This chapter is provided as an update on events at General Hospital. In particular, the time of the third set of interviews was, it turned out, just before the restructuring was announced. The nature of the restructuring is an important part of more fully understanding the case.
Shortly after the final interviews were conducted in September, Dr. Lewin announced the long-awaited management restructuring in mid-October 1994. The essence of the restructuring was that every management position in the hospital was eliminated and an entirely new management structure provided. The number of staff affected was never published, but a good guess is that 175 to 200 management positions were eliminated. The restructuring reduced the number of management layers from eleven to seven.
The restructuring involved two steps. The first step eliminated all of the senior-level management positions in the hospital. It was announced that twenty new positions had been created and that anyone interested in them could apply. Job descriptions were published. The restructuring recast the reporting lines for the departments of the hospital to a number of positions. The Manager III positions to which they had reported were eliminated. Some of the positions were entirely new, such as a number of service-line management positions. General Hospital did not have formal service lines.
Staff had three days to apply for one or more of the positions and anyone could apply. Dr. Lewin, the new Hospital Director, the new Assistant Provost (both started in July) and the manager of ambulatory