Date of Award


Degree Name

Doctor of Education


Teaching, Learning, and Leadership

First Advisor

Dr. Dave Cowden

Second Advisor

Dr. Jianping Shen

Third Advisor

Dr. Larry Pfaff


Reengineering was a management tactic designed to reduce costs and increase efficiencies in the work place. Although many hospitals reported reengineering efforts were a priority during the latter part of the 1990s, little research has been done to determine the effects of reengineering on cost and quality performance indicators.

This research studied a large regional medical center located in southwest Michigan, which implemented patient-focused care redesign. Within this medical center, ten separate and distinct patient care departments were studied over a 5-year period. These departments included critical care, medical, surgical, obstetric and pediatric areas. During the first year o f the study, data reflected pre-reengineering performance indicators. The last year of data collection reflected post-reengineering data. The intervening three years represented various stages of design and implementation of reengineering. Performance indicators were identified prior to the reengineering effort. Cost indicators included cost per case, cost per patient day and full-time equivalents (FTEs) per adjusted occupied bed. Indicators of quality included medication errors, patient falls and nosocomial infections. Other performance indicators included staff turnover rates, occupational exposure to blood and body Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. fluids, mortality and RN mix. Cost per case was reduced 8.5%. As an isolated performance indicator, cost per case demonstrates success for the reengineering effort. Yet, it is difficult to determine the hidden costs of errors, employee turnover, litigation and patient complications on actual case costs. Based on the inability to create this linkage, relative success of reengineering, from a cost perspective, cannot be fully determined.

Throughout the five-year period, the pattern varied for each o f the quality indicators. Declines in RN mix did not demonstrate a significant relationship with the outcome indicators of patient falls and medication errors, two indices of quality from a nursing perspective. Reengineering may have had a short-term negative effect on quality indicators such as nosocomial infections, occupational exposures to blood and body fluids and employee turnover rates. Most indicators were at or near preengineering levels by the end of the five-year period with select indicators demonstrating improvement.

Access Setting

Dissertation-Open Access