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Results for “Hospital Restructuring”

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At least 343 records · Page 19Linked to original sources
PubMed1998

Managing organizational challenge and change: closing an inpatient unit.

The effects of a turbulent health care delivery market have impacted the day-to-day reality of acute care hospitals. One effect is that the supply of acute care hospital beds currently exceeds the demand, a trend that is expected to continue to the year 2000 and beyond. Nursing administrators at St. Marys Hospital Medical Center made the decision to close an inpatient unit in order to better match acute care bed supply to existing demand. Decision support for closure, organizational change, and lessons learned from the closure process are discussed.

Decision Making, Organizational↗
PubMedDate not supplied

Computer simulation as a basis for pharmacy reengineering.

Using computer simulation can enhance the management decision-making process. Simulations can predict the effects on cost and quality of services. This article discusses the use of computer simulation to assist in planning the reengineering process to change a hospital's drug distribution from a decentralized pharmacy satellite system to a centralized robotic drug dispensing system. Because computer simulation was based on a fixed set of circumstances, circumstances changed before system implemented. Nursing and pharmacy staff and line managers were involved in the review, planning, and implementation that resulted in positive economic and quality outcomes for this project. For organizations to achieve successful change, administrators must play an active and essential part.

Computer Simulation↗
PubMed1996

A comprehensive critical care course.

Downsizing and tighter budgets are making it difficult to find cost-effective courses to prepare nurses for specialty area patient care. This is particularly true of small community hospitals, where overhead costs of group classes are high and participant numbers are low. To address this concern, a self-paced, multimedia teaching program with a nontraditional teaching/learning format was developed.

Clinical Competence↗
PubMed1997

Legal update-1996, Part 1.

In the midst of managed care and hospital restructuring, delegating tasks previously performed by the nurse remains a constant issue. This month's column begins a summary of legal updates and discusses recent case examples and emerging trends.

Humans↗
PubMed2003

Leading your leader.

Learn how one facility developed nurse managers' leadership skills through a questionnaire process and training opportunities.

Delivery of Health Care, Integrated↗
PubMed1997

The culture of morning report: ethnography of a clinical teaching conference.

We studied the structure, process, and subjective meaning of "morning report," a time-honored, medical teaching conference attended by faculty, house officers, and students at a pediatric teaching hospital. Methods included participant observation, focused interviews, and content analyses. Results showed substantial variation by rank in behavior, perception, and participation based on a highly structured division of labor. The most frequent suggestion for improving morning report was to shorten it. Data indicate that morning report, at least at our study site, is out of step with current learner-centered models, seems perfunctory, and may be costly in the current climate of decreased revenues and downsizing. The persistence of morning report, despite these liabilities, attests to its significance as a cultural event.

Anthropology, Cultural↗
PubMed1995

Redesigning patient care roles: a case study.

Many hospitals and health care systems have reacted to changes in health care over the last 10 years through operational redesign. This article provides a graphic and detailed discussion of how one institution dealt with a core redesign issue--changing provider roles and how they affect service, quality, and cost.

Decision Making, Organizational↗
PubMed1997

Privatization of a public hospital: a quality improvement strategy.

Public hospitals face mounting challenges posed by the rise of managed care, increasing hospital competition, growing responsibilities in indigent care, and stagnant public sector revenues. Privatization exists as a viable strategy for reengineering the structure and operation of public hospitals to meet the new demands of quality and efficiency imposed by a rapidly changing health care environment.

Delivery of Health Care, Integrated↗
PubMed1999

Reengineering outcomes management: an integrated approach to managing data, systems, and processes.

The integration of outcomes management into organizational reengineering projects is often overlooked or marginalized in proportion to the entire project. Incorporation of an integrated outcomes management program strengthens the overall quality of reengineering projects and enhances their sustainability. This article presents a case study in which data, systems, and processes were reengineered to form an effective Outcomes Management program as a component of the organization's overall project. The authors describe eight steps to develop and monitor an integrated outcomes management program. An example of an integrated report format is included.

Attitude of Health Personnel↗
PubMed2001

Hospital conversion foundations. Issues in creation, operation, and evaluation.

A major healthcare transformation in the United States is the conversion of nonprofit hospitals to for-profit entities, and the creation of hospital conversion foundations for the nonprofit charitable assets, which now exceeds $9 billion. Because less than 21% of the 525 hospitals converting from nonprofit to for-profit ownership have established a hospital conversion foundation, the public's monetary losses are considerable. This article examines some of the key legal and organizational issues related to hospital conversion foundations including factors related to establishing fair value of the converting hospital, foundation mission, use of conversion revenue, governance, and evaluation.

Foundations↗
PubMed2006

Planning emergency patients: An attempt to change the nature of the emergency department.

