Short version: A hospital's outsourcing services. Outsourced managers are abusing hospital employees to induce employee turnover and replace those employees with their own firm's workers. Hospital management is enjoying the reduced costs reflecting positively on their own performance metrics while not witnessing the employee abuse firsthand.

Question: What can employees do if an outsourced manager is trying to push them into leaving or get them fired?


A hospital is in the process of outsourcing some of its internal services. If an outsourced firm can drive employees away or get them fired, then the firm may get to replace current hospital staff with their own employees. Managers from outsourced firms seem to have an active interest in doing so, some more than others.

An outsourced firm's strategy seems to be a combination of:

  1. Provide ample documentation of alleged issues to make it easy for the hospital to fire current employees on a whim.

  2. Facilitate current employee turnover by making the work environment as unpleasant as possible.

At current, a particular outsourced firm has been successful in having several long-time employees in related departments leave while bringing in more of their own staff. Continued abuse is pushing more current employees in that direction.


A manager from this particular outsourced firm has adopted aggressive tactics. As I have friends and family in the hospital, I'm now involved in regular discussions about these problems, and I'd like to offer some helpful advice on how to deal with this manager.

This outsourced manager's tactics appear to include:

  1. Reporting anything that they can make sound problematic in some way.

    • Example: Manager entered hospital kitchen area, where crammed aisles mean that employees occasionally bump into each other. Manager got an employee to bump into them. Manager is threatening to report employee to HR for intentional assault.

    • Example: Employees have desk work and visit patients. Manager threatened to report employees for allegedly fooling around in the privacy of their offices.

  2. Behaving in a rude fashion under the guise of professional concern.

    • Example: Manager pulls employees off to the side and criticizes employees for arbitrary decisions in a non-constructive fashion.

    • Example: Manager interrupts employees as they talk to "correct" their word choices in fairly silly ways. Such as, if an employee says something happened "a day ago", manager may correct that it was actually just 20 hours ago.


I'm not exactly sure how hospital management feels about these issues, but realistically, they might be inclined to look the other way. The issue's that the outsourced firms might be able to replace current staff for less money.

The issue exists for the current staff and patients, as both are suffering due to this artificial-turnover environment where employees are being demoralized and hindered while trying to deliver patient care.

The hospital's management is currently enjoying the cost-cutting, as it's leading to successful performance metrics while hospital employees are burning themselves out trying to pick up the slack. While the overall situation is unsustainable, there's no apparent personal reason that the hospital's management should care. For them, correcting the problem will mean hurting their own bottom line, effecting a major conflict-of-interest that's probably inspiring them to look the other way and give the outsourcing firms the benefit-of-the-doubt.

  • 7
    What do you think you could do to fix this? Senior management has no incentive to help you, HR has no incentive to help you, unless you could nail this guy down on something the hospital could get sued over you're all out of luck. If the guy is doing his job by the book but over the top and annoyingly, like it sounds from your description, you seem to be SOL. The interests of the people in charge don't align with those of the employees. Small silver lining: They could have just started canning people outright without pretense, so at least people have some time to find a new job now
    – Magisch
    Commented Jul 3, 2017 at 11:02
  • 20
    If you're going to try and convince CEO types that outsourcing is generally bad for long term performance be my guest but you're trying to fight the world's largest windmill there.
    – Magisch
    Commented Jul 3, 2017 at 11:03
  • 5
    it would seem the only possible hope here would be literally political pressure, that is to say, building a case in the press that "outsourcing is not working in the local hospital". The sad reality in the US is, you "have no rights" as a worker, as harsh as that sounds. Note that your employer can - very simply - fire you if they happen to want to. So, all of what you say above is a complicated reason "they may fire you". But - they can fire you at any time at all, for absolutely no reason. (In almost all states.) So, it's tough.
    – Fattie
    Commented Jul 3, 2017 at 13:59
  • 27
    This calls for a warning strike. You don't have management on your side here. They merely use the third party as leverage to reduce labour cost. Is the company unionized and is there a union representative you could talk to? Commented Jul 3, 2017 at 14:45
  • 11
    Creating a hostile work environment is a form of harassment. By allowing this manager to continue in this manner, both the hospital and the outsourcing firm are exposing themselves to the risk of a workplace harassment lawsuit. IANAL, but in the place of the affected employees, I would bring it up to the hospital HR, and if they don't take action, I would consult a lawyer.
    – asgallant
    Commented Jul 3, 2017 at 15:19

5 Answers 5


Outsourcing is cyclical, with two conflicting motivations: Cost, and control.

In-house employees are easy to control because you employ them directly and can direct them. They are part of the reporting structure, but tend to cost more as payroll tax, benefits, et cetera are paid by the business.

