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At least 19 recordsLinked to original sources
PubMed1996

Restructuring hospitals, restructuring nursing.

The global economy is in the depths of recession. Organizations from virtually every industry, including manufacturing and service, have responded by reducing expenses and cutting operational costs. Health care restructuring is one result of the new economy. Hospitals worldwide have been flattening organizational charts and reducing costs. Downsizing, rightsizing, restructuring--whatever term is used, the message is the same: people are a cost to be reduced.

Cost-Benefit Analysis↗
PubMed2002

The relationship of role-related variables to job satisfaction and commitment to the organization in a restructured hospital environment.

BACKGROUND AND PURPOSE: Many factors in today's hospitals can influence how physical therapists view their work experience. Changing roles, with the accompanying stress, and professionalism may contribute to a therapist's perception of his or her job and the organization in which he or she works. In this study, the relationship between changes in physical therapist role behaviors following hospital restructuring and 2 work-related outcomes--job satisfaction and commitment to the organization--was studied. The influence of stress and occupational commitment on these outcomes also was examined. SUBJECTS AND METHODS: Through a survey of 273 hospital-based physical therapists, changes in physical therapist role behaviors, levels of stress, occupational commitment, job satisfaction, and commitment to the organization following restructuring were identified and examined. RESULTS: Six role behavior dimensions reflecting professional and organizational responsibilities were identified from the data. After controlling for sample demographics, the professional role behaviors, specifically those reflecting interaction and integration with other practitioners, appeared to exert a small, but positive, influence on job satisfaction and commitment to the organization. In addition, occupational commitment had a positive influence, whereas stress had a negative influence on job satisfaction and commitment to the organization. DISCUSSION AND CONCLUSION: Multiple aspects of a clinician's role could influence job satisfaction and commitment to the organization following hospital restructuring. The most influential factor was stress, which often accompanies organizational change. However, the positive influence of occupational commitment and the role behaviors that involve increased interaction with other people reflect professional role characteristics described in the Guide to Physical Therapist Practice were noted.

Adult↗
PubMed1992

The shape of things to come: restructuring hospitals for the '90s. Interview by Karen Gardner.

John D. Leech, chairman of the health care practice in the law firm of Calfee, Halter & Griswold, Cleveland, OH, has been a hospital trustee for more than 20 years. From 1970-87, he served as president and chairman of the board of Hillcrest Hospital, Mayfield Heights, OH, and for the last four years he has been a trustee of Health Hill Hospital for Children, Cleveland, where he is currently secretary of the board. In addition to his professional and hospital responsibilities, Leech has been a trustee mentor for the American Hospital Association for a number of years; in this capacity, he has helped more than 30 hospital and system boards understand their governance role and function more effectively. From his legal practice as well as his contact with boards all over the country, Leech has developed a keen understanding of how hospitals are adapting to the changing health care environment and what role boards must play in the evolutionary process. He recently talked with Trustee editor Karen Gardner about hospital restructurings and the issues confronting governing boards.

Governing Board↗
PubMed2001

Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years.

OBJECTIVE: Hospital restructuring often results in fewer inpatient beds, increased ambulatory services, and closures of hospitals or emergency departments (EDs). The authors sought to determine the impact of systematic hospital restructuring on ED overcrowding. METHODS: Time series analyses of average monthly overcrowding for EDs in Toronto, Ontario, Canada, from 1991 and 2000 (n = 20 hospitals, 120 months) were conducted. Autoregression models evaluated the rate of increase of overcrowding before and during systematic restructuring. A secondary analysis included total ED visits, patient age, and sex distribution as covariates. Seasonality was assessed by means of spectral analysis. RESULTS: Severe and moderate overcrowding averaged 3% and 14% of the time each month, respectively, over the whole period. Before restructuring (n = 74 months), severe and moderate overcrowding averaged 0.5% and 9% per month, respectively; during restructuring (n = 46 months), the monthly averages were 6% and 23%, respectively. Neither severe nor moderate overcrowding was increasing before restructuring. During restructuring, however, both increased significantly (severe 0.2% per month [p < 0.0001]; moderate 0.5% per month [p < 0.0001]). Similar results were found after controlling for ED utilization. Female gender independently predicted increased overcrowding; older age predicted reduced moderate overcrowding; number of total visits was not a predictor. Spectral analysis revealed significant seasonality in overcrowding. CONCLUSIONS: Hospital restructuring was associated with increased ED overcrowding, even after controlling for utilization and patient demographics. Restructuring should proceed slowly to allow time for monitoring of its effects and modification of the process, because the impact of incremental reductions in hospital resources may be magnified as maximum operating capacity is approached.

