Industrial and organizational psychology

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Robert G. Badgett, M.D.[1]

Industrial and organizational psychology is "the branch of applied psychology concerned with the application of psychologic principles and methods to industrial problems including selection and training of workers, working conditions, etc."[1]

Research studies in organizational psychology can be:

  • Experimental or causal studies. Ex-vivo laboratory with volunteers in simulations or games.
  • Observational or correlational studies. In-vivo field studies.

Organizational states

Differences between the states have been challenged and instead an A-factor has been proposed[2]. However, this assesrtion has been challenged[3].

Workforce wellbeing has been described as a combination states, "job satisfaction, work engagement, and lower burnout"[4].

Organizational commitment, while not strictly a state, has conceptual overlaps with engagement. Meyer and Allen's proposes a three-factor organizational commitment scale (OCS)[5]: affective, continuance, normative[6][7]. Engagement, especially dedication, is correlated with commitment[8].

Outcomes of these states are discussed in the separate "Outcomes" section below this.

Flourishing

Flourishing involves a positive state of psychological or social well-being and positive functioning (not necessarily learning) and addresses life in general rather than just work.[9]

Keys recommends measuring with the 14-item Mental Health Continuum Short Form (MHC-SF)[10][11]:

  • psychological or social well-being
  • high score on 6 of 11 scales of positive functioning

However, the concept is variably conceptualized thus making it difficult to study.[12] Some authors do not include positive functioning[13].

Important contributors to flourishing focus on relationships with others at work and are[14]:

  • Giving to others (due to impact on meaningfulness)
  • Task assistance receipt (due to impact on job satisfaction)
  • Friendship (due to positive emotions at work)
  • Personal growth (due to impact on life satisfaction).
Measurement

A six-point scale has been proposed[15][16].

A short scale to measure flourishing has been proposed.[17]

Thriving

Thriving has two components according to factor analysis[18]:

  • Vitality. In this analysis, vitality is very similar to Schaufeli's Vigor subscale of the UWES-9 Engagement scale (see 'Engagement' below)
  • Sense of learning or improvement

One similar, proposed definition is[19]"

an employee who is thriving in a state of optimal health as one for whom the functions of maintenance, growth, and generativity support each other

Alternatively, Microsoft has defined in their Work Trend Index that thriving is "“to be energized and empowered to do meaningful work.”[20] Thus, Microsoft's "energized" maps to Spreitzer's vitality and "empowered" implies learning and improvement. Microsoft includes questions such as:

  • "Would you say you are thriving or struggling with the following types of bonds or relationships at work?"

A separate body of research has emerged more recently that gives a broader definition to thriving, but does not cite the above research that has used factor analysis to identify core features[21].

Importance

87% of U.S. workers across industries report that their job "requires [the respondent] to learn new things".[22]

Measurement

Thriving can be measured[23]:

  • "I see myself continually improving"
  • "I continue to learn more as time goes by"

Thriving can also be measured by[24]:

  • "To what extent do you learn new things at work?
  • "To what extent do the things you learn at work help your in your life"
  • "To what extent do the things you learn at work enable you to thrive in life"

Responses range from 1 = “not at all” to 5 = “to an exceptional degree”

A component of thriving can be measured by[25]:

  • "I am frequently taught new things by other people in this clinic."

Antecedents

The antecedents of thriving have been reviewed[26]. Thriving is negatively correlated with burnout[18][27]; however, this benefit may be confined to employees with high openness to experience[27]

Thriving is fostered among employees whose regulatory focus is promotional by an "employee involvement climate", defined as having employees who "mutually understand that they (a) possess the power to make decisions and act on them, (b) may access and share the informational resources needed to undertake those actions effectively, (c) have opportunities to update their knowledge in order to continually develop their effectiveness, and (d) are rewarded for improving the effectiveness of their work unit and organization"[28].

Outcomes

A meta-analysis by Kleine found that "that thriving exhibits small, albeit incremental predictive validity above and beyond positive affect and work engagement, for task performance, job satisfaction, subjective health, and burnout".[29]

Engagement

Engagement has three dimensions according to factor analysis[30]:

  • Vigor (physical engagement)
  • Dedication (effective engagement)
  • Absorption (cognitive engagement)

Engagement depends on both organizational factors and personnel personality[31].

  • Inadequate job resources are a cause as found in the job demands-resources model of burnout[32].
  • Engagement is associated with organizational success[33][34], including in health care[35].
  • Engagement is associated with leadership styles[36]
  • Employee personality may account for 50% of variance in engagement[37]. Associated personality traits are positive affectivity, proactive personality, conscientiousness, and extraversion.

