The Science Journal of the American Association for Respiratory Care
INTRODUCTION. Health care reform has dictated significant changes in operations of health centers. Respiratory Care departments have struggled to meet these financial demands through downsizing and institutional realignments while providing optimum patient care. One approach to meet the department goals of patient care in face of decreased funding is to utilization work redesign models involving cross-training of employees. UMHHS is a large tertiary teaching institution which has recently implemented a significant cost-containment program. Respiratory Care, at UMHHS, has historically operated as two distinct departments; adult and pediatric/neonatal. Each department has being solely responsible for the staffing and financial operations within each patient population. To comply with the institutional cost containment goals, Respiratory Care services where integrated into one operation and staff were required to provide service support between pediatrics and adults. We examined our ability to meet operational goals and staff perceptions following the implementation of this cross-training effort. METHODS. Staffing positions, financial cost and services were obtained over the past four fiscal years from department records and hospital finance reports. A survey was constructed and distributed to staff members who have been actively involved with the cross-training program, as well as, staff members who did not participate. The purpose of the survey was to identify staff perceptions and concerns about cross-training. RESULTS. Over the past 4 fiscal years, total staff FTE's have decreased 19.9 positions (17.1%). Service support (billable procedures or activity hours) have demonstrated stable or slight increase over the same time period. Cross-train support hours, however, have increased 93% (FY96 versus FY98). 70% of the adult therapists who responded to our employee survey, felt that the cross-training program helped to reduce overtime and on-call support. In contrast, only 5% of the pediatric therapists who responded felt that cross-training helped to reduce overtime and on-call. 35% of the adult staff and 37% of the pediatric staff felt that the quality of care provided by cross-trained therapist maintained departmental standards. CONCLUSIONS. Our results indicate that expanding job responsibilities for staff therapists help to meet the financial objectives for the department and institution. However, the staff perceptions significantly contrast with institutional objectives. A significant number of staff involved, either directly or indirectly, with this type of work redesign do not perceive benefits associated with cross-training service support. These perceptions must be addressed to meet the increasing demands placed upon RC departments as we proceed with health care reform.