Exploring the link between organizational values and human resource certification
j o u r n a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / h u m r e s
Exploring the link between organizational values and humanresource certification
The Eli Broad Graduate School of Management, Michigan State University, N475 North Business Complex, East Lansing, MI 48824‐1122, United States
We contribute to the discussion of human resource (HR) certification by identifying
organizational values as a key antecedent to (1) an organization's use of HR certification and
(2) whether organizational members choose to pursue HR certification. Building on research
which has looked at the influence of organizational values on the behavior and attitudes of theorganization and its employees, we propose that key organizational values will influence theextent to which an organization and its members value HR certification. Specifically, weexplore the relationship between the organizational values of innovation, people orientation,and stability and the extent to which an organization uses HR certification for selectionpurposes. In addition, we propose that these key organizational values will also influencewhether the organization's members pursue HR certification. Exploring the link between keyorganizational values and HR certification is critical to our understanding of an organization'sHR practices and the behavior of its employees. By taking a more organization focusedperspective, we highlight the top-down effects of organizational values on the value of HRcertification and call for additional research on the antecedents of the value of HR certification.
2012 Elsevier Inc. All rights reserved.
“It's not hard to make decisions when you know what your values are”Roy Disney, The Walt Disney Company
Organizations are defined by their values. Values serve as a foundation for an organization's culture (
shaping and guiding the choices, attitudes, and behaviors of the organization and its members Although research has typically focused on the relationship between organizational values and employeeattitudes and behaviors ), there is renewed interest in understanding the impact of organizational valueson strategic decisions (). For example, research suggests that an organization's values can influence the pursuitand adoption of human resource practices (), responses to environmental issues (andperceptions of organizational change ). The influence that organizational values have onshaping the attitudes and behaviors of the organization as well as its members holds important implications for ourunderstanding of human resource (HR) certification.
E-mail addresses: (A.S. Garza), (F.P. Morgeson).
1053-4822/$ – see front matter 2012 Elsevier Inc. All rights reserved.
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recently proposed a multi-level framework for research on HR certification. Their model
begins with an organization's use of HR certification as a selection tool. They argue that this top-down effect will drive HRmanagement knowledge and HR department human capital, which in turn will influence macro- and micro-level outcomes (e.g., HRdepartment reputation, individual level pay). In so doing, the authors highlight the importance of the organization, and more specificallythe organization's perceived value of HR certification for staffing purposes. Although valuable, this model is silent with respect to theantecedents that influence an organization's use of HR certification as a selection tool. That is, what drives organizations to value HRcertification? Why do some organizations value HR certification whereas others do not? In addition, why might employees choose topursue HR certification, particularly if there is no immediate financial gain?
To address this gap, we build upon and extend Lengnick-Hall and Aguinis' multi-level model by incorporating organizational
values. Specifically, based on past research we argue that an organization's values will influence (a) the extent to which theorganization uses HR certification as a selection tool, and (b) whether the organization's members pursue HR certification andrecertification. Although Lengnick-Hall and Aguinis chose to focus specifically on the organization's use of HR certification forselection purposes, we acknowledge the dual influence of organizational values on both the organization's decisions (i.e., theextent to which HR certification is used in selection decisions) and on its members (i.e., the extent to which organizationalmembers pursue HR certification). As noted by , organizational values influence what ought to be in anorganization as well as how members ought to behave. Understanding what drives an organization to value HR certification is animportant issue to explore because it can help us better understand the organization's HR practices around certification, as well asthe behavior of its employees.
With this in mind, we review the extant literature on the perceived value of HR certification. Building upon this research, we
then address the role of organizational values. Next, we discuss organizational values as a critical driver of the organization's useof HR certification for selection purposes and on the employee's pursuit of HR certification. In so doing, we contribute to the HRcertification literature by taking an organization focused perspective, where we discuss the top-down effects of organizationalvalues on the value of HR certification.
