Organizational Redesign and Effect on Nursing Care

Afza.Malik GDA

Nursing Care and Organizational Redesign

Organizational Redesign and Effect on Nursing Care

Whats is Organizational Redesign,Redesigning During Time,Redesigning and Outcomes,Redesigning and Organizational Characteristics,Redesigning and Employee Reaction,Cause and Effect of Redesigning.

Whats is Organizational Redesign

     Organizational redesign, or restructuring, as some experts refer to the process, is the transformation of an organization's architecture and methods for providing services. It involves a revamping of structures and processes for purposes of achieving efficiency and maximum production outcome. 

    In the case of health care organizations, the redesigned production process is expected to produce improved employee, patient, and organizational outcome. 

    Although the term “organizational redesign” generally implies a fundamental change in the way things are done, the term also is commonly used to describe a variety of changes occurring at the unit, department, or organizational level. 

    This variation in level of focus and measurement has posed difficulties in measuring the true effect of organizational redesign on employee and care delivery outcomes.

Redesigning During Time 

    Studies of organizational redesign increased dramatically during the 1990s after health care institutions across the US, and elsewhere began instituting varying degrees of organizational change. Most of this research was conducted after health care organizations made the decision to redesign. 

    Consequently, most redesign initiatives were implemented without the benefit of supporting evidence to guide the changes made or the effects proposed. As a result, a number of the redesign efforts failed and many institutions have re-instituted some of the processes eliminated during the redesign activities.

Redesigning and Outcomes 

    Nursing studies of organizational redesign have explored a number of individual and organizational factors that contribute to the outcomes seen. Most investigations have focused on the employee's response to redesign. although a few have included organizational and patient outcome indicators as well. 

    Findings are mixed, with some studies showing improvements in nurse perceptions of work group collaboration, interpersonal relationships, and job satisfaction (Ingersoll et al., 2002) and others reporting increased uncertainty (Blythe, Baumann, & Giovannetti, 2001), worry (Barry -Walker, 2000).

    Emotional stress (Denton, Zeytinoglu , Davies, & Lian, 2002; Greenglass & Burke, 2001), dissatisfaction (Barry-Walker; Denton et al.; Greenglass & Burke), disempowerment (Blythe et al.) , anger, despair (Ingersoll, Fisher, Ross, Soja, & Kidd, 2001).

    Anxiety, emotional exhaustion, depression, cynicism (Greenglass & Burke), fragmentation of relationships (Blythe et al.), and mistrust of administration (Ingersoll et al. al., 2001). 

    When redesign initiatives are targeted at the institution as a whole, redesign impact is felt at all levels of the organization, with midlevel managers also reporting feelings of inadequacy, ambiguity, frustration, and loss of position power as a result of redesign activities (Ingersoll, Cook, Fogel, Applegate, & Frank, 1999). 

    A survey of chief executive officers in one study supported employee believes that the overall gains in quality of care are not as substantial as the cost savings to the institution and that the cost savings are overpowered by the serious dissatisfaction of the staff ( Urden & Walston , 2001).

Redesigning and Organizational Characteristics

    Several studies of organizational redesign suggested that individual and organizational characteristics can reduce the negative effects of the organizational change. Employees with higher levels of perceived self-efficacy and positive coping (Greenglass & Burke, 2001) reported less distress in response to organizational redesign. 

    In addition, organizations that promote increased nurse involvement in decision making (Ingersoll, Kirsch, Merck, & Lightfoot, 2000; Laschinger , Finegan , Shamian , & Almost, 2001) and that have a prior history of effective change processes, which has been defined in one study as organizational readiness (Ingersoll et al.) were less likely to report serious negative effects from redesign initiatives.

Redesigning and Employee Reaction

    Regardless of the extent of the redesign underway, staff reaction is strong. Clearly evident in the reports of organizational redesign is a level of employee disruption that is well beyond what was anticipated by the administrators undertaking the redesign initiatives. 

    Even when information was shared, concerns were expressed about what to expect and when the disruption would end. Staff nurse and manager worry about quality of patient care also is a consistent theme across studies. Investigations of the impact of organizational redesign on patient outcomes are less evident, although a few do exist. 

    In a study by Soviet and Jawad (2001), redesign outcomes were assessed primarily through a comparison of nurse resource variables and their impact on patients and cost. In this study, most hospitals had implemented reductions in RN staff as a component of their redesign initiatives. 

    Findings suggested that hospitals with the greatest reductions in RN staff have the poorest outcomes. An important finding of this study was the increased cost per patient discharge in hospitals with lower rather than higher percentages of RN staff. 

    This cost outcome finding was supported in a small study by Barry-Walker (2000), in which costs of care per patient day increased rather than declined following organizational redesign.

     Most of the research concerning organizational redesign has been conducted either during the course of or shortly after the redesigns were implemented. Little information is available concerning the long-term effect of these change processes and whether any or all of the redesign components remain intact. 

    Follow up studies would be useful to clarify which elements have been sustained or refined over time. Furthermore, because the studies reflected immediate post implementation time frames, some of the observed effect may have been the result of the turbulence caused by the change rather than the components of the redesign models themselves.

Cause and Effect of Redesigning

    Evident in the research concerning organizational redesign is the need for better methods for determining cause and effect relationships between redesign components and outcomes seen. 

    Determining the effect of organizational, environmental, and individual factors on redesign outcomes is also important, as preliminary results suggest differences exist across employees and work settings. Attention to the organization's culture and history of (readiness for) change experiences, likewise, appears to be an important aspect of successful organizational redesign. 

    Opportunities for staff nurse involvement in decision making and planning for change is also apparent. Future investigations of organizational redesign initiatives should also focus on both the processes used to implement the redesigns and the outcomes they are expected to achieve. 

    Without an indication of what was done, which is best identified through the process component of an organizational assessment, no cause/effect determinations can be made about the changes in the outcomes seen.

     In addition, the consistent use of reliable, valid instruments developed according to some theoretical framework is essential for cross-comparisons of study findings and the development of databased recommendations. 

    The establishment of standards for the collection of organizational performance and patient outcome indicators would also be useful, with national clearinghouses for the development of comparison benchmarks. Some work is currently under way in this regard, but not all institutions can afford to participate in the data analysis processes required and many are unaware of the resources available. 

    Published standards of practice, organizational processes, and benchmarked outcome indicators would help eliminate this concern. 


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