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Results for “Hospital Restructuring”

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PubMed1999

Decision-making activity and influence of nurse executives in top management teams.

This study assesses the impact on decision-making when introducing the nurse executive into the top management team (TMT) in Veterans Affairs Medical Centers. Results indicate that nurse executives formally elevated to the TMT were no more likely to perceive greater involvement in decision-making than non-TMT nurse executives or nurses informally appointed to the TMT. However, nurse executives in all categories perceived themselves as more involved in strategic decisions than other TMT members.

Decision Making, Organizational↗
PubMed1999

Longitudinal evaluation of professional nursing practice redesign.

OBJECTIVES: The authors describe a 5-year study at a western university teaching hospital that evaluated the effect of organizational redesign on nurse job satisfaction, autonomy, and patient satisfaction. BACKGROUND: Change in institutional status from public to private authority stimulated this hospital to map a new direction for professional nursing practice, to strengthen autonomy and job satisfaction while improving quality care outcomes. Evaluating redesign changes systematically provided significant longitudinal trended data to guide nurse executive actions. METHODS: Phase-I evaluation, from 1992 to 1995, was a quasi-experimental design comparing pre- and poststudy outcomes of facilitator-led activities on units receiving interventions compared with control units. Of 12 outcome variables measured, 3 were sustained longitudinally into Phase II: nursing job satisfaction using the McCloskey Mueller Satisfaction Scale (MMSS), autonomy using Schutzenhofer's Scale, and patient satisfaction using the Picker Institute survey. Data were trended across units and departments over a 5-year period. RESULTS: Phase-I results reported that control units held higher nursing documentation scores than the experimental units. There were no significant differences in aggregate nurse job satisfaction scores. Nurse autonomy scores significantly improved. Other results are reported descriptively. Phase II continued the evaluation, reporting no differences in nurse job satisfaction aggregate scores a decline in autonomy, and decreased patient satisfaction scores. There were significant differences by units and across departments. CONCLUSIONS: Longitudinal evaluation provides significant data to guide nurse executives in an uncertain healthcare environment. Of theoretical interest is the absence of congruence in nurse job satisfaction and autonomy scores, suggesting more independence between these variables than previously reported.

Colorado↗
PubMed1999

Informatics and process improvement. The clinical design unit.

Seeking to integrate departments and services, reduce costs, and enhance quality, administrators at a university medical center implemented a clinical design unit. The authors describe the operations of the unit in testing new processes before rollout to the entire center.

Academic Medical Centers↗
PubMed2000

The impact of systems redesign on staff, patient, and financial outcomes.

OBJECTIVES: The purpose of this study was to measure the impact of a change initiative using the strategies of inpatient bed consolidation and patient population reaggregation on staff, patient, and financial outcomes. BACKGROUND: Bed consolidation and patient population reaggregation are extensively used strategies in the hospital industry. However, the state of science as it relates to these two strategies is limited, with no studies measuring the effect of bed consolidation, patient reaggregation, or both in isolation of multiple other concurrent care model changes. METHODS: An exploratory, single case, longitudinal field study design with embedded levels of analysis was used for the study. The impact associated with the reaggregation and consolidation of the acute inpatient system of care was evaluated at the organization, the acute inpatient nursing unit, and the individual nursing staff member levels. This article reports the outcomes found at both the nursing unit level and the staff member level on three general medicine nursing units. Baseline nursing unit-level data are reported from fiscal year 1994-1995 and the first half of fiscal year 1995-1996 (July 1995 through December 1995); data from January 1996 through June 1996 reflect the planning phase of the project. Outcomes related to the change process are reported from the time period January 1996 through June 1997. Staff perceptions of multiple variables were measured at five different data points over a 2-year period. Both quantitative and qualitative data were collected. RESULTS: Unit-level cost and hours per patient day (HPPD) increased during or immediately after the merger of major patient populations on two of the study units; no significant variation was found in medication errors or patient falls. The quantitative and qualitative data analysis of the nursing staff member surveys revealed a nursing staff that was dissatisfied with many aspects of their job, worried about job security, had low morale, and had many concerns about the quality of care provided to patients. CONCLUSIONS: This study suggests that consolidation and reaggregation strategies may cause an increase in costs and HPPDs, at least on a short-term basis. Also, these strategies may have a significant effect on the morale and job satisfaction of unit-level nursing. In light of these findings, on-going testing of the efficacy of consolidation and patient reaggregation strategies in improving quality and cost outcomes is essential.