2. Differences in the perceived value of HR certification
Given the costs associated with HR certification, both in terms of time and money, research has sought to understand its
perceived value for employees and employers. For example, examined the relationshipbetween HR certification and career opportunities. They analyzed the percentage of HR job announcements posted on four jobsearch engines (e.g., careerbuilder.com) over a 1-week period. Of the 1873 job announcements they reviewed, only 4.2% requiredor preferred HR certification. More recently, found that universityundergraduates who passed the Professional in Human Resource (PHR) certification exam were more than twice as likely toobtain an HR job than those who did not take or did not pass the exam. However, they found that passing the PHR exam was not asignificant predictor of starting salary or number of promotions received. found similar results. Ninety percent of the supervisors they surveyed felt that having a HR certified professional was generally beneficial, but that HRcertification did not have a significant influence on hiring or salary decisions. In contrast, the HR Certification Institute found thatapproximately one-half of participating certified HR professionals received recognition from their organization for theircertification. In addition, approximately one-third reported that their HR certification resulted in higher pay
Together, these mixed results would seem to suggest that organizations differ in their perceptions of the value of HR
certification. For their part, found that the requirement or preference for HR certification in jobannouncements varied across industry type. Specifically, approximately 10% of job announcements in manufacturing, 10% of jobannouncements in accommodation and food services, and 7% of job announcements in health care and social assistance includeda statement indicating that HR certification was required or preferred. In contrast, none of the job announcements intransportation and warehouse, and only .7% of job announcements in retail trade required or preferred HR certification. Consistent with this, found that perceptions of the value of HR certification varied greatly across a sample ofthree Midwestern Universities. For example, one university had a required capstone course for HR majors designed to preparestudents for the exam, and only students who passed the PHR exam graduated as HR majors. Another university stronglyencouraged HR students to take the PHR but it was not a formal requirement. Finally, the third university neither promoted thePHR exam nor offered a structured method for studying for the exam.
These findings suggest that organizations differ in their perceptions of the value of HR certification. Because the majority of
research has focused on the relationship between HR certification and career outcomes (e.g., job offers, starting salary), muchremains to be understood about the factors that influence perceptions of HR certification. As noted by given the increasing popularity of HR certification, it is critical to determine its value to individuals and organizations. Weagree whole-heartedly, yet we also believe that an understanding of the value of HR certification would be incomplete without aconsideration of the broader organizational context in which this evaluation is made. That is, it is essential that we understandwhy some organizations might value HR certification more so than others.
Research on the influence of organizational values may help shed light on the different perceptions of HR certification across
organizations. At the core of an organization's culture are its values. Research suggests that as a key component of theorganization's context and culture (), organizational values play a critical role in thebehavior and attitudes of the organization and its employees (Thiswould suggest that an organization's values may influence the extent to which it values HR certification. In the following sections,
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we review past findings on the impact of organizational values before discussing its influence on an organization's use of HRcertification for selection decisions.
Past research has defined organizational values in numerous ways. For example,
defined an organization's values as “defining elements around which norms, symbols, rituals, and other cultural activities revolve”(pp. 491–492). More recently, defined values as those elements of the context that “describecharacteristics of organizations (), guide action and behavior () and serve to differentiateorganizations ” For their part, defined organizational values as standards forevaluating member behavior and organizational success. Albeit different definitions, the heart of organizational values rests in itsability to guide and influence the choices, priorities, actions, and attitudes of the organization and its members ). As noted by an organization's values “provide an elaborate andgeneralized justification both for appropriate behaviors of members and for the activities and functions of the system.”
A considerable body of research exists that has sought to understand the relationship between organizational values and the
organization's and member's attitudes and behaviors (By looking at these past findings, we may be able to understand howorganizational values influence the extent to which an organization and its members value HR certification.
3.1. Influence on organizational decisions
Organizational values form the framework from which all other strategic decisions are made. In a 1990 interview titled
“Values make the company,” then Chairman and CEO of Levi Strauss & Co., Robert D. Haas described the importance of theorganization's core values (what they termed “the aspirations”) on key decisions within the company. He talked in detail abouthow the company's values not only shaped the occupational roles and responsibilities of its employees, but also the company'sperformance evaluations, training programs, organization of work, and key business decisions. When asked specifically about theinfluence of the company's values on business decisions, he gave the following example:
“The Aspirations make us slow down decisions. We challenge ourselves more explicitly to give some factors more weightthan we did before — especially the impact of a plant closing on the community. There have been plants we have decidednot to close, even though their costs were higher than other plants we did close. The reason was the community impact”().
