title: Healthcare restructuring and hierarchical alignment: why do staff and managers perceive change outcomes differently?
abstract: OBJECTIVE
  Healthcare organizations have undergone major change efforts in the past decade. Sustained change is related to continued alignment among organizational participants and may fail with incongruent perceptions of change. This study identifies factors contributing to the alignment in perceptions of organizational change outcomes between executives and all other employees.
  
  
  METHODS
  The sample included 10 hospitals with survey responses from 421 executives and other employees. Using hierarchical linear modeling (HLM), perceptual alignment was modeled at the first level as a function of goal commitment, goal clarity, goal acceptance, goal specificity, staff participation, available skill set, and knowledge and at the second level as organizational size.
  
  
  RESULTS
  Descriptive statistics showed employee perception of outcomes differed among personnel levels. HLM results showed that goal specificity, appropriate staff training, reward incentives, effective communication, information sharing, and organization's ability to sustain changes induced perceptual alignment in change outcomes. Staff involvement in designing change efforts increased perceptual misalignment, whereas involvement during implementation and maintenance phases increased alignment.
  
  
  CONCLUSIONS
  This research uses cross-sectional data from 10 hospitals. Data were gathered from surveys that may have recall bias as hospitals were surveyed at different times after the implementation of their restructuring.
  
  
  CONCLUSIONS
  Our findings enhance the understanding of processes and mechanisms that enable healthcare organizations to align organizational participants' efforts during change. Results suggest that decision-makers should create incentives to encourage innovative practices, institute effective communication mechanisms, selectively disseminate information, and involve participants in implementing and maintaining changes to achieve intended outcomes. ORIGINALITY/VALUE OF ARTICLE: This article provides unique insight into the importance and causes of organizational alignment after major restructuring. Too often, organizations' change efforts fail after implementation. Effective change requires continued effort and alignment to embed the desired changes.
authors.affiliation: School of Public Health University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA. stephen-walston@ouhsc.edu
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Walston
authors.forename: Ann F
authors.initials: AF
authors.lastname: Chou
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D006739:Hospital Administration; D006740:Hospital Administrators / Q000523:psychology; D006801:Humans; D016014:Linear Models; D009936:Organizational Innovation; D009937:Organizational Objectives; D010564:Personnel, Hospital / Q000523:psychology*