Organization of health services

1. Organization of health services

2. The term organization refer to " any collection of persons, materials, procedures, ideas or facts so managed & ordered that in each case the combination of parts makes a meaningful whole that at achieving organization objectives.

3. In other words the process of organization implies the arrangement of human & nonhuman resources in an orderly fashion to make a meaningful whole that accomplishes organizational objectives.

4. Acquisition of human & non human resources After deciding on the major operating units & departments the required resources must be acquired & fitted in the right place. On appointment every employee must be informed of what is expected of him (his/ her responsibility) & what is within his / her power (his/ her authorities). This is usually found in the "job description".

5. Organizational charts formal relationship between people in various position in the organization. They shown who supervises whom & how various jobs& departments are linked together to make achieve coordinated system. Main channels of communication (downward, upward , horizontal, and diagonal)

6. Downward flow of authority (orders & commands) from superior to subordinate to = chain of command. Upward flow of communication (accountability) from subordinates to superior. Horizontal flow of communication between employees of the same level. Diagonal communication flow between employees of different level have different functions (e.g. between nursing station and pharmacy )

7. In a chart solid lines denotes lines of command (line of authority) whereas dotted lines denotes counseling or advisory line.

8. Types of charts Skeleton charts: these present only the main units or departments of the organization

9. Personal charts: these show the major positions or titles and may be the names of persons occupying them. It is simply a diagram of the formal authority structure. It shows by job title , who reports to whom, and who has authority over whom, but does not show the extent of that authority or the duties each person in the organization is expected to perform, except in so far as duties are implied by job titles.

10. organizational manuals including job description are prepared in relation to charts. Rarely we have a functional chart.

11. Functional chart: include a brief description of the functions, purposes, duties and activities of each person, but these are rarely done since they are usually replaced by manuals including (job description and job specification)

12. Advantages of organizational charts 1. The executive managers to think more specifically about the actual relationship between workers. 2. It give a quick visual illustrations of the structural design & communications in the organization. 3. they can be useful tool to familiarizes outside about the organization as well as to train & orient new employees since they show lines of authority, channels of communication.

13. Disadvantages of organization charts 1. Must be updated continuously. 2. not practical with executives whom like freely changes jobs & relations of employees. 3. Preparation & circulation may be expensive in a large organization. 4. May produce hard feelings for those low in the hierarchy. 5. Difficult to describe all relationships of the entire organization on the chart.

14. Formal VS informal organizations The formal organization is planned prescribed structure that displays the formal organizations pattern of authority and responsibility relationships.

15. The informal organization is unplanned interactions between members which actually not depicted on any organizational chart. These relationships and interactions which occur spontaneously between members of the organization.

16. The basis of the interaction between these informal groups or subsystems may be social, technical, or power ties, may be, the informal organization affects to a great extent the achievement of the organizational goals.

17. Positive aspects of informal organizations Complement the formal organization. Provides necessary social values and stability to workgroup. Simplifies the manager job. Provide an additional channel of communication (grape vane).

18. Negative aspects of informal organization 1. Dissimilar objectives. 2. role conflict.

19. Principles of classical Organization chart Departmentalization: It is the major operating division into which the work may be divided. Departmentalization is the process of grouping activities into units for Purposes of administration.

20. The grouping process follows certain patterns It can be grouping by services in which case activities directly associated With services are grouped together Grouping can be by location e.g. inpatient & outpatient department, or by geographic area, which occurs when activities are widely dispersed. This has the benefit of meeting local needs.

21. Grouping by clients. This resorted to assure attention to certain groups of People like mothers and children�. Etc. Grouping can also be by time e.g. morning, afternoon & night shifts.

22. 111- Specialization & Division of labor The work necessary to accomplish goals & objectives is then divided into Specialized tasks & assigned to specific individuals. Dividing work into Specialized tasks is advantageous because each individual has limitations & because a greater uniformity & skill in performance can be obtained through Specialization of work.