A number of empirical studies have sought to understand the relationship between a company's values and the organization's
actions and practices. For example, studied 88 corporations to develop a more comprehensive understanding ofthe impact of nine different organizational values. The authors found that organizations with different value structures varied in howthey described and reacted to organizational change. More recently, used an ethnographic longitudinal research designto study the relationship between organizational values and the organization's response to environmental issues (e.g., energy andwaste management, sustainable development, office-waste recycling reduction). Within two large-scale organizations, Bansal foundthat the company's values explained whether the organization chose to respond to a given environmental issue. In addition, she foundthat the organization's values also determined the scope, scale, and speed of the company's response. Thus, it is clear thatorganizational values play a key role in determining the organization's attitudes and actions.
Other research has focused more specifically on the influence of organizational values as they relate to a company's HR
practices, policies, and decisions. For example, found that strong, clear, and visible organizational valueswere related to rigorous recruitment and selection processes (e.g., company recruits are subject to at least four in-depthinterviews, company actively facilitates deselection during the recruitment process by revealing minuses as well as pluses). Fortheir part, used a qualitative research method to identify five core values within 97 nonprofit theaterorganizations. These prosocial (i.e., expanding community access to and appreciation for the arts), artistic (i.e., artistic creativity,innovation, and independence), financial (i.e., financial stability and security), market (i.e., commitment to customer satisfaction),and achievement (i.e., publically recognized excellence) values were then empirical linked to the company's decisions regardinghuman resource allocations. Specifically, the authors tested the relationship between each of the organizational values and thenumber of full-time employees devoted to either outreach, development, marketing, or design and acting. Results indicated thatorganizations higher on the prosocial value dimension invested significantly more in outreach and education employees, whereasorganizations higher on the artistic value dimension were more likely to have a greater number of employees dedicated to designand acting. In contrast, organizations higher on the achievement value dimensions were less likely to have full-time employeesdevoted to design and acting activities but were more likely to employ full-time development staff.
In one of the largest scale studies to date, examined the relationship between organizational values and
bundles of HR practices in 661 organizations across a full range of industries and organizational size. Building on the work of, the authors derived three core organizational values from a factor analysis of 28 organizational values. Thevalues of innovation, people orientation, and stability were found to differentially relate to five types of HR bundles consisting of19 human resource practices (e.g., recruitment, mentoring, and benefits). For example, organizations that value innovation tend
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to focus on using reward packages to attract and motivate employees. Their findings suggest that “organizations possess HRsystems consistent with their values,” (p. 874) and that “organizations maintain some level of fit between their HR systems andtheir espoused values” Hence, it is clear that the type of HR practices adopted by an organization isinfluenced by the organization's core values.
Because the use of HR certification in selection decisions (i.e., the extent to which organizations value HR certification)
represents a key HR practice, we chose to focus on the three values identified by In the following section, wediscuss each core organizational value in greater detail before addressing its influence on the organization's perceived value of HRcertification.
3.2. Organizational values and the use of HR certification for selection decisions
found that three organizational values, innovation, people orientation, and stability, relate to HR practices
adopted by the organization. Innovative organizations value employee risk taking, competitiveness, experimentation, andleveraging potential opportunities. People oriented organizations value collaboration, supportiveness, information sharing,flexibility, and respect and tolerance. Finally, stable organizations value predictability and continuity.
Innovative organizations require employees that possess an extensive knowledge base and skill set that allows them to
experiment, take risks, and capitalize on opportunities In addition, highly innovativeorganizations operate in environments that often require rapid response to change. Thus, employees must be prepared to adjustand to handle new information. Because there are significant costs associated with developing employee knowledge and skills,highly innovative organizations are likely to purchase already competent and qualified human resources off the market ratherthan investing significant amounts of time and money in training employees (In turn, “these organizationsensure that the human resources that they hire off the market are immediately capable through sophisticated selection andrecruitment practices” (This “buy” orientation allows the organization to focus on taking risks, being firstto market, and on adjusting to changes more quickly than if new employees had to be trained ). By buying human resources off the market, organizations that value innovation are able to adapt quickly without having toinvest in training. This would seem to suggest that organizations that value innovation will be more likely to value employeeswith HR certification when making selection decisions because certification signifies the mastery of a particular area of the HRbody of knowledge (). Thus, certified HR professionals already possess a preexistingbody of information, knowledge, and skills straight from the market that is particularly attractive to organizations that valueinnovation.
Proposition 1. The use of HR certification in selection decisions will be higher in innovative organizations than in people oriented orstable organizations.
