Structure and Principles of Organization Hospital organization: its structure and hospital sub-system

OGINNI MODept of Nursing Science

Obafemi Awolowo University, Ile-Ife

DEFINITION OF ORGANIZATIONAL STRUCTURES• Organisations are complex adaptive systems that use people, tasks

and technologies to achieve specified goals and objectives.• It is a social system always open systems which : receives inputs, processes inputs (conversion) and discharges

outputs to the environment It has sub-systems which interact and are interdependent on one

another e.g. purchasing, production, sale/marketing, accounting, subsystems. Large organisations are generally 'complex', having many inter-related facets and areas that need to be co-ordinated, managed together to achieve efficiencies and effectiveness in achieving stated goals and objectives.

Organisations then need to be adaptive, o respond to ongoing changes in the environments in which they operate e.g. the political, social, economic and technological conditions that together form the environment in which organisations operate.

Organisational structure• Is the pattern of relationships among positions

in the organisation and among members of the organisation.

• Structure defines tasks and responsibilities, work roles and relationships, and channels of communication , divides work among members of the organisation, and co-ordinates their activities so that they are directed towards achieving the same goals and objectives of the organisation..

Objectives of organisation structure

• accountability for areas of work undertaken by groups and individual members of the organisation

• co-ordination of different parts of the organisation and different areas of work

• effective and efficient organisational performance, resource utilisation, monitoring , etc

• flexibility in order to respond to changing environmental factors and satisfaction of members of the organisation

Dimensions of organisational structure• Child (1988) suggests six major dimensions as components of an

organisation structure:• allocation of individual tasks and responsibilities, job specialisation and

definition• formal reporting relationships, levels of authority and spans of control• grouping together of sections, departments, divisions and larger units• systems for communication of information, integration of effort and

participation• delegation of authority and procedures for monitoring and evaluating the

action• motivation of employees through systems for performance appraisalDeficiencies of organisatinal structhere can lead to• low motivation and morale• late and inappropriate decisions• conflict and lack of co-ordination• poor response to new opportunities and external change• rising costs - e.g. diseconomies of scale

TYPES OF ORGANIZATION

• INFORMAL AND• FORMAL ORGANIZATION

INFORMAL ORGANISATIONAND

• The informal organization is the interlocking social structure or aggregate of behaviors, interactions, norms, personal and professional connections through which work gets done and relationship are built among people who share a common organizational affliation or cluster of affliations.

• It consists of a dynamic set of personal relationships, social networks, communities of common interest, and emotional source of motivation.

The key characteristics of informal organization include • Constant evolvement.• Dynamism and responsiveness.• Excellent motivation.• Treating people as individuals.• Difficult to pin down.• Essential for situations that change quickly or are not yet fully

understood.

FUNCTIONS OF INFORMAL ORGANIZATION• Keith Davis suggests the following functions: 1. Perpetuation and reinforcement of the cultural and social values and

particular lifestyle which preserve group unity and integrity.2. Provision of social status and satisfaction by sharing , playing and work

together, making friends which contribute to personal esteem, satisfaction and a feeling of worth.

3. Promotion of communication among members developing communication channels or system to keep its members informed about what management actions will affect them in various ways.

4. Provision of social control by influencing and regulating behaviors inside and outside the group. Internal control persuades members of the group to conform to its life style.

Other benefits in cludes• blending with formal system• Ligthening management work load.• Filling gap in management• Encouraging improved management practice

DISADVANTAGES OF INFORMAL GROUPS

• Informal organization also possess the following potential disadvantages and problems that requires careful management attention

• RESISTANCE TO CHANGE: Perpetuation of values and life styles causes informal groups to become overly protective of their “culture” and therefore resist change within the organisation.

• ROLE COFLICT: The quest for informal group satisfaction may lead members away from formal organizational objectives. What is good for and desired by the group members may not be good for or costly for the organization.

• RUMOR: communication of unverified and untrue information that can create a devastating effect on employees causing conflicts, poor morale, establishment of bad attitudes and deviant or violent behavior.

• CONFORMITY: Social control promotes and encourages reluctance to act too aggressively or perform too high a level. This can harm the formal organization by stifling initiative, creativity and diversity of performance

FORMAL ORGANIZATION• This is usually set out in writing, has a fixed set of rules of intra

organization procedures and structures that ostensibly leave little discretion for interpretation which are usually strictly followed. It

• The work is delegated to each individuals of the organization and works towards the attainment of definite goals, which are in compliance the goals of the organization

• The authority’s responsibility and accountability of individuals in the organization is very well defined.

• There is well defined hierarchical structure which is inherent in any formal organization.

• Permit the application of the concepts of specialization and division of labour, division of work among individuals according to their capacity helps in greater specialization and division of work.It has a well determined objectives and policies.

• Activities of the individuals are checked with strict observance of principle of coordination.

