The impact of systems redesign on staff, patient, and financial outcomes

OBJECTIVES: The purpose of this study was to measure the impact of a change initiative using the strategies of inpatient bed consolidation and patient population reaggregation on staff, patient, and financial outcomes. BACKGROUND: Bed consolidation and patient population reaggregation are extensively used strategies in the hospital industry. However, the state of science as it relates to these two strategies is limited, with no studies measuring the effect of bed consolidation, patient reaggregation, or both in isolation of multiple other concurrent care model changes. METHODS: An exploratory, single case, longitudinal field study design with embedded levels of analysis was used for the study. The impact associated with the reaggregation and consolidation of the acute inpatient system of care was evaluated at the organization, the acute inpatient nursing unit, and the individual nursing staff member levels. This article reports the outcomes found at both the nursing unit level and the staff member level on three general medicine nursing units. Baseline nursing unit-level data are reported from fiscal year 1994-1995 and the first half of fiscal year 1995-1996 (July 1995 through December 1995); data from January 1996 through June 1996 reflect the planning phase of the project. Outcomes related to the change process are reported from the time period January 1996 through June 1997. Staff perceptions of multiple variables were measured at five different data points over a 2-year period. Both quantitative and qualitative data were collected. RESULTS: Unit-level cost and hours per patient day (HPPD) increased during or immediately after the merger of major patient populations on two of the study units; no significant variation was found in medication errors or patient falls. The quantitative and qualitative data analysis of the nursing staff member surveys revealed a nursing staff that was dissatisfied with many aspects of their job, worried about job security, had low morale, and had many concerns about the quality of care provided to patients. CONCLUSIONS: This study suggests that consolidation and reaggregation strategies may cause an increase in costs and HPPDs, at least on a short-term basis. Also, these strategies may have a significant effect on the morale and job satisfaction of unit-level nursing. In light of these findings, on-going testing of the efficacy of consolidation and patient reaggregation strategies in improving quality and cost outcomes is essential.