Page 1 of 1

Using Workforce Practices to Drive Quality Improvement: A Guide for Hospitals

Organizational Assessment

The following checklist may be used to assess the extent to which your organization has adopted high-performance work practices (HPWPs). The goal of the assessment is to create awareness of the areas in which your organization may direct future efforts.

HPWPYes, we currently use this practiceWe have a plan in place to implement this practiceNo, we do not currently use this practice
Organizational Engagement Practices
Communicate mission, vision, and values   
Share performance information   
Involve employees in key decisions   
Track and reward performance   
Staff Acquisition and Development Practices
Rigorous recruiting   
Selective hiring   
Extensive training   
Career development   
Frontline Empowerment Practices
Employment security   
Reduced status distinctions   
Teams/decentralized decisionmaking   
Leadership Alignment/Development
Linking management training to organizational needs   
Planning succession   
Tracking and rewarding performance   

Return to Contents



Collins J. Good to great: why some companies make the leap... and others don't. New York: Harper Collins; 2001.

Collins led a team of people to investigate how 11 companies successfully moved from good to great. They identified several traits that were present in all 11 companies but largely absent from a group of comparison companies. Collins presents these traits and organizes them into a framework. The book includes many stories and examples geared toward leaders interested in moving their organizations from good to great.

Executive pay and quality: new incentive links—national survey results. Minneapolis, MN: Integrated Healthcare Strategies; 2007. Available at:

The report presents findings from a survey of hospital CEOs and human resource executives from 119 organizations regarding the motivations, levels, metrics, and methods of incentive pay for hospital physician and administrative leaders during the summer of 2007.

Eaton S. Beyond "unloving care": linking human resource management and patient care quality in nursing homes. International Journal of Human Resource Management 2000;11(3): 591-616.

Through case studies of 20 long-term care organizations, the author concludes that low-quality care is linked to employees' low quality jobs and work environments. The author provides examples of innovative human resource management practices and work structures that have resulted in high-quality long-term care and observes that these promising structures require change in work organization and HR. She describes common barriers to the diffusion of promising structures and offers a "high performance" model of nursing home organization.

Gabow P, Eisert S, Karkhanis A, et al. A toolkit for redesign in healthcare. Prepared by Denver Health under Contract No. 290-00-0014. Rockville, MD: Agency for Healthcare Research and Quality; 2002. AHRQ Publication No. 05-0108-EF. Available at:

This toolkit presents an approach for comprehensively redesigning and transforming hospital care, based on the experience of Denver Health. The toolkit describes the factors that compel a hospital to begin a transformation and provides planning steps, strategies for proposing implementation projects, and metrics for the implementation phase. The toolkit enables readers to identify the attributes of their systems that are similar to or different from those of Denver Health and assess how these attributes may influence their approach to the redesign described.

Frankel AS, Leonard MW, Denham CR. Fair and Just culture, team behavior, and leadership engagement: the tools to achieve high reliability. Health Services Research 2006;41(4):1690-1709.

The authors observed that industries outside of health care have improved reliability by applying innovative concepts to interpersonal relationships and administrative hierarchical structures. The authors introduce and describe three initiatives that can serve as a cornerstone for improving reliability in health care organizations: (1) a fair and just culture, (2) teamwork training and communication, and (3) leadership walk rounds. They argue that the three initiatives are critical and related requirements for safe and reliable care, and they offer many implementation examples.

Keroack MA, Youngberg BJ, Cerese JL. Organizational factors associated with high performance in quality and safety in academic medical centers. Academic Medicine 2007;82(2):1178-86.

The authors used qualitative methods to identify organizational factors at academic medical centers that distinguished superior performers from average ones. Common qualities shared by top performers included a shared sense of purpose, a hands-on leadership style, accountability systems for quality and safety, a focus on results, and a culture of collaboration.

Kotter JP. Leading change: why transformation efforts fail. Harvard Business Review 2007 Jan;96-103.

Based on observations of more than 100 companies' efforts to remake themselves into better competitors, Kotter describes eight critical success factors, including forming a powerful guiding coalition, creating and communicating the vision, and empowering others to act on the vision. He also offers two general lessons learned from more successful cases: (1) change process goes through a series of phases that usually require a considerable length of time, and (2) critical mistakes in any phase can have a devastating impact, slowing momentum and negating hard-won gains.

Martin LA, Nelson EC, Lloyd RC, et al. Whole system measures. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. Available at:

The authors present 13 measures that can be used to examine quality at the system level. The measures can be a useful framework for organizing measures of care quality and can contribute to an organization's balanced scorecard or dashboard of strategic performance measures. The authors offer guidance for implementing the whole system measures, including roles for specific individuals.

McAlearney AS. Using leadership development programs to improve quality and efficiency in healthcare. Journal of Healthcare Management 2008;53(5):319-31.

The author uses data from three qualitative studies of leadership development to describe how leadership development programs can improve quality and efficiency. Analyzing data from 200 interviews conducted between 2003 and 2007 with health system managers and executives, academic experts, consultants, and others, the author identifies four opportunities for these programs to improve quality and efficiency: (1) increasing the caliber of the workforce, (2) enhancing efficiency in the organization's education and development activities, (3) reducing turnover and related expenses, and (4) focusing organizational attention on specific strategic priorities.

Meyer JA, Silow-Carroll S, Kutyla T, et al. Hospital quality: ingredients for success—overview and lessons learned. New York, NY: Commonwealth Fund; July 2004. Available at

The authors summarize findings on the key ingredients that contribute to the success of quality improvement strategies, based on site visits and interviews with four top-performing hospitals. They describe four key elements for success: developing the right culture, attracting and retaining the right people to promote quality, devising the right processes for QI, and giving staff the right tools for the job.

Nolan TW. Execution of strategic improvement initiatives to produce system-level results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007. Available at:

In many organizations, quality improvement began with individual improvement projects. Over time, quality improvement has become part of the strategic plans of many health care organizations. Based on interviews with health care and non-health care organizations and their experience at IHI, the authors offer a framework for executing strategic initiatives to achieve systemwide results. The framework contains three interrelating parts: system-level aims, pervasive local improvement, and continuous development of people's capabilities to lead improvement and attain system-level results.

Reinertsen JL, Bisognano M, Pugh MD. Seven leadership leverage points for organization-level improvement in health care, 2nd ed. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2008. Available at

Based on learning from 100,000 Lives, 5 Million Lives, and other IHI initiatives, the authors offer seven "Leverage Points" for leaders to achieve results in quality and safety at the level of entire organizations and care systems. The seven Leverage Points will help leaders get started with quality initiatives and prioritize actions. The white paper offers several examples of the field application of each leverage point and includes a self-assessment tool to help administrative, physician, and nursing leaders design and plan their work using the Seven Leadership Leverage Points.

Tzafrir SS and Gur A. HRM practices and perceived service quality: the role of trust as a mediator. Research & Practice in Human Resource Management 2007;15(2):1-16.

Organizational practices are among the most important drivers of employee satisfaction. The authors collected data from 411 employees and managers of an Israeli health care organization and found that human resource management practices have a direct impact on employee perceptions of service quality.

Return to Contents

AHRQ Publication No. 11-0003-EF

Page last reviewed June 2010
Internet Citation: Using Workforce Practices to Drive Quality Improvement: A Guide for Hospitals: Organizational Assessment. June 2010. Agency for Healthcare Research and Quality, Rockville, MD.