Like highly innovative organizations, people oriented organizations aim at selecting and hiring the best people
). In addition, these organizations are more likely to treat their employees fairly by paying equitable wages and attractivebenefits. This commitment to selecting and hiring the best people is likely to influence the extent to which organizations hirecertified HR professionals. Because HR certification signifies a given level of knowledge that distinguishes certified candidatesfrom other applicants, people oriented organizations are likely to value HR certification when making selection decisions. However, unlike highly innovative organizations, people oriented organizations are more likely to take a long-term perspectivewith respect to their employees' professional development (That is, people oriented organizations are morelikely to ensure that their employees are provided with developmental opportunities and are able to gain additional knowledgeand skills. For example, they are more likely to provide new employees with career mentors to assist in their development (Because high people oriented organizations focus on employee development and have a long-term perspective withrespect to their employees, they are more likely to hire applicants that do not have HR certification when compared with highlyinnovative organizations. In addition, people oriented organizations do not face the same time constraints that highly innovativeorganizations face. As a result, these organizations can devote the necessary time and resources to develop employees who arenot initially hired with HR certification.
Proposition 2. The use of HR certification in selection decisions will be higher in people oriented organizations than in stableorganizations but will be lower than in innovative organizations.
Organizations that value stability and predictability in their human resources stand in contrast to innovative and people
oriented organizations ). To achieve stability in their human resources, these organizations strive to provideextensive training and development programs for their employees. Like people oriented organizations, organizations that valuestability take a long-term perspective to their employees' career paths. By providing training and development opportunities, theorganization can help assure standardization and predictability across their employee's work behaviors (Thus, unlike innovative organizations that utilize a “buy” strategy to hire the best applicantsoff the market, organizations that value stability may choose a “make” strategy where the organization develops their own humanresources. As such, organizations that seek predictability and stability may choose to train candidates in accordance with their
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particular goals and priorities. Consequently, an organization that seeks to develop and make their own human resources may beless concerned with hiring HR certified professionals.
Proposition 3. The use of HR certification in selection decisions will be lower in stable organizations than in innovative or peopleoriented organizations.
3.3. Influence on employee attitudes and behaviors
The influence of organizational values can extend beyond the organization's decisions. Employees draw from the
organization's values to guide their own attitudes and behaviors. In the following section, we build upon the large body ofevidence that looks at the influence of organizational values on employee behaviors. Using this research and the work of , we propose that the organizational values, innovation, people orientation, and stability will determine the extent towhich employees within the organization value HR certification.
Organizational values can significantly impact employee attitudes and behaviors (
Thus, research suggests that to better understand organizational behavior, scholarsshould adopt a values-oriented approach As noted by “Organizational values arebelieved to shape every move and decision made by employees at all levels…” Research indicates that an organization's valuescan impact a wide range of employee outcomes from workaholism to employee innovation In a series of studies, Jin et al. examined the influence of organizationalvalues on employee and manager unethical behaviors. They found that organizations that value collaboration, creativity,encouragement, empowerment, and trust, reported lower levels of unethical behaviors. In contrast, organizations that valuestructure, hierarchy, power, regulation, and procedures were more likely to engage in unethical behaviors (examined the influence of organizational safety values in a sample of fleet drivers. Theirfindings suggest that organizational safety values directly influence employee and manager safety values, which in turn influenceemployee safety behaviors. Clearly, organizational values play a critical role in influencing the behaviors and actions of itsmembers.
Given this influence, we suggest that the organizational values, innovation, people orientation, and stability will influence
employee perceptions of the value of HR certification as evidenced by the employee's pursuit of HR certification.
3.4. Organizational values and employee pursuit of HR certification
Consider the following dilemma. You are a HR professional for an organization and currently do not have HR certification.
Should you invest your time, effort, and money in taking the HR certification exam? Or, should you forgo these costs and spendyour time elsewhere? When making this decision, you are likely to consider the extent to which your organization values andrewards HR certification. Organizational values are critical because they signal to its members what the organization identifies asimportant Research has shown that employees adopt the values that are rewarded in theirorganizations (Thus, to understand why employees choose to pursue HR certification (or to recertify) one mustconsider the context within which that decision takes place, and in particular the organization's values.
Organizations that value innovation require that employees maintain a set of knowledge and skills that allow them to produce
new ideas and information while responding quickly to a rapidly changing environment. Thus, employees must be prepared toadjust and to handle new information. As such, employees in innovative organizations are likely to seek out continuousimprovement and development opportunities. HR certification exams require test-takers to demonstrate a given level of masteryover HR knowledge that may allow them to implement forward thinking HR practices. In addition, to maintain one's HRcertification, HR professionals must retake the exam every three years thus representing an opportunity for continuousdevelopment.