Alternative view

Agency theory "assumes that humans are self-interested rational beings whose actions should be constrained to achieve organizational goals (which are opposing)".[38]

Macey and Schneider have divided engagement into[39]

  • Trait engagement (disposition)
  • State engagement (feelings as described above by Schaufeli)
  • Behavioral (outcomes - extra-role behavior). Google has chosen to measure behavioral engagement: innovation, execution, and employee retention[40].

Engagement and burnout may be related[41]:

  • Emotional exhaustion may be the opposite of vigor
  • Cynicism may be the opposite of dedication
Measurement

Engagement can be measured by several validated scales[42][43].

  • Schaufeli's UWES-9 contains 9 question measuring the three scales vigor, dedication, and absorption.[42] The single highest loading question for each scale is below what the two additional items for each factor:
    • Vigor: "At my work, I feel bursting with energy"
      • "At my job, I feel strong and vigorous."
      • "When I get up in the morning, I feel like going to work"
    • Dedication: "I am enthusiastic about my job"
      • "My job inspires me"
      • "I am proud of the work that I do"
    • Absorption: "I am immersed in my work"
      • "I get carried away when I’m working"
      • "I feel happy when I am working intensely"
  • Three item variants of Schaufeli's UWES-9 using one item from each factor.
    • A UWES-3 using the three items that loaded first for each dimension has been validated in German university students[44] and in diverse settings across 5 countries[45].
      • “At my work, I feel bursting with energy” (vigor)[45]
      • “I am enthusiastic about my job” (dedication)[45]
      • “I am immersed in my work” (absorption)[45]
    • An other 3-item version of the UWES-9 has been validated that has the following variation[46]:
      • "Time flies when I am working" for absorption
    • Another 3-item version of the UWES, using the variations below, has been validated[47]:
      • "At my work, I feel full of energy" (vigor)
      • "Time flies when I am working" (absorption)
    • Another 3-item version of the UWES, using the variations below, has been validated[48]:
      • "At my job, I feel strong and vigorous" (vigor)
Benchmarks for selected items from the UWES-9[42] engagement survey
Dimension Item APA, 2014
(always, very often) 		NHS, 2019
(always, often)
Vigor I look forward to going to work.(NHS)
When I get up in the morning, I feel like going to work (APA 2014 and NIOSH) 		33 60
Dedication I am enthusiastic about my job (NHS, APA 2014).
My work inspires me (NIOSH) 		40 75
Absorption Time passes quickly when I am working (NHS)
I am immersed in my work (APA 2014, NIOSH) 		40 76
Mean score 3.62 (across 9 items)
American Psychological Association (2014). 2014 Work and Well-Being Survey. Available at http://www.apaexcellence.org/assets/general/2014-work-and-wellbeing-survey-results.pdf

National Health Service. NHS Staff Survey Results. Available at https://www.nhsstaffsurveyresults.com/homepage/national-results-2019/breakdowns-questions-2019/ (data for full-time employees of acute and combined trusts.

Rich, Levine, and Crawford[43] measure engagement with three dimensions: physical, emotional, and cognitive. Example questions from these three dimensions include:

  • Physical: I try my hardest to perform well on my job
  • Emotional: I feel energetic at my job; I am enthusiastic in my job
  • Cognitive: At work, I focus a great deal of attention on my job; At work, I am absorbed by my job

Satisfaction

Main article: Job satisfaction

Satisfaction with work is a "pleasurable or positive emotional state resulting from the appraisal of one's job or job experiences”[49].

Satisfaction has been similarly measured for life in general with single questions[50].

Job satisfaction differs from measuring life satisfaction[51].

Burnout

Main article: Burnout (psychology)

Workaholism more closely correlates with burnout than with engagement, although workaholism correlated with both (weakly negatively with engagement [via absorption])[52].

Engagement may not simply be the opposite of burnout. Engagement and burnout may be related more specifically[41]:

  • Emotional exhaustion may be the opposite of vigor
  • Cynicism may be the opposite of dedication

The distinction between burnout and depression is not clear[53].

Antecedents

Regarding engagement and job satisfaction, the meaningfulness of work strongly correlates. An analogy has been proposed for housestaff wellbeing that asserts that meaningfullness (relevance) is most important[54]:


Sigmund Freud...thought the meaning of life was sex. Alfred Adler thought it was power. And Viktor Frankl thought it was relevance.