Adult↗
PubMed2002

Social work in restructuring hospitals: program management five years later.

Hospital restructuring in North America has involved re-engineering, downsizing, reorganizing, and remodeling of traditional hierarchical functional organizations into multisite programmatic conglomerates. The implications for professional disciplines have been dramatic in that departments such as social work have been dismantled and social work practice has come under the domain of program managers representing multiple disciplines. In this study 12 hospitals in Ontario, Canada, that were studied in the early stages of restructuring in 1995 expanded to 22 sites by 1999. The effect of the mergers and moves to program management on the social work profession was examined. The key findings are that social work line positions were not lost, but accountability and recruitment were no longer in the hands of the discipline. These findings suggest that it is more critical now than ever for social workers to champion their contributions to health.

Health Services Research↗
PubMed2004

Implementation of hospital restructuring and nursing staff perceptions of hospital functioning.

Hospital restructuring and downsizing has taken place in most developed countries during the past ten years. A small but growing body of research findings has identified aspects of these changes that serve as sources of stress for nursing staff, as well as features of the restructuring process that contribute to more effective transitions. This research reports results of a longitudinal study of hospital restructuring and downsizing on nursing staff perceptions of hospital effectiveness. Data were collected in November 1996 and again in November 1999 from nursing staff using questionnaires. Would the way hospital restructuring was implemented and managed in 1996 be related to nursing staff perceptions of hospital functioning in 1999? The findings showed positive but moderate relationships between more favorable restructuring processes and perceptions of hospital functioning.

Attitude of Health Personnel↗
PubMed1997

Hospital restructuring and the epidemiology of hospital utilization: recent experience in Ontario.

OBJECTIVES: The author highlights changes in hospital utilization that have occurred in association with restructuring of Ontario hospitals. The basic features of the epidemiology of hospital utilization described link the analysis of the organizational and structural components of hospitals with a more comprehensive evaluation of the impacts of their restructuring and have implications for international comparative studies. METHODS: Data from the Canadian Institute for Health Information and the Canadian census were analyzed to provide a population-based description of hospital utilization and care. These hospital data provided information on changes in the patterns of care that occurred during restructuring, based on hospital separations for the fiscal years 1991-1992 through 1995-1996. RESULTS: Analysis of hospital utilization patterns revealed a 30% decrease in the days of care provided per 1,000 population during the period, the result of declines in both the age-adjusted inpatient separation rates and average length of hospital stay. The shift of surgical treatment to outpatient settings contributed to the reduction in inpatient days of care. The decline in utilization was experienced unevenly across age groups, with the elderly experiencing less of the decline than did younger age groups. Individuals living in the poorest areas used more inpatient care than did those living in the richest areas, although the gap in utilization narrowed over the period. CONCLUSIONS: International comparisons of the epidemiology of hospital utilization and the impact of hospital restructuring will require the use of multiple data sources and the development of shared evaluative frameworks. Health data systems in Canada support the assessment of the broader impacts of hospital restructuring and offer a framework for developing research projects that can provide useful information on these important changes in health-care policy.

Adolescent↗
PubMed2002

The impact of hospital restructuring on social work field education.

Hospital restructuring has had a dramatic impact on social work practice and field education. In a qualitative focus group study of nine educational coordinators responsible for educational programs in teaching hospitals with 25 to 100 social workers each, four main themes emerged: (1) difficulty managing field education when the actual change experienced in restructuring hospitals was far less progressive and systemic than the hospital missions espoused; (2) a struggle to maintain stable student programs when change was unpredictable; (3) the importance of support, reciprocity, and advocacy from the university; and (4) the need to be creative in delivering the educational program while undergoing organizational change.

