Productivity-enhancing work innovations: remedies for what ails hospitals?

Prospective pricing, the proliferation of alternative delivery systems, and the demands of third party payers and corporate employers for the containment of health care costs have engendered the keen interest of hospital executives seeking strategies for improving labor productivity. Despite this interest, the relevant literature suggests that few work innovations designed to enhance labor productivity have been implemented in hospitals. This article describes generic versions of four such work innovations--quality circles, union-management committees, autonomous work groups, and gainsharing--and discusses relevant research indicating the types of benefits gained from each and the reasons why some have failed. Each innovation's potential for success in hospitals is evaluated, and suggestions for increasing the effectiveness of each in hospitals is offered.