The key antecedent of thriving is proposed to be self-determination theory, which includes autonomy, competence, and relatedness. This emphasis links thriving to self-determination theory of Deci. Studies have validated autonomy as an antecedent of thriving. Autonomy may be related to creative self-efficacy.

Teams may be important via their connection to membership and relatedness[55].

How to foster thriving has been reviewed and includes:

  • Providing decision-making discretion
  • Sharing Information. Using transparency and open book management
  • Minimize incivility at work
  • Provide performance feedback
  • Promote diversity
  • Mastery of tasks. In 1908, the Yerkes-Dodson law, and later the concept of 'flow' by Csikszentmihalyi, both propose that engagement is strongest when a task is intermediate in difficulty. Idea implementation leads to feelings of self-efficacy[56].

Regarding autonomy, its influence can sometimes be negative, perhaps due to overconfidence[57][58]. In a in vitro study:

  • Students were both assigned to teams and told what idea to pursue: worst performance
  • Students could choose their teammates, but they were assigned an idea to work on: best performance
  • Students were assigned to teams, but were given the autonomy to choose their own idea: best performance
  • Students were allowed to choose both their teammates and their ideas: worst performance

Characteristics of individuals

The "Big Five personality traits" are:

  • Openness to experience
  • Conscientiousness
  • Extraversion
  • Agreeableness
  • Neuroticism

Of these, conscientiousness, openness to experience.

Characteristics of managers

Characteristics of managers= of managers have been found to be important for physicians and nurses[59].

Knowledge sharing and hiding

Knowledge hiding may happen in the presence of job insecurity[60].

Knowledge sharing among team members is more likely when hierarchy stability across team members was low[61].

Theory and models of antecedents, indicators, and outcomes

The antecedents of thriving have been reviewed[26].Yerkes-Dodson Law suggestions that the relationship between performance and arousal is bell-shaped so that performance may decrease with excessive arousal. This is similar to work by Csikszentmihaly[62]. The concept of "competence frustration" (versus "flow") suggests a similar bell-shaped relationship between task difficulty and engagement[63]

Phipps-Taylor has reviewed and merged theories to have four factors that influence engagement once Hygiene factors have been fulfilled[64]Ryff, earlier, has a very similar proposal[65][66]. A collaboration of the NIOSH and RAND yielded similar concepts[67].

Ryiff, 1989[65][66] Phipps-Taylor, 2013[64] NIOSH-RAND, 2018[67]
Purpose
Autonomy
Growth
Environmental Mastery
Relations
Self-acceptance

 Social purpose
Autonomy/power

Mastery
Relatedness

Hygiene factors 		Meaning/purpose
Autonomy/control


Peers/coworkers, manager/org support

Hygiene factors

Self-determination theory

Self-determination theory was proposed in the early 1980s.[68] In this theory, autonomy, mastery (competence), and relatedness have been validated as components[69][70] and contains three factors:

  • Autonomy
  • Mastery
  • Relatedness and social connections

This framework of three items was revised to four factors by Spreitzer in 1992; not clear why relatedness was not included[71][72]:

  • Autonomy
  • Competence
  • Meaningfulness
  • Impact

Gagne included these four themes (impact and mastery merged) in 2006[73].

The SDT and Spreizter models were consolidated, with relatedness or membership included, by Ryff [66] and Phipps-Taylor[64]:

  • Ryff's six-factor model in 1989[65] of 1) 'autonomy', 2) 'environmental mastery', 3) 'purpose in life', 4) 'positive relationships', and the addition of 'personal growth' and 'self-acceptance'. Interestingly, the addition of personal growth presaged Spreitser's inclusion of personal growth in her subsequent model of thriving later in 2011.

SDT and JDR have been integrated[74].

SDT has also been proposed to explain learner behavior in medical education[75].

The components of control

The dimensions of job control may include[76]

  • "Decision authority (i.e., decision latitude concerning one's work pace and phases, and independence from other workers while carrying out tasks)"
  • "Skill discretion (i.e., the level of cognitive challenges and variety of tasks at work)"
  • "Predictability on the job (i.e., the clarity of work goals and opportunity to foresee changes and problems at one's work)"

The Finnish Occupational Stress Questionnaire measures these dimensions with 5 questions each such as[77]:

  • Decision authority, “Can you plan your work by yourself?”)
  • Skill discretion, (e.g., “Is your work monotonous or variable?”)
  • Predictability, (e.g., “Can you anticipate the problems and disturbances arising in your work?”)

Positive outcomes associated with self-determination

Employee perception of the factors of self-determination theory and servant leadership are more likely to have extra-role behavior[78]. Empowerment may be important in diverse industries[79].

