Background
Methods
Search strategy
Database | Number of hits |
---|---|
Embase | 1 217 |
MEDLINE | 355 |
Web of Science | 186 |
Cochrane | 1 |
PubMed | 49 |
CINAHL | 286 |
Google Scholar | 157 |
Total | 2 251 |
Inclusion/exclusion criteria
Selection strategy
Data analysis
Empowerment-enhancing bundles
Employee involvement in influencing work process/outcomes Formal grievance procedure and complaint resolution systems Job enrichment (skill flexibility, job variety, responsibility) Self-managed or autonomous work groups Employee participation in decision making Systems to encourage feedback from employees | |
Motivation-enhancing bundles
Formal performance appraisal process Incentive plans (bonuses, profit-sharing, gain-sharing plans) Linking pay to performance Opportunities for internal career mobility and promotions Health care and other employee benefits | |
Skills-enhancing bundles
Job descriptions/requirements generated through job analysis Job-based skill training Recruiting to ensure availability of large applicant pools Structured and validated tools/procedures for personnel selection |
Quality appraisal
Results
Study characteristics
MMAT score | |||||
---|---|---|---|---|---|
Study design | 25% | 50% | 75% | 100% | Total |
*
|
**
|
***
|
****
| ||
Quantitative | – | 13 | 18 | 26 | 57 |
Qualitative | 1 | 8 | 13 | 14 | 36 |
Mixed methods | 1 | 3 | 9 | 5 | 18 |
Total | 2 | 24 | 40 | 45 | 111 |
Link between HRM practices and performance outcomes
HRM practices | Number of performance outcomes | Total | ||
---|---|---|---|---|
1 outcome | 2 outcomes | 3 outcomes | ||
Single HRM practice | 19 | 7 | 0 | 26 |
Bundles of HRM practices | 62 | 22 | 1 | 85 |
Total number of studies | 81 | 29 | 1 | 111 |
Authors, year, country | HRM practices | Employee outcome | Team outcome | Organizational outcome | Patient outcome | MMAT Score |
---|---|---|---|---|---|---|
1. Training and education | ||||||
Ajayi, 2013, Nigeria [75] | training nurses on computer-skills | improved efficiency | – | *** | ||
Eygelaar & Stellenberg, 2012, S.Africa [94] | training on nursing care | improved quality of care | – | **** | ||
Issahaku et al., 2012, Ghana [100] | training (clinical and administrative staff) | improved performance | – | **** | ||
Jacobs & Roodt, 2008, S.Africa [102] | knowledge sharing organizational culture /learning practice among professional nurses | reduced turnover intention | – | **** | ||
Esan et al., 2014, Nigeria [148] | training residence doctors | improved job satisfaction | – | *** | ||
Letlape et al., 2014, S.Africa [150] | in-service training on confidence building | improved quality of care | – | ** | ||
Mduma et al., 2015, Tanzania [155] | simulation training on delivery and neonatal care | decreased mortality | ** | |||
Bergman et al., 2008, Tanzania [146] | trauma team training of physicians and nurses | improved job satisfaction | improved team performance | – | * | |
Uys et al., 2005, S.Africa [166] | training on supportive supervision | improved job satisfaction | improved quality of care | – | ** | |
Crofts et al., 2015, Zimbabwe [172] | onsite-team training on obstetric emergency care | improved team performance in clinical practices | improved maternal deaths | ** | ||
2. Salary and compensation | ||||||
Aberese-Ako et al., 2014, Ghana [69] | incentives /monthly transport allowances | improved performance | – | **** | ||
Nwude & Uduji, 2013, Nigeria [120] | fair and adequate compensation | improved job performance | – | ** | ||
Atambo et al., 2013, Kenya [83] | implementing incentive systems | improved performance | improved efficiency of service delivery | – | *** | |
Ashmore & Gilson, 2015, S. Africa [80] | additional wage incentives for specialists | improved retention | – | **** | ||
3. Rostering and scheduling | ||||||
McIntosh & Stellenberg, 2009, S. Africa [154] | implementing staff control strategy/scheduling/ to control moonlighting | turnover intention continued (not improved) | improved quality of care | – | ** | |
Nyathi & Jooste, 2008, S. Africa [121] | managing reutilization and workload | reduced absenteeism among nurses | – | *** | ||
Osisioma et al., 2015, Nigeria [122] | implementation of flexible working arrangements | improved performance | – | ** | ||
Rispel et al., 2014, S.Africa [126] | managing rostering & scheduling to control moonlighting | reduced intention to leave | – | **** | ||
4. Task shifting | ||||||
