The North Hawaii Community Hospital said it is laying off 13 full- and part-time workers to cope with continued operating losses.

The 39-bed acute-care hospital in Waimea said the cuts will occur this month and has offered affected workers a package that includes 20 hours of severance for each year of service, medical and dental insurance through the end of May and access to counseling.

The hospital said it has had operating losses totaling $15 million over the past two years, including a $10 million loss in 2008 that was the worst in the facility's 14-year history.

It said the problems occurred because of a number of factors, including the loss of an orthopedic surgeon, people deferring care because of the economy and the need to increase efficiency in some units.

This year, North Hawaii Community Hospital hopes to cut its operating deficit to $2.5 million through a series of initiatives. It said the hospital has taken a number of steps trying to boost efficiency.

"This was really the last adjustment we needed," said John White, chief executive officer.

He said this includes trying to match the hospital's staffing with work levels.

The cuts amount to about 3.6 percent of the hospital's 360-person staff.

The hospital said it was cutting eight clinical positions, including four at its Kohala Home Health and two each at its outpatient rehabilitation therapy and its pharmacy.

It also is letting go five people in administrative positions.

The hospital said all of the people being let go are eligible for rehiring.

North Hawaii Community Hospital has gone through a number of changes in recent years, including installing nine new board of directors in late 2008. That came after layoffs involving 59 workers, or 13 percent of its staff, in August of that year.

White joined the hospital a year ago from Samaritan Healthcare in Washington state, where he was credited with helping the 50-bed hospital achieve better quality ratings and financial results.