Chapter 2: Understanding and Working in Organizations

Chapter 2: Understanding and Working in Organizations

Organization Defined as a formally constituted group of people who have identified tasks and who work together to achieve a specific purpose defined by the organization. All organization have purpose and structure.

To understanding of how the organization in which you are employed is structured. You need to ask these questions: To whom do I report? To whom can I delegate? To whom do I go with a problem or concern? How do I report error? Who will evaluate me ? Am I responsible for evaluating someone else? These and many other questions are answered by understanding the organization’s structure and function.

Understanding Organizational Structure and Function Organizational Structure: Means the way in which a group is formed, it’s chains of command, it’s lines of communication, and the process by which decision making occurs. The formal working relationships and identifies who is accountable and responsible for various jobs that make the organization viable.

The organizationis hierarchically arranged,with people employed in the defined roles within the organization having different levels of power (or authority) and rank from what others have.

Max Weber (father of organizational theory) placed high value on bureaucracy (the administration of institutions through departments or subdivisions managed by sets of officials who followed an inflexible routine) and it’s importance in the operation of an organization.

Gardner, 1995 referred to bureaucracy as a closed, rational system that focuses on internal interactions and places emphasis on organizational order and control. It does not take into consideration the complexity of multifaceted health care organizations of the twenty-first century.

Kotter (1995) states “a central feature of modern organizations is interdependence, where no one has complete autonomy, where most employees are tied to many others by their work, technology, management system, and hierarchy.” This is certainly true in today's health care facilities. The structure of any organization is designed to allow it to accomplish its purposes in an efficient and effective way.

Organizational Function Is the way interactions actually occur within the organization. It is often complex and may be related to characteristics of the employees as well as to the planned structure of the organization itself.

Types of Organizational Structure Tall or centralized structure, Flat or decentralized structure, Matrix structure. Two other approaches that affect structure: Adhocracy, Shared governance.

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1. Tall Organizational Structure: It also called centralized, because most of the decision-making authority and power is held by a few persons in central positions that typically are found at the top of the chart.

Advantages: The ability of an individual to be an expert in the narrow area over which he or she is responsible, such as intravenous (IV) therapy. Use fewer skilled individuals, they supervised others who carry out standardized procedures. Because the supervisor has fewer people to supervise, close supervision is possible.

Disadvantages: Most skilled individuals may end up doing nothing but supervising. The very closely supervised people may feel barely audible and in extreme cases even mistrusted. Difficult communication; it must pass through many layers.

Disadvantages: The person with authority for decision-making may be quite far removed from the actual situation. Implementation of a decision may be excessively delayed. Some communication never reach the individual who might be able to make a decision for change when that is needed.

2. Flat or Decentralized Structure: District 1 District 5

2. Flat or Decentralized Structure: In type of organization, decision-making is commonly spread out among many people. Close supervision is not possible when supervisor responsible for many people. Manager relies on individuals to make independent decision individuals have an opportunity to develop their own abilities and autonomy. People see the organization as more humanistic. The result is greater job satisfaction for the majority of the individuals.

Advantages: Decentralized organization is the simplification of communication pattern, which flow easily from lower levels to higher levels in a direct manner. Less chance of communication becoming lost or distorted. Speed with which the organization can respond to problems or new opportunities.

Disadvantages: The individual in charge may have so many individuals with whom to relate that the various parts of the organization do not work together as effectively as desired. The manager may lack critical information to make decision at that higher level. Managers may have lack expertise in the wide variety of operations making inappropriate decisions. A greater need for on going education of individuals within the organization to enable them to make good decision.

Many health care organization are moving toward more decentralization models for nursing services.

3. Matrix Structure Vice-Pres. Development. Vice-Pres. Financial Dept Plan & Marketing Pt. Serv. Develop.

3. Matrix Structure Are most often found in very large , multifaceted organizations. These may be seen as autonomous units within a hospital established to offer special type of services, such as women’s centers which might include obstetricians and weight loss specialists, psychologists and psychiatrists plastic surgeons, or sports medicine centers. The goal is to attract more patients who will appreciate having all the services available in one area and involves a team approach.

3. Matrix structure “cont.” Ford and Randolph (1992) discussed the difficulty that continues to exist in defining a matrix organization. They suggest that matrix management often is whatever a company defines it to be, and state that project management has likewise come to mean a variety of things That is either tall or flat and is thought of as the functional structure. Project structure overlies the matrix structure, creating two directions for lines of authority, accountability, and communication or a multiple command system. These structures may also be referred to as cross-functional.

Functional managers (or line managers) have the responsibility of maintaining adequate staffing, developing or acquiring skills needed to support the projects, and providing for evaluation and career development of personnel. The project manager directs the project team that develops project standards and management practices, and oversees their application to the various projects.

Advantages: Bring together wide expertise and often generates more creative solutions as a result of flexible use of human resources. The team managers learn more about one another’s concern, and this involvement may also improve their working relationships, functional integration, and skill development.

Advantages: Advantages are derived from creation of horizontal communication linkages that solve information processing problems. Communication is improved by the close contact with all organizational groups, which is required of managers to assure project success.

Disadvantages: Can result in areas of leadership conflict, poor communication, lack of understanding of roles and expectations, cost created by dual authority, and concern regarding personal evaluation. A team member who will be evaluated by both the team leader and the base department manager may feel a conflict and find it frustrating to be asked to do more than is realistic within the time allotted.

