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Changes in the Quality of Care

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Do you think that the quality of care in healthcare has changed in the last 5-10 years? Why or Why not?

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Solution Summary

This question looks at the changes in the quality of care in healthcare in the last decade comparing the United States, Canadian and European experiences. Supplemented with two articles on the changes in healthcare over time.

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1. Do you think that the quality of care in healthcare has changed in the last 5-10 years? Why or Why not?

The last decade has been characterized by reduced health care spending, restructuring and an emphasis on improved efficiency (Beardwood, Walters, Eyles, & French, 1999). Hospital administrators adopted a variety of human resource strategies including downsizing and the redeployment of nursing personnel to reduce expenditures (Baumann et al., 1996). These strategies had a dramatic impact on all health care workers. Changes in staffing exacerbated the demands on hospital workers at a time when they were dealing with rising patient acuity precipitated by demographic changes and technological advances. Workloads increased and there were lower staff to patient ratios, shorter lengths of stay and less continuity of care (Beardwood, Eyles, French, & Walters, 1995).

A number of studies describe the impact of hospital restructuring on nursing personnel, the largest group of health care professionals. Three descriptive studies from the United States demonstrate how downsizing and hiring unlicensed personnel affected the quality of nurses' worklife (Salmond, 1995; Shindul-Rothschild, Berry, & Long-Middleton, 1996; Shindul-Rothschild & Duffy, 1996). A survey of the perceptions of nurses in two pairs of merging hospitals in Ontario, Canada also suggested that restructuring decreased the quality of worklife (Cameron, Horsburgh, & Armstrong-Stassen, 1994a; 1994b). The studies suggest that restructuring led to higher workloads, greater stress, reduced job security and job satisfaction, poor morale and lower professional and organizational commitment and, that personal as well as work lives were affected. Redeployment confronted personnel with the actual or potential loss of their jobs (Suderman, 1995). Job insecurity and the threat of potential job loss often resulted in anxiety, depression, burnout, poor health, sleeping problems and an increased rate of absenteeism (Vahtera, Kivimaki, & Pentti, 1997).

During restructuring, redeployment and job change involved a number of different processes. In many hospitals, redeployment of nurses was linked to 'bumping'. In unionized hospitals, collective agreements with nurses contain a 'layoff and recall article' regulating the procedures ...

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