title: Health care provider outcomes during and shortly after acute care restructuring in Newfoundland and Labrador.
abstract: OBJECTIVE
  To monitor changes in human resource indicators during six years of restructuring in Newfoundland and Labrador, and to measure providers' perceptions of reform impact and attitudinal and behavioural reactions comparing changes in the St John's region, where hospital aggregation occurred, to other regions.
  
  
  METHODS
  Data on human resource indicators from 1995/96 to 2001/02 were obtained and analysed. The Employee Attitude Survey was sent to acute care staff (n = 5353) to assess perceptions of reform impact on workplace conditions, work-related attitudes, turnover intentions and personal characteristics. The response rate for 2000 and 2002 was approximately 42% (n = 1222 and 1034, respectively). Only respondents to both surveys (n = 589) were used in the analysis.
  
  
  RESULTS
  Increases in average employee and full-time equivalent numbers occurred in the St John's region, despite hospital closure and aggregation. Increases in staff dislocation and turnover were observed, but paid sick hours decreased. Sick leave and overtime costs increased. Although perceived workplace conditions, and attitudes and behaviours were generally negative, there was evidence of improvement over time, especially in St John's. Few significant regional or provider group differences were observed on most study variables.
  
  
  CONCLUSIONS
  Aggregation of hospitals in St John's did not lead to a decrease in employee counts, or deterioration in human resource indicators or attitudes. However, province-wide initiatives are needed to promote more positive work environments and increase organizational effectiveness.
authors.affiliation: School of Nursing, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada. cway@mun.ca
authors.forename: Christine
authors.initials: C
authors.lastname: Way
authors.forename: Deborah
authors.initials: D
authors.lastname: Gregory
authors.forename: Michael
authors.initials: M
authors.lastname: Doyle
authors.forename: Laurie
authors.initials: L
authors.lastname: Twells
authors.forename: Brendan
authors.initials: B
authors.lastname: Barrett
authors.forename: Patrick
authors.initials: P
authors.lastname: Parfrey
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003625:Data Collection; D005260:Female; D018166:Health Care Reform; D006754:Hospital Restructuring; D006801:Humans; D008297:Male; D008875:Middle Aged; D009523:Newfoundland and Labrador; D015279:Organizational Culture; D010557:Personnel Administration, Hospital; D010564:Personnel, Hospital / Q000523:psychology; D012040:Regional Health Planning; D017132:Workplace