Table 1 Operationalization and description of unit-level organizational changes

Merger

At least one of the following criteria must be met:

• If at least 90% of employees at one unit (A) move to a different unit (B), all employees at the old unit (A) are categorized as having been through a unit-level merger.

• If at least 20% of employees at the new unit (B) come from a merger unit – all employees at the new unit (B) are also categorized as having been through a unit-level merger.

• If a new unit is created (B), with at least 90% of employees coming from at least two different units in the hospital - all employees in the new unit are also categorized as having experienced a unit-level merger.

Two units become one. For example, two wards treating blood related diseases at the hospital in this study merged both physically and operationally as they were decided to continue their operations in one hospital location.

Downsizing

At least one of the following criteria must be met:

• A unit reduces the staff by at least 20% during the quarter and the unit is not categorized as experiencing unit-level merger, unit-level outsourcing or unit-level insourcing.

• An employee is categorized as experiencing a unit-level downsizing if there has been a downsizing in the unit the employee works in at the beginning of and/or at the end of the quarter.

A reduction in the number of personnel. To define downsizing quantitatively, we applied the same level as Røed and Fevang [36], who defined major downsizing as a reduction exceeding 20%. Similar to downsizing at the organizational level, unit-level downsizing generally occurs without layoffs [36]. Strategies aimed at staff reductions in a unit entails withstanding renewal of temporary contracts, not filling vacant positions, in addition to transferring employees to other jobs within the hospital or to a neighboring hospital.

Spin-off

The following criterion must be met:

• If a new unit is created (B), with at least 90% of employees coming from the same old unit (A) in the hospital, the employees in the new unit (B) are categorized as experiencing a unit-level spin-off.

A new organizational unit is created within the organization by making part of an old organizational unit an organizational work-unit in its own right. For example, the emergency psychiatric unit was separated within the hospital to become an independent unit.

Insourcing

The following criterion must be met:

• If a new unit (B) is established with at least 90% of the employees coming from outside the hospital, then all the employees in the new unit (B) are categorized as experiencing a unit-level insourcing.

An organizational unit not previously a part of the hospital becomes an integral part. The hospital becomes responsible for the subject area, the employees and the day-to-day operations. Geographical relocation is not necessary. The area of forensic subjects was transferred from the Norwegian Institute of Public Health to the hospital in this study.

Upsizing

At least one of the following criteria must be met:

• If the unit increases personnel by at least 20% during the quarter, but the unit is not categorized as experiencing unit-level merger, unit-level outsourcing or unit-level insourcing.

• An employee is categorized as experiencing a unit-level upsizing if there has been an upsizing in the unit the employee works in at the beginning of and/or at the end of the quarter.

Increasing the number of personnel. In order to define upsizing quantitatively, we applied the same level as Røed and Fevang [36].

Outsourcing

The following criterion must be met:

• If at least 90% of the employees in one unit (A) stop working in the organization – all employees at the old unit (A) are categorized as experiencing a unit-level outsourcing.

The units are relocated organizationally (e.g. to another hospital) and the unit is no longer a part of the hospital. A geographical relocation is not required. For example, employees in the purchasing department at the hospital in this study were outsourced to another employer with which the hospital had close affiliations. The department still serves the hospital staff, but they are organized and officially employed by an external “sister-organization”.

Stability

The following criterion must be met:

• If the unit experiences none of the changes above. This implies that at least 80% of the employees working in the unit during the previous quarter still work in the unit at the end of the current quarter, and that at least 80% of the employees working in the unit at the end of the quarter also worked in the unit during the previous quarter. It also suggests that the unit has not grown or been reduced in size by 20% or more.