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PubMed1994

Patient-centered redesign. More collaborative clinical input into capital budget decisions.

As part of a restructuring program at a large, acute care hospital, a new, collaborative form of clinical management called triads has been initiated. Members of these collaborative management teams are being collectively empowered to better enable them to establish a continuously improving, cost-effective clinical service. This article describes the impact of this new structure on the capital budgeting process in changing a centralized, committee-based system of decision making with limited clinical nursing input to one that is increasingly decentralized, interdisciplinary, and focused on patients.

Budgets↗
PubMed1993

How much do you have to save to make a profit on restructuring?

"I can't afford to restructure my hospital!" The truth is that you may not be able to afford not to restructure! Yes, there are up-front financial investments required to lift your institution to a new level of performance. But these investments can be dwarfed by the returns achieved when more and more of your personnel dollars go to caring for patients, and less and less go to perpetuating the red-tape and bureaucracy which plagues the modern American hospital.

Cost Savings↗
PubMed1997

Organizational restructuring in health care: a successful approach.

The process of redesigning the internal organization structure of the Hamilton Civic Hospitals provides a successful example of this type of transformation. Based on a strategic approach to change, this multiphased process used a modified delphi technique to allow maximum participation in a total redesign of the structure during a four-month time frame. Implementation, which followed over the next year, resulted in a 40 percent reduction in management positions and the integration of the two sites of the hospital.

Efficiency, Organizational↗
PubMed1998

A shared community-based practice: an alternative model for WOC nursing practice.

In the past, as the populations in many communities have grown, WOC nurses have been hired for each of the major health care facilities located in that community. However health care restructuring has caused many local hospitals to reevaluate their use of specialty practice nurses, including ET/WOC specialists. In response to this trend, a shared community practice model was established that has allowed each agency to make use of ET nursing service on an "as needed" basis, while maintaining daily accessibility to this important resource person. This article describes the evolution and growth of this practice model during the past two decades of intense reform in health care delivery.

Community Health Services↗
PubMed1993

To pilot or not to pilot, that is the question. Choosing your first step in restructuring? Look before you leap!

To pilot, or not to pilot, that is the question! Don't allow yourself in your eagerness to restructure to fall victim to taking this decision too lightly. Sometimes establishing a pilot of a restructured environment is indeed the best way to go--particularly when the advantages of a pilot are the key hurdles to overcome toward broad acceptance and support for hospital-wide restructuring at your institution. However, implementing a pilot can also be a big step off of a short pier if the value of these advantages pale in comparison to the disadvantages. Sure, you may need to restructure one unit/area at a time for strategic or other reasons. And you always have the prerogative to pull the plug if things go south. But be aware of the important difference between the "first unit" of many and a "pilot" approach to restructuring. Like everything else associated with successful restructuring, understanding the crucial trade-offs behind the "to pilot, or not to pilot" decision can determine whether your restructuring initiative is off to a flying start, or a long way from starting to fly.

Decision Making, Organizational↗