Introduction
The hospital setting under investigationThe hospital under investigation is a specialist unit that provides care and treatment for different rheumatic conditions. The hospital organization was reformed in 2004. Based on a subscriber-producer model, service provision is now closely organised around distinct areas of specialisation. This offers advantages in terms of training and developing staff skills and competencies. The adoption of this model implied not only a reorganisation of health care activities, but also a complete overhaul of the cost centre structure. During 2005, individuals were appointed to assume responsibility for a large number of services and products. (1, 2)The hospital has 220 beds, several outpatient units and 382 permanent staff. Patient care has been organised through multidisciplinary teams since the 1950s. These consist of rheumatologists, nurses, social workers, physiotherapists, occupational therapists and orthopedists and other health care professionals. (2, 3)
Organizational changesContinuous change in complex healthcare environments is a challenge for nurse leaders, but it can also be a boon. Change can leverage the introduction of innovations that improve the quality of care delivery. It all depends on how change is managed. (4) Thus, implementing change in organizations is a key nursing leadership competency and at the same time daunting responsibility. (5)Health care organizations have seen numerous reforms in the past few years, and even more changes are expected in the near future to further step up efficiency. In the change management important issues are e.g. the roles of power and political behaviour, how much change can be planned and controlled, how to combine top-down and bottomup approaches, the role of emotions, and how to understand the change management process. (6) The single biggest group of health care professionals to be affected by recent hospital downsizings is that of nurses. It has been suggested that the quality of patient care could be adversely affected if nurses lose their trust in the system because loss of job security (7, 8). Empowerment has been reported to be crucial to the successful restructuring of an organiza-tion (9) The key factors that create an empowered environment during transitions are access to information and participation in the decisionmaking process (7, 9), adequate staff resources, mutual support (10) and a feeling of confidence in the changeover process in general (7) Information sharing and participation in decision-making Many recent studies have shown that information-related issues have a major impact in terms of promoting work-related empowerment in health care organizations. Open communication and adequate and accurate information sharing in a timely fashion enable staff to take part in the decision-making process. Giving staff members the opportunity to participate in meetings and taking their views and suggestions into consideration have been found to strengthen the experience of empowerment (7,11,12) and to crea...