Lower Primary Care Nurse Articles Discussions

Journal of Business Research 68 (2015) 1466–1467 Contents lists available at ScienceDirect Journal of Business Research Can company restructuring create a healthier work environment, promote corporate entrepreneurship, and improve productivity?☆ Jesús Ruiz a,c,⁎, Alicia Coduras b,c,1 a b c University of Valencia, Spain Nebrija University, Spain EDEM, Spain a r t i c l e i n f o Article history: Received 15 February 2014 Received in revised form 15 December 2014 Accepted 15 January 2015 Available online 11 March 2015 Keywords: Best practices Human resources Production Workplace a b s t r a c t This study explores relationships between best practices in human resource (HR) management and the humanization of production processes. The study analyzes how best practices in HR management affect organizational health, productivity, and competitiveness in 4 workplaces with 480 employees. These workplaces implement a 3-year program of 20 practices in a sector specializing in fresh cut IV gamma products. Results show that these practices yield significant improvements in productivity indicators, risk prevention, corporate entrepreneurship, and work environment. © 2015 Published by Elsevier Inc. 1. Introduction and theoretical background The global economic crisis forces companies to increase productivity and competitiveness. Companies are aware they must align employee views with such strategies (Chuang, Chen, & Chuang, 2013). To do so, companies strive to humanize labor relations and redesign HR management practices. Hence, many management models treat people’s strategic value as a competitive advantage and a driver of economic growth. Numerous studies indicate that companies’ HR practices relate to the achievement of company objectives (Boselie, Hesselink, Paauwe, & van der Wiele, 2001; Delery & Doty, 1996; West, 1997). Three theoretical perspectives on HR practices exist: the universalistic perspective, the contingency perspective, and the best fit or configurative perspective. Building on the theory of human capital, human resources, and human capabilities, the universalistic model refers to the existence of HR practices whose effect on performance is always positive, regardless of other internal or external elements (Pfeffer, 1994). The universalistic model is the most human approach of the three theories. The contingency perspective posits that company strategy influences how HR practices affect performance. Finally, the configurative perspective ☆ The authors are grateful to Domingo Ribeiro, University of Valencia, and José Manuel Saiz-Álvarez, Nebrija University, for offering comments and suggestions to improve this manuscript. ⁎ Corresponding author at: EDEM Business School, Poeta Quintana 1, 46004 Valencia, Spain. E-mail addresses: jruiz@edem.es (J. Ruiz), acoduras@edem.es (A. Coduras). 1 EDEM Business School, Poeta Quintana 1, 46004 Valencia, Spain. Lower Primary Care Nurse Articles Discussions

http://dx.doi.org/10.1016/j.jbusres.2015.01.035 0148-2963/© 2015 Published by Elsevier Inc. suggests that company variables, including HR practices, often interact, leading to configurations that affect performance. Both the universalistic and configurative perspectives posit that HR practices’ overall effect is positive (Pfeffer, 1994). According to the universalistic perspective, the effect is independent of other practices. Conversely, under the configurative perspective, effects depend on other practices (Bassett-Jones, 2005). In the contingency perspective, the effect can be positive or negative depending on the company’s strategy. Studies in this field show a negative relationship between high performance and turnover. Conversely, studies show positive relationships between type of supervisor and high performance and training (Kalleberg & Moody, 1994); between performance-based remuneration and employee motivation (Dowling & Richardson, 1997); and between participation in decision-making and employees’ commitment to the company (Wallace, 1995). 2. Method 2.1. Test instruments The model comprised 20 good practices in HR management: communicating last year’s performance and next year’s objectives, designing a host plan, designing a set-up plan, establishing employee responsibilities, publishing a bulletin, gathering suggestions, conducting interviews, providing an employee assistance program, presenting results, producing a daily results table, conducting campaigns, holding troubleshooting groups, creating a happy-birthday program, scheduling breakfasts with managers, holding open days, studying the work J. Ruiz, A. Coduras / Journal of Business Research 68 (2015) 1466–1467 environment, running a training school, holding daily meetings, organizing technical training days, and opening an operations forum. Lower Primary Care Nurse Articles Discussions

