Healthcare reform organizational change

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Seek to understand why staff think innovations or changes do not align with the existing culture and mission. The CEO told these leaders to take two steps: first, listen to the doctors and staff to understand why they perceive misalignment between the myriad of changes and the values of the organization; second, reframe and strengthen the connection between innovations and the core values of the hospital, so it no longer seems like a misalignment.

Elsewhere, a CEO of a large integrated health system told us about seeking to understand staff perspectives through weekly rounds. In one case, he listened to nurses express resistance to a new process for end-of-shift patient handoffs. Many nurses thought the new process took much longer and hindered the exchange of information.

The CEO addressed their concerns by focusing on the improvement in patient care. He highlighted that with the new process, patients were more engaged in their care and better understood the need for medications or procedures, which in turn affected the ultimate outcome of patient health.

Once the nurses accepted the rationale, the focus of the conversation shifted to logistical barriers that kept them from adopting this change e. Alignment of common values enabled and motivated them to work through this change adoption together. Engage employees with data to explain the problem, its urgency, and how to address it. Data and metrics can create an awareness of problems, a means to explore them, and a goal post to measure progress. Based on data from the Centers of Disease Control and Prevention CDC , on any given day, about one in 25 hospital patients gets at least one health care-associated infection.

A common cause is poor hand hygiene: The CDC suggests that, on average, health care providers clean their hands less than half of the times they should. The leader of a large integrated hospital system shared with us how they used data to change existing norms and routines and drive more hand washing. A safety group collated this data by unit and included it in a posted weekly report. During morning huddles, unit and division leaders shared the data and started conversations about potential reasons behind the numbers.

This weekly dialogue not only kept the problem in the forefront, but also engaged employees in diagnosing the barriers and factors outside of their control that made change hard to implement. In one discussion, employees shared that when the batteries in the hand sanitizer dispensers died, it decreased handwashing until workers from another floor could replace the batteries. A simple change of moving spare batteries to the units and allowing anyone to replace them eliminated a critical barrier to improving adoption.

Pay attention to the behaviors you reward and tolerate. As part of the same hand washing initiative, hospital system administrators created a Speak Up program, which empowers and trains nurses, staff, and doctors to call out anyone failing to wash their hands, on the spot, as they moved from patient to patient. For the campaign to work, no one, regardless of level or status, was immune from a reminder to wash his or her hands. Engrained cultural norms and power relationships about speaking up needed to be shaken e.

The weekly huddle meetings became a time to acknowledge those who bucked the existing power norms and reinforce the new behaviors.

At these, the CMO handed out Starbucks gift cards to the staff that spoke up to physicians and others when they did not wash their hands. Rewarding new behaviors that contradicted the existing norms reinforced the message that it is safe to act in new ways.

The change would not stick if doctors were exempt from feedback about noncompliance. Doctors were also encouraged to thank anyone who spoke up to them when they forgot to wash their hands. When physicians negatively reacted to feedback from staff and resisted the culture change, an administrator reached out to them.

The status quo persists when bad behaviors at any level of the organization are tolerated. When leadership understands that turning a blind eye to one bad behavior can decimate the adoption of innovation by others, they may be more willing to hold difficult conversations with the highest-status employees in their organization.

However, many of the ongoing changes in hospitals are motivated fully or partially by increasing resource efficiency i. Further, organizational change may also represent a job demand that negatively impacts hospital staff. The job demands—resources JD-R model proposes that a wide variety of job characteristics are determinants of employee well-being and performance Bakker and Demerouti, The JD-R model posits that job demands, such as high work pressure, emotional demands or role ambiguity, negatively impact employee health and well-being, whereas job resources such as social support, performance feedback and autonomy may spark a motivational process leading to job-related learning, work engagement and organizational commitment.

Organizational change can both increase existing and introduce new demands Smollan, , as well as represent a demand in and of itself. Schaufeli clusters job demands into categories of qualitative, quantitative and organizational demands. Qualitative job demands include mental job demands, meaning the attention and concentration that the work requires.

