Peggy Leatt

Downsizing, reengineering, and restructuring: long-term implications for healthcare organizations.

Summary This article provides a framework for analyzing how downsizing and reengineering have affected healthcare organizations. These approaches are reviewed, and key tools that have been used, such as across‐the‐board cuts, reorganizing, and redesigning, are described. Examples are drawn from healthcare as well as other business sectors. The consequences of cost reduction strategies for an organizations performance in terms of costs, quality of services, and satisfaction of consumers and employees are explored. The case is made that an organizations context‐that is, its culture, level of trust, and leadership‐is an important factor that influences the effect of cost‐cutting strategies. Characteristics of organizations where downsizing has a better chance of succeeding also are described.

Measurement of staff empowerment within health service organizations.

A measure of empowerment was developed and its psychometric properties evaluated. Employees (n = 52) of two hospitals participated in semistructured interviews and a pilot test of the research instrument. A second study was undertaken with professional, support, and administrative staff (n = 405) of four community hospitals. Psychometric evaluation included factor analysis, reliability estimation, and validity assessment. Subjects responded to questionnaires measuring empowerment, leadership behavior, organizational citizenship behavior and job behaviors related to quality improvement. Factor analysis indicated three dimensions of empowerment: behavioral, verbal, and outcome empowerment. Coefficient alphas ranged from .83 to .87. The three dimensions were positively related to leadership behavior that encouraged self-leadership and negatively related to directive leadership. The three dimensions discriminated between the empowerment level of managers compared to that of nonmanagement staff. Empowerment predicted organizational citizenship behavior and job behaviors related to quality improvement.

Nursing subunit technology: a replication.

Overton, Schneck, and Hazletts (1977) measurement of nursing subunit technology was replicated using 157 subunits of 9 types located in 24 hospitals in Alberta. A 21-item questionnaire was given to nurses, and the answers were subjected to factor analyses. Results indicated three dimensions of technology: instability, uncertainty, and variability. Because of the similarity of these variables to those in the Overton, Schneck, and Hazlett study, the results suggested a high degree of construct validity for the measure. The technological dimensions also differentiated among the types of subunits in the same pattern as in the original study. A relatively quick method of obtaining measures of instability, uncertainty, and variability by using composite scores was tested and found reliable.

A Framework for Assessing the Performance of Integrated Health Delivery Systems

Competing demands for resources within the health care system require health care providers to ensure the most effective and efficient use of resources. The evidence from the United States, the United Kingdom and other jurisdictions suggests that integrated health delivery systems (IDS) may be a cost-effective way to meet the health care needs of a population. This article introduces a framework for use in monitoring and evaluating the performance of an integrated delivery system. The establishment of a consistently used evaluation framework for integrated delivery systems will provide the government, governing bodies and other evaluators with an effective assessment tool that will enable greater understanding of the impact of the IDS on the health care system. It will also provide information to enable ongoing performance improvements within the system.

Criteria for grouping nursing subunits in hospitals.

Data from 135 nursing subunits were used to identify a set of organizational variables that best explained the grouping of activities into nursing subunits in hospitals. Relatively strong support was provided for technology as a basis for grouping nursing subunits; characteristics of the hospital, including its type, size, and location, also were relevant.

Is the grass any greener? Canada to United States of America nurse migration

AIM Little or no attempt has been made to determine why nurses leave Canada, remain outside of Canada, or under what circumstances might return to Canada. The purpose of this study was to gain an understanding of Canadian-educated registered nurses working in the USA. DATA SOURCES Data for this study include the 1996, 2000 and 2004 USA National Sample Survey of Registered Nurses and reports from the same time period from the Canadian Institute for Health Information. FINDINGS This research demonstrates that full-time work opportunities and the potential for ongoing education are key factors that contribute to the migration of Canadian nurses to the USA. In addition, Canada appears to be losing baccalaureate-prepared nurses to the USA. DISCUSSION These findings underscore how health care policy decisions such as workforce retention strategies can have a direct influence on the nursing workforce. Policy emphasis should be on providing incentives for Canadian-educated nurses to stay in Canada, and obtain full-time work while continuing to develop professionally. CONCLUSION Findings from this study provide policy leaders with important information regarding employment options of interest to migrating nurses. STUDY LIMITATIONS This study describes and contrasts nurses in the data set, thus providing information on the context of nurse migration from Canada to the USA. Data utilized in this study are cross-sectional in nature, thus the opportunity to follow individual nurses over time was not possible.

Are managers compensated for hospital financial performance

Management compensation in a sample of 213 nonprofit hospitals in Ontario, Canada, is examined. Management compensation is determined first and foremost by hospital size and teaching status. Results indicate only a weak relationship between management compensation and hospital financial performance.

Corporatization and deprivatization of health services in Canada

Canadas system of health services has been shaped by the forces and values in the Canadian political, cultural, social, and economic environment; these forces continue to place constraints on future changes. We distinguish between “corporatization” and “privatization,” and the implications of each for improved efficiency of the system. Although the organization of health services is, in certain provinces, undergoing significant structural changes, there is evidence that rather than privatizing, the system may actually be continuing to experience what we have termed deprivatization, as the scope of government involvement expands to include a more comprehensive definition of health care. Trends in Canada differ considerably from those in the United States; universal health insurance has curbed the ability and desire of institutions to exclude members of some socioeconomic groups from receiving care. U.S.-based models, if applied to Canada, could lead to both higher costs and lower quality of care. Considerable efficiencies can be realized within Canadas current system.

Sources and Management of Organizational Stress in Nursing Sub-units in Canada

The main objectives in this research were to explore differences in kinds of stress in varying types of nursing sub-units in hospitals and to examine the relative importance of sub-unit characteristics such as the technology, size, environment, context, structure, and internal sub-unit processes in contributing to sub-unit stress. Five kinds of stress were identified: stress from traumatic emotional experiences, psychogeriatric work load, scheduling of work, physician-nurse relationships, and personality role stress; some of these were found to be associated with variations in the technology of the sub units, but did not appear likely to be modifiable through changes in structural design and organizational processes. Other types of stress were related to both the technology and the sub-unit environment and these appeared to be more amenable to modification through the type of structure and internal processes of the sub-unit.

Multidisciplinary Teams in Health Care: Lessons from Oncology and Renal Teams

An indepth study conducted on units treating renal disease and cancer clinics determined that multidisciplinary teams are relatively commonplace in these areas. Developing four team organizational structures — sequential, primary, nucleus and dynamic — the authors hypothesize that each varies on a continuum in terms of how highly structured they are. The framework suggests that the ideology of equal participation on the team is the most difficult to sustain, and that difficulties typically arise as organization requirements become more complex. More research seems to be indicated to develop a comprehensive organizational framework, and the probable effect of organizational form on team performance. One of the key issues addressed is team leadership.