Canada↗
PubMed1999

Improving computer skills to support hospital restructuring.

A vital part of restructuring in hospitals is a continuing effort to find ways to meet the growing demands of caregivers for efficient ways to enter and retrieve patient information. The process of effectively meeting these demands was coordinated through the leadership and efforts of the chief nurse executive and the information manager for nursing at New York Veterans Affairs Medical Center. These efforts resulted in timely support for restructuring, improvement in the development of competency skills among nursing staff, and increase in the use of electronic methods for documentation of patient care. Discussion of the changes implemented include approaches and content of training for computer skills development, a position description for an expanded role of a nurse in the field of informatics, and the facility's structure that fits a patient-centered care model.

Computer User Training↗
PubMed2001

Hospital restructuring: impact on nurses mediated by social support and a perception of challenge.

Health care has not escaped the economic rationalization experienced throughout the western world during the 1990s. In Australia, the introduction of Casemix and its accompanying budget cuts has required major restructuring in hospitals. Change can be stressful yet a consultative style, beliefs that change in challenging, and good support were proposed as mediators of the negative effects of change for nurses. This article presents data from 201 nurses working in three Australian hospitals. The results indicate that, despite restructuring changes during the previous 12 months and their high impact upon hospital and nurse conditions, nurses maintained a strong sense of professional efficacy. However, these changes and their impact also predicted nurse burnout. Nurses felt unable to challenge the actual restructuring changes (closed units/beds) however and saw working against the impact of these changes (reduced time, resources) as a challenge. Management's communications about the changes was proposed as a mediator against burnout but this hypothesis was not supported. Nurses considered management to have adopted a top-down approach and this non-consultative style of communication also predicted nurse burnout. The restructuring changes, their impact, and poor communication style, and burnout also predicted nurses' intentions to quit; however, a sense of professionalism mediated this intent. The implications of the findings are discussed.

Attitude of Health Personnel↗
PubMed1999

A quality roadmap of a restructured hospital.

This paper presents a quality roadmap of a restructured hospital. Specifically, a case study is showcased to reveal how a FOCUS-PDCA model is applied to the Central Portering Services (CPS) within a restructured hospital, to provide better service to other departments within the hospital who can then in turn value add to the patient care delivery chain. The preliminary results suggest that implementers of quality and service improvement programmes using the FOCUS-PDCA approach should note some of the key implementation difficulties. These difficulties occur at all levels and include issues relevant to change management, process improvement programmes, accessibility to data, communication and judicious execution of the change process.

Hospital Restructuring↗
PubMedDate not supplied

Mitigating the impact of hospital restructuring on nurses: the responsibility of emotionally intelligent leadership.

BACKGROUND: A decade of North American hospital restructuring in the 1990s resulted in the layoff of thousands of nurses, leading to documented negative consequences for both nurses and patients. Nurses who remained employed experienced significant negative physical and emotional health, decreased job satisfaction, and decreased opportunity to provide quality care. OBJECTIVE: To develop a theoretical model of the impact of hospital restructuring on nurses and determine the extent to which emotionally intelligent nursing leadership mitigated any of these impacts. METHODS: The sample was drawn from all registered nurses in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (N = 6,526 nurses; 53% response rate). Thirteen leadership competencies (founded on emotional intelligence) were used to create 7 data sets reflecting different leadership styles: 4 resonant, 2 dissonant, and 1 mixed. The theoretical model was then estimated 7 times using structural equation modeling and the seven data sets. RESULTS: Nurses working for resonant leaders reported significantly less emotional exhaustion and psychosomatic symptoms, better emotional health, greater workgroup collaboration and teamwork with physicians, more satisfaction with supervision and their jobs, and fewer unmet patient care needs than did nurses working for dissonant leaders. DISCUSSION: Resonant leadership styles mitigated the impact of hospital restructuring on nurses, while dissonant leadership intensified this impact. These findings have implications for future hospital restructuring, accountabilities of hospital leaders, the achievement of positive patient outcomes, the development of practice environments, the emotional health and well-being of nurses, and ultimately patient care outcomes.

