The Effect of an Organizational Change from LDRP to LDR on Outcomes

Purpose: This study compares the performance metrics and satisfaction rates of patients and staff before and after a change from an LDRP to a LDR care delivery model and explores nurses’ perceptions of the two different care delivery models.
Significance: There is very little in the literature that provides evidence about the effect of the LDR and LDRP or single room maternity concept (SRMC) on organizational culture and performance and the experience of patients, families and providers.  Janssen (2000) reported findings from a comparison study of the satisfaction rates of low risk women who delivered in an LDR (n=221) as compared to an LDRP (n=205).  The results indicated that the women delivering in the LDRP were more satisfied than the comparison group in all areas evaluated.  Another study by Janssen (2001) compared the satisfaction levels of nurses who changed from the LDR care delivery model to a new unit using the LDRP care delivery model.  The nurses’ reported an overall improvement in satisfaction with their work environment, perceptions of the quality of care they were able to provide, competence levels, and nursing practice environment.  Other authors report the efficacy of the LDRP or SRMC concept as a means of ensuring family centered care and helping new parents in their transition to care giver (Crompton, et al.). 
In spite these few reports shared in the literature, there are only anecdotal stories about the efficacy of one care model as compared to the other.  There are many anecdotal stories about improvements in patient care outcomes, increases in volumes and market share, and improved staff satisfaction when a hospital chooses to change from the LDR to the SRMC concept.  On the other hand, there are an equal number of anecdotal stories about SRMC or LDRP’s that changed to the LDR + postpartum model because the staff could not adapt to the new model of care, staffing costs increased, or the hospital experience such success with increased volumes that they chose to expand by adding only postpartum rooms and converting LDRP’s to LDR’s. 
Methods:  This study uses a mixed method approach with a comparison of organizational metrics and satisfaction rates of patients and providers and a descriptive survey to describe nurses’ perceptions of the advantages and disadvantages of the LDRP and LDR care delivery models.  Nurses who had participated in the organizational change were included in the study.  Parametric statistics will be used to measure the differences in organizational metrics and satisfaction levels, and non-parametric statistics will be used to describe the sample and the common themes identified in the survey.  The study will be completed by November 15, 2007 and the findings will be shared in scholarly journals and conference presentations.
Conclusion: More evidence is needed to facilitate decision making about the maternity care delivery models.  This presentation will provide both qualitative and quantitative findings to report the effects of the LDR or LDRP care models on the organizational performance and on patient and provider satisfaction rates.