Frequent change in, for instance, organizational structures stemming from reorganizations requires constantly adapting to new ways of working, which may increase these mental demands. Quantitative demands include work overload and perceptions of the pace of change.

In the hospital context, where many change efforts aim for increased efficiency, it is reasonable to assume that work overload may become more prevalent as a result of organizational change. Perceiving that changes are happening too fast, as may be the case if the frequency of change is high, is also regarded as a job demand.

Work engagement fosters extra-role performance Schaufeli and Salanova, It may therefore contribute to reducing the prevalence of performance obstacles, as engaged employees are more likely to go the extra mile and contribute to finding workarounds that enable patient treatment despite the existence of performance obstacles or solutions to eliminate performance obstacles.

Reduced work engagement as a result of frequent organizational change may, conversely, lead to less such extra-role performance and to the persistence of performance obstacles. If organizational change is indeed a job demand, it may also contribute to negative emotions for employees, which narrows cognitive skills and the employees' ability to come up with workarounds and solutions Fredrickson, Our first hypothesis is that: H1. Organizational change will be positively related to performance obstacles.

Research testing the JD-R model has found that as job demands increase and job resources decrease, job satisfaction decreases as a result of maladaptive coping Alarcon, The category of organizational job demands also includes not agreeing with changes. If employees do not agree with a certain change effort, the organizational change itself is a demand. We know from previous research that Norwegian physicians have resisted NPM-inspired reforms and that they do not believe stated goals such as equality of access to care, medical quality and hospital productivity have been furthered by them.

This belief is most strongly held by physicians who are not in management positions Martinussen et al. Divergent changes to management, organizational structures and overall goals and strategies may therefore be considered as organizational job demands for this group.

Given that physician job satisfaction is believed to be directly related to their work, changes that are perceived as limiting their opportunities to perform the work according to their preferred professional standards may therefore contribute to lower job satisfaction.

This is particularly true when the changes are related to management, organizational structures, overall goals and strategies as opposed to merely technological or related to new modes of patient treatment. Given our understanding of the changes included in our data as often divergent to the medical professional logic, we believe that higher frequencies of organizational change will be a job demand related to lower job satisfaction for physicians.

We therefore hypothesize that: H2. Organizational change will be negatively related to job satisfaction. Following this definition, leadership is an activity or a set of behaviours. It is not exclusively tied to top executive positions, but may be performed by a wide range of actors who are in positions that allow them to influence other actors.

Many theories on leadership styles make a distinction between leaders who primarily focus on production and work tasks and leaders who focus on staff relationships Borgmann et al. Recognising a need to further elaborate the task—relations dichotomy of leadership behaviours, Yukl argues that it is important to distinguish between task-, relations- and change-oriented behaviours, because all of these three categories and the leadership tasks contribute to understanding effective leadership , Yukl et al.

Task-oriented behaviours are primarily concerned with the efficient and reliable accomplishment of tasks, and relations-oriented behaviours with increasing mutual trust, cooperation and employee identification with the team or organization.

Change-oriented leadership behaviours include monitoring and interpreting the environment, envisioning new possibilities for the organization, explaining the need for change, suggesting new and creative solutions and experimenting with new approaches for achieving objectives, taking a long-term perspective on problems and opportunities and negotiating for support from other actors on behalf of the department.

The leadership behaviours of interest in this study are performed by hospital middle managers. These managers are responsible for organizing staff and patient treatment in individual departments. This leadership role is considered as particularly challenging, due to the high complexity of actors, competencies, interests and authority relations that characterize hospitals Denis et al. As actors holding managerial responsibilities while also being located at the operative lever, they hold a position balancing between and connecting the control and cure worlds and may perform both managerial and professional duties and forms of leadership.

