Regionalization: Canadian-style integrated networks. A case study.

Developing a successful integrated network requires senior management to scrutinize and apportion available resources--technologies, beds, personnel and so forth--on a regional basis. Regionalization--the Canadian version of integrated networks--increasingly came to be seen as the answer that would work, and in New Brunswick the broadest efforts have been made. Fifty-one hospital and health center boards across the province were dissolved, and health services in the province were apportioned into seven regional hospital corporations, with an eighth encompassing the entire province. At Region 3 Hospital Corporation, a strategic planning exercise helped management identify resources. New information systems were put in place to provide resource utilization information for designating facilities for the level of care they would provide, as well as to provide feedback to physicians and develop critical pathways. Support services were consolidated. Budget reductions caused the curtailment of new service plans, but also increased cooperation among clinicians and non-clinical managers. Layoffs created worker bumping throughout the system to accommodate union seniority rules. Nearly three years into regionalization, most people in New Brunswick say they are satisfied with the healthcare they receive.