Disadvantages: Dual-reporting relationships may also be a concern. Individuals within the organization may report to at least two managers, the nursing manager and the project director. This can lead to confusion and conflict, and ambiguity; a price individuals may have to pay for working in a matrix.

Persons working in a matrix organization need good interpersonal skills and training because they will be working in a collegial rather than a hierarchical relationship. Power balance between the two structures may become a concern.

4. Adhocracy Structure This type of structure uses teams of specialists who are organized to complete a particular project or task. Composed primarily of highly specialized professionals. The work is delegated by a director to members of the project team who provide particular expertise. The team are creative, flexible, and fluid.

The role of the leader is to create the process for effective problem solving and is based on the belief that the best thinking come from team effort. • Team of this nature work especially well when trying implement change. • This structure might be seen in hospice organizations, and community health.

The Relationship with the Organization Authority and Accountability Authority: refers to the official power an individual has to approve an action, to command and action, or to enforce a decision. Formal authority is conferred by virtue of an explicit set of expectations , such as those found in job descriptions, the manager agrees to meet. Informal authority come from promises the manager makes that are often left implicit, such as the expectation that the individual will be trustworthy, competent, considerate, and demonstrate values and skills that are predictable.

The concept of authority is associated with power, because it legitimizes the right of the manager or supervisor to give direction to others and expect them to comply. In bureaucratic organizations, authority originates at the top of the organizational hierarchy and works its way down. The expectation is that the subordinates will follow direction from the manager.

A second view of authority is the acceptance theory It proposes that a leader earns authority from the subordinate. It is a bottom-up approach in which the subordinate gives authority to the manager. In reality, in the best-working organizations, perhaps it is a bit of both.

Accountability Refers to the process of answering for what occurs in an ethical and legal sense, it represents an obligation to perform certain activities and duties. It may use this term interchangeably with responsibility. When the nurse delegates task to others remains accountable or legally liable for the outcomes. Ex. Registered nurse assign the task of taking blood pressure. The RN. is still responsible and accountable for - Assuring correct reading, and - Appropriately documented.

The structure of the organization helps designate the authority and accountability of all persons working within that body. Indicates who gives instructions to whom and who must answer for the actions that follow.

Problem arise in organizations when people are asked to be responsible for certain outcomes but are not provided with authority with which to accomplish the goals. Organizations are healthier when the structure and function are well described, authority is appropriately provided to match responsibilities, and this information is known to all involved.

Chain of Command It identifies the path of authority and accountability from one individual with top administrative authority to the individuals at the very base of the organization. It also referred to as organizational hierarchy.

The Nursing Administrator gives directions to and evaluates the performance of The Assistant Administrator who in turn gives direction to and evaluates the performance of TheNurse Manager

Frequently use the language “report to” which indicates that the nurse manager is accountable for his or her activities to the nursing administrator. As registered nurse, you will likely have the responsibility of giving direction to an overseeing the activities of the practical nurse and the nursing assistant, and in turn, report to you.

Channels of Communication Defined as the patterns of message giving within an organization, and they typically correspond to the chain of command. Formal communications are not supposed to skip or loop any levels. In bureaucratic organization, it is generally considered improper and inappropriate to skip or bypass any of the levels in the communication system.

Channels of Communication “cont.” Not all communication follows these formal pathways. others ,especially those that involve subordinates in decision making, encourage communication outside those lines if the desired action would be accomplished more efficiently. Effective function often requires that a manager communicate directly with individuals at many different positions in the organization.

Span of Control Means the number of individuals a person is responsible for managing. A narrow span of control, the individual will be responsible for only a few people and perhaps one or two task areas, this individual is likely to be an expert in the task area (IV therapy). Wide span of control, if given responsibility for the IV team, the emergency dept. and the staffing office, this person could not possibly be a clinical expert in every area and it is unlikely to be involved in providing direct care in those departments.

Factors affecting appropriate span include: Size of the organization. Organization’s philosophy. Services provided. Availability of resources (human resources). The manager’s expertise and abilities. The skills and experience of the employees. The task to be accomplished. The level in which the organization at which the position occurs.

Job Descriptions It is a written statements, found in policy manuals that describe the duties and functions of the various jobs within the organization. They outline the scope of authority, responsibility, and accountability involved in each position. The Job Description should provide: The broad general guidelines under which the individual will function. The basis for performance evaluation of the person working in that role.

The job description for a nurse in an outpatient clinic will be quite different from that for a nurse in critical care.

Organizational Charts It is used to depict the structure of the organization. It identifies to whom various individuals within the organization report. It is a graphic, pictorial means of portraying various roles and patterns of interaction among parts of the system.

The Organizational Chart Presents the formal structure of an organization. Shows relationships of people or departments to one another. Provides information on the size of the organization. Provides the formal chain of command. Lines of communication and the authority for decision making.

The Organizational Chart Is typically represented by boxes stacked in a pyramid-shaped chart. The greater authority exists at the top of the chart (often a single box) referred to as executives, administrators or the management. Declines as you move toward the base of the structure (many boxes) referred to as staff or employees. The level between the top and the base known as middle management; a group responsible for coordinating and controlling activities of a specified group of workers.

Chapter 2: Understanding and Working in Organizations