Issues in the Creation of Specialized Medical and Surgical Units

In response to increasing inpatient demands, PCMC added 24 beds to the Children's Medical-Surgical (CMS) unit in January of 2004. Until that time, the CMS unit consisted of 44 beds for medical and surgical patients over three years of age. With the addition of the 24 beds, the CMS unit was divided into two units, a 40 bed medical unit, and a 28 bed surgical unit. This addition presented unique challenges in leadership restructuring. Managing the change also required the resolution of major staffing and patient placement issues. In spite of the challenges, there was also an opportunity to improve the quality of patient care for both medical and surgical pediatric patients. PCMC's Administrative Council (AC) (consisting of the CEO, COO, Chief Nursing Officer, and other key direc- tors) was charged with deciding whether to expand the CMS unit or make two separate units. The decision to make two separate units was based on the desire to realize the advantages of increased specialization and to limit staff size to that which one leadership team could successfully manage. The benefits of two specialized units include con- solidated geography for patient placement (a significant physician satisfier), specialization of nursing skills, and appropriate staff size for a leadership team to manage and develop. A further benefit included enhanced physician- nurse relationships and communication due to decreased staff size and close interaction with specialists. Throughout the decision making process, communication was ongoing and frequent. The CNO, the AC key decision maker for this process, communicated frequently with the CMS director who in turn provided the available informa- tion to her staff. As the staff provided feedback, the CMS director sent it to the CNO who in turn presented it to the AC. This process gave the staff representation, an opportu- nity to provide feedback, and time to adjust to the upcom- ing changes. This process facilitated the "unfreezing" stage of the change process. Staff members were able to understand the driving forces for the change, and, in re- turn, the director and AC were able to determine ways to manage the restraining forces that would resist the change (Cummings, 1999; Lewin, 1951). Communication, itself is a key strategy utilized to reduce resistance to change (Kotter & Schlesinger, 1979).