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The role of hospitals' HRM in shaping clinical performance: a holistic approach

Hospitals are under pressure to achieve high levels of clinical performance. Some research has demonstrated that HRM processes positively influence organisational-level performance, but these effects are often examined in isolation, without exploring how they may influence performance via interactions with other sub-system processes. In this study, we develop and test a model of how HRM processes influence hospitals' clinical performance (continuity of quality patient care) in the context of processes emerging from three other hospital sub-systems (strategic and operations management, information management, and health and safety). Utilising rigorous multi-rated, industry-based hospital accreditation data relating to 465 Australian hospitals, we first evaluated the construct validity, reliability and discriminant validity of the data as being reflective of the clinical performance outcome, and the enacted processes emerging from four distinct hospital sub-systems. In testing the hypotheses, we found that in the context of management, information management, and health and safety processes, the effective functioning of HRM processes significantly influenced the continuity of quality patient care. There was also further evidence that the effectiveness of HRM processes significantly moderated the relationships between: (1) strategic and operations management processes; and (2) health and safety processes and the continuity of quality patient care. On the basis of these findings, we argue that the simultaneous and interdependent influence of multiple processes should be considered when examining the influence of the effective functioning of HRM processes on organisational-level performance in hospitals.