional piece work system to a cases, the underlying concept was not clear
continuous flow method. However, profitability enough for one to say which HR system is (or
was improved. The costs of the complementary systems are) really more effective than others. The
practices associated with piece work, for example variety in the studies also limits generalisation.
206
Case studies, such as Freeman and Kleiner’s649 examining the effects of different work schedules
offered convincing evidence of effects in one (such as flexitime, compressed work week and shift
situation but generalisation to either other sites or work) on various intermediate and final outcomes.
assumed related or similar interventions would be However, the results cannot be presented in an
premature. But even in some of the case studies additive manner due to the varied nature of the
there was insufficient detail of some practices to practices and outcomes studied.
be certain about what they entailed, most notably
Schuster’s653 insufficient detail of the changes in job The review of the health literature identified
design in his cases. the heterogeneity of the studies included in the
review and that finding is replicated here where
the diversity of research topics in terms of HRM
Conclusions practices and outcomes measured often make it
difficult to develop generalisable conclusions. This
The literature search to identify studies assessing point is well-illustrated by the categories of work
the impact of HRM practices on intermediate and design, staffing and training and development
final outcomes in non-health-sector settings found where the HRM practices clearly fell into distinct
evidence in nine of the ten categories of HRM subcategories.
practices established in Chapter 4. These are:
There are some exceptions to this finding, where
• work design small numbers of papers were sufficiently similar to
• staffing allow cumulative conclusions to be made.
• training and development
• compensation and rewards Within the work design literature, consistent
• communication evidence has been found for the positive impact
• family friendly of increased job control and negative impact of
• employee involvement, representation and high demands on employee outcomes, such as
participation job satisfaction and absenteeism. Additionally, a
• performance appraisal and performance number of concurring studies have established a
management positive link between autonomous team working
• integrated measures. and employee outcomes relating to individual/team
productivity and job satisfaction.
Work design has attracted most research attention
accounting for over 50 of the identified studies. Research investigating job rotation, job
Other areas that have been the frequent focus of enlargement and job enrichment has concentrated
research include staffing (23 studies), training more on the impact of job enrichment alone.
and development (25 studies), compensation and Enriched jobs have been shown to be linked
rewards (29 studies) and performance management to reduced turnover, and to have a positive
(28 studies). In contrast with this, no evidence was relationship with a number of intermediate
found in the area of single status/harmonisation. outcomes including job satisfaction, motivation,
This distribution of studies perhaps reflects the involvement and commitment. Studies also
fact that the practices studied are in the longer mostly supported a positive relationship between
established and more traditional HRM areas. job enrichment and employee performance and
reduced turnover.
Additionally, the majority of studies included in
this section measure individual level outcomes. Within the literature on staffing, the studies
Less research has looked at final outcomes (i.e. investigating differing recruitment and selection
organisational performance). techniques reported broadly positive impacts of
these tools on intermediate outcomes including
As noted in Chapter 7 (Results, Work design), there intention to leave, employee productivity, person–
are differences in the types of HRM practice that organisation fit and job satisfaction.
have been the focus of longitudinal research in
the health and non-health sectors. Less research The studies across five broad training areas
attention had been given here to the specific offer perhaps the best opportunity to develop
staffing practices of skill mix, staff ratios and generalisable conclusions. Although diversity was
working hours. In direct contrast with the health found in the types of training in this category
literature this chapter reports on six studies (five subcategories) within each of these there was
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reasonable similarity between the studies. Studies of results support the positive impact of using
including performance and skill enhancement employee participation when making key decisions
training provided consistent evidence that this that affect them.
type of training is associated with a range of
positive outcomes. These are mostly measured at Despite these areas of commonality, the review is
the individual level and often reflect the specific characterised by diversity and a lack of cumulative
purpose of the training. Some of these studies data. Overall, there are no more than four or five
include limited evidence on final outcomes, such studies in any of the HRM practice categories that
as profitability and quality outcomes. Overall, the study the same intervention and outcomes. In
majority of studies present positive evidence on the addition, variations in organisational context in the
outcomes specific to the training. non-health literature make it difficult to know how
generalisable any findings are.
A group of studies that fall within both the
performance management and compensation These findings point to significant gaps in
and reward categories looked at the impact of longitudinal research in all of the HRM practice
goal setting and feedback and found consistently categories studied. These gaps exist on both the
positive results. Goal setting and feedback were types of interventions being studied under a given
found to enhance employee performance, practice and also the type of outcomes being
particularly when goal setting is participative. In investigated.
relation to compensation and rewards, several
studies suggest that the effects of goal setting and Despite these limitations, the findings do indicate
feedback are enhanced by incentives. some promising areas and give some indication
of where the general HRM evidence base could
The final area in which a consistent set of findings inform future practice, policy and research in the
was identified is that of employee participation, NHS.
representation and involvement. Here the majority
208
Chapter 9
Intermediate and final outcomes:
correlations and effects
Introduction outcomes on health and non-health final
outcomes.
This chapter addresses Objectives 3 and 4 of the
review. It first considers findings from the literature The chapter first presents methodology and
on the relationship between intermediate outcomes findings from the meta-analyses in relation to
of HRM practices. It then goes on to look at correlations among intermediate outcomes and
what evidence exists for the causal link between between intermediate outcomes and employee
intermediate and final outcomes. The findings behaviours (Objective 3.1). The methodology
reported here specifically address: and findings for the longitudinal studies linking
intermediate with final outcomes are presented
• Objective 3: 3.1 What is the evidence on the below (see Findings for Objective 4.2 and Findings
intercorrelations of intermediate outcomes? for Objective 4.1).
• Objective 4: 4.1 What is the evidence for the
impact of intermediate outcomes on non-
health final outcomes? Review methodology
• Objective 4: 4.2 What is the evidence for the
impact of intermediate outcomes on patient No systematic reviews were identified in the
care outcomes? searches for Objective 3.1. The methodology in
relation to this objective therefore draws exclusively
Chapter 4 describes the intermediate and final on meta-analytic reviews. We next provide a brief
outcomes, identified from the HRM literature description of meta-analysis followed by details of
for inclusion in this review. In Chapter 4 the the strategy used to identify and assess relevant
importance of a third set of variables (salient meta-analyses.
employee behaviours) was also recognised. In
relation to Objectives 3 and 4 this means the Overview of meta-analysis
relationship between intermediate outcomes and
salient productivity related employee behaviours Meta-analysis is a powerful tool for summarising
(e.g. the association between job satisfaction and evidence of a relationship of interest across a
job performance). Employee behaviours were number of studies. Taking the example of job
therefore considered alongside intermediate and satisfaction and organisational commitment, it
final outcomes. These three groups of variables allows individual studies reporting correlations
form the basis for the searches undertaken for this between these two intermediate outcomes to be
chapter. aggregated to provide an estimate of their true
correlation. Meta-analyses are therefore an effective
Two sources of evidence were identified for this way of quantitatively reviewing the correlations
section, their use depending on the research among the intermediate outcomes and their
objective: relationships with employee behaviours. The
large number of studies reporting correlations
• Meta-analyses and systematic reviews were of interest to Objective 3.1 also points to the use
used to examine the correlations among of meta-analyses as the best source of evidence.
intermediate outcomes and the relationship For example, Judge et al.656 reporting on the
of intermediate outcomes with employee correlation between job satisfaction and job
behaviours. performance, carried out a meta-analysis on 254
• Individual longitudinal studies (in the studies, comprising a sample size of 54,471 for
absence of any systematic reviews) were used all the studies, offering a far better synthesis of
to investigate the impact of intermediate research than non-quantitative methods of review
would allow.
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Intermediate and final outcomes: correlations and effects
Meta-analytic search strategy • The meta-analysis or review had to report

A literature search (see example of typical research, correlations between the dependent variable
below) was performed to identify meta-analyses and at least one other selected intermediate
and reviews on the selected intermediate outcomes. outcome of interest, one of the employee
For each intermediate outcome, a search was behaviours (e.g. job performance), or a final
conducted of the following electronic databases: outcome of interest (e.g. patient outcomes,
MEDLINE, CINAHL, PsycINFO and Business profitability).
Source Premier. Searches combined a validated • The meta-analysis or review had to report
search filter for identifying meta-analyses and a corrected correlation coefficient for this
systematic reviews (developed in MEDLINE but relationship. A correlation coefficient corrected
translated for the different databases)657 with takes into account unreliability of the measure
a term, or terms, describing the intermediate of the independent variable or sampling error.
outcome of interest. For example, searches for • The meta-analysis or review had to report the
occupational commitment looked for the terms number of studies/samples from which the
‘professional’ or ‘occupational’ and ‘commitment’. correlation coefficient was calculated.
Sensitive searches were used in order to capture all
possible papers. Two reviewers independently sifted the results
of literature searches to identify meta-analyses
and reviews that satisfied these inclusion criteria.
Reference tracking was also performed on included
Typical search
Database: Ovid MEDLINE <1950 to January Week studies. Informal methods such as contact with
2 2007> experts and purposive searching offered an
additional potential source of relevant studies.
1 cochrane database of systematic reviews.jn.
(3984)
2 meta-analysis.pt. (14,165)
Critical appraisal
3 medline.tw. (19,737) All meta-analyses and reviews are vulnerable to
4 systematic review.tw. (8284) different types of bias or error, which, in turn,
affect their validity and reliability (see Appendix
5 search.tw. (76,046) 9 for a fuller discussion of bias in meta-analyses).
6 or/1–5 (97,040) Meta-analyses and reviews should aim to use
7 organi?ational commitment.tw. (262) measures to limit the various potential sources of
error or bias that may affect their methodological
8 6 and 7 (12) quality and their findings.659 The guidelines and
reviews evaluating this form of analysis all stress
the importance of adequate searches to identify
relevant studies, the need for explicit inclusion
Identifying meta-analyses for criteria, and the need to appraise the quality of
inclusion in the review included studies.659–662
For inclusion in the review, meta-analyses had to The quality of all included meta-analyses in this
satisfy the following criteria: section of the review was evaluated using a checklist
developed for this study (see Appendix 10), based
• The study had to be a meta-analysis or on currently available checklists663,664 research on
systematic review providing an analysis of meta-analysis61,659–662,665–667 and piloted on meta-
‘the results of several independent … trials or analyses included in this review. The checklist was
studies’.658 This excludes articles that perform developed to assess the efforts made by selected
analysis on a primary sample collected for meta-analyses and reviews to limit publication bias,
the analysis, but that are described as a meta- selection bias and extractor bias, and to examine
analysis by its authors. the robustness of the results.659,662
• The dependent variable of the meta-analysis
or review had to be one of the selected Details of the assessment of bias of all meta-
intermediate outcome variables listed in analyses included in the review can be found
Chapter 4, such as organisational commitment at Appendix 11. For ease of interpretation, a
or job satisfaction. brief summary of the definitions of correlational
strength and assessment of bias is given below.
210
Interpretation of results Findings for Objective 3.1

Correlations were described as very small (less than
0.1), small (at least 0.1), medium (at least 0.24 but The primary aim of Objective 3.1 is to review the
less than 0.37) or large (minimum correlation of correlations between intermediate outcomes in
0.37) based on the guidance of Cohen.668 We use order to establish the extent to which they overlap
the corrected correlation coefficient from the meta- with each other. So, for example, if we have
analyses to assess this. measured job satisfaction, what extra information
do we get from measuring organisational
The checklist (Appendix 10) evaluated whether commitment? In line with the project brief, we
the reported measures taken by the meta-analyses restricted our literature search to meta-analyses
included in this report made the likelihood of the that assessed intermediate outcomes. However, a
different types of bias or error low, moderate or large subset of the meta-analyses of intermediate
high. If the likelihood of publication bias were low, outcomes also assessed one or more productivity or
for example, then the quality of this element of the performance-related employee behaviours. Given
meta-analysis could be said to be high. the importance of these behaviours in the overall
HRM performance picture (as discussed in Chapter
Search results 4), we felt it important to include them although
they are supplementary to the original project
The search for meta-analyses or systematic reviews brief.
of intermediate outcomes identified no systematic
reviews. The number of meta-analyses reporting on One of the intermediate outcomes included in the
the various intermediate outcomes is presented in review is that of climate. Two of the meta-analyses
Table 55. included in this section of the review examined
psychological climate. They differed from the other
Overview of quality meta-analyses in this section due to the range of
The failure of all but one of the included meta- variables they covered and the complexity of inter-
analyses to appraise the quality of their included relationships they examined. Additionally, while
studies lowers their quality and their findings most meta-analyses report individual correlations,
should be accepted with caution. This caution the climate meta-analyses also report a more
should be enhanced still further in cases where no complex model of possible causal pathways, from
sensitivity or moderator analysis was performed, climate to attitudes to employee behaviours. This
or where there is high publication, selection or means that they were unsuited to inclusion in the
extractor bias. synthesis of meta-analyses. We report findings from
the two climate meta-analyses separately for clarity.
TABLE 55 Results of the meta-analysis search
No. found No. satisfying

(minus inclusion No. from
Intermediate outcome duplicates) criteria other sources Total
Motivation 55 1 0 1
Job satisfaction 121 15 2 17
Organisational commitment 40 15 3 18
Professional commitment 3 3 0 3
Engagement 0 0 1 1
Burnout 37 2 0 2
Job involvement 8 3 1 4
Turnover intentions 18 0 0 0
Psychological contract 0 0 0 0
Organisational justice 26 6 0 6
Organisational support 0 0 1 1
Organisational climate 1 1 1 2
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The findings for the review of Objective 3.1 are magnitude to suggest construct redundancy,
therefore described as follows: and it is reasonable to conclude that each of the
intermediate outcomes may contribute to efforts to
• summary of the correlations among the understand and manage employee behaviours.
intermediate outcomes
• summary of the correlations between the The meta-analyses provide the pattern of
intermediate outcomes and employee correlations that one might expect theoretically –
behaviours not only because some of the constructs share some
• correlations between climate, other conceptual space (e.g. both job satisfaction and
intermediate outcomes and employee organisational commitment tap into employees’
behaviours. affective reactions to their jobs and organisations),
but also because there are proposed causal linkages
Correlations among between the intermediate outcomes.
intermediate outcomes
The meta-analyses tend to classify variables studied
Table 56 summarises the corrected correlations in relation to the dependant variables in one of
between the intermediate outcomes reported in three ways:
the meta-analyses. Where there was more than
one meta-analysis reporting the relationship • antecedents variables considered to contribute
between two intermediate outcomes, the range of the development of the dependant variable
correlation values from the meta-analyses is shown. • correlates variables for which there is not
No meta-analyses of engagement or psychological consensus about the causal ordering with the
contract met the inclusion criteria. dependant variable
• consequences variables considered to be
Table 56 shows moderate to high correlations influenced by the dependant variable.
between all of the intermediate outcome variables
where data are available. A key objective of the So, for example, Rhoades and Eisenberger208 in
brief for this study was to identify whether each their meta-analysis of organisational support,
intermediate variable identified offered something proposed antecedents included organisational
different. The associations between, for example, justice; consequences of organisational support
job satisfaction and organisational commitment included job satisfaction, organisational
(0.65), although strong, are not of sufficient commitment, job involvement, and turnover. In
TABLE 56 Corrected correlations between intermediate outcomes
1 2 3 4 5 6 7 8
1. Motivation
2. Job satisfaction 0.41
3. Organisational 0.56 0.53 to

commitment 0.65
4. Occupational 0.44 to 0.44 to
commitment 0.51 0.61
5. Job involvement 0.33 to 0.44 to 0.52 to
0.45 0.53 0.67
6. Turnover intent –0.34 to –0.46 to –0.3 –0.3 to
–0.46 –0.51 –0.31
7. Organisational justice – 0.47 to 0.4 to –0.4
distributive 0.56 0.51
8. Organisational justice – 0.43 to 0.38 to –0.4 0.67
procedural 0.62 0.57
9. Organisational support 0.62 0.63 to –0.51 0.59
0.73
212
the Meeyr et al.669 meta-analysis of organisational give systematically higher scores than their less
commitment, proposed antecedents included optimistic counterparts.
organisational justice and organisational support;
proposed consequences included turnover Although there is uncertainty regarding the causal
intentions; and proposed correlates included job ordering among the intermediate outcomes, all are
satisfaction, job involvement and occupational proposed to be implicated in the development of
commitment. However, the meta-analyses were salient organisational behaviours (job performance,
mostly conducted on cross-sectional research. OCB and withdrawal behaviours). We next turn
Although, the meta-analyses provide the patterns to the correlations between the intermediate
of correlations that one might predict, the fact that outcomes and individual employee behaviours.
we are dealing with correlations leaves uncertain
the causal ordering of the observed associations. Correlations between
For example, organisational justice is predicted intermediate outcomes and
to be a source of attitudinal outcomes such as individual employee behaviours
job satisfaction, but it is likely that perceptions
of justice are themselves an outcome of attitudes Meta-analyses were found for relationships between
towards work as well as being an antecedent.670 all the intermediate outcomes and at least one
There is a strong likelihood of reciprocal causal employee behaviour. The most comprehensive
influences between many, if not all, of these data examined relationships with job satisfaction
constructs. and organisational commitment, which is perhaps
unsurprising given the long history and enduring
A further limitation of the studies should be noted. popularity of these concepts in the research
Research on intermediate outcomes has consisted literature. Table 57 summarises the correlations
almost entirely of survey research using self-report between the intermediate outcomes and
measures. Thus, many of the relationships may performance-related employee behaviours.
be inflated due to common method variance.
It has become widely accepted that correlations Generally, the meta-analyses reported here support
between variables measured with the same method significant, small to moderate relationships,
(e.g. self-report surveys) are possibly inflated due between intermediate outcomes and individual
the propensity of the subject to answer similarly employee behaviours (positive relationships
to multiple items. For example, more optimistic with job performance and OCB, and negative
or organisationally committed employees rating relationships with withdrawal behaviours).
a number of intermediate outcomes might However, relationships between absence and
TABLE 57 Corrected correlations between intermediate outcomes and employee behaviours
Organisational
Organisational
Occupational
commitment
commitment
(distributive)
(procedural)
involvement
satisfaction
Motivation
Turnover
support
Justice
Justice
intent
Job
Job
Turnover –0.12 to –0.17 to –0.17 to –0.13 to 0.33 to –0.5 –0.46 –0.11

–0.26 –0.29 –0.21 –0.16 0.38
Absence –0.15 to –0.11 to –0.14

–0.24 –0.23
Job performance 0.15 to 0.13 to 0.07 to 0.09 0.13 to 0.36 0.18 to

0.3 0.30 0.22 0.15 0.2
Organisational 0.23 to 0.28 0.2 to 0.22 to 0.22 to 0.22 to

citizenship 0.28 0.32 0.25 0.27 0.28
behaviour
213

intermediate outcomes are consistently small, and performance might be less about a causal
questioning the posited link between absence and relationship and more to do with the influence of
attitudes. Equally, the correlations between job other factors on both variables.
involvement and employee behaviours are all weak.
While many of the correlations point towards links These caveats to the satisfaction–performance
between intermediate outcomes and employee relationship generally apply to the other
behaviours, it is clear that caution is required in intermediate outcome-employee behaviour
interpreting these results. Some conceptual and correlations in Table 57. The correlations mostly
methodological problems are illustrated when demonstrate significant associations between
we consider, for example, the meta-analytic employee psychological states and important
correlations between job satisfaction and job employee behaviours but there is unresolved causal
performance. ambiguity.
The relationship between job satisfaction and job One further point, given the intermediate
performance has been described as the ‘Holy Grail’ outcomes are interrelated and therefore each will
of occupational and organisational psychologists671 not have a unique relationship with the employee
and has generated a considerable research behaviours, the question arises as to the degree
effort. As Table 57 shows, the strength of the to which the above associations with employee
correlations from the three meta-analyses reported behaviours are independent from one another. As
in this review vary from small to moderate. The already discussed in this section, the association
most recent meta-analysis, by Judge et al.656 is between job satisfaction and performance may be
superior in terms of methodological quality to partly accounted for by the association between
any of the other meta-analyses included in this organisational support and performance, or
report (see Appendix 11 for quality reviews of they may be linked in a causal chain, such
the meta-analyses). Examining several hundred that job satisfaction plays some part in linking
studies, Judge et al.656 found an average corrected organisational support and job performance. This
correlation between job satisfaction and job means that it is not possible to arrive at conclusions
performance of 0.3. Although a correlation of about whether an intermediate outcome has a
0.3 qualifies as a ‘moderate’ effect size using unique relationship with employee behaviours.
Cohen’s668 rule of thumb (see Critical appraisal,
Interpretation of results, above), this result suggests Correlations between climate,
the relationship is a significant one and should be other intermediate outcomes
treated as important, given the multitude of factors and employee behaviours
that may determine job performance.
We next look at two meta-analyses of climate that
However, although the correlations might have attempted to model more than one step in the
encourage an interpretation that job satisfaction causal chain between intermediate outcomes and
causes performance, we cannot determine from employee behaviours, and have sought to provide
these mostly cross-sectional investigations whether a more complete model of employees’ reactions to
this is the case. It appears quite plausible that their work environment.
there is an effect of performance on satisfaction.
Job satisfaction may be ‘a response to previous Employees’ perceptions of virtually every aspect
goal-achievement, job effectiveness, and associated of their work environment have been included in
personal rewards’ (Warr:672 410). Associated climate research, including the organisation as a
personal rewards may be, for example, increased whole, senior management, job characteristics,
pay, recognition and positive feedback, autonomy supervisors and co-workers. The picture is
or skill use, with possible ramifications for levels of further confused by the overlap of climate
job satisfaction. dimensions with other intermediate outcomes,
such as organisational support, and indeed with
An additional interpretation of the satisfaction– HRM practices. For example, job characteristics
performance relationship is that additional perceptions may be included in a climate measure
variables cause both job satisfaction and and also classified as measure of job design.
performance.672 For example, organisational
support might increase job satisfaction while We report here the results of two climate meta-
also creating an environment for effective job analyses which have attempted to meaningfully
performance. The correlation between satisfaction classify the array of climate dimensions. The
214
climate meta-analyses by Carr et al.673 and Parker Each meta-analysis adapted the model slightly,
et al.674 in addition to reporting various one-to-one depending on the specific climate facets each
relationships between climate and intermediate adopted in order to categorise the extensive range
outcomes and/or employee behaviours, each of climate dimensions they studied.
tested a series of models proposing that climate
affects individual work outcomes through affective Carr et al.673 categorised their wide variety of
and cognitive states, such as job satisfaction and climate dimensions according to the three facets of
motivation. This procedure is useful for comparing climate proposed by Ostroff;675 affective, cognitive
alternative explanations for relationships, but and instrumental. Affective climate is concerned
should be used with caution. Correlations that are with interpersonal and social relationships
being compared come from different samples and between employees, and includes the dimensions
populations and are not comparable in the same of participation, cooperation, warmth and social
way as correlations from the same sample. rewards. Cognitive climate relates to individuals
and their involvement in work activities, and
Both meta-analyses drew upon the model of HRM, includes the dimensions of growth, innovation,
climate and productivity proposed by Kopelman et autonomy and intrinsic rewards. Instrumental
al.154 This model proposes that HRM practices in climate is concerned with task involvement
part shape organisational climate (comprising goal and getting things done in the organisation,
emphasis, means emphasis, reward orientation, and comprises the dimensions of achievement,
task support and socioemotional support). Climate hierarchy, structure and extrinsic rewards.675 See
represents employees’ perceptions of what the Table 58 for the correlations between the climate
organisation is like in terms of its policies, practices facets and intermediate outcomes and employee
and procedures. The climate in turn impacts behaviours reported by Carr et al.673
on important individual- and organisational-
level outcomes (e.g. job performance, OCBs and Carr et al.673 then tested a series of conceptual
withdrawal behaviours) through the impact it models based on Kopelman et al.’s154 work using
has on cognitive and affective states, such as job meta-analytic path analysis. Figure 5 shows the final
satisfaction, work motivation and organisational path model that best represents the data.
commitment. The model suggests that HRM does
not directly impact on employee psychological This model shows differential relationship of
states; rather, HR practices are perceptually affective, cognitive and instrumental climate
filtered (i.e. climate) by employees. Subsequent perceptions with job satisfaction and organisational
cognitive and affective states then mediate the commitment. Affective climate has a stronger
relationship between climate and individual- and relationship with organisational commitment than
organisational-level outcomes. Furthermore, do the cognitive and instrumental facets, while
Kopelman et al.154 propose that different climate affective and instrumental climate perceptions
dimensions are related to different cognitive have a stronger relationship with job satisfaction
and affective states, which, in turn, impact on than does cognitive climate. Job satisfaction and
different outcomes. For example, the impact on organisational commitment each have a unique,
withdrawal behaviours occurs primarily through negative relationship with withdrawal (turnover),
job satisfaction and motivation, whereas the impact while job satisfaction also has a unique, positive
on job performance occurs primarily through relationship with both job performance and well-
motivation alone.154 being. This indicates that the relationships between
TABLE 58 Correlations between dimensions of climate, intermediate outcomes and employee behaviours
Intermediate outcomes and behaviours

Climate Job Organisational Job Well-
dimensions satisfaction commitment involvement Motivation being Turnover Performance
Affective 0.46 0.34 0.17 –0.28 0.09
Cognitive 0.33 0.28 0.07 –0.07 0.05
Instrumental 0.44 0.26 0.11 –0.33 0.05
215

Cognitive and
Climate affective states Outcomes
Job
Affective
performance
0.29 0.18
Job
0.23 satisfaction
0.12 0.22
Psychological
Cognitive
well being
–0.34
0.15
0.26 Organisational
commitment
0.10 –0.10
Instrumental –0.15 Withdrawal
FIGURE 5 Path model relating climate to outcomes (Carr et al. 2003673). Figures in the diagram are regression weights that
demonstrate the strength of the relationship on a scale between 0 and 1.
the three climate facets and job performance, cooperation, pride and warmth; and organisational
well-being and withdrawal are indirect, occurring attributes include innovation, management
through their relationship with job satisfaction and, awareness and openness of information. Parker
with withdrawal only, through their relationship et al.674 refer to these facets collectively as
with organisational commitment. Instrumental psychological climate perceptions. See Table 59 for
climate is the only facet to have a direct the correlations between the climate facets and
relationship with an outcome variable, having intermediate outcomes and employee behaviours
a direct, negative relationship with withdrawal reported by Parker et al.674
behaviours.
Parker et al.674 developed a path model in
The model infers causal links; however, it is an attempt to identify causal links between
important to remember that it is based on organisational climate and behavioural outcomes
correlational data and causal interpretations should (Figure 6). Like Carr et al.,673 the authors then
not be assumed. The majority of measures in the tested a series of conceptual models based on
model were obtained via self-report methods, Kopelman et al.’s154 work using meta-analytic path
thereby potentially inflating the relationships analysis. Figure 6 shows the final path model that
reported as a result of common method variance. best represents the data. Parker et al.674 found
evidence that a general climate factor accounted
In contrast with Carr et al.,673 Parker et al.674 for the relationship of the five climate dimensions
classified their wide range of climate dimensions with work outcomes. This is in line with James and
according to the five facets of climate posited by James’212 argument that a common judgement
Jones and James676 concerning work environment process underlies diverse climate dimensions. This
perceptions, namely job, role, leadership, work process is hypothesised to represent an assessment
group and organisational characteristics. Job of whether the work environment is viewed as
characteristics include autonomy, challenge and personally beneficial or detrimental to one’s well-
importance; role characteristics include ambiguity, being.
conflict and overload; leader characteristics
comprise goal emphasis, support and upward This model shows an indirect effect of
influence; work group characteristics, include psychological climate perceptions on performance,
216
TABLE 59 Climate categories and intermediate outcomes and behaviours
Intermediate outcomes and behaviours

Climate Job Organisational Job Well-
dimensions satisfaction commitment involvement Motivation being Turnover Performance
Job 0.22 0.26 0.26 0.20 0.35 0.10
Role 0.28 0.22 0.22 0.09 0.27 0.06
Leader 0.41 0.32 0.32 0.21 0.44 0.16
Work group 0.48 0.27 0.27 0.20 0.25 0.12
Organisation 0.42 0.36 0.36 0.22 0.29 0.13
through their relationship with job satisfaction, In this chapter, we have so far considered the
work attitudes and motivation. The five facets relationships among the intermediate outcomes
of climate have a stronger relationship with and the relationships between the intermediate
job satisfaction than with job involvement outcomes and employee behaviours that may
and commitment, while job involvement and contribute towards organisational performance.
commitment have a stronger relationship with However, organisational performance is not merely
motivation than does job satisfaction. However, an aggregate of individual performance. In this
only job satisfaction also has a direct, positive section and the next we review the evidence for
relationship with performance. This means that the impact of intermediate outcomes, such as
the relationship between psychological climate job satisfaction, on health and non-health final
perceptions and performance is mediated by job outcomes (Objectives 4.1 and 4.2).
satisfaction, work attitudes and motivation, i.e.
that the effects of climate are indirect, occurring
through its relationship with job satisfaction Findings for Objective 4.2
and work attitudes and, in turn, through their
Longitudinal research on
relationship with motivation.
intermediate outcomes and
As with the results of Carr et al.,673 and the other patient outcomes
meta-analyses reported in this chapter, causal Research question
relationships are not proven, and many of the Do intermediate outcomes, such as job satisfaction,
correlations are potentially inflated. have an impact on the patient care outcomes of
Job
satisfaction
0.18 0.23
0.61
General
0.15 Motivation 0.06 Performance
climate
0.43 0.28
Work attitudes:
Job involvement
and commitment
FIGURE 6 Path model relating climate to outcomes (Parker et al. 2003).674 Figures in the diagram are regression weights that
demonstrate the strength of the relationship on a scale between 0 and 1.
217

mortality rates, patient waiting times, patient safety, assessing the impact of the one on the other679
patient satisfaction and patient length of stay? or by considering a patient care outcome not of
interest, for example hospital admissions680 or
Method adherence to therapy.681 A previous review has also
A systematic search of the literature was conducted noted the lack of longitudinal studies examining
to identify potential studies to answer this research the impact of nurses’ job satisfaction on key patient
question. The following databases were MEDLINE, outcomes.682 This lack of evidence has not been
EMBASE, CINAHL, SSCI, PsycINFO, King’s Fund addressed in the intervening years.
database and IBSS. In order to be included, studies
have to satisfy the following criteria. Summary
There is therefore no longitudinal evidence to
Inclusion criteria assess whether intermediate outcomes, such as job
• Longitudinal study design. satisfaction or burnout impacts on the patient care
• Intermediate outcome related to health outcomes of mortality rates, patient waiting times,
professionals (e.g. job satisfaction among patient safety, patient satisfaction and patient
nurses or doctors). length of stay.
• One of the following patient outcomes:
mortality, waiting times, length of stay, patient
satisfaction, patient safety. Findings for Objective 4.1
• The study must test the causal relationship
Impact of intermediate
between the intermediate outcome and the
patient care outcome. outcomes on non-health final
outcomes
Exclusion criteria To identify evidence for the impact of intermediate
Unpublished dissertations. outcomes on final outcomes in the non-health
sectors, longitudinal studies were searched for to
Results and discussion provide stronger evidence of a causal link between
The literature search retrieved the following the two. The procedure (see Conclusions, below)
numbers of unique studies for each of the was repeated here, the only difference being
intermediate outcomes (Table 60). that the variables termed as final outcomes are:
performance, productivity or customer outcomes.
The titles and abstracts of all the retrieved studies
were independently assessed for inclusion by two Details of studies
reviewers. No studies were identified that satisfied Six studies meet the inclusion criteria (Table 61).
the inclusion criteria. Some studies satisfied all but Five of these studies were conducted in the USA
one of the criteria, and so had to be excluded. For and one in the UK. Five of these studies have
example, non-longitudinal design, by performing a prospective longitudinal research design and
data collection of two different types of data at two one uses a retrospective analysis of a longitudinal
different times (two cross-sectional studies rather data set. The duration of the studies varies from
than a single longitudinal study),677,678 studying the 12 months to 8 years. Two studies use cross-
impact of an intervention on both the intermediate industry sample, with Schneider et al.683 using data
outcome and the patient outcome, but not from 35 companies and Patterson et al.36 reporting
TABLE 60 Studies for intermediate outcomes and patient outcomes
Intermediate outcome Records retrieved by searches Records satisfying inclusion criteria

Job satisfaction 279 0
Burnout 63 0
Organisational commitment 7 0
Professional commitment 2 0
Motivation 25 0
Turnover intentions 7 0
Climate 1 0
218
TABLE 61 The impact of intermediate outcomes on non-health final outcomes
Study, Design, sample Intermediate

country size, duration outcome(s) FM Outcomes Outcome measure(s) Results +ve/–ve
DOI: 10.3310/hta14510
Schneider et Prospective Service climate No Customer Survey designed by the Reciprocal causation:
al. (1998)217 longitudinal perceptions of authors Analysis examined the relationship between service
USA 134 branches of service quality climate and service quality, both at two points in time
a bank The results indicated that climate for service led to
subsequent customer perceptions of service quality
but that there was also a reciprocal effect for customer
perceptions and climate
Bernhardt et Prospective Employee satisfaction No Customer satisfaction Surveys designed by the Using a time-series analysis of the data, the study finds
al. (2000)684 longitudinal Restaurant authors a positive relationship between customer satisfaction
USA 382 restaurants performance (sales, Company records and organisational performance
of the same customer counts, No longitudinal analysis was conducted for the
company profitability) relationship between employee satisfaction and
customer satisfaction, though the cross-sectional

12 months
analysis reveals that these two variables are positively
related. The authors also suggest that employee
satisfaction is linked with organisational performance
but they recommend longitudinal research to establish
their cross-sectional findings
Koys (2001)685 Prospective Employee satisfaction No Organisational Surveys designed by the Positive:
USA longitudinal OCB effectiveness: authors The results of the study show that employee
28 stores Customer Company records satisfaction, OCB, and employee turnover predict
Employee turnover satisfaction; profits
2 years organisational effectiveness in the subsequent year.
Using cross-legged regression shows that Year l’s HR
outcomes account for 14%–31% of the variance in
Year 2’s organisational effectiveness. A second set of
regression analyses shows that Year l’s organisational
effectiveness accounts for 0%–7% of the variance in
Year 2’s HR outcomes
continued
219
220
TABLE 61 The impact of intermediate outcomes on non-health final outcomes (continued)
Study, Design, sample Intermediate

country size, duration outcome(s) FM Outcomes Outcome measure(s) Results +ve/–ve
Schneider et Retrospective Employee attitudes: No Financial performance ROA Reverse causation:
al. (2003)683 longitudinal Job satisfaction: Market performance EPS The analysis revealed that Overall Job Satisfaction and
USA 35 companies Satisfaction with Satisfaction With Security were predicted by ROA and
8 years empowerment; EPS more strongly than the reverse (although some
satisfaction with job of the reverse relationships were also significant);
fulfilment; satisfaction Satisfaction With Pay suggested a more reciprocal
with pay; satisfaction with relationship with ROA and EPS
work group; satisfaction The study highlights the existence of reverse
with security; satisfaction causality; i.e. employee attitudes are determined by
with work fulfilment; organisational performance
overall job satisfaction
Patterson et Prospective Organisational climate Yes Company Company data Positive:
al. (2004)36 longitudinal Overall job satisfaction performance: Subsequent productivity is significantly related with
UK 42 manufacturing Productivity and eight aspects of organisational climate and also
Organisational profitability
companies commitment with average job satisfaction (supervisory support,
12 months concern for employee welfare, skill development,

effort, innovation and flexibility, quality, performance
feedback, and formalisation). Job satisfaction mediates
the relationship between climate and productivity
Morrow Prospective Voluntary employee No Organisational Cost per loan: Total Mediation effects:
and McElroy longitudinal turnover efficiency: expenses per subunit minus Cost-per-loan efficiency is found to fully mediate
(2007)686 31 subunits of a Cost per loan; loan commission and bonuses relations between voluntary employee turnover and
USA mortgage services generation (i.e. input), divided by the two organisational performance outcomes, profitability
company number of loans per month and customer satisfaction, in both synchronous and
Organisational (i.e. output)
12 months subunit performance; longitudinal analyses
profitability; Loan generation: The ratio
customer satisfaction of the total amount of loans
funded per subunit per
month (i.e. output) divided
by the number of sales
employees (i.e. input)
Profitability: Basis points
Customer satisfaction:
Company records
EPS, earnings per share; OCB, Organisational Citizenship Behaviour; ROA, return on assets.
data from 42 manufacturing firms. Four studies performance in cyclical and found stronger
investigate the same organisation but sample evidence of reverse causality, i.e. employee attitudes
across various subunits of these organisations. The are determined by organisational performance.
study by Bernhardt et al.684 uses data from 382 The analysis revealed that overall job satisfaction
restaurants; Koys685 reports data from 28 stores of and satisfaction with security were predicted by
the same organisation; Schneider et al.217 collected return on assets (ROA) and earnings per share
data from 134 branches of a bank; and Morrow and (EPS) more strongly than the reverse (although
McElroy686 investigated 31 subunits of a mortgage some of the reverse relationships were also
services company. significant); satisfaction with pay suggested a more
reciprocal relationship with ROA and EPS.683
Intermediate outcome variables studied
Four of the six studies have used employee A fourth study684 uses a longitudinal analysis
satisfaction as a predictor variable; other predictor only between the two final outcomes of customer
variables used by these studies are organisational satisfaction and restaurant performance; it reports
climate, service climate, organisational the link between job satisfaction and customer
commitment and employee turnover. satisfaction using a cross-sectional analysis.
Outcomes The fifth study in this group217 used a prospective

