It is now four months after the initial interviews and downsizing, which was accomplished without major incident. During this time, little additional work has been accomplished toward planning and implementing Phase 2—reengineering which is expected to flatten the hospital’s hierarchy, combine or eliminate administrative roles, and reduce the number of registered nurses by replacing them with lower-paid personnel.
During the past four months a number of important changes have occurred. First, an informal hiring freeze has been implemented after the reduction in force. This amounts to a continuation of the freeze that was in place before the reductions. The hiring freeze created attrition that minimized the number of employees who had to be laid off. A committee has been developed to review requests to fill open positions. Requests approved by the committee are subsequently approved by Jacob Dohrman, Dr. Lewin, and Dr. Maggiano. The result is a slow and meticulously documented process that must consider every aspect of operations in order to demonstrate need. This process has as its aim avoiding filling positions which, if filled, it is thought may have to be eliminated in Phase 2.
A second change has been the selection of a new consulting company to lead the work of Phase 2. The selection process was handled at the highest levels of the