YOUNGSTOWN, Ohio - Valley Care has announced a new round of layoffs at Northside Medical Center.

In a memo to employees, the CEO at Northside Medical Center. Kirk Ray says the elimination of 56 full time positions is part of a restructuring.

These changes will primarily affect positions in nursing, respiratory, imaging and laboratory including both union and non-union employees.

Ray says for efficiency the hospital will be combining a small number of related care units, while still providing primarily private patient rooms.

The CEO says these actions are needed due to significant patient volume declines and shrinking reimbursements.

In August, Northside Medical Center announced that 77 full time employees would be laid off or have work hours reduced.

The hospital says hospitals are facing more challenges and competition as advances in treatment have made more services available on an outpatient basis.

In the memorandum, Kirk Ray says "We will never compromise on quality, compassion or patient safety."

As was the case in August, the staffing cutbacks do not affect Valley Care's other local hospitals, Trumbull Memorial and Hillside Rehabilitation.