The outcomes are customer satisfaction, customer design to examine the relationship between
perceptions of service quality, and financial service climate and final outcomes. Specifically, it
performance (profits or market performance), examined the links between employee perceptions
productivity. One study has used organisational of service climate and customer perceptions of
effectiveness as a final outcome.686 service quality across 134 bank branches. Survey
responses were collected from both employees
Results and customers at two time points, approximately
Job satisfaction is investigated by four of the six 2 years apart. The results indicated that climate for
studies. Two studies use prospective longitudinal service led to subsequent customer perceptions of
analysis to explore the impact of job satisfaction on service quality, but that there was also a reciprocal
final outcomes.36,385 Both studies report a positive effect for customer perceptions and climate.
relationship between job satisfaction and final
outcomes. There are two studies that have explored the
relationship between customer satisfaction and
The study by Patterson et al.36 also measured financial outcomes, which in the current review
organisational climate and found that job we have treated as final outcomes. The study by
satisfaction mediated the relationship between Bernhardt et al.684 finds a positive relationship
organisational climate and company productivity. between customer satisfaction and organisational
Encouragingly, this study shows a similar pattern performance; the study by Morrow and McElroy686
of results to the path models based on meta- found cost-per-loan efficiency to fully mediate
analyses of climate and employee performance relations between voluntary employee turnover
by Carr et al.673 and Parker et al.674 reported below and two organisational performance outcomes,
(see Conclusions). So, together, these three studies profitability and customer satisfaction, in both
find that employee attitudes (e.g. job satisfaction) synchronous and longitudinal analyses. Such
mediate the relationship between climate and studies point to the multiple stages that may lie
performance at the individual level and at the between HRM practices and financial performance.
organisational level.
Omissions
Across 28 retail stores, Koys685 found that employee Other than limited data on the impact of employee
satisfaction was moderately correlated with store satisfaction and climate on final outcomes in the
profitability in the subsequent year, and strongly non-health sector, no longitudinal evidence was
correlated with subsequent customer satisfaction identified on the impact of intermediate outcomes
ratings. on final outcomes.
The study by Schneider et al.683 used a retrospective Summary

design of employee attitude data over 8 years in up There are six studies in this review of longitudinal
to 35 companies to conclude that the relationship studies on the link between intermediate outcomes
between job satisfaction and organisational and final outcomes. Five of the studies use a
221

prospective longitudinal research design and one we cannot determine whether one intermediate
study uses a retrospective analysis of a longitudinal outcome (e.g. high job satisfaction) promoted the
data set. Four studies have collected data from employee behaviour (e.g. good work performance),
various subunits of the same organisation and whether behaviours enhanced the intermediate
two have used cross-organisation data. Four of outcomes, whether both effects occurred, or
the six studies examine the relationship between whether third variables were causally more
job satisfaction and final outcomes; two studies important. Nevertheless, the data do point towards
explored the link between climate and final the importance of the intermediate outcomes for
outcomes, one looking at general organisational salient employee behaviours.
climate, the other at climate for service; the other
intermediate outcomes in this review have not been There were few meta-analytic data on motivation
subjected to longitudinal investigation in relation and none on the psychological contract. Both
to final outcomes. Given the few longitudinal constructs have considerable prominence in the
studies linking any given intermediate outcome HRM and organisational behaviour. In the case of
with a final outcome we cannot arrive at any clear the psychological contract this absence may reflect
conclusion about the causal connection between the concepts relative newness, but also because
these intermediate and final outcomes. it is an ‘umbrella construct capturing a range of
variables associated with trust, commitment and
the exchange of expectations and obligations’
Conclusions (Sparrow:687 15) and, consequently, it has been
operationalised in many different ways. However,
This chapter has covered a wide range of there is little doubt that the psychological contract
research, reviewing intercorrelations between the is seen by many commentators as a useful vehicle to
intermediate outcomes (Objective 3.1), and the help understand and predict employee behaviour.
impact of intermediate outcomes on final outcomes
in both the non-health literature (Objective 4.1) There were very few longitudinal studies to bring to
and the health literature (Objective 4.2). bear on Objective 4.1. In non-health settings there
was some limited evidence about organisations’
Many, but not all of, the intermediate outcomes average job satisfaction, climate and company
were covered by meta-analyses. While there performance, but very few studies have examined
remains debate over the value of measuring each of both intermediate and final outcomes on two or
the intermediate outcomes as a separate domain of more occasions.652 Schneider et al.683 did examine
assessment in relation to performance, the strength data at multiple time points, albeit on a very small
of the correlations does not indicate construct sample ranging from only 12 to 35 companies.
redundancy. The significant intercorrelations Their finding of reverse causality between
stem not only from some conceptual overlap and average satisfaction and financial performance
mostly likely common method variance, but also emphasises the need for caution in making causal
because there are causal linkages between the interpretations, and also the need for further, more
constructs. For example, employee perceptions of robust research.
the organisation, as embodied in such constructs
as climate, organisational support and justice, There were no relevant longitudinal studies
are generally proposed to shape motivation and examining intermediate outcomes to patient
employee attitudes, such as commitment and outcomes. It is therefore worth noting that there
satisfaction. However, the causal linkages between are cross-sectional studies on staff intermediate
these domains remain unclear. outcomes and patient outcomes. For example,
Robertson et al.688 found that nurse job satisfaction
Additional analyses reviewing the meta-analytic averaged at the ward level was related to observed
correlations between the intermediate outcomes standards of care delivery. Leiter et al.689 found
of HRM and salient employee behaviours that patients treated on wards where nursing staff
were mostly consistent in showing significant averaged greater job-related emotional exhaustion
associations, although none was large. However, (a dimension of burnout) were less satisfied with
to date most research has merely asked about the their nurses, doctors and average quality of care.
existence or otherwise of a significant association These investigations are clearly worth pursuing
between intermediate outcomes and employee with more substantial longitudinal data sets.
behaviours. From this correlational data alone
222
Chapter 10
Measuring the intermediate outcomes
of HRM: the reliability of measures
Introduction general or an aspect of it) in the same way as the
other items in the scale. The most appropriate
This chapter focuses on objective two of the statistic to assess a scale’s reliability is known as
research. Specifically, it is concerned with Cronbach’s alpha and is expressed as a value
answering the following question: What is the between 0 and 1. Cronbach’s alpha is the average
evidence on the reliability of measures of the correlation of each item in a scale with all of the
intermediate outcomes of HRM practices covered other items in that scale. For a scale to have good
by this review? reliability (good internal consistency), as a rule of
thumb it should have a Cronbach’s alpha of at least
The chapter first considers the ways in which the 0.7. We have used this measure as the best indicator
properties of a scale or measure are evaluated. of scale reliability.
The process of selecting measures of intermediate
outcomes for the review is described and the Test–retest reliability
evidence used in the review is identified. Finally, Test–retest reliability concerns the extent to which
evidence about the reliability of selected measures a scale’s measurements are consistent over time.
is presented. It is not always appropriate but can be helpful in
assessing how well a measure performs. Hence
in situations where the work environment (for
What is measurement example) is expected to be stable, test–retest
reliability? reliability of a measure of work environment
(the correlation between the time 1 and time 2
This review is concerned with self-report measures measures) should be > 0.7. Equally, in situations
or scales used in survey instruments. Reliability where the work environment is expected to change
is an important aspect of the quality of such (e.g. in response to HRM practices) test–retest
measures. A scale’s reliability refers to how reliability can be low. Test–retest reliability is less
consistently the scale measures a psychological frequently reported in evaluation articles and is of
feature or work characteristic. Psychometrics is the less interest to the current review.
statistical process concerned with developing or
assessing the quality of measurement scales and Inter-rater reliability
scale reliability is one of the properties by which a A third form of reliability concerns the stability or
scale’s quality is rated psychometric. consistency of a measure when used by different
raters given the same experiences (inter-rater
Methods of measuring reliability reliability). Inter-rater reliability is important
when results are aggregated and analysed at
The focus of this part of the review is the reported the organisational level (such as using the mean
reliabilities of scales that measure the intermediate job satisfaction score across all employees in an
outcomes of HRM practices. Two basic forms of organisation to represent organisational level job
reliability exist for self-report instruments: internal satisfaction). It is usually measured by intraclass
consistency and test–retest reliability. correlation (ICC) of which there are two forms.
ICC1 measures the extent to which individuals in a
Internal consistency group agree (the basis for justifying aggregation to
The internal consistency of a scale indicates the the mean is that there is good general agreement
extent to which all of the items in the scale are within a group, so a mean score is not hiding
broadly measuring the same phenomenon as each high levels of variation between individuals).
other. For example, in a job satisfaction measure, ICC2 assesses the reliability of the mean score
the internal consistency would demonstrate the (approximately this measures the extent to
extent to which each item or question in the scale which the mean scores on a scale for two random
is actually measuring job satisfaction (either in subsamples of the same group correlate). While of 223

Measuring the intermediate outcomes of HRM
interest to the current review, inter-rater reliability performance chain. The intermediate outcomes
in the form of ICCs is only relevant to studies using included here were first identified in Chapter 4 as
organisational level aggregated data, which, as this having the most potential in explaining the HRM–
review has established, are few in number, so it performance link. Evidence on the causal links
has not been possible to report ICCSs for the data between HRM practices and these intermediate
presented in this chapter. outcomes was then reviewed in Chapters 5–7.
In the context of this review, those intermediate
Challenges in reviewing outcomes that have been demonstrated to be
reliability sensitive to HRM practices are deemed ‘valid’ to
measure:
In order to review the reliability of a scale, it is
ideal to identify several examples of scale use • motivation
and compare reliability scores from a number of • job satisfaction
different samples. Previous reviews of the reliability • organisational commitment
of measures have highlighted a number of • occupational/professional commitment
challenges inherent in extracting these data from • engagement
the social science research literature:49 • burnout
• job involvement
• inconsistent use of measures although a well- • turnover intentions
established measure is cited in the article, the • psychological contract
authors may have adapted or deleted items • organisational justice
from the scale or altered response categories • organisational support
(sometimes without stating this in the article) • climate.
• inaccurate reporting of reliability data reliability
statistics are given for the original or some Process for selecting specific
historical sample rather than the current intermediate outcome measures
sample in the article for review
• inconsistent reporting of reliability data in
articles although scales are used, their The aim is to identify key measures for each
reliabilities are not reported for the sample. intermediate outcome domain included in the
review. The strategy used is a four-step process:
These factors taken together mean that although
there might, on the surface, be a large number • First, for each of the above 12 intermediate
of articles that report using a specific measure, outcomes the specific measures used in the
there may in practice only be a limited amount of studies were identified. Where an intermediate
information available on the measure’s reliability. outcome had a single scale associated with it,
or if there were any scales predominantly used
A further complication for this review is the extent in the health literature, these would be selected
to which one-off scales or single items have been for the review of reliability. This exercise
used to measure concepts of interest. Where a scale revealed that for a number of intermediate
appears only once in the literature its reliability outcomes no single scale emerged as the main
is of relatively limited use in a review such as this. or preferred measure. In some instances, the
Single items cannot have their reliability assessed measure used was a one-off, designed by the
by the methods described here (as reliability is researchers or was simply not specified at all.
based on the relationships between items). For In other cases a number of specific measures
these reasons the review developed a pragmatic were each used by one study or a small number
strategy for identifying relevant evidence, which is of them. In these cases, expert opinion was
described below (see Conclusions). used to select the best-established measures.
• Second, where an intermediate outcome area
was not covered by the studies included in
Which intermediate this review (as is the case with psychological
outcomes is it valid to contract) or the measure identified in this
review was felt to be too specific for general
measure in this context? use (as with climate for creativity and
In line with the project brief, this review uses innovation) the subject experts on the research
validity to refer to the relevance of measuring team identified an appropriate measure for
224 certain intermediate outcomes in the HRM inclusion.
• Third, for each of the included measures, a Established scales used in the review:
recent review of reliability data was sought. One
evidence source was invaluable in this: Taking
the Measure of Work – a guide to validated scales Warr et al. (1979):475 Intrinsic Job Motivation
for organisational research and diagnosis201
provides a comprehensive review, drawing on
all papers using validated measures published
in 15 top organisational research journals over
the period 1990–9. Scale description
• Fourth, for the intermediate outcomes not This is a six-item scale measuring intrinsic job
covered by Fields’ review201 a search was motivation, i.e. the degree to which an employee is
undertaken for reviews of reliability for scales motivated to perform well in his/her current job in
measuring the intermediate outcome. If no order to be intrinsically satisfied. The scale is taken
review of scale reliability could be identified from Warr et al.’s475 Work and Life Attitudes Survey.
then purposive searching was undertaken
for a meta-analysis or longitudinal study to Items and response category
supplement the data presented here. Meta- • ‘I feel a sense of personal satisfaction when I do
analyses were also used where conceptual this job well.’
uncertainty existed around a measure. The • ‘My opinion of myself goes down when I do
aim of this search was to identify reliability this job badly.’
data for the selected measures and to • ‘I take pride in doing my job as well as I can.’
highlight if there were other well-established • ‘I feel unhappy when my work is not up to my
measures for any of the outcomes that had not usual standard.’
already been covered in the review. In some • ‘I like to look back on the day’s work with a
instances intermediate outcomes had only sense of a job well done.’
been studied in cross-sectional research, so • ‘I try to think of ways of doing my job
no example scales were covered in this review. effectively.’
However, these intermediate outcomes had
been identified by the expert panel as being Each item is rated on seven-point Likert-type scale,
theoretically important and were thought where 1 = no, I strongly disagree, 2 = no, I disagree
to have demonstrable links with important quite a lot, 3 = no, I disagree just a little, 4 = I’m
employee behaviours such as job performance not sure about this, 5 = yes, I agree just a little,
and staff turnover. 6 = yes, I agree quite a lot, and 7 = yes, I strongly
agree.
The remainder of the chapter presents evidence
on scale reliabilities for measures of intermediate Reliability
outcomes of HRM practices identified earlier in A coefficient alpha value of 0.65 for test–
the report. For each intermediate outcome, the use retest reliability, based on 60 participants, was
of scales in the review is summarised and the main reported.475
scale used to measure that outcome is descibed.
Items and response categories are given and One review of measures of motivation was
reliability data reported. identified.690 This does not include the Warr et al.475
measure, nor does it provide scale reliabilities for
the measures it identifies. Eleven measures of work
Reliability of intermediate motivation are listed (including the JDS).
outcome measures
Job satisfaction
Motivation
Five studies reported using measures of motivation Job satisfaction was the most widely measured
as an outcome of HRM practices. Three studies intermediate outcome in the review. Over 50
each used a different established scale, one study studies reported data using 17 different measures.
used the researchers own scale and one study did Measures differ in the sense that they either
not specify the measure of motivation. Of the three measure overall satisfaction (e.g. with items such as
established measures, one was developed in the ‘in general, I like working here’) or they measure
UK475 and is presented here. A second measure, satisfaction with individual facets of a job (e.g.
which includes a subscale of work motivation (the pay, autonomy, supervision), which can then be
JDS), is reported below (see Job satisfaction). combined to give an overall satisfaction score. 225

The measures commonly used in studies in this • ‘My own feelings generally are not affected
review all measure satisfaction with facets of the much one way or the other by how well I do on
job to some degree. Additionally, some measures this job.’
distinguish between intrinsic satisfaction (job • ‘Most people on this job feel a great sense of
content) and extrinsic satisfaction (rate of pay and personal satisfaction when they do the job well.’
security).475 • ‘Most people on this job feel bad or unhappy
when they find that they have performed the
Four measures emerge as the most commonly used work poorly.’
in this type of research:
Responses for the items in the general and work
motivation subscales are scored on a seven-point
Likert scale: 1 = disagree strongly, 2 = disagree,
Hackman and Oldham (1974):195 Job Diagnostic 3 = disagree slightly, 4 = neutral, 5 = agree slightly,
Survey (JDS)
6 = agree, and 7 = agree strongly.
Smith et al. (1969):243 Job Descriptive Index (JDI)
Weiss et al. (1967):473 Minnesota Satisfaction Satisfaction with opportunities for
Questionnaire (MSQ) growth
Warr et al. (1979):475 Job Satisfaction Questionnaire • ‘The amount of personal growth and
development I get in doing my job.’
• ‘The feeling of worthwhile accomplishment I
get from doing my job.’
The most commonly used measure was JDS. The • ‘The amount of independent thought and
overall and facet-specific job satisfaction scales of action I can exercise in my job.’
the JDS form part of a larger questionnaire that • ‘The amount of challenge in my job.’
was first developed in the early 1970s. The full
JDS measures a range of different aspects of work Facet-specific items
including motivation, job characteristics. The job • Security
satisfaction and work motivation subscales are –– ‘the amount of job security I have’
reported here. –– ‘how secure things look for me in the
future in this organisation’.
Scale description • Compensation
This is a 25-item measure consisting of four –– ‘the amount of pay and fringe benefits I
subscales: overall satisfaction; internal work receive’
motivation; growth satisfaction; and satisfaction –– ‘the degree to which I am fairly paid
with specific facets of the job. Details of the for the amount I contribute to this
measure are taken from Fields201 ‘Taking the Measure organisation’.
of Work’. • Satisfaction with co-workers
–– ‘the people I talk to and work with on my
Items and response categories job’
Overall satisfaction –– ‘the chance to get to know other people
• ‘Generally speaking I am very satisfied with while on the job’
this job.’ –– ‘the chance to help other people while at
• ‘I am generally satisfied with the kind of work I work’.
do in this job.’ • Satisfaction with supervisor
• ‘I frequently think of quitting this job.’ –– ‘the degree of respect and fair treatment I
• ‘Most people in this job are very satisfied with receive from my boss’
the job.’ –– ‘the amount of support and guidance I
• ‘People on this job often think of quitting.’ receive from my supervisor’
–– ‘the overall quality of the supervision I
Internal work motivation receive in my work’.
• ‘My opinion of myself goes up when I do this
job well.’ The response categories for growth satisfaction
• ‘I feel a great sense of personal satisfaction and facet-specific satisfaction are: 1 = extremely
when I do this job well.’ dissatisfied, 2 = dissatisfied, 3 = slightly dissatisfied,
• ‘I feel bad and unhappy when I discover that I 4 = neutral, 5 = slightly satisfied, 6 = satisfied, and
have performed poorly on this job.’ 7 = extremely satisfied.
226
Reliability • ‘For me this is the best possible of all

Fields201 reports Cronbach’s alphas of between organisations for which to work.’
0.55 and 0.92 for the various satisfaction subscales.
General satisfaction is reported to have an alpha of The response category is a seven-point Likert scale:
0.77, internal work motivation an alpha of 0.67. 1 = strongly disagree, 2 = moderately disagree,
3 = slightly disagree, 4 = neither disagree nor
Other measures of job satisfaction agree, 5 = slightly agree, 6 = moderately agree, and
Fields201 identifies a further 20 validated measures 7 = strongly agree.
of job satisfaction.
Reliability
Organisational commitment Fields201 reports reliabilities ranging between 0.74
and 0.92 from 13 studies using the measure.
Twenty-one studies report on the links between
HRM practices and organisational commitment. Other measures of organisational
Six different scales of organisational commitment commitment
were identified, the most frequently used being Fields201 identifies nine validated measures of
those of Mowday et al.173 and Meyer and Allen:477 organisational commitment in addition to the two
identified here. This figure includes one scale of
Scales used in this review: occupational commitment, which is reported next.
Occupational/professional
Mowday et al. (1982):173 Shortened OCQ commitment
Meyer and Allen (1984):477 Affective Commitment One measure of professional or career commitment
was identified in the papers included in the review:
The shortened Organisational Commitment Scale

is presented here.
Blau (1985):691 The Career Commitment Scale
Scale description
This is a nine-item scale measuring the extent
to which an individual accepts or shares the
organisation’s goals, is prepared to exert effort on Scale description
the part of the organisation and wishes to maintain This is an eight-item measure of occupational
membership of the organisation. commitment developed with nursing staff in a
North American hospital. In this context, career
Items and response categories commitment is defined as one’s attitude towards
• ‘I am willing to put in a great deal of effort one’s profession or vocation.691
beyond that normally expected in order to help
this organisation to be successful.’ Items and response category (slightly abbreviated
• ‘I talk up this organisation to my friends as a scale items are reported here as they appear in the
great organisation to work for.’ original article).
• ‘I would accept almost any type of job
assignment in order to keep working for this • ‘If I could get another job different from being
organisation.’ a nurse and paying the same amount I would
• ‘I find that my values and the organisations probably take it.’*
values are very similar.’ • ‘I definitely want a career for myself in
• ‘I am proud to tell others that I am part of this nursing.’
organisation.’ • ‘If I could do it all over again, I would not
• ‘This organisation really inspires the very best choose to work in the nursing profession.’*
in me in the way of job performance.’ • ‘If I had all the money I needed without
• ‘I am extremely glad that I chose this working, I would probably still continue to
organisation to work for over others I was work in the nursing profession.’
considering at the time I joined.’ • ‘I like this vocation too well to give it up.’
• ‘I really care about the fate of this organisation.’ • ‘This is the ideal vocation for a life work.’
227

• ‘I am disappointed that I ever entered the ––‘When I get up in the morning, I feel like
nursing profession.’* going to work.’
• ‘I spend a significant amount of personal time • Dedication
reading nursing-related journals or books.’ –– ‘I am enthusiastic about my job.’
–– ‘My job inspires me.’
(*Indicates that the item is reverse scored.) –– ‘I am proud of the work that I do.’
• Absorption
The scale uses a five-point response category, which –– ‘I feel happy when I am working intensely.’
Blau691 describes as ranging from 1 = strongly –– ‘I am immersed in my work.’
disagree to 5 = strongly agree. –– ‘I get carried away when I am working.’
Reliability Response category

Blau691 reports a Cronbach’s alpha of 0.87 for All items are rated on a seven-point Likert-type
the career commitment scale. A second sample scale, where 0 = never, 1 = almost never, 2 = rarely,
(consisting of roughly one-half repeat respondents 3 = sometimes, 4 = often, 5 = very often, and
and one-half new respondents) gave a Cronbach’s 6 = always.
alpha of 0.85. Fields201 reports alphas of 0.76–0.88
from five studies using the measure. Reliability
Cronbach’s alpha coefficients ranged between 0.60
Engagement and 0.88 (median = 0.77) for the three-item vigour
subscale, between 0.75 and 0.90 (median = 0.85)
None of the studies in the current review measured for the three-item dedication subscale, and between
engagement, so no specific scales were identified 0.66 and 0.86 (median = 0.78) for the three-item
this way. The literature search was also unable to absorption subscale.692 Cronbach’s alpha for the
identify any reviews of the reliability of a measure whole nine-item measure varied between 0.85 and
of engagement. This section therefore draws on 0.92 (median = 0.92).692
evidence from a single study on the development
of a short measure of engagement, which has been Coefficients for test–retest reliability were
widely used in cross-sectional research on HRM: 0.61, 0.56 and 0.60 for the subscales of vigour,
dedication and absorption, respectively, based on a
sample of 293 participants, and 0.71, 0.66 and 0.68
Schaufeli et al. (2006):692 Utrecht Work Engagement for each of the subscales, respectively, based on a
Scale – shortened version (UWES-9) sample of 2111 participants.
Coefficients for test–retest reliability for the whole

Scale description nine-item measure were 0.64 and 0.73, based on
This is a nine-item measure of work engagement, samples of 293 and 2111 participants, respectively.
i.e. a positive work-related state of fulfilment
characterised by vigour (high levels of energy while Burnout
working, and persistence in the face of difficulties),
dedication (sense of significance, enthusiasm, Thirty studies included a measure of emotional
challenge and pride) and absorption (being fully strain. A wide range of concepts were covered by
concentrated and deeply engrossed in work). This the studies including negative emotions, stress,
measure is a shortened version of the original, 17- exhaustion, irritation, anxiety, self-esteem and
item UWES.179 psychosomatic complaints. There was also great
variation in the measures used; however, the
There are three items on each of the three Maslach Burnout Inventory (MBI) was the most
subscales: vigour, dedication and absorption. frequently reported (four studies):
Example items
• Vigour
Maslach and Jackson (1981, 1984):693,694 Maslach
–– ‘At my work, I feel bursting with energy.’
Burnout Inventory (MBI)
–– ‘At my job, I feel strong and vigorous.’
228
Scale description –– ‘I have become more calloused towards

The MBI was developed with health care people since I took this job.’
professionals. The original MBI is a 25-item –– ‘I worry that this job is hardening me
measure comprising three subscales: emotionally.’
–– ‘I feel some clients blame me for some of
• Emotional exhaustion characterised by low their problems.’
energy and feeling emotionally drained, also –– ‘I don’t really care what happens to some
referred to as compassion fatigue. clients.’
• Depersonalisation typified by treating patients or
clients as objects rather than people. Respondents are asked to rate each item according
• Diminished personal accomplishment the tendency to the intensity and frequency of their experience
to evaluate oneself negatively, or experience on a scale ranging from 1 (very mild) to 7 (very
reduced feelings of job competence. strong). There has been a tendency in research
studies to use only the frequency measure.
More recently a general scale (MBI–General
Survey) has been developed.188 The general survey Reliability
broadly parallels the original MBI, with the main Many studies have used the MBI and reviews of
change being that items on depersonalisation are these typically report Cronbach’s alphas of 0.74–
replaced with one on cynicism. 0.89 for the three subscales.695
A 22-item version of the MBI has been developed Other measures of burnout
and found to be reliabile.695,696 The 22-item scale is Research into burnout has largely been dominated
reported here. by use of the MBI. One review of measures of
burnout was identified697 in which two other scales
Items and response category are reviewed.
• Exhaustion subscale
–– ‘I feel emotionally drained from my work.’ Job involvement
–– ‘I feel fatigued when I have to get up in the
morning to face another day in the job.’ Four studies include a job involvement measure
–– ‘Working with people all day is really a as an outcome of HRM. Two studies reported
strain for me.’ using Lodahl and Kejner424 and one study used a
–– ‘I feel ‘burned out’ from my work.’ measure by Kanungo.593 The fourth study did not
–– ‘I feel frustrated by my job.’ specify the scale used.
–– ‘I feel I’m working too hard on my job.’
–– ‘Working directly with people puts too No reviews of the reliability of job involvement
much stress on me.’ measures were identified. A meta-analysis of job
–– ‘I feel like I’m at the end of my rope.’ involvement189 established that the two scales
–– ‘I feel used up at the end of the day.’ cited here tended to measure the same concept
• Personal accomplishment and that there were no substantive differences in
–– ‘I can easily understand how my clients feel relationships with other associated variables (e.g.
about things.’ job satisfaction). The more recent Kanungo593 scale
–– ‘I deal very effectively with the problems of is reported here.
my clients.’
–– ‘I feel I am a positive influence on other
peoples lives through my work.’ Kanungo (1982):593 Job Involvement Questionnaire
–– ‘I feel very energetic.’ (JIQ)
–– ‘I can easily create a relaxed atmosphere.’
–– ‘I feel exhilarated after working with my
clients.’ Scale description
–– ‘I have accomplished many worthwhile This is a 10-item scale to describe an employee’s
things in this job.’ specific beliefs regarding his/her relationship with,
–– ‘In my work I deal with emotional or involvement in, his/her current job.
problems calmly.’
• Depersonalisation Example items
–– ‘I feel I treat some clients as impersonal • ‘The most important things that happen to me
“objects”.’ involve my present job.’
229

• ‘To me, my job is only a small part of who I • ‘I will probably look for a new job in the next
am.’ year.’
• ‘I am very much involved personally with my
job.’ Response category
• ‘I live, eat and breathe my job.’ Item 1 is rated on a seven-point Likert-type scale,
• ‘Most of my interests are centred around my where 1 = not at all likely, 2 = somewhat likely,
job.’ 3 = quite likely, and 7 = extremely likely.
• ‘I have very strong ties with my present job
which would be very difficult to break.’ Items 2 and 3 are rated on a seven-point
• ‘Usually I feel detached from my job.’ Likert-type scale, where 1 = strongly disagree,
• ‘Most of my personal life goals are job- 2 = disagree, 3 = slightly disagree, 4 = neither agree
oriented.’ nor disagree, 5 = slightly agree, 6 = agree, and
• ‘I consider my job to be very central to my 7 = strongly agree.
existence.’
• ‘I like to be absorbed in my job most of the Reliability
time.’ A coefficient alpha value of 0.83 is given based on a
sample of more than 400 participants.619
Response category
Each item is rated on six-point ‘agree–disagree’ Psychological contract
Likert-type scale.
No studies measuring psychological contract were
Reliability found in the review of longitudinal studies. Equally,
Coefficient alpha values for the JIQ, as calculated no review of psychological contract scales was
by Kanungo,593 were 0.87 for internal consistency identified in the literature. The details of the scale
(based on 703 participants) and 0.85 for test–retest reported here are drawn from the Psychological
reliability (based on 63 participants). Contract Inventory Technical Report.698
Turnover intentions
Rousseau (2000):698 Psychological Contract
Over 50 of the studies in this review included some Inventory (PCI)
form of absence, turnover or turnover intention
measure. In 36 cases, a one-off or unspecified scale,
or company records were used. The remaining
studies cited 10 different scales, the most frequently Scale description
cited being the Intention to Quit subscale of the This scale measures four dimensions of the
Michigan Organisational Assessment Questionnaire psychological contract; relational (long-term or
(used in three studies). open-ended employment arrangements, based on
mutual trust and loyalty), balanced (dynamic, open-
No reviews of the reliability of turnover intention ended employment arrangements), transactional
scales were identified. (short-term employment arrangements, based
primarily on economic exchange), and transitional
(a cognitive state that reflects the consequences
Cammann et al. (1979):619 Intention to Turn Over of organisational change). All four dimensions
are considered from the perspective of both the
employee and the employer.
Scale description
This is a three-item subscale of the Michigan The dimensions of relational and transactional
Organizational Assessment Questionnaire, psychological contract are generally considered to
measuring an employee’s intentions to leave his/ underpin the concept and, therefore, only these
her job. two scales are reported below.
Items and response category Items and response categories

• ‘How likely is it that you will actively look for a Employer obligations
new job in the next year?’ ‘Consider your relationship with your current
• ‘I often think about quitting.’ employer. To what extent has your employer made
the following commitment or obligation to you?’
230
• Relational related factors: distributive justice refers to the

–– ‘Concern for my personal welfare.’ degree of perceived fairness in organisational
–– ‘Be responsive to employee concerns.’ outcomes, given one’s inputs to the organisation;
–– ‘Make decisions with my interests in mind.’ procedural justice is concerned with the perceived
–– ‘Concern for my long-term well-being.’ fairness of the procedures by which a given
–– ‘Support me in meeting higher goals.’ outcome is arrived at; and interactional justice is
• Transactional perceived as the interpersonal treatment people
–– ‘Limited involvement in the organisation.’ receive when procedures are implemented. Both
–– ‘Training me only for management.’ meta-analyses recommend the measurement of the
–– ‘A job limited to specific, well-defined three constructs.
responsibilities.’
Fields201 identifies only one scale measuring all
Employee obligations three justice components in his review of measures
‘Consider your relationship with your current for organisational research, which is presented
employer. To what extent have you made the here.
following commitment or obligation to your
employer?’
Niehoff and Moorman (1993):700 Distributive,
• Relational Procedural and Interactive Justice
–– ‘Make personal sacrifices for this
organisation.’
–– ‘Take this organisation’s concerns Scale description
personally.’ This is a 20-item scale, five items relate to
–– ‘Protect this organisation’s image.’ distributive justice, six to procedural justice and
–– ‘Commit myself personally to this nine to interactional justice.
organisation.’
• Transactional Items and response category
–– ‘Perform only required tasks.’ • Distributive justice items
–– ‘Do only what I am paid to do.’ –– ‘My work schedule is fair.’
–– ‘Fulfil a limited number of responsibilities.’ –– ‘I think my level of pay is fair.’
–– ‘Only perform specific duties.’ –– ‘I consider my workload to be quite fair.’
–– ‘Quit whenever I want.’ –– ‘Overall the rewards I receive here are
–– ‘I have no future obligations.’ quite fair.’
–– ‘Leave at any time I choose.’ –– ‘I feel that my job responsibilities are fair.’
–– ‘I have much fewer commitments.’ • Procedural justice items
–– ‘Job decisions are made by the general
Response category manager in an unbiased manner.’
All items were measured on a five-point Likert- –– ‘My general manager makes sure that all
type scale, where 1 = not at all, 2 = slightly, employee concerns are heard before job
3 = somewhat, 4 = moderately, and 5 = to a great decisions are made.’
extent. –– ‘To make formal job decisions my general
manager collects accurate and complete
Reliability information.’
No reliability data are reported for the PSI. –– ‘My general manager clarifies decisions
and provides additional information when
Organisational justice requested by employees.’
–– ‘All job decisions are applied consistently
Four studies reported using a measure of across all affected employees.’
organisational justice. Two studies developed –– ‘Employees are allowed to challenge or
specific scales, one was unspecified and the fourth appeal job decisions made by the general
study used a scale based on Gilliland’s699 procedural manager.’
justice rules. • Interactive justice items
–– ‘When decisions are made about my
Two meta-analytic reviews of the concept job, the general manager treats me with
were identified.202,670 Both supported the kindness and consideration.’
conceptualisation of justice as three distinct but –– ‘When decisions are made about my job,
231

the general manager treats me with respect part. There is a shorter 17-item version of the
and dignity.’ scale, which is presented here. It consists of eight
–– ‘When decisions are made about my job, items about how employees perceive themselves
the general manager is sensitive to my to be valued by the organisation and nine items
personal needs.’ about the extent to which the organisation
–– ‘When decisions are made about my job, considers their well-being in the decisions that
the general manager deals with me in a it makes. Shorter versions have been used, but
truthful manner.’ the scale authors recommend that both facets of
–– ‘When decisions are made about my job, perceived organisational support are used in its
the general manager shows concern for my measurement.208
rights as an employee.’
–– ‘Concerning decisions about my job, the Items and response category
general manager discusses the implications ‘Listed below is a series of statements that represent
of the decisions with me.’ possible feelings that individuals might have
–– ‘The general manager offers adequate about the company or organisation for which they
justification for decisions made about my work. With respect to your own feelings about the
job.’ particular organisation with which you are now
–– ‘When making decisions about my job, the working [name of organisation] please indicate
general manager offers explanations that the degree of your agreement or disagreement
make sense to me.’ with each statement by checking one of seven
–– ‘My general manager explains very clearly alternatives below each statement.’
any decision made about my job.’
• ‘The organisation values my contribution to its
Responses are on a seven-point scale ranging from well-being.’
1 = strongly disagree to 7 = strongly agree. • ‘If the organisation could hire someone at a
lower salary to replace me it would do so.’*
Reliability • ‘The organisation fails to appreciate any extra
Fields201 reports Cronbach’s alpha coefficients for effort from me.’*
the scales as follows: distributive justice 0.72–0.74; • ‘The organisation strongly considers my goals
procedural justice 0.85 and interactive justice 0.92. and values.’
• ‘The organisation would ignore any complaint
Other measures of organisational justice from me.’
Fields201 identifies 18 additional validated measures • ‘The organisation disregards my bests interests
of organisational justice. The majority focus either when it makes decisions that affect me.’
on procedural justice or distributive justice. • ‘Help is available from the organisation when I
have a problem.’
Organisational support • ‘The organisation really cares about my well-
being.’
One measure of perceived organisational support • ‘The organisation is willing to extend itself in
was reported in the studies included in the review order to help me perform my job to the best of
and is reported here. my ability.’
• ‘Even if I did the best job possible the
organisation would fail to notice.’
Eisenberger et al. (1986):206 Survey of Perceived • ‘The organisation is willing to help me when I
Organistional Support need a special favour.’
• ‘The organisation cares about my general
satisfaction at work.’
Scale description • ‘If given the opportunity, the organisation
Perceived organisational support is a would take advantage of me.’*
unidimensional scale with two facets, valuation • ‘The organisation shows very little concern for
of employee contribution and concern about me.’*
employee well-being.208 The Survey of Perceived • ‘The organisation cares about my opinions.’
Organisational Support measures the employee’s • ‘The organisation takes pride in my
view of the extent to which his/her organisation accomplishments at work.’
values them, is concerned with their well-being • ‘The organisation tries to make my job as
and chooses to reward greater effort on their interesting as possible.’
232
(*Indicates that an item is reverse scored.) was felt to be too specific to be of general use so is
not included here.
Responses are scored on a seven-point scale,
running from 1 = strongly disagree to 7 = strongly The literature review identified two meta-analytic
agree. reviews of molar climate measures;673,674 two recent
studies of climate in health-care settings;701,702 and
Reliability one review of safety climate in health care.703 Both
Rhoades and Eisenberger208 describe the scale as of the studies in health-care settings support the
unidimensional and having high internal reliability. importance of safety climate in determining patient
This is confirmed in their review of more than 70 safety outcomes (including medication errors).
studies, most of which use the Survey of Perceived
Organisational Support. Fields, in his review of The review of Flin et al.703 examines the
the measure, reports coefficient alpha values from psychometric properties of 12 measures of safety
three studies, ranging from 0.74 to 0.95. climate and concludes that the Hospital Survey
on Patient Safety has undergone more rigorous
Other measures of organisational testing than other measures and met more of their
support psychometric criteria. The scale is reported here.
No other measures of organisational support were
identified.
Sorra and Nieva (2003):704 Hospital Survey on
Organisational climate Patient Safety
Measuring organisational climate is especially

complex due to the multifaceted nature of the Scale description
concept. A wide range of dimensions can be
covered in a generic climate model, and there Safety climate is measured by 10 dimensions in
is little consensus about which dimensions it is the Sorra and Nieva704 instrument. Of these, Flin
important to measure. Measures of organisational et al.703 recommend that three dimensions, relating
climate typically adopt one of two distinct to teamwork and organisational learning, are not
approaches. First, the molar approach that looks used (as they are not demonstrated to be specific to
at employees’ perceptions of a variety of formal safety climate). The seven remaining dimensions
and informal practices, policies and procedures in are described here.
an organisation. The two meta-analyses reported
in Chapter 8 adopt this broad approach to climate Items and response category
measurement. However, there is no consensus Safety culture dimensions – unit level
about which climate measures should be included. • Supervisor/manager expectations and actions
Existing climate measures cover a vast number and promoting safety
variety of dimensions with little consensus as to the –– ‘My supervisor/manager says a good word
areas of organisational functioning that should be when he/she sees a job done according to
covered. established safety procedures.’
–– ‘My supervisor/manager seriously considers
Second, facet-specific approaches try to identify staff suggestions for improving patient
a few key elements of climate that are relevant safety.’
to the specific research question and use a small –– ‘Whenever pressure builds up, my
number of scales to measure those relevant climate supervisor/manager wants us to work faster
dimensions. There is emerging evidence to suggest even if it means taking short cuts.’*
that specific climates (e.g. safety, innovation, –– ‘My supervisor/manager overlooks patient
customer service) are important in predicting safety problems that happen over and
specific organisational outcomes. In particular, in over.’*
the health sector, safety climate has emerged as a • Communication openness
prominent area of research in relation to patient –– ‘Staff will freely speak up if they say
outcomes. something that may negatively affect
patient care.’
One measure of climate was identified in the –– ‘Staff feel free to question the decisions or
studies included in the review, the facet-specific actions of those with more authority.’
measure of creative and innovative climate.251 This
233