Throughout the day, arrivals of patients at the emergency department (ED) are unannounced, unpredictable and fully determined by chance. Healthcare professionals in the ED naturally react as quickly as possible when patients arrive. We wondered whether they could somehow act in advance. We introduced a planning system that enabled the ED to regulate arrival times of emergency patients referred by the general practitioner. The system established direct contact between the general practitioner and the ED at the press of a button. As a result, the ED was able to schedule a fraction of its unpredictable patient demand. Implementation of the system at large was unsuccessful however. Changing the nature of the ED turned out to be far more difficult than expected. In our opinion, successfully planning emergency patients requires that the ED has full control over the referral process, and that scheduled patients are treated in a separate, undisturbed care process.

Appointments and Schedules↗
PubMed2005

Effects of New Zealand's health reengineering on nursing and patient outcomes.

BACKGROUND: In 1993, New Zealand (NZ) implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The cost control focus was similar to reengineering efforts implemented by other countries struggling with escalating health care costs, particularly the United States. OBJECTIVE: The study's purpose was to examine the effects hospital reengineering may have on adverse patient outcomes and the nursing workforce. RESEARCH DESIGN: The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. SUBJECTS: All medical and surgical discharges from NZ's public hospitals (n = 3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n = 65,221 nurse responses) from 1993 through 2000 were examined. MEASURES: Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. RESULTS: After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. CONCLUSIONS: In the chaotic environment created in NZ by reengineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organizational change plays in patient outcomes, the unintended consequences of health care reengineering and market approaches in health care, and nursing's unique contribution to quality of care.

Adult↗
PubMedDate not supplied

Palliative care: rapid redesign to support systemwide quality improvement.

Large-scale change techniques and rapid redesign methodologies were used to improve the quality of care delivered to patients at the end of life in a large, multihospital healthcare delivery system. By bringing key stakeholders from across the system together at a symposium to formulate the vision and critical criteria for palliative care programs, as well as to develop a flexible set of design tools, each region in the system could respond to the unique needs of its own community. Hospice length of stay for the system improved by 100% in the year after the systemwide symposium.

Catholicism↗
PubMed2000

Medical workforce planning. Comparing reality with aspirations.

The debate on reorganisation of hospital services is fertile ground for expert opinion. The Joint Consultants Committee (JCC) have produced the most recent view on the ideal acute hospital size and consultant staffing; however, their ideal is far removed from reality. A survey of trusts across the West Midlands found that many are falling short of the recommendations, such as meeting a one-in-five consultant on-call rota for the major admitting specialties and providing adequate cover in the core sub-specialties of general medicine and general surgery. While the JCC recommendations give a welcome direction and focus to workforce planning, reaching some of these will require a large financial investment and an increase in the number of trainees. Prioritising the recommendations may help to facilitate implementation by health-care providers.

Catchment Area, Health↗
PubMed1996

Re-engineering operating theatres: the perspective assessed.

Refers to the widely experienced and appreciated difficulties in scheduling hospital operating theatres to make effective use of resources, and to avoid delays and overruns that can adversely affect patient care and staff morale. Reports the findings and recommendations of a project based in the Surgical Directorate of Leicester General Hospital NHS Trust which sought to address these problems from a business process re-engineering perspective. Covering the whole patient trail, from referral to discharge describes the project's progress through four phases concerning process mapping, the collection of staff opinions and ideas through a combination of interviews and surveys, collection of data on patient flows and procedure times, and a final "handover" phase in which broad recommendations were passed back to the Surgical Directorate for implementation with staff involvement. Details the recommendations which include a shift to cross-functional teamworking in a number of areas, along with the development of a revised theatres policy and a strengthened theatres co-ordination function. In view of recent substantial and harsh criticisms of the re-engineering perspective, seeks to offer a balanced assessment of the perspective applied to a health care setting, exploring both the problems and benefits.

Appointments and Schedules↗
PubMed1997

Towards a new health care paradigm. Patient-focused care. The case of Kingston Hospital Trust.

Patient-focused care (PFC) and business process re-engineering (BPR) have been advocated in the academic literature as techniques to improve both quality of service and reduce costs. Seeks to separate and delineate the components of PFC and BPR and, using the case study method, describe the adoption and implementation process of PFC in medicine and maternity by one London NHS Trust Hospital. Reports the impact of this innovation on service delivery, staff reconfiguration and multi-skilling. Identifies preconditions and key success factors and indicates lessons for the future.

Ergonomics↗
PubMed1998

Tracks of change in hospitals: a study of quasi-market transformation.

Examines the process of change in hospitals that has emerged following the introduction of the health quasi-market in 1991. Blends empirical evidence with Greenwood and Hinings' archetype and tracks of change concepts to analyse the process which is labelled quasi-market transformation (QMT). Argues that, before 1991, hospitals tended to operate within structures and systems underpinned by an interpretive scheme. Represents these similarities of configuration as the directly-managed (DM) hospital archetype. When change initiatives challenged this configuration, the outcomes were negotiated and resulted in "adjustmental" change. In contrast, shows the introduction of the quasi-market to have involved the first transformation of the DM archetype's interpretive scheme, systems and structures. Analyses four years of transition to reveal that QMT has been interpreted differently within hospitals. However, presents data to suggest that many hospitals now display significant similarities in terms of configuration. Represents these similarities within the emerging Trust hospital archetype.

Decision Making, Organizational↗