A questionnaire to the entire workforce explored employees’ perceptions of each practice. The questionnaire comprised 20 six-point Likert-type items ranging from disagreement (1) to agreement (6). A separate questionnaire evaluated work environment. The questionnaire comprised 39 six-point Likert-type items, which in turn formed nine groups of factors: company characteristics, information and communication, leadership, development, job characteristics, work resources, teamwork, compensation, and revenues and HR rating. Three variables measured the program’s effect: daily absenteeism, voluntary rotation, and monthly accidents with or without medical leave. 1467 according to the HR performance and work-climate improvement program. The third shows the progress of financial performance. The fourth shows the progress of HR performance. The analyses test whether the actions improve the company’s financial and HR performance. Principal component analysis yields one principal component (i.e., the program’s effect) comprising seven variables representing actions in the program. This component explains 70% of the original variance. Scores of this component then represent independent variables in two general linear models whose dependent variables are financial performance and HR performance. Finally, simple regression models for each variable in the financial and human resources data sets used time as an explanatory variable to examine the program’s effect on all dimensions. 2.2. Participants and research design 4. Results Participants were 480 employees from four workplaces of a company specializing in fresh cut IV gamma products. Employees participated in this study over three years. The study adopted the ABA design: test/ retest reliability over three years with the same sample. Implementation of practices had five steps: first, commitment of senior management; second, diagnosis of current HR practices; third, planning (objectives, actions, media, timing, and tracking); fourth, communication and staff awareness; and fifth, implementation and monitoring. 3. Analysis The data yield a time series of monthly observations starting in September 2007 and ending in April 2010 (32 observations). The series contains four data sets. Lower Primary Care Nurse Articles Discussions

The first gives the number of employees each month. The second gives figures representing the actions in place Table 1 Regression analyses results. General linear model 1: financial performance Independent variable = program’s effect Dependent vars. B Sign. R2 Finances (BAI) Service rate Claim strange bodies Other claims Cost model Losses Health hygiene audit General expenses 811,603 0.61 −6.64 −39.54 −479,709 −3.97 0.14 794,575 0.000 0.000 0.000 0.000 0.000 0.000 0.012 0.000 39.2 60.1 73.6 79.8 53.6 87.5 19.3 87.5 General linear model 2: HR performance Independent variable = program impact Dependent vars. B Sign. R2 % non-wished rotation % total rotation % accidents Work environment % incidents % temporary work % absenteeism −0.30 −3.22 −0.12 8.78 −3.14 −2.78 −3.14 0.000 0.000 0.046 0.000 0.000 0.001 0.000 61.1 77.9 12.6 93.4 75.1 30.3 85.0 Simple linear regression analyses of trend Independent variable = time Focus: HR Dependent vars. B Sign. R2 % non-wished rotation % total rotation % accidents Work environment % incidents % temporary work % absenteeism −0.03 −0.34 −0.02 52.49 −0.34 −0.35 −0.33 0.000 0.000 0.001 0.000 0.000 0.000 0.000 65.4 77.0 29.9 68.9 78.7 42.8 81.3 Source: Authors’ own work. All analyses yield significant results and imply the program’s positive effect. Table 1 summarizes results. Prior to applying the regression models, Kolmogorov–Smirnov tests and Cronbach’s alpha (0.558) check the data’s suitability for the analysis techniques. All signs of regression coefficients are consistent with expectations of the HR practices’ effects. Thus, revenue (i.e., financial performance) increases after implementing the program. Productivity rate, results of the hygiene audit, general expenses, and work environment also improve after implementing the program. Likewise, HR practices improve work indicators whose coefficients take negative signs (i.e., absenteeism, rotation, accidents, and factors affecting productivity). 5. Conclusions Applying good HR practices in this company significantly improves financial performance, HR performance, and work environment. Company investment in HR practices is profitable and leads to greater productivity in corporate entrepreneurship because the company can develop new product lines after implementing these HR practices. Benefits of this change are growth, diversification, and greater corporate entrepreneurial spirit. Results corroborate the universalistic theory. Companies should consider this perspective when improving HR management. Results, though not generalizable, verify that HR programs can promote a healthier work environment, boost corporate entrepreneurship, and improve productivity. Such programs are therefore recommendable for all types of companies. References Bassett-Jones, N. (2005). Lower Primary Care Nurse Articles Discussions

