BackgroundThe search for causal links between human resource management (HRM) and organisational performance has dominated academic and practitioner debates for many years. However, much of this work comes from contexts outside health care and/or the UK.ObjectivesThis study tested the later stages of a well-established HRM model, testing whether or not there was evidence of causal links between staff experience and intermediate (staff) and final (patient and organisational) outcomes, and whether or not these differed in parts of the NHS. We used large-scale longitudinal secondary data sets in order to answer these questions in a thorough way.Data sourcesSearches were conducted using Health Management Information Consortium, MEDLINE, PsycINFO, Social Sciences Citation Index and EBSCOhost(from inception to May 2012).MethodsStaff experience data came from the national NHS staff surveys of 2009, 2010 and 2011, with trust-level measures of staff absenteeism, turnover, patient satisfaction, mortality and infection rates gathered from the same NHS years. Several analytical methods were used, including multilevel analysis, mediated regression, latent growth curve modelling and cross-lagged correlation analysis.ResultsIn general, the pattern was that better staff experiences are associated with better outcomes for employees and patients. Multilevel analysis found that the positive effects of staff perceiving equal opportunities on employee outcomes were especially strong, as were the negative effects of aggression and discrimination. Organisational-level analysis showed that better staff experiences (particularly those associated with better well-being and better job design, and more positive attitudes about the organisation generally) were linked to lower levels of absenteeism and greater patient satisfaction. There was some evidence that the relationship with absenteeism is causal, although the causal link with patient satisfaction was less clear-cut. Some relationships between staff experience and turnover, and some between staff experience and patient mortality, were also found (and a few with infection rates), with longitudinal analysis comparatively unclear about the direction of causality. Although many staff experiences were associated with absenteeism and patient satisfaction, these effects were not mediated and the reason staff experiences are linked to patient satisfaction appears to be separate from the link with absenteeism. In general, there is no single group of staff (or geographical region) for which staff experiences are the most important. However, nurses’ experiences generally had the strongest effects on absenteeism, followed by medical/dental staff. Few clear or explainable patterns for other staff group effects were found. Absenteeism was most readily predicted by staff experience in the West Midlands. Two Action Learning Sets of managers, and patient and public involvement representatives broadly supported the emerging findings of the factors that seemed to be important indicators of staff satisfaction and organisational outcomes.LimitationsThe relatively blunt nature of the data used meant that conclusions about the direction of causality were less clear. More specific limitations included that we had to limit outcome variables to those that were available already, that many variables were available for acute trusts, and that we could not break down data further within trusts or years.ConclusionsOverall, the research confirmed many expected links between staff experiences and outcomes, providing support for that part of the overall HRM model in the NHS. However, conclusions about the direction of causality were less clear (except for absenteeism). This is probably due in part to the relatively blunt nature of the data used. Future research may involve the careful evaluation of interventions designed to improve staff experience on more specific groups of staff, and the continued use of secondary data sources, such as those used in this report, to answer more specific, theoretically driven questions.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Researchers are becoming increasingly interested in the use of transformational leadership theory in higher education teaching (often referred to as transformational instructorleadership). Much of this body of research investigates a direct association between transformational instructor-leadership and student outcomes. In the present study, we take a step further by investigating (a) student engagement as a mechanism in the relationship between transformational instructor-leadership and students' academic performance and (b) structural distance as a moderator of the relationship between transformational instructor-leadership and student engagement. Using a sample of 183 students across the UK, the findings supported student engagement as a full mediator, but did not support structural distance as a moderator. This study contributes to theory by (a) showing a key underlying process through which transformational instructor-leadership is related to students' academic performance and (b) empirically examining all three dimensions of student engagement. Limitations, suggestions for future research, and practical implications are discussed.
In response to increased calls for research that can provide greater understanding of the relational and contextual issues surrounding leader identity construction processes, this qualitative study aims to provide insights into the subjective experience of constructing a leader identity within the context of organizations. Drawing on data from 50 semi-structured interviews, this paper focuses on significant sub-themes, which were grouped into two categories, namely identity catalysts (e.g. issues that participants identified as positively aiding in their leader identity construction process) and identity barriers (e.g. issues that participants identified as negatively impacting their leader identity construction process). These catalysts and barriers will be elaborated upon and their relationship to leader identity explained. This paper provides new insights into the leader identity construction process by using Leadership Identity Construction Theory as a lens for interpretation, and offers notable implications for theory, research and practice.
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