The HRM and Performance Link:
The Case of Adult Social Care
Rosemary Lucas and Carol Atkinson
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
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)
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?
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
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)
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)
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
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
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 job…it’s either there or
not there...it’s not a job that you come to for
the wages...or the glamour. CW, Establishment
5
Relational returns: social
interaction
• …even the cleaning staff…all muck in to help us…if we ever
need anything doing by them they’re straightaway there. CW,
Establishment 2 (teamwork)
• ….they went to [location] and…hired a big, big coach and all
the residents went out on day trip…I thought to myself…that
is amazing. CW, Establishment 12 (sharing & friendship)
• …we all talk together like on our phones…if a few of us are out
on the road and we’ve got a bit of a gap time and we maybe
meet at Tesco for a brekkie but otherwise we don’t really see
each other. CW, Establishment 15 (to mitigate isolation and
limited teamwork in domiciliary care)
Relational returns: security
•
•
•
•
•
Fewer than 25% < 1 year’s 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 degree…I was thinking about doing mental
health nursing and I just went and sent my application
off…would be good to push myself further. CW, Establishment
4 (commitment to sector)
Relational returns: status, recognition
& work importance
•
...Over the years, especially my partner's friends…look up to
people like me because not everybody can do that [carer’s
job]…CW, Establishment 12 (status & pride)
• …the only job I’ve ever done where I go home at the end of
the day and I feel like I’ve really done something…it isn’t like
the ‘same old, same old’ where you might work in a shop and
you’re just sat on a till…you’re faced with new challenges
every day and you know the smallest thing that you might do
for somebody. CW, Establishment 15 (recognition & work
importance)
Relational returns: workload, work
variety & work conditions
• I used to go home very satisfied…Now…you'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 nurses…and the other care staff understand that I have
responsibilities outside. This is the first place I've ever
worked…a 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)
Relational returns: authority,
control & autonomy
• …that would probably depend what the decision was going to
be…sometimes we haven't got the experience to make major
decisions…they do try and involve you. CW, Establishment 2
(clear parameters)
• …you’re not herded anywhere, you’re like left to just get on
with it…they give you these clients and you’re responsible
whilst you’re there for them…you’re the boss…I just…love the
job. CW, Establishment 6 (autonomy)
• …It’s difficult because you go from people with dementia to
people with severe mental problems…it’s a bit scary…we have
a lot of responsibility. CW, Establishment 16 (responsibility)
Relational returns: feedback
• Basically it’s a bit of an open session but we
cover all areas. It’s very good. You come out
and you think, oh glad you told me that. CW,
Establishment 6 (formal supervision 2-3
months)
• She’s on call 24 hours a day. If I’ve 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)
Relational returns: development
opportunities & advancement
• [Manager]’s put on training days…going to do dementia care
mapping, there’s about six of us in the group…In the process
of changing all the corridors…having themed corridors…for
improvement for their cognitive stimulation. CW,
Establishment 13 (training to support innovation)
• I’ve done the Dementia Course…then I did the Health and
Safety…we get fire lectures every year…mandatory moving
and handling, the health and safeties every three years I think
– they’re increasing that…we’ve just finished Infection
Control…so I’ve put my name down for the Medical Care one.
CW, Establishment 14 (on and off-job training)
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