title: Merging of three  hospitals into one university hospital.
abstract: BACKGROUND
  The merging of hospitals into health enterprises ensued from the Norwegian hospital reform of 2002. A complex restructuring process lasting from 2007 to 2009 resulted in the merger of three hospitals into the University Hospital of North Norway.
  
  
  METHODS
  Clinical activities were reorganised into fewer and larger units (divisions) and changed from in-patient to day treatment. Leadership was established across geographic units, and a programme for improving patient care pathways was launched. The experience gained is described by means of activity data from January 2006 to April 2011.
  
  
  RESULTS
  The number of patient contacts in the somatic sector was temporarily reduced by 7 % in 2009. The mean waiting period increased from 80 days in 2006 to 108 days in 2010, but fell to 85 days in 2011. In psychiatry and specialised cross-disciplinary addiction therapy, the number of patient contacts increased, and waits were unchanged or shortened. National quality indicators showed unchanged or improved results. The number of scientific publications increased by 62 %. Productivity (DRG points per employee-month) increased from 0.73 to 0.79. The annual financial outcome was improved by NOK 537 million (12 % of the 2006 budget). 81 % of the employees were satisfied with their jobs after the restructuring.
  
  
  CONCLUSIONS
  We maintained activity and the quality of patient treatment at a high level through the change period, and the hospital's financial position has improved. The methods used do not allow conclusions on possible causal relationships between the change process and the results achieved in core activities.
authors.affiliation: University Hospital of North Norway and Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Norway. tor.ingebrigtsen@unn.no
authors.forename: Tor
authors.initials: T
authors.lastname: Ingebrigtsen
authors.forename: Marit
authors.initials: M
authors.lastname: Lind
authors.forename: Thomas
authors.initials: T
authors.lastname: Krogh
authors.forename: Jorunn
authors.initials: J
authors.lastname: Lægland
authors.forename: Hege
authors.initials: H
authors.lastname: Andersen
authors.forename: Even
authors.initials: E
authors.lastname: Nerskogen
mesh_terms: D017046:Cost Savings; D006273:Health Facility Merger / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006739:Hospital Administration; D006785:Hospitals, University / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D009664:Norway; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care; D012042:Registries / Q000706:statistics & numerical data*; D012106:Research / Q000706:statistics & numerical data; D014850:Waiting Lists