–– ‘Staff are afraid to ask questions when Reliability

something does not seem right.’* Sorra and Nieva704 report reliabilities for the scales
• Feedback and communication about error as follows:
–– ‘We are given feedback about changes put
into place on event reports.’
–– ‘We are informed about errors that happen Supervisor/manager expectations and actions pro-
in this unit.’ moting safety: Cronbach’s alpha = 0.75
–– ‘In this unit, we discuss ways to prevent Communication openness: Cronbach’s alpha = 0.72
errors from happening again.’
Feedback and communications about error:
• Non-punitive response to error Cronbach’s alpha = 0.78
–– ‘Staff feel like their mistakes are held
against them.’* Non-punitive response to error: Cronbach’s
alpha = 0.79
–– ‘When an event is reported, it feels like
the person is being written up, not the Staffing: Cronbach’s alpha = 0.63
problem.’* Hospital management support for patient safety:
–– ‘Staff worry that mistakes they make are Cronbach’s alpha = 0.83
kept in their personnel file.’* Hospital handoff and transitions: Cronbach’s
• Staffing alpha = 0.80
–– ‘We have enough staff to handle the
workload.’
–– ‘Staff in this unit work longer hours than is
best for patient care.’* Conclusions
–– ‘We use more agency/temporary staff than
is best for patient care.’* Scales for nine of the intermediate outcomes were
–– ‘We work in “crisis mode”, trying to do too identified in the studies included in this review.
much, too quickly.’* Two intermediate outcomes domains (engagement
• Hospital management support for patient and psychological contract) were not covered in the
safety studies included in this review. However, they were
–– ‘Hospital management provides a work felt to be conceptually important areas (particularly
climate that promotes patient safety.’ for future research) and measures were identified
–– ‘The actions of hospital management show via expert opinion. In one area, climate, the only
that patient safety is a top priority.’ measure used in an included study was felt to be
–– ‘Hospital management seems interested in too specific to an area (creativity) for general use
patient safety only after an adverse event in studying the effects of HRM. Again the subject
happens.’* experts on the team identified alternative climate
measures that are of theoretical interest in an NHS
Safety culture dimensions – hospital setting.
wide
• Hospital hand-offs and transitions: An extensive review of validated measures of a
–– ‘Things ‘fall between the cracks’ when range of work-related variables (Fields201) was used
transferring patients from one unit to as the primary source of information for five of
another.’* the intermediate outcome areas (job satisfaction,
–– ‘Important patient care information is organisational commitment, occupational
often lost during shift changes.’* commitment, organisational justice and
–– ‘Problems often occur in the exchange of organisational support). For the remaining seven
information across hospital units.’ areas, reviews of scale reliabilities were sought,
–– ‘Shift changes are problematic for patients and where none could be found we drew on meta-
in this hospital.’* analyses or empirical studies to provide some data
on reliability and other scales.
(*Indicates the item is reverse scored.)
The studies included in this review used a wide
Responses are measured on a five-point Likert-type range of scales within most of the intermediate
scale, where 1 = strongly disagree, 2 = disagree, outcome areas, while in other areas a far smaller
3 = neither, 4 = agree, and 5 = strongly agree. number of scales, or no scales were found.
234
The same pattern was found in the reviews of (e.g. engagement). This is not a reflection on their
validated measures. The large numbers of scales theoretical importance.
identified in areas such as job satisfaction and
organisational justice are a reflection of both The aim here was to provide reliability information
the popularity of such concepts in the research on scales demonstrated as having causal links in
literature and their multidimensionality – often the HRM performance chain. Overall, validated
scales are developed to measure specific facets scales with published reliability data were found
of an intermediate outcome (e.g. procedural, for 10 of the 12 intermediate outcomes, the only
distributive or interactional justice). The lack of exceptions being psychological contract and
scales of other areas in longitudinal HRM studies engagement. This is perhaps a reflection of the
included in this review indicates either the relative relatively recent recognition of the potential offered
youth of the concepts in HRM research terms by these outcomes for explaining links in the HRM
(e.g. psychological contract) or the popularity of performance chain. The subject experts on the
cross-sectional as opposed to longitudinal research team identified promising scales for these areas.
235

Chapter 11
Conclusions and recommendations
Introduction such as those in many areas of medicine where
the methodology was first developed. Specifying
Identifying the links between HRM and individual and defining the interventions and outcomes
and organisational performance is a critical to be studied was particularly complicated, and
issue for policy-makers and practitioners. Since consequently developing inclusion and exclusion
the earliest studies in the USA by researchers criteria and a robust means of synthesis was not
such as Arthur14,648 and Huselid,18 many a straightforward matter. As a result, this report
commentators have concluded that the evidence presents an assessment of the evidence in relation
of the performance benefits of effective HRM to a wide range of HRM practices, rather than
is increasingly strong. As Marchington and an in-depth appraisal and synthesis of findings
Zagelmeyer705 note, a number of reports in the involving a few well-defined practices. There are
UK have stated that the economic and business two methodological principles that have guided the
case for good people management is now proven. review:
For example, in the UK, the CIPD706 reported
that ‘more than 30 studies carried out in the • The review is, in the main, concerned with
UK and the USA since the early 1990s leave no cause and effect and, therefore, mostly restricts
room to doubt that there is a correlation between itself to the type of evidence capable of
business management and performance, that the providing causal explanations.
relationship is positive, and that it is cumulative’ • The review adopts a broad and inclusive
(CIPD 2001:706 4). However, there is not unanimity approach to the assessment of evidence in
about the strength of the evidence and judgements order to reflect the complex and diverse nature
vary as to the extent to which the case is proven. of the HRM literature.
More considered reviews of the evidence suggest
that it is too early to be conclusive about the effects Given the multiple research questions this review
of HR practices on performance.30 Hence the sought to answer, along with the breadth of some
current review is a timely assessment of the nature of the research questions and the time limitations
and strength of the evidence linking HRM to on the project, we did not attempt a coverage of all
performance. literature relevant to HRM, such as that on culture,
strategy and leadership, but these concepts are
included where they are directly tied to the HRM
Systematic review practices reviewed (e.g. leadership training).
methodology
Previous reviews on the evidence base for the Identification of HRM
HRM performance link have been conducted practices
with varying degrees of adherence to systematic
principles, but none has followed the protocols of An immediate challenge for the research team was
systematic review methodology. There is no real that of marshalling the diverse/diffuse terminology
tradition of using this approach in the HRM field within HRM into categories that could be used
and their use more generally in organisational consistently throughout the review. Practices were
behaviour and management areas has only recently identified using three different methods:
emerged. Such reviews are still limited in number.
• a review of reviews
Systematic review methodology offers the most • expert opinion
sophisticated means of identifying and synthesising • all practices identified from the subsequent
large amounts of evidence from disparate literature searches were then mapped back
sources, as is the case in the HRM literature. on to the categories created by the first
The HRM topic itself, however, presented two methods, to test their coverage and
several challenges often not encountered in inclusiveness.
more limited and clearly demarcated reviews, 237

Two researchers independently undertook classification (SIC) codes that allows further
reciprocal translation on the HRM practice breakdown of the data by sector. It is recommended
terms in order to test the equivalence of themes that further analysis of this database is undertaken
across different research papers. This quickly to provide more detailed information about the use
demonstrated the diversity of approaches and of HRM in the health sector that this permits.
definitions within the HRM literature, and led us
to adopt a search strategy based on broader terms The categories of HRM practices, work design
such as HRM and personnel management. and staffing, training, employee involvement and
performance management, which we have found to
On the one hand, the implications for this review be most consistently associated with positive patient
are that by adopting a broad search strategy, the outcomes in the health sector have also been shown
evidence collected is an accurate reflection of the by the data in WERS to have good coverage in
diversity of research within HRM, but is more both health and non-health sectors. However, the
difficult to distil into a few key messages. On information on them is not as deep as one would
the other hand, as in any review, some relevant ideally like, as we do not have strong information
research studies may not have been identified, on the variety of forms that each HRM practice
particularly in this case if they did not include may take. Such variations may lead to differences in
HRM, personnel management, or an equivalent their effects and durability.
term in the title or abstract and were not identified
via citation searching or reference tracking. Additionally, there is a need for awareness
about the potential gap between intended HRM
practices and actual or implemented practices.
Range and fidelity of use of Social policy research has shown that the extent
HRM practices in the UK of implementation fidelity may affect whether
a practice has its desired impact. However, no
Objective 1 for the research is concerned with generic measure of implementation fidelity exists
identifying the main methods of HRM practices, and there is little consistency in its measurement in
the extent of their use in UK organisations, and the social policy area. Within HRM, some studies
the degree to which HRM policy is implemented. do gauge whether policies and practices have
Initial work to identify the main methods of been implemented as they should be (e.g. reduced
HRM identified 10 broad categories of practice/ hours working, and monitoring and feedback),
intervention. These were then searched for in high- but, on the whole, the fidelity with which HRM
quality HRM surveys in the UK. Several surveys practices are implemented is rarely measured in
were identified that examined the range of HRM the research. However, only by evaluating whether
practices being used in organisations in the UK. Of a practice has been implemented properly can we
these, the WERS in particular is an excellent source assess whether any lack of impact is due to poor
of data on the extent of use of practices, providing implementation or the inadequacies of the practice
some data on each of the broad categories of HRM itself. Without assessing fidelity, it is also unclear
practice. The majority of categories of practice whether any positive outcomes produced could
identified in this review are also reported in surveys be improved still further by increasing fidelity to
as present in over 70% of UK workplaces. However, the original model. Implementation fidelity has
within an individual workplace the extent of their then to be considered as a potential moderator
use may vary as they may not be used for all staff. of outcomes, i.e. a variable that can influence the
relationship between an HRM practice and its
Not all specific practices in each broad category outcome.
used in this review are measured. For example,
a survey might measure some aspects of work Consequently, implementation fidelity needs to
design, for example job autonomy, but not others, be measured and this report offers a framework
for example role breadth. Hence, the range of and guidance for understanding and evaluating
approaches to HRM practices within each broad the fidelity in practice. A major implication for
category of HRM activity is unknown. Separate the findings of this review is that it is unclear
information for the health sector is sparse and whether variations in outcome or inconclusive
points to the need for better monitoring of HRM findings are due to methodological weaknesses
practices used in the NHS and elsewhere in the in which researchers have failed to distinguish
health sector. WERS uses standard industrial between HRM policies as intended and HRM
238
practice as enacted. The recommendation here is commitment. Firm conclusions cannot be drawn
for better methodological rigour in the assessment from this research base.
of implementation fidelity within HRM and
performance research. Some constructs have emerged more recently (e.g.
engagement and psychological contract) and,
therefore, while theoretically important, may not
Evidence for the link yet have been the subject of longitudinal research.
between HRM practices and The research in health settings on burnout and job
satisfaction is perhaps unsurprising, as burnout has
intermediate outcomes in long been proposed as a potential adverse reaction
the health sector to care work, and job satisfaction is the most widely
researched intermediate outcome in organisational
Intermediate outcomes are the intended outcomes psychology and organisational behaviour research,
of HRM practices, such as attitudes that may act which chimes with how the layperson would first
as a link between HRM and final outcomes such as approach the assessment of work.
patient care. Longitudinal studies examining the
relationship between HRM and such outcomes in Overall, very limited evidence was found and
the health field were identified by two strategies. the main theoretical links have not been tested
First, a broad search for HRM and any outcome, longitudinally in the health sector. Considerably
with no limitations set in the search terms of type more longitudinal research is needed on a wider
of outcome or setting, was undertaken. Second, a range of variables to understand the impact of
more specific search of the link between HRM and HRM practices on final outcomes in the NHS.
patient outcomes was conducted. One quasi-longitudinal British study has appeared
subsequent to our review by West et al.,707 which
Longitudinal studies were found to exist for only uses aggregated data from a somewhat diverse set
5 of the 12 intermediate outcomes identified of practices to create an index of high-performance
for inclusion in the review. No longitudinal HRM system, and finds it is significantly related to
evidence was found for the impact of a large mortality rates in hospitals, controlling for prior
number of categories of HRM practices: these mortality.
were recruitment, training, communication,
employee involvement, family-friendly practices
and performance management. Additionally, Impact of HRM practices on
no longitudinal studies were identified that patient outcomes
reported on the links between HRM practices
and intermediate outcomes such as motivation, The longitudinal research suggests that three
job involvement, occupational commitment, types of HRM practices – employee involvement,
engagement, organisational justice, organisational training and performance management – have a
climate, psychological contract and perceived positive impact on the key patient-care outcomes:
organisational support. The review demonstrates mortality rates, length of stay, waiting times,
that longitudinal research linking HRM practices patient safety and patient satisfaction. More
and intermediate outcomes is underdeveloped in specifically, working in quality improvement teams,
the health field. training, and feedback were consistently and
strongly associated with reduced infection rates,
The findings of the research examining the impact although much of the evidence is based on studies
of HRM practices on intermediate outcomes in the USA. We might therefore target each of these
identified in this review were far from conclusive. practices for further research.
Positive relationships were found between team
working on morale and job satisfaction, job variety More than one-half of the studies involving
and turnover intentions, and job complexity and patient outcome identified in the review examined
job satisfaction. However, the numbers of studies the impact of different staffing models through
on these relationships is small, and, moreover, comparisons of cases using different grades and
other variables, such as job demands, job control, types of staff, different combinations of staff in
task reallocation, role ambiguity, pay and employee teams, or different lengths of shift. The research
involvement, were not found to have a consistent on the health sector is therefore very different from
impact on job satisfaction or organisational the non-health sector research, which has been less
concerned with staffing practices.
239

The mechanisms (i.e. the intermediate outcomes Third, some HRM practices have been the subject
or performance-related employee behaviours) of research in both the health and the non-health
by which these HRM practices impact on patient sectors. However, a major difference between the
outcomes have not been explored. This could research in the two sectors is the specific practices
be because the HRM practices that make up the that have been studied within each HRM category.
majority of studies in this area (i.e. staffing levels, For example, the studies in work design in non-
substitution) are not primarily conceptualised as health settings cover five main topics: team work,
having an impact via employee psychological states job complexity, job demands and control, job
such as satisfaction and motivation. For example, rotation, enlargement and enrichment, and role
they may affect the way work is done. Nonetheless, conflict or clarity. The work design studies in
we should not rule out the possibility that such health are more limited in scope. Within staffing,
issues as staffing levels may have important for example, health research has focused more
implications for employee outcomes such as on topics such as staffing levels and substitution,
burnout or commitment without further research. whereas the non-health research has looked more
at recruitment and selection, induction and flexible
The recommendation here is that future research working practices.
on HRM considers the impact of these practices
on important employee psychological states and Some other differences are to be expected. The
behaviours as well as at the patient outcomes level. final outcomes differ, between the health and non-
Studying a broader range of employee outcomes heath sectors, but also the intermediate outcomes
will help provide a better understanding of these and productivity-related employee behaviours
processes in an NHS setting. have received much greater attention in non-
health compared with health settings. Although
there is a large number of studies in the non-
Impact of HRM on health field, which have examined longitudinally
intermediate and final the relationship between some of HRM practices
and employee outcomes such as satisfaction,
outcomes in the non-health commitment and employee performance and
literature turnover, there are clear gaps in the HRM
literature. The coverage of intermediate outcomes
A comparison of the non-health literature that was such as engagement, psychological contract and
reported in Chapter 8 with the health literature climate are in non-health sectors just as neglected
reported in Chapters 6 and 7 reveals a number of as they are in health.
clear similarities. First, there is an imbalance in the
practices covered, so, in both areas certain domains The majority of studies in both areas present
of HRM are covered disproportionately more positive relationships between the practices
than in others. Practices in the categories of work studied. This may reflect a bias in the acceptance of
design and staffing are more prevalent, whereas papers by journal editors and referees’ comments.
practices in other categories such as family friendly, But its implication is that we do not have a very
communication and employee representation are firm basis for ruling out some practices as definitely
underexplored. There are no studies of single not contributing significantly or independently to
status in either area. The gaps in research are final or intermediate outcomes. An examination of
not dissimilar between the two sectors in terms of the cross-sectional studies, if there were sufficient
the broad categories of HRM practice for which on specific practice–outcome links, might be used
evidence was identified. to identify some of these.
Second, there is considerable heterogeneity in the There is some similarity among the studies in this
research within each of the HRM categories for review, although it is rare for more than three or
both the health and non-health areas, and very four studies to be sufficiently similar to compare
few replication studies exist. This limits what a directly, so many of the findings in this report are
systematic comparison of the studies in a particular based on only a small number of studies. However,
domain can achieve, as we are not comparing the it is possible to identify some broad themes
same practices or performance measures. underlying the findings.
240
Broad emergent themes the impact of training on the specific intended

from the health and non- outcomes of the training initiatives. In some cases
there is evidence for the impact of training on
health literature more general employee attitudes and perceptions.
Work design There is also some limited evidence for the impact
of training on the final outcome of organisational
In the area of work design in the non-health performance. But again, evidence is limited and
literature, the most studied practices are in the further longitudinal research at the organisational
employee autonomy and control categories, level is required to clarify the nature of these
specifically within the studies on job enrichment, relationships.
team working and job control. Job enrichment
(i.e. providing employees with opportunities to Performance management
take on broader roles with greater decision-making
responsibility) was found to have universally Support for the impact of performance
positive effects on employee psychological states management practices is found in both the health
and positive employee behaviours. In addition, and the non-health literature. There is evidence
the weight of evidence on semiautonomous and from both sectors for the importance of feedback
autonomous teams (i.e. enriched jobs within on performance outcomes. In the non-health
team working) points again to positive impacts sector, feedback was found to have a positive
on employee attitudes and behaviours (e.g. impact on job performance and job satisfaction
productivity). Further evidence for the importance but this literature places greater emphasis on
of employee autonomy within the work design the importance of participative goal setting in
literature can be found in studies of job demands conjunction with feedback. This specific link has
and control. This is a key theory in the area of work not been tested in the health literature.
stress and most studies have looked at individual
outcomes such as job satisfaction and psychological Promising practices
and physical health outcomes. These studies have revealed what the Advanced
Institute for Management Research programme
These studies provide consistent evidence for (www.aimresearch.org/promising.html) refers
the positive impact of increased job autonomy to as ‘promising practices’ – work design that
on employee outcomes such as job satisfaction, enhances employee autonomy and control,
absence and health. Taken together, these studies training, performance management (in the form of
emphasise the potential importance of HRM feedback, participative goal setting, education) and
initiatives that involve designing jobs which employee involvement.
provide employees with the opportunity to have
control and discretion over their work. Although The work design practices were central to
one longitudinal study has found evidence the original concepts of high-involvement or
for an association between enriched jobs and commitment models,191,708 but, nonetheless,
organisational outcomes of company productivity have increasingly been neglected in the HRM
and profitability, further longitudinal research at performance literature, as a recent overview31 has
the organisational level is needed to build a more shown to be the case. However, intensive training
robust picture of organisational effects.34 that has been more central to the resource-based
theory of the firm is also important. Indeed
In the parallel field of employee participation, the the emphasis on workers’ knowledge and skill
small number of studies reviewed here support the acquisition are, along with empowerment, the
widely advocated principle of involving employees core elements of the Lawler191 and Walton708
in the design and implementation of changes (e.g. models. They are also key to the more recent
job redesign) that affect their work. Specifically Bailey framework as adopted by Appelbaum et
in the health literature, employee involvement al.13 and others, in which practices that enhance
through quality improvement teams was found to employee skills and provide employees with a
be effective in terms of improved patient outcomes. forum to participate (through work organisation
changes such as empowerment) are central.
Training There is further evidence for the significance
of these from a longitudinal study of practices
In the area of training, findings in both health in manufacturing, which was not published at
and non-health areas are consistently positive for the time of our review. Birdi et al.709 replicated
241

the findings of Patterson et al.34 reported in this practices in terms of organisational performance.
review. Both studies found independent effects Limitations in the methods and particularly
for job enrichment (empowerment in the terms the measures means that, in many cases, the
of the Birdi et al.709 study) and extensive training underlying concept is not clear enough for one
on organisational performance, but not for the to say which HR system is (or systems) are really
operational management initiatives of total quality more effective than others or whether there
management, JIT and advanced manufacturing are some practices that account for most of the
technology. effect. Even in some of the case studies there was
insufficient detail of some practices to be even
Research effort expended on these promising certain what these entailed. Nor again can it be
areas may have the most pay-off but it would be ruled out that one or more practice is a critical
a mistake given the heterogeneity and limited ingredient and the others are of little consequence
scope of the studies in the HRM if research were to for performance. The variety in the studies also
overconcentrate on these for a number of reasons. limits generalisation. Case studies, such as that
First, other practices, especially those for which of Freeman and Kleiner,649 offered convincing
there is no research, may be important. Second, evidence of effects of a package of practices in one
while they may be critical ingredients in a package situation, but generalisation to either other sites or
of HRM practices, they may have synergistic assumed related or similar interventions would be
effects on other practices. For example, Birdi et al. premature.
found that team working was not independently
associated with productivity but it enhanced the Finally, we should not neglect practices outside
impact of both training and empowerment, as the HRM domain. As we have seen, their impact
well as operational practices such as JIT. This may be affected by the use of HRM practices. It
contrasts with the results of the longitudinal US may also be that their use is strongly related to
study by Capelli and Neumark149 included in the use of HRM practices, which means that we
our review, which tested for synergies between can not be sure that if they are not included in the
practices but found no strong ones The practices analysis any link between an HRM practice and
relating to work organisation and training were performance that is found is either spurious or is
limited, however, to team working, cross-training a mediator of the link between the other practice
and job rotation not enrichment or other training and performance. In contrast, if HRM practices are
measures. found to be significant and non-HRM practices are
found not to be then this strengthens any argument
Third, it may yet be that integrated approach about their importance.
to HRM in which practice use is a reflection of
a more fundamental orientation on the part of
management, be it high involvement or something Relationship between
else, is more significant for practice than any one intermediate outcomes and
individual practice. A cross-sectional study using
WERS9883 data shows that an integrated measure
final outcomes
of high-involvement management centred on The intermediate outcomes examined in this
work organisation practices such as team-working, review assessed a range of mental, emotional and
idea-capturing methods, and functional flexibility attitudinal states that are hypothesised to provide a
is related to the level and rate of change in bridge between HRM and performance. While we
productivity.647 Nonetheless, this high-involvement acknowledge that HRM practices can have a direct
management is shown to be discrete from job impact on the knowledge and skills of employees,
enrichment, as, for example, it is being used in which, in turn, may influence organisational
contexts where job autonomy is low as in mass performance, this review concentrated on the
production manufacturing firms. Moreover, job role of employee sociopsychological states.
enrichment is more strongly related to labour The aim of Objective 3.1 was to investigate the
productivity than high-involvement management. correlations between these intermediate outcomes
to assess whether they form discrete concepts. In
The studies of integrated measures of HRM that some cases the meta-analyses reporting strong
we reviewed in Chapter 8, while showing that HR intercorrelations between some of the variables,
systems do make a difference to performance, but not to the degree that there was construct
found no evidence of an optimal bundle of redundancy.
242
The review also explored, through meta-analytic the organisation’s climate are shaped, which, in
data, the correlations between the intermediate turn, determine employee attitudes and behaviours
outcomes and productivity-enhancing behaviours. supportive of organisational performance. HRM
The premise here is that the intermediate practice do not have a direct impact on employee’s
outcomes are determinants of salient employee attitudes and behaviours; rather HRM practices are
behaviours, which, in turn, help generate effective firstly filtered and interpreted by employees so they
organisational performance. The correlations arrive at a view of what the organisation is like and
between most of variables mostly were small to the goals that it pursues.155
moderate.
An understanding of the impact of HRM
Two limitations of the meta-analyses are important practices on how employees perceive their work
to note. First, their concentration on cross-sectional environment, and, in turn, the effect of this on
research means that it is not possible to draw their behaviours is then valuable and a promising
conclusions about the causal direction of any of the area for further research. However, rather than
relationships. Second, it is not possible to identify treat climate as a catch-all concept that measures
the unique relationship between each intermediate employee perceptions about organisation life,
outcome and employee behaviours. a more productive approach is to examine the
link between the strategic focus of particular
The studies of the impact of intermediate outcomes HRM practices and climate. For example, if an
on final outcomes were sparse. No longitudinal organisation’s policy is to promote employee
research was found that examined the impact involvement, voice and participation through
of intermediate outcomes on patient outcomes its HRM practices, to what extent do employees
(Objective 4.1). In the non-health field, a small perceive that the organisation is enacting this
number of longitudinal studies were identified that focus. Such an approach also acknowledges the
examined the impact of intermediate outcomes importance of assessing the implementation
(average employee job satisfaction and climate) on fidelity of HRM practices.
organisational performance (Objective 4.2). While
the studies in this review show associations, the
evidence on the casual direction of this relationship Measures of intermediate
is mixed. This relationship is a crucial link for outcomes
the premise that HRM influences final outcomes,
partially through its impact on employee outcomes In order to identify and report on the reliability
such as job satisfaction, and we clearly need more of intermediate outcome measures, the scales
substantial data sets for surer interpretation. in all included studies were identified. This
demonstrated that the number of measures of
Despite these caveats it is worth highlighting intermediate outcomes included in the studies
here a notable consistency in the findings on the varied between types of outcomes. In some
relationships between climate, employee attitudes areas with a long research tradition such as job
and performance at the individual level and satisfaction large numbers of different scales
the organisational level. At the individual level, were identified. In other, arguably more recent
two meta-analyses indicated that relationships areas of HRM research interest, no generic
of climate (employees’ perceptions of formal scales appropriate to an NHS setting could be
and informal policies, practices, procedures and identified (as was the case for climate, for which
rewards) with job performance were mediated measures vary widely in terms of subject matter
by employee attitudes such as job satisfaction. precluding the identification of any one measure
In other words, the studies suggest climate as particularly appropriate for HRM research)
perceptions affect individual-level performance or there was no evidence from longitudinal
through their impact on employee attitudes. This research examining the link (as was the case for
finding was replicated at the organisational level, psychological contract).
as the association between organisational climate,
measured by employees’ perceptions averaged Scales varied in the degree to which they were
for each company, and company productivity or established, with examples of one-off scales or
profitability was found to be mediated by average single-item measures. Where a well-established
level of job satisfaction. These studies provide scale could be identified for an intermediate
support for the idea that HRM practices are the outcome area, it was selected for inclusion in the
means through which employee’s perceptions of review. Where several comparable scales were
243

found or no scale could be identified the subject chain and, moreover, there is insufficient evidence
experts on the review team advised on scale that HRM causes changes in organisational
selection. A major review of measures201 was used performance. The conclusion from our analysis is
as the primary source of reliability data for scales that, on the one hand, it would be premature to say
in 5 of the 12 areas. For the remainder, purposive that we have a strong evidence base for the HRM
searching was undertaken for reviews of reliability, performance link; on the other hand, however,
meta- analyses or longitudinal studies using to there is some evidence supporting elements of
provide reliability data for the scale. each stage in the causal chain and theoretical
grounds for believing that an HRM system based
Scales were included for two intermediate outcomes on enhancing employee skills, attitudes and
– engagement and psychological contract – despite behaviours should be beneficial for organisational
the fact that these two outcomes were not amongst performance, and, specifically, in the case of the
those measured by studies in this review. The NHS, patient outcomes. However, there is a clear
rationale is that both are of burgeoning importance need for research that overcomes the weaknesses of
in HRM research and their conceptual importance the current studies.
in the area justified their inclusion.
In general, reasonable reliability data were found Future research

for all scales, with the exception of psychological
Big science
contract, for which no evidence was available.
Unsurprisingly, reliability data were reported from Many of the studies that we have reviewed are
a larger number of studies for well-established limited in scope to one or two practices and
measures (e.g. job satisfaction). Reliabilities for intermediate or outcome variables. Studies of this
most scales were over the 0.7 rule-of-thumb kind, especially on new practices or in under-
threshold, which indicates good scale reliability. researched contexts such as health organisations,
will continue to be useful. But the implications
The scales presented here provide a good starting of our overview of the evidence in relation to the
point for the investigation of intermediate six questions we have addressed is that research
outcomes in the NHS based on the relevant of a much larger scale is required, which covers
literature. Many of the scales identified are not all aspects of the chain from practices to final
specific to the health sector and, given the range of outcomes, and which enables one to test the
intermediate outcomes included in studies in this differential effects of individual practice, synergistic
review and the specific nature of many of the HRM relationships and integrated approaches.647 This
practice and intermediate outcome links, there is echoes Wall and Wood’s30 conclusion that there
scope for adapting existing scales or developing is a need in the HRM area to adopt a strategy of
bespoke scales for the NHS in relation to key articulating and investigating the relative merits
intermediate outcomes. More generally, developing of competing hypotheses, for more longitudinal
or adapting scales for ‘newer’ intermediate studies with data from multiple sources or
outcomes, such as psychological contract, would independent audits of HRM, rather than relying on
support and encourage research in this area. questionnaire surveys using the response of a single
person in the organisation. Many of the important
questions are ones that also require large samples
Conclusions and the greater the number of variables involved,
the larger the sample size required, especially to
The HRM performance relationship is test for synergies or integrated use. High response
complex, multifaceted and multidirectional. rates in such large sample sizes are also required if
Many frameworks of HRM and performance we are to provide a firm base for generalisation.
emphasise linkages between HRM and employee
performance, mediated through workforce skills The principles underlying the design criteria for
and employee psychological states, which result such studies are the ones that have guided the
in superior organisational performance. However, longitudinal and experimental studies on which
there is, as we have seen, no longitudinal research we have largely concentrated our review. So, the
exploring the totality of any causal chain from overall weaknesses of the research area we have
HRM to intermediate outcomes and employee reviewed stem not from the design, but rather
behaviours, to organisational performance. Cross- from the almost inevitable limitations of the small-
sectional research also is limited to parts of the scale funding that characterises social science.
244
This argument has implications for funding and sector is based on the Core Standards data. The
resource allocation. Funding for an individual HCC requires Trusts to declare their degree of
or research team, over just a few years, does not compliance with the Government’s core standards
provide the resources to deploy the recommended for health care. The core standards are not HR
methods. What is required, as Wall and Wood30 practices in themselves, but specify the need for
suggest, is much more intensive collaboration than systems to be in place within Trusts, for example
is the current norm among the many potentially to ensure that clinicians continuously update skills
interested parties, including academics, employer and techniques relevant to their clinical work (C5c,
organisations, employee organisations, professional HCC Annual Health Check, 2007/8). Empirical
bodies and government departments. In short we research could be undertaken to map core
need big science projects on management practices standards to HR practice areas and assess the range
and performance that build on the understanding of specific systems in place in Trusts to meet these
generated by such systematic reviews as this one. core standards, providing data on a limited range
of HR priorities within Trusts and offering the
The notion of ‘big science’ does not preclude scope to explore the differential impact of specific
detailed study of the nature of practices, the HR practices against a particular core standard.
intention behind them or the fidelity of their
implementation. Indeed, as noted earlier in the Change and intervention studies
chapter, smaller studies that examine intent and
the depth of practices might be useful. However, To date, most research conducted to investigate
attending to such detail and the diversity in the way the links between HRM and performance, and
in which the same generic practice is designed and the relationships with, and between, intermediate
used could be seen as amplifying the need for a outcomes and employee behaviours have been
large team of coordinated researchers as in natural cross-sectional and correlational. While in
science, for example the Human Genome Project. many cases the associations are as predicted,
we cannot verify causality. We concur with Iles
Using and supplementing and Sutherland710 (in their review of change
existing data management in the NHS) that we more need quasi-
experimental research, which is better suited to
There are several ways in which existing data detecting causal effects. The prevalence of changes
sources could be further used to inform this area in HRM policies and practices, especially in work
of investigation, some examples of which are given organisation, provide a good opportunity for
here: researchers and health-care managers to examine
the impact of changes in HR practice on employee
First, WERS,83 an example of a large survey and and patient outcomes. We need to use change
hence ‘big science’ by current standards, collects programmes to gather robust and comprehensive
data on the health sector and does, in fact, follow data to help unpick the multiple dimensions
up questions about use of HR practices with a and relationships that constitute HRM and
further layer of questions (e.g. is appraisal used performance. However, assessing the impact of any
for pay or development), but in fact there has been HRM initiative must be done with care, taking into
little or no use made thus far of these data. Further consideration its relationship with other practices,
bespoke analysis of the WERS data set could the organisational context in general, and using
provide more detailed information about the use of robust methodologies for studying employee
general HR practices in the health sector. responses and organisational outcomes.
Second, it would be highly desirable to supplement Multilevel investigation of HRM

the HCC Staff and Patient Surveys with a regular and performance
survey of HR practices at the organisational/trust
level. This could provide a powerful resource for In recent years, research on HRM and performance
identifying effective HR practices and their effects has mainly adopted an organisational level of
on employees within the health sector. It could be analysis, empirically testing associations between
updated regularly as new practices come on stream HRM practices and performance. In contrast, more
and old ones are discontinued. traditional research in HRM and organisational
behaviour has gathered individual-level data and
A third area that could provide opportunity for examined the relationships between employee
the exploration of HR practices in the health attitudes and behaviours that we identified as
245

intermediate outcomes in the review. Given that Concluding comments

HRM performance models propose that superior
HRM practices result in more skilled, committed, This review shows that the longitudinal evidence
motivated and productive employees, which, in on the linkage between HRM and performance is
turn, enhance organisational effectiveness, it is limited, especially within the health sector. Many
impossible to understand how HRM practices cross-sectional studies within the non-health sector,
influence performance without considering these and a small number within the health sector,
mechanisms. Ostroff and Bowen155 highlighted have found an association between HRM and
that this causal chain is based on multilevel issues, performance, but they cannot claim to demonstrate
in which we have an organisational-level linkage a causal link. We know little about how, and in what
between HRM and organisational performance, circumstances, HRM may be lead to enhanced
and individual-level linkages between employees’ performance. However, we are optimistic that the
psychological states and behaviours. But there is shortfall of evidence is more due to limitations in
also a cross-level and multilevel premise that there the quality of research data rather than the likely
is a collective influence of employee psychological spuriousness of claims about the importance of
states and employee behaviours on organisational HRM for employee and organisational outcomes.
performance. Therefore, to understand the Major empirical challenges remain if we are to
linkages between HRM and performance, we understand the HRM and performance link; but
need integrated research at multiple levels, yet ‘big science’, change and intervention studies
a multilevel perspective has rarely been applied and multilevel research will help considerably in
to this issue. Advances in multilevel analysis progressing our understanding of the relationship
now provide powerful techniques for analysing between HRM and performance.
longitudinal and multilevel models of HRM and
performance. We strongly advocate using such an
approach to capturing change in HRM practices
and performance, incorporating measures at
individual and other relevant levels of analysis (e.g.
team, ward).
246
Acknowledgements
Contribution of authors All authors were involved in the development of
the methodology. Jo Rick was responsible for day-
Malcolm Patterson, Jo Rick, Stephen Wood and to-day project management, Christopher Carroll
Andrew Booth designed the review and drafted and Shashi Balain conducted the searches, and all
the protocol and were responsible for its ongoing authors were involved in sifting of articles and data
conduct. extraction. All authors contributed to the drafting
of the report and approved the final version.
247

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of the antecedents, correlates, and consequences of
279

Appendix 1
Taken from original proposal to NCCSDO
Introduction morale to the modernisation of the NHS and its
The research will be conducted by a team from models of patient care such as Protocol Based Care
the University of Sheffield, based at The Institute (NHS Modernisation Agency 2003). In the words
of Work Psychology (IWP) and the School of of the Department of Health’s website ‘Successful
Health and Related Research (ScHARR): Malcolm human resources management improves efficiency
Patterson, Jo Rick, Stephen Wood, Andrew Booth, through a culture that supports and develops
Tony Smith, Malcolm Whitfield and two research its staff, allowing the workforce to share in the
associates. In line with the invitation to tender organisation’s objectives’.
(ITT), a panel of around eight expert advisers
will be recruited. The proposed project seeks to The desire to base the modernisation on evidence
maximise the strengths of the two Institutes and is confirmed by the Department’s attempt to
to build particularly on the strong contribution support its overall orientation with research
that the IWP has made to the human resource findings. It thus, for example, offers the finding
management (HRM) field, empirically and that patient mortality rates improve in acute
theoretically, and ScHARR and Jo Rick have hospitals where an HR director is on the Trust
made to the development of systematic literature Board in support of its view that ‘Human resources
reviewing generally and particularly in the management is vital to the NHS’. In this way, the
medical and health-related areas. The research Department of Health and associated bodies are
design aims to achieve the objective of delivering mirroring the more general emphasis on employee
a critical review of the evidence for the validity development and empowerment as the key to
and reliability of measures of HRM, through an maximising the human resource’s contribution
examination of the five objectives outlined in the to strategic objectives of organisations. It is this
tender document. human capital approach to HRM that has been
at the centre of the literature on HRM in the past
This section sets out the following: decade. In the light of the centrality given it in the
tender document, it will form the fulcrum of our
• the research context and background to the research. First it will be a core part of the literature
study, including policy relevance and related reviewed and it will form the starting point for
research identifying the other literatures and avenues that
• our understanding of the aims and objectives we need to include in the review. For example, the
of the research and the associated research core of the HRM performance literature focuses on
issues aggregates of practices, but we will need to extend
• our proposed methodological approach and to that which looks at single practices, for example
analytic methods to be used payment systems.
• our proposed timetable for the research
and the outputs we would produce from the In some overviews29,646,711,712 of the HRM
research. performance literature there has been a stress on
how the research is demonstrating a link between
Background to the study human capital approach and key organisational
outcomes. If the evidence were perhaps as strong
Appropriate HRM policies and practices are widely as these reviews or the authors of some individual
seen as vital if the NHS is to change the process studies might suggest, there would be little need
of health care and improve outcomes for patients. for this research project. The studies are not so
The key issue is to identify what are appropriate, homogeneous, consistent in their results or without
and the evidence on which this can be based. methodological weaknesses for us to conclude this.
The Department of Health statement and the Indeed several recent reviews29 have questioned
NHS’s Modernisation Agency have repeatedly the evenness of the results and highlighted the
stressed the vital role of human resources, skill methodological issues in this area. The implication
development, involvement, teamworking and is that the field is young and there is a need to
281

