A longitudinal study into the effectiveness of the HPO Framework

The case of a social care and rehabilitation organization

• Purpose – The academic and management literature offers an abundance of techniques for helping organizations improve their performance. Generally, though, these techniques have not been subjected to rigorous, evidence-based evaluation or have been tested in practice over time. The purpose of this paper is to describe a longitudinal study into the effectiveness of the High Performance Organization (HPO) Framework at a social care and rehabilitation organization.
• Design/methodology/approach – The HPO Framework was applied at LIMOR in the Netherlands. The longitudinal nature of the study consisted of conducting an “HPO diagnosis” twice at the organization, in 2012 and 2015. In the second diagnosis, the effectiveness of the interventions the organization undertook to address the recommendations originating from the first HPO diagnosis was also measured.
• Findings – The study aimed to discover whether the HPO Framework was a suitable improvement technique with which to increase the performance of a social care and rehabilitation organization in a sustainable way. The results showed that it was used to ward off and contain the negative effects of external turbulent developments, and thereby helped LIMOR to perform better than comparable organizations.
• Originality/value – As a longitudinal study of the workings and effects of the HPO Framework at a social care and rehabilitation organization, this study is the first of its kind. Moreover, it addresses two gaps in the current literature, by contributing longitudinal evidence to the body of knowledge on improvement techniques, specifically in the non-profit sector, and by adding insights on the practical workings of the HPO Framework in a non-profit context, specifically the social care and rehabilitation sector.
• Keywords – Organizational performance, High performance organizations, Healthcare management, HPO Framework, Longitudinal approach
• Paper type – Research paper

1. Introduction

The academic and management literature provides an abundance of techniques which their authors claim will help organizations to improve their performance. One might expect that the authors of such studies would invest in subjecting their techniques to rigorous evidence-based
management research in order to test their ideas in practice over a certain time period and evaluate whether they have sustainable positive effects, thereby proving their relevance to managerial practice (Pfeffer and Sutton, 2006; Kieser et al., 2015). In reality, this is hardly ever
done, and in practice it turns out that many of these so-called “miracle cures” have, at best, only a short-term positive effect (Axson, 2010; Parnell et al., 2012). Thus, there seems to be a distinct gap in the extant literature regarding studies that evaluate the effectiveness of  organizational improvement techniques (Rosenzweig, 2007; HakemZadeh and Baba, 2016). One way to evaluate this effectiveness would be to subject the improvement technique to a longitudinal study, an approach that can be defined as “an empirical inquiry that investigates a
contemporary phenomenon as it changes over time within its real-life context, especially when the boundaries between phenomenon and context (including temporal context) are not clearly evident” (Rainer, 2011, p. 733), or, even more precisely, as research in which “data are collected on one or more variables for two or more time periods, thus allowing at least measurement of change and possibly explanation of change” (Menard, 2008, p. 3).

This paper describes a longitudinal study into the effectiveness of the “High Performance Organization (HPO) Framework” (de Waal, 2012) at a social care and rehabilitation organization. The HPO Framework aims to guide organizations in their transition from average to high performance. An HPO is defined as “an organization that achieves financial and non-financial results that are increasingly better than those of its peer group over a period of time of five years or more, by focussing in a disciplined way on what really matters to the organization” (de Waal, 2012, p. 5). The effectiveness of this framework in increasing sustainably and enduringly the performance of organizations has been validated several times, but not yet in non-profit organizations. Accordingly, this study tests the efficacy of the HPO Framework over time at a social care and rehabilitation organization.
There is hardly any scholarly literature to be found on improving social care organizations themselves, with most research seemingly focussed on the improvement of treatment methods. Thus, the research question of the present study is as follows:

RQ1. Is the HPO Framework an effective technique with which to address the performance issues of social care and rehabilitation organizations?

Accordingly, this study aims to address two gaps in the current literature: in the theoretical literature, by contributing longitudinal evidence to the current limited body of knowledge on the effects of improvement techniques in the specific context of the health sector (Kovner, 2014); and, in the practitioner literature, by adding knowledge on the applied workings of the HPO Framework in a healthcare context, specifically the social care and rehabilitation sector.
The remainder of this paper is structured as follows. The next two sections briefly describe the social care and rehabilitation sector and discuss previous research into high performance therein. This is followed by sections specifying the HPO Framework and the case study company. Subsequently, the research approach and research results are discussed. Finally, the article’s conclusion is presented, potential limitations of the research are considered, and opportunities for future research are suggested.

2. The social care and rehabilitation sector

Social care and rehabilitation organizations are public organizations working under a government framework of the law on social provision (Costa and Anderson, 2011). Social care is administered through local authorities, and in essence is a locally delivered service operating to centrally determined policy goals (Clarkson et al., 2009). The main goal of social care and rehabilitation is to maintain and enhance the individual well-being of people, by supplying services that try to achieve and sustain the optimum state of health of the recipients of these services (Schmid, 2002). A rehabilitation centre is a distinct form of social care organization that specializes in providing care for the particular needs of patients, ranging from individuals suffering with a specific illness or injury to those who are homeless. People typically attend rehabilitation centres because they need particular care and treatment protocols that hospitals or town councils often do not offer but they urgently require (Chandra et al., 2014). Thus, the “client base” of social care and rehabilitation organizations consists of persons needing specialized care and/or therapy that assists them in their restoration to good health and improves their quality of life.
In effect, social care and rehabilitation organizations deal with the urgence sociale of people – situations of “social emergency” – as well as broader crisis interventions addressing such situations (FEANTSA, 2005). The workforce within social care and rehabilitation organizations comprises both medical (e.g. physicians in specialty fields, nurses) and non-medical personnel (Chandra et al., 2014)…

Read all finding and interventions, published in Emerald Insight, in this paper!