title: Canadian hospitals in transformation.
abstract: OBJECTIVE
  This article reviews health system reform in Canada and discusses how hospitals are restructuring staffing patterns and redesigning work in response to increasing budgetary constraints.
  
  
  METHODS
  Two models for work redesign at the patient unit level are contrasted, one employing a mix of registered nurses and registered practical nurses and one using registered nurses and assistive personnel. Principles and rationale for work redesign are discussed.
  
  
  RESULTS
  Both models for patient care redesign reduce registered nurse positions and both appear to yield some cost savings. These models for patient care redesign are controversial among providers, and there is no consensus as to which model is preferable. No research has been undertaken to determine whether staffing changes and work redesign result in adverse patient outcomes.
  
  
  CONCLUSIONS
  Regionalization of hospitals is reducing inpatient capacity in Canada, although the pace of regionalization varies in the different provinces. Hospital re-engineering is designed to reduce expenditures by reducing the cost of staffing. Research is needed to evaluate the results of re-engineering on patient outcomes and their relationship to registered nurse staff reductions.
authors.affiliation: APM Incorporated, Toronto, Ontario, Canada.
authors.forename: M B
authors.initials: MB
authors.lastname: Decter
mesh_terms: D002170:Canada; D018166:Health Care Reform / Q000639:trends; D006302:Health Services Research / Q000639:trends; D006754:Hospital Restructuring / Q000458:organization & administration / Q000639:trends*; D006801:Humans; D016294:Models, Nursing; D009313:National Health Programs / Q000639:trends; D009741:Nursing Staff, Hospital / Q000458:organization & administration / Q000600:supply & distribution / Q000639:trends; D010348:Patient Care Team; D010561:Personnel Staffing and Scheduling; D000078329:Workforce