Appendix 1
take stock of the work so far before a further big that will, regardless of the context, outperform
investment is made in the area and particularly all others, either eternally or at this particular
if the general models are to be considered in the historical conjuncture. Outside of the human
under-researched service sectors like health care. resource (HR) and organisational behaviour
The core background factors to this application arenas, in the strategy literature, the resource-
are then (1) the salience being given to HRM as a based theory of the firm5,6 has also highlighted the
major determinant of organisational performance; way in which human resources and the knowledge
(2) the conclusions that research is supporting a embodied in them may be decisive for the long-
link between HRM and performance; while, on term competitive advantage of firms, while in the
the other hand (3), that there is a questioning of operations management literature7–10 the emphasis
the homogeneity and robustness of the research is on how HR practices and the knowledge and
evidence; and (4) the timeliness of taking a broad- skills of workers are decisive for the successful
ranging stock-take of the HRM field and its exploitation of lean production11 and other modern
implications for health-care policy. We shall now management methods (see, for example, Dean and
expand on each of these factors. Bowen12 on total quality management).
The salience given to HRM in both Research supports the core thesis
health care and as a universal model The second background factor is the widely
The key background to the study is then the expressed view that the main research studies in the
growing attention over the past 20 years to HRM as HRM area have confirmed that high-involvement
a major contributor to organisation performance, management does positively affect organisational
even in capital or technological intensive performance. The basic hypothesis that underlies
industries. It is assumed to contribute both in its much of this work is that: high-involvement HR
own right and as a support for such other modern systems will have positive effects on organisational
management practices as total quality management performance. As academics have sort to move
and just-in-time (JIT). So, in the health context beyond advocacy of high-involvement systems, they
HRM adds to the human capital of the workforce have focused on testing this hypothesis. A spate
and helps support new modes of organisation, of research studies in the 1990s were motivated by
technology and patient delivery. Its importance this. Many concluded that high-involvement HR
derives from an assumption that some forms of systems do perform best.13–20 Several overviews
personnel management have greater effects on the of the studies21,22 concluded on the basis of the
development, skills and motivation of employees first few studies that the universalistic hypothesis
than others. Forms that are thought to have such is supported. The increasing use of the term
effects, as the tender specification acknowledges, ‘high-performance’ model to describe the set
are indeed often labelled HRM. Alternative labels of practices might be seen as implying that the
are the human capital, high-commitment, high- matter is indeed settled, much as a drug might be
involvement and high-performance approaches. named by the disease it is known to cure. Overviews
For ease of presentation we shall refer to the have tended to present the studies in a rather
specific model as the high-involvement model and homogeneous way, largely assuming that it can
use HRM when a potentially more all-embracing be taken for granted they have been studying the
concept of personnel management is being same phenomenon and the results are broadly the
referred to. same. These reviews have led to the conclusion that
the main issue now is to explain the link between
Much of the attention given to the high- high-involvement management performance, i.e.
involvement or -commitment HRM system has assess the mechanisms between them or get inside
been advocatory. Contrasting it with a traditional the black box between the system and the outcome.
Taylorist or Fordist approach, academics (e.g. A second issue might be the extent to which the
Pfeffer,2 Kochan and Osterman,3 Walton1) link will be found in all contexts, and particularly
have been at the forefront of publicising high- in service industries such as health care. The
involvement management as a progressive form majority of the early studies were in manufacturing,
of management that can remove past restrictions and it is significant that one of the few early
to economic efficiency and achieve high-quality studies in services24 found evidence of a contingent
performance, and thus sharpen the competitive relationship between the human capital approach
edge of Western organisations and improve public and performance. In the past few years there have
sector delivery. The argument is that there is a been more studies that have either been in the
unique set of practices or approach to management service sector or included it in their study15,25–27 and
282
the results have been mixed. Studies specifically on practices as supports to help motivate and
health care are emerging, For example, West et al.’s equip people to work in a new more flexible
study28 has investigated the link between HRM and and proactive way. On the other hand are those
patient mortality. who do not prioritise the task system but treat
high-involvement management as entailing
The debate is far from over the use of the whole gamut of sophisticated
A third background to the study is the increasing personnel management methods and conceive
realisation that the portrayal of the studies as them as primarily operating through people’s
providing conclusive evidence for a universal link commitment and sense of whether they are
between HRM and performance is premature, and being treated fairly and consistent with their
that there is a clear need to delve more deeply psychological contract. The two approaches
both in to the studies and the reality of high- need not affect greatly the practices researchers
involvement management and its links to other include in their studies, but the first would
aspects and methods of management. The reviews not treat them in an undifferentiated way.
so far have not used the systematic review methods Nonetheless, the inclusion of job design and
we propose to adopt, hence the timeliness of the work organisation practices is one major source
project. of diversity between the studies. The other is
incentive systems with some studies treating
There are eight reasons for extending the debate: them as part of high-involvement management
or at least performance management, others as
1. The results of the various studies are neither contradicting it.
as clear-cut nor as uniform as some have 4. The vast majority of studies are based on
concluded (see Wood29 and particularly his reported use of a practice and do not assess its
table 1 for summary of the main results). effectiveness or differentiate between its mere
Within studies, there is unevenness in the existence and its effective implementation.
findings between performance measures. While For example, appraisals may be conducted
some results point to universal effects, others but the extent to which they are done well
do not. Moreover, in many studies only the or whether they are mainly for control or
universal hypothesis has been tested, so one payment purposes rather than development
cannot rule out the contingency argument that or employee involvement purposes is not
the effects of high-involvement management considered.
on performance are contingent on a third 5. It is not always clear whether high involvement
factor, either a dimension of the context or or performance management is being defined
the strategy of the organisation, even when simply as the combined used of the best
a positive link between high-performance practice in each domain of human resources,
management and performance has been a synergistic set of practices, or by a more
found. fundamental managerial orientation.713 In fact
2. A variety of other hypotheses have been tested, the discussion so far has begged the question
including the contingency hypotheses that of how we define and identify a system. Most
high-involvement management works best studies have defined an HR system a priori,
when used in conjunction with other quality often with little theoretical justification, as
or lean practices. The results of these in some the emphasis has been on testing the high
cases question the universal thesis. involvement–performance link rather than first
3. There is considerable variability across studies investigating the relationship between practices
in the practices included either in the model or the nature of any systems. Researchers have
of high-involvement management or the set of measured HRM on the basis of differentiating
practices used to test its link to performance. organisations by their usage of a set of
Some of the differences are terminological, practices, the precise means varying between
perhaps reflecting disciplinary biases or studies. They then correlate the measure
a quest to differentiate ones wares. But a with performance measures. The problem of
core difference within the literature can be simply aggregating practices to provide an
identified. On the one hand are those who see overall measure is that each practice is treated
the core of high-involvement management implicitly as if it were equally important.
as changes in work organisation, job design With only a few exceptions (e.g. Patterson
and employee involvement methods (and et al.33 forthcoming), studies have provided
particularly idea capturing) with the other insufficient information about which individual
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Appendix 1
or subset of practices has the strongest effects on intermediate HR outcomes (e.g. labour
and which may be marginal or even irrelevant. turnover in Huselid18) or concentrated on
In one case13 where this was done and it was commitment and satisfaction (e.g. Patterson et
shown that only some of the practices affect al.,36 Wright et al.37). Several authors hint at, but
performance, and, moreover, that their do not explore in depth, other mechanisms, for
strength varied between industrial context, the example Guest and Conway38 imply procedural
authors still framed their conclusions in terms justice. The emphasis in statements on the
of an overall (high-performance work) system modernisation of health care, in addition to
yielding superior performance. Aggregating morale and staff development, is on achieving
practices does not allow one to test whether the what might be termed the strategic integration
effects are synergistic and begs the question of individuals into the organisation so that
of whether the pattern of association between they both understand and share the goals that
practice use reflects a single underlying achieving patient care entail and consequently
orientation [which, in statistical terms, would orientate their behaviour towards common
be implied if a one-factor model could be fitted visions. Studies outside the narrow confines
to the data (see, for example, Wood and de of the HRM studies, particularly building
Menezes26 and Wood29]. on the job redesign and lean production
6. Despite the differences in focus and measures, literature, point to the importance of the
most of the studies share a basic research kinds of attitudes that advocates of total
design, which has a number of weaknesses. quality management and other modern
These include: management methods highlight, for example
i. The use of cross-sectional designs – quality consciousness (e.g. Peccei and Wood39)
limiting causal inference (i.e. do HRM continuous improvement orientation (Coyle-
practices promote performance, or does Shapiro40) or flexible work orientation (Parker
better performance encourage greater et al.41).
investment in HRM?). 8. The majority of studies have concentrated
ii. Reliance on a single data source (e.g. on a narrow range of HRM practices in
CEO or HRM Director) for information isolation, the exception being those that
on HRM practices and performance have included TQM in their analysis (e.g.
– resulting in measures of unknown MacDuffie,20 Patterson et al.,33 de Menezes
reliability and susceptible to common- and Wood713), but there is a general failure to
method bias (see, for example, the debate assess the effectiveness of HRM and related
between Huselid and Becker42 and Gerhart practices relative to both other key elements of
et al.43 on the reliability of measures based management such as leadership and practices
on single respondents). further afield, such as R&D expenditure.
iii. Many but not all include small samples,
low response rates and a concentration Taking stock of the HRM performance
on a limited range of sectors – limiting area
generalisability. The fourth background factor is the clear need
7. There has been insufficient theoretical to appraise the area in depth prior to developing
discussion or empirical exploration of the further studies. Despite the diversity in the
mechanisms or intervening variables that studies and the limitations of their methodology,
might explain any link between HRM and the studies thus far have provided a foundation
performance. Labels such as high commitment from which broader and more methodologically
and involvement imply certain mechanisms appropriate studies can be designed. There is
that are concerned with the extent to sufficient promise in the body of evidence to
commitment or engagement on the part consider major investments in the area. However,
of the work force, which is mirrored in the it is timely to invest in detailed assessment of what
importance given to morale in statements we know and can take from the studies so far. If an
about the modernisation of health care. Much exercise is treated as the foundation for both good
of the theoretical justification that precedes HRM practice and the next stage of research, it
the empirical studies, however, implies that will need, however, to go beyond simply assessing
skills, knowledge and learning might be as the studies. As we have implied, they have been
important, independent of attitude change. limited. Assessing their precise limits will be part of
While some studies have sought to include the analysis of them. But, as we have implied, some
intervening variables these have either centred of the limits are clear:
284
1. The focus has been on the practices– the likely literature available to provide relevant
performance link to the neglect of both evidence. We then consider the main research
theoretical discussion and research on the issues and associated implications for the design of
nature of the association between the practices. the methodology.
2. The mechanisms or intervening variables that
might explain any links have been insufficiently Objectives for the research
explored, theoretically or empirically, and what
discussion there has been has been limited. This research aims to deliver an up-to-date,
3. The precise performance variables that one comprehensive and authoritative critical review
would expect particular HR practices to have of scientific evidence in relation to the reliability
been linked to have not been spelt out. and validity of measures of HRM. Specifically, the
4. Research studies have not tended to be research comprises the following five subsections
designed to test multiple competing for which the research must make explicit the
hypotheses. evidence in order to achieve its objectives.
5. How the high-involvement management
model links to other elements of management Describe HRM methods and measure
practice and theory and particularly leadership the fidelity with which they may be
corporate governance has been neglected. implemented (Objective 1)
We understand this objective of the research is
In order to overcome these weaknesses any concerned with identifying the main methods of
taking-stock exercise should be broad ranging, HRM, how widespread is their use, the fidelity with
well beyond the narrow confines of the recent which they are implemented (i.e. the degree to
HRM performance studies. There is also a need which HRM policy is put into practice), and how
to examine in more depth the applicability of that fidelity can be assessed. This is potentially a
practices to all settings and how they may have to very wide literature with different approaches to
be adapted in specific service organisations. Health the definition and measurement of specific HRM
care provides an excellent example to aid this. methods. The implications for this research are
discussed below (see The scale of the relevant
The importance for policy of finding out if there literature).
is a link between a given model of HRM and
performance is self-evident. But the above implies Review the reliability of measures of
that the key issues are: is any relationship general particular intermediate outcomes
or specific? Is it an underlying orientation towards (intended outcomes of HRM that may
development and involvement or is it certain key effect patient care indirectly, e.g.
practices that is key? If the latter, are there a few morale, absences from work, stress)
critical ingredients or is there a holistic set that (Objective 2)
react together synergistically? Is HRM largely a We understand this research objective is concerned
support for operational practices? If there is a link, with the robustness and utility of measures of a
which are the key performance measures that are number of intermediate outcomes, i.e. the results
most affected by HRM? And, above all, why and of HRM methods that can impact on patient care.
what are the mediating variables? If the crucial Such an exercise inevitably involves the cataloguing
thing is internal consistency between practices and of intermediate outcomes. These are likely to be
ensuring policy is realised through them, is HRM wide-ranging and, in some instances (e.g. stress
simply one of a number bundle that works, as the measures), command a substantial literature in
configuration approach implies? In the health- their own right. Additionally, as we have argued
care case, the additional question is the extent to above, we will consider as broad a range of
which ideas like lean production can be readily intermediate variables are possible. We extend
translated to the health-care context, and where from the current concern with commitment and
there has been a conscious attempt how successful involvement to other individual-level outcomes,
has it been. All these issues are entailed in the five such as stress, morale and procedural fairness,
objectives of the study as proposed in the tender as well as newer ‘outcomes’, such as proactivity.
document. Clearly, dealing with such a potentially vast and
uneven literature and deciding what it is feasible,
Research objectives and issues pragmatic and desirable to include in relation to
the current study has major implications for the
The next section (Objectives for the research) research methodology and these are discussed
considers each of the research objectives and below (see The state of the relevant literature). 285

Appendix 1
Review of the literature on the See below (The scale of the relevant literature) for
correlation of intermediate outcomes to a description of our proposed approach to rating
each other (Objective 3) the evidence on quality criteria and the conclusions
We understand this objective of the research to be that can be drawn from different types of evidence.
concerned with establishing the extent to which
individual measures of intermediate outcomes Investigation of the sensitivity of
contribute unique information. An important issue intermediate outcomes to individual
to note here is that whilst the general literature HRM methods alone or in conjunction
may indicate a high degree of correlation between with each other (Objective 5)
certain intermediate outcome measures, it is As with Objective 4 of the research, we understand
possible that these measures will behave differently this element of the study to be concerned with
when considered in relation to specific HRM evidence both of the association between the
methods or final outcomes (relevant to research presence of HRM methods and intermediate
Objectives 4 and 5). outcomes, as well as with evidence of any causal
link between changes in HRM methods and
Interrogation of the literature intermediate outcomes. That is the extent to which
investigating the correlation of there is evidence that, for example, changes in
intermediate outcomes with final HRM practices cause reductions in self-reported
outcomes (be these business or patient stress. As for the previous subsection of the
centred) (Objective 4) research, there is a large body of cross-sectional
We understand this objective of the research to research detailing evidence of the co-existence of
require evidence on two levels: specific HRM methods and intermediate outcomes.
However, research of the type that can provide
• the correlation (i.e. level of association) evidence of the extent to which HRM methods
between the presence of certain intermediate bring about specific intermediate outcomes is much
outcomes (e.g. improvements in morale) and more limited and likely to amount to only a few
the presence of certain final outcomes (e.g. studies in total. Once again, the same implications
improvements in clinical quality standards), for the research are identified and these are
and, where possible, discussed more fully below (see The scale of the
• evidence of a causal link between intermediate relevant literature).
outcomes and final outcomes (i.e. evidence
that improvements in morale led to improved Research issues and
clinical quality standards). methodological solutions
Some evidence exists (of a cross-sectional nature) Thinking through the research objectives in the
that demonstrates associations between, for ITT there are a number of technical and scientific
example, job satisfaction (intermediate outcome) issues that this research will need to overcome:
or self-reported stress (intermediate outcome)
and organisational performance (final outcome). • nature of evidence sought
However, limited evidence about the impact of • scale of the relevant literature
both types of outcome can be drawn from cross- • state of the relevant literature
sectional studies. The research concerned with • ensuring work is free from bias.
cause and effect is likely to be a relatively small
literature with only a limited number of studies of Each of these research issues is discussed in
a longitudinal design and sufficiently robust as to turn and the implications for the design of the
demonstrate the intermediate–final outcome link methodology are highlighted.
causally.
The nature of the evidence sought
The issues for the research to address are thus: The five inter-related objectives of this project
call for a comprehensive review of the literature
• how to ensure that all such longitudinal in relation to a number of different questions.
research is identified, and Answering the research questions posed in the ITT
• how to clearly distinguish the level of evidence demands evaluations of different types of evidence
identified and the type of conclusions that can from different sources. Table 62 summarises the
be drawn in the report. information/evidence needs for all five subsections
of the research.
286
TABLE 62 The information needs
Research subsection Source of information

Types of HRM methods Project team, expert advisor panel, interviewees,
literature search
Fidelity with which implemented Project team, expert advisor panel, interviewees,
literature search
Types of intermediate outcomes Project team, expert advisor panel, interviewees,
literature search
Reliability and validity of intermediate outcome measures Expert advisor panel, systematic review
Evidence for the impact of HRM methods on intermediate outcomes Expert advisor panel, systematic review
Types of final outcome Project team, expert advisor panel, interviewees,
literature search
Reliability and validity of measures of final outcome if appropriate Expert advisor panel, systematic review
Evidence for the impact of intermediate outcomes on final outcomes Expert advisor panel, systematic review
Italics indicate that an awareness of the issues in these areas is implicit, if not specified in the tender document.
The range of evidence needs has several One potential strategy for dealing with the scale of
implications for the research design: the literature, as recommended in the ITT, is the
use of existing systematic reviews of the literature.
• a process that keeps the review firmly focused Where they exist, we will seek to use such sources;
on the research objectives however, it is inevitable that in some areas there
• clear and efficient strategies for identifying will be no such reviews, or that they will be out of
relevant evidence within the literature date or of poor quality and it will be necessary to
• clear rational for including or excluding studies resort to original sources. A key requirement of
from the review the methodology for this research, therefore, is
• clarification about the type of evidence being the need for expertise in the most sophisticated
drawn into the analysis and the conclusions systems for data retrieval and synthesis of evidence.
that can be drawn.
A further consideration in dealing with a
The scale of the relevant literature literature of this scale is to have sophisticated and
The scale of the literature pertaining to this study transparent rationale for the scoping and targeting
is immense. Searches on a single database for the of content relevant literature. In order to deliver
term ‘HRM and performance’ alone would typically this we propose to use an approach based on the
produce in excess of 500 peer-reviewed references. medical model of systematic reviews,49,50 which
The grey literature (i.e. relevant articles that have members of the team have successfully used in
not undergone a peer review process, or individual similar previous studies. Implicit in the proposed
case studies) may also be significant. approach is the use of a standard proforma to
apply relevance criteria to each potential source of
Additionally, many of the relevant intermediate evidence. This is an efficient and reliable method
outcomes for this research (e.g. stress, job of rapidly identifying the most important articles
satisfaction, morale) command extensive literatures from a large body of literature. The approach
in their own right. A search on the relevant is described fully in the methodology (see
databases for each intermediate outcome area Methodological approach, below).
would be likely to generate a list of references,
in some cases, reaching the thousands. For The state of the relevant literature
example, a recent review of Psychosocial Hazard The literature relating to the research objectives,
(Stressor) Measures,49 which looked specifically at particularly Objectives 2–5, is likely to be very
the reliability and validity of measures of stress, uneven in terms of size, depth, availability
identified in excess of 3000 original sources of of reviews and type of questions covered. For
potential relevance, which, when checked against example, in certain areas, recent, comprehensive
criteria for content, elicited in excess of 150 usable systematic reviews of the reliability of intermediate
articles. outcomes measures (Objective 2) exist (e.g. Stressor
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Appendix 1
measures, Rick et al.50). Equally, cross-sectional Our judgement is that it will be possible to provide
studies reporting on the presence of specific HRM easily accessible information about the quality
practices, such as job design or training, and and quantity of evidence in relation to each of the
intermediate outcomes, such as job satisfaction, main relationships of interest within each research
are relatively plentiful (Objective 5). In contrast, subsection through the development of quality
longitudinal studies demonstrating causality ratings for the review. This is an approach that
between, for example, organisational commitment has been used previously to aid the assimilation
and final outcomes, such as, for example labour of wide-ranging evidence about different subjects
productivity, are relatively scarce (Objective 4) as (see, for example, the Department of Health715
would be studies of specific HRM practices and publication on selection of appropriate mental
‘new’ intermediate outcomes such as proactivity health interventions and the British Psychological
(Objective 5). Society review of Level B measures, Bartram et
al.716). We feel that this will be particularly useful
A further consideration here is that, dependent for Objectives 4 and 5 of the research, where
on the availability of evidence, the research the ITT specifies that the intended audiences
subsections call for the comparison of very different are general (and will not necessarily be research
types of evidence. For example, the methodology literate).
will need to make consistent comparisons across
systematic reviews, meta-analyses, traditional The research team (e.g. Michaels and Booth717) are
reviews, empirical peer-reviewed articles, case aware of the existence of numerous such schemes
studies and grey literature. A further complication that have been used to classify the literature in this
inherent in the nature of HRM research is that the way.717–722 Rather than invent yet another variation,
approaches often combine very different types of we would attempt to identify an appropriate
data. For example, studies show the use of different existing classification of strength of evidence,
measures of individual HRM practices, variation in based on the type of question being asked and the
HRM system composition across studies, variation type of evidence being used to address it. Critical
in the techniques researches use to combine elements of such a classification would include
HRM practices into coherent groups, different whether the research is theoretical, observational
levels of analysis (e.g. HRM and organisational or experimental, the overall robustness of the study
performance data at workplace, business and design (where experimental) and whether there
corporate level, and intermediate data at individual is homogeneity or heterogeneity of results. Such
and organisational level) and a combination of a grading system would be agreed on completion
objective and self-report measures of, for example, of the criteria and identification of the key
performance (Wall and Wood;712 Wright and relationships of interest. However, for the purposes
Gardner714). of illustration, the system might (for illustrative
purposes only) resemble the following:
In order to ensure consistency in approach when
comparing such different types of evidence and • theoretical knowledge suggests X (*)
data, we will develop a system for recording the • one cross-sectional study or several with
various types of research design, types of data varying results (**)
collected and the quantity of data identified in • several cross-sectional studies with the same
each source of evidence. This will be based on results or one longitudinal study (***)
existing classifications, but be tailored to the issues • several longitudinal studies with conflicting
and complexities of the HRM literature. Such an results (****)
approach is implicit within the systematic review • several longitudinal studies with consistent
process. results (*****)
• randomised controlled trial(s) (******).
Aside from proforma for reviewing each individual
source of evidence, a primary concern of this Selection of an appropriate classification system
review is to establish what can be said about each of might well vary according to the different levels
the five subsections of the research overall on the of evidence sought in relation to the research
basis of theoretical and empirical knowledge. This subsections specified in the ITT.
should not only reflect the state of the literature
overall, but should identify any uncertainties in the Ensuring the research is free from bias
evidence base, drawing attention to areas where A major task for the researchers undertaking this
the evidence is strong or weak, or where there is no review is to demonstrate that the work is conducted
288 reliable evidence. in a way that is free from bias. Previous research by
members of this team in the area of reviews (e.g. of evidence around a given research question
the psychosocial hazards research by Rick et al.49), and making recommendations for practice. This
has highlighted the need for explicit, transparent approach involves a number of stages:
criteria to be developed for literature reviews. These
criteria should reflect generally agreed standards • formulating specific, answerable questions for
within research and should be developed in each of the research subsections
line with the specific aims and objectives of the • devising the most parsimonious search
project. It must also be possible to demonstrate strategies for identifying relevant data
that these criteria are applied by the researchers • developing inclusion and exclusion criteria
in a systematic way (e.g. through checks including (based on relevance to the research questions
inter-rater reliability). This ensures that the review and minimum quality standards) for sifting all
process is as free from bias as it is possible to make identified sources of evidence
it, and that any other researchers conducting the • developing review proforma for assessing the
same task with the same criteria would achieve quality of evidence in each data source (passing
similar results. This further reinforces the the inclusion/exclusion criteria sift) in relation
arguments for adopting a systematic review process to the specific review questions
in line with the approach that we will propose here. • synthesising the assessments for each specific
review question
In addition to using a systematic approach to the • summarising and drawing conclusions on the
review process, we propose to establish a panel evidence in relation to each.
of experts to contribute to specific stages of the
research. Expert advisers would be appointed Each of these stages is described fully below. A
on the basis of their expert knowledge of the potential difficulty of this approach is that often
HRM literature and/or their knowledge of the the available evidence about any question is small
health sector and/or the contribution they can in quantity, of poor quality or inconsistent. For this
make (through experience) to developing the reason the review will demonstrate a sensitivity to
appropriate processes for conducting this type of the particular requirements of systematic reviews of
review. The rationale is twofold: the management literature.56,723 This will recognise
the need to consider the best available evidence,
• It provides an efficient way of assessing leading even where rigorous experimental studies are not
edge knowledge on HRM methods and available, and, if necessary, where no empirical
literature, the context for this research and the evidence exists, resorting to the best theoretical
best procedural approaches for conducting this approaches. In doing so, the collaborating team
type of review. will draw on their considerable experience of
• Given the immature nature of the evidence different types of integrative synthesis of evidence-
base, it seeks to achieve consensus in the based approaches to general management
processes for identifying the best evidence topics.49,50 They will draw on systematic reviews
available in relation to the research questions of the health management literature (National
specified in the ITT. Institute of Clinical Studies80) in order to inform an
appropriate methodology.
Such a consultative approach should ensure
that the processes developed for conducting the Research stages
research are as free from bias as possible, and as
relevant as possible to the focus of this research. We envisage a methodology comprising the
following stages.
The next section describes the proposed
methodological stages for this research. Establish expert advisor panel
One of the first steps in the project will be to
Methodological approach establish the expert adviser panel, which will have
Systematic literature reviews an number of roles:
The literature review will be conducted according 1. helping to identify experts for the interviews
to established evidence-based principles developed 2. contributing to the list of HRM practices
in medicine and allied health fields, as a systematic 3. suggesting additions to the identified literature
way of pulling together and assessing the quality for each subsection of the research
289

Appendix 1
4. helping to develop the inclusion/exclusion Objective I: Catalogue of methods of

criteria for each subsection of the research HRM and fidelity with which they have
5. helping to define appropriate rating criteria been applied
for each element of the study. This will require close and iterative work between
the literature-searching team and the subject
Three expert advisers have already expressed experts to generate an exhaustive list of methods
willingness to fulfil this duty (we would wish to of HRM. This list will be generated through
approach a further five people should the contract interviews with experts, by textual analysis of
be awarded): sample HR policies, and by thematic analysis of
a select but wide-ranging purposive sample of
• Professor Kevin Daniels, who has expertise in existing reviews, traditional and systematic, of the
HRM, particularly in relation to intermediate HRM literature. The expert advisors will be asked
outcomes and as a journal editor (Journal of to identify for each method the best evidence
Occupational and Organizational Psychology, available about the fidelity with which methods
JOOP) has an excellent overview of the have been implemented, looking beyond published
literature in this area. articles and books to include unpublished literature
• Dr Rob Briner, who has extensive knowledge and research groups in the area.
of the data on intermediate outcomes and
links between intermediate and final outcomes. This will include identifying the experts’
Dr Briner is also a journal editor (Human general perspective on questions such as the
Relations), so brings considerable knowledge of body of evidence in relation to both single and
the current literature in this area to the project. combinations of HRM methods and the range
• Dr Olga Tregaskis, who has worked for many of measures for assessing the fidelity with which
years in international HRM. Her research methods have been implemented. Pre-existing
focuses on multinationals, national training frameworks (such as Wright and Gardener714)
and employment regulations, flexible working, classifying levels of implementation in HRM
and training and development. Dr Tregaskis methods will also be used to provide further insight
is the UK representative on the Academy of into how methods have been put into practice.
Management International Management
Division, an international network of HRM Objectives 2–4
academics, and thus brings to the project an In contrast with the theoretical sampling required
understanding of both European and North for Objective 1, the remaining research objectives
American research on this subject and excellent will be addressed via a series of systematic reviews.
links with the international HRM academic The application of scientific methods limits bias
community. in the identification, appraisal and synthesis of
all relevant studies that address a specific focused
Both Professor Daniels and Dr Briner have question. In particular, where logistic constraints
worked on previous systematic literature reviews such as those required for completion of this
conducted by the Institute for Employment report exist and where data are plentiful, it is most
Studies and therefore also have expertise in efficient to conduct a ‘review of reviews’. This
developing appropriate tools for the review (i.e. means that, rather than examining all the primary
setting appropriate inclusion/exclusion criteria and papers cited in reviews or replicating synthesis
developing tailored quality rating criteria). of data from these papers the reviewers critically
examine conclusions drawn by the authors of these
In addition to an expert panel we would also seek reviews.
at this stage in the research to create links with
other research groups who are working on the Wherever possible, we will use existing systematic
same or related questions. Specifically, the Service reviews of the literature for each of the Objectives
Delivery and Organisation (SDO) commissioned 2–5 of the study.
research on the effects of work and stress on
outcomes for patients, and the Policy Research Review of reviews
Programme commissioned research on HR Systematic searches will be conducted through
interventions and outcomes in the NHS. As well identified keywords on databases such as Web of
as any others, in the UK or abroad, who can be Science, MEDLINE, PsychLit and the Emerald
identified by the expert advisers. suite of management databases. This will be done
at two levels:
290
• the macro level (for terms such as HRM, HR e-mail, introducing the project, informing them
practices, personnel, staff recruitment, staff of publications already identified and asking them
development) for the references for other relevant published or
• the micro level for specific HRM methods unpublished evidence. This request will be followed
as identified in Part I of the research (e.g. up by up to two reminders as necessary.
worker participation, training, job security,
promotion, teamworking, incentives); Towards the end of the project a brief
intermediate outcomes (e.g. morale, stress, supplementary search for recent journal articles
proactivity, commitment); and final outcomes and publications will be conducted to ensure an up-
(e.g. performance, organisational performance, to-date bibliography and evidence base.
turnover, productivity, retention, clinical
standard, patient care). As the need is for transparent criteria, it is
essential that our methodology in identifying and
These computer searches will be supplemented reviewing evidence is both explicit and objective.
by citation searching (to detect research studies We therefore propose to conduct this review by
that share a common ancestry) and related-article adhering strictly to predetermined criteria for
features to allow the generation of related concepts. assessing published work. Such criteria will reflect
Hand-searching and examination of relevant generally agreed standards within research,
journals (examples include: Academy of Management developed to meet the specific aims and objectives
Journal, European Journal of Innovation Management, of the project (e.g. Popay et al.,724 Oxman725).
Health Care Management Review, Health Services In demonstrating that these criteria have been
Research, International Journal of Human Resource applied in a systematic way this will ensure that the
Management, Journal of Healthcare Management, review process is as free from bias as is possible,
Journal of Management Development, Journal of ensuring reproducibility for complementary
Managerial Psychology and Journal of Organizational projects or subsequent work.
Behavior) will be supplemented by tightly focused
searches of the internet using advanced search The methodology for the literature review process
features. will involve four main stages, each building on
the previous one. Unlike many reviews where
New systematic reviews the search processes are conducted early in the
We anticipate that Objectives 3 and 4 of the project and then retrieved materials passed on
research in particular will require in-depth to the review team, the iterative nature of the
appraisal and analysis of existing reviews together project combined with the task dependencies
with the conduct of a new review. The theoretical arising from Objectives 1–5, will require ongoing
framework for the new review will divide the interaction with the expert advisers needing to be
mechanisms identified into those where the consulted at each stage. For example, the compiled
evidence base derives from within the health bibliography will be circulated to the expert
literature, those where the literature originates panel on a number of occasions with a request for
from general management and those where both additional evidence omitted from the list. Further
literatures are represented. Each item of evidence items will thus be added to the database, and the
identified will be assessed both for the strength of updated bibliography circulated again asking the
its signal regarding application to HRM in health experts to check for omissions.
organisations and its noise regarding limitations of
research design.73 A systematic literature review will Summary of stages of review for
be conducted using accepted systematic literature Objectives 2–4
search techniques for the years 1995–2004. Online For each substantive review, the following stages
searches of relevant computerised bibliographic will be undertaken:
databases will be undertaken using comprehensive
permutations of key words representing • formulation of specific questions to be
mechanisms and key words depicting outcomes. answered
Databases to be searched will again include: • development of inclusion and exclusion criteria
MEDLINE, PsycInfo, the Emerald databases and based on the relevance of the articles to the
Web of Science. review questions and minimum quality criteria
• development of review criteria for assessing the
The expert advisors will identify key researchers quality of evidence
in the area. These researchers will be contacted by • training of review team and piloting of criteria
291

Appendix 1
• conduct of review and data extraction within the team and resolved prior to completion
• synthesis of data and analysis of results. of the reviews. While this approach necessarily
deviates from idealised conditions of quantitative
Bibliographic software review, whereby two reviewers extract data for every
The reference management software package included paper, we believe that this approach is
reference manager will be used for this review. This justified by the nature of the evidence types being
package allows direct transfer of references from considered. In contrast with formal meta-analysis,
the electronic databases. References will be coded there is little empirical methodological research
according to source of the reference, whether the to indicate incremental benefits for dual data
paper is for inclusion, and, if so, to which of the extraction and analysis where non-quantitative
objectives it will likely contribute. This system of research is being examined. However, all issues or
coding will ensure that lists of publications can be queries arising from the extraction or analysis will
easily retrieved according to topic area or purpose be referred for a second opinion (either to another
within the review. researcher or a member of the expert panel), and
where a candidate homogeneous quantitative
Objective 5: to assess the subset is identified these papers will be subject to
sensitivity of intermediate dual extraction and analysis.
outcomes to individual HRM
Initially, evidence tables containing such details as
practices citation, setting, study type, level, scope/variables,
By this stage of the review it is anticipated that outcomes/results and comments will be produced
the team will have identified points of theoretical by the research associates. These will then be
saturation. For each combination of methods and subjected to detailed analysis and quantitative/
outcomes (intermediate and final) they will identify qualitative review by the experts on the review
methods where there is: team.
• strong evidence, either for or against, yielded Timetable and milestones

by systematic reviews
• strong evidence, either for or against, from There is as yet, no fixed start date for the project.
primary studies We would be able to start immediately and propose
• indicative evidence only, either for or against, the timetable and milestones as in Table 63.
from observational studies, case studies, grey
literature Project outputs
• no evidence.
The primary output of this project will be a
This review will thus alert readers to the extent written report presenting the results of work on
and nature of the strengths and weaknesses in the each of the five objectives in separate chapters in
evidence discussed in relation to individual studies recognition of the different target audiences for
and the field more broadly. each subsection. This report will thus include the
conventional sections on recommendations for
Intended approach to data practice (where such evidence exists to support
extraction and analysis for these) and recommendations for future research.
research Objectives 2–5 In addition it will follow the brief in the tender
document by extending its consideration more
Once inclusion and quality rating criteria have widely to policy implications. In addition to the
been developed, training of the review team will research report, the research team will identify the
take place to ensure consistency of approach. The most appropriate avenues for dissemination of the
aim of this training will be to anticipate queries work. The outputs of the research will be submitted
and to develop a protocol for tackling issues as to relevant peer reviewed health-related journals
they arise during the review. For example, several such as Health Service Management, and more
papers will be selected and each member of the general management and organisational behaviour
review team will review the papers separately. journals such as Human Resource Management
The inter-rater reliability will be calculated, and Journal, Journal of Occupational and Organizational
training and documentation expanded, until Psychology and Journal of Organizational Behavior.
ratings show an acceptably high level of agreement. Articles and news features will also be submitted to
In addition, areas of disagreement will be discussed non-peer-reviewed journals such as Health Service
292
TABLE 63 Timetable
Activity Timeframe [month(s)]

Appoint expert panel 1
Recruit research associates 1–3
Identification of HRM methods and measures of fidelity 2–5
Findings from subsection I of the research – HRM methods and measures of fidelity 6
Review of reliability of measures of intended outcomes of HRM 5–11
Review of the correlation of intermediate outcomes to each other 5–11
Draft outputs from subsections II and III of the research for comment and feedback 12–15
Review of the relationship between intermediate outcomes and final outcomes 12–19
Review of the sensitivity of intermediate outcomes to individual HRM policies 12–19
Synthesis of overall report to NHS 19–24
Journal and SDO Newsletter. We will also undertake Occupational Psychology Conference, European
presentations of research plans and objectives, Academy of Occupational Health Psychology,
intermediate findings and overall final findings at European Association of Work and Organisational
conferences, seminars and professional meetings, Psychology, and the Academy of Management
such as SDO conferences, Public Health Association Conference.
Conference, British Psychological Society
293

Appendix 2
HRM practice categories and definitions
HR category Definition
Work design Organisations have particular functions to accomplish if they are to meet their objectives.
Those functions comprise a number of tasks, which are then grouped to form jobs undertaken
by individuals. Job incumbents typically are trained to carry out their prescribed tasks, and
given a certain degree of discretion over how they do so. ‘Job design’ refers to the outcome of
this process and may be defined as the specification of the content and methods of jobs
Other terms often used as synonymous for job design include ‘work design’ and ‘job’ or ‘work
structuring’. ‘Work organisation’ is also frequently used to encompass job design, but usually
signifies broader perspective linking jobs more explicitly to their organisational context
Within the field of organisational behaviour job design has specifically focused on properties of
the job, referred to as ‘job characteristics’, such as the variety of tasks in jobs and the amount
of discretion job incumbents have in completing those tasks
Staffing: Recruitment/ Traditionally, recruitment has been conceptualised as the organisational process that precedes
selection/placement/ selection. More specifically, recruitment has been described as the process of generating
working hours/staffing pools of applicants for job vacancies; selections as the process of choosing from among those
levels/skill mix applicants. Recruitment has been regarded as an attraction activity, selections as a screening or
winnowing activity
More recently, recruitment and selection have come to be regarded as less distinct activities
Training and development When learning events are planned in a systematic fashion and are related to events in the
work environment, they are called training programmes. From this point of view, the training
process is defined as the systematic acquisition of skills, rules, concepts or attitudes, which
results in improved performance in the work environment (Goldstein 1993726)
Most training programmes have the following stages:
Need assessment: Consists of a series of analyses that assess the organisation, the job and
the person performing the job in order to provide input for the design and evaluation of the
training system. This stage requires determination of which tasks are required on the job and
which knowledge, skills and abilities are necessary to learn to perform those tasks
Training environment: Once the tasks, knowledge, skills and abilities and objectives have been
specified, the next step is designing the environment to achieve the objectives. Training is a
delicate process that requires a supportive learning environment. The training process must be
designed to facilitate the learning of the knowledge, skills and abilities required to perform the
tasks that the trainee needs for successful job performance
Training evaluation: The number of different types of objectives that organisations hope training
programmes can achieve varies widely. However, the true efficacy of any training programme
lies in how the programme is evaluated against pre-determined objectives. The evaluation
process centres around two procedures – establishing measures of success (criteria) and using
research designs to determine what changes have occurred during the training and transfer
process. Criteria must be established for both the evaluation of trainees at the conclusion of
the training programme and the evaluation of on-the-job performance
Compensation and Pay can be in cash or benefits, such as health care, a paid vacation or a company car. Payment
rewards systems vary within and across organisations in their mix. Some organisations pay all
employees a base salary whereas others use variable pay where some portion of employees’
pay is uncertain. For example, performance-related pay refers to a number of pay programmes
that link pay to the individual, group and organisation level performance measures. Pay
programmes that influence pay mix are merit pay, incentive pay, gainsharing, profit-sharing and
stock options. Pay can also be described in terms of its level, i.e. how much organisations pay
for specific jobs, and in terms of its structure which refers to the nature of pay differentials
within an organisation. Payment systems can influence attitudes and behaviours of employees,
and which employees are attracted to the organisation and which decide to leave
295

