Henderson Julie, Willis Eileen, Toffoli Luisa, Hamilton Patricia, Blackman Ian
School of Health Sciences, Flinders University, Adelaide, SA, Australia.
School of Nursing & Midwifery, University of South Australia, Adelaide, SA, Australia.
Nurs Inq. 2016 Dec;23(4):368-376. doi: 10.1111/nin.12151. Epub 2016 Aug 22.
Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care.
澳大利亚与其他国家一样，已将新公共管理（NPM）引入公立部门医院，以控制医疗成本。新公共管理与服务提供外包、政府绩效指标的达成、劳动力灵活性以及资源配给相关。本研究探讨人员配置和其他资源配给对非工作时间护理服务提供的影响。数据通过对澳大利亚两家大型都市医院的21名护士进行的半结构化访谈收集。参与者确定了与新公共管理相关的四种策略，这些策略增加了非工作时间的工作量，并影响了提供护理服务的能力。这些策略是功能灵活性、人员的垂直替代、满足外部设定的绩效指标以及外包。我们得出结论，成本控制以及绩效指标的达成，已将传统上在工作时间进行的工作扩展到人员配备和物质资源较少的非工作时间。这增加了护理工作量，并可能导致护理服务不完整。