Idea implementation improves wellbeing via self-efficacy[56].

Negative outcomes associated with the absence self-determination

The English Whitehall study (Whitehall data sharing policy) found that "the largest contribution to the socioeconomic gradient in CHD frequency was from low control at work" [80]. The Whitehall study asked " Fifteen items deal with decision authority and skill discretion, and these were combined into an index of decision latitude or control". The most significant outcome was "doctor-diagnosed ischaemia".

A later analysis of the Whitehall II study suggests that the harm may not confined to respondents who reported that stress affected their health - rather than simply those that reported stress[81]. Another follow-up analysis suggested importance to the perception of justice at work[82].

The Finnish cohort found that the association may be more specifically due to predictability at work (“Can you anticipate the problems and disturbances arising in your work?”)[76]

However, the causality of these associations has been disputed in the West of Scotland collaborative study that measured stress with the Rose Questionnaire that does not specifically ask job control[83]. The Scottish studies summarize the conflict in their Table.

Job demands–resources (JD-R) framework

Job demands–resources (JD-R) framework[32] proposes that "resources energize employees and foster engagement, which, in turn, yields positive outcomes such as high levels of well-being and performance"[84]

This framework ties to the theory as components of the framework "are regarded as playing a motivational role, since they help fulfil human needs for autonomy, competence or relatedness".[84]

Social exchange theory (SET)

"According to SET, relationships between employees and employers are based on norms of reciprocity."[84]


Kahn's theoretical framework

Kahn posed that three key attributes of work are meaningfulness, psychological safety. and availability (availability is related to mastery) [85] and later validated by May[86] .

Culture and Climate

Organizational culture is "beliefs and values shared by all members of the organization. These shared values, which are subject to change, are reflected in the day to day management of the organization"[87]. Components of culture have been described based on anthropology[88][89][90].

Organizational culture affects organizational effectiveness[91]

Employee involvement climate, defined as having employees who "mutually understand that they (a) possess the power to make decisions and act on them, (b) may access and share the informational resources needed to undertake those actions effectively, (c) have opportunities to update their knowledge in order to continually develop their effectiveness, and (d) are rewarded for improving the effectiveness of their work unit and organization" is associated with thriving among employees whose regulatory focus is promotional[28].

The role of work climate has been examined in studies based on complexity science[92][93], in order to predict why quality improvement projects succeed[94][95][96] and fail[97].

However, attributes of culture study may not be well based on theory and linked to the above settings.[98]

A reciprocal, beneficial relationship has been proposed between a positive work climate and mission goals[99]. This may be similar the Matthew effect[100].

Outcomes of positive organizational psychology

A systematic review reported that most studies found benefit on outcomes of health care organizations that have positive organizational psychology[101].

Outcomes of engagement

Benefits

Engagement may be more important than job satisfaction of intrinsic motivation in predicting job performance[102].

Engagement is associated with organizational success[103][104], including in health care[35].

Innovation and curiosity.[105]

Job crafting and proactive and prosocial behavior

Prosocial behavior may occur[106].

Googler-to-Googler (G2G) is an example of institutionally supported shared learning of crafted idea. This was started in 2007, possibly by Lazlo Bock who was at Google till 2016[107], or Karen May, VP of People Development[108]

Employees may recommend their job to others[109]. This is a type of prosocial behavior.

Harm

Engagement has been suggested to be susceptiable to the "Too-Much-of-a-Good-Thing Effect"[110][111]. n addition, high engagement has been associated with:

  • Harm in family life[112].

If harm occurs from too much engagement:

  • Short-term and long-term effects may different. In a two-wave panel study, short-term adverse effects were found for high levels of engagement, but no adverse effects were found for long-term engagement[113]
  • Absorption may be associated with more harm outside of work than the other dimensions of engagement[114]
  • The effect may be curvilinear[115][113].
  • May interact with workaholism[116]. However, this may mainly occur through absorption[117]

In summary, harm from high levels of engagement may be focused on absorption and may only be short-term.

Leadership

Main article: Leadership

The distinction between management has become blurred[118].

Interventions to promote positive organizational psychology

Available studies have been reviewed.[119] Studies using appreciative inquiry have been done.[120][121]

Switching to a flatter organizational structure may help[122].

In the U.K. National Health Service, the Boorman report makes 20 recommendations[123] Subsequent systemic review of interventions incorporating these recommendations has found benefit on the workforce[124].

Gamification may help[125].

