The paper presents findings drawn from a review of previous research on a subject of increasing relevance to HR researchers and practitioners in healthcare organisations. The paper indicates alternative approaches to research and practice in light of extant research.

Despite substantial evidence for a relationship between human resource management (HRM) and the performance of individuals, relatively few studies have examined the role of employee expectations. This article reports on a study involving six National Health Service (NHS) organizations across England. Healthcare employees expected their employers to provide: infrastructure, HR practices and support, which they linked to improved performance especially in relation to patient care and service innovations. Counterintuitively, effort was maintained towards immediate patient care when expectations were unmet, seemingly, because of public service values. The findings indicate that public service values may be a strong determinant of performance as it relates to patients, moderating potential short-term adverse effects of unmet expectations. In contrast, longer term effects on patient care and service development were less readily moderated by these values. This study offers differential accounts illustrating effects on performance gained through improved working conditions and through work intensification. K E Y WO R D S expectations healthcare human resource management individual performance psychological contract values 7 0 1 Human Relations

The NHS has experienced a significant amount of organisational change and restructuring, which has included numerous mergers and de-mergers, since the Labour party came to power in the UK in 1997. However, to date there has been little in the way of evaluation of such changes, particularly the impact of organisational restructuring on the staff involved. This paper examines the human aspect of a merger, and subsequent de-merger, within a primary care trust (PCT) in the North of England, using a focus group methodology. The findings demonstrate that leadership and management styles have a significant impact on staff experiencing such changes. In addition, the psychological contract can be damaged due to the impact of several factors, inducing exit or intention to leave. Employees experienced a constant cycle of change with little time for stabilisation or adjustment, leading to negativity and lowered motivation at times.

Background: Clinical practice guidelines (CPGs) in medicine are recommendations supported by systematic review of evidence to facilitate optimal patient outcomes. Primary care practices are expected to implement more than 200 CPGs, overwhelming many practices. This qualitative study elucidated the perspectives and priorities of family medicine physicians and office managers in grouping CPGs to facilitate implementation. Methods: A qualitative study was performed using individual, semistructured interviews. During the interviews the participants completed an open card-sort exercise grouping 20 CPGs. Purposive sampling was used to identify family medicine physicians and office managers practicing in medically underserved zip codes listed in the local medical society directory. Seven physicians and 6 office managers were interviewed. The interviews were transcribed and analyzed using thematic analysis and compared with the card-sort results. Results: Thematic content analysis identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for implementation: delegation, personalization, triggers, and change management. The card sort exercise revealed grouping by standardized preventive care visit, standardized rooming and discharge processes, and chronic illness. Chronic illness-based groupings and personalization of guidelines were recognized as presenting barriers to delegation of CPGs to the care team. Development of standardized preventive exams, standard rooming and discharge processes and chronic disease management were identified as promoting CPG adherence through team-based care. Standardized workflows provided opportunities for task delegation through predicable roles. Medicalization of CPG implementation relied heavily on the physician alone to remember to adhere to CPGs and inhibited task sharing by not giving office staff clear disease-based protocols to follow. Conclusions: This study identified priorities and perspectives of office managers and physicians when grouping multiple CPGs for concomitant implementation: delegation, personalization, triggers, and change management. Successful implementation was perceived to be associated with standardized preventive exams, standard rooming and discharge processes, and chronic disease management.

Objectives:Findings from a study exploring the links between leadership development coaching and performance are reported in this paper.Design:The study adopted a mixed-method approach. The participants were drawn from an opportunity sample of 36 senior managers who took part in a leadership development programme in a metropolitan borough council. Surveys were used to assess the impact of coaching on performance before, during and after several one-to-one coaching sessions. Semi-structured interviews were also undertaken with 10 coachees at the end of the coaching.Methods:Surveys assessed individual and organisational benefits of coaching, including interpersonal relationship and task accomplishment skills. Semi-structured interviews focused on the impact of coaching on individual and organisational performance, together with its impact on the organisational client base: the public.Results:There was a difference in leadership skills in the pre- and post-survey results. Both the quantitative and qualitative results indicate improved individual and organisational performance. The qualitative data also illustrate a positive impact on the organisational client base: the public.Conclusions:Coaching impacts positively on individual and organisational performance. It enhances well being and reduces stress as well as helping coachees to move towards a more transformational style of leadership. Despite methodological difficulties in evaluating the impact of coaching, further well designed evaluation research is required if the true impact of coaching on different aspects of performance is to be demonstrated.