In this study, we are mainly interested in their managerial leadership and the ways in which they act on and lead their staff in the context of the specific organizational changes studied. While hospital middle managers are in charge of several processes in their respective departments, they are usually not the instigators of changes to management, organizational structures or overall goals and strategies.

These types of changes more often stem from the levels above the departments, such as hospital top leadership, regional health authorities or national health policy. The leadership behaviours of middle managers may, however, still be more or less change-oriented. Their leadership role in terms of these particular types of organizational change is largely to act as mediators between higher levels and department-level employees Birken et al.

In continuously changing contexts, leader behaviour and attitudes may be crucial to the way in which employees perceive, accept and are affected by change Sanchez-Burks and Huy, Change-oriented leadership may intuitively be associated mainly with leader initiation of a large number of changes. However, it is rather a leadership style characterized by being attuned and adaptive to the environment, explaining the need for change, finding ways of working at the operative level that may contribute to achieving new objectives and being skilled at processes of implementing changes.

Exhibiting these leadership behaviours may be a way for middle managers to fulfil the role of change mediator for their employees. The source of stress related to rapidly changing work environments in addition to the increased job demands outlined earlier has also been found to be uncertainty and perceptions of poor change processes characterized by lack of consultation, information and management support Brown et al. A change-oriented middle manager, who clearly communicates the reason for and content of change, may buffer the negative effects of continuously changing hospital environments by providing information in a convincing manner, thereby contributing to the employees' individual sensemaking Rouleau, ; Jimmieson et al.

Change-oriented leadership has also been found to have a significant, although small, effect on performance Borgmann et al. In the case of performance obstacles, change-oriented leaders may be effective in reducing their prevalence due to their ability to search for and suggest new solutions to department-level problems.

Compared with task- and relations-oriented leadership, it has the largest and a positive influence on job satisfaction Borgmann et al. We therefore hypothesize that: H3. Change-oriented leadership will be negatively related to performance obstacles. Based on the traditional centrality of autonomy and control for the medical profession, and the divergent nature of organizational changes inspired by NPM, we are particularly interested in the role played by physician participation in decision-making in mediating the impact of frequent organizational change.

Job resources are defined as those physical, psychological, social or organizational aspects of the job that may be functional in achieving work goals, reduce job demands and their associated costs or stimulate personal growth and development Demerouti et al. They are important tools in dealing with job demands and have a motivational potential but are also important in and of themselves. In the JD-R framework, job control is included as a job resource located at the level of the organization of work Bakker and Demerouti, , and it includes not only autonomy over immediate tasks and time constraints but also participation in decision-making Alarcon, Job control has consistently been found to be an important job resource for fostering motivation and engagement.

Job resources may also fuel job satisfaction Sousa-Poza and Sousa-Poza, Participation in decision-making and having the opportunity to influence how work is performed is a highly valued resource for physicians. This means that we can expect it to be positively related to job satisfaction particularly for this group, and it also points to the importance of exploring how frequent organizational change experienced by physicians is related to this specific job resource.

If key resources are either threatened with loss, actually lost or significant effort fails to deliver expected resources, individuals will experience stress. Generally speaking, organizational change can be experienced as a threat since it poses a risk of losing valued resources such as status, income or comfort Dent and Goldberg, , Van Den Heuvel et al. Organizational changes that take place in the wider context of a shift away from physician autonomy and self-regulation may lead to actual loss of the resource of participation in decision-making, or at least be perceived as a threat to this valued resource, leading to lower levels of well-being at work, lower engagement and negative emotions.

In addition to being a job resource which may contribute to reducing the prevalence of performance obstacles via employee motivation, work engagement and positive emotions as explicated earlier, physician participation in decision-making is also an aspect of what is referred to as medical engagement Spurgeon et al. Medical engagement may serve to distribute decision-making to a wider set of actors, thereby allowing a more diverse set of expertise and skills to contribute to problem-solving Denis and Baker, Allowing decision latitude for physicians who are not in formal management positions may therefore serve to decrease the prevalence of performance obstacles.