• Messages are communicated through scalar chains.

Principles of Organizational structure • Organizational structure is the framework by which a company

communicates, develops goals and then works on achieving those goals.

• The principles of organizational structure are the methods by which the organization maintains that structure, and the processes it uses to keep the structure efficient.

1. Hierarchy of Command• Respect for the authority of management and the executive team

creates a functional line of communication. Instructions and decrees given by the top management are validated by the belief in the hierarchy structure of the organization.

• Everyone in the company can follow the trail of responsibility for projects, understand who they report to and how the management structure affects their jobs.

• This is why the pyramid structure of organizational charts has emerged.

• At the very top is the Chief Executive Officer.

Principles of Organizational structure 2. Role Definition• This is helps to properly define the roles, responsibilities and standing of each

person within the company to create an understanding of what is expected from, and how individual performance can affect the efficiency of the entire organization.

3. Evaluating Outcomes• Monitoring the outcome of individual projects and ongoing performance

evaluation of individuals help to determine the strengths and weaknesses in the organizational structure whichcan be corrected through training, reallocation of company assets such as equipment, or eliminating ineffective employees or those performing duplicate tasks.

• The strengths of the organization can be amplified to identify future managers of the company, determine successful processes that can be used in future projects, and improve the processes used to reach future company goals.

4. Altering Organizational Structure• Ability to remain dynamic and change to suit the needs of the company.

Elements that necessitate change in an organizational structure include changing customer needs, a change in company management, new technology, etc

OTHER PRINCIPLES

• The principle of unity of Command: An employee may interact with many individuals in the course ofthe work but should be responsible to only one Supervisor.

• The principle of Requisite Authority: when responsibility for a particular task is delegated to a subordinate, subordinate must also be given authority over resources needed for taskaccomplishment.

• The Principle of Continuing Responsibility: When a manager delegates a function to a subordinate, the manager's responsibility for that function is in no way diminished.

• The Principle of Organizational Centrality: Workers who interact with the greatest number of other workers receive greatest amount of work related information and become most powerful in organizational structure.

Organizational Concepts are• 1. Responsibility- is the obligation to do, to the best of one’s

ability, the task that has been assigned,• or delegated. In any organization, responsibility Nursing

Leadership and Management begins with the overall objective of the organization. For example, for nurses in a hospital, service or patient care is the responsibility.

• 2. Authority- the right of decision and commands -An individual with authority has the right to make decisions about his or her own responsibilities. Responsibility and authority are delegated down the scalar chain.

• 3. Delegation- is the process of assigning duties or responsibilities along with corresponding authority to another person. Authority must be delegated with the responsibility.

• 4. Accountability- is answering to someone for what has been done. It is related with responsibility

Types of organisational structure• This is how the organisation's mission is divided into discrete roles and

tasks of individuals within the organisation. • These can fall into the following categories:Functional, product/ service,

geographical, divisional, matrix• Functional - grouping of major functions e.g. contracting, information,

finance, personnel and public health in health authorities• It increases utilisation and co-ordination of groups of people with

technical/specialised expertise• increases development and career opportunities for people in

departments but it encourages sectional interests and conflicts which make it difficult for organisation to adapt to product/service diversification

• Product/Service - grouping by service/ product i.e. orthopaedic, surgical, psychiatric, etc, rather than medical, nursing, paramedical, hotel services (functional).It increases diversification, adaptability is increased if service/ product requires technical knowledge or large equipment but it encourages service conflicts

Types of organisational structure contd• Geographical - a nationalised service develops regions, areas

or district health authorities. e.g.\Primary Care Trusts, Strategic Health Authorities. It is more responsive to local/ regional issues and different cultures, national/ state laws etc but can lead to localities/ regions conflicting with each other

• Divisional - grouping of services and/ or geography and functionality (but with functions such as finance, personnel, planning retained at headquarters). It is suitable for international companies who are highly diversified, working in more than one country e.g. pharmaceutical company with divisions in each country producing and marketing products developed by parent company.

• It corporate strategic control with production and marketing independence at divisions

Types of organisational structure contd• Matrix - grouping of projects and functions, e.g. highly complex

industries, Primary Care Trusts (PCTs). It allows more than one critical orientation to the operations of the organisation. It is useful when there is need to process simultaneously large amounts of information and need for sharing resources

• It combines vertical and lateral lines of communication and authority• stability and efficiency (of mechanistic structure) with flexibility and

informality (of inorganic structure)• emphasises project aims are all-important but it creates potential

conflict between project leader and functional leader regarding resources

• project may be jeopardised if project members as well as leaders enter the conflict on opposite sides