Alberta↗
PubMedDate not supplied

Hospital restructuring and nursing leadership: a journey from research question to research program.

The 1990s brought new fiscal realities to healthcare, leading to nursing job loss estimates in tens of thousands following widespread hospital restructuring to manage costs and improve efficiency. This research aimed at examining (a) how multiple episodes of hospital restructuring leading to layoff of nurses affected nurses who remained employed and (b) whether and how nursing leadership mitigated or intensified the negative effects of hospital restructuring on nurses. This dissertation comprised 3 empirical studies leading to 5 publications. The first study was a systematic literature review; the second and third used structural equation modeling to develop and test theoretical models addressing nursing practice environments and effects of hospital restructuring on nurses. The combined findings in this dissertation illustrate that hospital restructuring had significant negative physical/emotional health effects on nurses who remained employed. Nurses who worked for resonant (emotionally intelligent) leadership reported positive health and well-being, and opportunities to provide quality patient care. Nurses who worked for dissonant leadership reported greater negative effects of hospital restructuring. These findings led to a beginning theory of relational energy--a mechanism of mitigation whereby resonant nursing leaders invest energy into collaborative relationships with nurses, thereby positively influencing health and well-being, and, ultimately, outcomes for patients.

Alberta↗
PubMedDate not supplied

Hospital restructuring stressors, support, and nursing staff perceptions of unit functioning.

Hospital restructuring and downsizing have taken place in most developed countries during the past 10 years. A small but growing body of research findings has identified aspects of these changes that serve as sources of stress for nursing staff during these transitions as well as organizational initiatives that facilitate those transitions. This study reports results from a longitudinal study of hospital restructuring and downsizing on nursing staff perceptions of hospital functioning. Data were collected in November 1996 and again in November 1999 from hospital-based nursing staff using questionnaires. The findings showed moderate but statistically significant relationships between restructuring stressors and organizational support in 1996 and perceptions of hospital functioning in 1999. Nursing staff reporting higher levels of restructuring stressors and lower hospital support in 1996 indicated more negative perceptions of unit and hospital functioning in 1999.

Adult↗
PubMedDate not supplied

Hospital restructuring stressors: support and nursing staff perceptions of unit functioning.

Hospital restructuring and downsizing have taken place in most developed countries during the past ten years. A small but growing body of research findings has identified aspects of these changes that serve as sources of stress for nursing staff during these transitions as well as organizational initiatives that facilitate those transitions. This study reports results from a longitudinal study of hospital restructuring and downsizing on nursing staff perceptions of hospital functioning. Data were collected in November 1996, and again in November 1999, from hospital-based nursing staff using questionnaires. The findings showed moderate but statistically significant relationships between restructuring stressors and organizational support in 1996 and perceptions of hospital functioning in 1999. Nursing staff reporting higher levels of restructuring stressors and lower hospital support in 1996 indicated more negative perceptions of unit and hospital functioning in 1999.

Adult↗
PubMed2006

Does restructuring hospitals result in greater efficiency?--An empirical test using diachronic data.

Hospitals are being restructured more frequently. Increased cost efficiency is the usual justification given for such changes. All 20 major teaching hospitals in Australia's two most populous states were investigated by classifying each over a 5-6 year period in terms of their cost efficiency (average cost per case weighted by Australian diagnosis-related group [AN-DRG] data and adjusted for inflation) and structure, categorized as traditional-professional (TP), clinical-divisional (CD), or clinical-institute (CI). In all, 12 hospitals changed structure during the study period. There was slight evidence that CD structures were more efficient than TP structures but this was not supported by other evidence. There were no significant differences in efficiency in the first or second years following changes from either TP to CD or TP to CI structures. All four hospitals changing from CD to CI structure became significantly less efficient. This may be due to frequency rather than type of change as they were the only hospitals that implemented two structural changes. Hospitals that changed or did not change structure were similar in efficiency at the beginning and at the end of the study period, in overall efficiency during the period, and in trends toward efficiency over time. The findings challenge those who advocate restructuring hospitals on the grounds of improving cost efficiency.

Efficiency, Organizational↗