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PubMed2001

Stress and the effects of hospital restructuring in nurses.

This study examines the extent of stress and burnout experienced by nurses during hospital restructuring. It includes both job-related outcomes such as job satisfaction and burnout, and psychosomatic outcomes such as depression. The study compares effects attributable to number of hospital restructuring initiatives with those attributable to specific work stressors such as workload, bumping (where one nurse replaces another due to greater seniority), and use of unlicensed personnel to do the work of nurses. It also examines the role of personal resources including self-efficacy and coping. Results show that, in hospitals undergoing restructuring, workload is the most significant and consistent predictor of distress in nurses, as manifested in lower job satisfaction, professional efficacy, and job security. Greater workload also contributed to depression, cynicism, and anxiety. The practice of bumping contributed to job insecurity, depression, and anxiety. The results point to specific deleterious effects of hospital restructuring. Implications of the findings are discussed. The extent to which workload issues are managed through appropriate practices can be expected to match the extent of nurses' experience of either job satisfaction or depression and anxiety. Such practices need to be part of an ongoing process of interaction between the hospital administration and nurses.

Adaptation, Psychological↗
PubMed1997

Hospital restructuring in the United States, Canada, and Western Europe: an outcomes research agenda.

OBJECTIVES: This article describes the extent and nature of hospital restructuring across the United States, Canada, and Western Europe, countries with differently organized and financed health-care systems, and assesses the feasibility of international research on the outcomes of hospital restructuring. METHODS: The conceptual background, context, and focus for the Bellagio conference on Hospital Restructuring in North America and Western Europe held in November 1996 is provided, illustrating key issues on hospital and workforce trends using the US data with international comparisons. RESULTS: Hospital systems internationally are undertaking very similar restructuring interventions, particularly ones aimed at reducing labor expenses through work redesign. Nursing has been a prime target for work redesign, resulting in changes in numbers and skill mix of nursing staff as well as fundamental reorganizing of clinical care at the inpatient unit level. Yet little is known about the outcomes of such organizational interventions and there are few efforts in place to critically evaluate these actions. CONCLUSIONS: Restructuring of the hospital workforce and redesign of work in inpatient settings is widespread and markedly similar across North American and Europe, and warrants systematic study. Cross-national studies of the impact of restructuring inpatient care on patient outcomes would yield valuable lessons about the cost-quality tradeoffs in hospital redesign and re-engineering, as well as inform national planning about the numbers and types of nurses needed in the coming decades.

Canada↗
PubMed2000

Effects of hospital restructuring on full time and part time nursing staff in Ontario.

This study examined the effects of hospital restructuring and downsizing on full-time and part-time nursing staff. Data were collected from 1362 nursing staff, a 35% response rate, using anonymous questionnaires. Measures included personal and situational characteristics, hospital restructuring and downsizing variables, work outcomes and psychological well-being indicators, and work-family experiences. Although full and part-time nurses were significantly different on most personal and demographic characteristics, both groups experienced and described hospital restructuring and downsizing similarly. Full-time nurses reported greater emotional exhaustion and poorer health and indicated greater absenteeism and lower intention to quit.

Adaptation, Psychological↗
PubMed2000

Hospital restructuring and downsizing in Canada: are less experienced nurses at risk?

The health care sector has undergone significant change during the past decade as hospitals struggle to provide the same service with fewer resources. This study examined perceptions of hospital restructuring and downsizing and their effects on nursing staff as a function of years in nursing. Data were obtained from 1,362 staff nurses by questionnaire. Nursing staff having less tenure generally described and responded to hospital restructuring and downsizing in more negative terms. Nursing staff having less tenure were in better health, reflecting their younger age. Some implications for hospital administration and the nursing profession are raised. Entrants to hospital-based nursing staff positions are the life blood of the profession. Their reactions to hospital restructuring and downsizing may influence their commitment to nursing as well as hospital functioning. The profession may have difficulty attracting young women and men into nursing programs. As longer tenured nursing staff retire, a potential shortage of nurses may result.

