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Faced with rising costs and declining revenues, the board of directors for a community hospital located in a large East Cost city decided to combine its obstetrics and pediatrics units. The obstetrics service was located in the oldest part of the facility, and the labor and delivery rooms were cramped and inefficient. A large medical center nearby offered comfortable, family-centered accommodations and state-of-the-art equipment. As a result of the more state-of-the-art equipment at the large medical center, several obstetricians had recently moved their practices from the community hospital to the medical center. The board was reluctant to discontinue obstetrics services because the hospital had a long history of providing maternity care to the surrounding community. However, overhead costs for the underutilized and obsolete unit were skyrocketing, and the cost of replacing the unit was prohibitive. The pediatrics unit, in contrast , was housed in the newest wing of the hospital. The hospital’s emergency department was one of only two in the city equipped to provide pediatric trauma services, and a number of patients were admitted to the service through the emergency department. In addition, a large physician group that specialized in pediatric oncology admitted hundreds of patients to the facility each year. The physician group was recognized nationwide and handled referrals from pediatrics throughout a four-state area. The consolidation of services made sense to the board on several levels. From a cost-control perspective, closing the obsolete facility would save the hospital millions of dollars in renovation expenses. The consolidation also made send from a patient care point of view. Expectant mothers who were known to have high-risk pregnancies could plan to deliver their babies at a facility that specialized in treating pediatric patients. In addition, the head of the obstetrics unit was scheduled to retire soon, and the board saw an opportunity to make significant changes in the clinical area. The board believed that the obstetrics service should change its focus from handling routine deliveries to handling high-risk pregnancies and thus overcome the competitive disadvantage the hospital now faced when compared with the medical center. The board voted to seek funding for a new center of excellence for the care of high-risk mothers and newborns. Combining the two units will require fundamental changes because the units are managed in very different ways. The department head of the obstetrics unit is a traditionalist, and the obstetrics staff is accustomed to deferring to his judgement when problems arise. By contrast, the department head of the pediatrics unit believes in self-managed work teams, and her unit is structured into cross-functional teams with independent decision-making authority. There are other obvious differences as well: one unit treats adults and the other treats children. One unit treats women who stay in the unit for a day or two at most, whereas the other treats infants, children, and adolescents for conditions that require complex treatment regimens and long hospital stays. Parents often sleep in their children’s rooms for weeks at a time. Each of the units has a separate identity, and a certain animosity has developed between the units over time. Case Study Question 1. How do you think the nurses who work on the two units will feel about the change? How will the department heads feel? Who will lose what? How could those losses be acknowledged? 2. Create a communication plans for the project. How would you describe the purpose of the change? What tools would you recommend to communicate information about the project? 3. Determine who you think should act as a change manager for the consolidation?

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