A Special Issue on Work and Employment Relations in Health Care

Source: ILR Review, Vol. 69 no. 4, August 2016
(subscription required)

From the introduction:
Editorial Essay: Introduction to a Special Issue on Work and Employment Relations in Health Care
Ariel C. Avgar, Adrienne E. Eaton, Rebecca Kolins Givan, and Adam Seth Litwin

…..This special issue of the ILR Review is designed to showcase the central role that work organization and employment relations play in shaping important outcomes such as the quality of care and organizational performance. Each of the articles included in this special issue makes an important contribution to our understanding of the large and rapidly changing health care sector. Specifically, these articles provide novel empirical evidence about the relationship between organizations, institutions, and work practices and a wide array of central outcomes across different levels of analysis. This breadth is especially important because the health care literature has largely neglected employment-related factors in explaining organizational and worker outcomes in this industry. Individually, these articles shed new light on the role that health information technologies play in affecting patient care and productivity (see Hitt and Tambe; Meyerhoefer et al.); the relationship between work practices and organizational reliability (Vogus and Iacobucci); staffing practices, processes, and outcomes (Kramer and Son; Hockenberry and Becker; Kossek et al.); health care unions’ effects on the quality of patient care (Arindrajit, Kaplan, and Thompson); and the relationship between the quality of jobs and the quality of care (Burns, Hyde, and Killet). Below, we position the articles in this special issue against the backdrop of the pressures and challenges facing the industry and the organizations operating within it. We highlight the implications that organizational responses to industry pressures have had for organizations, the patients they care for, and the employees who deliver this care……

Articles include:
Nurse Unions and Patient Outcomes
Arindrajit Dube, Ethan Kaplan, and Owen Thompson
The authors estimate the impact of nurse unions on health care quality using patient-discharge data and the universe of hospital unionization in California between 1996 and 2005. They find that hospitals with a successful union election outperform hospitals with a failed election in 12 of 13 potentially nurse-sensitive patient outcomes. Hospitals were more likely to have a unionization attempt if they were of declining quality, as measured by patient outcomes. When such differential trends are accounted for, unionized hospitals also outperform hospitals without any union election in the same 12 of 13 outcome measures. Consistent with a causal impact, the largest changes occur precisely in the year of unionization. The biggest improvements are found in the incidence of metabolic derangement, pulmonary failure, and central nervous system disorders such as depression and delusion, in which the estimated changes are between 15% and 60% of the mean incidence for those measures.

How Do Hospital Nurse Staffing Strategies Affect Patient Satisfaction?
Jason M. Hockenberry and Edmund R. Becker
In this article, the authors evaluate the role of the nurse staffing mix on hospital patient satisfaction. Using three years (2009 to 2011) of hospital patient satisfaction data linked to data on the productive staffing hours of registered nurses (RNs), licensed vocational nurses, nurse’s aides, and contract nurses for 311 California hospitals, the authors analyze how nurse staffing levels affect 10 dimensions of patient satisfaction. The findings indicate that a higher level of RNs per bed appears to increase overall patient satisfaction. Conversely, hospitals with a higher proportion of nursing hours provided by contract nurses have significantly lower levels of patient satisfaction on scores related to overall patient satisfaction and nurses’ communication with the patient. The results have implications for RN staffing strategies and inform the broader literature on worker-skill mix and employment arrangements.

Who Cares about the Health of Health Care Professionals? An 18-Year Longitudinal Study of Working Time, Health, and Occupational Turnover
Amit Kramer and Jooyeon Son
Health care workers are employed in a complex, stressful, and sometimes hazardous work environment. Studies of the health of health care workers tend to focus on estimating the effects of short-term health outcomes on employee attitudes and performance, which are easier to observe than long-term health outcomes. Research has paid only scant attention to work characteristics that are controlled by the employer and its employees, and their relationship to employees’ long-term physical health and organizational outcomes. The authors use data from the National Longitudinal Survey of Youth (NLSY) from 1992 to 2010 to estimate the relationships among working time, long-term physical health, job satisfaction, and turnover among health care employees. Using a between- and within-person design, they estimate how within-person changes in work characteristics affect the within-person growth trajectory of body mass index (BMI) over time and the relationship between working-time changes and physical health, and occupational turnover. The study finds that health care employees who work more hours suffer from a higher level of BMI and are more likely to leave their occupation.

Health Care Information Technology, Work Organization, and Nursing Home Performance
Lorin M. Hitt and Prasanna Tambe

The Consequences of Electronic Health Record Adoption for Physician Productivity and Birth Outcomes
Chad D. Meyerhoefer, Mary E. Deily, Susan A. Sherer, Shin-Yi Chou, Lizhong Peng, Michael Sheinberg, and Donald Levick

Creating Highly Reliable Health Care: How Reliability-Enhancing Work Practices Affect Patient Safety in Hospitals
Timothy J. Vogus and Dawn Iacobucci

Filling the Holes: Work Schedulers As Job Crafters of Employment Practice in Long-Term Health Care
Ellen Ernst Kossek, Matthew M. Piszczek, Kristie L. McAlpine, Leslie B. Hammer, and Lisa Burke

How Financial Cutbacks Affect the Quality of Jobs and Care for the Elderly
Diane J. Burns, Paula J. Hyde, and Anne M. Killett