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| Case Study 1 |
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| "Transforming a Dutch Hospital" |
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| Background |
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| Work Structuring has been applied successfully in various health sector environments. This major project involved the re-organisation of an acute hospital in the Netherlands. |
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| Hospital Organisation: The Problem |
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| This medium-sized, regional hospital of 440 beds was formed from the merger of two smaller hospitals. It had particular problems with its planning systems, personnel structures and functional roles, all of which led to a high level of absenteeism (especially amongst nursing staff), low morale and unsatisfactory service levels. |
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| Application |
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| Using the Work Structuring principles, the different healing processes were identified and appropriate healing organisations (wards) were clustered so that each contained the resources needed to affect its particular healing transformation. Wards were also optimised at a maximum size of 20 staff (head nurse, nurses, trainees and ancillary staff). Nurses' jobs were redesigned to ensure that each nurse carried out the complete range of duties involved in providing a full patient-centred service. Wards were then grouped into Divisions, each comprising clusters of healing processes with maximum commonality. |
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| The structures of the clinical support departments were also analysed for optimum 'fit' with the Work Structuring organisational principles. Improvements were made to radiology (smoother administration, more delegation to radiographers, better planning systems); analytical laboratories (separation of the management from the professional leadership role, decentralisation of some lab tasks to the wards); physiotherapy (alignment of personnel to the ward structures); outpatients (administrative streamlining, reorganisation of personnel into group structures based on the healing transformation); operating theatres (creation of a properly defined first-line manager, sharpening of planning and emergency co-ordination procedures); the hotel function including purchasing, stores, kitchens, technical services (a reallocation of elements of each function to give a more rational structure, clear accountabilities and greater quality of service); the training department ('whole' jobs for trainers and clear alignment with the rest of the hospital organisation) and the top management structure (including a Division Head for outpatient and paramedical departments). |
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| Throughout the project great emphasis was placed on repeatedly communicating the Work Structuring principles to hospital staff through a wide variety of means. All staff were involved in a detailed consultative process around all change proposals. Formal commitment to the changes was obtained from the Workers' Council, medical staff, hospital governors and senior management, and a detailed implementation plan for each facet of the project with appropriate resources and timetabling was prepared. |
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| Levels of professionalism improved significantly in the wards, absenteeism among nurses fell by 33%, morale greatly improved, cost savings were made, service levels of clinical support departments improved dramatically, e.g. X-ray and lab test turn-rounds became quicker, outpatient waiting times fell, and the quality of food improved in the restaurant. |
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