1) Upon the story presented, necessary actions should be taken to overcome the hospital’s problems. St. Mary’s Hospital last year’s numbers showed the necessity of such actions. For the first time, since the hospital started operating, they presented deficit on its revenue. St. Mary’s hospital had some major problems in a few departments. During the last few years, the occupancy, or the number of patients in the hospital, has been declining. Such problem is explained by changes made to reimbursement policies, a larger emphasis on outpatient services, and an increase in local competition. Another major problem the hospital faces is the performance appraisal system. It seems inadequate for the system in operation because it lacks precise appraisal in individual employees. Such problem can be understood by the fact that the hospital never had to face a layoff before. This could be the reason why they have such a sloppy performance appraisal system in place. In reality, the hospital never had to make any use of it.
2) Since the situation requires immediate change, the use of attrition would not be appropriate. The deficit in their budget is a major problem for the hospital. The hospital needs short term and immediate alternatives. Maybe in the future, the hospital could try to incorporate attrition to a similar problem; but now is not the right now. One good alternative for the hospital is to adapt better marketing strategies in order to obtain more impatient services. Also, the hospital could position itself as a locally better service provider. It would increase and attract more patients. Another alternative that could be feasible is the hospital specializing in certain procedures such as skim burn cases, heart transplants, or any other procedure that would easily be accessible and not very costly to the training of the personnel. The number of employees could still be the same. It would attract not only locals, but also