Assignment focuses on changes occurring in hospital organization or community with rising costs and declining revenues.

Scenario
The current set-up is a community hospital which is facing problems at present with rising costs and declining revenues. Obstetrics service is located in the oldest part of the facility and the labour and the delivery rooms were cramped and inefficient. Obstetricians were recently moving from the community hospital to the medical centre, where there are better opportunities in terms of comfortable, family centred accommodation and state of art equipment as well.

Reflection:
The feeling of nurses who work on the two units will obviously need some motivation and preparation to absorb the proposed changes. At the outset, obstetrician division is not prepared well to take up the high risk cases; hence they may be required special training to move them off from the traditional practice they are involved in from quite a long time. However they may find it more joyful that the facilities are going to get updated and new provisions and features will add them to perform better. However paediatrician nurses need to be prepared for new workloads, Since they are already accustomed to decentralization in decision making and exposed to working in cross functional scenarios, there won't be much problems in this regard, however it may be required that necessary actions need to be taken to improve their capacity building and to tune up to let them serve the expected high demands in future.

Since the obstetrician department head is retiring shortly; it is most probable that her decision and opinions will not be of much concern. At most her advises can be sought to make the division more effective and her expertise can be sought in enabling the vision for new future. The Pediatrician department head may be excited for this new change. She may even take this opportunity to take up the overall lead of the community hospital and can enable necessary functional integration of the obstetrician demands of high risk maternity wards with paediatrician divisions. Further in accordance to her proactive and decentralized operational vision, she may suggest some more organizational changes to absorb the proposed changes in the structure and operations.

As such there is not much loss, the only thing is that the traditional obstetrician patients will not be availing the services at the hospital and they need to go for city medical centre. This is loss for the community hospital. However in future if once the capacity and revenues of the organization are developed, again the organization can think of developing a general ward for routine maternity cases also. Some of the nurses who are not skilled in taking up the new challenges of the high risk maternity cases will obviously lose their job functions and perhaps may be asked to change the job. In such cases the health care centre need to acknowledge their losses by providing necessary compensation to them.

 It is the rule of time and need for sustenance. Both for individual or community or organization, change is the need of the hour and entities are expected to move from doing old identity things and expected to embrace new ways and means of doing things(Hayes,2018) for sustaining.

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