The paradox of diversity management, creativity and innovation. Creativity and Innovation Management, 14(2), 169–175. Boselie, P., Hesselink, M., Paauwe, J., & van der Wiele, T. (2001). Employee perceptions on commitment orientated work systems. ERIM working paper no. ERS-2001-02-ORG. Rotterdam: Rotterdam School of Management. Chuang, C. -H., Chen, S. -J., & Chuang, C. -W. (2013). Human resource management practices and organizational social capital: The role of industrial characteristics. Journal of Business Research, 66(5), 678–687. Delery, J. E., & Doty, D. H. (1996). Modes of theorizing in strategic human resource management: Tests of universalistic, contingency, and configurational performance predictions. Academy of Management Journal, 4(39), 802–835. Dowling, B., & Richardson, R. (1997). Evaluating performance-related pay for managers in the National Health Service. International Journal of Human Resource Management, 3(8), 348–366. Kalleberg, A., & Moody, J. (1994). Human resource management and organizational performance. American Behavioral Scientist, 7(37), 948–962. Pfeffer, J. (1994). Competitive advantage through people. California Management Review, 36(2), 9–28. Wallace, J. E. (1995). Corporatist control and organizational commitment among professionals: The case of lawyers working in law firms. Social Forces, 3(73), 811–840. West, M. A. (1997). Developing creativity in organizations. Lower Primary Care Nurse Articles Discussions

Leicester: BPS Books. Available online at www.sciencedirect.com N u r s O u t l o o k 6 8 ( 2 0 2 0 ) 1 4
2 5 www.nursingoutlook.org Elements of the healthy work environment associated with lower primary care nurse burnout Linda Y. Kim, PhD, MSN, RN, PHNa,b,*, Danielle E. Rose, PhD, MPHb, David A. Ganz, MD, PhD, MPHb,c,d, Karleen F. Giannitrapani, PhD, MPHe,f, Elizabeth M. Yano, PhD, MSPHb,g, Lisa V. Rubenstein, MD, MSPHd,g,h, Susan E. Stockdale, PhD, MAb,i a b Cedars-Sinai Medical Center, Los Angeles, CA VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, CA c Division of Geriatrics, Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, CA d RAND Health, Santa Monica, CA e VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Palo Alto, CA f Department of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA g Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA h Division of General Internal Medicine and Health Services Research, UCLA Geffen School of Medicine, Los Angeles, CA i Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, Los Angeles, CA ARTICLE INFO Article history: Received 6 December 2018 Received in revised form 26 May 2019 Accepted 21 June 2019 Available online June 27, 2019 Keywords: Healthy work environment Interprofessional collaboration Nurse burnout Patient-centered medical home Primary care nurses ABSTRACT Background: Little is known about the relationship between primary care nurses’ work environment and burnout, particularly in settings where patient-centered medical homes (PCMH) have been implemented. Purpose: To investigate the relationship between PCMH nurses’ work environment and burnout. Methods: Multivariable analyses were performed using two waves of survey data from PCMH registered nurses (RNs; n = 170) and PCMH licensed vocational nurses (LVNs; n = 181) in 23 primary care clinics. Findings: True collaboration was inversely associated with PCMH RN burnout (b =
2.6, 95% confidence interval [CI] =
4.29,
0.08, p < .01). Meaningful recognition was inversely associated with PCMH LVN burnout (b =
5.1, 95% CI =
8.36,
1.82, p < .01). In models with all nurses, RN (vs. LVN) position was associated with higher levels of burnout (b = 6.2, 95% CI = 2.47, 9.84, p < .01). Discussion: This study highlights the important role of the work environment in reducing PCMH nurse burnout. Strategies to foster team collaboration and meaningful recognition should be investigated to reduce PCMH nurse burnout. Cite this article: Kim, L.Y., Rose, D.E., Ganz, D.A., Giannitrapani, K.F., Yano, E.M., Rubenstein, L.V., & Stockdale, S.E. (2020, January/February). Elements of the healthy work environment associated with lower primary care nurse burnout. Nurs Outlook, 68(1), 14
25. Lower Primary Care Nurse Articles Discussions

