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PubMed1994

Work restructuring overview and implications for pharmacists.

Patient-centered work restructuring reduces costs and improves quality by helping hospitals make better use of high-skilled professionals in an environment that requires few non-valued activities in fulfilling patient clinical and support needs. Described in this article are the critical elements of core process reengineering, several principles of patient-centered care, the implications for pharmacy, and the pharmacist's role in the new environment. The goal is to increase the amount of time pharmacists spend in clinical decision making, education, and monitoring to help expedite patient recovery, shorten lengths of stay, and improve utilization effectiveness.

Hospital Restructuring↗
PubMed2004

Two decades of organizational change in health care: what have we learned?

The 1980s and 1990s witnessed a substantial wave of organizational restructuring among hospitals and physicians, as health providers rethought their organizational roles given perceived market imperatives. Mergers, acquisitions, internal restructuring, and new interorganizational relationships occurred at a record pace. Matching this was a large wave of study and discourse among health services researchers, industry experts, and consultants to understand the causes and consequences of organizational change. In many cases, this literature provides mixed signals about what was accomplished through these organizational efforts. The purpose of this review is to synthesize this diverse literature. This review examines studies of horizontal consolidation and integration of hospitals, horizontal consolidation and integration of physician organizations, and integration and relationship development between physicians and hospitals. In all, around 100 studies were examined to assess what was learned through two decades of research on organizational change in health care.

Delivery of Health Care↗
PubMed2004

Ten Australian ICU nurses' perceptions of organisational restructuring.

The Australian healthcare system underwent radical reform in the 1990s as economic rationalist policies were embraced. As a result, there was significant organisational restructuring within hospitals. Traditional indicators, such as nursing absenteeism and attrition, increase during times of organisational change. Despite this, nurses' views of healthcare reform are under-represented in the literature and little is known about the impact of organisational restructuring on perceived performance. This study investigated the perceived impact of organisational restructuring on a group of intensive care unit (ICU) nurses' workplace performance. It employed a qualitative approach to collect data from a purposive sample of clinical nurses. The primary method of data collection was semi-structured interviews. Content analysis generated three categories of data. Participants identified constant pressure, inadequate communication and organisational components of restructuring within the hospital as issues that had a significant impact on their workplace performance. They perceived organisational restructuring was poorly communicated, and this resulted in an environment of constant pressure. Organisational components of restructuring included the subcategories of specialised service provision and an alternative administrative structure that had both positive and negative ramifications for performance. To date, there has been little investigation of nurses' perceptions of organisational restructure or the impact this type of change has in the clinical domain. Participants in this study believed reorganisation was detrimental to quality care delivery in intensive care, as a result of fiscal constraint, inadequate communication and pressure that influenced their workplace performance.

Adult↗
PubMed1987

Corporate reorganization: today's challenge.

Reduced demand for inpatient services has forced many healthcare organizations to diversify and seek other revenue-generating activities. The author reviews the pros and cons for corporate reorganization and lends insights from his personal experience of a corporate restructure. The various forms of corporate structure are reviewed along with guidelines on when an organization should not proceed with a corporate restructure.

Certificate of Need↗
PubMed2001

A new governance framework. A rural system reinvents its board structure.

Take a rural health care system, remove its long-time and well-respected CEO who's just retired, and throw in the need to streamline a clunky governance structure--and you have the Copley Health System in Vermont. In response, the system has come up with some fresh ideas about how to restructure for its future.

Delivery of Health Care, Integrated↗
PubMedDate not supplied

Restructuring of laboratory services at the Detroit Medical Center. Process and outcomes.

Following an era of "do more, earn more," the health-care industry, including physicians and hospitals, has been faced with cost-containment measures. With this in mind, the Detroit Medical Center (DMC) embarked on a laboratory consolidation initiative to achieve this objective in 1985. The DMC entered into a partnership with Damon Clinical Laboratories, forming Damon Clinical Laboratories at the Detroit Medical Center. This partnership resulted in the consolidation of laboratory services within the DMC and the establishment of an outreach activity. In December 1992, it was decided that the partnership would be dissolved, with the DMC assuming full ownership and responsibility for the management of laboratory services. Thus, DMC University Laboratories was created and is currently in its third year of operation. This article presents how the decision to consolidate laboratory services within the DMC was made, along with the process and outcomes of consolidating the operations of seven hospital laboratories.

Communication↗
PubMed1994

Competition among hospitals in the United States.

The value added by acute-care hospitals is in the form of specific procedures (therapy, operations, testing) and the bed care necessary to make the procedures effective. When more than one hospital exists in a local area (defined in many studies as a radius of 15 mi/24 km) they compete for market share, since greater market share has a positive effect on economies of scale, utilization rates, learning curves and levels of quality. Competition is not only with other hospitals (and 75% of all hospitals do have a competitor within 24 km), but also with doctors who now perform some procedures in their offices, and with specialized clinics. The first strategy is to attract physician allegiance since they act as gate-keepers, directing patients to specific hospitals. This is done through personal amenities, professional amenities and enhancement to personal prestige and income. This competition for physician allegiance has a direct effect on utilization rates (doctors want spare capacity to suit their needs), on the range of services and facilities offered (doctors want more support), and on length of stay (doctors want longer stays). All of these increase the hospital's costs. The second strategy is to enter into contracts with third-party payers who will direct their clients to specific or preferred hospitals. The negative effect is that in competitive markets such payers may be able to bargain prices down. However, hospital differentiation makes it difficult for payers to make complete substitutions among them. As well, since the payers compete for clients, they often use hospital alliances as a selling point and therefore are often cooperative rather than confrontational in their negotiations. One tactic used by hospitals is to stress quality of service. But since quality in health care is hard to measure, patients are often unable to make direct assessments of alternatives. Hospitals therefore often 'signal' quality in various ways which may, and often do, increase hospital costs. (Some of these signals also attract physicians). Price is not a major element in competition. Most other strategies and tactics raise hospital costs and therefore price. Pressure from payers is turned back through differentiation (preventing substitution) and hospital-payer alliances for clients. Health care comes in too many packages to allow effective price competition. A final tactic is to increase the range of services or facilities offered. Enhanced services attract doctors by offering more support; attract some patients direct; and help to recapture market share lost to specialized clinics.(ABSTRACT TRUNCATED AT 400 WORDS)

Catchment Area, Health↗