Evaluation of the multifunctional worker role: a stakeholder analysis.

Health care organizations are rethinking how care is delivered because of incentives generated by managed care and a competitive marketplace. An evaluation of a work redesign project that involved the creation of redesigned unlicensed caregiver roles is described. The effect of model implementation on patients, multiple categories of caregivers, and physicians was measured using several different approaches to data collection. In this evaluation, caregivers perceived the institutional culture to be both market-driven and hierarchical. The work redesign, along with significant changes in unit configuration and leadership over the same period, significantly reduced job security and satisfaction with supervision. Quality indicators suggested short-term declines in quality during model implementation with higher levels of quality after implementation issues were resolved. Objective measurement of the outcomes of work redesign initiatives is imperative to assure appropriate adjustments and responses to caregiver concerns.