Fattened and flattened: the expansion and contraction of the modern organization

In a changing world, organizations must change as surely as individuals must change. Recent years have been seen an increase in organizational "flattening", the tendency to shrink the organizational structure through the removal of layers in the hierarchy. Today flattening is especially prevalent in health care, particularly in hospitals, as the industry adjusts to various external pressures through mergers, acquisitions, and sometimes closures. While organizational growth, or "fattening", is usually slow, occurring sometimes imperceptibly over long periods of time, flattening is usually abrupt and therefore painful. Especially affected are first-line supervisors and middle managers. The supervisor's main defense against obsolescence in this new environment is to become as multifaceted as possible, recognizing that one's future security lies not in constancy and specialization but rather in flexibility and adaptability.