Outsourced employees are cheaper because the contracting firm is given a fee and is then told to staff positions. However, there is far less control, less familiarity with operations, no loyalty, and no direct consequences for incompetence. The outsourcing company may take some heat for a job done poorly, but the management is rarely held accountable and often, one mediocre employee is swapped for another when something is done wrong.

Since you can't compete directly on the money spent, you need to emphasize the hidden costs of outsourcing. If you can discuss with management, point out the following:

  • Lack of control: The outsourcing company is just filling positions to feed their bottom line, not to ensure the best interests of the hospital
  • Lack of quality: As the outsourcing company's motivation is to fill positions and get paid, not to ensure quality of work, there will ALWAYS be a decline in quality.
  • Liability: THIS ONE could be your silver bullet. If quality of care drops to where the outsourced employees are violating HIPAA or endangering patients, it could be MAJOR lawsuit time. Document ANYTHING that could point this out. The aggressive actions of that manager could also be construed as creating a HOSTILE WORKING ENVIRONMENT I hope the hospital has a big checkbook....
  • Lack of ethics: Again, focus on how the manager's lack of ethics will affect the bottom line
  • Bad Press: Similar to legal liability, if patients start tweeting out or FBing the lousy service they are receiving, it's going to hit them in the wallet.

TLDR: Show the hospital management how there's more to the bottom line than simply the cost of salary.

  • 7
    @henning I was put on an outsourcing team once. You'd be surprised just how stupid management can be for not considering the factors I pointed out. But, I'm curious to hear your experience/alternative solutions. Commented Jul 3, 2017 at 14:52
  • 19
    @henning I was transferred from one department to the outsourcing group. I became very skilled at poking holes in the logic. In the USA, there have been so many miserable failures that there is a new term "Backsourcing", which is essentially undoing the outsourcing, and the reasons cited are the reasons I have listed. Commented Jul 3, 2017 at 15:14
  • 1
    don't forget that some outsource firms will fill posts with their best staff at first, and then swap them out for the cheapest, most useless once they have taken over. So a company needs to ensure the staff get retained, and if you do this, you might as well hire them directly.
    – gbjbaanb
    Commented Jul 4, 2017 at 13:18
  • 6
    One other problem with outsourcing is that you get what is in the contract. In other words all the hidden mechanisms are gone one day and you discover how your company actually works. This has been disastrous to some high tech companies in the late 2000' where the IT staff was outsourced and started to work though tickets. No more "hey John, can you ....", their answer was "sorry but I am now measured on tickets" (yes, they were pissed off for being outsourced). Gone are the "outrageous cost of in-house employees", and sometimes gone is the company as well...
    – WoJ
    Commented Jul 4, 2017 at 21:19
  • 1
    @WoJ Oh yes, 100% accurate. Our group was gutted in the early 00's for just such a reason. We just fixed things so our "turnover log" was usually non-existent as we'd fixed everything by the time the next group took over. We were gutted because we didn't have anything in the turnover log, so according to management, we were overstaffed. Tickets are the only way to protect yourself now. Commented Jul 4, 2017 at 22:07

It depends on employees rights where you live, but normally your strongest option would be to organize the workers in a Union.

Also, start documenting you work and work-related incidents as well as anything on the manager in question. This is not a one-way-street.

  • 2
    This is in the US, so they're probably out of luck for that. In nearly all US states, the company could go "Well, we'll be replacing your all. Today is your last day, don't let the door hit you on your way out. No references" on a whim if they wanted to. Hinting at unionizing is a good way to make that happen.
    – Magisch
    Commented Jul 3, 2017 at 11:13
  • 4
    +1 for the union idea. While the outsourcing firms are selectively preying on lower-level employees who're more easily replaced, the hospital environment has a strong cohesive culture, as most of the medical professionals are there out of their common concern for human health. Forming a union or getting one in-place would probably be quite a hurdle, but since even the doctors and specialists would be likely to join in, it does seem like one potential approach.
    – Nat
    Commented Jul 3, 2017 at 11:15
  • 9
    @RichardU The BLS has unemployment for medical professionals at 1.5% in May 2017, making it one of the most-employed fields that they list. I'd be interested if you could find a good reference speaking to a glut of medical professionals.
    – Nat
    Commented Jul 3, 2017 at 13:45
  • 8
    @Magisch As soon as an employer learns its employees are attempting to unionize, that becomes illegal. Actually directly informing management of attempts to unionize might offer protection.
    – Andy
    Commented Jul 3, 2017 at 17:40
  • 4
    @immibis They can claim whatever they want, but the regulations are pretty strictly enforced and the DOL is going to be highly skeptical. A former coworker/friend of mine would leave immediately if someone even joked about unionizing.
    – Andy
    Commented Jul 3, 2017 at 22:08

I'm not actually sure that you're interpreting the situation right, because of the points you listed:

The local hospital became privatized a few years back, and is now in the process of outsourcing some of its internal services

So there's new senior management and new down the line management. That means the work culture and general decision making process has probably shifted and will shift further yet.

