title: Staff perception of the impact of health care transformation on quality of care.
abstract: OBJECTIVE
  To study how medical professionals perceived recent organizational changes and financial cut-backs in terms of organizational and health care quality.
  
  
  METHODS
  A cross-sectional questionnaire survey.
  
  
  METHODS
  County council of Stockholm.
  
  
  METHODS
  A random sample (n=936; 70% response rate) of physicians and nurses employed by the county council of Stockholm.
  
  
  METHODS
  Staff perception of how recent changes impacted on staff-perceived quality of care, staffs' skills development, management, and perceived organizational efficacy.
  
  
  RESULTS
  Over 60% of the respondents rated that patients' access to health care had diminished as a result of ongoing changes. A similar percentage also perceived a decline in the quality of health care delivered in general. However, fewer staff rated a decline during the last year in the quality of care provided by their own department (44%). Staff rating that quality of care in their own department had worsened during the last year also scored substantially lower on all counts of organizational well-being. The most important determinants of staff-perceived quality of care were staff access to pertinent information concerning their daily work and organizational changes, participatory management, performance management, and job commitment. Job satisfaction was more strongly associated with organizational well-being than staff-perceived quality of care.
  
  
  CONCLUSIONS
  Staff perception should be used as an additional indicator of quality of care. To improve quality of care further, management should encourage staff involvement in everyday management issues, including up-to-date information about organizational goals and mission.
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden. bengt.arnetz@medhs.ki.se
authors.forename: B B
authors.initials: BB
authors.lastname: Arnetz
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D013548:Sweden; D016526:Workload