Appendix 2
Communication Through communication, organisations and their members exchange information, form
understandings, coordinate activities, exercise influence, socialise, and generate and maintain
systems of beliefs, symbols and values. Communications has been called the ‘ “nervous system”
of an organised group’ and the ‘glue’ that holds organisations together
Due to the complexity of the organisational communication process and the many levels
at which communication occur, there is no generally agreed theory of organisational
communication. Different positions have been advanced on several issues
There are at least two positions on the role of communication in organisations. One regards
communication as a subprocess that plays an important role in other organisational processes.
For example, communication serves as a channel for the exercise of leadership or for the
maintenance of interorganisational linkages. The other position argues that communication is
the process that constitutes the organisation and its activities. Rather than being a subsidiary
to key phenomena such as leadership, communication is regarded as the medium through
which these phenomena and, more generally, organisations are created and maintained
Organisations have two distinct communication systems: formal and informal. The formal
communications system is a part of the organisational structure and includes supervisory
relationships, work groups, permanent and ad hoc committees, and management information
systems. The informal communication system emerges from day-to-day interaction among
organisational members. Ties in the informal network are based on proximity, friendship,
common interests and political benefits more than formal job duties. The informal system
includes the ‘grapevine’ and the ‘rumour mill’
Employee/family friendly The term ‘work and family’ or the ‘family friendly workplace’ is one that recognises the non-
workplace family responsibilities of its employees, and develops and implements policies
that allow employees to simultaneously fulfil work and family responsibilities. Different
commentators propose different definitions, usually accompanied by a list of policies that
allegedly meet their criteria. Hartin (1994: 76),728 for example, describes ‘family-friendly’
policies as those ‘designed to minimise the impact of work on family life’ and identifies the
‘family-friendly’ policies currently in force as varieties of leave for maternity or paternity,
sickness, emergencies and compassionate reasons; career breaks and extended leave;
flexitime, part-time work and rostered days off. Gary Johns, Assistant Minister for Industrial
Relations in 1994 in Australia, identified family-friendly work policies ‘as flexible working
arrangements, permanent part-time work, job-sharing, career break schemes, paid or unpaid
family leave, and assistance with child care and elder care responsibilities that can help workers
balance their work and family responsibilities’ (Work and Family 1994729)
Single status/status Single status refers to the provision of common terms and conditions of employment to all
harmonisation/status employees of a single enterprise. It means, essentially, that all workers of whatever grade
differentials will share the same set of employment benefits (pension, sick pay, annual leave, parental and
maternity provisions) and be paid through the same mechanism (e.g. annual salary). Single
status contrasts with the traditional ‘status divide’ between hourly paid manual workers and
salaried staff, and may arise either from trade union negotiating pressure or from a desire on
the part of the employer to foster teamwork and commitment. The achievement of single
status can be costly and for this reason there may be incomplete harmonisation of employment
conditions across the workforce hierarchy
Harmonisation is referred to as movement away from separate terms and conditions of
employment for manual hourly paid and white-collar salaried employees, towards single status,
i.e. common basic terms and conditions of employment. Harmonisation most frequently
affects holiday and leave entitlement, redundancy pay and occupational pensions. It may also
have a symbolic element involving the use of common restaurant and car-parking facilities or a
standard company uniform
Employee representation/ Employee involvement has been used to describe a wide range of practices in organisations.
involvement/participation Common to all these practices is the attention paid to increasing employee influence over how
their work is carried out or over other areas of organisational policy and practice
Appraisal/performance There is no universally accepted definition of performance management, and it is sometimes

management used simply to refer to ‘performance appraisal’ or to ‘performance-related pay’. However, it
is increasingly coming to mean a general, integrated HR strategy that seeks to create a shared
vision of the purpose, aims and values of the organisation, to help each individual employee
understand and recognise their part in contributing to them, and, in so doing, to manage and
enhance the performance of both individuals and the organisation. Typically, elements of such a
strategy will include developing the ‘mission statement’ and business plan, objective setting and
other methods of performance measurement, appraisal, performance-related pay and various
approaches to enhancing internal communication
296
Higher-level concept Organising the work process so that non-managerial employees have the opportunity to
(HPWP/HPWS) contribute discretionary effort is the central feature of an HPWP. HPWPs emphasise the
devolution of the gathering and processing of information to the level of non-managerial
employees, who act on and use the information for problem-solving and decision-making.
No one has consistently defined, or even uniformly named, HPWPs (Bakker 1999;730 Becker
and Gerhart 1996;23 Delaney and Goddard 1997;731 Wood 199935). They have been called
HPWSs, alternate work practices, and flexible work practices (Delaney and Goddard 2001731).
Despite the name variances, many of these programmes share common elements, including
rigorous recruitment and selection procedures, incentives based upon performance, and
extensive training programmes focused on the needs of the business (Becker et al. 1997153).
Essentially HPWPs require heavy investment in human capital that is intended to enhance
employee skills, knowledge, motivation and flexibility with the expectation that the employer is
providing employees the ability and the opportunity to provide input into workplace decisions
(Van Buren and Werner 1996732). Companies expect this empowerment to enable employees
to adapt quickly and readily to rapidly changing product and labour market conditions, and to
improve operational efficiency and firm performance (Becker and Huselid 1998;16 Cappelli and
Neumark 2001149)
HPWP, high-performance work practice; HPWS, high-performance work system.
297

Appendix 3
HRM practice categories and associated
terms from the literature
HRM practice categories Example terms for HRM practices from the literature
1 Work design Team working
Job design
Job rotation
Work characteristics, job control, job demands
2 Staffing, recruitment and Computer-based orientation programme
selection Employee referrals as a hiring practice
Use of WABs
Orientation programme
Selection processes; employee perceptions of selection processes
3 Training and development Cultural learning interventions
Time management training
Feedback training
Cultural diversity awareness training
Training in reflective communication
Teacher training in probation schools
Lifelong learning and training
Quality awareness training
4 Compensation and reward Labour–management cooperation and trust
Compensation system, merit pay, bonus plans
Group incentives
Economic incentives
Incentives, performance awards; special act or service awards; quality step
increases; time-off awards
Promotion
Contingent rewards
Incentives: Financial bonus; enhanced fees
Gain-sharing
5 Communication Communication briefings
Communication briefs
Communication skills
Contact among team members
Feedback
Goal communication
Opportunity to participate/communication
Reinforcement schedule and feedback function
Two-way communication
6 Family friendly/work–life WIF, FIW
balance Utilisation of available workplace support
Employer-provided health insurance
Work–life balance
299

Appendix 3
HRM practice categories Example terms for HRM practices from the literature
7 Single status/harmonisation None
8 Employee involvement Employee participation in the job evaluation process
PPM system
9 Appraisal/performance Performance feedback
management Performance appraisal feedback
PMS; participation in implementation of a PMS
Goal setting, goals and personal projects, goal setting and appraisal
Supervision: No supervision; direct human supervision; and computer monitoring
Positive attendance improvement programme; recognition programme: Personal
attention; public celebration; use of mementoes; time-framed recognition; clarity
of expectations; source of acknowledgement
Performance management
Appraisal; participation; goals
Reinforcement schedule and feedback function
10 Higher-level concept (HPWP/ Opportunity to participate/communication; skills; incentives; appraisal systems;
HPWS) PRP; flexible employment practices
FIW, family interfering with work; HPWP, high-performance work practice; HPWS, high-performance work system;
PMS, performance management system; PPM, participative productivity management; PRP, performance-related pay;
WAB, weighted application blank; WIF, work interfering with family.
300
Appendix 4
Guidance on monitoring
implementation fidelity
There should be some
T his guidance highlights the necessary
components and steps that need to be satisfied
or followed if a policy is to be implemented as it
monitoring of compliance
• Monitoring to ensure that those responsible for
should be, and so have its intended effect. the delivering the practice are doing so.
• Monitoring to ensure that the practice being
There should be a policy delivered is in accordance with the written
document describing the policy in terms of those covered by it, its
practice frequency and duration.
• By preference, this monitoring should consist
There is a greater chance of high implementation of independent observation of the policy
fidelity if the description is simple, but the in practice, but may also include employee
document should provide as many of the following perceptions and experience of the practice.
details of the practice as possible:
There should be strategies
• whom the practice is to cover (all staff or only in place to ensure continued
certain staff) implementation in the long
• who is to deliver it or be responsible for its
implementation (e.g. line manager, HR staff)
term
• when, how often and for how long the practice • Training for new members with responsibility
should be delivered. for delivering the practice.
• Ongoing support for and monitoring of those
There should be strategies to delivering the practice.
help implementation of the • Long-term monitoring to ensure that the
practice practice being delivered is in accordance with
the written policy in terms of those covered by
• Training for those delivering the practice. it, its frequency and duration.
• Documents, manuals or guidance for those
delivering the practice.
• Ongoing support for those delivering the
practice.
301

Appendix 5
Implementation fidelity checklist
303

Appendix 5
This checklist assesses how well a policy is being implemented in an organisation

(Questions C1–4 and E1–4). The checklist also records information on moderators of
implementation to help explain the level of implementation achieved (Questions D1–
9). Section F collates the data from sections B–E. This is a tool for anyone who
wants to evaluate the fidelity with which a written policy has been implemented (this
could be academic researchers, HR managers or staff, line managers or employees).
A. What is the source of the following information about the policy?
Policy document  Company records 

Interviews with / questionnaires OR several HR staff
to single HR manager  
Interviews with / questionnaires OR employees
to line manager(s)  
POLICY
B. Do you have a written policy on ____________________________
If so, fill in a separate list for each practice relating to that policy
(eg. different types of appraisal, training, payment systems)
PRACTICE
C. What is the practice? ____________________________
1. According to this written policy, how often should the practice take place?
2. According to this policy, who should be covered by this practice?
All staff Some staff Don’t know

  
If some staff, who are they?
3. According to this policy, what are the various elements of this practice?
(eg. appraisal: to be by line manager; to be 1 hour; to offer employee opportunity for
feedback)
304
4. Which of these elements of this practice are ‘core’, that is, are considered
essential to the practice having its desired effect?
4.a. How have the ‘core’ elements of the practice been decided?
D. What strategies exist(ed) to facilitate implementation of the policy?
1. Who is responsible for delivering the practice?
HR staff Line managers Other

  
2. Did the people responsible for delivering the practice receive any training?
Yes No Don’t know

  
Details
2.a. If there was training, who delivered the training?

(eg. HR professionals)
3. Were guidelines or a manual provided for people responsible for delivering the
practice?
Yes No Don’t know

  
Details
4. Were the people affected by the practice involved in its development or their
opinion asked about the practice?
Yes No Don’t know

  
305

Appendix 5
Details
5. Was the quality of delivery by people responsible for the practice monitored?
Details
(eg. Feedback, performance monitoring)
5. Was the quality of delivery by people responsible for delivering the practice
5. Was the quality of delivery by people responsible for the practice monitored?
monitored?
(eg. Feedback, performance monitoring)
(eg. feedback, performance monitoring)
5. Was the quality of delivery by people responsible for delivering the practice
Yes No Don’t know
monitored?
performance monitoring) 
(eg. feedback, 
Details Yes No Don’t know
  
Details
6. Was there any ongoing support provided to the people responsible for delivering
the practice?
(eg. support services, helplines, technical help)
6. Was there any ongoing support provided to the people responsible for delivering
Yes No Don’t know
the practice?
(eg. support 
services, helplines, technical
help) 
  
Details
7. Did the practice require any new facilities or materials, and if so, were they made
available?
Yes No Don’t know

7. Did the practice require any new facilities or materials, and if so, were they made
available?   
  
Details
306
Are any strategies in place to sustain full implementation over time?
8. Is there formal training for new members of staff responsible for delivering the
practice?
Yes No Don’t know

  
Details
If there is training, who delivers the training?

(eg. HR professionals)
9. Are guidelines or a manual provided for new members of staff responsible for
delivering the practice?
Yes No Don’t know

  
Details
E. Is the policy being implemented as planned or intended?
This needs to be assessed by a combination of independent observation of staff or

company records and data collection from managers and employees. The
benchmark for the answers to these questions is provided by the answers to
Questions C1–4.
1. What is the source of the following information about implementation?
Independent observation by Company records

researchers  
Interviews with / questionnaires to By HR staff
HR staff by researchers  
line managers by researchers  
employees by researchers  
307

Appendix 5
2. Is the practice implemented as often as required?
Always Most of the time Sometimes Rarely Never Don’t know

     
3. Are all eligible employees covered by the practice?
Yes No Don’t know

  
If No, how many / what percentage are actually covered by the practice?
If a practice is only called upon irregularly, how many eligible employees have called
on the practice when they wished or were required to do so? (eg. parental leave,
working from home)
4. Are the other elements of the practice, as described in Question C3, being
implemented?
1 Yes  No 
2 Yes  No 
3 Yes  No 
4 Yes  No 
5 Yes  No 
5. Have the designated ‘essential’ elements of the practice been implemented?
1 Yes  No 
2 Yes  No 
2 Yes  No 
F. Results
1. Is the policy being implemented as intended?
Fully Mostly Only in part Not at all Cannot tell

    
2. How many measures has the organisation taken to facilitate implementation?
Very many Quite a lot Some Very few None Don’t know
     
308
3. Can the number of facilitation strategies help to explain the level of

implementation?
Yes No Cannot tell

  
4. Does the quality of delivery help to explain the level of implementation?
Yes No Cannot tell

  
5. Does participant responsiveness help to explain the level of implementation?
Yes No Cannot tell

  
309

Appendix 6
Patient outcomes search strategy
T ypical patient outcomes search filter

(MEDLINE):
19. (waiting adj3 (time$ or list$)).tw. (6131)
20. (patient$ adj5 (delay$ or cancel$)).tw. (12190)
21. or/18–20 (20497)
Database: Ovid MEDLINE 22. exp Patient Satisfaction/ (28719)
<1966 to May Week 1 2006> 23. (patient$ adj3 satisf$).tw. (19017)
24. 22 or 23 (40517)
Search strategy 25. (patient$ adj5 quality of life).tw. (17451)
1. (patient$ adj2 safety).tw. (4712) 26. exp “Quality of Life”/ (54173)
2. exp SAFETY/ (28534) 27. exp PATIENTS/ (35451)
3. exp PATIENTS/ (35451) 28. 26 and 27 (1335)
4. 2 and 3 (249) 29. 25 or 28 (18557)
5. exp Infection Control/ (34544) 30. exp MORTALITY/ (174087)
6. hospital acqui$ infection$.tw. (980) 31. mortality.tw. (230754)
7. MRSA.tw. (4671) 32. exp SURVIVAL/ (2334)
8. risk management/ (9191) 33. survival.tw. (320503)
9. exp Patients/ (35451) 34. or/30–33 (596061)
10. 8 and 9 (118) 35. exp “Length of Stay”/ (33765)
11. (risk management adj5 patient$).tw. (168) 36. exp Patient Discharge/ (11491)
12. 1 or 4 or 5 or 6 or 7 or 10 or 11 (44413) 37. exp Patient Readmission/ (4097)
13. exp Patient-Centered Care/ (3744) 38. length of stay.tw. (11433)
14. exp Patient Participation/ (10587) 39. ((hospital or patient$) adj5 readmi$).tw. (2949)
15. patient-cent?red care.tw. (413) 40. ((hospital or patient$) adj5 discharg$).tw.
16. (patient$ adj3 choice$).tw. (6048) (31848)
17. or/13–16 (20034) 41. or/35–40 (75104)
18. exp Waiting Lists/ (4289) 42. 12 or 17 or 21 or 24 or 29 or 34 or 41 (777098)
311

Appendix 7
Typical HRM and longitudinal search filters
Database: Ovid MEDLINE 2. longitudinal$.tw. (71367)
<1966 to November Week 3 3. exp Retrospective Studies/ (248824)
2005> 4. retrospective study.tw. (39390)
5. exp Prospective studies/ (209208)
Search strategy 6. prospective study.tw. (56189)
1. exp Personnel Management/ (84372) 7. quasi-experimental.tw. (1827)
2. (human resource$ or HRM).tw. (2180) 8. (follow-up$ or follow$ up).tw. (346566)
3. ((HR and (organi?ation$ or staff$ or employ$)) 9. repeat$ measure$.tw. (12546)
not (hazard$ or ratio$)).tw. (2020) 10. (post-test or posttest or (pre adj5 post)).tw.
4. ((high performance or high involvement or (24056)
high commitment) adj2 work).tw. (29) 11. (T1 or T2 or T3).tw. (73071)
5. or/1–4 (87742) 12. baseline.tw. (148159)
13. (Over time or time period).tw. (55619)
Database: Ovid MEDLINE 14. interrupted time series.tw. (234)
<1966 to May Week 1 2006> 15. predict$ design$.tw. (64)
16. exp Case Control/
Search strategy 17. exp Cohort studies/
1. exp Longitudinal Studies/ (539439) 18. or/1–17
313

Appendix 8
Example Business Source Premier
and PsycInfo search filters
Business Source Premier 2. HRM* or Human resource manag* or Human
(Ebsco) resourc* or high perf* high commitment*
S1 (DE “PERSONNEL management”- exploded) (4538 records)
(154567 records) HRM* or Human resource manag* or Human
S2 TI ( human resource* or HRM ) Or AB ( resourc* or high perf* high commitment* or
human resource* or HRM ) (27272 records) personnel managem* (14831 records)
S3 TI HR Or AB HR (13945 records) HRM* or Human resource manag* or Human
S4 TI ( high commitment work or high resourc* or high perf* high commitment*
involvement work or high performance work or explode personnel management (17336
) Or AB ( high commitment work or high records)
involvement work or high performance work ) 3. explode ‘Longitudinal-Studies’ in DE (14229
(209 records) records)
S5 TI (organisation* or organisation* or 4. ‘Repeated-Measures’ in DE (260 records)
staff* or employ*) Or AB (organisation* or explode ‘Prospective-Studies’ in DE (264
organisation* or staff* or employ*) (603395 records)
records) 5. Retrospective stud* (1702 records)
S6 (S1 OR S2 OR S3 OR S4 OR S5) (813114 explode ‘Retrospective-Studies’ in DE (243
records) records)
S7 TI ( longitudinal* or quasi-experimental or 6. ‘Followup-Studies’ in DE (12282 records)
retrospective study or prospective study or 7. (explode ‘Longitudinal-Studies’ in DE) or
followup or follow-up ) Or AB ( longitudinal* (‘Repeated-Measures’ in DE) or (explode
or quasi-experimental or retrospective study ‘Prospective-Studies’ in DE) or (Retrospective
or prospective study or followup or follow-up ) stud*) or (explode ‘Retrospective-Studies’
(11694 records) in DE) or (‘Followup-Studies’ in DE) (28266
S8 TI ( follow* up or repeat* measure* or baseline records)
or post-test or posttest ) Or AB ( follow* up or 8. (HRM* or Human resource manag* or Human
repeat* measure* or baseline or post-test or resourc* or high perf* high commitment*
posttest ) (9196 records) or explode personnel management) and
S9 TI ( T1 or T2 or T3 or over time or time ((explode ‘Longitudinal-Studies’ in DE) or
period or interrupted time series or predict* (‘Repeated-Measures’ in DE) or (explode
design ) Or AB ( T1 or T2 or T3 or over time ‘Prospective-Studies’ in DE) or (Retrospective
or time period or interrupted time series or stud*) or (explode ‘Retrospective-Studies’ in
predict* design ) (18559 records) DE) or (‘Followup-Studies’ in DE) (213 records)
S10 (S7 OR S8 OR S9) (39449 records) 9. 1 or 2 or 3 or 4 (25082 records)
S11 (S6 AND S10) (1323 records) 10. 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 (57459)
11. 13 and 14 (289 records)
PsycINFO
1. explode ‘Personnel-Management’ in DE (14118
records)
315

Appendix 9
Discussion of bias in meta-analyses
Publication bias Extractor bias
The tendency for academic journals to publish The extraction of data for the meta-analysis should
only studies with significant results means that be ‘explicit, unbiased and reproducible’ (Cook
any meta-analysis based on a limited search of et al.659) If only a single reviewer is involved in
the literature may be open to publication bias coding or extracting data from studies for a meta-
because smaller studies demonstrating no effect, analysis or review, or if no assessment is made of
or a negative effect, may be being omitted.662 the consistency between two or more reviewers
This form of bias is the most researched.61,666 The performing coding or data extraction (e.g. inter-
failure to conduct a comprehensive multimethod rater reliability score), then there is an increased
literature search of various sources, including so- likelihood of bias or error entering the analysis
called ‘grey literature’, i.e. unpublished studies because the data on which it is based may not have
and research published in sources other than been recorded consistently.662 The potential degree
peer-reviewed journals, increases the likelihood of of this so-called extractor bias is therefore assessed
this publication bias. The potential for relevant, by the checklist.
published literature or evidence to be missed is
also increased. If this occurs, the meta-analysis Quality appraisal
may be affected by so-called publication bias. This
is because a limited literature search may only A major source of bias also resides in the
find those studies listed in one or two of the most methodological quality of included studies. Giving
popular databases or catalogued with a particular equal weight to studies of very different quality
keyword or term. Consequently, other, equally may have an adverse effect on the validity of the
relevant and potentially important studies listed findings of a meta-analysis; this is emphasised in
in other databases and catalogued using slightly all of the literature evaluating meta-analyses.659–662
different terms may therefore be missed. The If there is variation in the methodological quality
findings of any analysis based on such a limited of included studies then there is an increased
literature search would therefore be compromised likelihood of a ‘false-positive’ conclusion or Type
because it would not represent all of the relevant II error (that there is an effect, when in fact
and available evidence on the topic. The checklist there is not), if, for example, less rigorous or
therefore makes an evaluation of the degree of methodologically robust studies have provided
potential search or publication bias in the included the larger effect sizes in the meta-analysis. On the
meta-analyses and reviews. other hand, these less rigorous studies might also
potentially obscure the results of the higher-quality
Selection bias studies and give a ‘false-negative’ conclusion, or
Type I error (indicating no effect, when there
In order to guard against inconsistency in the is one).725 The failure to conduct some form of
selection of studies, meta-analyses need to develop quality assessment means that either these less
and apply explicit inclusion criteria. The more rigorous studies cannot be excluded or sensitivity
specific and detailed the criteria, the more likely analyses cannot be performed to gauge the effect
it is that only primary research studies satisfying on the overall effect size found by the analysis of
these criteria will be included, and therefore the studies of different quality. The checklist developed
more consistent and homogeneous the sample for this report therefore evaluates whether a
included in the analysis.662 The checklist therefore quality assessment of included studies had been
includes an evaluation of stated inclusion criteria in performed, in order to assess whether potential
order to assess the potential degree of any selection bias or error may have been introduced into the
bias in the analysis. meta-analysis or review from this source. However,
no meta-analysis in this field conducted such an
317

Appendix 9
evaluation, so it exists as a potential source of bias this model nor some other appropriately selected
in every meta-analysis or review included in this random effects model has been used.
paper.
Moderator or sensitivity analysis
Analysis
Sensitivity analysis (sometimes called ‘moderator
Random effects models give a more conservative, analysis’) is used to test assumptions about the
cautionary, and therefore reliable, estimate of findings of the analysis by exploring the effect of
effects sizes, that is the size of the relationship excluding certain studies from the analysis, or by
between two variables. Fixed effects models should comparing the results for different subgroups. For
only be used for meta-analyses where there is clear example, by excluding studies with the smallest
homogeneity between effects sizes. A meta-analysis sample sizes, it is possible to determine whether
should therefore test for the homogeneity or the analysis is subject to publication bias.733 Or,
heterogeneity of effect sizes in order to determine by excluding studies of poorer quality, it can
the most appropriate effects model.665,667,733 If a be assessed how far study quality affects the
Q-statistic/chi-squared statistic or credibility interval results. The outcome is a more robust analysis
indicates heterogeneity (i.e. if the Q-statistic or that has tested assumptions that might affect its
chi-squared statistic is significant or the credibility findings.659,662,733 For meta-analyses relating to
interval includes 0) then the analysis needs to use intermediate outcomes, a sensitivity analysis might
a random effects model. In the absence of any involve either comparing the results of overall
such test, a random effects model should be used. correlations with those for particular measures of a
However, it is always preferable to use a random concept only. For example, Lodahl and Kejner’s424
effects model because this test is only capable of measure of job involvement has 20- and six-item
detecting heterogeneity when the heterogeneity scales, and a sensitivity or moderator analysis
of effect sizes is large, and the number of studies would examine results for overall and more specific
is neither too small nor too large.733–735 The failure measures of job involvement.189 The performance
to use the appropriate model might mean that the of such an analysis permits a more rigorous
overall effect size reported is more precise than the assessment of the findings of the meta-analysis.
data can actually support. However, almost all of The meta-analytic process advocated by Hunter
the meta-analyses included in this report used the and Schmidt and Hunter et al.736,737 requires the
random effects model of Hunter and Schmidt736 performance of such moderator analyses, so many
and Hunter et al.737 The checklist therefore records of the included meta-analyses have tested the
whether this model has been used, but reports the robustness of their results in this way.
potential presence of potential bias only if neither
318
Appendix 10
Checklist to assess bias in meta-analyses
Study
Potential degree of bias

Data collection (tick, circle, or highlight)
Search strategy/terms given
Alternative terms that could have been used?
If comprehensive strategy given with alternative terms Low
If basic strategy given Moderate
If no strategy or terms given High
Databases searched
PsycINFO
ABI/INFORM
Others
If 3 or more Low
If 2 Moderate
If 1 or less High
Grey literature sources
Dissertation abstracts
Conference abstracts
Others
If 1 or more Low
If none High
Other methods
Hand-searching
Reference tracking
Contacting authors
If done 2 or 3 Low
If done 1 Moderate
If done none High
Test for publication bias (e.g. funnel plot or other) Bias depends on findings
Specific criteria Low
No information on criteria High
Coding (data extraction)
Inter-rater reliability or consistency score or done by more than 1 analyst Low
1 analyst only, no information or can’t tell High
Quality assessment
Formal appraisal of included studies Low
Only certain journals used (peer-reviewed) Moderate
No quality assessment at all High
319

Appendix 10
Study
Potential degree of bias

Data collection (tick, circle, or highlight)
Analysis
Test for homogeneity of between study effects’ sizes
Chi-squared statistic or Q-statistic or credibility interval Low
No test High
Appropriate effects model used
Hunter and Schmidt736 (random effects model adjusting for sampling error and Low
reliability of measures, but no other heterogeneity)
Other random effects model Low
Fixed effects Moderate
Unknown High
Robustness of analysis
Sensitivity or moderator analysis performed (e.g. by measure, population etc.)
Yes Yes
No High
Overall summary Potential degree of bias
Data collection (greater effort to achieve comprehensive information
retrieval means reduced potential for publication bias)
If 3 or more lows Low
If 2 lows Moderate
If 1 low, 2 moderates, 1 high Moderate
If 3 or more moderates Moderate
If 2 or more highs High
(If test for publication bias has been done, findings of this override above comments)
Inclusion criteria (greater effort to select relevant studies means reduced Low or high
potential for selection bias)
Coding (extractor bias) Low or high
Quality assessment Low
Moderate
High
Analysis
If random effects model used Low
If fixed effects model used after test for heterogeneity demonstrated homogeneity Moderate
between studies
If fixed effects model used after test for heterogeneity demonstrated heterogeneity High
between studies
Sensitivity analysis
Yes Low
No High
320
Appendix 11
Assessment of bias for included meta-analyses
S o far we have provided overviews of the meta-

analytic results of the intercorrelations among
the intermediate outcomes, and correlations
Job satisfaction
Correlations with other intermediate
outcomes
between the intermediate outcomes and employee Studies
behaviours. Next is a more detailed breakdown of The literature search identified 121 studies, four of
the meta-analyses from which the overviews are which met the inclusion criteria:
constructed. Description, quality appraisal and
results of the included meta-analyses for each • Faragher et al.739 conducted a meta-analysis
intermediate outcome are provided below. of 485 studies, reporting data on correlations
between job satisfaction and burnout. The
Motivation analysis did not require studies only to have
Correlations with other intermediate used a particular measure or measures of job
outcomes satisfaction for them to be included.
Studies • Hellman740 conducted a meta-analysis of
50 studies, reporting adjusted correlation
No meta-analyses of motivation satisfied the coefficients for the relationship between job
inclusion criteria. satisfaction and turnover intentions. The
analysis did not specify the scales used to
Correlations with behaviours measure either variable.
Studies • Brown and Peterson741 performed a meta-
The literature search identified 55 studies, one of analysis of 59 studies and reported corrected
which met the inclusion criteria:738 correlation coefficients for the relationships
between job satisfaction and organisational
• Judge and Ilies738 conducted a meta-analysis of commitment, propensity to leave (turnover
65 studies with 78 samples, reporting data on intentions), work motivation and job
correlations between two facets of motivation involvement.
(goal setting and expectancy) and a single • Finally, Blegen742 conducted a meta-analysis
dimension of OCB (conscientiousness). of 48 studies, reporting adjusted correlation
coefficients for the relationship between job
Critical appraisal of meta-analyses satisfaction and both commitment and fairness.
Publication and extractor bias were high in the The analysis did not specify the scales used to
meta-analysis of Judge and Ilies,738 although measure either variable.
selection bias was low. Moderator analyses were
performed by testing for the effect of setting on the Also, Witt and Nye743 conducted a meta-analysis
results. on their own sample of 56 correlations using their
own composite measure. Although correlation
Results coefficients between ‘global’ satisfaction and
This moderate quality meta-analysis found a perceived fairness of pay or promotion across a
medium correlation between goal setting and sizeable number of samples were reported, this was
conscientiousness (0.28) and a small correlation not a cross-study meta-analysis and so has been
between expectancy and conscientiousness (0.23). excluded from this review.
However, any conclusions should be drawn with
caution, as the findings are from only one meta- Critical appraisal of meta-analyses
analysis. Three out of the four meta-analyses that satisfied
the inclusion criteria for this review were of
relatively high quality. The studies of Faragher et
321

Appendix 11
al.739 and Blegen742 were of high quality as they • Judge et al.656 carried out a meta-analysis of 254
only had one potential source of serious bias, while studies comprising 312 independent samples,
the potential for other types of bias was only low. and reported data on correlations between job
Faragher et al.739 was subject to low publication satisfaction and job performance.
and selection bias, and was only vulnerable to high • Organ and Ryan162 conducted a meta-analysis
extractor bias in the coding of studies. Moderator of 55 studies (55 samples), reporting data
analyses were performed by testing the effect on on correlations between satisfaction and five
the results of using both fixed and random effects dimensions of OCB (altruism, civic virtue,
models. Blegen742 had relatively high publication courtesy, sportsmanship and compliance, but
bias because a specific search was conducted to not conscientiousness).
identify unpublished studies, but details of all other • Brown and Peterson,741 as mentioned in
aspects of the literature search are extremely vague. the section on job satisfaction correlations
However, potential selection and extractor bias was with other intermediate outcomes, above,
low; a test for homogeneity was performed and a performed a meta-analysis of 59 studies and,
random effects model was used; and moderator in addition to the correlations between job
analyses were performed by testing the effect of satisfaction and the intermediate outcome
setting and publication date on the results. variables of interest, reported corrected
correlation coefficients for the relationships
The meta-analysis of Brown and Peterson741 was of between job satisfaction and both performance
similar, relatively high quality: it had low selection and turnover.
and extractor bias, but there was potentially a • Carsten and Spector747 conducted a meta-
moderate amount of publication bias. This meta- analysis of 47 studies examining the
analysis used a fixed effects model rather than a relationship between job satisfaction and
random effects model, testing for homogeneity, employee turnover.
which revealed consistency across effect sizes; • The meta-analyses performed by Irvine and
although they did perform moderator analyses by Evans,748 comprising 11 studies, and by Tett
testing for the effect of different populations and and Meyer,749 comprising 155 studies (178
different measures. samples), both examined the relationship
between job satisfaction and turnover.
Finally, the quality of the meta-analysis by • The meta-analysis of Farrell and Stamm750
Hellman740 was very low: publication, selection, was based on 72 studies and reported
and extractor bias were all high (no details were correlations between job satisfaction and two
given of any of these processes) and no information absence variables (total time lost and absence
was given about the effects model used, although frequency).
moderator analyses were performed. • Iaffaldano and Muchinsky157 reported a
meta-analysis of correlations from 74 studies
Correlations with behaviours on various aspects of job satisfaction and its
Studies relationship to performance. Petty et al.751
The literature search identified 121 studies, 14 of performed a similar meta-analysis on the same
which met the inclusion criteria: variables based on 31 studies, but focused
specifically on individual level job satisfaction
• Dalal744 conducted a meta-analysis of 38 studies and performance.
with 49 samples, reporting data on correlations • Steel and Ovalle752 conducted a meta-analysis
between job satisfaction and an overall score of 34 studies and reported data on correlations
for OCB. between job satisfaction and turnover, while the
• LePine et al745 conducted a meta-analysis of meta-analysis of Scott and Taylor753 examined
37 studies (37 samples) and reported data on the relationship between job satisfaction and
correlations between satisfaction and an overall absenteeism in 23 studies (114 correlations).
score for OCB.
• Harter et al.746 conducted a meta-analysis of 42 Critical appraisal of meta-analyses
studies across 36 organisations conducted by The methodological quality of the meta-analyses
the Gallup Organization. They reported data included in this report ranged from very good
on correlations between job satisfaction and to very poor. One meta-analysis was of very high
turnover (measured as a dimension of business quality,656 six meta-analyses were of relatively
unit performance). high,157,162,741,744,745,749 one was of moderate quality747
and five were of only low quality.748,750–753
322
The rigorous meta-analysis carried out by Judge et Sensitivity analyses were also performed to test the
al.656 was superior to the other analyses involving robustness of the findings by evaluating the impact
job satisfaction in this section. Although only on effect sizes of different outcome measures.
one electronic database was searched, potential
publication bias was low because searches of The meta-analysis of Brown and Peterson741 was of
unpublished literature, hand-searches of 21 relatively high quality (for details, see Correlations
journals and reference tracking of previous meta- with other intermediate outcomes, above).
analyses took place. Furthermore, the potential for
publication bias is acknowledged and a test carried The meta-analysis of Laffaldano and Muchinsky157
out by Judge et al.656 suggests limited effects on the was also of relatively high quality. There was
results. Potential selection bias was low as inclusion moderate potential publication bias because only
criteria were clear, although no information about one database and no sources of grey literature
the number of reviewers involved or about inter- were searched, although supplementary literature
rater reliability was given. Extractor bias was also searching methods were used. Selection and
low, with inter-rater reliability reported for the extractor bias were both low because inclusion
coding process. The random effects model of criteria were specific and detailed, and the
Hunter and Schmidt736 was used and a test for reliability of the coding was tested and an
the homogeneity of effect sizes was performed. inter-rater reliability score reported. No test of
Moderator analyses, again superior to those of the homogeneity of effect sizes was performed, but a
other meta-analyses included, were also performed, random effects model was used. Sensitivity analyses
testing for the effects not only of different measures were performed to assess the effect on the results
of satisfaction and performance, but also of study of year of publication and the different measures
design and quality. In particular, these moderator of job satisfaction and performance used by the
analyses tested for the effects of longitudinal versus included studies.
cross-sectional studies and of high-ranked versus
low-ranked journals or sources; no other meta- Moderate quality meta-analyses
analyses distinguish these factors. The meta-analysis of Carsten and Spector747 was
of moderate quality. Potential publication bias
The meta-analyses of Dalal744 and Organ and was moderate as there were no sources of grey
Ryan162 were both good methodologically. In literature and only one database was searched,
both cases, there was moderate publication bias although supplementary literature searching
because only a small number of databases or grey methods were used. Selection bias was low because
literature sources were searched, but otherwise inclusion criteria were specific and detailed, but
selection and extractor bias were low. Both studies no details were provided about the coding process
also performed sensitivity analyses. LePine et al.745 so potential extractor bias was high. A test of
had moderate potential publication bias because homogeneity of effect sizes was performed, and a
grey literature was searched and relevant authors random effects model was used, but the sensitivity
contacted, but had low selection bias because analysis by occupational group alone was limited.
inclusion criteria were clear. LePine et al.745 also
performed a test for homogeneity, used a random Low quality meta-analyses
effects model for the analysis, and performed The meta-analysis of Petty et al.751 had a number
moderator analyses by testing for the effect on the of substantial weaknesses. The literature search
results of using different measures of OCB and was extremely limited, consisting only of hand-
measuring different dimensions of this concept. searching a number of journals, so the potential for
Only extractor bias was high. publication bias was high. Extractor bias was also
high: no information was given about the coding
The meta-analysis of Tett and Meyer749 was of of the included studies. Potential selection bias,
moderate to high quality. The literature search however, was low because clear inclusion criteria
could have been more comprehensive, as only were given. There was no test for homogeneity of
one bibliographical database was searched, but effect sizes, but a random effects model was used
multiple methods were used, a specific search was and moderator analyses were performed based on
made for unpublished studies, and the potential the different measures of job satisfaction, such as
for some publication bias in the included sample the JDI.
of studies was acknowledged. Potential selection
bias was low. A test for homogeneity was performed The meta-analysis of Irvine and Evans748 was also of
and a random effects model used for the analysis. poor quality. A test for homogeneity was performed
323