Best practices

In medicine, recommendations for high-performance work systems are available and include[126][127]:

  • Engaging staff
  • Acquiring and developing talent
  • Empowering the frontline. However, empowering one segment of the frontline may result in bordering another segment[128].
  • Aligning leaders
  • Employee and Organizational outcomes

Emerging, new ideas

Unionization may be able help physicians in training[129].

Surveys to solicit employee feedback

Serial surveying of employee opinion may be effective[130][131]. However, action in response to feedback is needed[132]. Thus, selective action may cause feedback to create a Matthew effect as leaders who are already successful may be disposed to act on the feedback[133].

Employees can help guide survey design[134].

Many surveys are available[135][136].

NHS Staff Surveys

The NHS Staff Surveys have been administered since 2003 in England. In Scottland, the NHS-Scottland also fields surveys[137] .

Contents
Workforce states

Burnout is not measured with Maslach's survey[138]. A proxy question for the emotional exhaustion component is available:

  • "During the last 12 months have you felt unwell as a result of work related stress."

Job satisfaction is not measured directly, but a proxy question is available:

  • "I would recommend my organisation as a place to work."

Engagement, using three items from the UWES-9[139], has been measured since 2012:

  • Vigor/vitality: "I look forward to going to work."
  • Dedication: "I am enthusiastic about my job."
  • Absorption: "Time passes quickly when I am working."

Thriving is not available although a validated scale is available[18]. The Staff Surveys has one related question:

  • "The team I work in often meets to discuss the team’s effectiveness."
Leadership tactics
Main article: Leadership

Empowerment, using questions similar to Spreitzer's Measuring Empowerment survey which measures[140]:

  • Meaningfulness or purpose
    • Not directly asked. Related question is "The opportunities I have to use my skills."
  • Competence or efficacy
    • "I am able to do my job to a standard I am personally pleased with."
  • Self-determination
    • "I have a choice in deciding how to do my work."
    • "There are frequent opportunities for me to show initiative in my role."
  • Impact
    • "I am able to make improvements happen in my area of work." and other, similar questions

Complexity leadership theory is partly measured although not using validated items from scales for complexity leadership theory (information gathering and information using)[141][142] and validated items from reciprocal learning[25][143][144] and Relational Coordination Scale[143].

  • Generative (information gathering)
    • "Is patient / service user experience feedback collected within your directorate / department?"
    • "I receive regular updates on patient / service user experience feedback in my directorate / department"
  • Administrative (information using)
    • "The team I work in often meets to discuss the team’s effectiveness."
    • "When errors, near misses or incidents are reported, my organisation takes action to ensure that they do not happen again."
    • "Feedback from patients / service users is used to make informed decisions within my directorate / department"
    • "I am confident that my organisation would address my concern" and similar questions

Public reporting and reporting of workforce state to external stakeholders

See also: Burnout (psychology)

This may include public reporting.

Public reporting has been used to try to improve organizational culture.[145][146] Recommendations for how to report have been proposed.[147][148]

Environmental, social and corporate governance (ESG)

Environmental, social and corporate governance (ESG) was defined in 2004 by U.N. Secretary General Kofi Annan[149]. The "S" includes workforce.

The organizations CDP, CDSB, GRI, IIRC and SASB may start collaborating iva the Impact Management Project of the World Economic Forum and Deloitte[150]

Another collaboration is the recent creation of the [International Sustainability Standards Board] (ISSB) within the IFRS Foundation[151].

Groups striving to implement these goals:

The IIRC and SASB merged in 2021 to form the Value Reporting Foundation[153].

ESG ratings, when not conflicting, predict future ESG activity[154].

Concerns have been made about the need to improve the quality of reporting to increase impact[155][156].

'Comply or explain' may be an option for implementing ESG reporting[157].

Shareholder activism

One lever ESG reporting has is to guide proxy voting on ESG-related shareholder proposals[158].

Examples of a shareholder activism have been reported[159][160].

Human resource management

Human resource management practices are associated with hospital mortality[161][162].

