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PubMed1993

The financial performance of diversified hospital subsidiaries.

Despite its proliferation, we know relatively little about the impact of hospital restructuring to offer new services. This exploratory study examines the relationship between types of services offered and financial performance among separately incorporated subsidiaries of acute care hospitals. We draw data from the subsidiaries of all hospital firms operating in one state (Virginia) that requires reporting by all such firms. Results from multiple regression analyses of 1987 data indicate that units that existed longer, produced health care or related products, or were nonprofit subsidiaries of nonprofit firms tended to be more profitable than the other subsidiaries.

Evaluation Studies as Topic↗
PubMed1995

Foundations of market restructuring: local hospital cluster and HMO infiltration.

Much has been said about the rapid penetration of HMOs. Yet, little attention has been given to another, equally important trend--the consolidation of hospitals into local systems and networks. The number of local hospital clusters has increased significantly in recent years. They are now taking the lead in the majority of markets across the country in forming integrated systems.

Catchment Area, Health↗
PubMed2000

[The restructuring of the American hospital sector in the arena of managed care].

This article summarises the evolution of management in American hospitals under managed care. More specifically, the article is centred on the measures decided upon by hospitals over the past years aiming to improve profitability which was neglected by managed care organisations. These measures involve both internal and external reforms and have largely weakened many hospitals, but have also allowed for the implementation of a number of systems that benefit the policyholder (therapeutic recommendations, a comparative study of care offered by health institutions, etc.). Furthermore, not all hospitals handle these difficulties with the same success, depending on their geographical location or their status. Some are reinforced by these strategies, while others are forced to close. These measures have often resulted in mergers between hospitals, reorganisation of services, or laying off personnel. While some of these strategies are above all strategies for withdrawal, which translate into savings that are detrimental to patients, it is equally possible to observe strategies for recovering demand (specialising care, partnerships in research and prevention, etc.). The latter, however, is less frequent than the former, which shows the serious crisis American hospitals are experiencing today.

Delivery of Health Care↗
PubMedDate not supplied

Innovative service redesign and resource reallocation: responding to political realities, mental health reform and community mental health needs.

General hospital mental health programs in large inner city communities face challenges in developing responsive services for populations facing high rates of serious mental illness, substance abuse, homelessness, and poverty. In addition provincial political pressures such as Mental Health Reform and hospital restructuring have caused general hospital mental health programs to reevaluate how services are delivered and resources are allocated. This paper describes how one inner city mental health service in a university teaching setting developed successful strategies to respond to these pressures. Strategies included: (a) merging two general hospital mental health services to pool resources; (b) allocating resources to innovative care delivery models consistent with provincial reforms and community needs; (c) fostering staff role changes, job transitions, and the development of new professional competencies to complement the innovative care delivery models; and (d) developing processes to evaluate the effects of these changes on client.

Community Mental Health Services↗
PubMed1984

Hospital unbundling: seize the opportunity.

As hospital restructuring becomes more frequent, therein lies an opportunity for pathologists to establish regional laboratories, either independently or as joint ventures with hospitals. The author discusses some of the pressures to unbundle, and steps that pathologists can take to meet this challenge.

Facility Regulation and Control↗
PubMed2000

An ethnography of midwifery work patterns during organisational redesign.

Despite a substantial increase in midwifery research since the early 1990's, there remains a lack of available research into the everyday practice of midwives. In general, hospitals are striving to reduce costs and increase efficiencies, so many hospital-based midwives are being exposed to hospital restructuring processes. The primary purpose of my research was to learn about the work patterns of hospital midwives during organisational redesign. A large Brisbane hospital, as part of its hospital-wide organisational redesign plan, merged two postnatal wards to create a new, larger unit. With this amalgamation, the ward midwives were exposed to several service delivery changes. Midwifery work patterns during this organisational change revealed a milieu characterised by a culture of business. The impact of change introduced ritual and personal elements that influenced midwifery work patterns.

Anthropology, Cultural↗
PubMed1995

Restructuring Canada's hospitals--looking for financial vital signs.

Hospitals across Canada are busy restructuring their facilities and services, trying to head off a crisis precipitated by increasing patient demand and static or declining provincial government funding. The challenge is compounded by a looming age wave of elderly. In Ontario, and Toronto in particular, the country's hospital heartland, an unusual interdisciplinary committee has reached out far beyond obvious health care sources, to the public that uses these facilities and services.

Aged↗
PubMed1997

Issues in patient-focused care for the respiratory care practitioner.

Patient-focused care is the redesign of patient care so that personnel and resources are organized around the patient instead of departments. The reasons are many but usually involve cost reductions and improvement in the customer's perception of quality. Goals for this process include grouping patients by diagnosis, decentralizing services, and cross-training staff. The respiratory care practitioner is well prepared to fit into the patient-focused care model. Recent surveys show the impact of hospital restructuring on respiratory care to be rather positive.

Decision Trees↗
PubMed1993

Getting the economic gains where and when you need them most.

Often, even before the vision for the restructured hospital is completed, talk begins about "which area to implement first" and "how many areas to tackle." Certainly, there are many considerations in making these decisions such as, the political mood with physicians and staff, synergy with changes already on the books, areas which are vacant and easily renovated, and more. However, these decisions may limit the alternatives for your Economic Change Strategy. They may even implicitly set it for you. And, as such, they should be taken very seriously because they directly impact the when and how much of your economic gains from restructuring. Want to get the most economic gains from restructuring? Define your Performance, Operational, Cultural and Economic Change Strategies and keep them in sync. And you won't be betting the farm that chance will do that for you.

Cost Savings↗
PubMed1999

Work-family conflict, spouse support, and nursing staff well-being during organizational restructuring.

This study examined work and family conflict, spouse support, and nursing staff well-being during a time of hospital restructuring and downsizing. Data were collected from 686 hospital-based nurses, the vast majority (97%) women. Nurses reported significantly greater work-family conflict than family-work conflict. Personal demographic but not downsizing and restructuring variables predicted family-work conflict; downsizing and restructuring variables but not personal demographics predicted work-family conflict. Spouse support had no effect on work-family conflict but reduced family-work conflict. Both work-family conflict and family-work conflict were associated with less work satisfaction and greater psychological distress.

Adaptation, Psychological↗
PubMed1997

Hospital reform and nursing labor market trends in Canada.

OBJECTIVES: Trends in the Canadian registered nurse (RN) workforce during the past 3 decades are examined, and the implications of current hospital sector retrenchment for RN employment are considered. METHODS: A descriptive review using relevant literature and existing databases on the nurse workforce is presented. RESULTS: From the 1960s through the 1980s, the Canadian RN workforce grew exponentially, fueled by expansions in the health-care delivery system under Medicare, rising inpatient acuity and skill-intensive patient care, enhanced access to nursing education, and increases in the numbers of women entering the workforce. Acute care hospitals have and continue to be the predominant employer of RNs. However, the 1990s have witnessed considerable hospital retrenchment, and with that retrenchment the growth of the hospital RN workforce has slowed dramatically. CONCLUSIONS: The ultimate outcomes of hospital retrenchment for the RN workforce remain unclear. Some speculate that the quality of care and working conditions will deteriorate in hospitals, as hospital administrators replace RN staff with lesser trained personnel to reduce costs. Others see change in the hospital sector as an opportunity for RNs to expand their scope of practice and responsibility in outpatient settings. The need for national and international research on the outcomes of hospital restructuring on patient care and the work of RNs is critical to sound policy making.

Adult↗