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Table 5 Overview of included redesigns, continued

From: Towards an organisation-wide process-oriented organisation of care: A literature review

  University of Wisconsin Hospitals and Clinics (UWHC)
Setting A 489-bed tertiary care centre in Madison, United States
Aim redesign To improve efficiency and patient satisfaction, and stabilising institutional financial health while keeping quality high
Study design Uncontrolled before - after study
Evaluation period 2000 to 2004
Redesigned services Heart and vascular care, oncology and paediatric care
Strategy type Organisational restructuring approach
Measures to change working procedures Incentives for clinical care lines and departments
Outcomes in general Financial: each clinical care line demonstrated improved percent margin, improved net revenues, and increases in local and regional market share; Operational: operational efficiency, measured by patient volume change, inpatient length of stay data, improved from pre clinical care line metrics; Patient satisfaction: improved patients satisfaction surveys were documented for each clinical care line
Outcomes on indicators  
Financial Margins (profits [%]):
- Heart and vascular care: ↑ (from 4.2 to 10.3)
- Oncology: ↑ (from 14 to 15.5)
- Pediatric care: ↑ (from -8.2 to -0.8 )
Operational efficiency Length of stay:
- Heart and vascular care: ↓ (from 8.5 to 5.5 days)
- Oncology: ↓ (from 6.7 to 6.0 days)
- Pediatric care: ↓ (from 5.4 to 4.4 days)
Patient volume (Inpatients discharges [ID]/outpatients visits [OV]):
- Heart and vascular care: ID ↑ (from 3220 to 3550), OV ↑ (from 31.915 to 36.556)
- Oncology: : ID ↑ (from 2738 to 2795), OV ↑ (from 87.858 to 89.507)
- Pediatric care: : ID ↑ (from 2632 to 3047), OV ↑ (from 114.369 to 123.997)
Patient Satisfaction Press Ganey Surveys for overall rating of care received:
- Heart and vascular care: ↑ (from 85 to 96)
- Oncology: ↑ (from 85 to 94)
- Pediatric care: ↑ (from 85 to 91)
Patient Safety No quantitative figures reported.
Factors for success Enthusiastic participation of clinicians and their willingness to change practice patterns to achieve care efficiencies; Administrative support which made it possible to reorganise and relocate care units within the hospital to centralise areas of specialty care and to adopt universal nursing practices on units where patients had similar requirements
Challenges To get agreement for collaboration of staff clinicians and their willingness to change practice patterns