The HRM and Performance Link: The Case of Adult Social Care

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The HRM and Performance Link The Case of Adult
Social Care

• Rosemary Lucas and Carol Atkinson

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Introduction

• DoH White Paper (2006) and Options for Excellence
  Review (2009)
• Strategic approach to workforce planning
  alignment of HR policies to organizational
  outcomes
• Assumed positive relationship between HR practice
  organizational performance
• Project to address the links between rewards
  incentives, recruitment retention difficulties
  outcomes for service users (quality
  continuity of care) in adult social care

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Conceptual framework

• Total reward systems (TRS) as the key HR
  intervention (tailored from limitations of HPWS
  relevant to context)
• Quality of care is key performance indicator
  (Eaton, 2000, De Prins and Henderickx, 2007)
• TRS comprise a mix of monetary/non-monetary
  compensation relational returns e.g. learning
  opportunities, recognition status, challenging
  work, employment security (Milkovich and Newman,
  1996)

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Conceptual framework

• Right mix produces positive outcomes (Currall et
  al., 2005) but only where significant
  compensatory relational returns both present
  (Siefert et al., 1990)
• As TRS are costly can expect only to observe them
  in high quality employment sectors
• How do employees perceive their TRS and what are
  the implications for quality and continuity of
  care?

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Social care

• 1.75 million paid jobs 40,000 establishments
• Skills for Care lead role in training and quality
  framework
• National Minimum Standards (NMS) e.g. staffing
  levels, skills and Care Quality Commission (CQC)
  inspection
• Internal sector reports suggest positive progress
  in workforce strategy

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Other studies in social care

• UK conventional wisdom of poor employment
  conditions and work experiences (Machin et al.
  2003, Grimshaw Carroll, 2002)
• Good HR can have a positive impact for a minority
  in Australia (Harley et al., 2007) N America
  (below) but may be mitigated by TU presence
• Generally negative association (also Eaton, 2000)
• Cannot be effective unless nature of work is
  changed (Berg Frost, 2005) workplace climate
  is supportive (Rondeau Wagar, 2001)

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HR interventions and effects

• No real consensus about features and efffects
• Risk of different and unforeseen outcomes
• TRS fits DoH strategic approach to adopt a set of
  behavioural HR interventions designed to recruit,
  retain, develop motivate employees ?
  organizational effectiveness
• Employees best placed to judge effectiveness
• Focus on front-line care workers (CW)

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Methods

• Statistical analysis of National Minimum
  Dataset-Skills for Care (NMDS-SC) and possible
  connections to CQC ratings of quality
• Scoring system to evaluate HR practices in
  establishment on 5 point scale (excellent to
  poor)
• 18 establishments selected from sampling frame of
  104 establishments

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Total compensation

• Basic rates 30p above NMW (5.73) in residential
  care and 45 p above in domiciliary care but
  seniority differentials as little as 20p more
• Little additional compensation
• we look at profit and affordability we
  recognise link between pay and recruitment and
  retention and try to pay more than other local
  providers. RM, Establishment, 15

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Total compensation

• Pay of little concern to CW overridden by
  desire to help people, provide high quality care
  make a difference
• you have to have a caring background to want to
  work in this environment as well to want to do
  this sort of jobits either there or not
  there...its not a job that you come to for the
  wages...or the glamour. CW, Establishment 5

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Relational returns social interaction

• even the cleaning staffall muck in to help
  usif we ever need anything doing by them theyre
  straightaway there. CW, Establishment 2
  (teamwork)
• .they went to location andhired a big, big
  coach and all the residents went out on day
  tripI thought to myselfthat is amazing. CW,
  Establishment 12 (sharing friendship)
• we all talk together like on our phonesif a few
  of us are out on the road and weve got a bit of
  a gap time and we maybe meet at Tesco for a
  brekkie but otherwise we dont really see each
  other. CW, Establishment 15 (to mitigate
  isolation and limited teamwork in domiciliary
  care)

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Relational returns security

• Fewer than 25 lt 1 years service
• Half in same job for over 5 years
• 7 in 10 worked in care sector for over 5 years
• Three-quarters planned to stay
• No, as much as I'd love to stay, I need to
  motivate and push myself further...get myself a
  highly qualified skill. Going to uni and getting
  a degreeI was thinking about doing mental health
  nursing and I just went and sent my application
  offwould be good to push myself further. CW,
  Establishment 4 (commitment to sector)

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Relational returns status, recognition work
importance

• ...Over the years, especially my partner's
  friendslook up to people like me because not
  everybody can do that carers jobCW,
  Establishment 12 (status pride)
• the only job Ive ever done where I go home at
  the end of the day and I feel like Ive really
  done somethingit isnt like the same old, same
  old where you might work in a shop and youre
  just sat on a tillyoure faced with new
  challenges every day and you know the smallest
  thing that you might do for somebody. CW,
  Establishment 15 (recognition work importance)

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Relational returns workload, work variety work
conditions

• I used to go home very satisfiedNowyou're lucky
  if you have the time to do what you need to do
  without just having that little bit extra to be
  able to sit and you know have a minute talking to
  them.it's just not care. CW, Establishment 13
  (staff shortages)
• My nursesand the other care staff understand
  that I have responsibilities outside. This is the
  first place I've ever workeda lot of people say
  that this is one of the best places to work for
  people who have kids and other responsibilities.
  CW, Establishment 2 (flexibility work-home
  balance)

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Relational returns authority, control autonomy

• that would probably depend what the decision was
  going to besometimes we haven't got the
  experience to make major decisionsthey do try
  and involve you. CW, Establishment 2 (clear
  parameters)
• youre not herded anywhere, youre like left to
  just get on with itthey give you these clients
  and youre responsible whilst youre there for
  themyoure the bossI justlove the job. CW,
  Establishment 6 (autonomy)
• Its difficult because you go from people with
  dementia to people with severe mental
  problemsits a bit scarywe have a lot of
  responsibility. CW, Establishment 16
  (responsibility)

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Relational returns feedback

• Basically its a bit of an open session but we
  cover all areas. Its very good. You come out and
  you think, oh glad you told me that. CW,
  Establishment 6 (formal supervision 2-3 months)
• Shes on call 24 hours a day. If Ive had a lot
  you know, sometimes the work load gets a bit
  pressured, I get that support from her. CW,
  Establishment 10 (available help support)

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Relational returns development opportunities
advancement

• Managers put on training daysgoing to do
  dementia care mapping, theres about six of us in
  the groupIn the process of changing all the
  corridorshaving themed corridorsfor improvement
  for their cognitive stimulation. CW,
  Establishment 13 (training to support innovation)
• Ive done the Dementia Coursethen I did the
  Health and Safetywe get fire lectures every
  yearmandatory moving and handling, the health
  and safeties every three years I think theyre
  increasing thatweve just finished Infection
  Controlso Ive put my name down for the Medical
  Care one. CW, Establishment 14 (on and off-job
  training)

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Conclusions

• Indications of HR interventions (TRS) having a
  positive effect can work in low-value
  employment
• Call into question that TRS must comprise
  significant compensatory relational returns to
  produce positive outcomes
• Supportive workplace climate, good management
  health working relationships for most CW
  underpinned by supporting regulatory framework
• Managerial change work intensification clashed
  with some CW work orientations
• Refutes wisdom that CW working lives are
  exploitative unrewarding