The literature on change-oriented leadership outcomes does not clearly define the role of employee autonomy as a mediator Borgmann et al. Change-oriented leadership may be positively related to autonomy because change-oriented leaders solicit the advice of employees in finding new solutions and facilitate participatory change processes leading to more employee involvement Bryson et al. This can lead to an experience of participation in decision-making in the work setting for employees.

We hypothesize the following: H5. Employee participation in decision-making will mediate the influence organizational change and change-oriented leadership have on performance obstacles and job satisfaction. Our hypotheses are illustrated in Figure 1. We collected the data for this study from four Norwegian hospitals.

The study adopted a cross-sectional web-based survey design distributed via an internal web application to all of the health authority's employees. The survey consisted of a range of validated questions tailored to 1 carrying out a work environment survey commissioned by the regional health authority and 2 collect research data.

The response rate for physicians was Respondents gave their informed consent by turning in the questionnaire, and all survey responses were anonymous. The Norwegian Centre for Research Data and the relevant hospital committees approved the research.

Organizational change was measured using three items asking respondents to rate the extent to which various events changes had affected their organization within the past 12 months Baron and Neuman, The events included were 1 changes in management, 2 reorganization and 3 establishment of new overall goals and strategies.

Cronbach's alpha values for all scale items are reported in Table 2. Change-oriented leadership was measured using six items that are part of Yukl's framework of leadership styles. Performance obstacles were measured using items developed from the structural quality indicators included in the national system of hospital quality indicators NDH, Participation in decision-making was measured using the autonomy scale of the Organization Assessment Survey Dye, The following four items were included: 1 In my department, we get to influence the standards that constitute good work.

Basic descriptive statistics, bivariate correlations and Cronbach's alpha were analysed using SPSS Bivariate correlations were used to analyse relations between variables. Cronbach's alpha was used to assess internal consistency of factorial dimensions.

AMOS Arbuckle, was used for the remaining analysis. Confirmatory factor analysis CFA was carried out in order to ensure the validity of measurement concepts. CFA ensures concept validity by demonstrating that the overlap with each factor is acceptable. Further, the structural model was estimated using structural equation modelling SEM. Using SEM allowed us to evaluate the relationships between the latent factors in the hypothesized theoretical model.

Bootstrap analysis bootstrapped resamples was performed to estimate indirect effects and the mediating role of participation in decision-making Hayes, Descriptive statistics are presented in Table 1. Statistical variation was considered to be satisfactory for all dimensions.

Organizational change was positively correlated with performance obstacles 0. The correlations between job satisfaction and performance obstacles and between organizational change and change-oriented leadership were not hypothesized in our theoretical model. All other correlations were consistent with our theoretical model.

CFA was carried out for the five latent factors and their respective indicators before testing the structural model. The latent factors were allowed to correlate in the model. Standardized factor loadings were satisfactory, ranging from 0.

The internal consistency analysis shows Cronbach's alpha values ranging from 0. The homogeneity of factors was considered to be good.

Moreover, estimated beta coefficients generally support the underlying theoretical model and hypotheses Figure 2 , except for the relationship between change-oriented leadership and performance obstacles H3 which was found not to be significant. In summary, we found that the organizational changes in question were positively related to performance obstacles both directly and indirectly through participation in decision-making, meaning that more change was related to a higher prevalence of performance obstacles.

As hospitals are subjected to increasing demands, reforms and policy changes, they have no option but to continuously change. A crucial question is whether these changes contribute to improving service quality. Former research on the effects of NPM-inspired reforms has identified disappointing results Braithwaite et al. In our study, which is located at the department level, findings suggest that more change is actually related to a higher prevalence of performance obstacles.

There is reason to comment on the direction of causality in this relationship. Departments that have a high prevalence of performance obstacles could be subjected to more change in order to solve these issues. However, the changes included in the data — which are changes to management, organizational structures and overall goals and strategies — are not the type of changes decided on at the level of the individual departments where our respondents perform their work. We therefore believe it is more reasonable to interpret our finding as an indication that organizational changes which in the current health policy climate are often motivated by cutting costs and increasing control and efficiency may indeed create more work system performance obstacles.

