LR11 / Clinical Risk Management (CRM) Practice on Hospital Re-engineering

Type of Patient Safety Practice
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
“Best fit” category of the reported practice


Human factors
Patient safety theme the SCP/clinical risk management practice is aimed at
Hospital re-engineering
Objective of the CRM practice
Pevious studies have found a relationship between nursing staffing and patient outcomes, decreases in hospital nursing staff may affect care quality[5-9]. The study[1] was conducted to examine the effects that New Zealand’s hospital reengineering may have on adverse patient outcomes and nursing workforce.
Short description of the CRM practice, including any references for further information
In New Zealand (NZ), the government implemented policies aimed at controlling costs in the public health care system through market competition, generic management and managerialism[10]. The NZs health care reengineering strategies included the creation of a health care market, replacement of traditional leadership with professional “business” managers, and managerialism.
Innovator of the SCP, country of origin
United States
Involved health care staff
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
United States/acute care/[6-9,11]
New Zealand/ Public hospitals[1]
Summary of evidence for effectiveness, including references
Re-engineering increased the demands on nurse’s time by increasing workloads without providing new time and work-saving approaches and technologies. In addition, increases in nursing workloads increases adverse patient outcomes[1]. Lower staffing levels due to reengineering and the associated increase in nursing workload leads to hurried, delayed, ommitted, fragmented or erroneous care[2-4].
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Summary of available information on feasibility, including references
Existing implementation tools, including references
Potential for/description of patient involvement in the CRM practice, including references
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
[1] McCloskey BA, Diers DK (2005) Effects of New Zealand’s health reengineering on nursing and patient outcomes. Med Care 43:1140-1146

[2] Aiken LH, Clarke SP, Sloane DM, Sochalski JA, Busse R, Clarke H, Giovannetti P, Hunt J, Rafferty AM, Shamian J (2001) Nurses’ reports on hospital care in five countries. Health Aff (Millwood ) 20:43-53

[3] Heinrich J. Nursing workforce multiple factors create nurse recruitment and retention problems. (Rep. No. GAO-01-912T). 2001. Washington, DC, United States General Accounting Office. 19-2-2013.

[4] Unruh L (2003) Licensed nurse staffing and adverse events in hospitals. Med Care 41:142-152

[5] Aiken LH, Sloane DM, Lake ET, Sochalski J, Weber AL (1999) Organization and outcomes of inpatient AIDS care. LDI Issue Brief 5:1-4

[6] Kovner C, Gergen PJ (1998) Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image J Nurs Sch 30:315-321

[7] Lichtig LK, Knauf RA, Milholland DK (1999) Some impacts of nursing on acute care hospital outcomes. J Nurs Adm 29:25-33

[8] McGillis HL, Doran D, Pink GH (2004) Nurse staffing models, nursing hours, and patient safety outcomes. J Nurs Adm 34:41-45

[9] Sovie MD, Jawad AF (2001) Hospital restructuring and its impact on outcomes: nursing staff regulations are premature. J Nurs Adm 31:588-600

[10] Gauld RD (2000) Big bang and the policy prescription: health care meets the market in New Zealand. J Health Polit Policy Law 25:815-844

[11] Aiken LH, Clarke SP, Sloane DM, Sochalski J, Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 288:1987-1993

Any additional information on the CRM (e.g. implementation barriers and drivers)