Ferrinho et al., 2015, Mozambique & Zambia [95] | task shifting practice | reduced staff shortage and improved quality of care | – | *** | ||
Jennings et al., 2011, Benin [103] | task shifting practices for lay nurse aides | improved efficiency of health care | – | ** | ||
Olson et al., 2014, Malawi [161] | task shifting in patient triage and treatment | improved quality of care | reduced inpatient mortality | *** | ||
Sanjana et al., 2009, Zamia [164] | task shifting for lay counselors | reduced staff shortage, reduced rate of errors and | – | ** | ||
Galukande et al., 2013, Uganda [96] | task shifting (surgical) practice | improved staff shortage | decreased mortality | **** | ||
O’Malley et al., 2014, Namibia [162] | task shifting from doctors to nurses | improved quality of service | – | *** | ||
5. Managing employees | ||||||
Nigussie & Demissie, 2013, Ethiopia [158] | leadership styles of nurse managers | increased job satisfaction | – | **** | ||
Okurame, 2009, Nigeria [160] | mentoring practices | improved job satisfaction | – | **** |
Author, year, country | HRM themes | Performance outcomes | MMAT Score | ||||
---|---|---|---|---|---|---|---|
Empowerment -Enhancing practices | Motivation-Enhancing practices | Skills-Enhancing practices | Employee outcome | Organizational outcome | Patient Outcome | ||
Ajemigbitse et al., 2013, Nigeria [68] | supportive supervision | job-based skill training | improved prescribing errors among junior physicians | *** | |||
Ackerman & Phil, 2007, S.Africa [70] | teamwork | management support, scheduling | improved job satisfaction | ** | |||
Francis & Roger, 2012, Ghana [71] | supervision | salary, supplementary allowances, leadership support, recognition | job-based skill training | improved retention and staff motivation | **** | ||
Simiyu & Moronge, 2015, Kenya [72] | teamwork, work-life balance, communication practice | salary, supplementary benefits | recruitment | improved performance | **** | ||
Allegrazi et al., 2010, Mali [73] | feedback on performance | training | improved patient safety | **** | |||
Akinyemi & Atilola, 2013, Nigeria [74] | salaries | training | improved job satisfaction | **** | |||
Abubeker et al., 2014, Nigeria [76] | compensation | training | reduced turnover intention | *** | |||
Asegid et al., 2014, Ethiopia [77] | salary, supplementary allowances | training | improved job satisfaction and reduced intention to leave | **** | |||
Ackerman & Bezuidenhout, 2007, S.Africa [78] | teamwork | scheduling(flexi-time system) | staff turnover(continued) | *** | |||
Ashmore, 2013, S.Africa [79] | supplementary allowances | job-based skill training | improved job satisfaction and reduced moonlighting | **** | |||
Nyakundit et al., 2012, Kenya [81] | recognition, incentives | training | improved performance | improved quality of care | *** | ||
Atambo et al., 2013, Kenya [82] | recognition, incentives | training | improved performance | improved efficiency in service delivery | **** | ||
Aveling et al., 2015, Rwanda & Ethiopia [84] | teamwork | training, staffing | improved quality of care and safety of care | **** | |||
Awasses et al., 2013, Namibia [85] | recognition, staff performance appraisal, remuneration, supplementary financial allowances | in-service training | improved performance of nurses | *** | |||
Ayeiko et al., 2011, Kenya [86] | supervision, feedback | training | improved quality of care | **** | |||
Waju et al.,2011, Ethiopia [87] | management support | staffing, training | improved performance | improved patient satisfaction | **** | ||
Bhengu, 2000, S. Africa [88] | rostering & scheduling, salary | reduced intention to leave improved motivation | **** | ||||
Bradley et al., 2008, Ethiopia [89] | mentorship, training | improvement in hospital management skills (efficiency) | **** | ||||
Bradley & McAuliffe, 2009, Malawi [90] | remuneration | training | improved performance improved staff retention | *** | |||
Dagne et al., 2015, Ethiopia [91] | communication/supervisor feedback | job content management of schedules, performance review, financial incentives, recognition | staffing | improved motivation of health professionals | improved quality of care | **** | |
De Brouwere et al., 2009, Senegal [92] | teamwork, task shifting | improved maternal mortality | *** | ||||
Dieleman et al., 2006, Mali [93] | salary, performance appraisal, reward system | training | improved motivation | **** | |||