The mechanisms underlying this relationship may be that job demands lead to lower work engagement and negative emotions, which in turn contribute to less extra-role performance, narrower cognitive skills and less resourceful and solution-oriented workers Bakker et al. A second, and equally crucial, question is how employees are affected by organizational change.

Adding to an existing literature which has so far reported mixed results on the question of how organizational change in healthcare organizations impacts physician job satisfaction Westgaard and Winkel, , our study finds a significant and negative relationship. Our study contributes towards this need by specifically including changes related only to management, organizational structures, overall goals and strategies and relating these changes to the wider literature on healthcare reform and physician reactions to reforms.

Our findings suggest that these specific changes do in fact contribute to decreases in physician job satisfaction. This could, first, be because the changes represent job demands that are generally believed to negatively affect job satisfaction Alarcon, Secondly, considering the importance of the professional work of physicians for their job satisfaction Casalino and Crosson, , because these specific changes affect the work in ways that make them less satisfied with their opportunities to perform their job in the way that they prefer.

In the terms of the JD-R framework, organizational change appears to be a job demand, whereas change-oriented leadership and participation in decision-making are job resources. Our study is not a test of a comprehensive JD-R model, but we included the job resource of participation in decision-making as a meditator because of its assumed centrality to the profession in question, because the literature on changes in the healthcare field has been concerned with how such participation is changing in healthcare systems Byrkjeflot, and because medical engagement is called for in the literature on healthcare service improvement Spurgeon et al.

The test of the relationships between participation in decision-making and performance obstacles and job satisfaction resulted in some of the largest effects in our model. Our findings suggest that participation in decision-making on issues of defining success criteria, goals and actions and influence in decisions affecting the employees as well as having good opportunities for influence in general is actually quite important in relation to job satisfaction and performance obstacles.

Regarding the positive relationship with job satisfaction, the underlying mechanisms could be the general positive effect that the JD-R model and conservation of resources theory of stress posit between valued job resources and job satisfaction, or, again, there could also be a more physician-specific relationship as participation in decision-making allows physicians to shape the way work is performed, thus leading to physician job satisfaction.

Regarding the negative relationship with performance obstacles, we believe the mechanisms could be both the fact that job resources foster more engaged workers and that physician participation in decision-making distributes decision-making across a wide set of actors who are in intimate contact with potential workflow problems and who are also able to come up with solutions before these problems become actual obstacles. Job resources are particularly important in fostering motivation and work engagement when job demands are high Bakker and Demerouti, This point should be noted in the case of physicians, as their work is characterized by high demands in several different categories.

This means that while we found a rather weak relation between organizational changes and the job resource of participation in decision-making in the present study, the fact that a significant and negative relation was indeed found could nevertheless have substantial negative effects for the well-being and performance of physicians due to their overall high demand work situation.

It should also be noted that our survey only asked respondents to report changes in the past 12 months. If the negative relationship between changes and participation in decision-making has been persistent over longer periods of time prior to our study, and continues beyond the year respondents reported on, the total effect on the job resource of participation in decision-making could be larger in a long-term perspective.

If this is the case, this development runs in the opposite direction of current calls for more medical engagement in hospitals Spurgeon et al. On the contrary side, however, boosting the job resource of participation in decision-making in a high demand context is also important, and our findings suggest that change-oriented leadership may contribute to do so.

Leadership has often not been included in research applying the JD-R-model Schaufeli, , but the test of the model in our study suggests that change-oriented leadership may actually be considered a job resource. We believe this is a valuable finding in relation to existing literature on job demands and job resources and change-oriented leadership, as well as to managerial practice.

Based on previous research, we expected change-oriented leadership to be positively related to job satisfaction and negatively related to performance obstacles. We found a relatively small direct relationship between change-oriented leadership and job satisfaction.