Appendix 11
and a random effects model was used, but there motivation. The high-quality meta-analysis of
was a high degree of publication and extractor bias, Farragher et al.739 found a large, positive correlation
and a moderate degree of selection bias. Although between low job satisfaction and burnout (0.48).
sensitivity analyses were performed, these results There were medium to large negative correlations
were not related to job satisfaction. with turnover intentions in two studies, although
one of these meta-analyses was of very low
The analysis of Scott and Taylor753 was of similar quality.740
low quality. The potential for publication bias
was high because the details of the literature A relatively large number of meta-analyses
search consisted of no more than the statement reporting correlations between job satisfaction
that, ‘A comprehensive review of the … literature and employee behaviours were included in this
uncovered 23 studies’. Inclusion criteria were review, therefore only those of high or moderate
limited, and potential extractor bias was high. quality will be included here. Three meta-analyses
However, although no test for homogeneity was reported small to medium positive relationships
performed, a random effects model was used and between job satisfaction and overall measures of
sensitivity analyses were performed, based on OCB, and three reported small to medium negative
different measures of absenteeism. associations between job satisfaction and turnover.
The rigorous meta-analysis by Judge et al.656 found
The meta-analyses by Harter et al.746 Farrell a moderate positive relationship between job
and Stamm750 and Steel and Ovalle752 were satisfaction and performance (0.30), while two
methodologically weaker. In Harter et al.746 other studies found positive but small correlations.
publication bias was high because studies were only
included if they were undertaken by the Gallup Organisational commitment
Organization. Some selection criteria were applied
to the small pool of available studies, although Correlations with other intermediate
these were limited, and no information was given outcomes
on coding of data, so extractor bias may be high Studies
also. However, the form of analysis was good: a The literature search identified 40 studies, 10 of
random effects model was used and subgroup which met the inclusion criteria.175,176,754–761 An
analyses were performed. additional meta-analysis that satisfied these criteria
was identified by reference-tracking of included
In the other two analyses, extractor bias was high meta-analyses.669 The definition of organisational
in both because no information was given on how commitment used by these studies is within the
the coding process was performed. Publication broad definition outlined in Chapter 4:
bias was moderate in Farrell and Stamm750 because
databases were searched and other information • The various meta-analyses performed by
retrieval methods, such as reference-tracking and Cooper-Hakim and Viswesvaran754 were
hand-searching of journals, were used, but no based on findings from 997 articles, which
grey literature sources were searched. Publication included correlations between organisational
bias was high in Steel and Ovalle752 because the commitment and career commitment, job
literature search performed was even more limited. satisfaction and turnover intentions. The
However, selection bias was low in Farrell and primary studies used many different measures
Stamm750 and Steel and Ovalle752 because inclusion to measure these correlates.
criteria were given. Neither analysis tested for • Meyer et al. 669 conducted a meta-analysis
homogeneity of effect sizes, although both did use of 155 samples from both published and
a random effects model. Both analyses performed unpublished studies. The meta-analysis
sensitivity analysis based on the occupation status reported correlations between organisational
of the sample, but Steel and Ovalle752 conducted an commitment and the following intermediate
additional analysis based on time to turnover. outcomes of interest: justice, occupational
commitment, job satisfaction and pay
Results satisfaction. The analysis only included data
Generally, the high-quality meta-analyses reporting from studies that used one or more of the
correlations with intermediate outcomes found commitment measures (affective, continuance
job satisfaction to have a moderate to high or normative) developed by Allen and Meyer,741
positive association with perceptions of fairness, Meyer and Allen174,477,762 or Meyer et al.763
organisational commitment, job involvement and
324
• Colquitt et al.755 performed a meta-analysis The meta-analyses of Cooper-Hakim and

of 106 studies, reporting correlations Viswesvaran,754 Meyer et al.,669 Colquitt et al.,755
between organisational commitment and job Wallace,176 and Mathieu and Zajac759 were all
involvement. of similar moderate quality. Only extractor
• The meta-analysis of Mathieu and Zajac759 bias was high in the analysis of Meyer et al.669
was based on 124 studies (174 independent because information was not given on coding of
samples) and reported correlations with the studies. Publication and selection bias were
the following behavioural or attitudinal low, and moderator analysis was used to test the
outcomes of interest to this study: motivation, effect on the results of using different measures
professional/occupational commitment, and of organisational commitment. The potential for
job satisfaction. This meta-analysis did not selection bias was high in the meta-analysis of
specify particular measures as an inclusion Mathieu and Zajac759 but the scope for publication
criterion, but 132 of the samples assessed and extractor bias was low, and moderator analyses
attitudinal commitment, 28 assessed calculative were performed by type of commitment. The
commitment, and 14 either combined the two meta-analysis of Wallace176 was of similar quality.
or assessed another type of commitment. It was also subject to low publication and selection
• Cohen and Gattiker756 conducted a meta- bias, but the potential for extractor bias was high.
analysis of 27 studies (31 samples) examining However, moderator analyses were performed
correlations with pay satisfaction, a dimension by testing for the effect on the results of the
of job satisfaction. Once again, this meta- professionalism, position or occupation of the
analysis did not specify particular measures as sample, and for the scale used.
an inclusion criteria.
• Wallace176 conducted a meta-analysis of 25 In the meta-analysis of Cooper-Hakim and
studies (25 samples) and reported data on Viswesvaran,754 the potential for selection bias was
correlations with organisational commitment low and both data collection and coding were high
only. Particular measures were not specified as quality, so publication and extractor bias were
inclusion criteria. low. No test for homogeneity was performed, but
• Cohen758 conducted a meta-analysis of 30 an appropriate random effects model was used.
studies (41 samples) and reported data on No moderator analysis was performed to test
correlations with turnover intentions, although the robustness of the results. The meta-analysis
no particular measures were specified as of Colquitt et al.755 was of slightly lower quality,
inclusion criteria. having low selection and extractor bias, but high
• Randall760 conducted a meta-analysis of 35 publication bias because it consisted only of a
studies (35 samples), but reported no data hand-search of named journals and contacting
on correlations between organisational experts in the field: there was no search of
commitment and the intermediate outcomes of electronic databases or sources of grey literature.
interest to this study. No test of homogeneity was performed, but the
• The meta-analyses of Cohen175 and Cohen random effects model of Hunter and Schmidt736
and Hudecek757 also did not correlate was used. No moderator analyses were performed.
organisational commitment with any outcomes
of interest. Methodologically, the weakest meta-analyses were
• Finally, Ferris and Aranya761 reported conducted by Cohen758 and Cohen and Gattiker.756
correlations between different organisational Extractor bias was high in both because no
commitment scales and intention to quit, job information was given on how the coding process
satisfaction and professional commitment. was performed. Selection bias was high in Cohen758
However, this was an analysis of their own because no information was given, and publication
sample, rather than a meta-analysis of two or bias was also high because the only information
more samples. provided on how this meta-analysis identified
included studies was the performance of ‘both
Critical appraisal of meta-analyses manual and computer-assisted searches of social
None of the meta-analyses that satisfied the science, psychology and managerial literature’.
inclusion criteria for this review were of high Publication, selection and extractor bias were all
quality, but the methodological quality of several high in Cohen and Gattiker.756 However, moderator
was moderate. analyses were performed by both meta-analyses.
325

Appendix 11
Correlations with behaviours based on 124 studies (174 independent

Studies samples). Correlations between organisational
The literature search identified 40 commitment and both turnover and job
studies, 11 of which met the inclusion performance (as rated by others) were
criteria.162,175,744,745,754,757–760,764,765 Three additional reported.
meta-analyses that satisfied these criteria were • Randall760 conducted a meta-analysis of 35
identified by reference tracking of included meta- studies (35 samples) and, despite including
analyses:669,750,752 no data in relation to correlations with
the intermediate behaviours of interest,
• The meta-analyses performed by Cooper- reported correlations between organisational
Hakim and Viswesvaran,754 as mentioned in commitment and the final outcomes of
the previous section, were based on findings performance, attendance and remaining in the
from 997 articles, which included correlations organisation (the last two being the inverse of
between organisational commitment and the absence and turnover variables).
turnover, in addition to the correlations with • The meta-analyses of Cohen175 and Cohen
intermediate outcomes described previously. and Hudecek757 both reported corrected
Dalal744 conducted a meta-analysis of 38 studies correlations from 24 studies (36 samples) for
(49 samples), and reported data on correlations turnover and organisational commitment.
between organisational commitment and an • The meta-analysis of Farrell and Stamm750 was
overall score for the six dimensions of OCB. based on 72 studies and reported correlations
This meta-analysis did not specify particular between organisational commitment and the
measures or characteristics of measures as absence variables of total time lost and absence
inclusion criteria. frequency.
• Meyer et al.669 conducted a meta-analysis of 155 • Steel and Ovalle752 conducted a meta-analysis
samples and, in addition to the correlations of 34 studies and reported data on correlations
with intermediate outcomes mentioned above, between organisational commitment and the
reported correlations between organisational final outcome of turnover.
commitment and OCB. • The analysis of Wright and Bonett764 was not
• LePine et al.745 conducted a meta-analysis a true meta-analysis because it only reported
of 37 studies (37 samples), reporting data the correlation coefficients of organisational
on correlations between organisational commitment and performance in identified
commitment and an overall score for the six studies, rather than providing an overall
dimensions of OCB (altruism, civic virtue, corrected correlation.
courtesy, sportsmanship, compliance and
conscientiousness). Critical appraisal of meta-analyses
• The meta-analysis of Riketta765 was based One of the meta-analyses that satisfied the
on 93 published studies (111 independent inclusion criteria for this review was of high
samples) and reported correlations between quality,765 but the methodological quality of many
attitudinal organisational commitment and job was good or moderate.
performance.
• Organ and Ryan162 conducted a meta-analysis The meta-analysis of Riketta765 was of high quality:
of 55 studies (55 samples). They reported publication, selection and extractor bias were all
data on correlations between organisational low, and although no search was performed to
commitment and five dimensions of OCB identify unpublished material, a clear rationale
(altruism, civic virtue, courtesy, sportsmanship, for this was given. A test for homogeneity was
and compliance, but not conscientiousness). performed and a random effects model was
• Cohen758 conducted a meta-analysis of 30 used for the analysis. Moderator analyses were
studies (41 samples) and reported data on also performed, including population, type of
correlations with turnover and performance, performance, and different performance and
alongside the correlation mentioned previously commitment measures.
in relation to organisational commitment and
intermediate outcomes. This meta-analysis did The meta-analyses of Dalal744 and Organ and
not specify particular measures as an inclusion Ryan162 were both good methodologically.
criterion. Publication bias was moderate in both because
• The meta-analysis of Mathieu and Zajac,759 only a small number of databases or grey literature
as mentioned in the previous section, was sources were searched. Selection and extractor
326
bias were both low, and each study also performed The analyses of Cohen and Hudecek757 and
moderator analyses. Cohen175 essentially reported the same data.
Potential publication bias was only moderate in Results

the study of LePine et al.,745 as grey literature was A relatively high number of organisational
searched and relevant authors were contacted. commitment meta-analyses were included for
Inclusion criteria were clear, so selection bias was review, so we report just on those studies of
low. A test for homogeneity was performed and reasonable quality (although still with multiple
a random effects model was used. Moderator sources of bias). Organisational commitment
analyses were also performed by testing for the had a large negative relationship with turnover
effect on the results of using different measures of intentions and a large positive association with job
OCB and measuring different dimensions of this satisfaction, organisational support, and motivation
concept. Only extractor bias was high. (although this last relationship is from a small
number of studies in a single meta-analysis). There
The meta-analyses of Cooper-Hakim and are moderate to high positive associations with
Viswesvaran,754 Meyer et al.669 and Mathieu and organisational justice and job involvement.
Zajac759 were all of moderate quality. Details
of biases in these analyses are described in the Similarly, with regards meta-analyses reporting
previous section. associations between organisational commitment
and behaviours, only those studies of reasonable
Randall760 had low publication bias (a test was quality have been included here. Organisational
performed to demonstrate this) and selection bias, commitment had small to moderate positive
but high extractor bias because no information correlations with OCB, small positive correlations
was provided on how the coding was performed. with performance, and a small to moderate
This meta-analysis used a random effects model negative association with turnover.
and performed moderator analyses to test for
the effect on the results of excluding different Professional/occupational
commitment and performance measures, and commitment
certain populations, from the analysis.
The weaker meta-analyses, methodologically, were outcomes
conducted by Cohen and Hudecek,757 Cohen,175,758 Studies
Farrell and Stamm750 and Steel and Ovalle.752 The literature search identified three studies,
Extractor bias was high in all because information two of which met the inclusion criteria.176,177 The
was not given on how the coding process was definition of professional commitment used by
performed. Publication bias was moderate in these studies falls within the broad definition
Cohen and Hudecek,757 Cohen,175 and Farrell outlined in Chapter 4:
and Stamm750 because databases were searched,
and other information retrieval methods, such as • Lee et al.177 conducted a meta-analysis of
reference-tracking and hand-searching of journals, 76 studies (77 samples), reporting data on
were used, but no grey literature sources were correlations between professional commitment
searched. Publication bias was high in Steel and and the following intermediate outcomes
Ovalle752 because the literature search performed of interest: job satisfaction, burnout and
was so limited. However, selection bias was low organisational commitment. The inclusion
in Cohen,175 Farrell and Stamm750 and Steel and criteria required a consistent definition of
Ovalle752 because inclusion criteria were given. occupation commitment, so only studies using
Selection bias was high in Cohen and Hudecek757 specified scales were included.
and Cohen758 because no information regarding • Wallace176 conducted a meta-analysis of 25
inclusion criteria was reported. As mentioned studies (25 samples) and reported data on
previously, publication bias was also high in correlations with organisational commitment
Cohen758 because very little information was only. This meta-analysis did not specify
provided with regard to how studies to be included particular measures as inclusion criteria, but
in the meta-analysis were identified. However, some almost one-half of the included studies used
moderator analyses, based on the age, tenure, a version of the organisational commitment
profession or time to turnover of the sample questionnaire (OCQ), with the word
population, were performed. ‘organisation’ being substituted with the word
‘professional’. 327

Appendix 11
Critical appraisal of meta-analyses albeit of good quality. In relation to organisational

These two meta-analyses were both of moderate behaviours, Lee et al.177 and Cooper-Hakim and
quality. The study of Lee et al.177 was good. It Viswesvaran754 reported professional commitment
was subject to only moderate publication bias, to have a weak negative association with turnover,
low selection and extractor bias, and moderator and a very weak to weak positive relationship with
analyses were performed by testing the effect on performance.
the results of whether the sample was professional
or non-professional. The meta-analysis of Wallace176 Engagement
was of only slightly lower quality. It was also subject
to low publication and selection bias, but the Correlations with other intermediate
potential for extractor bias was high. However, outcomes
moderator analyses were performed, testing for the Studies
effect on the results of the professionalism, position No meta-analyses of engagement satisfied the
or occupation of the sample, and for the scale used. inclusion criteria.
Correlations with behaviours Correlations with behaviours

Studies Studies
The literature search identified three studies, two The literature search identified one study that met
of which met the inclusion criteria:177,754 the inclusion criteria:746
• Lee et al.741 conducted a meta-analysis of • Harter et al.746 conducted a meta-analysis of

76 studies (77 samples). Alongside the 42 studies across 36 organisations conducted
intermediate outcomes already discussed, by the Gallup Organization. They reported
data on correlations between professional data on correlations between engagement and
commitment and the organisational behaviours turnover (measured as a dimension of business
of supervisor-rated performance and turnover unit performance).
were reported.
• The multiple meta-analyses conducted by Critical appraisal of meta-analysis
Cooper-Hakim and Viswesvaran754 were based In terms of methodology, this was a low-
on findings from 997 articles. Correlations quality meta-analysis. Publication bias was high
between occupational commitment and both because only studies undertaken by the Gallup
turnover and performance were reported. Organization were included. Some selection criteria
were applied to the small pool of available studies,
Critical appraisal of meta-analyses although these were limited. Information was not
Both of the meta-analyses included were of given on coding of data, so extractor bias may have
moderate quality. The study of Lee et al.177 was been high. However, the form of analysis was good:
of good quality (see previous section for further a random effects model was used, and subgroup
details). The potential for selection bias in the analyses were performed.
study of Cooper-Hakim and Viswesvaran754 was low
to moderate because the inclusion criteria were Results
limited and not specific. Publication and extractor This meta-analysis found a moderate negative
bias were also low, as both data collection and correlation between engagement and employee
coding were of high quality. Although a test for turnover (–0.30), with turnover considered to be a
homogeneity was not performed, an appropriate consequence of engagement. Nevertheless, these
random effects model was used. Moderator findings should be treated with caution, as the
analyses were not performed. meta-analysis was of low quality.
Results Burnout
The meta-analyses of both Lee et al.177 and
Wallace176 found large positive correlations between Correlations with other intermediate
professional commitment and organisational outcomes
commitment. Lee et al.177 also reported a strong Studies
positive association with job satisfaction (0.44) and The literature search identified 37 studies, two
a strong negative association with burnout (–0.44), of which met the inclusion criteria.186,766 The
although it is important to acknowledge that definition of burnout used by these studies is within
these data came from a single meta-analysis only, the broad definition outlined in Chapter 4:
328
• Lee and Ashforth186 conducted a meta-analysis had only a single author so extractor bias was high.
of 61 studies (61 samples). They reported A random effects model was used, but, again, there
data on correlations between the three was no test for homogeneity of effect sizes and no
dimensions of burnout, namely emotional moderator analyses were performed.
exhaustion, depersonalisation and personal
accomplishment (based on the Maslach Results
Burnout Inventory, MBI), and the intermediate The meta-analyses of both Melchior et al.766 and
outcomes of job satisfaction, organisational Lee and Ashforth186 reported medium to large
commitment, job involvement and turnover negative relationships between the burnout
intentions. (overall burnout and the dimensions of emotional
• Melchior et al.766 conducted a meta-analysis exhaustion and depersonalisation for each study,
of nine studies. The small number of studies respectively) and job satisfaction. Although only
is due to the inclusion criteria: the studies reported by Lee and Ashforth,186 the correlations
included in this meta-analysis had to be between burnout (emotional exhaustion and
composed of nurses engaged in psychiatric depersonalisation) and organisational commitment
patient care. Further, the only variable of were negative and of moderate strength, while
interest in this meta-analysis with reported positive moderate to strong relationships with
data on correlations was job satisfaction, and turnover intentions and negative very small to
the mean corrected correlation statistic for this very large associations with job involvement were
variable was based on three studies only. Two of also reported. Taris46 found weak to moderate
these studies used the MBI as their measure of negative associations between two dimensions of
burnout, and one used the Tedium Measure of burnout and OCB. Nevertheless, the conclusions
Pines et al.250 drawn must be treated with caution, as these meta-
analyses had multiple sources of bias.
Critical appraisal of meta-analyses
The meta-analyses of Melchior et al.766 and Lee and Job involvement
Ashforth186 were both of low-to-moderate quality.
Both used a random effects model, although Correlations with other intermediate
neither tested for homogeneity of effect sizes. outcomes
The potential degree of publication, selection Studies
and extractor bias in both studies was moderate The literature search identified eight studies, two
only: some effort was taken to identify all relevant of which met the inclusion:189,754
studies, to select relevant studies, and extract
data with limited bias or error, but more could • Brown189 conducted a meta-analysis of 212
have been done. Also, neither study performed a studies (249 independent samples). The meta-
moderator or sensitivity analysis, so the robustness analysis reported correlations between job
of the findings was not tested. involvement and the following intermediate
outcomes of interest: organisational
Correlations with behaviours commitment, turnover intentions, job
Studies satisfaction and pay satisfaction. The primary
The literature search identified 37 studies, one of studies used many different measures to
which met the inclusion criteria:46 measure these correlates.
• Cooper-Hakim and Viswesvaran754 carried
• Taris46 conducted a meta-analysis of 16 studies, out multiple meta-analyses based on findings
reporting correlations between two of the from 997 articles. Correlations were reported
dimensions of burnout (emotional exhaustion between job involvement and organisational
and depersonalisation) and OCB. commitment, career commitment, job
satisfaction and turnover intentions. The
Critical appraisal of meta-analyses primary studies used many different measures
The meta-analysis of Taris46 was of low quality. to measure these correlates.
There was a high degree of potential publication
bias because only a single database was searched, Critical appraisal of meta-analyses
and no other methods of information retrieval were The meta-analyses that satisfied the inclusion
used. However, potential selection bias was low criteria for this review were all were of reasonable
because clear inclusion criteria were given, but no and comparable methodological quality. The
information was given on coding and the analyst analysis of Brown189 was of slightly higher quality
329

Appendix 11
than the two other meta-analyses: there was a and comparable methodological quality. The
moderate degree of publication bias because analysis of Brown189 was of slightly higher quality
only one database of peer-reviewed journals and than the two other meta-analyses (see previous
no grey literature sources were searched, but section for critical appraisal details).
the search strategy was good and both hand-
searching of journals and reference tracking were Farrell and Stamm750 had moderate publication
performed. The inclusion criteria were also limited, bias because several techniques were used to
introducing moderate potential selection bias, but find the evidence and databases were searched,
coding was rigorous so the potential for extractor although database names were not given. However,
bias was low. Brown,189 unlike Cooper-Hakim no searches of formal grey literature sources were
and Viswesvaran,754 also performed a moderator reported. Inclusion criteria were given, so selection
analysis (to test the effect of different measures bias was low, but extractor bias was high because no
of job involvement) and, therefore, the findings information was provided on the coding process.
of Brown189 are the most robust in this group of A random effects model was used, and some
studies. moderator analyses were performed, based on the
occupational status of the sampled population.
The potential for selection bias in the meta-
analysis of Cooper-Hakim and Viswesvaran754 In the meta-analyses of Cooper-Hakim and
was moderate because the inclusion criteria were Viswesvaran,754 both publication and extractor bias
limited and unspecific, whereas both publication were low, as data collection and coding were of high
and extractor bias were low because data collection quality, and the potential for selection bias was low
and coding were of high quality. Although no test to moderate because the inclusion criteria were
for homogeneity was performed, an appropriate limited and none specific. No test for homogeneity
random effects model was used. was performed, but an appropriate random
effects model was used. Moderator analyses were
Correlations with behaviours not performed beyond the focus on the different
Studies dimensions of the measurement of organisational
The literature search identified eight studies, commitment.
two of which met the inclusion criteria.189,754 A
further meta-analysis was identified by reference- Results
tracking:750 Large positive correlations were found between
job involvement and overall organisational
• Brown,189 as mentioned in the previous commitment, while medium to large positive
section, conducted a meta-analysis of 212 correlations were found between job involvement
studies (249 independent samples), reporting and satisfaction. Turnover intentions were reported
correlations between job involvement and the to have a moderate negative association with job
following organisational behaviours of interest: involvement.
performance, absence and turnover.
• The various meta-analyses performed by Small negative relationships were reported with
Cooper-Hakim and Viswesvaran754 were based turnover and small to large negative relationships
on findings from 997 articles, which reported, were found with absence. Brown189 also reported
in addition to the correlations mentioned a very small positive correlation between job
previously in relation to intermediate involvement and performance. However,
outcomes, correlations between job conclusions drawn from these findings must be
involvement and turnover. treated with caution, as all meta-analyses were
• The meta-analysis of Farrell and Stamm750 was subject to multiple biases.
based on 72 studies and reported correlations
between job involvement and the absence Turnover intentions
variables of total time lost and absence
frequency. No meta-analyses of turnover intentions satisfied
the inclusion criteria for intermediate outcomes or
Critical appraisal of meta-analyses organisational behaviours.
The meta-analyses that satisfied the inclusion
criteria for this review were all were of reasonable
330
Organisational justice Correlations with behaviours

Correlations with other intermediate Studies
outcomes The literature search identified 23 studies, five of
Studies which met the inclusion criteria:162,202,670,744,745
The literature search identified 23 studies, only
two of which met the inclusion criteria.202,670 The • Dalal744 conducted a meta-analysis of 38 studies
definition of justice or fairness used by these (49 samples) and LePine et al.745 a meta-analysis
studies falls within the broad definition outlined in of 37 studies (37 samples). Both reported
Chapter 4: data on correlations between overall scores of
organisational justice and an overall score for
• Cohen-Charash and Spector202 conducted a OCB.
meta-analysis of 190 studies (190 samples). • Cohen-Charash and Spector202 conducted a
They reported data on correlations between meta-analysis of 190 studies (190 samples),
perceived distributive and procedural justice reporting data on correlations between
and the following intermediate outcomes of perceived distributive and procedural justice
interest: job satisfaction (intrinsic, extrinsic and work performance (field and laboratory
and pay), trust, turnover intentions and studies) and OCB (including several of its
organisational commitment. The inclusion dimensions). Work performance was measured
criteria required the use of ‘specific measures of by a variety of scales, but it is unclear whether
perceived … justice’, but these were not named. this was always organisational performance or
• The meta-analysis of Colquitt et al.670 was individual task performance (p. 290).
performed on 183 studies (183 samples), • The meta-analysis of Colquitt et al.670 again
and reported correlations on the following mentioned in the previous section in relation
attitudinal and behavioural outcomes of to correlations with intermediate outcomes,
interest: organisational commitment, job was performed on 183 studies (183 samples)
satisfaction and trust. Studies need not have and reported correlations between justice and
used particular measures of justice to be performance, withdrawal (turnover) and OCB
included. (organisational and individual). Again, the
nature of performance being measured was not
Witt and Nye743 conducted a meta-analysis on their clear.
own sample of 56 correlations using their own • Organ and Ryan162 conducted a meta-analysis
composite scale, and so this study was excluded. of 55 studies (55 samples), reporting data on
correlations between fairness and OCB (an
Critical appraisal of meta-analyses overall score and the dimensions of altruism
Neither of the two meta-analyses included were of and generalised compliance).
high quality in terms of methodology. The meta-
analysis of Cohen-Charash and Spector202 had Critical appraisal of meta-analyses
low publication and selection bias, but extractor The meta-analyses of Dalal744 and Organ and
bias was potentially high (no information was Ryan162 were both good methodologically.
given about the coding process). Also, no test for Publication bias was moderate in both cases
homogeneity was performed, even though the because only a small number of databases
analysis used a fixed effects model.767 However, or grey literature sources were searched, but
moderator analyses were performed by testing for selection and extractor bias were low. Both
the effect on the results of the included study had studies also performed moderator analyses. The
been conducted in a ‘laboratory’ or in the field. methodological quality of the meta-analysis by
LePine et al.745 was also good. There was only
In the meta-analysis of Colquitt et al.670 both moderate potential publication bias because a
selection and extractor bias were low. However, the search for grey literature was conducted and
study was open to greater publication bias because relevant authors were contacted. Selection bias was
only one database of peer-reviewed articles and low because inclusion criteria were clear. LePine
no grey literature sources were searched, and few et al.745 also performed a test for homogeneity,
additional information retrieval techniques were used a random effects model for the analysis, and
used. Although Colquitt et al.670 performed no performed moderator analyses by testing for the
test for homogeneity, the random effects model effect on the results of using different measures of
of Hunter and Schmidt736 was used. Moderator OCB and measuring different dimensions of this
analyses were also performed. concept. Only extractor bias was high.
331

Appendix 11
The meta-analyses of Cohen-Charash and Correlations with behaviours

Spector202 and Colquitt et al.670 were of slightly Studies
lower quality (see previous section for details). The literature search identified one study that met
the inclusion criteria:208
Results
The two meta-analyses concerning relationships • As reported in the previous section, Rhoades
between organisational justice and intermediate and Eisenberger208 conducted a meta-analysis
outcomes202,670 reported large positive correlations of 73 studies, reporting correlations between
between justice and organisational commitment perceived organisational support (as measured
(affective and overall), job satisfaction and trust. by the SPOS; Eisenberger et al.206) and the
Cohen-Charash and Spector202 also found a strong behaviours of performance, OCB and turnover,
negative association with turnover intentions in addition to the correlations previously
(–0.40). However, neither study was of high quality. mentioned.
With regards organisational behaviours, all five Critical appraisal of meta-analyses

studies reported positive correlations between This meta-analysis was of high quality (see previous
organisational justice and OCB, ranging in critical appraisal section for details).
strength from weak to moderate. Cohen-Charash
and Spector202 and Colquitt et al.670 found small Results
associations between distributive justice and Rhoades and Eisenberger208 reported strong,
performance and medium to large associations positive correlations between organisational
between procedural justice and performance. The support and procedural justice (0.59),
meta-analysis of Colquitt et al.670 also reported organisational commitment (0.67) and job
large negative relationships with turnover (–0.50 satisfaction (0.62). The relationship with job
and –0.46 for distributive and procedural justice, involvement was positive and of moderate strength
respectively). (0.32), whilst the association with turnover
intentions was strong and negative (–0.51).
Organisational support Weak positive correlations were found between
organisational support and job performance (0.18),
Correlations with other intermediate and OCB (0.22), and a weak negative correlation
outcomes with turnover (–0.11).
Studies
The literature search identified one study that Although it is not possible to infer causality from
met the inclusion criteria.208 They conducted the correlations, Rhoades and Eisenbeger208
a meta-analysis of 73 studies, reporting classify procedural justice as an antecedent
correlations between perceived organisational of organisational support, and organisational
support (as measured by the Survey of Perceived commitment, job satisfaction, job involvement
Organisational Support, SPOS; Eisenberger et and turnover as consequences of organisational
al.206) and the following intermediate outcomes support.
of interest: procedural justice, organisational
commitment, job satisfaction, job involvement and Organisational climate
turnover intentions.
Critical appraisal of meta-analyses outcomes and behaviours
This meta-analysis was of high quality. There was Studies
only a low degree of potential publication, selection The literature search identified two studies that
and extractor bias because a full range of sources met the inclusion criteria for the intermediate
were searched for published and unpublished outcomes of interest:673,674
studies using various methods, specific inclusion
criteria were applied, and coding was monitored. • Carr et al.673 conducted a meta-analysis
A random effects model was used, after testing for of 51 studies (70 samples), and reported
homogeneity of effect sizes. No moderator analysis correlations between the three facets of climate
was performed (based on organisation type). proposed by Ostroff675 – affective, cognitive
and instrumental climate perceptions – and
332
between each facet and job satisfaction leadership, work group and organisation and,
organisational commitment and psychological in addition to the correlations mentioned
well-being. The primary studies used many above, between these dimensions and
different measures to determine these performance.
correlates.
• Parker et al.674 conducted a meta-analysis of 94 Critical appraisal of meta-analyses
studies (121 samples), reporting correlations Both meta-analyses were of moderate quality (see
between the five facets of psychological climate previous critical appraisal section for details).
perceptions proposed by James et al. (e.g. Jones
and James676) – job, role, leadership, work Results
group and organisation – and between the five The meta-analysis by Carr et al.673 found large
facets and job satisfaction, job involvement, positive relationships between affective climate and
commitment, psychological well-being and job satisfaction (0.46) and instrumental climate
motivation. and job satisfaction (0.44), and a medium positive
correlation between cognitive climate perceptions
Critical appraisal of meta-analyses and job satisfaction (0.33). Medium positive
This meta-analysis of Carr et al.673 was of moderate correlations were reported between the three
quality. Potential selection and extractor bias were climate facets and organisational commitment
both low. The potential degree of publication bias (affective, 0.34; cognitive, 0.28; instrumental, 0.26).
was moderate because although hand-searching A very weak relationship was reported between
of specific journals and reference-tracking was cognitive climate perceptions and well-being
performed, only one electronic database and no (0.07), while weak relationships were reported
grey literature were searched, and no information between affective and instrumental climate and
was provided on the search strategy used. A well-being (0.17 and 0.11, respectively). Job
fixed effects model was used, after testing for performance was found to have very weak positive
homogeneity of effect sizes. Only path analysis, and associations with climate (affective, 0.9; cognitive,
not moderator analysis, was performed. 0.5; instrumental, 0.5), while turnover had a very
weak negative association with cognitive climate
This meta-analysis of Parker et al.674 was also of (–0.07) and moderate negative associations with
moderate quality. Potential selection and extractor affective (–0.28) and instrumental (–0.33) climate
bias were both low, as specific inclusion criteria and perceptions. For further analysis and interpretation
a high consistency score between five raters were of the findings, see Chapter 9 (Correlations
reported. Potential publication bias was moderate between climate, other intermediate outcomes and
because although clear search terms were included employee behaviours).
and reference-tracking was performed, only one
electronic database, and no grey literature, was The meta-analysis by Parker et al.674 reported
searched. The random effects model of Hunter and large, positive correlations between the climate
Schmidt736 was used, but no test for homogeneity facets of leader, work group and organisation and
was conducted and only path analyses, and not job satisfaction (0.41, 0.48, 0.42, respectively),
moderator analyses, were performed. a medium, positive correlation between role
characteristics and job satisfaction (0.28),
Correlations with behaviours and a small, positive correlation between job
The literature search identified two studies that characteristics and satisfaction (0.21). Job
met the inclusion criteria:673,674 involvement and commitment were grouped
together to form the dimension of ‘job attitudes’.
• As previously described, Carr et al.’s673 meta- Job attitudes was found to have a small, positive
analysis of 51 studies (70 samples) reported relationship with role characteristics (0.22), and
correlations between affective, cognitive and medium, positive relationships with job (0.26),
instrumental climate perceptions and between leader (0.32), work group (0.27) and organisation
each of these climate dimensions and job (0.36) characteristics. A strong, positive association
performance and withdrawal (turnover). was reported between leader characteristics
• Parker et al.674 conducted a meta-analysis of 94 and well-being (0.44), while moderate, positive
studies (121 samples), reporting correlations associations were reported between role, job,
between the climate dimensions of job, role, work group and organisation characteristics and
333

Appendix 11
well-being (0.26, 0.35, 0.35, 0.29, respectively). characteristics (0.09), and small correlations with
The relationship between role characteristics and job (0.20), leader (0.21), work group (0.20), and
performance was found to be very weak (0.06), organisation (0.22) dimensions. See Table 59 for a
while the relationships between job, leader, work summary of these correlations. For further analysis
group and organisation characteristics with and interpretation of the findings, see Chapter 9
performance were all reported to be small (0.10, (Correlations between climate, other intermediate
0.16, 0.12, 0.13, respectively). Motivation was outcomes and employee behaviours).
found to have a very weak correlation with role
334
Health Technology Assessment reports