In line with the organizational value of innovation and the “buy” strategy toward human resources, these organizations are
likely to reward employees for their innovation, creativity, and adaptability. Thus, high innovation organizations are more likelyto motivate employees using competitive knowledge or skill-based pay This would suggest that employees arelikely to receive greater recognition for HR certification and recertification. Hence, organizations that value innovation are likelyto have a greater number of HR professionals that pursue certification.
Proposition 4. Innovative organizations will have a greater number of HR professionals that pursue HR certification than stableorganizations.
People oriented organizations value, care, and support their employees. These organizations are similar to those identified by
as “clan” type organizations. suggest that these type of organizations valueaffiliation, collaboration, and trust. This results in greater employee participation, involvement, and commitment. One way inwhich HR professionals may seek to contribute to their organization and demonstrate their commitment is to seek out knowledgeand skills sets that will allow them to participate and add to the organization. To achieve this goal, HR professionals may be morelikely to pursue HR certification. In addition, people oriented organizations encourage employees to focus on their development
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and to take a long-term perspective with respect to their careers (Thus, although people oriented organizationsmay be less concerned with initially selecting HR certified professionals, they are more likely to encourage HR professionals toseek out HR certification and recertification as they continue in their careers.
Proposition 5. People oriented organizations will have a greater number of HR professionals that pursue HR certification than stableorganizations.
Organizations that value stability focus on routinization, formalization, and consistency. A core assumption of these organizations
is that control, stability, and predictability foster efficiency Because their focus is on conformity andpredictability, stable organizations are likely to standardize employee behaviors through extensive training and development. This isconsistent with their “make” strategy toward human resources where the organization seeks to align the knowledge and skills ofemployees with the organization's specific goals and priorities. This focus on control, consistency, and rule orientation in turn mayinfluence an organization's preference to develop their own employees instead of encouraging them to seek outside developmentalopportunities. In support of this, research suggests that high stability organizations are less likely to empower employees As such, HR professionals in these organizations may view HR certification as unnecessary given the strong norm for internaltraining and development. In addition, organizations that value stability are less likely to reward employees via knowledge or skill-based pay. Given that stable organizations are unlikely to motivate employees to seek out external developmental opportunities, HRprofessionals within these types of organizations are less likely to pursue HR certification or recertification.
Proposition 6. Stable organizations will have a lower number of HR professionals that pursue HR certification than innovative orpeople oriented organizations.
As noted by the impact of values “lies not in and of the values themselves, but in the coordinated actions and
behaviors they are known to encourage and foster” (p. 221). In this article, we build upon the work of by looking at organizational values as drivers of an organization's use of HR certification for selection purposes. Inaddition, we extend their model and propose that organizational values will also influence the extent to which employees chooseto pursue HR certification.
It is clear that organizations have different values. These values, in turn, are likely to influence the extent to which
organizations value HR certification when making selection decisions. An organization that values innovation and wishes to savetime and money associated with developing employees may instead choose to select candidates that already possess a given set ofknowledge and skills. As such, these organizations are most likely to value HR certification when making selection decisions. Incontrast, organizations that highly value stability and predictability in their human resources may be less likely to value HRcertification in their initial selection decisions. Instead, these organizations may choose to develop and train employees post-hireto fit with the organization's specific needs.
Employees are also sensitive to organizational values, particularly given the fact that they are often attracted to, selected by,
and remain in organizations due to an organization's values and the specific practices implied by those values (). Such values have a top-down influence on employee decisions and behavior, which is consistent with an emerging body ofresearch that demonstrates how context can come to shape worker behavior ().
Although research has sought to better understand organization and employee perceptions of the value of HR certification,
these efforts have largely ignored the role of the organizational context in influencing these evaluations. Based on a large body ofresearch that has looked at the critical role of organizational values, we propose that the organizational values of innovation,people orientation, and stability will directly influence perceptions of the value of HR certification. By focusing on organizationalvalues as a driver of the value of HR certification, we help encourage research to consider a broader set of organizational-levelfactors and cross-level effects.
In this paper we have argued for a link between organizational values and organizational and employee behavior (see ).