This may be because physician job satisfaction is directly related to their professional work. There may be other leadership styles, such as forms of leadership that are not primarily managerial, but more directly related to the professional work of physicians, that have a stronger direct relationship with physician job satisfaction.

We also found a non-significant relationship with performance obstacles. However, the mediation of participation in decision-making in these relationships suggests that change-oriented leadership effectively influences these outcomes via participation in decision-making.

This is a contribution to the leadership literature, as the role of autonomy as a mediator of change-oriented leadership outcomes has not previously been clearly established Borgmann et al. The relationship between change-oriented leadership and autonomy in the form of participation in decision-making is in fact the strongest in our model, suggesting that change-oriented middle managers are able to allow their subordinates decision latitude and include them in processes that impact their work and their work environment.

Our findings support an argument for the importance of change-oriented leadership in work environments where demands are high, change is continuous and often divergent, and autonomy is highly valued by employees, important to job satisfaction and a contributor to organizational performance.

Finally, while there might have been a stronger direct relationship between more purely professional leadership of physicians and job satisfaction, hospital middle managers hold large, managerial responsibilities in their leadership roles.

They are expected to serve as connectors between the control and cure worlds, and we believe that identifying ways in which this leadership can be constructively executed is of value. Our study focusses on outcomes at the department level. This is where middle managers perform their leadership, employees experience their opportunities for participation in decision-making and their job satisfaction, and performance obstacles are encountered.

However, this is not the organizational level at which the types of changes we have measured are normally initiated. We did not hypothesize a relationship between change-oriented leadership and organizational change, because we do not believe it is reasonable to assume that change-oriented middle managers in hospitals meaningfully influence the initiation of changes to management, organizational structures or overall goals and strategies Edling and Sandberg, Their responsibility is rather to implement, adapt and translate top management decisions Williamsson et al.

There is, however, a significant and negative correlation between organizational change and change-oriented leadership in our data, and it can be interpreted in two ways. First, change-oriented middle managers may be able to buffer their department from changes initiated at higher organizational levels or able to prioritize which change initiatives to implement in their own department.

In this interpretation, change-oriented leadership negatively impacts the frequency of the types of change included in our variable. Second, causation could run in the opposite direction. In this interpretation, frequent organizational changes may reduce the opportunity for middle managers to perform their leadership in a change-oriented manner.

Frequent changes, particularly of the kind that stem from NPM inspired policies, could impose too many demands on these managers for them to be able to prioritize these leadership activities Wallin et al. The content of these changes may also impact their decision latitude negatively, leaving them relatively more powerless in shaping a change-oriented leadership at the department level.

In conclusion, we believe it is relevant to connect our findings to the identified need for medical engagement in improving healthcare quality. The studied organizational changes appear to contribute to increased performance obstacles and decreased physician job satisfaction, while also being to some extent unavoidable due to pressures from the policy environment surrounding hospital organizations. Implementing managerial practices that offset the negative effects of these changes could enable hospitals to strike a balance between meeting the demands of new policies, maintaining a positive work environment for their physicians and avoiding obstacles to their job performance.

There are two distinct, but related, managerial implications to be drawn from our findings. First, medical engagement implies the involvement of physicians in organizational issues as well as in the professional work of treating patients. Participation in decision-making is an aspect of such engagement and should be encouraged and safeguarded by hospital leadership in change processes as well as in day-to-day operations.

Opportunities for taking part in and influencing organizational decisions imply a distribution of leadership to a wider group of actors than formal managers only and a potential for bringing a more diverse set of knowledge and competencies into decisions on issues important to quality outcomes Denis and Baker, This is particularly important in highly complex organizations such as hospitals, where different actors are highly specialized within different professional fields Denis et al.

This constructive relationship between medical engagement and quality outcomes has been documented in previous research Spurgeon et al. Our findings suggest the same effect.

