Organization Change in a University Hospital: A Six Year Evaluation Report of the HORIZONS Project

Many health care organizations are currently engaged in changing the design of their health care services delivery system. The issues of cost containment, quality, and access are prominent. This paper reports on the impact of the implementation of a new organization design at one university hospital. The organization change effort (named HORIZONS) was a five year project funded in part by the Robert Wood Johnson Foundation and the Pew Charitable Trusts. In a changing health care environment, the project was undertaken with three goals in mind: (1) to maintain and enhance quality of patient care; (2) to improve the quality of working life; and (3) to accomplish this in a budget neutral manner. Initiated as a program to strengthen hospital nursing, the project became a patient-focused redesign effort encompassing both clinical and administrative affairs. The core ideas of the project approach included systems thinking, interactive planning and idealized design. This evaluation reports on the project's progress after six years.