NR 534 Healthcare Systems Management – Week 6: Planned Change: Leadership of Reduction in Workforce

Part I: Approach to the Organizational Mandate

In this section, provide a statement of purpose for the paper and overview of what will be covered in the paper, including the overview of tasks, potential challenges, and implications of a reduction in workforce in general.

Part II: Reduction in Workforce-Deciding

This section deals with the initial task of determining which employees that will be let go during the reduction in workforce. In Section A, you are to select the 10 positions based solely on the information in Table 1. The questions following the table address the content that should be included in your paper. Once completed, move to Section B, Table 2 and again address the content being asked in your paper.

Scenario

Roxboro Medical Center is a 200-bed inpatient facility located in a sprawling suburban area in the rural south. Until two years ago, it was the only medical facility within a 75-mile radius when The Jonas Center, a 100-bed day hospital and ambulatory care center, opened 25 miles away. Over the past two years, Roxboro has lost approximately 25% of its market share. The 10% drop last year was adjusted for through re-organization of the workforce, reduction in hours, attrition of employees through early retirement and changing jobs to the new facility. However, this year there has been an additional 15% decline in market share resulting in a dire need to reduce the workforce. Since Roxboro is restricted by mandatory staffing ratios, and last year they lost the maximum number of staff possible and still remain within regulatory compliance. The board of directors, CEO, and CFO have determined a 30% reduction in the management workforce across the hospital will be needed. The timeline for this to occur is over the next six (6) months. It will be up to the department heads to determine how they will reduce the positions and re-organize job duties.

Section A: Table 1: Human Resource Manager Work Metrics

You are the Chief Nursing Officer and have the largest number of management positions because yours is the largest department in the hospital. With a total of 33 positions that include house supervisors, unit managers, and charge nurses, you are being asked to reduce the total number by 30%, or ten (10) positions. Further attrition through job changes or retirement is not anticipated. Human Resources has established two criteria for the reduction in workforce (RIF). These are last hired and low performance. Each department is sent a chart that includes this information on employees who have been with the hospital 15 years or less and the performance rating for each.

Your table has no identifiers and while you might have an idea of who the people are, you have only positions information available. Your table looks like this:

Roxboro Medical Center

Human Resources Manager Work Metrics

Position

Years since Hire

Time in Management

Performance Rating

Ave/Recent

Unit Size/ number of beds

RIF or Stay

Rationale

HS.1

10

3 years

High/High

HS.2

12

8 years

High/High

HS.3

15

12 years

High/Low

UM.1

6

2 years

High/High

UM.2

5

18 months

High/High

UM.3

4

2 years

High/Low

UM.4

7

5 years

High/Low

UM.5

10

9 mths

High/High

UM.6

15

5 years

High/Low

CN.1

5

1 year

High/High

CN.2

8

4 years

High/High

CN.3

3

2 years

High/High

CN.4

2

6 mths

Too soon to evaluate

CN.5

12

4 years

High/Low

CN.6

6

2 years

High/Low

CN.7

8

3 years

High/Low

*Performance evaluations are expressed as A/R = average for years in position/most recent year

HS=House Supervisor: UM=Unit Manager; CN=Charge Nurse;

Based only on the Human Resources given you in this table include the following information in your paper:

Who will you choose? Rationale?

What was your approach to making the selection?

How easy or difficult was it to make your decisions with only this information?

What challenges were presented in making these choices?

Section B: Table 2: Human Resource Manager Work Metrics with Related Information

The word is out that the RIF is going to occur though no details of the process have been shared with the employees. You’re getting calls frequently from some of the staff who want to know if they are in danger of being dismissed or sharing reasons why they can’t be.

Since making your preliminary decision of who to let go, and before you’ve made any announcements, you record the information you received from some of the staff and placed it in your table. Now the table includes the size of the units where each of these positions is located which will be important in the reorganization, and some of the personal information gleaned from telephone calls you’ve received. Having these pieces of information causes you to question your original decisions. The shaded area contains the information now known to you and is not part of the table that came from HR.

