Gateway Hospital is a 500-bed tertiary-care hospital located in a busy metropolitan area. A

recent employee satisfaction survey scored well below the national norms on most scales. The hospital

has been facing higher than average turnover and vacancy rates. Recruitment of professional

positions is very difficult because the hospital has gained a reputation as a bad place to

work, especially if one is new; the term “eat their young” seems to be a prevalent description.

Salaries are below the local market, as are annual pay increases. In many departments there

seems to be a critical shortage of staff, and closing services has been a recent topic of discussion.

Additionally, the financial picture of the organization is bleak. The payor mix has changed;

Medicare cutbacks are impacting the bottom line, as are changes in private insurance funding.

Key physicians are beginning to take their services elsewhere, as they sense the inefficiency of the

hospital processes.

The various stresses appear to be having a significant impact on the overall morale of employees.

Poor teamwork is rampant, and communication breakdowns seem to be a normal occurrence.

Several leaders have been let go in an effort to address issues.

The leadership of Gateway Hospital is extremely concerned about the organizational prognosis

and has decided to begin to address the issues by enlisting the assistance of a consulting team.

One member of the team is a financial expert who has been hired to address the significant financial

issues affecting the hospital. The time frame on fixing the financial issues is one of a critical

need; since the environment is rapidly changing, the consultant must get a handle on how to help

the hospital operate successfully, given the current financial downslide.

A second member of the team is hired to address the morale and employee issues. A review of

the employee opinion survey is conducted, and trends are identified in exit interviews. Employee

interviews and focus groups are held in an attempt to determine the root cause of the morale

issues, as well as the breakdown in teamwork and communication.

The data collection is discussed with leadership; after a series of discussions, leadership admits

that many of the financial pressures have created a “knee jerk” reaction to staffing issues, often

cutting back dramatically on employee hours. This would create a crisis mode and the need to ask

employees to work harder. This cycle has created a significant lack of trust from the employee’s

perspective, coupled with the fact that employees have not felt that they have been apprised of the

reasons for the roller coaster changes and have not been offered any words of appreciation when

they have either reduced their hours or worked in a crisis.

The consultant and the leadership agree that in order to fix the “people” issues of the organization,

there will need to be a culture shift of leadership and employee interactions so that a trust

can be rebuilt.


1. On the basis of these issues, what OD interventions do you think should be utilized to address

the problems this hospital is facing?

2. How would you proceed if you were the consultant in this case?

3. What skill set do you think the practitioner will need in order to be effective in this organization?

4. What type of a time line would you establish if you were this consultant?

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