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PubMed1997

Trends in hospital restructuring and impact on the workforce in Germany.

OBJECTIVES: The author describes the impacts of hospital restructuring and reform legislation in Germany on the nursing workforce. METHODS: A descriptive analysis using selected literature is presented. RESULTS: Driven by the increased service needs of an aging population and the imperative to contain health-care costs, the hospital sector is shrinking while increasing its intensity of care delivery. Within this environment, the demand for patient-focused, high-quality nursing care is high, whereas the number of new graduates entering the nursing field is declining. Despite absolute increases in the number of nurses employed by the hospital sector, evidence suggests that hospitals are operating with a nursing workforce deficit. The recent reform law of 1992 mandates several changes with large implications for nursing. These include a linking of the hospital sector with outpatient care; a focus on rigorous, interdisciplinary quality assurance; and a revaluing of the adequacy of hospital nurse staffing. CONCLUSIONS: Hospitals will remain the major employers of nurses, with new outpatient sector opportunities. Adequate nurse staffing methodologies, sound personnel retention strategies, and reform of care delivery models are needed to assure high-quality nursing care in the hospital sector.

Ambulatory Care↗
PubMed2001

Evidence for concurrent validity of responses by survivors of hospital restructuring.

This study examined use of control, escape coping, and restructuring responses of survivors among hospital-based nursing staff who had survived significant hospital restructuring and downsizing. Four restructuring responses of survivors proposed by Mishra and Spreitzer in 1998 were considered: hopeful, obliging, cynical, and fearful. Data were collected from 744 nursing staff by questionnaire. Multiple regression analyses indicated greater use of active coping by more hopeful and more obliging survivors and greater use of escape coping by more cynical survivors.

Adaptation, Psychological↗
PubMed1997

Hospital restructuring initiatives in Canada.

OBJECTIVES: Recent changes in the organization, staffing, and utilization of acute hospitals in Canada are reviewed with regard to the potential implications for quality of care, national nurse workforce requirements, and research. METHODS: Available national and selected provincial data and trends in hospital utilization, capacity, and staffing are synthesized. RESULTS: Health system reform in Canada has resulted in lower utilization of acute inpatient resources, excess hospital capacity, and increased budgetary constraints in the hospital sector. In response, there is widespread hospital restructuring, which includes modifications in nurse staffing ratios and skill mix. Little is known about the potential impact of these changes on patient outcomes. From a workforce perspective, changes in the hospital sector have reduced demand for registered nurses but nursing schools have not modified enrollments. As a result, new graduates are experiencing difficulty obtaining registered nurse positions. CONCLUSIONS: Research should be undertaken to evaluate the impact of changes in the organization and staffing of hospitals on patient outcomes, and on the future requirements for nurses.

Canada↗
PubMedDate not supplied

Hospital restructuring, workload, and nursing staff satisfaction and work experiences.

This study examined changes in patient-nurse ratios resulting from hospital restructuring and the relationship of such changes to nursing staff satisfaction, psychological health, and perceptions of hospital functioning. Data were obtained from 744 hospital-based nursing survivors using questionnaires. Fifty-three percent of staff nurses indicated an increased patient-nurse ratio. Nursing staff indicating increased ratios generally reported less job satisfaction, poorer psychological (but not physical) health, and less effective hospital functioning.

Adult↗
PubMed2003

Survivors and victims of hospital restructuring and downsizing: who are the real victims?

This study reports the results of a longitudinal study of the effects of hospital restructuring and downsizing on nursing staff satisfaction and psychological well-being. Participants completed questionnaires in November 1996 and November 1999. All were employed as hospital-based nurses in 1996 but some had left hospital nursing for other jobs by 1999. Nurses still employed in hospital settings (N=744) were compared with nurses now employed elsewhere (N=74). Hospital-based nursing staff reported less job satisfaction, more absenteeism, greater psychological burnout and poorer psychological well-being than nurses now employed elsewhere.

Absenteeism↗
PubMed2002

Hospital restructuring: identifying the impact on patients and nurses.