Hall, 2004, S. Africa [97] | salary, supplementary incentives/ allowances, scheduling | reduced intention to leave | ** | ||||
Honda & Vio, 2015, Mozambique [98] | incentives, scheduling, salaries | job-based skill training | improved job satisfaction and retention | *** | |||
Libeziako et al., 2013, S. Africa [99] | teamwork practice | salary, supplementary allowances | improved motivation | ** | |||
Jack, 2013, Ghana [101] | teamwork | compensation, allowances | recruitment/staffing, training | improved retention | ** | ||
Kamanzi & Nikosi, 2011, Rwanda [104] | remuneration, recognition | job-based skill training | improved level of motivation | **** | |||
Kekana et al., 2007, S.Africa [105] | teamwork | performance appraisal, remuneration, scheduling | improved job satisfaction | **** | |||
Khamis & Njau, 2014, Tanzania [106] | salary, allowances, management support, rostering & scheduling | staffing, training | improved quality of care at outpatient | **** | |||
Kotzee & Couper, 2006, S. Africa [107] | salaries, allowances, recognition | training, mentorship | improved retention of doctors | **** | |||
Kruger & Bezuidenhout, 2015, S. Africa [108] | scheduling, promotion, management support | training | reduced female doctors dissatisfaction in balancing professional work and family lives | **** | |||
Liphoko et al., 2006, S.Africa [109] | performance appraisal, promotion, management support | job-based skill training | improved job satisfaction of nurses | *** | |||
Leshabari et al., 2008, Tanzania [110] | communication/ feedback | performance evaluation, salaries | improved job satisfaction and motivation | **** | |||
Longmore & Ronnie, 2014, S.Africa [111] | communication | salaries, performance appraisal | training | improved retention of doctors | * | ||
Luboga et al., 2011, Uganda [112] | compensation/salaries, benefits, recognition, scheduling workload, management support | training, staffing | improved job satisfaction and retention of physicians | ** | |||
Makapela & Useh, 2015, S.Africa [113] | salary, management support, allowance | job-based skill training | improved retention | *** | |||
Mathauer & Imhoff, 2006, Benin & Kenya [114] | supervision | recognition, allowances, salary | job-based skill training | improved motivation | **** | ||
Mbindyo et al., 2009, Kenya [115] | employee engagement, communication | promotion, leadership support, performance appraisal, incentives | improved quality of care | **** | |||
McAuliffe et al., 2009, Malawi [116] | teamwork | management support | staffing | improved task performance | ** | ||
McAuliffe et al., 2013, Malawi, Tanzania & Mozambique [117] | job autonomy, task shifting, teamwork, supervision | leadership support | improved job satisfaction and reduced intention to leave | *** | |||
Mokoka et al., 2010, S.Africa [118] | salary, rostering & scheduling, management support | training | improved retention of nurses | *** | |||
Mubyazi et al., 2012, Tanzania [119] | supervision | Incentives | staffing, training | improved motivation | *** | ||
Pieterson, 2005, S.Africa [123] | pay, management support, scheduling, promotion | improved job satisfaction | *** | ||||
Pillay, 2009, S.Africa [124] | teamwork, job autonomy, job security | rostering & scheduling | training | improved job satisfaction and motivation | **** | ||
Prytherch et al., 2012, Tanzania [125] | rostering & scheduling, salaries, incentives, recognition/promotion | increased job performance | *** | ||||
Selebi & Minnaar, 2007, S.Africa [127] | supportive supervision | salaries | improved job satisfaction | *** | |||
Sikwese et al., 2010, Zambia [128] | staffing/ selection, training | improved efficiency of service delivery | *** | ||||
Siril et al., 2011, Tanzania [129] | supervision, teamwork | compensation, rostering & scheduling | training | improved quality of care | **** | ||
Ssengooba et al., 2002, Uganda [130] | rostering & scheduling | staffing | improved hospital performance (efficiency and effectiveness) | ** | |||
Stodel & Stewart-Smith, 2011, S.Africa [131] | supervision | scheduling | training, mentorship | improved retention | *** | ||
Tabatabai et al., 2013, Tanzania [132] | employee engagement | salary, incentives, scheduling, management support | training | reduced internal migration (public to private) | ** | ||
