The effect of the total amount of work hours and the benefits of a shortening is frequently debated, but very little data is available. The present study compared a group (N = 41) that obtained a 9 h reduction of the working week (to a 6 h day) with a comparison group (N = 22) that retained normal work hours. Both groups were constituted of mainly female health care and day care nursery personnel. The experimental group retained full pay and extra personnel were employed to compensate for loss of hours. Questionnaire data were obtained before and 1 year after the change. The data were analyzed using a two-factor ANOVA with the interaction term year*group as the main focus. The results showed a significant interaction of year*group for social factors, sleep quality, mental fatigue, and heart/respiratory complaints, and attitude to work hours. In all cases the experimental group improved whereas the control group did not change. It was concluded that shortened work hours have clear social effects and moderate effects on well-being.
Work redesign and re-engineering have become the buzzwords of the 1990s as all sectors of the health care arena struggle to meet the demands of patient care while coping with increasing fiscal constraint. Redesign and re-engineering are terms that describe a wide range of strategies in health care and radically different models of care delivery. These new approaches to care are shifting the way we view care delivery and how it is structured. This paper describes the principles of redesign and re-engineering, common applications in health care organizations, outcomes and evaluation. Multiskilling and use of genetic health care workers are addressed. The potential impact on the practice of oncology nurses is explored as well as strategies to meet the challenges of today's health care environment.
Health prevention seeks to avoid the onset of disease or symptoms by eliminating or at least minimizing environmental factors that increase the risk of illness. This article describes Ability OnLine, an innovative program designed to reduce the isolation young people can experience in a healthcare facility or when confined to their home. The electronic bulletin board is a friendly platform for disabled and chronically ill children to easily communicate with their peers and adult and teen mentors.
St. Joseph's Healthcare Hamilton (SJHH) supports a grassroots green team, called Environmental Vision and Action (EVA). Since the creation of EVA, a healthy balance between corporate projects led by corporate leaders and grassroots initiatives led by informal leaders has resulted in many successful environmental initiatives. Over a relatively short period of time, environmental successes at SJHH have included waste diversion programs, energy efficiency and reduction initiatives, alternative commuting programs, green purchasing practices, clinical and pharmacy greening and increased staff engagement and awareness. Knowledge of social movements theory helped EVA leaders to understand the internal processes of a grassroots movement and helped to guide it. Social movements theory may also have broader applicability in health care by understanding the passionate engagement that people bring to a common cause and how to evolve sources of opposition into engines for positive change. After early successes, as the limitations of a grassroots movement began to surface, the EVA team revived the concept of evolving the grassroots green program into a corporate program for environmental stewardship. It is hard to quantify the importance of allowing our staff, physicians, volunteers and patients to engage in changes that they feel passionately about. However, at SJHH, the transformation of a group of people unsatisfied with the organization's environmental performance into an 'engine for change' has led to a rapid improvement in environmental stewardship at SJHH that is now regarded as a success.
The regionalization of healthcare in Alberta has been instrumental in changing the way we deliver healthcare to the population. In Calgary, the restructuring involved the closing of three acute care hospitals and a significant reduction in beds per capita. This reduction in inpatient beds behooved Senior Management in acute care to be innovative and responsive to the utilization of existing resources. The Department of Patient Transition Services was conceived with a mandate to provide assistance and support in utilization management and discharge planning, administrative coordination, system support and integration support. The evolution of this unique department is described.
To explore the current and pending strategic agenda of Ontario hospitals (the largest consumers of the provincial healthcare budget), a survey of Ontario acute care hospital CEOs was conducted in January 2004. The survey, with an 82% response rate, identifies 29 strategic priorities under seven key strategic themes consistent across different hospital types. These themes include (1) human resources cultivation, (2) service integration and partnerships, (3) consumer engagement, (4) corporate governance and management, (5) organizational efficiency and redesign, (6) improved information use for decision-making, (7) patient care management. The extent to which an individual hospital's control over strategic resolutions is perceived may affect multilevel strategic priority-setting and action-planning. In addition to supporting ongoing development of meaningful performance measures and information critical to strategic decision-making, this study's findings may facilitate a better understanding of hospitals' key resource commitments, the extent of competition and collaboration for key resources, the perceived degree of individual control over strategic issue resolution and where systemic resolutions may be required.
Specialization has enabled one person to develop a high level of expertise in one management function. The entire department of nursing, not just one unit, shares the benefits of this expertise. The result is efficient and effective use of resources. The lateral relationship between the administrative support team and clinical manager teams has promoted communication flow and exchange while keeping the decision-making power at the clinical level. The implementation of the administrative support team has provided the right solution to the problem: specialized support.