Organizational downsizing has increased exponentially worldwide and is also affecting the healthcare industry. It is one thing to speak abstractly of the need to reduce costs and quite another to actually tell a worker the bad news that he or she has been laid off. This paper offers practical advice to healthcare managers on conducting unpleasant conversations with employees based on a widely used medical model--the SPIKES protocol. This strategy has been extensively employed by physicians and other health care professionals who frequently communicate negative information to patients and is offered as an approach that can be easily and effectively adapted by healthcare managers when they must tell a person they have been terminated. Although breaking the bad news of a cutback will never be easy, having a plan of action that entails sound business and medical advice and is also the necessary thing to do can help firms carefully manage and execute reorganizations for the well-being of the organization and the terminated worker.