Planning for complex change: insights from the Metro Toronto District Health Council Hospital restructuring project

Restructuring and large-scale organizational change have become facts of life in Ontario's health care sector in recent years. Nearly every jurisdiction in Ontario has undergone systemwide hospital restructuring studies, and individual hospitals have increasingly turned to large scale re-engineering processes to improve efficiency and effectiveness. One example of planning for significant change was a hospital restructuring study undertaken by the Metropolitan Toronto District Health Council between 1993 and 1995. This article provides an overview of key insights gleaned from the project, including an analysis of the effectiveness and utility of some of the major planning strategies and tactics employed to realize project objectives. Given the organizational, process and communications issues faced by the study, many of the insights provide will be relevant to other groups engaged in planning for large-scale change processes, who face tough decision making in similarly complex environments.