Thatte & Choi, 2014, Kenya [133] | supervision | written job descriptions, training | improved service quality | ** | |||
Uwaliraye et al., 2013, Rwanda [134] | feedback | training | improved performance of nurses and midwives | *** | |||
Yami et al., 2011, Ethiopia [135] | teamwork | supplementary allowances, salary | training | improved job satisfaction | **** | ||
Bekker et al., 2015, S. Africa [136] | communication | rostering & scheduling | enhanced job satisfaction | *** | |||
Chandler et al., 2009, Tanzania [137] | salary, management support, rostering & scheduling | training | improved performance | improved quality of care | **** | ||
Chi et al., 2015, Burundi & Uganda [138] | rostering & scheduling, remuneration | staffing | improved quality of maternal care | *** | |||
Chirwa, 2000, Malawi [139] | performance appraisal | Staffing | improved quality of care | *** | |||
Hollup, 2012, Mauritius [140] | job security and safety | salary | improved staff motivation | **** | |||
Klopper et al., 2012, S.Africa [141] | wages, study leave opportunities | skills-training for career advancement | job dissatisfaction | ** | |||
Lasebitan & Oyetundt, 2012, Nigeria [142] | rostering & scheduling, wages | staffing | improved retention | **** | |||
Mudaly & Nkosi, 2015, S.Africa [143] | scheduling, promotion, pay, rewards/incentives | training, staffing | reduced absenteeism | *** | |||
Tibandebage et al., 2015, Tanzania [144] | supervision | incentives, salaries, leadership support, rostering & scheduling | Staffing | improved performance | *** | ||
Courtright et al., 2007, Malawi, Uganda, Tanzania & Kenya [145] | supervision | management support | Training | improved performance | **** | ||
Doherty et al., 2013, S.Africa [147] | supervision, task shifting | improved quality of care, reduced staff shortage and workload | *** | ||||
Kamau & Omondi, 2015, Kenya [149] | supplementary allowances/incentives | job-based skill training | improved staff retention | **** | |||
Madzimbamuto et al., 2014, Botswana [151] | supervision | Training | improved quality of care | ** | |||
Mahlo & Muller, 2000, S.Africa [152] | communication | Training | improved quality of care | **** | |||
Manongi et al., 2009, Tanzania [153] | Salary | Training | improved performance | *** | |||
Nabirye, 2010, Uganda [156] | scheduling, pay, incentives/allowances | improved performance of nurses and job satisfaction | *** | ||||
Ndetei et al., 2008, Kenya [157] | Salary | Training | reduced migration of health workforce (retention) | *** | |||
Okeke, 2008, Nigeria [159] | salary | Recruitment | improved retention | ** | |||
Rauf et al., 2008, S.Africa [163] | task shifting | scheduling, performance evaluation/appraisal | reduced waiting time (maximized efficiency) | ** | |||
Thomas & Valli, 2006, S.Africa [165] | scheduling, salary | training, staffing | improved job satisfaction | **** | |||
Yeboha et al., 2014, Ghana [167] | communication | management support | Training | improved retention | *** | ||
Rawlins et al., 2003, Kenya [168] | feedback, teamwork | management support | staffing, written job descriptions | improved organizational performance (efficiency) | *** | ||
Giuseppe et al., 2002, Kenya [169] | communication, work-life balance | scheduling, management support | Training | improved task performance and improved retention of resident doctors | *** | ||
Ngao, 2013, Kenya [170] | recruitment/staffing, training, mentorship | improved quality of care | ** | ||||
Kotagal et al., 2009, Rwanda [171] | leadership support | staffing | improved patient satisfaction | ** | |||
Dowing, 2016, Uganda [173] | training, mentorship | improved nurses’ performance | *** | ||||
Faye et al., 2013, Senegal & Mali [174] | salary, supplementary allowances, scheduling, management support | training | improved job satisfaction | **** | |||
Doef et al., 2011, Kenya, Tanzania & Uganda [175] | scheduling, management support, supplementary allowances | staffing | improved job satisfaction and reduced level of burnout | **** | |||
Srofenyoh et al., 2012, Ghana [176] | teamwork, communication | leadership support | training | improved employee performance | improved patient satisfaction and clinical outcomes | *** | |
Woldegabriel et al., 2016, Ethiopia [177] | communication | scheduling, performance appraisal | selection/recruitment, training | improved intrinsic motivation of health workforce | **** | ||