Roxboro Medical Center

Manager Work Metrics with Relative Information

Position

Years since Hire

Time in Management

Performance Rating

Ave/Recent

Unit Size/number of beds

Relative information

HS.1

10

3 years

High/High

200

HS.2

12

8 years

High/High

200

HS.3

15

12 years

High/Low

200

Finished nursing school together

Single grandparent; has custody of two grandchildren; 34 yo

UM.1

6

2 years

High/High

20

Daughter of nurse in another unit

UM.2

5

18 months

High/High

30

Transferred from another unit after RIF last year

UM.3

4

2 years

High/Low

20

On FMLA for past 4 months; pre-eclampsia for one month prior to leave

UM.4

7

5 years

High/Low

30

Father is major contributor to dialysis center

UM.5

10

9 mths

High/High

15

Husband is second shift informatics supervisor for last 18 mths; potential for RIF

UM.6

15

5 years

High/Low

30

Negative attitude; slow to comply with changes

Single parent; one middles school child

CN.1

5

1 year

High/High

30

AONE Certified Nurse Manager

CN.2

8

4 years

High/High

20

CN.3

3

2 years

High/High

30

Mentors new graduate nurses

CN.4

2

6 mths

Too soon to evaluate

20

CN.5

12

4 years

High/Low

20

has moved up leadership ladder from LPN to CN with Roxboro

CN.6

6

2 years

High/Low

30

Best friend was RIF last year

CN.7

8

3 years

High/Low

20

Serves on Shared Governance Committee

*Performance evaluations are expressed as A/R = average for years in position/most recent year

HS=House Supervisor: UM=Unit Manager; CN=Charge Nurse;

With the new information that is now in the table, how are your preliminary decisions changed?

Who will you choose? Rationale? What changes did you make to your original decision?

What was your approach to making the selection?

How easy or difficult was it to make your decisions with the additional information?

What challenges were presented in making these choices?

What role did ethics play in your choices?

Describe your internal conflict that occurred having this additional information.

How and with whom will you negotiate for your choices?

Part III: Reduction in Workforce-Planning the Change

The next part of your task is to reorganize/restructure the remaining workforce using the remaining employees. You were given a 6-month window of time to complete the RIF. This section deals with planning for the change.

Provide an overview of what the restructuring will look like, i.e. assuming you have 6 units and your workforce now consists of 23 management positions, how will you cover the units with the leadership and management needed.

Detail your plan for change using Kotter’s or Rogers’ change model that includes a timeline for implementation and a description of how decisions will be disseminated

Address three areas of anticipated conflict and how they can be mitigated through use of the change model

Part IV: Healthy work environment

This section addresses how a healthy work environment is maintained during a reduction in workforce. Describe the department and system-wide implications, impact, and potential conflicts that can occur with your RIF in general. Provide at two concrete strategies for addressing morale and motivation of remaining workforce.

Part V: Summary

The final section, summary should contain a restatement of purpose, and overview of what was accomplished, and what you learned from the process.

Answer

Planned Change Leadership Reduction of Workforce

Leadership and management in nursing are vital for professional and overall healthcare success. The leaders must make organization-wide decisions influencing the institution’s success and stability. Nursing leaders face many difficult decisions, most of which are ethical and necessary for organizational success and stability. They thus receive thorough training during studies and also at the workplace. They are required to follow the rules and regulations and organizational policies. Decisions include continuous improvement, hiring, layoffs, staff training, supervisory duties, and delegation of nursing roles. This paper reviews one of the leadership and management tasks decisions: the reduction in workforce management.

Part I: Approach to the Organizational Mandate

The purpose of this paper is to evaluate Roxboro medical center’s new policies on the reduction in workforce. The hospital has been forced to downsize due to emerging competition in the region, reducing the market share significantly. This paper will consider given policy factors in workforce reduction to make managers’ decisions to lay off and the rationale for laying them off. It will also consider other factors affecting the managers’ employment and workforce reduction decisions. Workforce reduction is a tough process that requires ethics and consideration. The other tasks will include motivating the remaining staff and overcoming the challenges associated with workforce reduction. Reduction in the workforce implies that some workers are either demoted or laid off. Dubey et al. (2020) note that RIF should follow the rules and regulations on the number of employees required and is done to meet workforce planning initiatives, budget, position elimination, and other events. Challenges to this change include worker anxiety, associated lawsuits, demotivation, job insecurity, increased burnout, and stress for the remaining workers (Kamal et al., 2019). Workers who fear losing their jobs and thus are unproductive and stressed as they fear losing their jobs.

