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Quality Medical Services in Hospitals Staff Perception Report (Assessment)

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Table of Contents
Purposes of the Article
Strengths and Limitations of the Research
Main Findings and Implications

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The article titled “HRM and strategic climates in hospitals: does the message come across at the ward level?” was written by Monique Veld, Jaap Paauwe, and Paul Boselie, and published Human Resource Management Journal in 2010. It is a relatively recent academic and peer-reviewed medical research article. In this study, the researchers examined the pursuits of two strategic goals for hospitals, which are the quality of medical service and safety measures, through the prism of HRM efforts at the ward level, as well as employee perceptions of these strategic goals and generation of the desired effect.

Purposes of the Article

The immediate purposes of this study are several. First, the researchers aim to test several hypotheses in regards to the effectiveness and effects of HRM strategies on medical service quality and safety. These hypotheses are (Veld, Paauwe, & Boselie, 2010):

Introducing a strategic climate to promote medical service quality and safety would have a positive effect on the ward commitment.
Shared perceptions and understanding of the implemented HRM practices improve ward commitment.
The presence of a strategic climate would ensure said shared perceptions and understanding of HRM practices.
Common understanding of the HRM performance management practices positively affect the strategic climate and the quality of medical treatment.
Common understanding of the HR autonomy practices improve the safety climate.
Improved communication reflects on both quality and safety components of the overall HRM strategy.
Common understanding of the supervisor performing behavior improves both the quality and safety components.

The other purpose of this study is to provide additional quantitative data to the relation between HRM and performance in a medical setting. According to the researches, while there have been plenty of meta-analyses dedicated to the subject, none of them focused specifically on hospitals and used the profit sector as the basis for the analysis. A hospital setting is a setting that involves coordination of numerous personnel on all levels, which means that practice-specific HRM practices are the key to evolving and improving the quality of service as well as patient and employee safety measures.

Strengths and Limitations of the Research

The study used a mix of qualitative and quantitative methods in order to collect the data later used in formulating and testing the hypotheses mentioned at the beginning of the research. The main quantitative data collection tool for this research was the questionnaire. According to the article, 576 questionnaires were processed and analyzed in the course of the study (Veld et al., 2010). Questionnaires as a source of information have several weaknesses to themselves, such as perception bias on the part of the people passing the questionnaire.

The researchers identify this, and state that the common method bias is the most likely kind of bias to affect the research. To work around it, they used split sampling techniques, such as distributing questionnaires in different hospitals, in order to ensure that the common method bias does not occur.

They are confident in the results. Another limitation of this research design is that the research does not implement any accurate performance measurements to identify the effectiveness or failure of particular HRM techniques. Lastly, the third limitation of the research comes from the fact that there is not enough of contemporary dedicated literature on the subject of HRM practices in a hospital setting. While this research is aimed to alleviate this lack of data to some degree, it still suffers from not having enough qualitative sources to use in the discussion section of the research.

Main Findings and Implications

All hypotheses in the research were proven to be correct, however the degree of moderation varied between them. For example, the statistic results found that a climate for quality is associated with greater ward commitment, while safety climate did not. Shared perceptions of HR practice bundles proved to have an effect in improving the two climate dimensions. In addition, the results found partial mediation of the HR practices on ward commitment.

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Practice-approached hypotheses numbered four through seven were found to be inconclusive, save for the hypothesis number 7, which states that supervisor informing behavior would have an effect on the quality of care and safety of care. While the quality of care did not see significant changes, safety of care saw gradual improvements (Veld et al., 2010).

There are several implications of this study that are identified by the researchers. One of the implications involves providing additional material in regards to the effectiveness of the HRM in promotion of medical care quality and medical safety in a hospital setting. It uses an analytical approach and synthesizes the available qualitative information to help in the assessment of quantitative data received through questionnaires. This research can be used as a foundation for others, in order to gain greater insights about the use of HRM and promotion of the strategic goals in hospitals.

From a practical standpoint, the research indicates that the best way of promoting strategic goals is through improved communication and facilitation of appropriate climate. However, it must also be noted that safety practices were the one to resist the influence of the climate meant to promote them. According to the study, this is due to the fact that current employee safety measures are not perceived as those aimed to actually protect the employee, but rather to fulfil a safety protocol, which causes the employees to be less motivated and less dedicated to the ward, despite the safety climate.

This conclusion is supported by later researches dedicated to the subject. Namely, Huang et al. (2016) states that the employee perceptions of the safety climate and their willingness to follow it are motivated by their job satisfaction, employee turnover rates, and other factors beyond the immediate effects of safety measures on injury prevention. McFadden, Stock, and Goven (2015) connect the issue with employee perception of the safety climate with the transformational style of leadership of the senior health management staff, as well as the promotion of the Constant Quality Improvement (CQI) strategy.

Based on these findings, it can be concluded that the promotion of safety climate in this research was proved ineffective due to a lack of leadership from senior hospital staff and low levels of satisfaction and high turnover rates. Hospitals are known to be high-stress environments, which are characterized by high turnover rates, and employee dissatisfaction, which gradually builds up overtime. This tendency is constant across all countries and regions around the world (Tarcan, Hikmet, Schooley, Top, & Tarcan, 2017).


This research provides important data in regards to the use of HRM practices to establish climates for safety and quality as primary means of promotion of two strategic goals and ward dedication, as well as the analysis of practical HRM in relation to these goals. The study found that quality climate influences the promotion of medical care quality to great degree, whereas safety climate perceptions seem to be disconnected from the actual notions and usefulness of safety, and is reliant on external factors that have to do with leadership, happiness and satisfaction, and low turnover rates.

It could be speculated that improvement in those areas would automatically lead to a better perception of safety climate and improved patient outcomes because of it. The research stresses out the importance of communication as a critical point that ensures the understanding of the goals and objectives at the ward level.

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Veld, M., Paauwe, J., & Boselie, P. (2010). HRM and strategic climates in hospitals: Does the message come across at the ward level? Human Resource Management Journal, 20(4), 339-356.

Huang, Y. H., Lee, J., McFadden, A. C., Murphy, L. A., Robertson, M. M., Cheung, J. H., & Zohar, D. (2016). Beyond safety outcomes: An investigation of the impact of safety climate on job satisfaction, employee engagement and turnover using social exchange theory as the theoretical framework. Applied Ergonomics, 55, 248-257.

McFadden, K. L., Stock, G. N., & Gowen, C. R. (2015). Leadership, safety climate, and continuous quality improvement: Impact on process quality and patient safety. Health Care Management Review, 40(1), 24-34.

Tarcan, M., Hikmet, N., Schooley, B., Top, M., & Tarcan, G. Y. (2017). An analysis of the relationship between burnout, socio-demographic and workplace factors and job satisfaction among emergency department health professionals. Applied Nursing Research, 34, 40-47.

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