Components of Human Resource Management can be divided[163]:

Technical Human Resource Management

  • Benefits and services
  • Compensation
  • Recruiting and training
  • Safety and health
  • Employee education and training
  • Retirement strategies
  • Employee/industrial relations
  • Social responsibility programs
  • EEO for females, minorities, etc.
  • Management of labor costs
  • Selection testing
  • Performance appraisal
  • Human resource information systems
  • Assessing employee attitudes

Strategic Human Rource Management

  • Teamwork
  • Employee participation and empowerment
  • Workforce planning—flexihitity and deployment
  • Workforce productivity and quality of output
  • Management and executive development
  • Succession and development planning for managers
  • Advance issue identification/strategic studies
  • Employee and manager communications
  • Work/family programs'*
High-Performance Work Practices (HPWP)

HPWPs, orginally developed by the U.S. Department of Labor[164], are human resource practices that[165][126]:

  • "increase employees’ knowledge, skills, and abilities (KSAs)"
  • "empower employees to leverage their KSAs for organizational benefit"
  • "increase their motivation to do so"

The following early study of HPWP have been found to affect employee outcomes (turnover and productivity) and measures of corporate financial performance[163]

Employee skills and organizational structures

  • What is the proportion of the workforce who are included in a formal information sharing program (e.g.. a newsletter)?
  • What is the proportion of the workforce whose job has been subjected to a formal job analysis?
  • What proportion of non-entry level jobs have been filled from within in recent years?
  • What is the proportion of the workforce who are administered attitude surveys on a regular basis?
  • What is the proportion of the workforce who participate in Quality of Work Life (QWL) programs, Quality Circles (QC). and/or labor-management participation teams?
  • What is the proportion of the workforce who have access to company incentive plans, profit-sharing plans, and/or gain-sharing plans?
  • What is the average number of hours of training received by a typical employee over the last 12 months?
  • What is the proportion of the workforce who have access to a formal grievance procedure and/or complaint resolution system?
  • What proportion of the workforce is administered an employment tesi prior to hiring?

Employee motivation

  • What is the proportion of the workforce whose performance appraisals are used to determine their compensation?
  • What proportion of the workforce receives formal performance appraisals?
  • Which of the following promotion decision rules do you use most often? (a) merit or performance rating alone; (b) seniority only if merit is equal; (c) seniority among employees who meet a minimum merit requirement; (d) seniority.
  • For the five positions that your firm hires most frequently, how many qualified applicants do you have per position (on average)?
Assessing employee attitudes (AHRQ)

High-Performance Work Practices have been more recently proposed by the United States [Agency for Healthcare Research and Quality] (AHRQ)[166][126]. These include:

Subsystem #1: Engaging Staff

  • Conveying mission and vision
  • Information sharing
  • Employee involvement in decision-making. Defined by the AHRQ as " Practices supporting employees' ability to influence the “decisions that matter” through mechanisms such as quality circles, process project teams, management/town hall meetings, and/or suggestion systems." "2007). Employee surveying and visibly acting on survey results also fit into this practice category."[126]
  • Performance-contingent compensation

Subsystem #2: Acquiring and Developing Talent

  • Rigorous recruiting
  • Selective hiring
  • Extensive training
  • Career development

Subsystem #3: Empowering the Frontline. Defined by the AHRQ as "These practices most directly affect the ability and motivation of frontline staff, clinicians in particular, to influence the quality and safety their care team provides."

  • Employment security
  • Reduced distinctions
  • Teams/decentralized decisionmaking

Subsystem #4: Aligning Leaders. Defined by the AHRQ as "These practices influence the capabilities of the organization's leadership in running and evolving the organization as a whole."

  • Management training linked to organizational needs. Defined by the AHRQ as "Practices involving the alignment of leadership development resources with the strategic direction of the organization. Examples include use of core competency models and/or incorporation of goals to guide training, assessment, and feedback programs."
  • Succession planning
  • Performance-contingent compensation

A meta-analysis in 2006 has shown the effectiveness of HPWPs for five dimensions of organizational performance measures: [165]:

  • productivity
  • retention
  • accounting returns
  • growth
  • market returns
Joint Commission

In 2013, the Joint Commission proposed a description of reliability[167]. Their description did not address who orhow decisions are made.

High-Performance Management System (IHI)

More recently in 2016, the Institute for Healthcare Improvement (IHI) developed the High-Performance Management System (HPMS)[168][169]. Key components are:

Primary Driver P1: Drive Quality Control

  • S1: Standardization: Processes exist to help define and disseminate standard work (what to do and how to do it).
  • S2: Accountability: A process is in place to review execution of standard work.
  • S3: Visual Management: Process performance information is continuously available to synchronize staff attention and guide current activities.
  • S4: Problem Solving: Methods are available for surfacing and addressing problems that are solvable at the front line, and for developing improvement capability.
  • S5: Escalation: Frontline staff scope issues and escalate those that require management action to resolve.
  • S6: Integration: Goals, standard work, and QI project aims are integrated across organizational levels and coordinated among units and departments.

