Hospital organisation and outcomes.

Hospital reorganisation and work redesign is being widely implemented. According to anecdotal and media accounts, a target of restructuring eVorts is often the workforce, of which nursing personnel (registered nurses, licenced practical nurses, and nurse aides) represent 37% of United States hospital employees. Hospital restructuring initiatives are altering nursing work force patterns by changing organisational and structural variables such as the number, types, and mix of nursing personnel available to provide care to patients. 4 As a result, individual nurses and professional organisations have expressed concern over the potential impact of these activities on patient care and nurse stress and burnout, and there is at least one recent study documenting a decline in nurses’ job satisfaction and higher nurse turnover associated with hospital restructuring. Reports in the media echo nurses’ concerns and describe elimination of registered nurses’ positions, lay oVs, substitution with unlicenced assistive personnel, adverse patient incidents, and deteriorating working conditions for hospital nurses. 7 These claims were supported in the United States by a national survey of registered nurses which reported widespread reductions in hospital nurse staYng, leading to unsafe staYng levels, eroding quality of patient care, and threatening patient safety. Nurses’ perceive a deterioration in care that has resulted from hospital reorganisation, but empirical evidence is lacking. 7 9 10 The widespread organisational restructuring and reengineering initiatives sweeping the hospital industry represent a target of opportunity for studying the impact of variation in staYng and organisation on patient outcomes, and for implementing the findings of such studies to improve patient outcomes. In this essay, we identify research that has been done by various investigators on hospital organisation and patient outcomes, describe some of our own recent research on that relation, and comment on where, in our estimation, additional research is needed.