Dear Editor:

I have recently read the article entitled "Redesign Not Downsize" by Sharon Coulter. I believe that the concept of redesign holds some validity in theory. However, in reality nurses, and other healthcare professionals, need not only to understand the theory but also to learn and apply effective strategies for team building to effectively accomplish the redesign effort. Numerous institutions have bought into the idea of redesign. Unfortunately, many of these institutions have not prepared their managers to practice the interpersonal skills needed during the redesign process.

Recently I was involved with a health care system that had undergone major organizational changes. Many nurses found it difficult to adapt to these changes, and this difficulty resulted in emotional strain on the nurses to the extent that they would betray their own colleagues. Extensive internal discord and contention diseased the morale of a formerly pleasant working milieu.

Subsequently I interviewed at a facility where the supervisor told me that the facility wanted to hire BSN nurses as part of their redesign effort.  A corporate goal of this facility was to seek out highly accredited BSN nurses. I held these credentials and  was hired to a full-time charge position at this facility. My credentials and references were carefully indexed and filed.

Unfortunately, I soon recognized that in reality I had been lured by the salesmanship of the hospital’s 35-year veteran supervisor who had been unable to fill the stressful and demanding position I had taken, a position that had evolved from their redesign effort. It was an impossible, no-win position. Effective team building strategies were absent throughout the organization. Needless to say I did not stay long at this facility.

So what’s all this talk about redesign?  What’s really going on? What’s really needed to make redesign work.  I suggest there are other factors in additional to the redesign itself that need to be considered. These factors may be even more significant than a new structure.  One of these factors is team building and solid interpersonal skills on the part of all managerial personnel in the agency. Many of these newly proposed structures are still foreign to nurses and other health care providers alike. These providers need leaders skilled in the human dynamics of the change process. Unfortunately, many health care professionals have been caught unaware by the undertow resulting from ineffective leadership during this wave of unprecedented change in health care.

Patricia A. Zander, RN, BSN (MSN Candidate)
Bensalem, PA

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