Part II: Reduction in Workforce-Deciding

RIF Decisions

Roxboro Medical Center

Human Resources Manager Work Metrics

Position

Years since Hire

Time in Management

Performance Rating

Ave/Recent

Unit Size/ number of beds

RIF or Stay

Rationale

HS.1

10

3 years

High/High

RIF

HS.2

12

8 years

High/High

Stay

HS.3

15

12 years

High/Low

Stay

UM.1

6

2 years

High/High

Stay

UM.2

5

18 months

High/High

RIF

UM.3

4

2 years

High/Low

RIF

UM.4

7

5 years

High/Low

RIF

UM.5

10

9 months

High/High

Stay

UM.6

15

5 years

High/Low

RIF

CN.1

5

1 year

High/High

RIF

CN.2

8

4 years

High/High

Stay

CN.3

3

2 years

High/High

RIF

CN.4

2

6 months

Too soon to evaluate

RIF

CN.5

12

4 years

High/Low

Stay

CN.6

6

2 years

High/Low

RIF

CN.7

8

3 years

High/Low

RIF

*Performance evaluations are expressed as A/R = average for years in position/most recent year

HS=House Supervisor: UM=Unit Manager; CN=Charge Nurse;

Who will you choose? Rationale?

The approach selected was majorly performance and the number of years a leader played a major role. The staff with the lowest performance were let go, except those who had been in management for a long time. The charts provided had already eliminated the time factor; thus, performance and the number of years were prioritized. The managers with the lowest performance were thus eliminated first.

What was your approach to making the selection?

The staff selected are outlined in the table above. As shown in the table, the rationale for selecting the remaining nurses is the need for balance in their various units while following the policies outlined. Each area charge nursing, house supervisory, and unit management all require management, and thus, requirements in each area had to be standardized to ensure some managers remain in these management areas.

How easy or difficult was it to make decisions with only this information?

It was not very difficult to make the decisions based on the information because there are only two factors to consider; performance and the number of years since hire. In addition, the time factor had already been eliminated, and only performance and time to some degree were to be considered. Dubey et al. (2020) note that policies primarily guide workforce reduction, but also other factors that would challenge the ethical and legal foundation of the decisions are necessary.

What challenges were presented in making these choices?

The major challenge was balancing the managers to ensure a balance in each unit. Some managers have been there for over ten years, and their recent performance has been low. Making decisions about whether to keep those with longer time or those with higher performance was difficult. In addition, letting staff who have been with the institution for a short-term go was also challenging. In addition, letting go of staff who have been with the organization longer but with recent performance, leaving those with high performance and a low period in the facility was challenging too.

Section B: Table 2: Human Resource Manager Work Metrics with Related Information

Roxboro Medical Center

Human Resources Manager Work Metrics

Position

Years since Hire

Time in Management

Performance Rating

Ave/Recent

Unit Size/ number of beds

RIF or Stay

Rationale

Second decisions

HS.1

10

3 years

High/High

RIF

RIF

HS.2

12

8 years

High/High

Stay

Stay

HS.3

15

12 years

High/Low

Stay

Stay

UM.1

6

2 years

High/High

Stay

Stay

UM.2

5

18 months

High/High

RIF

RIF

UM.3

4

2 years

High/Low

RIF

RIF

UM.4

7

5 years

High/Low

RIF

RIF

UM.5

10

9 months

High/High

RIF

RIF

UM.6

15

5 years

High/Low

Stay

Stay

CN.1

5

1 year

High/High

RIF

RIF

CN.2

8

4 years

High/High

Stay

Stay

CN.3

3

2 years

High/High

RIF

RIF

CN.4

2

6 months

Too soon to evaluate

RIF

CN.5

12

4 years

High/Low

Stay

CN.6

6

2 years

High/Low

RIF

CN.7

8

3 years

High/Low

RIF

*Performance evaluations are expressed as A/R = average for years in position/most recent year

HS=House Supervisor: UM=Unit Manager; CN=Charge Nurse;

With the new information that is now in the table, how are your preliminary decisions changed?

The preliminary decisions will NOT change. In leadership, employee perspectives are vital, and it is crucial to consider their complaints or the information they present to the table. The preliminary decisions will consider the importance of retaining some staff over others.

Who will you choose? Rationale? What changes did you make to your original decision?

The new information does not change the decisions made based on years. After the first time, I reconsidered all the factors at hand, such as years at work and performance also considered the number of years in leadership before making the decisions. The decisions remain unchanged once the other factors of performance and time in the facility are considered.

What was your approach to making the selection?

The approach was deciding if the reasons provided were adequate to ensure they were removed from the RIF. I also looked at the opportunity costs by determining who was the closest manager to let go on their behalf. For example, should I replace a manager with high performance with one who has been in the workforce for a long time but has recent poor performance?

How easy or difficult was it to make your decisions with the additional information?

Given the additional information, it was not easy to make the decisions considering the new information and how accepting their requests could affect the workforce.

What challenges were presented in making these choices?