Primary Driver P2: Manage Quality Improvement

  • S7: Prioritization: Processes are established to help prioritize frontline improvement projects based on organizational goals.
  • S8: Assimilation: Improvement projects are integrated into daily work.
  • S9: Implementation: Frontline teams have support to move from QI back to QC, integrating the results of QI projects into standard processes.

Primary Driver P3: Establish a Culture of High-Performance Management

  • S10: Policy
  • S11: Feedback
  • S12: Transparency
  • S13: Trust

The IHI HPMS does not well map to antecedents of workforce engagement[85][170]:

  • Membership and safety

( Availability and mastery

  • Meaningfulness
  • Autonomy or self-determination
Evidence of effectiveness

Several studies[162][171] and systematic reviews[165][172] report effectiveness.

Hiring practices

See also: Leadership § Selection and development of leaders
Gender

Women may make group decision making more effective[173] and be inclined to more effective leadership styles[174].

Opt-out promotion decisions may be effective in promoting gender equality[175]. Women are less likely to self-promote in their self-assesments[176][177]

Affirmative action or quotas may have mixed effects[178].

Lean-in training may cause harm by suggesting women are responsible for reducing disparities by changing themselves rather than the system[179].

Diversity training may cause harm[180].

Teamwork promotion

Promoting teamwork in healthcare may help address burnout in studies [181][182]

Teamwork might be effective be promoting mastery and membership.

Harmful practices

Overworked managers may treat employees unfairly[183]. Daily performance appraisal may be harmful[184].

Financial incentives

Financial targets may not help motivate[185].

Pay for performance can reduce mental health of employees[186].

However, one field study found that the impact of incentives can be positive depending on the management style[187].

Employee turnover

The antecedents of the turnover of medical assistants have been systematically reviewed[188].

Organizational decision making and conflict resolution

Organizational decision making is "the process by which decisions are made in an institution or other organization". [189]

Evidence-based recommendations have been made for decisions by small groups[190]:

  • "Keep the group small when you need to make an important decision"
  • "Choose a heterogenous group over a homogenous one (most of the time)"
  • "Appoint a strategic dissenter (or even two)"
  • "Collect opinions independently"
  • "Provide a safe space to speak up"
  • "Don’t over-rely on experts"
  • "Share collective responsibility"

Consensus

Group members may overestimate the degree of consensus[191]. This may be due to difficulty in inferring the opinion of a teammember[192].

Voting

There is conflicting evidence on the role of voting; however, studies varies in whether voting was attributed or anonymous and whether postdecisional voice by the minority opinion was encouraged and recorded.

There are multiple types of voting and multivoting may be the best choice[193]:

  • "Plurality voting, where voters can only choose one option." This can be problematic when more than two options occur and a spoiler effect phenomenon occurs.
  • "Ranked-choice voting, where voters indicate their preferences from best to worst"
  • "Multivoting is where voters are given multiple votes that they can allocate across options." The number of votes to allow voters to have is suggested to be great than 𝑜(𝑜―1)/2 where 𝑜 is the number of options.

On the other hand, in a non-randomized study that did not account for baseline conflicts, voting was associated with dissatisfaction[194]. It may be likely that these teams chose to vote because of diversity of perspectives whereas teams that choose consensus had more baseline homogeneity. In addition, post-decision voice was not clearly used.

After voting on organizational procedures, postdecisional voice by the minority group can reduce negative impact on perceptions of fairness and task commitment by employees in the voting minority. [195] In the study by Hunton, postdecisional voice was solicited by asking voters "their thoughts and feelings" about the options debated. Participants were also told that their postdecisional voice was "noninstrumental" and would not change the choice[195].

Delphi technique

A Delphi technique may be more effective.

The Delphi technique involves:

  1. Identifying a research problem
  2. Completing a literature search
  3. Developing a questionnaire of statements
  4. Conducting anonymous iterative mail or e-mail questionnaire rounds
  5. Providing individual and/or group feedback between rounds
  6. Summarizing the findings

A modified Delphi had been developed by the RAND Corporation.

The technique can vary regarding the ity of participants and the number of iterations or rounds.

The Delphi Technique can be conducted online either asynchronously via email or synchronously using a software such as ExpertLens.

Key attributes of the Delphi technique are[196][197][198]:

  • Structured interactions[196] or questionnaires[197]

Goal setting

In 1954, management by objectives was proposed[199] and has been sinced criticized[200].

The structure of goals has been proposed to be[201]:

  • Specific
  • Measurable
  • Assignable
  • Realistic
  • Time-related

Having specific organizational goals helps workforce engagement[202]

Objectives and key results (OKR) was proposed as an approach in 1983[203].