Puoane et al., 2008, S.Africa [178] | teamwork, supervision, feedback | leadership support, monitoring performance | in-service training and induction of new nurses | improved task performance | improved quality of care in the better performing hospitals | **** |
Single HRM practices and performance outcomes
HRM bundles and performance outcomes
Motivation-enhancing HRM practices
Skills-enhancing HRM practices
Empowerment-enhancing HRM practices
Conclusion
Author (year) | Aim of review | No. | Setting | HRM practices | Summary of findings |
---|---|---|---|---|---|
This review | To present a systematic review of empirical studies investigating the relationship between HRM and performance in SSA hospitals. | 111 | Saharan Africa Hospitals | 18 HR practices: -Training and education -Task delegation/task shifting -Compensation, salary, incentives -Promotion/recognition -Scheduling and rostering -Management/leadership support -Team work -Performance appraisal -Feedback/communication -Staffing -Selection/recruitment -Mentorship -Employee engagement -WLB -Job autonomy -Job security/safety -Written job description | HRM practices in SSA are linked to all categories of performance outcomes: individual employee outcomes (task performance, job satisfaction, motivation, retention, reduction in workload and moonlighting); team outcomes, organizational performance outcomes (quality of care, patient safety, timeliness, service efficiency, staff shortage) and patient outcomes (patient experience and clinical outcomes). |
Hyde et al. (2006) | To investigate how HRM can influence performance in organizations by addressing the question “How can HRM help NHS organizations to achieve their goals?” | 97 | European Hospitals | 10 HRM practices: -Training -Pay -Involvement -Selection -Team working -Performance appraisal -Job security -Job design -Equal opportunities -Career development | Bundles of practices are more likely to positively affect performance than single practices. There is insufficient evidence that a specific HRM practice is superior in increasing performance. Local and wider external contextual factors need to be taken into account when doing research in health sector. |
Boselie et al. (2005) | To see whether there might be commonalities and widely accepted trends in the theoretical perspectives, conceptualizations and methodologies used in the field of HRM and performance research. | 104 | European (Dutch) hospitals | 26 HR practices: -Training -Contingent pay and rewards, -Performance management -Recruitment -Team working -Direct participation -Good wages -Communication -Internal promotion -Job design -Autonomy -Employment security -Benefits -Formal procedures -HR planning -Financial participation -Symbolic egalitarianism -Attitude survey -Indirect participation -Diversity and equal opportunities -Job analysis -Socialization -Family-friendly policies -Exit management -Effectiveness of HR function -Social responsibility practices | The relationship between (some form of) HRM intervention and (some indicator of) performance is mediated by linking mechanisms. |
Combs et al. (2006) | To identify and analyze studies that investigate the relationship between at least one HPWP and organizational performance. | 92 | Manufacturing and service organizations | 13 HRM practices within HPWP: -Incentive compensation -Training -Compensation level -Participation -Selectivity -Internal promotion -HR planning -Flexible work -Performance appraisal -Grievance procedures -Teams -Information sharing -Employment security | HPWPs have a higher impact than individual practices on organizational performance (focused on operational and financial performance outcomes). |
Dieleman et al. (2009) | to explore if realist review of published primary research provides better insight into the functioning of HRM interventions | 48 | Low- and middle-income countries | 6 HRM practices: -Continuing education -Supervision -Payment of incentives -Decentralization of HRM functions -Regulation -Combination of HR practice such as training | HRM interventions can improve health workers’ performance. Mechanisms such as increased knowledge and skills, feeling obliged to change and health workers’ motivation caused change. Continuing education is likely to be effective in short term. Combined interventions are more likely to be effective in the long term. Thereby, context should be taken into account. |