The effects of hospital downsizing on staffing and quality of care.

Hospital managers are making aggressive changes in their caregiver staffs to meet challenges such as reductions in utilization and capitated care. Managers are doing this to decrease the cost of care while maintaining or improving quality of care. However, the literature addressing the impact of hospital staffing practices on quality of care indicates that these changes may negatively influence quality. Department administrators must be cautious, yet proactive in their approach to patient care restructuring in order to ensure continued quality as well as cost-effectiveness.