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Healthcare reform organizational change	Job control has consistently been found to be an important job resource for fostering motivation and engagement. Our study focusses on outcomes at the department level. Work systems in hospitals, contact carenet caresource modelled by Carayon et healthcare reform organizational change. GilmartinM. However, many of the ongoing changes in hospitals are motivated fully or partially by increasing resource efficiency i. Seek to understand why staff think innovations or changes do not align with the existing culture and mission. Organizational changes that take place in the wider context of a shift away from physician autonomy and self-regulation may lead to actual loss of the resource of participation in decision-making, or at least be perceived as a threat to this valued resource, leading to lower levels of well-being at work, lower engagement and negative emotions.
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Washington adventist hospital mental health service	One of the key concerns in Health care management is management of change and health care professionals are obligated both to acquire and to maintain the expertise needed to undertake their professional tasks, and all are obligated to undertake only those tasks that are within their competence. BirkenS. View author publications. Our hypotheses are illustrated in Figure 1. HoodC. An Aspen Publication, Participation in decision-making will be kaiser permanente woodbridge related to performance obstacles.
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Healthcare reform organizational change	Examples might include implementing a Continuous Quality Improvement CQI system or a simple reorganization of staff roles. In conclusion, organizational changes in health care are more likely to succeed when health care professionals have the opportunity to influence the change, feel prepared for the change and recognize the value of the change, including perceiving the benefit of the change for patients. Regardless, some of the organizational change tactics discussed earlier, such as describing the problem and the need for and urgency of change, are self-evident and will happen almost automatically. Others have noted that quality improvements seen with participation in value-based reimbursement models do not necessarily incur cost savings 9. Effective change has been characterized please click for source unfreezing old behaviours, introducing new ones, and re-freezing them. Recognising a need to further elaborate the task—relations dichotomy of leadership behaviours, Yukl argues that it is important to distinguish between task- relations- and change-oriented behaviours, because all of these three categories and the leadership tasks contribute healthcare reform organizational change understanding effective leadershipHealthcare reform organizational change et al. Changes to initial plans can be expected and should be clearly communicated.
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Although Medicaid spending growth decelerated in due to reduced enrollment, spending is expected to accelerate at an average rate of 7.

Along with policy and technological changes, the people who provide healthcare are also changing. Providers are an important part of the healthcare system and any changes to their education, satisfaction or demographics are likely to affect how patients receive care. Future healthcare providers are also more likely to focus their education on business than ever before. This growth may result in more private practices and healthcare administrators.

In recent years, the demographics of the medical profession have shifted. Women currently make up the majority of healthcare providers in certain specialties, including pediatrics and obstetrics and gynecology.

Nearly one-third of all practicing physicians are women. According to an Association of American Medical Colleges AAMC analysis, women comprise 46 percent of all physicians in training and nearly half of all medical students. Based on these statistics, we can assume more women may enter the medical profession in the coming years. African-American women are more likely to become doctors than their male counterparts, according to AAMC data.

While African-Americans comprise only four percent of the physician workforce, 55 percent of the African American physician workforce is female. This shift in demographics to include more women in healthcare supports diversity in the industry and represents overall population diversity. The prevalence of malpractice lawsuits is one way to evaluate the competence of healthcare providers.

The amount of malpractice claims in the U. As the trend of declining malpractice lawsuits continues, it may indicate that provider competence and patient care will continue to improve.

Job satisfaction is one area that must improve. Nurses report higher overall career satisfaction than doctors, based on results of the latest Survey of Registered Nurses conducted by AMN Healthcare and compared to the Physician Compensation Report.

Nine out of 10 nurses who participated in the survey said they were satisfied with their career choice. However, one out of every three nurses is unhappy with their current job. It is difficult to say whether job satisfaction will increase in the coming years, but continued technological advancements designed to streamline the healthcare process offer hope to those who may be frustrated with the complexity of their jobs. Demands on healthcare change due to various reasons, including the needs of patients.