Adult↗
PubMed1997

Planning for complex change: insights from the Metro Toronto District Health Council Hospital restructuring project.

Restructuring and large-scale organizational change have become facts of life in Ontario's health care sector in recent years. Nearly every jurisdiction in Ontario has undergone systemwide hospital restructuring studies, and individual hospitals have increasingly turned to large scale re-engineering processes to improve efficiency and effectiveness. One example of planning for significant change was a hospital restructuring study undertaken by the Metropolitan Toronto District Health Council between 1993 and 1995. This article provides an overview of key insights gleaned from the project, including an analysis of the effectiveness and utility of some of the major planning strategies and tactics employed to realize project objectives. Given the organizational, process and communications issues faced by the study, many of the insights provide will be relevant to other groups engaged in planning for large-scale change processes, who face tough decision making in similarly complex environments.

Community Participation↗
PubMed1998

Measuring and evaluating hospital restructuring efforts. Eighteen-month follow-up and extension to critical care, Part 1.

Increasingly, hospital restructuring is viewed with skepticism because of a lack of systematic and rigorous evaluation of its impact on quality of care. This first article in a two-part series describes comprehensive evaluation of the effects of hospital restructuring on patient satisfaction, nurse satisfaction, costs of care, and clinical quality on four medical-surgical units at a large tertiary hospital. In addition, early application of the model to critical care is described. A quasiexperimental pre- and post-design combined with concurrent control units for selected measures was the overall strategy. The authors conclude that comprehensive restructuring of hospital-based care can take place in a manner that preserves multiple dimensions of quality while decreasing costs. This only can be ascertained, however, through rigorous and systematic measurement and evaluation. Part 2 will detail application and evaluation of the restructuring model in the critical care environment.

Critical Care↗
PubMed2001

Hospital restructuring and nursing staff well-being: the role of personal resources.

This study examined the role played by two personal resources, job mobility options and financial resources, among nursing staff during a period of major hospital restructuring and downsizing. Data were collected from 1362 staff nurses using questionnaires. Personal resources were hypothesized to have direct and indirect effects on job satisfaction and psychological well-being in a model of hospital restructuring and its effects. The model included four variables: extent of hospital restructuring, future threats to the workplace, job satisfaction, and psychosomatic symptoms. LISREL analyses indicated that financial resources reduced perceptions of future workplace threats and psychosomatic symptoms while job mobility options were associated with higher levels of job satisfaction.

Career Mobility↗
PubMed1993

Reform brings opportunities for restructuring hospital systems. Interview by Donald E. Johnson.

Donna Shalala, Health & Human Services secretary, approved Oregon's Medicaid reform plan which will reduce the cost of health care services to the poor while expanding access to the state's 120,000 uninsured residents. Health coverage will not be provided for Oregonians below the federal poverty level who currently don't receive any Medicaid benefits. Health Care Strategic Management publisher and editor Donald E. L. Johnson and John King, president and CEO of Legacy Health System, Portland, discuss the ramifications of the Oregon Plan and the opportunities it provides for Oregon hospital systems.

Health Care Rationing↗
PubMed1996

Social work in restructuring hospitals: meeting the challenge.

From bureaucratic to programmatic institutions, hospitals across North America are experiencing restructuring. Using the results of a telephone survey and a semistructured questionnaire, this research study explores the effect of hospital restructuring on the organization and delivery of social work services and the strategies social workers select to manage change in a sample of Ontario hospitals. Respondents identified a number of issues related to control over the nature of work in the organization, social work roles, and the management of structural change. This article discusses the implications for the profession of the move to program management.

Delivery of Health Care↗
PubMed2001

Impact of restructuring scale: an instrument to measure effects of hospital restructuring.

