Downsizing and Organizational Restructuring: What Is the Impact on Hospital Performance?

Abstract

In recent years, hospitals have radically restructured their operations while significantly downsizing their workforces. To date, little is known about the combined effect of these change processes on organizational functioning. There have been few large‐scale studies investigating how hospitals have performed when both organizational restructuring and downsizing are used concurrently. The research reported here sets out to separate and isolate the independent and combined effect of organizational restructuring and downsizing on hospital performance. In particular, it aims to address the following question: Do hospitals which undergo significant organizational restructuring while maintaining their workforce complement perform any better than hospitals that institute significant restructuring while heavily downsizing, and any better than hospitals which heavily downsize but undertake little or no organizational restructuring? Categorical regression analysis results from a sample of 285 Canadian acute care hospitals suggest that organizational restructuring and downsizing have differential impacts on organizational performance. Hospitals which undertook significant organizational restructuring while heavily downsizing were perceived to perform better than hospitals that heavily downsized but conducted little or no organizational restructuring, but performed worse than hospitals that undertook significant restructuring while maintaining their workforce complement. However, when the method of conducting the change management process was controlled for, these performance differences were reduced or eliminated.     

Perceptions and Misperceptions of Major Organizational Changes in Hospitals: Do Change Efforts Fail Because of Inconsistent Organizational Perceptions of Restructuring and Reengineering?

Abstract

Over the past decade, many hospitals have invested in major restructuring and/or reengineering efforts designed to enhance their competitiveness by improving product quality and/or reducing costs. For a variety of reasons, these significant changes have not been systematically evaluated. This research provides an objective look at the results of restructuring/reengineering hospitals and an examination of the influences on employee perceptions of reengineering's outcomes. This research demonstrates that employees, including upper management, had little or no objective knowledge of the outcomes of their change efforts. However, perceptions of all employees involved in a major change effort are critical if their full participation is to be sustained. The ultimate sustainability of many hospital strategic change efforts may rest largely on subjective assessments of its outcomes. The research reported here suggests that such perceptions vary significantly by organizational level and may not be stable over time. While the passage of time sees improvements in managers' perceptions of reengineering results, line personnel become increasingly skeptical and less positive. Further objective research is encouraged to more definitely distinguish the impact of employee perceptions on change efforts' outcomes and sustainability.     

Funding,Management, and Individual-Level Factors: What Factors Matter in Predicting Perceived Organizational Effectiveness?

Scholars have examined organizational effectiveness in state and federal government agencies to determine which factors matter. Their findings revealed that public organizational effectiveness is affected by environmental, human resource management, organizational, and individual-level factors. However, what is conspicuously absent is the impact funding has on organizational effectiveness. To further previous literature, this article examined agency funding levels as well as management and individual-level factors to determine the relationship these factors had on organizational effectiveness. In doing so, a model was developed to predict perceived organizational effectiveness, and it was tested on 330 United States government workers in the state of New York. The findings from the analysis were clear: perceived organizational effectiveness was impacted by employee perceptions regarding the level of funding the agencies were allocated. Additionally, the level of role ambiguity and employee participation in decision-making as well as employee job performance and public service motivation levels were also found to matter. The implications and limitations of these findings are discussed in the article.     

What Does the “Terrorist” Label Really Do? Measuring and Explaining the Effects of the “Terrorist” and “Islamist” Categories

Many scholars and practitioners claim that labeling groups or individuals as “terrorists” does not simply describe them but also shapes public attitudes, due to the label's important normative and political charge. Yet is there such a “terrorist label effect”? In view of surprisingly scant evidence, the present article evaluates whether or not the terrorist label—as well as the “Islamist” one—really impacts both the audience's perception of the security environment and its security policy preferences, and if yes, how and why. To do so, the article implements a randomized-controlled vignette experiment where participants (N = 481) first read one out of three press articles, each depicting a street shooting in the exact same way but labeling the author of the violence with a different category (“terrorist”/“shooter”/“Islamist”). Participants were then asked to report on both their perceptions and their policy preferences. This design reveals very strong effects of both the “terrorist” and “Islamist” categories on each dimension. These effects are analyzed through the lenses of social and cognitive psychology, in a way that interrogates the use of the terrorist category in society, the conflation of Islamism with terrorism, and the press and policymakers' lexical choices when reporting on political violence.     

