1. Lineweaver, Lisa A. BSN, RN
  2. Battle, Cheryl E. BSN, RN,C
  3. Schilling, Rachelle M. BSN, RN
  4. Nall, Christina M. BSN, RN


Decentralization, cost containment, and downsizing continue in full force as healthcare organizations continue to adapt to constant economic change. Hospitals are forced to take a second and third look at how health care is managed in order to survive. Six Northwest Florida hospitals were surveyed in an effort to explore current changes within the healthcare delivery system. This article provides both managers and staff with an overview of recent healthcare changes in an area of the country with implications for staff development.


Healthcare corporations continue to battle silently between the quality and cost of healthcare services while dealing with insurance companies, the indigent, and the new Medicaid and Medicare programs of the decade. Insurance restrictions are increasing while coverage is decreasing. During economic healthcare reform, the public is continually reminded by healthcare facilities of their mission: patient-focused care. Some hospitals have hired consultant firms to enlighten them with current data and trends related to both significant and effective changes. With this information, hospitals are making their own constructive cost-effective hospital changes. This study found that there are many means of restructure occurring within the hospitals surveyed. Decentralization of departments, staffing, downsizing of nursing management, and the merging of units were common forms of restructuring within the hospitals surveyed. With regard to downsizing, some managers mentioned the practice of attrition whereby instead of refilling open managerial positions, the responsibilities were given to other managers within the facility.