The major challenge was determining if the reasons for not being RIF were ethical and adequate to keep them on the job. In this case, denying requests and sticking to the decisions was difficult.

What role did ethics play in your choices?

Ethics were significant in decision-making to avoid issues such as favoritism. Ethics also ensured that the decisions made were legally defensible and eliminated unfairness. Ethics also helped ensure the workforce remaining entails quality managers despite the changes (Mujtaba & Senathip, 2020). Managers make vital decisions for a facility, and ethics support the decision in ensuring the best and ethically and legally defensive decisions are made.

Describe your internal conflict that occurred having this additional information.

The internal conflict I encountered were majorly intrapersonal moral conflicts. I pitied some of these managers who feared losing their jobs ad who presented valid reasons to avoid RIF. Faraco et al. (2020) note that moral distress and moral conflicts are common among nursing leaders. Most of them presented valid reasons, and it is possible to keep them, but most of their decisions are insufficient to keep them in the place of more qualified managers. At this point, it will be unfair for some long-serving and well-performing managers to lose their jobs. Considering their reasons while still ensuring quality managers remained in the facility was the conflict at hand.

How and with whom will you negotiate for your choices?

I will work with the executive management team and negotiate the choices, although the choices are limited in this case, given the criteria for RIF. The individuals whom RIF separated will also require a negotiation period to present their case and then decisions made by the committee.

Part III: Reduction in Workforce-Planning the Change

The RIF activity has left the nursing department with 23 managers and 6 units to manage. Some of these managers, especially charge nurses, are necessary for the continuity of service delivery. However, amalgamating some of the closely related units is necessary. For example, the charge nurse in the maternity unit can also be the charge nurse in the maternal and child health clinic and post-natal ward, depending on the current workload. Depending on the workload, a house manager or unit manager can also be in charge of two closely related units/houses. Such decisions will be necessary to ensure the facility continues to deliver quality care despite the downsizing activity. The anticipated conflicts addressed by the change model are task, value, and relationship conflicts, as RIF employees blame the CNO for their situation.

Kotter’s eight-step model is the best to apply in implementing the desired change. The first step is creating a sense of urgency by explaining the situation and the need for change (Mayo, 2021). It is important to explain to the employees the need for change, including statistics on the changes in the market share. For RIF, it is difficult to psych people for the change; on the contrary, the desire is to manage anxiety and depression related to the decisions. The second step is building a coalition. As a nurse leader, it is important to have a team to implement the desired change. Having a team ensures the decisions consider many perspectives and the burden is not left on one individual. The third step is defining/forming a strategic vision. The step requires the manager to define the new changes and strategies. In RIF, the new change is a reduced workforce meaning that some workers will lose their jobs while others retain them.

The next step is communicating the change by enlisting a volunteer army and telling people the vision (Alaimo, 2022). The individuals need to understand why and how by sending the charts with the criteria to the units. The charts will help the staff understand the criteria and ease interpersonal conflicts arising after decisions are made. The step also eliminates discrimination and conflict when the manager is left to make decisions without a clearly outlined framework. Without a properly outlines framework, RIF can be unobjective and unethical, bringing many legal issues to the facility.

The fifth step is encouraging the act/enabling action by removing barriers (Alaimo, 2022). The step in RIF is difficult as one tries to explain to all the managers why they will lose their jobs. The sixth step is to create short-term wins. These may include managers when they were let go without a fight and determining the process and criteria for appealing. The activities in this step include restructuring the leadership and communicating these leadership roles to the current staff after RIF. The next step is tracking progress (Mayo, 2021). The step will entail reevaluating the decisions and their acceptance and denial rates, such as negotiating the exit criteria. The executive team will revisit the appeals, and a final decision will be reached. At this point, the decisions will be the final, paving the way from the last step, instituting/strengthening the change. This last stage entails integrating the change into the organizational policies. The change is permanent, and exit negotiations are complete and implemented at this stage.

Decision-making may be incomplete with only the information provided primarily because information on the managers who have worked for the facility for more than 15 years should be considered. Their unit distribution is vital for decision-making. These managers will help inform the managerial restricting the decisions, and their absence creates a gap for this assignment. It is also important to consider other factors as they arise in the discussion team.

Part IV: Healthy work environment

This section addresses how a healthy work environment is maintained during a reduction in the workforce. Describe the department and system-wide implications, impact, and potential conflicts that can occur with your RIF in general. Provide two concrete strategies for addressing the morale and motivation of the remaining workforce. The healthcare environment and also other sectors are negatively affected by RIF. The separated employees feel the effects as also those left behind. Roy (2020) notes that one of the effects is lost trust by employees, consumers/ patients, and the community. Studies show that RIF reduces job satisfaction in more than half of employees, causes a decline in organizational commitment in a third, and causes a decline in job performance in a fifth of the employee (Langster & Cutrer, 2021).