Health systems throughout the democratic world have been subject to 'reform' in recent years as countries have attempted to contain the rapidly rising costs of health care. Because hospital care accounts for a large proportion of health sector spending, hospital restructuring has been an important part of those changes. In an attempt to make hospitals more efficient and cost-effective, New Zealand, like other countries, has introduced extensive changes to the way in which treatment and care are delivered to patients, and to the way nurses' work is organised and managed. International research has identified links between the way in which nursing is organised in a hospital, and that hospital's patient outcomes. The current authors are part of a team of researchers undertaking research which uses the methodology of the International Hospital Outcomes Study to examine nurse staffing and patient outcomes in New Zealand's secondary and tertiary hospitals across the period 1988-2001. The research involves a large survey of all nurses working in the study hospitals, an examination of the way in which the hospitals have been restructured, and an analysis of patient outcomes.

Female↗
PubMedDate not supplied

A pragmatic approach to measuring and evaluating hospital restructuring efforts.

Organizations have expended enormous resources to restructure care delivery Despite the growing literature describing these organizational innovations there is a paucity of credible data that reflects systematic measurement and evaluation of such changes. This report not only describes a comprehensive research based restructuring effort in a 720 bed acute care hospital, but it also describes an outcomes evaluation strategy and associated findings that may serve as a model and a guide for other healthcare institutions.

Hospital Restructuring↗
PubMed1991

Hospital restructuring--the implications for allied health professions.

Allied health professionals are not immune to the forces affecting the health care system at the macro-policy and political level. Policy implementation at the organisational level can have serious consequences for health professions which are not effectively scanning the broader health care agenda and developing systematic strategic responses. This paper will explore the changing work environment for allied health professions as a result of current trends in organisational restructuring. Five models of hospital organisation will be presented and examined in terms of their potential impacts on the allied health professions.

Allied Health Personnel↗
PubMed2001

Hospital restructuring and the work of registered nurses.

American hospitals have undergone three waves of organizational restructuring in the past two decades. These changes have had direct effects on a key set of employees--nurses. A review of the relevant literature to identify the ways in which hospital restructuring affects the work of registered nurses focuses on three important structural characteristics of nursing work: nurses' work roles, workload, and control of work. The review concludes that the impact of restructuring on each of the characteristics affects nurses' satisfaction with their work and may also affect the quality of patient care. While much of the policy debate around restructuring focuses on the extent to which reductions in nurse staffing levels affects quality of care, it is important to examine not only changes in nurse staffing levels, but changes in the work performed by registered nurses, as well.

Decision Making, Organizational↗
PubMed1997

The effect of hospital restructuring on the role of physical therapists in acute care.

BACKGROUND AND PURPOSE: The purpose of this study was to develop a conceptual model describing the effect of hospital restructuring on the role of physical therapists working in an acute care hospital. SUBJECTS AND METHODS: Organizational and role changes within a single physical therapy department undergoing restructuring were identified using a qualitative case study methodology. Data were gathered from semistructured interviews of four key informants, observations, and artifacts. A conceptual model and case study were developed from the themes that emerged from the data. FINDINGS AND DISCUSSION: Role changes for physical therapists in patient care delivery included "being flexible," "being productive," "being responsible for the care of all patients," "focusing on patient discharge," and "using support staff." Roles changes in professional interaction included "sharing knowledge and information" and "helping, sharing, and coordination work." Implications for physical therapy are discussed.

Attitude of Health Personnel↗
PubMedDate not supplied

Voices from the trenches: nurses' experiences of hospital restructuring in Ontario.

