Restructuring clinical laboratories in Ontario--a '90s revolution

The results of the first-ever province-wide survey of laboratory restructuring initiatives in Ontario, Canada are presented. These initiatives coincide with the historically largest financial cuts to the publicly funded health-care delivery system in Ontario, Canada's most populous province. The laboratory system includes both public hospital and commercial sectors. A survey was mailed to every laboratory director in the province, with a 73% response rate from the hospital sector. The results show that most hospital laboratories are restructuring, the bed count of the hospital is not a determinant of change, and downsizing and multiskilling of staff are the most frequent strategies. Many hospital laboratories were also considering regional alliances or contracting out part or all of their services. Also, the survey showed that the majority of laboratories in community hospitals did not have Laboratory Information Systems, in contract to the situation in teaching facilities. Most hospitals employed some form of utilization management, with the most popular being education of their users. Many respondents viewed the effect of these changes on staff morale with disquiet and expressed anxiety about the potential adverse effects on quality. In many ways, these findings mirror those reported in the United States.