Academic Medical Centers↗
PubMed2000

Organizational culture and work redesign: experiences in three organizations.

Lack of attention to the organization's culture can mean failure for its strategic initiatives. The authors present the results of three case studies of work redesign initiatives in which organizational culture, as measured by the Competing Values Framework, was assessed before and after project implementation. The organization with a balanced culture at baseline and higher "adhocracy" (developmental) values after implementation was more successful than the two organizations with dominant baseline market and hierarchy cultures. Recommendations for increasing desired values and decreasing undesired ones are provided.

Allied Health Personnel↗
PubMed2001

Critical access hospitals: rural nursing issues.

Critical Access Hospitals (CAHs) are a recent federal initiative to address the fiscal concerns of small rural hospitals and improve access to healthcare for rural residents. A national effort exists to examine the outcomes of this federal initiative, but there is a paucity of information about nursing in CAHs. This pilot study, using survey techniques, examined rural nurses' perceptions of CAH conversion. The authors discuss the authorizing legislation, Medicare Rural Hospital Flexibility Program (MRHFP), and highlight survey findings on nurses' perceptions about hospitals that converted to CAH status. The information can be used by nursing administrators and educators to prepare nurses to work in CAHs that are located in more remote areas of the United States.

Attitude of Health Personnel↗
PubMed2003

Dual or dueling culture and commitment: The impact of a tri-hospital merger.

OBJECTIVES: This article addresses differences in RNs' commitment to their employing hospital versus the umbrella corporate organization, and the role of organizational culture during a tri-hospital merger. This study is the first to investigate the construct of dual commitment in healthcare organizations. BACKGROUND: Fiscal restraints, decreasing reimbursement, and increasing competition have made organizational mergers and acquisitions prevalent. As corporate culture changes, organizational variables previously related to organizational commitment may no longer apply. METHODS: RNs employed on general nursing units at 3 hospitals involved in a merger process completed 2 versions of Mowday's Organizational Commitment Questionnaire. Commitment to hospital and corporate system were examined. Semi-structured interviews, participant observation, and analysis of company documents assessed the organizational culture changes that have occurred. RESULTS: Thirty-one percent of the nurses returned completed questionnaires; 9 were interviewed. RNs from the acquiring hospital demonstrated a significantly stronger commitment to the corporate system than the nurses from the acquired hospitals. The RNs at all 3 hospitals showed significantly greater commitment to their own particular hospital than to the umbrella corporate system. CONCLUSIONS: Moderate level of commitment reflected uncertainty of job status, work overload, and feelings of unappreciation. These attitudes prevent nurses from exerting efforts on behalf of the organization.

Adaptation, Psychological↗
PubMed2003

Collaboration among nurse executives in complex environments: fostering administrative best practice.

In the past decade, many healthcare institutions have formed new partnerships, alliances, and networks. Collaboration among chief nursing officers and other leaders from affiliating institutions is essential to the success of these new organizational structures. The authors explore the nature of the collaboration among chief nursing officers and senior nurse leaders at 5 Harvard-affiliated teaching hospitals that provide cancer care. In particular, this article examines how collaborative relationships have been fostered and highlights the challenges, benefits, and outcomes of successful cross-institutional collaboration.

Benchmarking↗
PubMed1998

Developing a service line approach to quality improvement.

A specialty hospital in New England is undergoing a radical change in its quality program. It is shifting from a traditional quality assurance structure with 41 segregated committees to an integrated model based on service lines. The goals for this shift were fourfold: to reduce duplication of effort, to improve the level of integration of quality efforts across disciplines, to design a comprehensive system to evaluate care, and to enhance the communication of quality efforts. The article describes the rationale for selecting a service line model for performance improvement, the process of setting this change in motion, and the lessons learned along the way.

Female↗
PubMed2001

Managing women's and children's services: contemporary models as a template for the future.

Historically hospitals have struggled with organizational design and management of services within a single institution. The traditional design has been a bureaucracy with a hierarchical management structure. As individual hospitals develop new business relationships to form health systems, there is a need for innovative solutions that provide the flexibility and responsiveness necessary for successful health care management. One traditional business model, the SBU, or strategic business unit, may serve as a template for the development of product or service lines. The SBU has application for selected portions of a health care organization. The SBU will be discussed as it specifically relates to women's and children's health care services.

Adolescent↗
PubMed1987

Does hospital diversification improve financial outcomes?

