High-Performance Work Practices in CLABSI Prevention Interventions

Appendix 1. Definitions of High-Performance Work Practices

Final Report: Executive Summary (continued)

High-performance work practices (HPWPs) can be defined as practices that have been shown to improve an organization's capacity to effectively attract, select, hire, develop, and retain high-performing personnel. We refer to a set of specific HPWPs within an organization as a high-performance work system. Garman and colleagues (2011) identified the following HPWPs, organized into subsystems, as particularly relevant to health care providers.

Subsystem #1: Engaging Staff. The four practices in this organizational engagement subsystem share a common theme of ensuring employees' awareness of and personal stake in the organization's vision and its current level of success in pursuing that vision.

  • Conveying mission and vision—Activities associated with communicating the organization's scope and purpose to employees, and clarifying their role in supporting that purpose.
  • Information sharing—Practices through which current information on organizational performance and other information that could affect jobs is communicated to employees.
  • Employee involvement in decisionmaking— Practices supporting employees' ability to influence the “decisions that matter” through mechanisms such as quality circles, process project teams, management/town hall meetings, and/or suggestion systems.
  • Performance-contingent compensation— Policies and practices that link salary and/or bonuses to the employee's success in achieving organization-supportive goals. Examples include profit-related pay, gain-sharing, and goal-anchored bonuses.

Subsystem #2: Acquiring and Developing Talent. The four practices in this subsystem focus on building the quality of the organization's workforce through attention to attracting, selecting, and developing staff.

  • Rigorous recruiting— Activities and outcomes associated with outreach to attract new employees. Examples include referral incentives to current employees, employee branding, and alumni programs. This category also includes strategic practices such as workforce planning and evaluation of recruiting systems.
  • Selective hiring—Practices associated with ensuring that open positions are filled with the highest quality candidates available from the applicant pool. Examples include validated selection tools such as personality assessments, work samples, biodata, and/or assessment centers.
  • Extensive training—Activities involving investment in staff development that is more than mandated/more than typical as another strategy to achieve greater relative organizational effectiveness.
  • Career development—Practices that focus on identifying career opportunities/pathways for current employees, as well as providing training to support those opportunities. Practices related to career development also include an emphasis on internal labor pools for filling open positions.

Subsystem #3: Empowering the Frontline. These practices most directly affect the ability and motivation of frontline staff, clinicians in particular, to influence the quality and safety their care team provides.

  • Employment security— Policies and practices that ensure employees greater than mandated security in their positions. They include policies supporting freedom from repercussion for speaking up about systems issues/concerns and practices that generally support stable employment (e.g., avoiding layoffs).
  • Reduced status distinctions—Practices that emphasize egalitarianism across employee roles. Examples include policies and practices supporting open communication across disciplines.
  • Teams/decentralized decisionmaking—Practices of formalizing/defining employees according to teams and providing those teams (and the individuals on them) greater latitude in decisionmaking related to how their work is organized and completed.

Subsystem #4: Aligning Leaders. These practices influence the capabilities of the organization's leadership in running and evolving the organization as a whole.

  • Management training linked to organizational needs—Practices involving the alignment of leadership development resources with the strategic direction of the organization. Examples include use of core competency models and/or incorporation of goals to guide training, assessment, and feedback programs.
  • Succession planning—Practices designed to proactively identify and address future leadership needs through leadership workforce analysis, leadership career planning, and development targeted toward preparing future leaders for promotion.
  • Performance-contingent compensation—Practices that link a portion of leadership compensation to successful achievement of corporate, division, and/or departmental goals.


Garman AN, McAlearney AS, Harrison MI, et al. High-performance work systems in health care management, part 1: development of an evidence-informed model. Health Care Manage Rev 2011 Jul-Sep;36(3):201-13. http://www.ncbi.nlm.nih.gov/pubmed/21646880.

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Page last reviewed August 2015
Page originally created August 2015
Internet Citation: Appendix 1. Definitions of High-Performance Work Practices. Content last reviewed August 2015. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/cusp/clabsi-hpwpreport/clabsi-hpwpap.html