How Does Sustainability-Oriented Human Resource Management Work?: Examining Mediators on Organizational Performance

This study proposes a path model with a set of intermediary outcomes, namely, teamwork, employee satisfaction, and work motivation, to explain how the practices of sustainability-oriented HRM affect organizational performance. The analysis of 2015 Federal Employee Viewpoint Survey reveals that the three practices of sustainable management identified from the literature had indirect effects on organizational performance through a complex interaction among the three intermediate outcomes. In addition, it is found that diversity program has a negative total effect on performance. These findings imply that organizational justice and work/life balance program will lead to an increase in performance by strengthening the backbone of organization. Additionally, conducting the diversity programs for achieving democratic values may entail the cost of diminishing organizational performance probably in the short run.     

Food Price Changes and Household Welfare: What Do We Learn from Two Different Approaches?

The use of a marginal approach can significantly distort the predicted effects of large price variations on monetary welfare over the medium- to longer-term. This paper aims at shedding some light on the differences between a marginal approach and a non-separable agricultural household model with behavioural responses. When behavioural adjustments are allowed, households can adapt their consumption and production patterns by resulting in lower deteriorations in household welfare. The second-order effects introduced in the approach with responses reduce the negative effects due to the first-order consumption effects, with significant differences across quintiles. On average, the second-order effects represent up to roughly 40 per cent of total first-order effects.     

What is performance measurement for? Multiple uses of performance information within organizations

Recent research in performance measurement has focused on the tension between two uses of performance information: ‘passive’, to ensure compliance, and ‘purposeful’, to improve services. This article presents an in-depth study of two public sector organizations in England and shows that the main tension may actually lie between a combined purposeful and passive use, and an exclusively passive one. This tension was most pronounced between organizational levels, where a combined use was dominant among senior managers, and an exclusively passive one was prevalent among middle managers and frontline staff. This split was not intentional—instead, it reflected how people interpreted the role of performance measurement, suggesting that simply promoting greater use of information may not be sufficient for linking measurement with service improvement. This study extends the theoretical understanding of the dynamics of performance information use in organizations and generates implications for using performance measurement to improve service delivery.     

What Difference Do Polarisation Measures Make? An Application to China

In recent years there has been much discussion of the difference between inequality and polarisation. The vast literature on inequality is held to miss out key features of distributional change, which are better described as changes in polarisation. Axioms have been proposed which capture some of these differences, and measures of polarisation, as distinct from inequality, have been suggested. The theoretical distinctions proposed in this literature are indeed interesting. But do the newly proposed measures of polarisation give different results in comparing societies over time? We address these questions for China, where dramatic increases in inequality and polarisation have been much discussed in the literature. We find that, contrary to theoretical expectation, the new measures of polarisation do not generate very different results from the standard measures of inequality. The paper ends by considering a different approach to polarisation which might better conform to the policy concerns expressed in the specific context of China.     

How Does Globalisation Affect Regional Inequality within A Developing Country? Evidence from China

Developing countries are increasingly concerned about effects of globalisation on regional inequality. This paper develops an empirical method for decomposing the contributions of two major driving forces of globalisation, foreign trade and foreign direct investment (FDI), on regional inequality and applies it to China. Even after controlling for many other factors, globalisation is still found to be an important factor contributing to the widening regional inequality. The paper ends by investigating the role of factor market segmentations in aggravating the distributional effect of changing regional comparative advantages in the process of globalisation.     

What Really Divides Northern and Southern Europe?

Historically, liberal democracy was born as a means to curb the power of kings and tyrants through mechanisms that would ensure accountability and consent of the governed. A system of checks and balances—two legislative chambers, executive and independent courts—were instituted to ensure power did not become too concentrated. Today's highly diverse, mass consumer societies, however, have presented another set of challenges. Power is so diffused governance is becoming ineffective. The short‐term mentality of voters and the lobbying of special interests undermine the ability of democracies to focus on the long‐term and the common interest. Because there are more checks than balances, gridlock has supplanted consensus. In this section, we compare Chinese and Western systems on their ability to deliver good governance. The editors of the Economist magazine put the debate in historical context.     

Poverty and Disasters: Do Remittances Reproduce Vulnerability?

