title: Hospital restructuring in the United States, Canada, and Western Europe: an outcomes research agenda.
abstract: OBJECTIVE
  This article describes the extent and nature of hospital restructuring across the United States, Canada, and Western Europe, countries with differently organized and financed health-care systems, and assesses the feasibility of international research on the outcomes of hospital restructuring.
  
  
  METHODS
  The conceptual background, context, and focus for the Bellagio conference on Hospital Restructuring in North America and Western Europe held in November 1996 is provided, illustrating key issues on hospital and workforce trends using the US data with international comparisons.
  
  
  RESULTS
  Hospital systems internationally are undertaking very similar restructuring interventions, particularly ones aimed at reducing labor expenses through work redesign. Nursing has been a prime target for work redesign, resulting in changes in numbers and skill mix of nursing staff as well as fundamental reorganizing of clinical care at the inpatient unit level. Yet little is known about the outcomes of such organizational interventions and there are few efforts in place to critically evaluate these actions.
  
  
  CONCLUSIONS
  Restructuring of the hospital workforce and redesign of work in inpatient settings is widespread and markedly similar across North American and Europe, and warrants systematic study. Cross-national studies of the impact of restructuring inpatient care on patient outcomes would yield valuable lessons about the cost-quality tradeoffs in hospital redesign and re-engineering, as well as inform national planning about the numbers and types of nurses needed in the coming decades.
authors.affiliation: Center for Health Services and Policy Research, School of Nursing, University of Pennsylvania, Philadelphia 19104-6096, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sochalski
authors.forename: L H
authors.initials: LH
authors.lastname: Aiken
authors.forename: C M
authors.initials: CM
authors.lastname: Fagin
mesh_terms: D002170:Canada; D005060:Europe; D006302:Health Services Research / Q000191:economics; D017721:Hospital Costs / Q000639:trends; D006754:Hospital Restructuring / Q000191:economics / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000600:supply & distribution / Q000639:trends; D017063:Outcome Assessment, Health Care / Q000191:economics; D010561:Personnel Staffing and Scheduling / Q000639:trends; D014481:United States; D000078329:Workforce