As part of a company reorganization, about 160 employees at Novant Health, in Charlotte, North Carolina, are on the chopping block across its network of healthcare facilities.

The nonprofit provider employs 36,000 at 16 medical centers and has 1,900 physicians in 800 locations in the Carolinas. The cuts will primarily be in management and administrative divisions. Novant Health says it will support those whose jobs are eliminated, reported the Charlotte Observer.

The cuts are the biggest since 2015 when the company let go of 400 people, including 157 in Charlotte and Winston-Salem, as part of another reorganization at the time. It also previously eliminated 50 jobs in March, including those of several executives.

“In a challenging healthcare environment, we are focused on how we can work differently to prioritize direct patient care, operate more efficiently, and reimagine how we serve our patients,” Novant Health said in a statement.

The organization said that less than 0.5% of its employees would be cut but did not say how many in each region would be laid off, including Charlotte.

The reductions follow recent expansions and additions undertaken by the company this year. In February, its division, Novant Health Enterprises partnered with alternative asset management firm TPG, which offered its investing expertise in capital, growth, impact, real estate, and market solutions to expand the U.S. footprint of outpatient imaging centers owned by Novant’s wholly-owned subsidiary, MedQuest Associates.

It also signed an agreement to acquire Lake Norman Regional Medical Center, Davis Regional Medical Center, and their related businesses in March, including physician clinic operations and outpatient services from subsidiaries of Community Health Systems.

In June, it opened its $180 million Ballantyne Medical Center in Charlotte, providing residents access to a 168,000-square-foot hospital and a 56,000-square-foot medical office building that include emergency and inpatient services, diagnostic and surgical care, maternity care, as well as women’s health, orthopedics, cancer care, and various onsite specialty services.

At the same time, the company has paid for costly temporary employees, including travel nurses, to fill staffing shortages, and was reported to have barely broken even earlier this year by WHQR Public Media.

The healthcare system says the layoffs will “absolutely not affect our ability to deliver high-quality, safe care to our patients and communities.”

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