The Innovation Imperative in Health Care Organisations
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The Innovation Imperative in Health Care Organisations

Critical Role of Human Resource Management in the Cost, Quality and Productivity Equation

Edited by Peter Spurgeon, Ronald J. Burke and Cary L. Cooper

Health systems in the western world face increasingly intense pressure to contain or reduce costs, while countries such as China and India move towards universal coverage. The contributors illustrate that radical gains in efficiency and innovative practice are required internationally in health care systems. They argue that the high proportion of health care system costs invested in staffing place the human resource function at the forefront of meeting this challenge. Sustained system change and productivity gains, more effective management of staff and work climate are essential elements of reform and are all covered in this book.
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Chapter 7: Hospital restructuring and downsizing: déjà vu all over again

Ronald J. Burke


Health care organisations underwent dramatic restructuring during the mid-1990s in several countries and appear to be on the threshold of another wave of downsizing and restructuring. These processes resulted from efforts by various levels of government to control and reduce costs and some services. Governments are again under pressure to reduce ballooning budget deficits. This chapter has several objectives. First, it reviews what is known about organisational restructuring and downsizing in general. Second, it presents findings from several analyses of the effects of health care restructuring and hospital downsizing on nursing staffin Ontario, Canada, and in other jurisdictions, undertaken in the late 1990s and early 2000s. Third, it considers current discussions targeted at reducing health care expenditures and presents results of recently collected 2009/2010 data. Fourth, it offers practical recommendations for managing hospital restructuring and downsizing efforts to minimise their adverse effects.

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