Healthcare Management Forum

This paper illustrates the importance of giving emotional support and education to patients, families, staff and managers at The Queen Elizabeth Hospital, Toronto during the spring 1992 downsizing effort.

The Queen Elizabeth Hospital is a 601-bed, two-site facility which provides complex specialized rehabilitative and supportive care, teaching and research, as well as specialty programs in rehabilitation, geriatric service, geriatric psychiatry and long-term care.

Downsizing at The Queen Elizabeth Hospital meant the consolidation and closure of 82 long-term beds, on one nursing unit at each site, to offset a projected budget deficit of $5.4 million. Internal restraint over the past year and during the budget process reduced this deficit to $2.8 million, thus necessitating further downsizing consideration.

Background information includes a review of the recent downsizing literature. This paper describes the informal and formalized support activities that took place during the two-month process and the educational sessions that were provided on a regular basis. It gives specific attention to methodology and rationale.

The authors also make recommendations for the successful implementation of a downsizing process which can be beneficial to any health care setting involved in bed closure.

Cet article illustre l'importance du soutien émotionnel et de la formation offerts aux patients, aux familles, au personnel et aux gestionnaires durant la restructuration entreprise au printemps de 1992 au Queen Elizabeth Hospital de Toronto.

Le Queen Elizabeth Hospital est un établissement de 601 lits, réparti sur deux emplacements qui, tout en ayant vocation d'enseignement et de recherche, dispense des soins de réadaptation et d'entretien de pointe et met en oeuvre des programmes spécialisés de réadaptation médicale ainsi que des services gériatriques, de psychiatrie gériatrique et de soins prolongés.

La restructuration s'est traduite par une réorganisation des services et la fermeture de 82 lits de long séjour, soit une unité de soins dans chacun des deux emplacements, pour compenser un déficit budgétaire escompté de 5,4 millions de dollars. Des restrictions internes n'ont pu ramener ce déficit qu'à 2,8 millions de dollars, rendant ainsi nécessaires des coupures additionnelles.

L'article décrit les activités de soutien informelles et structurées qui ont eu lieu tout au long de cette transition qui a duré deux mois et évoque les sessions de formation dispensées sur une base régulière. Il accorde une attention particulière à la méthodologie et aux raison dictant cette action. Les auteures indiquent également des voies pour que le processus de rationalisation se déroule sans traumatisme.

This paper reports on the creation of a nursing workload data base of over 40,000 inpatient records by the Hospital Medical Records Institute (HMRI). During the 1989–90 fiscal year, five Ontario hospitals (four teaching, one community) reported total hours of nursing on the HMRI abstract along with standard clinical and demographic information. The accuracy of nursing workload data varied across hospitals and seemed to reflect differences in how data collection was implemented. When the data base was grouped by Case Mix Groups (CMGs), analysis demonstrated that patterns of resource utilization in nursing workload and length of stay were similar across CMGs. Results of this analysis indicate that the nursing workload component of the Resource Intensity Weight may be useful for estimating a hospital's nursing costs by CMG.

In order to determine the accuracy of predictions made using Physician Impact Analysis (PIA), a comparison was undertaken of predicted versus actual resource use for 10 new physician specialists at a southern Ontario community hospital. The predictions were done from 1987 to 1989 using methodology recommended by the Ontario Hospital Association (OHA) and available at that time. This included (1) Hospital Medical Records Institute data and (2) a hospital service department survey. A comparison was made between PIA predictions and actual physician resource utilization data gathered in 1991. There was little agreement between the two. The usefulness of PIA rests largely on its ability to generate accurate predictions about a new physician recruit's number of cases and hospital resource use. However, because this research was undertaken in only one community hospital, further evaluation of the PIA process is recommended.

Clinical Laboratory Sciences are under pressure to reduce the number of tests and cut staff and supply costs. The ability of academic centres to continue to deliver high quality service, teaching and research is threatened. In difficult economic times imaginative strategies are needed to look for solutions which will permit continued advancement in academic and clinical standards. Rationalization of service and cost-effective use of resources are not new concepts; however, there is a scarcity of models which have been developed and promoted by the providers of laboratory services, rather than those imposed by governments and other paying agencies. A model developed and evolved over the last two decades by The Hamilton Health Sciences Laboratory Program (HHSLP) is outlined.

Victoria Hospital Corporation in London has adopted a collaborative management model that involves the participation of medical, union and non-union staff in the administrative decision-making process within predetermined parameters. Reactions have been favourable from all sides — positive feedback from the groups involved and minimal negative public response to the sensitive decisions made concerning downsizing. Early indicators suggest increasing further the participation of union and non-union staff in decision-making on multiple levels, but with clearly defined “boundaries of responsibility.”

Using data from a study that involved 500 U.S. acute care hospitals, the author examines the relationship between the profitability of Diagnostic Related Groups (DRGs) and their DRG weight, and the similarity/difference of the most/least profitable DRGs across hospital types. Hospital administrators are cautioned that to engage in case mix management, they must use a management information system that provides the data necessary for determining the cost of treating each patient type within their own institution, not information derived from other facilities or other systems.

Given its political appeal, economic logic and community-based focus, regional planning has re-emerged as a significant strategic initiative in our shifting health care system. As regional planning becomes more prevalent in Canada, it is increasingly necessary to establish a framework of sound organizational behaviour principles in which it can succeed. These principles — which relate to human relations and group interactions — are especially relevant in a complex undertaking such as regional health planning which is often encumbered by stakeholder self-interest, philosophical differences and a tradition of autonomy and independent initiative.