Another wave of pink slips went out to workers at North Memorial Medical Center on Monday, as the health care system continues to downsize and restructure.

It was unclear how many staff members were let go. North Memorial is one of four level-one trauma centers in the Twin Cities area but has seen a significant drop in patient levels.

Officials at the Robbinsdale-based health care organization did not return calls. In an e-mailed statement, spokeswoman Wendy Jerde said most of the staff reductions do not involve direct patient care.

The moves come as the organization is "in the process of resizing and realigning" its flagship hospital "to position itself for growth in an evolving health care environment," according to the statement.

"The changes made [Monday] are part of a larger plan to ensure the entire North Memorial Health Care system is sustainable and successful as the organization continues to expand and strengthen its clinic and other outpatient services."

In late December, North Memorial eliminated an unknown number of leadership positions as it laid out a strategy that CEO Larry Taylor said would result in North Memorial eventually becoming "the size of a suburban hospital."

North Memorial Health Care also has a 75 percent stake in Maple Grove Hospital with Fairview Health Services, 11 primary care clinics, two urgent care clinics and one of the nation's largest medical transport fleets of helicopters and ambulances.

Memorial Health Care has about 5,000 employees, including 185 employed physicians.

As part of the new strategy to integrate operations, North Memorial will increase focus on building outpatient clinics and diversify into geriatric and end-of-life care.

North Memorial Health Care is the smallest health care system in the Twin Cities, with revenue of $670.4 million in 2011.

Jackie Crosby • 612-673-7335