Clearly, future research needs to be conducted to determine whether our propositions are empirically supported. A challengewith exploring these issues is the need to conduct research at the organizational-level. Because values are a property of theorganization, multiple organizations would need to be sampled in order to obtain variability in innovation, people orientation,and stability.
Table 1The influence of organizational values on HR certification.
Use of HR certification in selection decisions
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In addition, although we have chosen to focus on the values of innovation, people orientation, and stability, there are other
values that may be potentially meaningful. For example, the extent to which an organization values learning and developmentmight play an important role in the kinds of processes we describe. Future research would be wise to explore other potentiallyrelevant values.
Beyond values, however, there are numerous other factors that might impact whether an organization values HR certification.
We chose to focus on values given its clear connection to organizational culture and its impact on HR practice adoption, but otherfactors may be relevant. For example, the extent to which the HR function is viewed as a strategic partner and represents thestrategic core of the organization is likely to impact how an organization values HR certification. As Jack former CEO of General Electric noted, “Without a doubt, the head of HR should be the second most important person in anyorganization. From the point of view of the CEO, the director of HR should be at least equal to the CFO.” When a CEO feels this way,the HR function is likely to be viewed more positively, with a potentially meaningful impact on how HR certification is viewed inthe organization.
Another potentially interesting issue to explore is how values might differ across cultural contexts. The laws and regulations
around HR certification, the expectations of workers, and the general benevolence of organizations are likely to vary considerablyacross countries. The importance of continuous learning and development implied by HR certification is likely to be quite differentacross countries, and would be worthy of study. For example, conducted a comparative analysis of HR certificationamong three major certification programs (i.e., Human Resource Certification Institute, Human Resources ProfessionalsAssociation of Ontario, Institute of Personnel and Development) in the U.S., Canada, and the UK. She found that although therewere areas of similarity, there were major differences with respect to the HR certification programs' integration with thegovernment, industry, and academia. For example, UK's HR certification program coordinates with the government to developnational standards and qualifications whereas in the U.S. the HRCI is not integrated with any government agencies. One possibilityis that HR certification programs that are integrated with government agencies may have more perceived value amongstorganizations and employees, thus suggesting cross-cultural differences. Most recently, the found that employersoutside the U.S. placed a greater emphasis on providing study leave for HR professionals interested in certification and were morelikely to monitor increases in productivity and customer satisfaction resulting from certification. These findings provide initialevidence that the value of HR certification differs across countries and that considering the unique cultural values in thesecontexts may be an area of future study.
Finally, by focusing on organizational values, we have neglected the potentially important role that individual values can play
in pursuing HR certification. It is likely that an employee's own values toward development more broadly and HR certificationmore specifically will have a critical influence. Future research could explore this individual-level influence. In addition toexamining the solely organizational-level or individual-level influences, another potentially interesting area to explore is theextent to which congruence in these values might predict the value and pursuit of HR certification. A significant body of evidencesuggests that congruence between the organization's and the employee's values is likely to yield positive outcomes (). It is likely that high and lowlevels of value congruence will lead to high and low levels of pursuit of HR certification. What would be particularly interesting toexplore would be the disconnects in values, such as when an organization values certification but the employee does not or whenan organization does not value certification but the employee does. Which values become more important? Future research couldexplore such possibilities.
In our paper we have sought to highlight a neglected factor in the HR certification discussion, that of organizational values. As
we have suggested, an organization's values can have an important effect on the attitude an organization and its employees taketoward certification. Much research remains to be done, and we hope that our paper helps advance work in this importantdomain.
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NEW MICROBIOLOGICA, 30 , 346-349, 2007 Pharmacokinetics and pharmacodynamics in HAART and antibiotic therapy Marta Boffito St. Stephen’s Centre, Chelsea and Westminster Hospital, London, UK Therapeutic agents used to inhibit the HIV replication are used in combination. The achievement of effective plas-ma concentrations of the drug in its active form, and sustaining such concentrati
Schmerzkonzept des Zentrums für Zahn-, Mund- und Kieferheilkunde und der Klinik für Anästhesie und Intensivtherapie (Jugendliche, Erwachsene) Basistherapie Zusätzlich bei anhaltenden Schmerzen Zusätzlich bei Eingriffe NRS > 3 in Ruhe NRS > 5 - Stufe I - - Stufe IIa / IIb - - Stufe III - (so viel und so oft wie nötig!!) I