1. Drake, Kirsten DNP, RN, OCN, NEA-BC

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Q My organization is experiencing financial challenges and undergoing workforce changes. How can we do any more work with less staff?

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This is a very real situation as many organizations are facing myriad challenges. You noted that your organization is having financial difficulties. Is this due to poor performance, decreased reimbursement and change in payer mix, or internal issues? Evaluating the reasons is a good place to start before you message these changes to your staff. Knowing this information provides the why behind the actions, aids in communication, and will allow you to work through your feelings about the impending changes.


As hard as it sounds, organizations are doing more with less using various techniques. For example, one nonprofit hospital reduced its workforce by 2% due to decreased reimbursements, yet still improved some outcomes as a result.1 The CEO noted that staying focused on quality care is essential.


Chances are that you'll incur a workforce reduction at least once in your career, if not more. Because you know this reduction is coming, start planning. Work through the process with the four Ds: delete duplication, discipline, dedication, and determination.


* Delete duplication means eliminating duplicative work done by the unit team. Question direct care staff members about what they're doing that's also done by someone else (even another discipline). Then review work processes and assign the work to only one designated person/role.


* Discipline is needed to apply proven techniques to increase efficiency and efficacy of the processes used in your work area. In the previous example, the hospital utilized Lean methodology to make improvements and decrease cost.1 Six Sigma offers another view for decreasing waste in healthcare. Such techniques are employed by many organizations to improve operations. This is an opportunity for you to seek assistance from your quality department to learn about and apply these methods.


* Dedication as the leader is a necessity to keep your staff engaged during times of change. This entails having an open dialogue with staff members and asking them what they think they can do to address the changes. Trust that they'll share with you what they can and can't do. Commit to trying their ideas to be successful in fostering engagement.


* Determination is also a skill you'll deploy as you try to stay "above the line" as described in The Oz Principle.2 Above-the-line thinking means being accountable for the changes and not becoming a victim of the changes. It's easier to say, "They did this to us" than it is to say, "We can do this." As the leader, you must be determined not to fall into the victim role. By avoiding a victim mentality, morale won't take a downward spiral.



Keep the patient at the center of all conversations when making changes in staffing and workflow. The goal is for patients to never be aware that there was a change at all. And don't forget to take care of yourself during the change process-this is one of the toughest parts of leadership.




1. GE Healthcare. Doing more with less: one hospital's approach to high-quality healthcare. 2017. [Context Link]


2. Conners R, Smith T, Hickman C. The Oz Principle: Getting Results Through Individual and Organizational Accountability. New York, NY: The Penguin Group; 2010. [Context Link]