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By Sharon Gray
The findings of a study on the impact of restructuring on acute
care hospitals in Newfoundland has key implications for decision
makers related to controlling healthcare expenditures and improving
the climate of the workplace for healthcare workers.
The study was done by a team of researchers at Memorial headed
by Dr. Patrick Parfrey, University Research Professor, and Dr.
Brendan Barrett, professor of medicine. Funding for the study
was provided by the Canadian Health Services Research Foundation,
the Health Care Corporation of St. John’s and the Department
of Health and Community Services. The study coordinator was
Debbie Gregory, health policy analyst.
Regionalization of health boards occurred between 1995 and 1997;
in 1996 the largest of the province’s acute care boards,
the Health Care Corporation of St. John’s, implemented
program-based management, partly to facilitate the closure of
a hospital and the integration of clinical services.
“The main purpose of this study is to inform policy makers
and stakeholders, including consumers, about the impact of regionalization
of boards and rationalization of services in the acute care
setting,” said Dr. Parfrey. “We found that regionalization
by itself does not fully address what drives costs up, and may
not be an effective means to control healthcare expenditures.
For example, regionalization and planning facilitated rationalization
of services in St. John’s but control of costs did not
occur. If wage increases continue at the same rate and a cash
infusion is not provided, a reduction in employee numbers is
the most likely solution to controlling costs.”
The study found that there are opportunities for further integration
and rationalization of services and institutions throughout
the province. “Strategic planning and leadership is critical
to meeting these objectives and controlling costs.”
Dr. Parfrey said the study showed that hospital closure, in
the context of regionalization and program management, may not
necessarily lead to deterioration in healthcare provider attitudes,
patient satisfaction, or quality of care. “Control of
rising expenditures include infusion of new money, further rationalization
of services, efforts to improve work attendance, overtime and
productivity, efforts to reduce unnecessary demand, and reduction
of need as a result of improved population health.”
Dr. Parfrey said the study also showed that the climate of the
workplace needs to be improved. “Most employee groups
supported the need for restructuring and had reasonable levels
of general job satisfaction, but organizational commitment and
the emotional climate of the workplace were rated poorly. These
negative findings could not be directly attributed to the restructuring
itself.”
The study on hospital restructuring also looked at acute care
bed use and found that access to these beds is a problem that
will persist unless bed use improves. Problems include unnecessary
bed use because of inefficiencies within the hospital, such
as awaiting surgery or diagnostic procedures, or unnecessary
days due to inadequate access to alternate facilities such as
long-term care.
Overall, Dr. Parfrey said that there are many problems that
must be addressed in the province’s healthcare system.
“There is a steady increase in real healthcare costs with
an unabated demand for healthcare services, and there is poor
access to some services. Healthcare providers are dispirited.
Regional politics has created challenges and impeded change
processes in some regional health boards. The challenge will
be to rationalize services and improve efficiency, at the same
time as endeavour to enhance employee morale.” |
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issue: January 22, 2003
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