How high-performance work systems drive health care value: an examination of leading process improvement strategies

Qual Manag Health Care. 2012 Jul-Sep;21(3):188-202. doi: 10.1097/QMH.0b013e31825e88f6.


Background: As hospitals focus on increasing health care value, process improvement strategies have proliferated, seemingly faster than the evidence base supporting them. Yet, most process improvement strategies are associated with work practices for which solid evidence does exist. Evaluating improvement strategies in the context of evidence-based work practices can provide guidance about which strategies would work best for a given health care organization.

Methods: We combined a literature review with analysis of key informant interview data collected from 5 case studies of high-performance work practices (HPWPs) in health care organizations. We explored the link between an evidence-based framework for HPWP use and 3 process improvement strategies: Hardwiring Excellence, Lean/Six Sigma, and Baldrige.

Results and conclusions: We found that each of these process improvement strategies has not only strengths but also important gaps with respect to incorporating HPWPs involving engaging staff, aligning leaders, acquiring and developing talent, and empowering the front line. Given differences among these strategies, our analyses suggest that some may work better than others for individual health care organizations, depending on the organizations' current management systems. In practice, most organizations implementing improvement strategies would benefit from including evidence-based HPWPs to maximize the potential for process improvement strategies to increase value in health care.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Efficiency, Organizational*
  • Evidence-Based Practice
  • Health Workforce / organization & administration
  • Hospitals / standards
  • Qualitative Research
  • Quality Assurance, Health Care / methods*
  • Quality of Health Care*
  • United States