ABSTRACT
This report describes restructuring on four critical care units at an acute, tertiary care hospital in South-east Pennsylvania. Utilizing a Patient Centered Care conceptual framework that had been successfully applied in the medical-surgical areas, restructuring involved three main areas: revamping of work processes, inclusive of redesigned staff roles; environmental and facility changes; and enhancement of telecommunication and information systems. Preliminary analyses six months post redesign revealed improvements and maintenance in four outcomes areas--satisfaction, quality and efficiency, and costs of care.
Subject(s)
Critical Care/standards , Hospital Restructuring/organization & administration , Intensive Care Units/organization & administration , Patient Satisfaction , Quality Assurance, Health Care/organization & administration , Quality of Health Care , Efficiency, Organizational , Humans , Patient-Centered Care/organization & administrationABSTRACT
Critical care has enjoyed unobstructed growth during the past two decades; however, to remain viable, process and role changes are pivotal to ensuring continued quality, cost-effective, and efficient care. In this article, the second in a two-part series, the authors describe restructuring efforts, inclusive of their measurement and evaluation strategies, within four critical care units at an acute care, tertiary institution. Special emphasis is placed on the process, the authors' observations, and lessons learned to date. Part 1 (September 1998) presented evaluation data of the effects of hospital restructuring on patient and nurse satisfaction, costs of care, and clinical quality in four medical-surgical units.
Subject(s)
Critical Care/organization & administration , Hospital Restructuring , Intensive Care Units/organization & administration , Evaluation Studies as Topic , Humans , Institutional Management Teams , Intensive Care Units/standards , Management Audit , Models, Organizational , Organizational Innovation , Pennsylvania , Program Evaluation , Quality Indicators, Health CareABSTRACT
Increasingly, hospital restructuring is viewed with skepticism because of a lack of systematic and rigorous evaluation of its impact on quality of care. This first article in a two-part series describes comprehensive evaluation of the effects of hospital restructuring on patient satisfaction, nurse satisfaction, costs of care, and clinical quality on four medical-surgical units at a large tertiary hospital. In addition, early application of the model to critical care is described. A quasiexperimental pre- and post-design combined with concurrent control units for selected measures was the overall strategy. The authors conclude that comprehensive restructuring of hospital-based care can take place in a manner that preserves multiple dimensions of quality while decreasing costs. This only can be ascertained, however, through rigorous and systematic measurement and evaluation. Part 2 will detail application and evaluation of the restructuring model in the critical care environment.
Subject(s)
Hospital Restructuring/standards , Hospital Units/organization & administration , Quality of Health Care , Critical Care/standards , Evaluation Studies as Topic , Hospital Mortality , Humans , Job Satisfaction , Length of Stay , Nursing Staff, Hospital/psychology , Patient Satisfaction , Pennsylvania , Quality Assurance, Health CareABSTRACT
This article reports on study evaluating the effects of hospital restructuring on patient satisfaction, nurse satisfaction, cost of care, and clinical quality. The restructuring involved facility redesign, telecommunications enhancement, and implementation of patient care processes incorporating multiskilled personnel and case facilitation systems. The results indicate improved patient and nurse satisfaction, decreased length of stay and variable cost per patient day, and good clinical outcomes.
Subject(s)
Hospital Restructuring/standards , Hospitals, Teaching/organization & administration , Job Satisfaction , Patient Satisfaction/statistics & numerical data , Hospital Bed Capacity, 500 and over , Hospital Costs , Hospital Restructuring/economics , Hospital Restructuring/organization & administration , Humans , Nursing Service, Hospital/standards , Organizational Case Studies , Outcome Assessment, Health Care , Patient-Centered Care , Pennsylvania , Program Evaluation , Quality of Health CareABSTRACT
Organizations have expended enormous resources to restructure care delivery Despite the growing literature describing these organizational innovations there is a paucity of credible data that reflects systematic measurement and evaluation of such changes. This report not only describes a comprehensive research based restructuring effort in a 720 bed acute care hospital, but it also describes an outcomes evaluation strategy and associated findings that may serve as a model and a guide for other healthcare institutions.
Subject(s)
Hospital Restructuring/organization & administration , Management Audit/methods , Outcome Assessment, Health Care , Hospital Restructuring/standards , Hospital Units/organization & administration , Humans , Models, Organizational , Patient Satisfaction , Patient-Centered Care/organization & administration , Pennsylvania , Quality of Health CareABSTRACT
This article proposes that professional development be a core principle within an organization to equip staff members with the resources to adapt to change. Multiple examples of professional development activities are identified. Four absolutes to create an environment to support professional development are discussed. A successful professional development model at Lehigh Valley Hospital, Allentown, PA, is detailed, including examples of funding sources. Finally, the investigators furnish examples of how an environment rich in professional development activities fosters staff members' abilities to cope with change.