https://doi.org/10.1016/j.outlook.2019.06.018. Conflicts of interest: No conflicts of interest have been declared by the authors. * Corresponding author: Linda Kim, Cedars Sinai, Nursing Research Department, 8711 W. 3rd Street, Los Angeles, CA 90048. E-mail address: linyskim@ucla.edu (L.Y. Kim). 0029-6554/$ -see front matter Published by Elsevier Inc. https://doi.org/10.1016/j.outlook.2019.06.018 N u r s O u t l o o k 6 8 ( 2 0 2 0 ) 1 4
2 5 Introduction Work stress and burnout are significant concerns in nursing, as they not only affect individual nurses personally and professionally, but also the organizations in which they are employed and the patients they care for (Jennings, 2008). Nurse burnout has been linked to lower quality of care, poorer patient safety and health outcomes, and lower patient satisfaction (Cimiotti, Aiken, Sloane, & Wu, 2012; McHugh, Kutney-Lee, Cimiotti, Sloane, & Aiken, 2011; Poghosyan, Clark, Finlayson, & Aiken, 2010). Consequently, Bodenheimer and Sinsky (2014) suggested that the Triple Aim— national goals to optimize population health by (1) enhancing patient experience, (2) improving population health, and (3) reducing costs— expanded to the Quadruple Aim, adding the fourth goal of improving the work life of health care providers, including nurses. The American Association of Critical-Care Nurses Healthy Work Environment (AACN HWE) Standards, first issued in 2005 (Table 1), increased national and international attention to the work environment’s impact on nurse retention, team effectiveness, nurse and patient outcomes, and burnout, particularly in acute care settings (American Association of CriticalCare Nurses, 2016). However, attention to these standards applied in other settings including ambulatory care settings is also much needed, especially since the various service/departments in which nurses work, tasks performed, and the role played by the health care staff as well as the type of patients treated, may impact levels of nurse burnout (Monsalve-Reyes et al., 2018). In primary care settings, nurses’ role differs from that of acute care nurses, especially following implementation of patient-centered medical homes (PCMH)—a team-based model of patient care delivery that encompasses the core functions of primary health care. Within the PCMH model, responsibility for patients is shared by all team members in the PCMH, in contrast to the traditional physician-centric approach. The PCMH model also emphasizes continuity and long-term relationships with patients, in contrast to acute care settings that focus on fixing what “broke” and sending the patient back to primary care. As such, primary care nurses practicing within a PCMH model often share responsibilities for patient 15 care activities with other members of the interprofessional team consisting of the primary care provider and other health care professionals. They must also undertake expanded roles including chronic illness management, telephone triage, and coordination of longitudinal and comprehensive patient care delivery by initiating and informing referrals to other health care professionals and participating in team-based planning (Norful, Martsolf, de Jacq, & Paghosyan, 2017; Smolowitz et al., 2015). Lower Primary Care Nurse Articles Discussions

With the increasing number of primary care practices adopting the PCMH model of care delivery, a better understanding of the relationship between the PCMH practice environment and various burnout experienced by primary care nurses practicing in these settings is urgently needed. Much is already known about the relationship between various practice environment factors on nursing burnout in acute care settings (Dall’ora, Griffits, Ball, Simon, & Aiken, 2015; Demir, Ulusoy, & Ulusoy 2003; Laschinger, Grau, Finegan, & Wilk, 2010; McHugh & Ma, 2014). For instance, in acute care settings, lower levels of nurse staffing, working night shift, or shifts that last 12 hours or longer were linked to increased nurse burnout (Dall’ora et al., 2015; McHugh & Ma, 2014). Furthermore, higher levels of burnout were reported by nurses who experienced poor interprofessional relationships, including horizontal/lateral violence and bullying by physicians as well as other members of the nursing team (Demir et al., 2003; Laschinger et al., 2010). On the other hand, work environment factors including sufficient staffing, authentic leadership that provides recognition and support, participatory decision-making, and effective nurse
physician relationships, all promoted through workplace empowerment, were associated with lower levels of nurse burnout (Laschinger, Finegan, & Wilk, 2011; Laschinger & Leiter, 2006; Leiter & Laschinger, 2006). These mitigating factors (e.g., true collaboration, skilled communication, effective decision-making, authentic leadership, meaningful recognition, and appropriate staffing) are essentially the components of the HWE endorsed by the AACN. While several studies have examined various factors associated with burnout in primary care, little is known about the impact of the workplace environment on primary care nurse burnout, particularly those practicing in PCMH settings (Helfrich et al., 2014; Kim et al., 2018; Table 1 – AACN HWE Standards (AACN, 2016) Skilled communication True collaboration Effective decision-making Appropriate staffing Meaningful recognition Authentic leadership Nurses must be as proficient in communication as they are in clinical skills Nurses must be relentless in pursuing and fostering true collaboration Nurses must be valued and committed partners in making policy, directing and