The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital - A longitudinal study

OBJECTIVES. TO examine changes over time in the hospital staff's perception s of how rapid organizational change, caused by fiscal constraints imposed by governments, affects them, their work environment, and the quality of ca re and services that they provide. METHODS. A random sample of hospital employees (n = 900) of a large Ontario teaching hospital participated in a longitudinal study which involved surv eys at 3 measurement periods over a 2-year period. The questionnaire used i n this study included scales reflecting work environment, emotional distres s, personal resources, spillover from work to home and vice versa, and perc eptions regarding patient care and the hospital as an employer. RESULTS. Significant increases in depression, anxiety, emotional exhaustion , and job insecurity were seen among employees, particularly during the fir st year of the change process. By the end of the second year, employees rep orted deterioration in team work, increased unclarity of role, and increase d use of distraction to cope. Job demands increased throughout the period w hereas little change occurred in the employee's job influence or decision l atitude. Overall, the work environment was negatively affected. Although pa tient care was unaffected in the first year, a significant decline in perce ptions of patient care, attention to quality improvement, and overall quali ty of care were later seen. CONCLUSIONS. This study raises questions about whether hospital re-engineer ing and mergers will be able to achieve the cost reductions sought without sacrificing quality of work life. Along with the rapid change, there was in crease in emotional distress among staff and a deterioration in their relat ionship with their employer.