Dissertation

Hospital restructuring and process redesign: Are we improving our health care systems?

Reid, Lois Marion

1998

Overview

Scarborough General Hospital (SGH) was faced with ongoing funding and bed reductions that resulted in the need to dramatically change the way in which it provided services. By utilizing SGH 's longitudinal database, selected external reviews and internal committee documentation, the effects of the hospital's organizational restructuring and process redesign on access, scope, financial viability, satisfaction and quality were investigated. Findings indicated the hospital's new organizational structure balanced the economy of a centralized model with the flexibility of a decentralized model. The chosen patient centered care delivery model was successful in achieving cross-functional teams, empowerment of staff, expanded roles for registered nurses and registered practical nurses and multi-skilling. Care pathways successfully reduced the length of stay and patient aggregations supported efficient delivery of care. The patient centered care approach brought selected services closer to the patient and maximized the efficient use of resources. The study indicated the hospital's change initiatives were pro-active, creative and effective. Patient's access to services was maintained, scope of services were expanded, measures remained within acceptable levels. The hospital also maintained financial stability and achieved one of the lowest “costs per case” in its peer group throughout the period of the review (1994/95–1997/98). The study identified the hospital's strategy of simultaneously layering multiple change projects, coupled with very aggressive time frames, failed to recognize staffs' need to achieve an appropriate learning curve. Insufficient time was available for staff to incorporate new learning into their personal paradigms and practice patterns. Better alignment of individual change strategies with the overall strategic plan was needed to ensure that the advantages gained would be sustainable. It was concluded that organizational redesign that is well managed over the long term can result in minimal disruption to patient care, maintained access to services and sustained quality of care. Factors identified as affecting successful change include stability of funding, commitment of adequate resources to support the change initiatives and ability to coordinate and link the individual change initiatives into the overall change design.

• Publisher: ProQuest Dissertations & Theses
• Subject: Decentralization / Decision making / Employee empowerment / Empowerment / Health care / Health care management / Hospitals / Nurses / Organizational change / Organizational structure / Patient satisfaction / Quality of care / Skills / Strategic planning / Studies / Teams / Total quality
• ISBN: 9780612415966, 0612415961