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Volume 1, 1997 No. 11 No. 6
Newborn screening for inborn errors of Effectiveness of hip prostheses in
metabolism: a systematic review. primary total hip replacement: a critical
No. 1 By Seymour CA, Thomason MJ, review of evidence and an economic
Home parenteral nutrition: a systematic Chalmers RA, Addison GM, Bain MD, model.
review. Cockburn F, et al. By Faulkner A, Kennedy LG, Baxter
By Richards DM, Deeks JJ, Sheldon K, Donovan J, Wilkinson M, Bevan G.
TA, Shaffer JL. No. 12
Routine preoperative testing: a No. 7
No. 2 systematic review of the evidence. Antimicrobial prophylaxis in colorectal
Diagnosis, management and screening By Munro J, Booth A, Nicholl J. surgery: a systematic review of
of early localised prostate cancer. randomised controlled trials.
A review by Selley S, Donovan J, No. 13 By Song F, Glenny AM.
Faulkner A, Coast J, Gillatt D. Systematic review of the effectiveness of
laxatives in the elderly. No. 8
No. 3
By Petticrew M, Watt I, Sheldon T. Bone marrow and peripheral
The diagnosis, management, treatment
and costs of prostate cancer in England blood stem cell transplantation for
and Wales. No. 14 malignancy.
A review by Chamberlain J, Melia J, When and how to assess fast-changing A review by Johnson PWM,
Moss S, Brown J. technologies: a comparative study of Simnett SJ, Sweetenham JW, Morgan GJ,
medical applications of four generic Stewart LA.
No. 4 technologies.
Screening for fragile X syndrome. A review by Mowatt G, Bower DJ, No. 9
A review by Murray J, Cuckle H, Brebner JA, Cairns JA, Grant AM, McKee Screening for speech and language
Taylor G, Hewison J. L. delay: a systematic review of the
literature.
No. 5 By Law J, Boyle J, Harris F,
A review of near patient testing in Volume 2, 1998 Harkness A, Nye C.
primary care.
By Hobbs FDR, Delaney BC, No. 10
Fitzmaurice DA, Wilson S, Hyde CJ, Resource allocation for chronic
Thorpe GH, et al. No. 1
Antenatal screening for Down’s stable angina: a systematic review of
syndrome. effectiveness, costs and cost-effectiveness
No. 6 of alternative interventions.
Systematic review of outpatient services A review by Wald NJ, Kennard A,
Hackshaw A, McGuire A. By Sculpher MJ, Petticrew M,
for chronic pain control.
Kelland JL, Elliott RA, Holdright DR,
By McQuay HJ, Moore RA, Eccleston Buxton MJ.
C, Morley S, de C Williams AC. No. 2
Screening for ovarian cancer: a
No. 7 systematic review. No. 11
Neonatal screening for inborn errors of By Bell R, Petticrew M, Luengo S, Detection, adherence and control of
metabolism: cost, yield and outcome. Sheldon TA. hypertension for the prevention of
A review by Pollitt RJ, Green A, stroke: a systematic review.
McCabe CJ, Booth A, Cooper NJ, No. 3 By Ebrahim S.
Leonard JV, et al. Consensus development methods,
and their use in clinical guideline No. 12
No. 8 development. Postoperative analgesia and vomiting,
Preschool vision screening. A review by Murphy MK, Black NA, with special reference to day-case
A review by Snowdon SK, Lamping DL, McKee CM, Sanderson surgery: a systematic review.
Stewart-Brown SL. CFB, Askham J, et al. By McQuay HJ, Moore RA.
No. 9 No. 13
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Implications of socio-cultural contexts
A cost–utility analysis of interferon beta Choosing between randomised and
for the ethics of clinical trials.
for multiple sclerosis. nonrandomised studies: a systematic
A review by Ashcroft RE, Chadwick
By Parkin D, McNamee P, Jacoby A, review.
DW, Clark SRL, Edwards RHT, Frith L,
Hutton JL. Miller P, Thomas S, Bates D. By Britton A, McKee M, Black N,
McPherson K, Sanderson C, Bain C.
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A critical review of the role of neonatal Effectiveness and efficiency of methods No. 14
hearing screening in the detection of of dialysis therapy for end-stage renal Evaluating patient-based outcome
congenital hearing impairment. disease: systematic reviews. measures for use in clinical trials.
By Davis A, Bamford J, Wilson I, By MacLeod A, Grant A, Donaldson A review by Fitzpatrick R, Davey C,
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Ethical issues in the design and conduct A randomised controlled trial of Near patient testing in diabetes clinics:
of randomised controlled trials. different approaches to universal appraising the costs and outcomes.
antenatal HIV testing: uptake and
A review by Edwards SJL, Lilford RJ, By Grieve R, Beech R, Vincent J,
acceptability. Annex: Antenatal HIV
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The costs and benefits of paramedic Chinn S, Sterne JAC, Burney PGJ. By Bradley M, Cullum N, Sheldon T.
skills in pre-hospital trauma care.
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A review by Johnston K, Buxton MJ, management: (2) Dressings and topical
No. 18 agents used in the healing of chronic
Jones DR, Fitzpatrick R.
Systematic review of endoscopic wounds.
ultrasound in gastro-oesophageal No. 7 By Bradley M, Cullum N, Nelson EA,
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A systematic literature review of
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No. 19 No. 8 tomography: with particular reference
Screening for cystic fibrosis. to clinical applications in hepatic
Systematic reviews of trials and other A review by Murray J, Cuckle H,
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Taylor G, Littlewood J, Hewison J. coronary artery disease.
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UK: review and economic analysis. Gillespie WJ, Grant AM, Russell IT,
No. 1 By Zeuner D, Ades AE, Karnon J, Kiauka S, et al.
Informed decision making: an Brown J, Dezateux C, Anionwu EN.
annotated bibliography and systematic No. 21
review. No. 12 Antimicrobial prophylaxis in total hip
By Bekker H, Thornton JG, Assessing the quality of reports of replacement: a systematic review.
Airey CM, Connelly JB, Hewison J, randomised trials: implications for the
conduct of meta-analyses. By Glenny AM, Song F.
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No. 2 Jones A, et al. Health promoting schools and health
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No. 14
The role of expectancies in the placebo A systematic review of the role of Economic evaluation of a primary
effect and their use in the delivery of human papillomavirus testing within a care-based education programme for
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Cost and outcome implications of the Systematic reviews of wound care
organisation of vascular services. management: (3) antimicrobial agents
No. 1 By Michaels J, Brazier J, for chronic wounds; (4) diabetic foot
Palfreyman S, Shackley P, Slack R. ulceration.
The estimation of marginal time
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The effectiveness of domiciliary GD, Boddy FA.
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By Cameron I, Crotty M, Currie C, health visiting: a systematic review of
international studies and a selective No. 23
Finnegan T, Gillespie L, Gillespie W, Coronary artery stents in the treatment
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By Elkan R, Kendrick D, Hewitt M, of ischaemic heart disease: a rapid and
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No. 3 By Meads C, Cummins C, Jolly K,
Screening for sickle cell disease and Stevens A, Burls A, Hyde C.
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supplementary research. The determinants of screening uptake
and interventions for increasing No. 24
By Davies SC, Cronin E, Gill M, Outcome measures for adult critical
Greengross P, Hickman M, Normand C. uptake: a systematic review.
care: a systematic review.
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No. 4 Young JD, Rowan KM, Daly K, et al.
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A review by Reeves DJ, Alborz A, The effectiveness and cost-effectiveness
of prophylactic removal of wisdom A systematic review to evaluate the
Hickson FS, Bamford JM. effectiveness of interventions to
teeth.
promote the initiation of breastfeeding.
A rapid review by Song F, O’Meara S,
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Ultrasound screening in pregnancy: No. 26
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effectiveness, cost-effectiveness and
arrhythmias. A rapid and systematic
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Costs and benefits of community Mugford M, Neilson J, Roberts T, et al.
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By Morrell CJ, Spiby H, Stewart P, Treatments for fatigue in multiple
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effectiveness and cost-effectiveness of By Brañas P, Jordan R, Fry-Smith A,
the taxanes used in the treatment of Burls A, Hyde C.
No. 7 advanced breast and ovarian cancer.
Implantable contraceptives (subdermal By Lister-Sharp D, McDonagh MS,
implants and hormonally impregnated No. 28
Khan KS, Kleijnen J.
intrauterine systems) versus other Early asthma prophylaxis, natural
forms of reversible contraceptives: two history, skeletal development and
No. 18 economy (EASE): a pilot randomised
systematic reviews to assess relative
Liquid-based cytology in cervical controlled trial.
effectiveness, acceptability, tolerability
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and cost-effectiveness.
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No. 19 No. 29
No. 8 Randomised controlled trial of non- Screening for hypercholesterolaemia
directive counselling, cognitive– versus case finding for familial
An introduction to statistical methods
behaviour therapy and usual general hypercholesterolaemia: a systematic
for health technology assessment.
practitioner care in the management of review and cost-effectiveness analysis.
A review by White SJ, Ashby D, depression as well as mixed anxiety and
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No. 9 Bower P, Lloyd M, Gabbay M, et al.
Disease-modifying drugs for multiple No. 30
sclerosis: a rapid and systematic review. No. 20 A rapid and systematic review of
By Clegg A, Bryant J, Milne R. Routine referral for radiography of the clinical effectiveness and cost-
patients presenting with low back pain: effectiveness of glycoprotein IIb/
No. 10 is patients’ outcome influenced by GPs’ IIIa antagonists in the medical
Publication and related biases. referral for plain radiography? management of unstable angina.
A review by Song F, Eastwood AJ, By Kerry S, Hilton S, Patel S, By McDonagh MS, Bachmann LM,
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No. 31 Volume 5, 2001 No. 11

A randomised controlled trial Effectiveness of autologous chondrocyte
of prehospital intravenous fluid transplantation for hyaline cartilage
replacement therapy in serious trauma. No. 1 defects in knees: a rapid and systematic
By Turner J, Nicholl J, Webber L, review.
Clinical and cost-effectiveness
Cox H, Dixon S, Yates D. of donepezil, rivastigmine and By Jobanputra P, Parry D, Fry-Smith
galantamine for Alzheimer’s disease: a A, Burls A.
No. 32 rapid and systematic review.
No. 12
Intrathecal pumps for giving opioids in By Clegg A, Bryant J, Nicholson T,
McIntyre L, De Broe S, Gerard K, et al. Statistical assessment of the learning
chronic pain: a systematic review. curves of health technologies.
By Williams JE, Louw G, By Ramsay CR, Grant AM, Wallace
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SA, Garthwaite PH, Monk AF, Russell IT.
The clinical effectiveness and cost-
No. 33 effectiveness of riluzole for motor
No. 13
neurone disease: a rapid and systematic
Combination therapy (interferon The effectiveness and cost-effectiveness
review.
alfa and ribavirin) in the treatment of temozolomide for the treatment of
of chronic hepatitis C: a rapid and By Stewart A, Sandercock J, Bryan S,
recurrent malignant glioma: a rapid
systematic review. Hyde C, Barton PM, Fry-Smith A, et al.
and systematic review.
By Shepherd J, Waugh N, By Dinnes J, Cave C, Huang S,
No. 3 Major K, Milne R.
Hewitson P.
Equity and the economic evaluation of
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No. 34
By Sassi F, Archard L, Le Grand J. A rapid and systematic review of
A systematic review of comparisons of
effect sizes derived from randomised the clinical effectiveness and cost-
No. 4 effectiveness of debriding agents in
and non-randomised studies.
Quality-of-life measures in chronic treating surgical wounds healing by
By MacLehose RR, Reeves BC, diseases of childhood. secondary intention.
Harvey IM, Sheldon TA, Russell IT,
By Eiser C, Morse R. By Lewis R, Whiting P, ter Riet G,
Black AMS.
O’Meara S, Glanville J.
No. 5
No. 35 No. 15
Eliciting public preferences for
Intravascular ultrasound-guided healthcare: a systematic review of Home treatment for mental health
interventions in coronary artery techniques. problems: a systematic review.
disease: a systematic literature review, By Burns T, Knapp M, Catty J,
By Ryan M, Scott DA, Reeves C, Bate
with decision-analytic modelling, of Healey A, Henderson J, Watt H, et al.
A, van Teijlingen ER, Russell EM, et al.
outcomes and cost-effectiveness.
By Berry E, Kelly S, Hutton J, No. 16
No. 6
Lindsay HSJ, Blaxill JM, Evans JA, et al. How to develop cost-conscious
General health status measures for
people with cognitive impairment: guidelines.
No. 36 learning disability and acquired brain By Eccles M, Mason J.
A randomised controlled trial to injury.
evaluate the effectiveness and cost- By Riemsma RP, Forbes CA, No. 17
effectiveness of counselling patients Glanville JM, Eastwood AJ, Kleijnen J. The role of specialist nurses in multiple
with chronic depression. sclerosis: a rapid and systematic review.
By Simpson S, Corney R, No. 7 By De Broe S, Christopher F,
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for fragile X syndrome in the UK.
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By Pembrey ME, Barnicoat AJ,
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atopic eczema. of the clinical effectiveness and
cost-effectiveness of orlistat in the
By Hoare C, Li Wan Po A, No. 8
management of obesity.
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No. 38 commissioners.
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assessment: a review. A, Fitzpatrick R, Edwards S, Rock F, et al.
By Spiegelhalter DJ, Myles JP, effectiveness of pioglitazone for
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Systematic reviews of wound systematic review.
No. 39 care management: (5) beds; By Chilcott J, Wight J, Lloyd Jones
(6) compression; (7) laser therapy, M, Tappenden P.
The management of dyspepsia: a therapeutic ultrasound, electrotherapy
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By Delaney B, Moayyedi P, Deeks J, By Cullum N, Nelson EA,
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Flemming K, Sheldon T. a multicentre randomised controlled
trial of appropriately trained nurses
No. 40 No. 10 and preregistration house officers in
A systematic review of treatments for Effects of educational and psychosocial preoperative assessment in elective
severe psoriasis. interventions for adolescents with general surgery.
By Griffiths CEM, Clark CM, diabetes mellitus: a systematic review. By Kinley H, Czoski-Murray C,
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No. 21 No. 31 No. 4

Systematic reviews of the effectiveness Design and use of questionnaires: a A systematic review of discharge
of day care for people with severe review of best practice applicable to arrangements for older people.
mental disorders: (1) Acute day hospital surveys of health service staff and By Parker SG, Peet SM, McPherson
versus admission; (2) Vocational patients. A, Cannaby AM, Baker R, Wilson A, et al.
rehabilitation; (3) Day hospital versus By McColl E, Jacoby A, Thomas L,
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Almaraz-Serrano A, Creed F, Sledge W, effectiveness of inhaler devices used
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Kluiter H, et al. in the routine management of chronic
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asthma in older children: a systematic
No. 22 the clinical effectiveness and cost-
review and economic evaluation.
The measurement and monitoring of effectiveness of paclitaxel, docetaxel,
gemcitabine and vinorelbine in non- By Peters J, Stevenson M, Beverley C,
surgical adverse events. Lim J, Smith S.
small-cell lung cancer.
By Bruce J, Russell EM, Mollison J,
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No. 23 effectiveness of sibutramine in the
Action research: a systematic review and No. 33 management of obesity: a technology
guidance for assessment. Subgroup analyses in randomised assessment.
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No. 24 Mulheran PA, Egger M, Davey Smith G. No. 7
A rapid and systematic review of The cost-effectiveness of magnetic
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effectiveness of gemcitabine for the artery stenosis and peripheral vascular
treatment of pancreatic cancer. Depot antipsychotic medication
in the treatment of patients with disease: a systematic review.
By Ward S, Morris E, Bansback N, By Berry E, Kelly S, Westwood ME,
schizophrenia: (1) Meta-review; (2)
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evidence for the clinical effectiveness No. 35
Promoting physical activity in South
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oxaliplatin and raltitrexed for the trials of the effectiveness and cost- on prescription’.
treatment of advanced colorectal effectiveness of brief psychological
By Carroll B, Ali N, Azam N.
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No. 26 influenza in adults: a systematic review
No. 36 and economic evaluation.
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No. 27 implications for resource allocation and
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the knee joint. Beard SM, Tappenden P.
By Bryan S, Weatherburn G, Bungay No. 1
H, Hatrick C, Salas C, Parry D, et al. A study of the methods used to select No. 11
review criteria for clinical audit. Screening for gestational diabetes:
No. 28 By Hearnshaw H, Harker R, a systematic review and economic
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the clinical effectiveness and cost- By Scott DA, Loveman E, McIntyre
effectiveness of topotecan for ovarian No. 2 L, Waugh N.
cancer. Fludarabine as second-line therapy for
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B cell chronic lymphocytic leukaemia: a
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effectiveness of surgery for people with
By Hyde C, Wake B, Bryan S, Barton morbid obesity: a systematic review and
No. 29
P, Fry-Smith A, Davenport C, et al. economic evaluation.
Superseded by a report published in a
later volume. By Clegg AJ, Colquitt J, Sidhu MK,
No. 3 Royle P, Loveman E, Walker A.
No. 30 Rituximab as third-line treatment for
The role of radiography in primary refractory or recurrent Stage III or IV No. 13
care patients with low back pain of at follicular non-Hodgkin’s lymphoma: The clinical effectiveness of
least 6 weeks duration: a randomised a systematic review and economic trastuzumab for breast cancer: a
(unblinded) controlled trial. evaluation. systematic review.
By Kendrick D, Fielding K, Bentley By Wake B, Hyde C, Bryan S, Barton By Lewis R, Bagnall A-M, Forbes C,
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The clinical effectiveness and cost- A systematic review and economic The measurement of satisfaction with
effectiveness of vinorelbine for breast evaluation of pegylated liposomal healthcare: implications for practice
cancer: a systematic review and doxorubicin hydrochloride for ovarian from a systematic review of the
economic evaluation. cancer. literature.
By Lewis R, Bagnall A-M, King S, By Forbes C, Wilby J, Richardson G, By Crow R, Gage H, Hampson S,
Woolacott N, Forbes C, Shirran L, et al. Sculpher M, Mather L, Riemsma R. Hart J, Kimber A, Storey L, et al.
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A systematic review of the effectiveness A systematic review of the effectiveness The effectiveness and cost-effectiveness
and cost-effectiveness of metal-on- of interventions based on a stages-of- of imatinib in chronic myeloid
metal hip resurfacing arthroplasty for change approach to promote individual leukaemia: a systematic review.
treatment of hip disease. behaviour change. By Garside R, Round A, Dalziel K,
By Vale L, Wyness L, McCormack K, By Riemsma RP, Pattenden J, Bridle Stein K, Royle R.
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No. 16 No. 25 A comparative study of hypertonic
A systematic review update of the saline, daily and alternate-day rhDNase
clinical effectiveness and cost- in children with cystic fibrosis.
effectiveness of bupropion and nicotine
replacement therapy for smoking effectiveness of glycoprotein IIb/IIIa By Suri R, Wallis C, Bush A,
cessation: a systematic review and antagonists. Thompson S, Normand C, Flather M,
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No. 26 A systematic review of the costs and
A systematic review of the effectiveness, effectiveness of different models of
No. 17 paediatric home care.
A systematic review of effectiveness cost-effectiveness and barriers to
implementation of thrombolytic and By Parker G, Bhakta P, Lovett CA,
and economic evaluation of new drug Paisley S, Olsen R, Turner D, et al.
treatments for juvenile idiopathic neuroprotective therapy for acute
arthritis: etanercept. ischaemic stroke in the NHS.
By Cummins C, Connock M, By Sandercock P, Berge E, Dennis M,
Fry-Smith A, Burls A. Forbes J, Hand P, Kwan J, et al. Volume 7, 2003
No. 27
No. 18
A randomised controlled crossover trial No. 1
Clinical effectiveness and cost-
of nurse practitioner versus doctor- How important are comprehensive
effectiveness of growth hormone in
led outpatient care in a bronchiectasis literature searches and the assessment
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clinic. of trial quality in systematic reviews?
economic evaluation.
By Caine N, Sharples LD, Empirical study.
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Clinical effectiveness and cost- No. 2
Clinical effectiveness and cost – Systematic review of the effectiveness
effectiveness of growth hormone consequences of selective serotonin
in adults in relation to impact on and cost-effectiveness, and economic
reuptake inhibitors in the treatment of evaluation, of home versus hospital or
quality of life: a systematic review and sex offenders.
economic evaluation. satellite unit haemodialysis for people
By Adi Y, Ashcroft D, Browne K, with end-stage renal failure.
By Bryant J, Loveman E, Chase D, Beech A, Fry-Smith A, Hyde C.
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No. 20 Treatment of established osteoporosis: No. 3
Clinical medication review by a a systematic review and cost–utility Systematic review and economic
pharmacist of patients on repeat analysis. evaluation of the effectiveness of
prescriptions in general practice: a By Kanis JA, Brazier JE, Stevenson infliximab for the treatment of Crohn’s
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By Zermansky AG, Petty DR, Raynor By Clark W, Raftery J, Barton P,
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etanercept for the treatment of randomised controlled trial. and cost-effectiveness of routine anti-D
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No. 22 Screening for hepatitis C among No. 5
A systematic review and economic injecting drug users and in Systematic review and evaluation of the
evaluation of computerised cognitive genitourinary medicine clinics: use of tumour markers in paediatric
behaviour therapy for depression and systematic reviews of effectiveness, oncology: Ewing’s sarcoma and
anxiety. modelling study and national survey of neuroblastoma.
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The cost-effectiveness of screening for Early thrombolysis for the treatment The clinical and cost-effectiveness of
Helicobacter pylori to reduce mortality of acute myocardial infarction: a pulsatile machine perfusion versus cold
and morbidity from gastric cancer and systematic review and economic storage of kidneys for transplantation
peptic ulcer disease: a discrete-event evaluation. retrieved from heart-beating and non-
simulation model. heart-beating donors.
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The clinical effectiveness and cost- Screening for fragile X syndrome: a Can randomised trials rely on existing
effectiveness of routine dental checks: literature review and modelling. electronic data? A feasibility study to
a systematic review and economic By Song FJ, Barton P, Sleightholme explore the value of routine data in
evaluation. V, Yao GL, Fry-Smith A. health technology assessment.
By Davenport C, Elley K, Salas By Williams JG, Cheung WY,
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No. 19 help guidebook and patient-centred
Clinical effectiveness and cost–utility consultations on disease management
of photodynamic therapy for wet Effectiveness and cost-effectiveness
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Evaluation of molecular tests for
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Systematic review of the clinical
First and second trimester antenatal effectiveness and cost-effectiveness of The value of digital imaging in diabetic
screening for Down’s syndrome: tension-free vaginal tape for treatment retinopathy.
the results of the Serum, Urine and of urinary stress incontinence. By Sharp PF, Olson J, Strachan F,
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of ultrasound locating devices for patient education models for diabetes: preventive strategy.
central venous access: a systematic a systematic review and economic By Law M, Wald N, Morris J.
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A systematic review of atypical and planning clinical trials. evaluation.
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Literature searching for clinical and A systematic review and economic
cost-effectiveness studies used in health evaluation of magnetic resonance
technology assessment reports carried cholangiopancreatography compared
No. 1
out for the National Institute for with diagnostic endoscopic retrograde
What is the best imaging strategy for cholangiopancreatography.
Clinical Excellence appraisal system. acute stroke? By Kaltenthaler E, Bravo Vergel Y,
By Royle P, Waugh N. By Wardlaw JM, Keir SL, Seymour J, Chilcott J, Thomas S, Blakeborough T,
Lewis S, Sandercock PAG, Dennis MS, Walters SJ, et al.
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and treatment of influenza A and B. Systematic review and modelling of the new drugs for patients with a chronic
By Turner D, Wailoo A, Nicholson K, investigation of acute and chronic chest condition: the case of antibodies
Cooper N, Sutton A, Abrams K. pain presenting in primary care. against tumour necrosis factor in
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to evaluate the clinical and cost- No. 3
No. 12
effectiveness of Hickman line insertions The effectiveness and cost-effectiveness Clinical effectiveness and cost-
in adult cancer patients by nurses. of microwave and thermal balloon effectiveness of neonatal screening
By Boland A, Haycox A, Bagust A, endometrial ablation for heavy for inborn errors of metabolism using
Fitzsimmons L. menstrual bleeding: a systematic review tandem mass spectrometry: a systematic
and economic modelling. review.
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based midwifery-led care focused Clinical effectiveness and cost-
A systematic review of the role of
on individual women’s physical and effectiveness of pioglitazone and
bisphosphonates in metastatic disease.
psychological health needs. rosiglitazone in the treatment of type
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AGH, Sheldon TA, Grimley Evans J. cancer. extension of the midwife role including
By Jones L, Hawkins N, Westwood M, a randomised controlled trial of
No. 39 Wright K, Richardson G, Riemsma R. appropriately trained midwives and
Systematic review of isolation policies paediatric senior house officers.
in the hospital management of No. 6 By Townsend J, Wolke D, Hayes J,
methicillin-resistant Staphylococcus Effectiveness and efficiency of guideline Davé S, Rogers C, Bloomfield L, et al.
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multiple sclerosis: a systematic review. of pseudomyxoma peritonei. A multi-centre randomised controlled
By Beard S, Hunn A, Wight J. By Bryant J, Clegg AJ, Sidhu MK, trial of minimally invasive direct
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of anakinra for the treatment of information analysis in complex health in decision-analytic modelling in health
rheumatoid arthritis in adults: a economic models: developments on technology assessment.
systematic review and economic the health economics of interferon-β By Philips Z, Ginnelly L, Sculpher M,
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and cost-effectiveness of newer drugs of chronic myeloid leukaemia in
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bipolar affective disorder. economic analysis. Clinical effectiveness and cost-
By Bridle C, Palmer S, Bagnall A-M, By Dalziel K, Round A, Stein K, effectiveness of clopidogrel and
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Liquid-based cytology in cervical VenUS I: a randomised controlled trial economic evaluation.
screening: an updated rapid and of two types of bandage for treating By Jones L, Griffin S, Palmer S, Main
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Systematic review of the long-term and cost-effectiveness, and economic evaluation.
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Supplementation of a home-based Randomised evaluation of alternative Cervical screening programmes: can
exercise programme with a class- electrosurgical modalities to treat automation help? Evidence from
based programme for people bladder outflow obstruction in men systematic reviews, an economic
with osteoarthritis of the knees: a with benign prostatic hyperplasia. analysis and a simulation modelling
randomised controlled trial and health By Fowler C, McAllister W, Plail R, exercise applied to the UK.
economic analysis. Karim O, Yang Q. By Willis BH, Barton P, Pearmain P,
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Clinical and cost-effectiveness of once- inoperable oesophageal cancer. By McCormack K, Wake B, Perez J,
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potency topical corticosteroids for Bond J, Griffin SM.
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No. 15
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No. 49
AB, Campbell MK, Clemens FJ, lofepramine.
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By Greenhalgh J, Knight C, Hind D,
Beverley C, Walters S. No. 19
The investigation and analysis of
No. 1 No. 10 critical incidents and adverse events in
Randomised controlled multiple Measurement of health-related quality healthcare.
treatment comparison to provide a cost- of life for people with dementia: By Woloshynowych M, Rogers S,
effectiveness rationale for the selection development of a new instrument Taylor-Adams S, Vincent C.
of antimicrobial therapy in acne. (DEMQOL) and an evaluation of
By Ozolins M, Eady EA, Avery A, current methodology. No. 20
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et al. S, Harwood R, Foley B, Smith P, et al. health technology assessment.
By Raftery J, Roderick P, Stevens A.
No. 2 No. 11
Clinical effectiveness and cost- No. 21
Do the findings of case series studies
vary significantly according to effectiveness of drotrecogin alfa Clinical and cost-effectiveness of newer
methodological characteristics? (activated) (Xigris®) for the treatment immunosuppressive regimens in renal
of severe sepsis in adults: a systematic transplantation: a systematic review and
By Dalziel K, Round A, Stein K, modelling study.
Garside R, Castelnuovo E, Payne L. review and economic evaluation.
By Woodroffe R, Yao GL, Meads C,
By Green C, Dinnes J, Takeda A,
Bayliss S, Ready A, Raftery J, et al.
No. 3 Shepherd J, Hartwell D, Cave C, et al.
Improving the referral process No. 22
for familial breast cancer genetic No. 12 A systematic review and economic
counselling: findings of three A methodological review of how evaluation of alendronate, etidronate,
randomised controlled trials of two heterogeneity has been examined in risedronate, raloxifene and teriparatide
interventions. systematic reviews of diagnostic test for the prevention and treatment of
By Wilson BJ, Torrance N, accuracy. postmenopausal osteoporosis.
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344 Haites NE, et al. Roderick P. Nigris E, Brewer N, Davis S, Oakley J.
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A systematic review to examine Longer term clinical and economic A randomised controlled trial and
the impact of psycho-educational benefits of offering acupuncture care to cost-effectiveness study of systematic
interventions on health outcomes patients with chronic low back pain. screening (targeted and total
and costs in adults and children with population screening) versus routine
difficult asthma. By Thomas KJ, MacPherson
practice for the detection of atrial
H, Ratcliffe J, Thorpe L, Brazier J,
By Smith JR, Mugford M, Holland fibrillation in people aged 65 and over.
Campbell M, et al.
R, Candy B, Noble MJ, Harrison BDW, The SAFE study.
et al. By Hobbs FDR, Fitzmaurice DA,
No. 33 Mant J, Murray E, Jowett S, Bryan S,
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An evaluation of the costs, effectiveness epidural steroids in the management
and quality of renal replacement of sciatica. No. 41
therapy provision in renal satellite units By Price C, Arden N, Coglan L, Displaced intracapsular hip fractures
in England and Wales. Rogers P. in fit, older people: a randomised
By Roderick P, Nicholson T, Armitage comparison of reduction and fixation,
A, Mehta R, Mullee M, Gerard K, et al. No. 34 bipolar hemiarthroplasty and total hip
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Imatinib for the treatment of patients Scott NW, Forbes JF.
controlled trial to compare the
with unresectable and/or metastatic effectiveness and cost-effectiveness of
gastrointestinal stromal tumours: aggressive versus symptomatic therapy No. 42
systematic review and economic in established rheumatoid arthritis. Long-term outcome of cognitive
evaluation. behaviour therapy clinical trials in
By Symmons D, Tricker K, Roberts C,
By Wilson J, Connock M, Song F, Davies L, Dawes P, Scott DL. central Scotland.
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No. 35
No. 26 Major KA, et al.
Indirect comparisons of competing Conceptual framework and systematic
interventions. review of the effects of participants’ No. 43
and professionals’ preferences in
By Glenny AM, Altman DG, Song F, randomised controlled trials. The effectiveness and cost-effectiveness
Sakarovitch C, Deeks JJ, D’Amico R, of dual-chamber pacemakers compared
et al. By King M, Nazareth I, Lampe F, with single-chamber pacemakers for
Bower P, Chandler M, Morou M, et al. bradycardia due to atrioventricular
No. 27 block or sick sinus syndrome: systematic
Cost-effectiveness of alternative No. 36 review and economic evaluation.
strategies for the initial medical The clinical and cost-effectiveness of By Castelnuovo E, Stein K, Pitt M,
management of non-ST elevation acute implantable cardioverter defibrillators: Garside R, Payne E.
coronary syndrome: systematic review a systematic review.
and decision-analytical modelling. No. 44
By Bryant J, Brodin H, Loveman E,
By Robinson M, Palmer S, Sculpher Payne E, Clegg A. Newborn screening for congenital heart
M, Philips Z, Ginnelly L, Bowens A, et al. defects: a systematic review and cost-
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No. 28 By Knowles R, Griebsch I,
Outcomes of electrically stimulated A trial of problem-solving by Dezateux C, Brown J, Bull C, Wren C.
gracilis neosphincter surgery. community mental health nurses for
anxiety, depression and life difficulties
By Tillin T, Chambers M, Feldman R. among general practice patients. The No. 45
CPN-GP study. The clinical and cost-effectiveness of
No. 29 left ventricular assist devices for end-
By Kendrick T, Simons L,
The effectiveness and cost-effectiveness stage heart failure: a systematic review
Mynors-Wallis L, Gray A, Lathlean J,
of pimecrolimus and tacrolimus for and economic evaluation.
Pickering R, et al.
atopic eczema: a systematic review and By Clegg AJ, Scott DA, Loveman E,
economic evaluation. Colquitt J, Hutchinson J, Royle P, et al.
No. 38
By Garside R, Stein K, Castelnuovo
E, Pitt M, Ashcroft D, Dimmock P, et al. The causes and effects of socio- No. 46
demographic exclusions from clinical
The effectiveness of the Heidelberg
No. 30 trials.
Retina Tomograph and laser diagnostic
Systematic review on urine albumin By Bartlett C, Doyal L, Ebrahim S, glaucoma scanning system (GDx) in
testing for early detection of diabetic Davey P, Bachmann M, Egger M, et al. detecting and monitoring glaucoma.
complications. By Kwartz AJ, Henson DB, Harper
By Newman DJ, Mattock MB, No. 39 RA, Spencer AF, McLeod D.
Dawnay ABS, Kerry S, McGuire A, Is hydrotherapy cost-effective?
Yaqoob M, et al. A randomised controlled trial of No. 47
combined hydrotherapy programmes Clinical and cost-effectiveness of
No. 31 compared with physiotherapy land autologous chondrocyte implantation
Randomised controlled trial of the cost- techniques in children with juvenile for cartilage defects in knee joints:
effectiveness of water-based therapy for idiopathic arthritis. systematic review and economic
lower limb osteoarthritis. By Epps H, Ginnelly L, Utley M, evaluation.
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No. 48 No. 6 No. 15

Systematic review of effectiveness of Systematic review and evaluation Measurement of the clinical and cost-
different treatments for childhood of methods of assessing urinary effectiveness of non-invasive diagnostic
retinoblastoma. incontinence. testing strategies for deep vein
By McDaid C, Hartley S, Bagnall By Martin JL, Williams KS, Abrams thrombosis.
A-M, Ritchie G, Light K, Riemsma R. KR, Turner DA, Sutton AJ, Chapple C,
By Goodacre S, Sampson F,
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No. 49 Thomas S, et al.
Towards evidence-based guidelines No. 7
for the prevention of venous The clinical effectiveness and cost-
effectiveness of newer drugs for No. 16
thromboembolism: systematic
reviews of mechanical methods, oral children with epilepsy. A systematic Systematic review of the effectiveness
anticoagulation, dextran and regional review. and cost-effectiveness of HealOzone®
anaesthesia as thromboprophylaxis. By Connock M, Frew E, Evans B-W, for the treatment of occlusal pit/fissure
By Roderick P, Ferris G, Wilson K, Bryan S, Cummins C, Fry-Smith A, et al. caries and root caries.
Halls H, Jackson D, Collins R, et al. By Brazzelli M, McKenzie L, Fielding
No. 8 S, Fraser C, Clarkson J, Kilonzo M, et al.
No. 50 Surveillance of Barrett’s oesophagus:
The effectiveness and cost-effectiveness exploring the uncertainty through No. 17
of parent training/education systematic review, expert workshop and
economic modelling. Randomised controlled trials of
programmes for the treatment
conventional antipsychotic versus
of conduct disorder, including By Garside R, Pitt M, Somerville M,
new atypical drugs, and new atypical
oppositional defiant disorder, in Stein K, Price A, Gilbert N.
drugs versus clozapine, in people with
children.
schizophrenia responding poorly to, or
By Dretzke J, Frew E, Davenport C, No. 9 intolerant of, current drug treatment.
Barlow J, Stewart-Brown S, Sandercock J, Topotecan, pegylated liposomal
et al. doxorubicin hydrochloride and By Lewis SW, Davies L, Jones PB,
paclitaxel for second-line or subsequent Barnes TRE, Murray RM, Kerwin R,
treatment of advanced ovarian cancer: et al.
Volume 10, 2006 a systematic review and economic

