Hospital restructuring and its impact on outcomes: nursing staff regulations are premature.

Objective: Describe restructuring in the organization and delivery of patient care and the effects of nursing structure and processes on selected patient outcomes.

Background: Restructuring has been the dominant cost-reduction strategy in acute care hospitals. Changes occurred without a systematic look at how interventions impacted on the processes and outcomes of care.

Tailoring hospitals for managed care and integrated health systems.

Preparing the hospital for its new role in a capitated, managed care environment requires restructuring and re-engineering. Multiple approaches to achieving cost reductions while improving quality are discussed, with an emphasis on the nursing-led initiatives. An inventory of restructuring and re-engineering strategies from 15 university teaching hospitals is included.

An interview with Margaret D. Sovie. Interview by Connie R. Curran.

Margaret D. Sovie, PhD, RN, FAAN, is associate deputy executive director and chief nursing officer at the Hospital of the University of Pennsylvania, Philadelphia. In this interview, she discusses the pursuit of nursing excellence, the changing health care environment, innovations in documentation, and professional development.

Nurse manager: a key role in clinical outcomes.

As a central partner in the business of the hospital, the nurse manager's focus is on the delivery of high-quality care resulting in desired clinical outcomes at controlled costs. These outcomes require a partnership for patient care. Nurse managers develop and empower staff; forge collaborative and team relationships within nursing and with other disciplines and departments; and help to transform the hospital culture.

Hospital culture--why create one?

Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Creating, managing, and changing the culture are critical leadership functions that will enable the hospital to succeed. Strategic planning and effective implementation of planned change will produce the desired culture.

Redesigning our future: whose responsibility is it?

To thrive in the midst of health care chaos, restructuring is mandatory. By focusing on problem systems, to create the systems hospital executives can successfully empower staff to delivery high quality care while controlling costs.

Clinical nursing practices and patient outcomes: evaluation, evolution, and revolution (legitimizing radical change to maximize nurses' time for quality care).

Today's environment demands revolutionary as well as evolutionary changes in practice patterns. All clinical practices must be critically examined in terms of their contributions to quality patient outcomes, and their effects on nurses' time and morale.