Downsizing in the Hospital System: A Restructuring Process

Abstract

In an effort to maintain fiscal viability, hospitals have been undergoing major restructuring. This article reports on a study that examined innovative downsizing strategies used by 20 acute care hospitals in Ontario. The study team reviewed hospital operating plans and analysed the results of interviews conducted with administrators and employees about the downsizing process. Results revealed no uniformity of approach to downsizing. Although many administrators expressed the need for a cooperative approach, downsizing was typically conducted in a top down fashion, and was perceived very differently by staff and administrators. The authors suggest ways to improve restructuring efforts and put forward questions to guide future research.

Nursing staff mix models and outcomes

“…These observations raise questions about the processes used to undertake restructuring within nursing. Baumann et al. (1996) identified that nurses expressed concern about their degree of involvement in decisions about their future employment settings.…”

A Comprehensive Approach to Effectively Engage Physicians during a Hospital Closure: Using the Physician Engagement Model

“…Previous literature has recommended the use of the strategies either individually or in a combined approach as in the case of the PE model. 1,[4][5][6]11 McLellan et al investigated a similar multifaceted approach of educating and supporting nursing staff during an Ottawa hospital closure that showed promising results. 4,17 In addition, the authors showed that a communication strategy that was consistent and frequent was found to be quite successful and this is further supported by the current study.…”

“…ince the late '80s, hospitals worldwide have been closing. 1,2 In Canada, as a result of recent provincial health care restructuring, there have been hospital closures, particularly in Ontario, [3][4][5] British Columbia, 6 Saskatchewan 7 and Newfoundland and Labrador. 8 These closures have negatively affected staff and the community, for example, stress and burnout have been well documented in staff after a closure; [9][10][11] therefore, obtaining further input from these groups has been acknowledged.…”

Hospital restructuring in smaller urban Ontario settings: unwritten rules and uncertain relations

“…Instead, sites were selected where local restructuring decisions had been carried out, and the CEOs were approached because they had been closely involved in devising these local initiatives. Other studies have suggested that these types of local initiatives are less common in smaller community settings, especially those with only one hospital (e.g., Baumann et al 1996). A major reason for contacting these CEOs, therefore, was to find out more from them about why the hospital executive in these communities had chosen a more aggressive strategic response compared to other smaller hospitals in the province, and to recount their experiences in pursuing these initiatives.…”