If an outsourced firm can drive employees away or get them fired, then the firm may get to replace current hospital staff with their own employees. Managers from outsourced firms seem to have an active interest in doing so, some more than others.

Do you have any reason for this assumption besides an abrasive management style or percieved incompetence? It's worth remembering Hanlon's Razor (the principle that it is much more likely that someone is incompetent / bungled something then a malice of intent conspiracy going on). Maybe the managers have been brought in by new senior management to shake things up and upend some staff practices that they want to see change.

It sounds like you're getting a second hand account of some very disgruntled long time workers. It's worth noting that if your entire company culture shifts, like the hospital's culture is shifting right now, many long term employees may resist against that because they prefer or are used to the old way things are done. Again, that manager may have the expressed mission from senior management to shake things up and make people shape up or ship out.

But for now, lets assume that you're correct and that this is really a deliberate tactic to get long term staff to quit so they can be replaced by lower paid outsourcing staff. Then...

I'm not exactly sure how hospital management feels about these issues, but realistically, they might be inclined to look the other way. The issue's that the outsourced firms can realistically replace current staff for less money.

Senior management is definitely on their side. That means that you won't see senior management pushback for any of this. In fact, they may be welcoming it. (It's also possible they're firing people for cause to avoid paying unemployment to them - not too uncommon).

In that case, you can't really do much. Like the other answer suggests you could try to unionize, but that bares the very real risk of them just doing a mass-layoff on the first hint of it.

The hospital's management is currently enjoying the cost-cutting, as it's leading to successful performance metrics while hospital employees are burning themselves out trying to pick up the slack. While the overall situation is unsustainable, there's no apparent personal reason that the hospital's management should care.

Welcome to almost any poorly done privatization / acquisition ever. This is why your senior management won't care, and this is why there's very little you can do about this dynamic. Essentially, the new management realizes how much it pays (for them) to put on the thumbscrews tighter for the workers. You could try and convince them otherwise, but that's very unlikely.

Overall, it may be best for the affected workers to seek other jobs, hard as it may be. You seem to be on the losing side of a company culture shift.

  • Comments are not for extended discussion; this conversation has been moved to chat. Commented Jul 4, 2017 at 16:52

In the UK, reporting someone to HR for intentional assault, fully knowing that there was no assault, could have all kinds of bad consequences. My response to HR would be: Call the police, or it hasn't happened. With police involved, trying to persuade a colleague to be a witness for the non-existing assault would be either "perverting the course of justice" or "attempt to pervert the course of justice", and now we are talking about jail time. (Actually, in the UK a government minister and his wife both went to jail for exactly that, in a much less serious matter - lying about who drove a car that was caught speeding).

  • This question is tagged united-states, which has few to no laws that protect workers or punish managers who make false claims. We can put a man on the moon, but cannot protect the bottom-rung workers who make such great feats possible.
    – user16626
    Commented Jul 5, 2017 at 0:02

There are three options that you have:

(1) Have the employees of the hospital contact a lawyer and explain their case to them and that they're worried that they'll be terminated and that they're worried about the manager's behavior.

The lawyer will probably tell them to document everything perhaps via an email to HR. Every incident should lead to an email to HR. This can be used to create evidence of a pattern of behavior that might be against the law or against company policy that can later be relied upon in court.

The lawyer might also offer other advice. Don't skimp on the lawyer. Hire a big an expensive firm. You can afford it with a group.

(2) Convince the person who can hire or fire the manager that what the manager is doing is bad. This comes down to pretty much the same thing as with the lawyer. Document the behavior and then tell the CEO.

(3) Convince the manager. Have different employees write the manager about his behavior towards themselves but also towards employees. For example with the silly correction. Simply have the person who the manager corrected write an email that the correction was unnecessary and that it was not appreciated. Ask them also what value there was in correcting them. Then have another employee who witnessed this behavior write the manager with similar content. If the behavior continues or if the manager responds rudely, then cc HR in the response.

Don't forget that you're with a big group. You can even conspire to make false charges against the manager because the word of every member in the group can count for more than the word of the manager. Certainly in court. Of course I wouldn't advise you to do this. I advise strongly against this. But this is just to show that the manager is in a much weaker position to make false charges than the group is if they organize.

I would recommend hiring a lawyer in any case. What these people need is legal advice so they can fight this based on what their rights are.

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