Transitions in American hospitals: the necessary reshaping is taking place. "Turnaround" processes in organizations

American hospitals are reshaping and redefining the way they are managed and the way they provide care. More American healthcare organizations are stating that they are in a turnaround situation. Although there are no definite guidelines or criteria that place an organization in a turnaround situation, there are certain circumstances that are frequently present. These circumstances most often include a somewhat sudden change from a financially favorable situation. This may include revenue lost and/or increases in cost from operations, decreases in volumes that are most positive and favorable to the organization, sudden changes in key management or board representation, and sudden loss of key managers and staff needed for the successful operation of the organization. Any one of these factors or several can place an organization in such jeopardy that quick and decisive actions must be taken to ensure survival and future success. The specific conditions of a turnaround and the effectiveness of quick and decisive actions are critical for the survival of an organization or a system.