Acute care reform and its implications for health system and provider outcomes

The primary objective of this doctoral research was to examine the impact of acute care reform and its implications for health system and provider outcomes in Newfoundland and Labrador, Canada. A second objective was to identify the best predictor models of, health care provider outcomes (organizational commitment, intent to/ stay, and health care quality) at different phases of the reform process. Registered nurses, the largest group of employees in the acute care sector, were selected as the exemplar for model testing. -- This doctoral research was comprised of three empirical studies, each of which led to manuscripts for publication. The first study was an examination of the perceptions of system reform on health care providers (registered nurses, licensed practical nurses, physicians, allied health professionals, management personnel) conducted between 1999 and 2000. The second empirical study was are-survey of health care providers between 2001 and 2002. In the third study in 2005, the focus was on documenting registered nurses' changes in perceptions of health care reform and attitudes from previous years and monitoring consistency of predictors of final outcome (perceived health care quality, organizational commitment, intent to stay). Collectively, the three studies and the resulting five manuscripts constitute a thesis that forms the basis for an ongoing and future program of research for monitoring perceptions and attitudes over time and the consistency of predictors of outcome for all health care providers. -- The findings indicate that restructuring had a negative impact on health care providers' perceptions of the emotional climate, practice issues, collaborative relations, trust in employer, job satisfaction, organizational commitment, intent to stay and health care quality that was observed at all time periods. Key aspects of organizational culture emerged as significant predictors of intermediate (trust in employer and general job satisfaction) and final outcome for registered nurses. Health care provider perceptions of, the organizational culture and reactions to organizational change may, also have important implications for their health status, job performance, productivity and sick leave usage, as well as ultimately for organizational outcomes such as service quality, efficiency and costs. -- This research based evidence has major health policy implications for three levels: macro (governments), meso (regional health boards, senior leadership and managers of institutions, public) and micro (individual health care providers, professional bodies/unions). Innovative strategies to promote and enhance organizational culture (emotional climate, collaborative relations, and practice issues) may ultimately lead to higher levels of job satisfaction, trust in employer and organizational commitment, greater intent to stay, and more positive perceptions of health care quality