title: The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital: a longitudinal study.
abstract: OBJECTIVE
  To examine changes over time in the hospital staff's perceptions of how rapid organizational change, caused by fiscal constraints imposed by governments, affects them, their work environment, and the quality of care 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 surveys at 3 measurement periods over a 2-year period. The questionnaire used in this study included scales reflecting work environment, emotional distress, personal resources, spillover from work to home and vice versa, and perceptions 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 first year of the change process. By the end of the second year, employees reported deterioration in team work, increased unclarity of role, and increased use of distraction to cope. Job demands increased throughout the period whereas little change occurred in the employee's job influence or decision latitude. Overall, the work environment was negatively affected. Although patient care was unaffected in the first year, a significant decline in perceptions of patient care, attention to quality improvement, and overall quality of care were later seen.
  
  
  CONCLUSIONS
  This study raises questions about whether hospital re-engineering and mergers will be able to achieve the cost reductions sought without sacrificing quality of work life. Along with the rapid change, there was increase in emotional distress among staff and a deterioration in their relationship with their employer.
authors.affiliation: Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada. woodward@fhs.csu.mcmaster.ca
authors.forename: C A
authors.initials: CA
authors.lastname: Woodward
authors.forename: H S
authors.initials: HS
authors.lastname: Shannon
authors.forename: C
authors.initials: C
authors.lastname: Cunningham
authors.forename: J
authors.initials: J
authors.lastname: McIntosh
authors.forename: B
authors.initials: B
authors.lastname: Lendrum
authors.forename: D
authors.initials: D
authors.lastname: Rosenbloom
authors.forename: J
authors.initials: J
authors.lastname: Brown
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001007:Anxiety / Q000523:psychology; D001291:Attitude of Health Personnel; D002055:Burnout, Professional / Q000523:psychology; D003363:Cost Control; D003659:Decision Making, Organizational; D003863:Depression / Q000523:psychology; D005260:Female; D006754:Hospital Restructuring; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007588:Job Satisfaction; D008137:Longitudinal Studies; D008297:Male; D009864:Ontario; D009936:Organizational Innovation; D010557:Personnel Administration, Hospital; D010564:Personnel, Hospital / Q000523:psychology*; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013997:Time Factors; D000078329:Workforce