Redesigning mental healthcare delivery: is there an effect on organizational climate?

OBJECTIVE Many studies have investigated the effect of redesign on operational performance; fewer studies have evaluated the effects on employees' perceptions of their working environment (organizational climate). Some authors state that redesign will lead to poorer organizational climate, while others state the opposite. The goal of this study was to empirically investigate this relation. DESIGN Organizational climate was measured in a field experiment, before and after a redesign intervention. At one of the sites, a redesign project was conducted. At the other site, no redesign efforts took place. SETTING Two Dutch child- and adolescent-mental healthcare providers. PARTICIPANTS Professionals that worked at one of the units at the start and/or the end of the intervention period. INTERVENTION The main intervention was a redesign project aimed at improving timely delivery of services (modeled after the breakthrough series). MAIN OUTCOME MEASURES Scores on the four models of the organizational climate measure, a validated questionnaire that measures organizational climate. RESULTS Our analysis showed that climate at the intervention site changed on factors related to productivity and goal achievement (rational goal model). The intervention group scored worse than the comparison group on the part of the questionnaire that focuses on sociotechnical elements of organizational climate. However, observed differences were so small, that their practical relevance seems rather limited. CONCLUSIONS Redesign efforts in healthcare, so it seems, do not influence organizational climate as much as expected.