Abstract
In 1991, our University Hospital initiated a series of strategic changes designed to increase organizational effectiveness and efficiency, foster a culture of commitment to customer-driven service, and flatten the organizational structure, pushing decision making closer to the point of service. These events, although proactive and positive in their intent, triggered a significant, debilitating response among many members of the nursing staff. The authors discuss the experience of this organization, examines the process of transition and the responses of staff members to change, and provides recommendations for minimizing the sequelae of organizational transformation.
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