Table 5 Overview of included redesigns, continued

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