evaluation. No. 18
By Main C, Bojke L, Griffin S, Diagnostic tests and algorithms used
Norman G, Barbieri M, Mather L, et al. in the investigation of haematuria:
No. 1 systematic reviews and economic
The clinical and cost-effectiveness of No. 10 evaluation.
donepezil, rivastigmine, galantamine Evaluation of molecular techniques
and memantine for Alzheimer’s By Rodgers M, Nixon J, Hempel S,
in prediction and diagnosis Aho T, Kelly J, Neal D, et al.
disease. of cytomegalovirus disease in
By Loveman E, Green C, Kirby J, immunocompromised patients.
Takeda A, Picot J, Payne E, et al. By Szczepura A, Westmoreland D, No. 19
Vinogradova Y, Fox J, Clark M. Cognitive behavioural therapy in
No. 2 addition to antispasmodic therapy for
FOOD: a multicentre randomised trial No. 11 irritable bowel syndrome in primary
evaluating feeding policies in patients Screening for thrombophilia in high- care: randomised controlled trial.
admitted to hospital with a recent risk situations: systematic review By Kennedy TM, Chalder T,
stroke. and cost-effectiveness analysis. The McCrone P, Darnley S, Knapp M,
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effectiveness of computed tomography
effectiveness of enzyme replacement
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therapies for Fabry’s disease and
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By Black C, Bagust A, Boland A, a decision analysis for sampling and
Walker S, McLeod C, De Verteuil R, et al. treating infected diabetic foot ulcers. By Connock M, Juarez-Garcia A,
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A systematic review of the effectiveness
and cost-effectiveness of neuroimaging No. 13 No. 21
assessments used to visualise the seizure Randomised clinical trial, observational Health benefits of antiviral therapy for
focus in people with refractory epilepsy study and assessment of cost- mild chronic hepatitis C: randomised
being considered for surgery. effectiveness of the treatment of controlled trial and economic
By Whiting P, Gupta R, Burch J, varicose veins (REACTIV trial). evaluation.
Mujica Mota RE, Wright K, Marson A, By Michaels JA, Campbell WB, By Wright M, Grieve R, Roberts J,
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Ratcliffe J, et al. UK Mild Hepatitis C Trial Investigators.
No. 5
Comparison of conference abstracts No. 14
No. 22
and presentations with full-text articles The cost-effectiveness of screening for
in the health technology assessments of oral cancer in primary care. Pressure relieving support surfaces: a
rapidly evolving technologies. By Speight PM, Palmer S, Moles DR, randomised evaluation.
By Dundar Y, Dodd S, Dickson R, Downer MC, Smith DH, Henriksson M, By Nixon J, Nelson EA, Cranny G,
346 Walley T, Haycox A, Williamson PR. et al. Iglesias CP, Hawkins K, Cullum NA, et al.
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A systematic review and economic Etanercept and infliximab for the What are the clinical outcome and cost-
model of the effectiveness and cost- treatment of psoriatic arthritis: a effectiveness of endoscopy undertaken
effectiveness of methylphenidate, systematic review and economic by nurses when compared with doctors?
dexamfetamine and atomoxetine evaluation. A Multi-Institution Nurse Endoscopy
for the treatment of attention deficit By Woolacott N, Bravo Vergel Y, Trial (MINuET).
hyperactivity disorder in children and Hawkins N, Kainth A, Khadjesari Z, By Williams J, Russell I, Durai D,
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By King S, Griffin S, Hodges Z,
Weatherly H, Asseburg C, Richardson G, No. 32
The cost-effectiveness of testing for No. 41
et al.
hepatitis C in former injecting drug The clinical and cost-effectiveness of
users. oxaliplatin and capecitabine for the
No. 24
By Castelnuovo E, Thompson-Coon adjuvant treatment of colon cancer:
The clinical effectiveness and cost- systematic review and economic
effectiveness of enzyme replacement J, Pitt M, Cramp M, Siebert U, Price A,
et al. evaluation.
therapy for Gaucher’s disease: a
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update: a systematic review and A systematic review of the effectiveness
economic evaluation. of adalimumab, etanercept and
No. 25
By Kaltenthaler E, Brazier J, infliximab for the treatment of
Effectiveness and cost-effectiveness De Nigris E, Tumur I, Ferriter M,
of salicylic acid and cryotherapy for rheumatoid arthritis in adults and
Beverley C, et al. an economic evaluation of their cost-
cutaneous warts. An economic decision
model. effectiveness.
No. 34
By Thomas KS, Keogh-Brown MR, By Chen Y-F, Jobanputra P, Barton P,
Cost-effectiveness of using prognostic
Chalmers JR, Fordham RJ, Holland RC, Jowett S, Bryan S, Clark W, et al.
information to select women with breast
Armstrong SJ, et al. cancer for adjuvant systemic therapy.
By Williams C, Brunskill S, Altman D, No. 43
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A systematic literature review of the randomised controlled trial.
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interventions to prevent wandering in Psychological therapies including McDonagh AJG.
dementia and evaluation of the ethical dialectical behaviour therapy for
implications and acceptability of their borderline personality disorder: a No. 44
use. systematic review and preliminary
By Robinson L, Hutchings D, Corner Cost-effectiveness of cell salvage and
L, Beyer F, Dickinson H, Vanoli A, et al. alternative methods of minimising
By Brazier J, Tumur I, Holmes M,
perioperative allogeneic blood
Ferriter M, Parry G, Dent-Brown K, et al.
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No. 27
economic model.
A review of the evidence on the effects No. 36
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defibrillator therapy in different effectiveness of tests for the diagnosis Payne K, Elliott RA, McCollum C.
patient groups, and modelling of cost- and investigation of urinary tract
effectiveness and cost–utility for these infection in children: a systematic No. 45
groups in a UK context. review and economic model. Clinical effectiveness and cost-
By Buxton M, Caine N, Chase D, By Whiting P, Westwood M, Bojke L, effectiveness of laparoscopic surgery
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interferon alfa-2a for the treatment of in chronic fatigue syndrome: a et al.
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An evaluation of the clinical and cost- of five strategies for the prevention Mason A, Kainth A, Khadjesari Z, Bravo
effectiveness of pulmonary artery of nonsteroidal anti-inflammatory Vergel Y, et al.
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By Harvey S, Stevens K, Harrison D, By Brown TJ, Hooper L, Elliott RA, tools for acute abdominal pain.
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By Wardlaw JM, Chappell FM, review. device programme in the UK.
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A systematic review and economic Glucocorticoid-induced osteoporosis: Additional therapy for young
model of the clinical and cost- a systematic review and cost–utility children with spastic cerebral palsy: a
effectiveness of immunosuppressive analysis. randomised controlled trial.
therapy for renal transplantation in By Kanis JA, Stevenson M,
children. McCloskey EV, Davis S, Lloyd-Jones M. By Weindling AM, Cunningham CC,
Glenn SM, Edwards RT, Reeves DJ.
By Yao G, Albon E, Adi Y, Milford D,
Bayliss S, Ready A, et al. No. 8
Epidemiological, social, diagnostic and No. 17
economic evaluation of population
No. 50 screening for genital chlamydial Screening for type 2 diabetes: literature
Amniocentesis results: investigation of infection. review and economic modelling.
anxiety. The ARIA trial. By Low N, McCarthy A, Macleod J, By Waugh N, Scotland G, McNamee
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No. 18
No. 9
Methadone and buprenorphine for the The effectiveness and cost-effectiveness
Volume 11, 2007 management of opioid dependence: of cinacalcet for secondary
a systematic review and economic hyperparathyroidism in end-stage renal
evaluation. disease patients on dialysis: a systematic
By Connock M, Juarez-Garcia A, review and economic evaluation.
No. 1
Jowett S, Frew E, Liu Z, Taylor RJ, et al. By Garside R, Pitt M, Anderson R,
Pemetrexed disodium for the treatment
of malignant pleural mesothelioma: Mealing S, Roome C, Snaith A, et al.
a systematic review and economic No. 10
evaluation. Exercise Evaluation Randomised
No. 19
Trial (EXERT): a randomised trial
By Dundar Y, Bagust A, Dickson R, comparing GP referral for leisure The clinical effectiveness and cost-
Dodd S, Green J, Haycox A, et al. centre-based exercise, community-based effectiveness of gemcitabine for
walking and advice only. metastatic breast cancer: a systematic
No. 2 By Isaacs AJ, Critchley JA, See Tai review and economic evaluation.
A systematic review and economic S, Buckingham K, Westley D, Harridge By Takeda AL, Jones J, Loveman E,
model of the clinical effectiveness SDR, et al. Tan SC, Clegg AJ.
and cost-effectiveness of docetaxel
in combination with prednisone or No. 11
prednisolone for the treatment of Interferon alfa (pegylated and non- No. 20
hormone-refractory metastatic prostate pegylated) and ribavirin for the A systematic review of duplex
cancer. treatment of mild chronic hepatitis ultrasound, magnetic resonance
By Collins R, Fenwick E, Trowman R, C: a systematic review and economic angiography and computed
Perard R, Norman G, Light K, et al. evaluation. tomography angiography for
By Shepherd J, Jones J, Hartwell D, the diagnosis and assessment of
Davidson P, Price A, Waugh N. symptomatic, lower limb peripheral
No. 3
arterial disease.
A systematic review of rapid diagnostic No. 12
tests for the detection of tuberculosis By Collins R, Cranny G, Burch J,
Systematic review and economic
infection. Aguiar-Ibáñez R, Craig D, Wright K,
evaluation of bevacizumab and
et al.
By Dinnes J, Deeks J, Kunst H, cetuximab for the treatment of
Gibson A, Cummins E, Waugh N, et al. metastatic colorectal cancer.
By Tappenden P, Jones R, Paisley S, No. 21
No. 4 Carroll C. The clinical effectiveness and cost-
The clinical effectiveness and cost- effectiveness of treatments for children
effectiveness of strontium ranelate for No. 13 with idiopathic steroid-resistant
the prevention of osteoporotic fragility A systematic review and economic nephrotic syndrome: a systematic
fractures in postmenopausal women. evaluation of epoetin alfa, epoetin review.
beta and darbepoetin alfa in anaemia
By Stevenson M, Davis S, Lloyd-Jones associated with cancer, especially that By Colquitt JL, Kirby J, Green C,
M, Beverley C. attributable to cancer treatment. Cooper K, Trompeter RS.
By Wilson J, Yao GL, Raftery J,
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A systematic review of quantitative and et al.
A systematic review of the routine
qualitative research on the role and monitoring of growth in children of
effectiveness of written information No. 14 primary school age to identify growth-
available to patients about individual A systematic review and economic related conditions.
medicines. evaluation of statins for the prevention
of coronary events. By Fayter D, Nixon J, Hartley S,
By Raynor DK, Blenkinsopp
By Ward S, Lloyd Jones M, Pandor A, Rithalia A, Butler G, Rudolf M, et al.
A, Knapp P, Grime J, Nicolson DJ,
Pollock K, et al. Holmes M, Ara R, Ryan A, et al.
No. 23
No. 15
No. 6 Systematic review of the effectiveness of
A systematic review of the effectiveness
Oral naltrexone as a treatment for and cost-effectiveness of different preventing and treating Staphylococcus
relapse prevention in formerly opioid- models of community-based respite aureus carriage in reducing peritoneal
dependent drug users: a systematic care for frail older people and their catheter-related infections.
review and economic evaluation. carers. By McCormack K, Rabindranath K,
By Adi Y, Juarez-Garcia A, Wang D, By Mason A, Weatherly H, Spilsbury Kilonzo M, Vale L, Fraser C, McIntyre L,
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The clinical effectiveness and cost The clinical effectiveness and cost- The clinical effectiveness and cost-
of repetitive transcranial magnetic effectiveness of inhaled insulin in effectiveness of screening for open
stimulation versus electroconvulsive diabetes mellitus: a systematic review angle glaucoma: a systematic review
therapy in severe depression: a and economic evaluation. and economic evaluation.
multicentre pragmatic randomised By Burr JM, Mowatt G, Hernández
By Black C, Cummins E, Royle P,
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Philip S, Waugh N.
By McLoughlin DM, Mogg A, Eranti et al.
S, Pluck G, Purvis R, Edwards D, et al.
No. 34
No. 25 No. 42
Surveillance of cirrhosis for
A randomised controlled trial and hepatocellular carcinoma: systematic Acceptability, benefit and costs of early
economic evaluation of direct versus review and economic analysis. screening for hearing disability: a study
indirect and individual versus group of potential screening tests and models.
By Thompson Coon J, Rogers G,
modes of speech and language therapy Hewson P, Wright D, Anderson R, By Davis A, Smith P, Ferguson M,
for children with primary language Cramp M, et al. Stephens D, Gianopoulos I.
impairment.
By Boyle J, McCartney E, Forbes J, No. 43
O’Hare A. No. 35
Contamination in trials of educational
The Birmingham Rehabilitation
interventions.
No. 26 Uptake Maximisation Study (BRUM).
Hormonal therapies for early breast Homebased compared with hospital- By Keogh-Brown MR, Bachmann
cancer: systematic review and economic based cardiac rehabilitation in a multi- MO, Shepstone L, Hewitt C, Howe A,
evaluation. ethnic population: cost-effectiveness Ramsay CR, et al.
By Hind D, Ward S, De Nigris E, and patient adherence.
Simpson E, Carroll C, Wyld L. By Jolly K, Taylor R, Lip GYH, No. 44
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No. 27 positron emission tomography imaging
Cardioprotection against the toxic No. 36 in selected cancers.
effects of anthracyclines given to By Facey K, Bradbury I, Laking G,
children with cancer: a systematic A systematic review of the clinical,
Payne E.
review. public health and cost-effectiveness of
By Bryant J, Picot J, Levitt G, rapid diagnostic tests for the detection
and identification of bacterial intestinal No. 45
Sullivan I, Baxter L, Clegg A.
pathogens in faeces and food. The effectiveness and cost-effectiveness
By Abubakar I, Irvine L, Aldus CF, of carmustine implants and
No. 28
Wyatt GM, Fordham R, Schelenz S, et al. temozolomide for the treatment of
Adalimumab, etanercept and infliximab
newly diagnosed high-grade glioma:
for the treatment of ankylosing
a systematic review and economic
spondylitis: a systematic review and No. 37 evaluation.
economic evaluation. A randomised controlled trial
By McLeod C, Bagust A, Boland A, By Garside R, Pitt M, Anderson R,
examining the longer-term outcomes Rogers G, Dyer M, Mealing S, et al.
Dagenais P, Dickson R, Dundar Y, et al. of standard versus new antiepileptic
drugs. The SANAD trial.
No. 29 No. 46
Prenatal screening and treatment By Marson AG, Appleton R, Baker Drug-eluting stents: a systematic review
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effectiveness and expected value of No. 38
information analyses. Clinical effectiveness and cost- No. 47
By Colbourn T, Asseburg C, Bojke L, effectiveness of different models
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of managing long-term oral anti-
cost-effectiveness of cardiac
coagulation therapy: a systematic
No. 30 resynchronisation (biventricular pacing)
review and economic modelling.
Clinical effectiveness and cost- for heart failure: systematic review and
By Connock M, Stevens C, Fry-Smith economic model.
effectiveness of bone morphogenetic A, Jowett S, Fitzmaurice D, Moore D,
proteins in the non-healing of fractures By Fox M, Mealing S, Anderson R,
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and spinal fusion: a systematic review.
By Garrison KR, Donell S, Ryder J,
Shemilt I, Mugford M, Harvey I, et al. No. 39 No. 48
A systematic review and economic Recruitment to randomised trials:
No. 31 model of the clinical effectiveness strategies for trial enrolment and
A randomised controlled trial of and cost-effectiveness of interventions participation study. The STEPS study.
postoperative radiotherapy following for preventing relapse in people with
By Campbell MK, Snowdon C,
breast-conserving surgery in a bipolar disorder.
Francis D, Elbourne D, McDonald AM,
minimum-risk older population. The By Soares-Weiser K, Bravo Vergel Y, Knight R, et al.
PRIME trial. Beynon S, Dunn G, Barbieri M, Duffy S,
By Prescott RJ, Kunkler IH, Williams et al.
LJ, King CC, Jack W, van der Pol M, et al. No. 49
Cost-effectiveness of functional
No. 40 cardiac testing in the diagnosis and
No. 32
Current practice, accuracy, effectiveness Taxanes for the adjuvant treatment of management of coronary artery
and cost-effectiveness of the school early breast cancer: systematic review disease: a randomised controlled trial.
entry hearing screen. and economic evaluation. The CECaT trial.
By Bamford J, Fortnum H, Bristow K, By Ward S, Simpson E, Davis S, Hind By Sharples L, Hughes V, Crean A,
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No. 50 No. 5 No. 14

Evaluation of diagnostic tests when A multi-centre retrospective cohort A randomised controlled trial of
there is no gold standard. A review of study comparing the efficacy, safety cognitive behaviour therapy in
methods. and cost-effectiveness of hysterectomy adolescents with major depression
By Rutjes AWS, Reitsma and uterine artery embolisation for treated by selective serotonin reuptake
JB, Coomarasamy A, Khan KS, the treatment of symptomatic uterine inhibitors. The ADAPT trial.
Bossuyt PMM. fibroids. The HOPEFUL study. By Goodyer IM, Dubicka B, Wilkinson
By Hirst A, Dutton S, Wu O, Briggs A, P, Kelvin R, Roberts C, Byford S, et al.
Edwards C, Waldenmaier L, et al.
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Systematic reviews of the clinical No. 15
No. 6 The use of irinotecan, oxaliplatin
effectiveness and cost-effectiveness of
proton pump inhibitors in acute upper Methods of prediction and prevention and raltitrexed for the treatment of
gastrointestinal bleeding. of pre-eclampsia: systematic reviews of advanced colorectal cancer: systematic
accuracy and effectiveness literature review and economic evaluation.
By Leontiadis GI, Sreedharan A, with economic modelling.
Dorward S, Barton P, Delaney B, Howden By Hind D, Tappenden P, Tumur I,
By Meads CA, Cnossen JS, Meher S, Eggington E, Sutcliffe P, Ryan A.
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No. 52 No. 16
No. 7
A review and critique of modelling in Ranibizumab and pegaptanib for
The use of economic evaluations in the treatment of age-related macular
prioritising and designing screening NHS decision-making: a review and
programmes. degeneration: a systematic review and
empirical investigation. economic evaluation.
By Karnon J, Goyder E, Tappenden P, By Williams I, McIver S, Moore D,
McPhie S, Towers I, Brazier J, et al. By Colquitt JL, Jones J, Tan SC,
Bryan S.
Takeda A, Clegg AJ, Price A.
No. 53 No. 8
No. 17
An assessment of the impact of the Stapled haemorrhoidectomy
(haemorrhoidopexy) for the treatment Systematic review of the clinical
NHS Health Technology Assessment
of haemorrhoids: a systematic review effectiveness and cost-effectiveness
Programme.
and economic evaluation. of 64-slice or higher computed
By Hanney S, Buxton M, Green C, tomography angiography as an
Coulson D, Raftery J. By Burch J, Epstein D, Baba-Akbari
alternative to invasive coronary
A, Weatherly H, Fox D, Golder S, et al.
angiography in the investigation of
coronary artery disease.
No. 9
Volume 12, 2008 By Mowatt G, Cummins E, Waugh N,
The clinical effectiveness of diabetes Walker S, Cook J, Jia X, et al.
education models for Type 2 diabetes: a
systematic review.
No. 18
No. 1 By Loveman E, Frampton GK,
Clegg AJ. Structural neuroimaging in psychosis:
A systematic review and economic
model of switching from
evaluation.
nonglycopeptide to glycopeptide No. 10
antibiotic prophylaxis for surgery. Payment to healthcare professionals for By Albon E, Tsourapas A, Frew E,
patient recruitment to trials: systematic Davenport C, Oyebode F, Bayliss S, et al.
By Cranny G, Elliott R, Weatherly H,
Chambers D, Hawkins N, Myers L, et al. review and qualitative study.
By Raftery J, Bryant J, Powell J, No. 19
No. 2 Kerr C, Hawker S. Systematic review and economic analysis
of the comparative effectiveness of
‘Cut down to quit’ with nicotine different inhaled corticosteroids and
replacement therapies in smoking No. 11
Cyclooxygenase-2 selective non- their usage with long-acting beta2
cessation: a systematic review of agonists for the treatment of chronic
effectiveness and economic analysis. steroidal anti-inflammatory drugs
(etodolac, meloxicam, celecoxib, asthma in adults and children aged
By Wang D, Connock M, Barton P, 12 years and over.
rofecoxib, etoricoxib, valdecoxib and
Fry-Smith A, Aveyard P, Moore D. By Shepherd J, Rogers G, Anderson
lumiracoxib) for osteoarthritis and
rheumatoid arthritis: a systematic review R, Main C, Thompson-Coon J,
No. 3 and economic evaluation. Hartwell D, et al.
A systematic review of the effectiveness By Chen Y-F, Jobanputra P, Barton P,
of strategies for reducing fracture risk Bryan S, Fry-Smith A, Harris G, et al. No. 20
in children with juvenile idiopathic Systematic review and economic analysis
arthritis with additional data on long- No. 12 of the comparative effectiveness of
term risk of fracture and cost of disease The clinical effectiveness and cost- different inhaled corticosteroids and
management. effectiveness of central venous catheters their usage with long-acting beta2
By Thornton J, Ashcroft D, O’Neill T, treated with anti-infective agents in agonists for the treatment of chronic
Elliott R, Adams J, Roberts C, et al. preventing bloodstream infections: asthma in children under the age of
a systematic review and economic 12 years.
No. 4 evaluation. By Main C, Shepherd J, Anderson R,
Does befriending by trained lay workers By Hockenhull JC, Dwan K, Boland Rogers G, Thompson-Coon J, Liu Z, et al.
improve psychological well-being and A, Smith G, Bagust A, Dundar Y, et al.
quality of life for carers of people No. 21
with dementia, and at what cost? A No. 13 Ezetimibe for the treatment of
randomised controlled trial. Stepped treatment of older adults on hypercholesterolaemia: a systematic
By Charlesworth G, Shepstone L, laxatives. The STOOL trial. review and economic evaluation.
Wilson E, Thalanany M, Mugford M, By Mihaylov S, Stark C, McColl E, By Ara R, Tumur I, Pandor A, Duenas
350 Poland F. Steen N, Vanoli A, Rubin G, et al. A, Williams R, Wilkinson A, et al.
No. 22 No. 31 No. 3

Topical or oral ibuprofen for chronic The effectiveness and cost-effectivness Surgical procedures and non-surgical
knee pain in older people. The TOIB of minimal access surgery amongst devices for the management of non-
study. people with gastro-oesophageal reflux apnoeic snoring: a systematic review of
By Underwood M, Ashby D, Carnes disease – a UK collaborative study. The clinical effects and associated treatment
D, Castelnuovo E, Cross P, Harding G, reflux trial. costs.
et al. By Main C, Liu Z, Welch K, Weiner G,
By Grant A, Wileman S, Ramsay C,
Bojke L, Epstein D, Sculpher M, et al. Quentin Jones S, Stein K.
No. 23
A prospective randomised comparison No. 4
of minor surgery in primary and No. 32
Continuous positive airway pressure
secondary care. The MiSTIC trial. Time to full publication of studies of
devices for the treatment of obstructive
By George S, Pockney P, Primrose J, anti-cancer medicines for breast cancer
sleep apnoea–hypopnoea syndrome: a
Smith H, Little P, Kinley H, et al. and the potential for publication bias: a
systematic review and economic analysis.
short systematic review.
By McDaid C, Griffin S, Weatherly H,
No. 24 By Takeda A, Loveman E, Harris P, Durée K, van der Burgt M, van Hout S,
A review and critical appraisal Hartwell D, Welch K. Akers J, et al.
of measures of therapist–patient
interactions in mental health settings. No. 33 No. 5
By Cahill J, Barkham M, Hardy G,
Performance of screening tests for Use of classical and novel biomarkers
Gilbody S, Richards D, Bower P, et al.
child physical abuse in accident and as prognostic risk factors for localised
emergency departments. prostate cancer: a systematic review.
No. 25
The clinical effectiveness and cost- By Woodman J, Pitt M, Wentz R, By Sutcliffe P, Hummel S, Simpson E,
effectiveness of screening programmes Taylor B, Hodes D, Gilbert RE. Young T, Rees A, Wilkinson A, et al.
for amblyopia and strabismus in
children up to the age of 4–5 years: No. 34 No. 6
a systematic review and economic Curative catheter ablation in atrial The harmful health effects of recreational
evaluation. fibrillation and typical atrial flutter: ecstasy: a systematic review of
By Carlton J, Karnon J, Czoski- systematic review and economic observational evidence.
Murray C, Smith KJ, Marr J. evaluation. By Rogers G, Elston J, Garside R,
By Rodgers M, McKenna C, Palmer S, Roome C, Taylor R, Younger P, et al.
No. 26
Chambers D, Van Hout S, Golder S, et al.
A systematic review of the clinical No. 7
effectiveness and cost-effectiveness and
No. 35 Systematic review of the clinical
economic modelling of minimal incision
effectiveness and cost-effectiveness
total hip replacement approaches in Systematic review and economic
of oesophageal Doppler monitoring
the management of arthritic disease of modelling of effectiveness and cost
in critically ill and high-risk surgical
the hip. utility of surgical treatments for men
patients.
By de Verteuil R, Imamura M, Zhu S, with benign prostatic enlargement.
Glazener C, Fraser C, Munro N, et al. By Mowatt G, Houston G, Hernández
By Lourenco T, Armstrong N, N’Dow R, de Verteuil R, Fraser C, Cuthbertson
J, Nabi G, Deverill M, Pickard R, et al. B, et al.
No. 27
A preliminary model-based assessment No. 36
of the cost–utility of a screening No. 8
programme for early age-related Immunoprophylaxis against respiratory The use of surrogate outcomes in model-
macular degeneration. syncytial virus (RSV) with palivizumab based cost-effectiveness analyses: a survey
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How far does screening women for No. 24 Bortezomib for the treatment of
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frail elderly. insulin-treated diabetes mellitus coronary syndromes: a systematic review
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DE, Masson MA, Sampson F, Dixon evaluation of acceptability and cost- critique of the submission from Pfizer.
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By Stevenson M, Scope A, Holmes M, management of chronic ulceration of No. 1
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cell carcinoma: a systematic review and
Ustekinumab for the treatment of A prospective randomised controlled economic evaluation.
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Communication of carrier status
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human papillomavirus (HPV) testing in Colour vision testing for diabetic Sutherland AG, Cuthbertson BH,
primary cervical screening. retinopathy: a systematic review of Entwistle VA, McDonald AM, et al.
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YK, Ryder J, Sutton AJ, et al. Shepherd J, Sowden A, White I, et al. infarction heart failure.
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The effectiveness and cost-effectiveness No. 25
non-selective non-steroidal anti-
of biomarkers for the prioritisation Avoiding and identifying errors in
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of patients awaiting coronary health technology assessment models:
reduction of morphine-related side
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The clinical effectiveness and cost- Wijck F, Shackley P, Steen N, et al., on
effectiveness of topotecan for small cell behalf of the BoTULS investigators.
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Clinical effectiveness and cost- lung cancer: a systematic review and
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effectiveness of continuous
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No. 13 No. 21 exacerbations of ulcerative colitis.
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A randomised controlled trial of infection.
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cognitive behaviour therapy and
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motivational interviewing for people
a bypass-surgery-first versus a balloon-
with Type 1 diabetes mellitus with
angioplasty-first revascularisation Prasugrel for the treatment of acute
persistent sub-optimal glycaemic
strategy for severe limb ischaemia due coronary artery syndromes with
control: A Diabetes and Psychological
to infrainguinal disease. The Bypass percutaneous coronary intervention.
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A randomised controlled equivalence chronic hand eczema.
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trial of treatments for adolescent physiotherapy techniques in the
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Topotecan for the treatment of No. 34 No. 38

recurrent and stage IVB carcinoma of Exploring the needs, concerns and Towards single embryo transfer?
the cervix. behaviours of people with existing Modelling clinical outcomes of potential
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Sugammadex for the reversal of muscle
Azacitidine for the treatment of investigation of the characteristics and
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myelodysplastic syndrome, chronic management of affected women and the
relationship to pregnancy outcomes for
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No. 28
swine flu (influenza A H1N1v) on public modelling of the effectiveness and cost-
The safety and effectiveness of
responses to the outbreak: results from effectiveness of non-surgical treatments
different methods of earwax removal:
36 national telephone surveys in the for women with stress urinary
UK. incontinence.
evaluation.
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patterns. A multicentred randomised controlled
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Robertson C, Sheikh A, McMenamin J. for the treatment of growth disorders
School-linked sexual health services for
young people (SSHYP): a survey and in children: a systematic review and
Physical interventions to interrupt or economic evaluation.
systematic review concerning current reduce the spread of respiratory viruses: By Takeda A, Cooper K,
models, effectiveness, cost-effectiveness a Cochrane review. Bird A, Baxter L, Frampton GK,
and research opportunities. By Jefferson T, Del Mar C, Dooley L, Gospodarevskaya E, et al.
By Owen J, Carroll C, Cooke J, Ferroni E, Al-Ansary LA, Bawazeer GA,
Formby E, Hayter M, Hirst J, et al. et al. No. 43
A pragmatic randomised controlled
No. 31 No. 35 trial to compare antidepressants with
Systematic review and cost-effectiveness Randomised controlled trial and a community-based psychosocial
evaluation of ‘pill-in-the-pocket’ strategy parallel economic evaluation of intervention for the treatment of
for paroxysmal atrial fibrillation conventional ventilatory support versus women with postnatal depression: the
compared to episodic in-hospital extracorporeal membrane oxygenation RESPOND trial.
treatment or continuous antiarrhythmic for severe adult respiratory failure By Sharp DJ, Chew-Graham C, Tylee
drug therapy. (CESAR). A, Lewis G, Howard L, Anderson I, et al.
By Martin Saborido C, Hockenhull J, By Peek GJ, Elbourne D, Mugford M,
Bagust A, Boland A, Dickson R, Todd D. No. 44
Tiruvoipati R, Wilson A, Allen E, et al.
Group cognitive behavioural therapy
No. 32 for postnatal depression: a systematic
No. 36
Chemoprevention of colorectal cancer: review of clinical effectiveness, cost-
Newer agents for blood glucose control
systematic review and economic effectiveness and value of information
in type 2 diabetes: systematic review and
analyses.
evaluation. economic evaluation.
By Stevenson MD, Scope A, Sutcliffe
By Cooper K, Squires H, Carroll C, By Waugh N, Cummins E, Royle P, PA, Booth A, Slade P, Parry G, et al.
Papaioannou D, Booth A, Logan RF, et al. Clar C, Marien M, Richter B, et al.
No. 45
No. 33 No. 37 Screening for hyperglycaemia in
Cross-trimester repeated measures Barrett’s oesophagus and cancers of the pregnancy: a rapid update for the
testing for Down’s syndrome screening: biliary tract, brain, head and neck, lung, National Screening Committee.
an assessment. oesophagus and skin. By Waugh N, Royle P, Clar C,
By Wright D, Bradbury I, Malone F, By Fayter D, Corbett M, Heirs M, Fox Henderson R, Cummins E, Hadden D,
356 D’Alton M, Summers A, Huang T, et al. D, Eastwood A. et al.
No. 46 No. 48 Pemetrexed for the maintenance

Open-label, randomised, parallel- Computerised decision support systems treatment of locally advanced or
group, multicentre study to evaluate the in order communication for diagnostic, metastatic non-small cell lung cancer.
safety, tolerability and immunogenicity screening or monitoring test ordering: By Greenhalgh J, McLeod C, Bagust
of an AS03B/oil-in-water emulsion- systematic reviews of the effects and A, Boland A, Fleeman N, Dundar Y, et al.
adjuvanted (AS03B) split-virion versus cost-effectiveness of systems.
non-adjuvanted wholevirion H1N1 By Main C, Moxham T, Wyatt JC, Kay Everolimus for the second-line
influenza vaccine in UK children J, Anderson R, Stein K. treatment of advanced and/or metastatic
6 months to 12 years of age. renal cell cancer: a critique of the
By Waddington CS, Andrews N, No. 49 submission from Novartis.
Hoschler K, Walker WT, Oeser C, Reiner Relapse prevention in UK Stop By Pitt M, Crathorne L, Moxham T,
A, et al. Smoking Services: current practice, Bond M, Hyde C.
systematic reviews of effectiveness and
Evaluation of droplet dispersion during cost-effectiveness analysis. Bevacizumab in combination with
non-invasive ventilation, oxygen By Coleman T, Agboola S, Leonardi- fluoropyrimidine-based chemotherapy
therapy, nebuliser treatment and chest Bee J, Taylor M, McEwen A, McNeill A. for the first-line treatment of metastatic
physiotherapy in clinical practice: colorectal cancer.
implications for management of No. 50 By Whyte S, Pandor A, Stevenson M,
pandemic influenza and other airborne A systematic review of positron emission Rees A.
infections. tomography (PET) and positron
By Simonds AK, Hanak A, Chatwin emission tomography/computed Dronedarone for the treatment of atrial
M, Morrell MJ, Hall A, Parker KH, et al. tomography (PET/CT) for the diagnosis fibrillation and atrial flutter.
of breast cancer recurrence. By Maund E, McKenna C, Sarowar M,
Evaluation of triage methods used to By Pennant M, Takwoingi Y, Pennant Fox D, Stevenson M, Pepper C, et al.
select patients with suspected pandemic L, Davenport C, Fry-Smith A, Eisinga A,
influenza for hospital admission: cohort et al. Imatinib as adjuvant treatment
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treatment of rheumatoid arthritis. Tubeuf S, Pennant M, Fry-Smith A, et al.
Virus shedding and environmental By Connock M, Tubeuf S, Malottki K,
deposition of novel A (H1N1) pandemic Uthman A, Round J, Bayliss S, et al. Gefitinib for the first-line treatment of
influenza virus: interim findings. locally advanced or metastatic non-small
By Killingley B, Greatorex J, Capecitabine for the treatment of cell lung cancer.
Cauchemez S, Enstone JE, Curran M, advanced gastric cancer. By Brown T, Boland A, Bagust A,
Read R, et al. By Norman G, Soares M, Peura P, Oyee J, Hockenhull J, Dundar Y, et al.
Rice S, Suh D, Wright K, et al.
Neuraminidase inhibitors for
preventing and treating influenza in Rituximab for the treatment of
healthy adults: a Cochrane review. relapsed/refractory chronic lymphocytic
By Jefferson T, Jones M, Doshi P, Del leukaemia.
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Connock M, Uthman O, Bayliss S, et al.
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Intensity-modulated radiotherapy The clinical effectiveness and cost-
for the treatment of prostate cancer: effectiveness of rituximab for the first-
a systematic review and economic line treatment of chronic lymphocytic
evaluation. leukaemia: an evidence review of the
By Hummel S, Simpson EL, submission from Roche.
Hemingway P, Stevenson MD, Rees A. By Main C, Pitt M, Moxham T,
Stein K.
357

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Dr David Elliman, Southampton Dr Susanne M Ludgate, Department, Leeds Teaching
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Medical Adviser, National Mental Health Trust, Middlesex Hadleigh Practice, Corfe Public Health, London School
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Professor Margaret Dr Julie Mytton,
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Clinical Programmes Director, Senior Lecturer in Exercise, and Director, Department of Health, University of
Bazian Ltd, London Nutrition and Health, Centre Primary Care and Population Edinburgh
for Sport, Exercise and Health, Sciences, University College
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Dr John Pounsford, Senior Research Fellow, Barts Consultant Neurologist, Stroke Medicine, Senior
Consultant Physician North and the London School of Addenbrooke’s Hospital, Lecturer/Consultant Stroke
Bristol NHS Trust, Bristol Medicine and Dentistry, Cambridge Physician, Salford Royal
London Foundation Hospitals’ Trust,
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Professor E Andrea Nelson, Dr Emma Clark, Associate Professor in
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Professor of Primary Care,
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Service User Representative of Medicine and Dentistry, Service User Representative
London
Professor Paul Carding, Professor Maria Stokes,
Professor of Voice Pathology, Dr Shaheen Hamdy, Professor of
Newcastle Hospital NHS Trust, Clinical Senior Lecturer Neuromusculoskeletal
Newcastle and Consultant Physician, Rehabilitation, University of
University of Manchester, Southampton, Southampton
Manchester
Observers
Dr Phillip Leech, Ms Kay Pattison Dr Morven Roberts, Dr Ursula Wells
Principal Medical Officer for Senior NIHR Programme Clinical Trials Manager, MRC, PRP, DH, London
Primary Care, Department of Manager, Department of London
Health , London Health
Interventional Procedures Panel

Members
Chair, Mr Seamus Eckford, Dr Nadim Malik, Dr Ashish Paul,
Professor Jonathan Michaels, Consultant in Obstetrics & Consultant Cardiologist/ Medical Director, Bedfordshire
Consultant Surgeon & Gynaecology, North Devon Honorary Lecturer, University PCT
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Warwickshire NHS Trust Consultant Colorectal Surgeon,
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Hospital University NHS Hospital Foundation Trust Critical Care, South Devon Consultant Ophthalmologist,
Foundation Trust Healthcare NHS Foundation Royal Wolverhampton Hospitals
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Professor Nicholas Clarke, General Practitioner, Garswood
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University Hospitals NHS Trust & Westminster Hospital London
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Professor Imti Choonara, Director of Public Health, Reader in Pharmacoeconomics General Practitioner, Leeds,
Professor in Child Health, Bury Primary Care Trust and Deputy Director, Centre and Associate Director, NHS
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Professor Robin Ferner, Health, IMSCaR, Bangor Team, Leicester
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Dr Lesley Wise, Director, West Midlands Centre Dr Gillian Shepherd,
Unit Manager, for Adverse Drug Reactions, Dr Yoon K Loke, Director, Health and Clinical
Pharmacoepidemiology City Hospital NHS Trust, Senior Lecturer in Clinical Excellence, Merck Serono Ltd
Research Unit, VRMM, Birmingham Pharmacology, University of
Medicines & Healthcare East Anglia Mrs Katrina Simister,
Products Regulatory Agency Dr Ben Goldacre, Assistant Director New
Research Fellow, Division of Professor Femi Oyebode, Medicines, National Prescribing
Mrs Nicola Carey, Psychological Medicine and Consultant Psychiatrist Centre, Liverpool
Senior Research Fellow, Psychiatry, King’s College and Head of Department,
School of Health and Social London University of Birmingham Mr David Symes,
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Reading Dr Bill Gutteridge, Dr Andrew Prentice,
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Mr John Chapman, Strategic Health Authority Obstetrician and Gynaecologist,
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Professor Scott Weich, Consultant Respiratory Mental Health User Consultant, Consultant & University
Professor of Psychiatry, Paediatrician, Lothian Health Gloucestershire Lecturer in Psychiatry,
University of Warwick Board University of Cambridge
Professor John Potter,
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Professor of Public Health in Senior Clinical Lecturer in Medicine, University of East Nurse/Consultant, Dunston Hill
the Early Years, Health Sciences Speech and Language Therapy, Anglia Hospital, Tyne and Wear
Research Institute, Warwick University of Manchester
Medical School Dr Greta Rait, Dr Karim Saad,
Dr Yann Lefeuvre, Senior Clinical Lecturer and Consultant in Old Age
Dr Sabyasachi Bhaumik, GP Partner, Burrage Road General Practitioner, University Psychiatry, Coventry &
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Leicestershire Partnership NHS
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Mrs Val Carlill, Cardiologist, County Durham & Child Psychiatrist, University of College London
Service User Representative, Darlington Foundation Trust Oxford
Gloucestershire Dr Simon Wright,
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362
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Professor of Statistics in Consultant Vascular Surgeon, Director of Public Health and Professor of Health Economics
Medicine, Centre for Statistics Gloucestershire Royal Hospital, Deputy Dean of ScHARR, and Group Co-ordinator,
in Medicine, University of Gloucester University of Sheffield University of East Anglia
Oxford
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Professor of Social Gerontology Effectiveness, Centre for Health University of Cambridge, & Developmental Medicine
& Health Services Research, Services Research, University of Cambridge and Professor of Obstetrics
University of Newcastle upon Newcastle upon Tyne and Gynaecology, University of
Tyne Professor Stan Kaye, Liverpool
Professor Pam Enderby, Cancer Research UK Professor
Professor Andrew Bradbury, Dean of Faculty of Medicine, of Medical Oncology, Royal Mrs Julietta Patnick,
Professor of Vascular Surgery, Institute of General Practice Marsden Hospital and Institute National Co-ordinator, NHS
Solihull Hospital, Birmingham and Primary Care, University of of Cancer Research, Surrey Cancer Screening Programmes,
Sheffield Sheffield
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Confederation for Physical Medicine, London Professor William Rosenberg,
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Antenatal Teacher and Tutor Mr George Levvy, and Consultant Physician,
Professor Iain T Cameron, and President, National Chief Executive, Motor University of Southampton
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Laboratory Service, London Hospital NHS Trust of Public Health, Directorate Director of Public Health
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Dr Carl Counsell, Bec Hanley, Health, North & East Yorkshire School, University of Plymouth
Clinical Senior Lecturer in Co-director, TwoCan Associates, & Northern Lincolnshire
Neurology, University of West Sussex Health Authority, York Professor Sarah Stewart-Brown,
Aberdeen Professor of Public Health,
Dr Maryann L Hardy, Professor Alexander Markham, Division of Health in the
Professor Howard Cuckle, Senior Lecturer, University of Director, Molecular Medicine Community, University of
Professor of Reproductive Bradford Unit, St James’s University Warwick, Coventry
Epidemiology, Department Hospital, Leeds
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Gynaecology, University of Healthcare Management Dr Peter Moore, Professor of Health Service
Leeds Consultant, Reading Freelance Science Writer, Research, Centre for Health
Ashtead Services Studies, University of
Dr Katherine Darton, Professor Robert E Hawkins,
Warwick, Coventry
Information Unit, MIND – The CRC Professor and Director Dr Andrew Mortimore,
Mental Health Charity, London of Medical Oncology, Christie Public Health Director, Mrs Joan Webster,
CRC Research Centre, Southampton City Primary Consumer Member, Southern
Professor Carol Dezateux, Christie Hospital NHS Trust, Care Trust Derbyshire Community Health
Professor of Paediatric Manchester Council
Epidemiology, Institute of Child Dr Sue Moss,
Health, London Professor Richard Hobbs, Associate Director, Cancer Professor Martin Whittle,
Head of Department of Primary Screening Evaluation Unit, Clinical Co-director, National
Mr John Dunning, Care & General Practice, Institute of Cancer Research, Co-ordinating Centre for
Consultant Cardiothoracic University of Birmingham Sutton Women’s and Children’s
Surgeon, Papworth Hospital Health, Lymington
NHS Trust, Cambridge Professor Alan Horwich,
Dean and Section Chairman,
The Institute of Cancer
Research, London
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Systematic Review of The Links Between Human Resource Management Practices and Performance

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Health Technology Assessment 2010; Vol. 14: No.

Systematic review of the links between

M Patterson, J Rick, S Wood, C Carroll,

Health Technology Assessment

Contact details are as follows:

How do I get a copy of HTA on DVD?

M Patterson,1* J Rick,2 S Wood,3 C Carroll,4

Declared competing interests of authors: none

Published October 2010

This report should be referenced as follows:

Health Technology Assessment is indexed and abstracted in Index Medicus/MEDLINE,

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

Identification of HRM practices ................. 237 Appendix 4 Guidance on monitoring

Appendix 1 Taken from original Health Technology Assessment

Appendix 2 HRM practice categories Health Technology Assessment

Appendix 3 HRM practice categories

BSI bloodstream infection NA nursing aide

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

How widespread is the use of

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

of implementation fidelity is more established, –– staffing

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

Future research foci could be usefully revised to take account of some of

A ppropriate human resource management

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

Review aim, scope and

Objective 1: Objective 5: Objective 2: Objective 4:

performance, and possible intervening variables outcomes. It outlines the identification of

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

development of methodologies for the review of Applying the systematic

As a result, a sixth objective was added to the list:

TABLE 1 Research objectives and specific research questions

Research objectives Research questions

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

to be viewed as a compass rather than an anchor, Identifying longitudinal studies

a Denotes the less sensitive, more specific version of the filter.

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Search process reliability score is achieved.47 Where a question

TABLE 3 Search filters and databases used by report chapter

Search filter Database

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form is piloted on several studies to ensure that Objective 1

intermediate outcomes was examined to identify Objective 5

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© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

How widespread is the use 1. were weighted and representative of UK

The first aim is addressed in this chapter and the Results

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TABLE 5 Comparison of included surveys

Representative of Unit = workplace Public sector Health sector

Categorisation of practices There is more information on training where a

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

TABLE 7 Reported use of HRM practices: work design

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na, data not available.

given preference, other things being equal, over external

in the question, ‘When filling vacancies do you have any

© 2010 Queen’s Printer and Controller of HMSO. All rights reserved.

na, data not available.

Percentage workplaces with