Key performance indicators (KPI) is another approach that was described in 1990[204].

Objectives, goals, strategies and measures (OGSM) is another approach.

Stretch goals are inconsistently effective.[205].

There may be advantages to goals that are set by the workforce rather than management[206].

Goals developed with an outside view for reference class forecasting may avoid overly optimistic goals.[207][208]

Specific goals can create problems according to Goodhart's law.

The quality of goal setting can be measured with[209]:

  • Goal Instrument for Quality (Goal-IQ) developed in 2009. 11 items[210]
  • Goal and Action Plan Instrument for Quality (GAP-IQ) which updates the Goal-IQ. 17 items[209]

Point 11

(a) Eliminate work standards (quotas) on the factory floor. Substitute leadership.

(b) Eliminate management by objective. Eliminate management by numbers, numerical goals. Substitute leadership.

— Deming, W. Edwards., The Essential Deming: Leadership Principles from the Father of Quality (p. 141). McGraw-Hill Education. ISBN 0071790225

Deming suggests limiting measurement to identifying outliers.

Organizational change and innovation

See also: Quality improvement

The Cochrane Collaboration, in 2011, did not find evidence of methods that can improve organizational culture[211].

A survey for Practice adaptive reserve may[212] or many not[213] predict successful organizational change. Practive adaptive reserve is negatively associated with burnout[214][213]

Many studies have examined how to promote organizational change via patient-centered medical home in primary care by large projects such as the VA PACT[215][216][217] and the American Academy of Family Physician[218]. These methods have been systematically reviewed.

Endorsement/endorsing

Endorsing ideas, especially if the endorser uses language discordant to the endorser's gender[219].

  • Female endorser: "Agentic voice (task content; assertive, confident presentation style)"
  • Male endorser: "Communal voice (relational content; polite, humble presentation style)"

Innovation

Main article: Innovation

Two types:

  • Internal - adopting and adapting. Various issues affect knowledge sharing within an organization[220][221][222]. Recommendations to promote knowledge sharing are[222]:
    • "Design work in a way that encourages sharing and promotes the right type of motivation. Give stimulating work that uses brain cells and give people autonomy. Don’t overload people (which creates time pressure). Be careful when creating too many 'dependencies' between workers as it can also create pressure."
    • "Create a cooperative culture. Do not create competition through individual incentives or through labelling [sic] people as winners versus losers or publicly comparing them (for example, what messages do performance appraisals send?)."
    • "Act as a role model and share your knowledge with others. Show you trust others to make good use of the knowledge you share with them. Also make sure you use the knowledge they share with you competently and with integrity."
  • External - development

Appreciative inquiry

Main article: Quality_improvement § Appreciative_inquiry

Appreciative inquiry was developed in 1987 by Cooperrider and Srivastva[223] Appreciative inquiry is consistent with complexity science[224].

Positive deviance

Main article: Positive deviance

Positive deviance is consistent with complexity leadership[225][226][227] and learning health systems[228].

A positive deviance approach has been recommended to identify and disseminate best organizational practices[229][230] [231][232]Early description of this method was[229]:

  • "Develop case definitions"
  • "Identify four to six people who have achieved an unexpected good outcome despite high risk"
  • "Interview and observe these people to discover uncommon behaviours or enabling factors that could explain the good outcome"
  • "Analyse the findings to confirm that the behaviours are uncommon and accessible to those who need to adopt them"
  • "Design behaviour change activities to encourage community adoption of the new behaviours"
  • "Monitor implementation and evaluate the results"

Measuring

Overall measurement of learning and improvement can be measured with[23]:

  • "I see myself continually improving". Responses on a 7-point scale (1 = strongly disagree; 7=strongly agree).
  • "I continue to learn more as time goes by". Responses on a 7-point scale (1 = strongly disagree; 7=strongly agree).

Internal innovation due to reciprocal learning

  • "I am frequently taught new things by other people I work with". Responses scored from one (strongly agree) to five (strongly disagree).[25]

External innovation due to environmental scanning.

  • "the number of memberships in professional associations"[233]

Organizations

See also

References

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  3. ↑ Woznyj, Haley; Banks, George; Whelpley, Christopher; Batchelor, John; Bosco, Frank A. (2020). "Job Attitudes: A Meta-Analytic Review and the Creation of a Temporal Theoretical Framework". Academy of Management Proceedings. 2020 (1): 12492. doi:10.5465/AMBPP.2020.284. ISSN 0065-0668.
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