Every year, new cures and treatments help manage common diseases. Each such development affects the entire healthcare system as much as it has a positive impact on patients. As illnesses become more common, our healthcare system must adapt to treat them. Patient care needs will also evolve as the population ages and relies more heavily on resources such as Medicare and Medicaid. Patient empowerment is expected to increase with advances in technology.

The bubonic plague is a good example of a disease that can drastically change the healthcare system by quickly shifting all resources to handle an epidemic. In the Middle Ages, the Black Death spread so quickly across Europe that it is responsible for an estimated 75 million deaths.

It may be surprising that the bubonic plague still circulates today. In fact, according to Center for Disease Control data, there were 11 cases and three deaths in the U.

Although the bubonic plague is not near the threat it once was, other diseases and conditions of concern are on the rise. The following seven conditions are on the rise and can be expected to have an impact on healthcare in the near future:. The healthcare industry has identified these previous conditions, preparing to handle further increases with supplies and resources. However, a new threat is always possible.

If something similar to the Ebola virus spread across the country, this would have a drastic impact on patient care and healthcare facilities. The current baby boomer generation, which initially consisted of 76 million people born between and , will be coming to retirement age and will increase federal spending on Medicare and Medicaid by an average of 5.

Healthcare technology trends focus heavily on patient empowerment. The introduction of wearable biometric devices that provide patients with information about their own health and telemedicine apps allow patients to easily access care no matter where they live.

With new technologies focused on monitoring, research, and healthcare availability, patients will be able to take a more active role in their care. From policy to patients and everything in-between, the healthcare industry is constantly evolving. Aging populations, technological advancements, and illness trends all have an impact on where healthcare is headed. Since it is crucial to pay attention to shifts in society to understand where healthcare is headed, consider dedicating time each day to reading recommended industry literature that you will find in our list of 25 books for every healthcare professional.

The program provides traditional MBA core courses and specialized healthcare electives to help tailor the curriculum to your goals. Skip to main content. Historical Changes in Healthcare Healthcare reform has often been proposed but has rarely been accomplished.

The Complexity of Healthcare The many layers of variance in all parts of healthcare is what makes this system so complex. Health Insurance Market Choosing a healthcare plan illustrates the complexity of health insurance plans in the U. Healthcare Regulation Insurance is not the only complexity within the system.

How Change Impacts Healthcare Resources and Facilities Changes in the healthcare industry usually occur at the legislative level, but once enacted these changes have a direct impact on facility operations and the use of resources. Historical and Predicted Changes in Healthcare Facilities Cultural shifts, cost of care, and policy adjustments have contributed to a more patient-empowered shift in care over the last century. The Future of Medicare and Medicaid As the baby boomer generation approaches retirement, thus qualifying for Medicare, healthcare spending by federal, state, and local governments is projected to increase.

A Shift in Healthcare Providers Along with policy and technological changes, the people who provide healthcare are also changing. Demographics In recent years, the demographics of the medical profession have shifted.

Competence The prevalence of malpractice lawsuits is one way to evaluate the competence of healthcare providers. Satisfaction Job satisfaction is one area that must improve. Evolving Needs of Patients Demands on healthcare change due to various reasons, including the needs of patients. Illness Trends The bubonic plague is a good example of a disease that can drastically change the healthcare system by quickly shifting all resources to handle an epidemic.

The following seven conditions are on the rise and can be expected to have an impact on healthcare in the near future: Sexually Transmitted Infections: Chlamydia and gonorrhea rates have increased, and syphilis rates rose by Obesity: Obesity continues to be an issue in the U. Gilbert, F. Emerald Group Publishing Limited. Report bugs here. Please share your general feedback. Visit emeraldpublishing. Answers to the most commonly asked questions here.

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Please note you do not have access to teaching notes. Access and purchase options You may be able to access teaching notes by logging in via your Emerald profile. Abstract Purpose Governments everywhere are implementing reform to improve primary care. Findings The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services.

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