Service or product diversification is a popular recommendation made to hospitals to increase profitability and reduce financial risk as they face a more hostile environment. This paper presents results from an empirical study of these claims. Using data from all California nonprofit hospitals, the study finds that diversification, regardless of whether it is related or unrelated to preexisting services, is not associated with either increased profitability or reduced financial risk. However, other variables that do have these effects are identified in the research. Future research should evaluate the effect of both the size of and the length of time since the initial diversifying investment on financial variables.

Accounting↗
PubMed1992

Characteristics of the divested HCA and AMI hospitals.

The primary aim of this study was to compare and contrast the predivestiture managerial and market characteristics of the following: Divested and nondivested hospitals of Hospital Corporation of America (HCA) and American Medical International (AMI). The findings indicated that HCA hospitals with 1) lower occupancy rates, 2) less growth in revenues, 3) higher debt to total asset position, 4) fewer beds, 5) less growth in their elderly populations, and 6) less growth in their markets' per capita incomes had a higher probability of being divested into HealthTrust. The results for the AMI model were similar to those for the HCA model. AMI hospitals with 1) fewer beds, 2) less growth in their markets' per capita incomes, 3) lower salary expenses per discharge, 4) lower occupancy rates, and 5) increased growth in populations had a higher probability of being divested into EPIC.

Bed Occupancy↗
PubMed1996

Determinants of rural hospital conversion. A model of profound organizational change.

One widely discussed response to the severe problems faced by many rural hospitals is to convert them into organizations that provide health services other than general, acute inpatient care. This study identifies conversions that occurred nationally from 1984 to 1991. The study also empirically examines the determinants of conversion, using rural hospitals that did not convert (between 1984 and 1991) as a comparison group. The authors examine a set of factors that makes radical organizational change necessary (eg, poor performance) and reduces resistance to such change (eg, proximity to other hospitals). Results from discrete-time logistic regression show that converters are more likely than nonconverters to: have poor performance and fewer beds; be located very near to or very distant from similar hospitals; operate in larger communities; devote more of their care to areas other than acute inpatient care; and be members of multihospital systems. Converters also are less likely to be government owned. The need for future research on the effects of conversion is discussed.

Bed Conversion↗
PubMed1997

Hospitals in England: impact of the 1990 National Health Service reforms.

OBJECTIVES: This article aims to describe recent changes in English hospitals, with particular reference to the impact of the National Health Service (NHS) and Community Care Act of 1990. METHODS: Significant policies that have affected the functioning of the hospital sector of the British NHS are reviewed. Data from the NHS Department of Health are used to describe trends in utilization. RESULTS: The NHS and Community Care Act of 1990 radically changed the financial and organizational framework within which hospitals operate. By creating separate purchasing organizations, the act opened the way for competition between hospitals. In practice, such competition has been very limited. Central directives aimed at reducing waiting times for nonurgent admissions, as well as at raising the volume of work done relative to the finances available have been more significant influences. These changes, combined with rising numbers of emergency admissions, have put the physical and human resources of English hospitals under intense pressure. Admissions have risen, lengths of stay have fallen across all age groups, and ambulatory care has grown rapidly. CONCLUSIONS: There is little consensus on the future direction regarding the role and structure of acute-care hospitals. There is evidence, though, that improvements in the process and outcomes of care are possible within the current financial and organizational framework of the hospital sector.

England↗
PubMed1997

Health sector reform and trends in the United Kingdom hospital workforce.

OBJECTIVES: The authors examine changing trends in the profile and patterns of employment of the workforce in hospitals in the National Health Service (NHS) in the United Kingdom. The effect of the implementation of the NHS reforms is considered, with particular reference to the changing composition of the nursing workforce. The authors note that there are problems with establishing trend data because of altered information requirements as a result of the NHS reforms. METHODS: Analysis and review of data from secondary sources and research publications. RESULTS: Although hospital activity rates have grown, patient length of hospital stays decreased, and patient activity levels increased, there has not been a linked growth in the size of the nursing workforce. The main changes in the profile of the nursing workforce highlighted are a marked reduction in the numbers of nursing students and alterations in the skill mix between first- and second-level qualified nurses. The authors also note a large increase in the number of managerial and administrative staff employed and growth in medical staff numbers. Changes in working patterns and increases in contracting for support services and in the use of temporary staff also are discussed. CONCLUSIONS: There have been pronounced changes in the profile of the hospital workforce but little evaluation of the impact of these changes on outcomes of care.

Forecasting↗