Downsizing within a hospital: cutting care or just costs?

Downsizing of staff is becoming increasingly common in hospitals as a way to meet the demands of shrinking budgets. This study, based in Sweden, used a longitudinal design to study staff views of their work environment, their individual health and the quality of the care they were delivering during a period of hospital downsizing. Although there were no significant changes in perceptions of quality of care, perceptions of workload substantially increased whilst perceptions of mental energy substantially decreased. These two changes could point to future problems with quality of care after a period of hospital downsizing.

[Physicians' well-being is deteriorating. Results from a prospective intervention study. The mental energy decreases as workload increases]. / Läkarna mår allt sämre. Resultat från en prospektiv interventionsstudie: den psykiska energin minskar samtidigt som produktionskraven ökar.

The impact of the current transformation of health care on the well-being and working conditions of physicians has been analyzed in a 6-year prospective intervention study at the Orebro University Hospital (USO). Physicians' ratings of their work, organization and health have been compared with those of other health care professionals at USO, as well as with ratings by physicians in other hospitals. Feedback on survey results has been periodically provided to employees in all hospital departments as well as to hospital senior management. The results have formed the basis for a range of improvement initiatives. The study identified a number of positive changes, such as increased ratings on scales measuring social climate, skills development and participatory management. However, workload has increased and mental energy decreased during the same period.