As restructuring and downsizing occur throughout the workplace, many individuals are either losing their jobs or experiencing job insecurity. The study of downsizing is particularly important within the healthcare system where hospital mergers and closings, and severe cutbacks, have dramatically reduced healthcare services. Since nurses are the largest group employed by hospitals, they are the most likely to be affected by recent cutbacks. All this leads to the conclusion that a measure of the impact of restructuring is needed. This study reports on the Impact of Restructuring Scale--a new scale containing acceptable psychometric properties--that quantifies the effects of restructuring on organizations and individuals. The scale was applied to a sample of 1,363 nurses employed in hospitals undergoing restructuring and downsizing. The nurses returned a self-report questionnaire in which they reported their reactions to hospital restructuring and to specific job stressors.

Budgets↗
PubMed2002

Hospital restructuring and burnout.

Increasingly, organizations are experiencing changes as a result of extensive downsizing, restructuring, and merging. In Canada, government-sponsored medicine has been affected as hospitals have merged or closed, reducing essential medical services and resulting in extensive job loss for hospital workers, particularly nurses. Hospital restructuring has also resulted in greater stress and job insecurity in nurses. The escalation of stressors has created burnout in nurses. This study examines predictors of burnout in nurses experiencing hospital restructuring using the MBI-General Survey which yields scores on three scales: Emotional exhaustion, Cynicism, and Professional efficacy. Multiple regressions were conducted where each burnout scale was the criterion and stressors (e.g., amount of work, use of generic workers to do nurses' work), restructuring effects, social support, and individual resources (e.g., control coping, self-efficacy, prior organizational commitment) were predictors. There were differences in the amount of variance accounted for in the burnout components by stressors and resources. Stressors contributed most to emotional exhaustion and least to professional efficacy. Individual resources were more likely to contribute to professional efficacy and least to emotional exhaustion. Stressors and resources accounted for approximately equal amounts of variance in cynicism. Three conclusions were drawn. First, present findings parallel others by showing that individual coping patterns contribute to professional efficacy. Second, emotional exhaustion was found to be the prototype of stress. Third, prior organizational commitment, self-efficacy, and control coping resulted in lower burnout.

Adaptation, Psychological↗
PubMed1998

The evaluation of hospital restructuring efforts: satisfaction, quality, and costs.

This article reports on study evaluating the effects of hospital restructuring on patient satisfaction, nurse satisfaction, cost of care, and clinical quality. The restructuring involved facility redesign, telecommunications enhancement, and implementation of patient care processes incorporating multiskilled personnel and case facilitation systems. The results indicate improved patient and nurse satisfaction, decreased length of stay and variable cost per patient day, and good clinical outcomes.

Hospital Bed Capacity, 500 and over↗
PubMed2001

Outcomes of hospital restructuring and reengineering. How is success or failure being measured?

Healthcare has undergone tremendous changes during the last decade. In response to external forces, institutions and systems have sought to increase efficiency, decrease waste and duplication, and reshape the way that care is delivered. The authors describe the outcomes of restructuring and reengineering efforts in United States hospitals during the years 1997-1999. Internal hospital-restructuring strategies, methods for evaluation, and unexpected outcomes are discussed as well as recommendations for future outcome evaluation.

Attitude of Health Personnel↗
PubMed2004

The impact of hospital restructuring on home care nursing.

BACKGROUND: Health reform in many industrialized countries has prompted the shift from institutional to community care. In Ontario, this approach was instigated through the Health Services Restructuring Commission. OBJECTIVES: The purpose of this study was to determine whether changes in the hospital sector between 1996 and 2000 resulted in changes in the provision of home-care services by nurses and practical nurses. METHODS: This study was a retrospective trend analysis of linked hospitalization and home-care utilization data for Kingston for 1996 to 2000. The measures include the rate of home care and the volume and intensity of home-care services. RESULTS: Between 1996 and 2000 there was a net 4% increase in the age-gender standardized rate of admission to home-care nursing services, with a 10% rate rise between 1996 and 1997. The total volume of home-care services increased during the study, as did the average intensity of home-care service delivery over the first month post-hospitalization during the first four years. This article will give readers their first look at the changes in home-care nursing following hospital restructuring in Kingston.

Aged↗