Healthcare Considerations

Introduction

Various arms of Australia’s health care system have been subject to restructure as they struggle to contain the rising costs of providing such services, be they public or private. The Royal Brisbane & Women’s Hospital (RBWH), a division of Metro North Hospital & Health Service (MNHHS) is one such entity that began implementing a restructure in 2013 as part of a two-year plan motivated primarily due to the announcement of redundancy packages offered to nursing staff at MNHHS. During the initial phases of this process, the firm I worked for was engaged to assist in maintaining staff confidence in the hospital’s executive staff. This challenge was accepted by our firm with extreme trepidation, due to the high level of anxiety surrounding the change before the process had even been announced. When applying the symbolic frame to the RBWH, the employee culture shines brightly through. A great majority of nursing staff that we met with reported a deep sense of devotion arising out of a highly traditional picture of their profession.

These restructures were most applicable to the structural frame as the restructures caused significant loss of clarity and stability to nursing staff resulting in human resources aspects where staff experienced feelings of anxiety associated with the changes, and there were also implications for the political frame, where staff felt they were disempowered and experienced conflict with other staff members. Finally, the symbolic frame was more difficult to ascertain conclusively, but there is broad speculation that nurses felt there was a loss of meaning and purpose to their roles, in particular nurse managers.

Structural frame

As a hospital, the RBWH certainly aligns with the theories of the structural frame proposed by Bolman and Deal (Bolman & Deal, 2013). First, the RBWH as a business exists to reach a primary goal, to provide healthcare. Secondly, groups or departments within the organisation are best managed when the goal of the department trump personal needs. Third, each department should fulfil a specific business need and various management controls are put in place to ensure consistency throughout the hospital. Structural design contemplates two central issues. Firstly how to allocate work. A restructure of the RBWH human resources was thought to have the potential to relieve operational issues, specifically in order to realign and reprioritise spending for nursing services. This is the heart of the structural frame. Secondly though, the structural frame design also considers how to coordinate the efforts of staff once responsibilities have been allocated. In Australia, we demand that our healthcare system is highly efficient and this demand has led to significant and continuous change to the way hospitals are structured in terms of their human resources and their organisational structure. Mergers between organisations or changes to department sizes can impact on staff quotas. Changing job descriptions and skill mixes within departments are common strategies used by external forces (Laschinger, Finegan, & Shamian, 2001). In Queensland, we have political imperatives including budget constraints, the need to better coordinate health and social services, the ever increasing expectations of patients and often, negative media coverage when things go terribly wrong; the Bundaberg, ‘Dr. Death’ scandal and Queensland health pay debacle are just two such incidents. The impact of a restructure was not accounted for during the change process at RBWH and studies show that there is little evidence to demonstrate that these types of changes have any benefit to efficiency or that the outcomes improve (Fulop et al., 2002). Yet, as the most recent restructure of RBWH has demonstrated, the negative implications on patient outcomes and nursing workforce demonstrate a need to better understand these impacts. The nurses, as one of the largest components of the hospital workforce, are frequently faced with restructures. Because of their size, they are one of the largest operating expenditures and pressure exists to reduce the portion of HR cost, which results in hospitals being less likely to have adequate numbers of registered nurses, supervisors who are supportive of nurses, and various other organisation features that can be associated with the healthcare’s main purpose of good patient outcomes.