Nurses’ Views on Obstetrics and Pediatrics Change: Case Study

Read the case study  below and answer the corresponding questions:

Case Study To Use

Faced with rising costs and declining revenues, the board of directors for a community hospital PIN located in a large East Coast 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 units 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 several patients were admitted to the service through the emergency department. In addition, a large physician group specializing in pediatric oncology admitted hundreds of patients to the facility each year. The physician group was recognized nationwide and handled referrals from pediatricians 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 sense from a patient care point of view. Expectant mothers known to have high-risk pregnancies could plan to deliver their babies at a facility that specializes 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 faces compared to 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 differently. The department head of the obstetrics unit is a traditionalist, and the obstetrics staff is ' accustomed to deferring to his judgment 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 treats adults, and the other treats children. One unit treats women who stay in the unit for a day or 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 unit has a separate identity, and a certain animosity has developed between them over time.

Case Study Questions

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 communications plan for the project.
   • How would you describe the purpose of the change?
   • What tools would you use to communicate information about the project?
3. Who do you think should act as the change manager for the consolidation?