Nurses, the largest occupational group in health care, have been disproportionately affected by health care restructuring initiatives. A survey of registered nurses in Ontario was conducted in the fall of 1998 to examine factors influencing their work life quality in hospital settings. As a part of this survey, respondents were provided with an opportunity to share their concerns about work conditions in an open ended section of the questionnaire. Almost sixty percent of the nurses chose to respond to the open ended question (n = 230), divided equally between males and females. The purpose of the qualitative component of the study was to obtain a more in depth analysis of the effects of hospital restructuring initiatives on staff nurses' working conditions. All geographic areas of the province were represented in the responses. A content analysis of the data was conducted to determine major themes. Similar themes were found across all geographic areas. The four major categories of concerns that emerged from the qualitative analysis were quality of worklife, quality of patient care, relations with management, and cumulative impact of work conditions on feelings and attitudes. Nurses' perceptions of their quality of work life, concern for the quality of patient care and their emotional and attitudinal responses were very similar to those reported in a recent study of hospital staff nurses in the United States. The decade of the 1990's has been characterized as one of constant change bordering on chaos within the health care system in Canada and the United States. In Canada, government fiscal policies have resulted in less money being directed toward health care forcing the system to reorganize in order to meet new financial realities. Many of the organizing efforts have been directed toward the acute care sector of the health care system. Nurses, as the largest occupational group within the health care system, have been disproportionately affected by these efforts. The purpose of this study was to tap nurses concerns about the effects of these changes on their personal and work experiences.

Attitude of Health Personnel↗
PubMedDate not supplied

Correlates of nursing staff survivor responses to hospital restructuring and downsizing.

This study examines correlates of 4 archetypal survivor responses to organizational restructuring and downsizing proposed by Mishra and Spreitzer: hopeful, obliging, cynical, and fearful. Data were collected from 744 long-term nursing staff survivors of hospital restructuring and downsizing using questionnaires. Three types of correlates were considered: work outcomes, indicators of psychologic well-being, and perceptions of hospital functioning. Greater endorsement of cynical and fearful restructuring responses was associated with more negative work outcomes and lower psychologic well-being. Greater endorsement of both cynical and fearful responses was also found to be associated with more negative perceptions of hospital functioning and effectiveness.

Absenteeism↗
PubMed1990

Restructuring hospital costs to improve solvency and prevent bankruptcy.

The authors present a framework, derived from successful experience with an actual hospital turnaround, for helping hospital management to restructure costs quickly and strategically under the pressure of losses. The framework isolates structurally inefficient hospital overheads into four distinct categories and prescribes very different corrective actions for each of them. Application of the framework to bankruptcy is also discussed.

Cost Allocation↗
PubMed1999

The impact of hospital restructuring on social work services: a case study of a large, university-affiliated hospital in Canada.

The study investigates the impact of organizational restructuring on social work practice at a large, university-affiliated hospital. The article first reviews relevant literature on the patient-focused care model and presents an overview of the study setting. Several hypotheses are then presented that informed the research process. Workload measurement, interview, and questionnaire data are analyzed to test these hypotheses. The results indicate that the shift to program management has had some intended effects, particularly regarding increases in direct services supporting patients. Social workers reported somewhat lower levels of job satisfaction than expected, which partly reflects the dismantling of the professional infrastructure. Finally, the authors discuss implications for the future of the social work profession under the program management model.

Allied Health Personnel↗
PubMed2003

A critical examination of the hospital restructuring process in Ontario, Canada.

Little work has been done to consider the roles of different forms of knowledge and civil society actors in health policy development. Research on the role of knowledge in policy change has focussed on the contributions of social science knowledge and social scientists. This view assumes that the perspectives and knowledge of experts are the only valid input into the process and is non-critical in its analysis of health policy and health inequities. This paper challenges the reliance upon certain types of knowledge that are brought to bear on the health policy change process, and that knowledge and its creation are impartial activities. This paper presents a conceptual framework of health policy change that incorporates broad concepts of knowledge and civil society actors as contributing to health policy development. It also demonstrates the different dynamics that impinge upon knowledge and its use in health policy change. A case study on hospital restructuring in Toronto, Canada, is presented. Women's College Hospital fought recommended closure and merging of its inpatient services with Sunnybrook Health Science Centre. The case study examined the selection and use of knowledge by the Hospital in building its case against closure.

Health Facility Closure↗