Downsizing, Reengineering, and Restructuring: Long-Term Implications for Healthcare Organizations

Organisational design for health integrated delivery systems: Theory and practice

“…Along with the redesign of the governance structure, many restructuring processes have taken place at the micro-level [8]: re-engineering of health services, delivering procedures, adoption and adaptation of emerging working philosophies as patient focused care, continuous improvement, and total quality, etc. In a context of emerging consumerism, coupled with financial pressures to reduce costs and improve efficiency, and with social and professional pressures to increase quality (effectiveness and evidence-based medicine), attention to health services delivery design has became a key issue [9].…”

“…This is an issue we need to investigate at large, as healthcare organizations are growing bigger and more complex -as in the case of integrated delivery systems (IDS) -in an more and more unstable and demanding environment (managed care, regulations, consumers expectations, etc.). An environment that needs to be taken into account for the implementation of new and more effective organizational designs [8,11,12].…”

Converging patterns in hospital organization: beyond the professional bureaucracy

“…Organizational mechanisms, such as planning, programming, budgeting and control system, human resource management system, etc., are also involved in the redesign process. This set of interventions can fundamentally alter the design of clinical care and the relationships among care givers and between those and the administrators [47][48][49].…”

The Relationship of Role-Related Variables to Job Satisfaction and Commitment to the Organization in a Restructured Hospital Environment

“…For some clinicians, including physical therapists, their worst fears were realized as their roles were altered and some positions were eliminated through restructuring and downsizing. [1][2][3] For other clinicians, the changes offered new opportunities for autonomy and collaboration, and even a renewed sense of professionalism. [1][2][3] Yet even though hospital environments have been undergoing major changes for over 15 years, we do not have a good understanding of the relationship among the factors that interact to shape the work experience of clinicians within this health care setting.…”

“…[1][2][3] For other clinicians, the changes offered new opportunities for autonomy and collaboration, and even a renewed sense of professionalism. [1][2][3] Yet even though hospital environments have been undergoing major changes for over 15 years, we do not have a good understanding of the relationship among the factors that interact to shape the work experience of clinicians within this health care setting. 4 -7 If the work experience develops from a synthesis of employees' perceptions about the work they do, the organization they belong to, and the interpersonal relationships that bind these entities together, 8,9 then I believe many factors in today's restructured hospital environment have the potential to influence the perceptions of practitioners.…”