• does not tolerate diversification well• NOTE : Many large, complex organisations opt for mixed forms of

specialisation

Centralisation and decentralisation

This is determined by the power for decision making. • When this rests at a single point in the organisation - in the hands of one person

or group, the structure is 'centralised'. • If it is dispersed among many people/groups, it is known as 'decentralised' (or

distributed).• Centralisation and decentralisation is not usually found as absolutes, but rather

as two ends of a continuum.• It frees top management of routine every day decisions to concentrate on

strategic responsibilities• decisions are more local, quicker, more responsive to clients (patients)• increased awareness of cost effectiveness through the organisation• increased motivation and satisfaction by junior management• Disadvantages• requires good communication and adequate control to and from the centre• need for centre to co-ordinate/integrate• can lead to inequity in treatment of clients/patients• need individuals willing to take on additional responsibilitiesIn general, large organisations lean towards less centralisation, more specialisation,

more rules and procedures to be followed

Levels of the organisation• Drucker divided organisational layers into three main levels:• The technical level of the organisation- concerns specific operations

and defined tasks, with actual jobs to be done, and with performance of the technical function. Inter-relates with managerial level.

• The managerial level (or organisational level)-concerns the co-ordination and integration of work, at the technical level, e.g. resource allocation, administration and control of the operations of the technical function.

• The community level (or institutional level)-concerns the broad objectives and the work of the organisation as a whole. Decisions made at this level will include the selection of operations, development of organisations in relation to external agencies and the wider social environment, e.g. Board of Directors, governing bodies of universities. Control by legislation, codes of standards, professional or trade associations, political or government action and public interests.

Factors determining structural design:

• Design assumes discretion, an ability to alter the system. In the case of the organisational structure, design means 'turning those knobs' that influence the division of labour and the co-ordinating mechanisms thereby affecting how the organisation functions.

Mintzberg identified four broad groupings of organisational structure :

• Design of positions• Design of superstructure• Design of lateral linkages• Design of decision making

HOSPITAL ORGANIZATION: ITS STRUCTURE AND SUB-SYSTEM

• Hospital system is an interaction point between the hospital staff and the patient and his relatives. On arrivals of the patient, group of people from inside the hospital as well as from outside engage themselves for his care therefore hospital is an open system.

• Hospital system consists of co-ordinate activities provided by a variety of categories of hospital staff utilizing different skills and equipment.

• The hospital has patient essential and supportive services which include:

• Outpatient department services• Inpatient department services• Emergency and casualty service

Hospital supportive services include• Radiology services• Laboratory services centre• Sterile supply services• Laundry services• Blood bank• Mortuary• Rehabilitative services• Medical records• Medical social worker• Pharmaceutical services• Administrative services• Personnel management

• Financial management• House-keeping material

management• Utility services• Dietary services• Hospital engineering services• Transport • Medical store• Public relation• Communication, fire and

security

HOSPITAL ORGANIZATION: ITS STRUCTURE AND SUB-SYSTEM

• Hospital vertical organization structure is designed to ensure that health care workers are focused on their specific roles.

• With lives in their hands, hospital have to function very precisely, executing high quality services every hour of everyday.

• Organizations that have this sort of requirement usually take on a vertical organisation structure having many layers of management in heirracical order.

HOSPITAL STRUCTURE AND ORDER• Directors: Usually hospital is overseen by board of directors• Executives: The Chief Executive Officer is the top boss responsible for

everything that goes on in a hospital. However, hospitals usually have Chief Medical Officers, Chief Information Officers, Chief Financial Officers, Chief Nursing, etc.

• Department Administrators: The top managers of each hospital department report to

the core management. They are responsible for one type of medical or operational

services.

HOSPITAL STRUCTURE AND ORDER

There are non-patient care departments such as food services and billing

Clinical department usually have large staffs, therefore, administrators often have assistant administrators who help them oversee their multifaceted operations.

• Patient care managers: Within a department, there are the people who directly

oversee patient care. Nurse Managers, directors of rehabilitation services and supervising physician

• Service provider: Most of hospitals are composed of service providing staff.

From nurses and physical therapist to cooks and laundry workers etc.

REFERENCES• Arnoid Anderson,(2008), Principle of Effective Organization chart, University of

Toronto• Cecil A.,(2003), Understanding the impact of organizational structures, Medical

centre today.• Clifford Handey,(2006), Organizational structure of a Hospital, University of

North Texas. • Henry P., Personalty and Leadership Behaviour, Addison Wesley. • John K.,(2007), Navigating The Informal Organisation, Business Week.• Richard S., Understanding Organisation and Institution, Handbook of Social

Psychology,, Addison Wesley• Child J. Organization. 2 ed. Paul Chapman, 1988.• Drucker Peter (1998) on The Profession Of Management' Harvard Business

School Press• Mintzberg H (1979) The Structuring of Organisations. Englewood Cliffs. N

Jersey. Prentice Hall• © K Enock 2006

Assignment

• Take a study of a private and a government hospital in your locality. Compare and contrast between the organisational charts of each

• What factors shape these two?• What factors determines their

decentralisation and centralisation?