Abstract

In many low-income countries, remittances are important in sustaining people’s livelihood and become even more significant during disasters. Meanwhile, the literature suggests that remittances are mainly accessible to middle and upper-income households, rather than to the poorest, thus implying differential capacities amongst households to overcome crises. The present study uses cyclone Evan that hit Samoa in December 2012 as a case study to test this hypothesis. It focuses on the village of Tafitoala and draws on interviews and participatory activities undertaken with the poorest households of the community. It indicates that the poor receive little to no remittances and that they struggled more than the rest of the community to cope with and recover from the cyclone. Their lack of access to remittances had negative consequences on the security and sustainability of their livelihoods. We conclude that remittances reproduce or even increase both inequalities and vulnerabilities existing within the community of origin.     

What Are You Prepared to Do? NATO and the Strategic Mismatch Between Ends,Ways, and Means in Afghanistan—and in the Future

This article examines ISAF (International Security Assistance Force) operations in Afghanistan as a way to get at the strategic disconnects in ends, ways, and means that the author believes are endemic to large-scale protracted stability and COIN (counterinsurgency) operations against adversaries who do not pose palpable existential threats to the members of an alliance. The article focuses mainly on the period that followed President Barack Obama's December 2009 announcement of a civilian and military “surge” in Afghanistan through the early stages of the ISAF offensive in Marjah, which began in February 2010. The article concludes that the fundamental strategic issue is that the Allies are not willing (or able) to devote enough resources to achieve their stated objectives. No matter how much the “Ways” might be improved, the “Means” are not sufficient to attain the “Ends.” Thus, what is needed is a more realistic understanding of what ISAF can accomplish in Afghanistan and what NATO might be expected to accomplish in future operations.     

Why Do Poor People Co-Hold Debt and Liquid Savings?

I examine the use of flexible savings-and-loan accounts offered by SafeSave, a microfinance institution serving poor slum dwellers in Dhaka, Bangladesh. I find that 59 per cent of the clients co-hold, meaning that they borrow at high interest rates and simultaneously hold low-yield liquid savings. Co-holders could immediately pay down, on average, 32 per cent of their debt using liquid savings and thus avoid significant interest payments. The results show that co-holders are more likely to be regular workers subject to little income uncertainty, suggesting that co-holding is not a consequence of liquidity needs. The paper discusses alternative explanations.     

Economic Pathways to Women’s Empowerment and Active Citizenship: What Does The Evidence From Bangladesh Tell Us?

Abstract

This paper sets out to explore economic pathways to women’s empowerment and active citizenship in Bangladesh, a country where the denial of economic resources to women, and their resulting status as lifelong dependents on men, has long been seen as foundational to their subordinate status. While empowerment entails change in the lives of individual women and their interpersonal relations, the concept of active citizenship draws attention to women’s capacity to participate in the public life of their community. The paper draws on the existing literature on women’s access to various forms of paid work both to assess their impact in terms of empowerment and citizenship and to understand better the processes by which these changes might occur.     

Do Role Clarity and Job Satisfaction Mediate the Relationship between Telework and Work Effort?

The empirical association between telework and work effort, as well as how this relationship is mediated by role clarity and job satisfaction, is lacking in the literature. As a consequence, the direct and indirect impact of telework on work effort in U.S. federal government agencies was examined in the article. Results indicate that telework was inversely related to work effort. Moreover, role clarity and job satisfaction did not mediate the relationship between telework and work effort. The implications these results have for theory and practice are thoroughly discussed in the article.     

What Should We Do? Public Attitudes about How Local Government Officials Should Confront Fiscal Stress

Despite strong scholarly interest in the topic of fiscal stress, little attention has been paid to understanding how the general public thinks local governments should respond to situations where declining revenues endanger service levels. This study reports findings from a survey of 660 residents undertaken between November 2006 and January 2007 in the US state of Michigan to examine their support for eight potential strategies to cope with fiscal stress in five different local government services. We find that the public has a surprisingly nuanced perspective about these strategies and on their use for different services. Our findings may provide local policymakers with some insights about how to respond to fiscal stress.     

Does the Restrictiveness of State Tax and Expenditure Limitations Affect State Revenues and Expenditures?

This paper examines the impact of tax and expenditure limitations (TELs) on state governments. We examine how TELs are represented in empirical modeling. We compare and contrast an index of state-level TEL restrictiveness to a simple dummy variable approach. We use a panel of data for the 50 U.S. states to capture changes in state TELs and a generalized method of moments (GMM) dynamic panel estimator. We find that results vary across the two methods of capturing the presence of TELs, suggesting that simple dummy variables are not sufficient to capture the heterogeneity of TELs across states and over time.