In addition, institutions with a high RIF or RIF are unfair. They are at risk for a high turnover as the staff strives to look for more secure employment. Langster & Cutrer (2021) note that RIF is a change that is not well-received due to its effects, even on the leader making the decisions. One of the major RIF implications is an increased workload for the remaining staff. RIF is done for many reasons. RIF inevitably increases the workload for the remaining staff, especially for leaders (Langster & Cutrer. 2021). However, RIF has a positive impact on the organization, especially on the financial strategy. Potential conflicts in general after RIF include discontent in the process and following complaints and lawsuits. Individuals do not take being let go easily and often go for lawsuits, especially after perceiving that they were laid off unfairly.

After laying off staff, investing in the remaining crew is important. Investing in employee growth entails supporting them to do better and grow professionally. The interventions include offering them educational opportunities, sincere recognition and encouragement, and spot bonuses that can help motivate these employees (Dlouhy & Casper, 2021). RIF is a dull moment, and cheering them up would help them ease and feel help them feel motivated. Another strategy is increasing social interactions in the company (Miller et al., 2020). Miller et al. (2020) note that downsizing can negatively affect employees, and increasing social support and cohesion can help them feel and stay motivated in the facility. Every care professional needs others, and peer and organizational support is important. Social groups such as social groups and organized group activities for the leaders are vital. These support interventions can help the remaining workforce retain their performance and

Part V: Summary

This paper aimed to evaluate Roxboro Health Centre’s workforce reduction decisions. The tasks in this work included evaluating the managers’ list and eliminating them based on their performance and time since hire. Other reasons were then included, and decisions were reevaluated. This paper also evaluated the impact of RIF, the challenges the process faces, and strategies to improve morale and motivation among the staff. The lessons learned are that RIF is a challenging process that requires ethical ad policy considerations. It is a major change that should be done strictly without favoritism to avoid problems such as lawsuits that follow it. The information learned will affect decisions as a nurse leader in the future.

References

Alaimo, C. J. (2022). Embarking on Change. In HR Leadership During Bankruptcy and Organizational Change: A Practical Guide (pp. 39-45). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-030-95048-4_5

Dlouhy, K., & Casper, A. (2021). Downsizing and surviving employees’ engagement and strain: The role of job resources and job demands. Human Resource Management60(3), 435-454. https://doi.org/10.1002/hrm.22032

Dubey, P., Singh, G., Nagaraju, G., Gharat, K., Bharambe, S. D., & Vajarekar, A. (2020). Reduction of Workforce due to the Impact of Covid-19 and Occupational Health and Safety Management at the Workplace. International Journal of Occupational Safety and Health, 10(2), 92-9. http://dx.doi.org/10.3126/ijosh.v10i2.33287

Faraco, M. M., Gelbcke, F. L., Brehmer, L. C. D. F., Ramos, F. R. S., Schneider, D. G., & Silveira, L. R. (2022). Moral distress and moral resilience of nurse managers. Nursing Ethics29(5), 1253-1265. https://doi.org/10.1177/09697330221085770

Kamal, A. H., Wolf, S. P., Troy, J., Leff, V., Dahlin, C., Rotella, J. D., Handzo, G., Rodgers, P. E., & Myers, E. R. (2019). Policy changes key to promoting sustainability and growth of the specialty palliative care workforce. Health Affairs38(6), 910–918. https://doi.org/10.1377/hlthaff.2019.00018

Langster, H. J., & Cutrer, S. (2021). A Scoping Review of the Impact of Downsizing on Survivors. JONA: The Journal of Nursing Administration51(6), 329-333. https://doi.org/10.1097/NNA.0000000000001022

Miller, S. M., Kim, J., & Lim, D. H. (2020). “Everybody needs everyone”: a case study of workplace learning after a downsize. European Journal of Training and Development44(2/3), 159-170. https://doi.org/10.1108/EJTD-02-2019-0013

Roy, R. S. (2020). Downsizing–Overall Impact on Workforce and Organizational Performance. International Journal of Management Studies7(2), 118–127. http://dx.doi.org/10.18843/ijms/v7i1/01

Mujtaba, B. G., & Senathip, T. (2020). Layoffs and downsizing implications for the leadership role of human resources. Journal of Service Science and Management13(02), 209.

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