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January 8, 2004
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Study looks at ways to improve
acute hospital care delivery

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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Next issue: January 22, 2003

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