23. Theoretically therefore, division of labor increases the efficiency of individual & group performance. However one potential disadvantage of extreme specialization in work is its bad effect on job example of a worker in an automobile factory who spends 8 hours day performing one tiny repetitive task as inserting a special nail in a Special place clarifies how extreme specialization may have bad effects on the psychology of workers.

24. Another disadvantage is the tendency of employees within a given specialty to view their special task as more important than the overall organizational objectives. Therefore with specialization there are the problems of integrating & coordinating the Specialized units or departments to attain overall objectives.

25. 1V- Coordination: Coordination means assembling & synchronizing work efforts so that they function harmoniously to attain organizational objectives. In a health organization one finds many people, supplies, equipments, forces, services�. etc fitted together to form department, sections, hospitals, health centers�..etc.

26. In the coordination process many factors are involved  Parts and features that need to be arranged or operated together i.e. human and non-human resources (what is to be coordinated?). 2. Means by which by these parts are together like : laws, Skills, norms, committees �etc (how to coordinate) 3. Environment in which the parts to be coordinated and means to hold them are existing e.g. time place, distance of physical facilities�..et. (Where & when to coordinate?).

27. V- Equal Authority , Responsibility, and Accountability: Authority is the official power to act . It vested on the organizational head giving him the right to command and the subordinates the duty to obey. Responsibility refers to duty or an assignment. Accountability refers to the extent to which a sub ordinate may be held by this superior to be directly responsible for results good or bad.

28. VI- Centrality: Centrality indicates the location of a position in an organization where frequent communication occurs.

29. 1V- Centralization and Decentralization Refers to the level at which most or the operating decisions will be made. The greater the number of decisions made lower down the management Hierarchy the greater the degree of decentralization. Generally speaking, it is advisable that decisions concerning day- today matters should be Pushed down the organization structure and not be handled by top management.

30. Advantages of decentralization: 1- Quick action regarding specific problems. 2- Facilitates adaptation of decisions according to local needs. 3-Relieves top management from involvement in routine decisions thus saving time and energy. 4-Increases flexibility of action as junior staff are allowed to make Prompt decisions without having to wait for approval from to management.

31. 5- Is effective in developing the junior staff to hold top management Positions. 6- Decentralization of management decisions may be used to improve morale of lower level employees.

32. Advantages of Centralization. 1- Uniformity of policy and action. 2- Enables maximum use of the skills and knowledge of centralized Staff. 3-Fosters better control of the organizations activities. 4-Enables the use of not highly skilled subordinates since every little detail is set by the top management.

33. Note: The operational question faced by to management in deciding What amount of centralization decentralization is desirable? Can only be answered by saying that it depends on the individual Situation.

34. A concept which has come to be considered as an integral part of the Centralization and decentralization issue is �delegation of authority�. The more delegation of authority the greater the decentralization.

35. V- Unity of Command: The classical principle of command suggested that each individual in the Organization should be directly responsible to, and receive orders from, Only ONE supervisor and through this ultimately answerable to the head Of the organization.

36. This prevents reception of conflicting orders from more than one superior which may lead to deleterious effects. No man can serve two masters �. At the same time, subordinates may be able to play one superiors against another & thereby escape responsibility.

37. Management by exception The manager need only be called upon to handle the exceptions to the patterned decisions� (i.e. the exceptions to the routine decisions), he has previously made in setting up the policies, rules and Procedures. This way the manager becomes involved only with the exceptional, non- routine decisions, which usually pertain to more Serious situations whereas the subordinate handles the day � to � day decisions.

38. Criticism of classical theory The motivational assumptions are incomplete and in accurate. Intra-organizational conflict (competition) is generally ignored. Little attention is given to the role of cognition in task identification and decision. The phenomenon of program elaboration receives little emphasis.

39. Modern organizational structure Project organization: As a structural means for focusing a large amount of talent and resources for a given period on a specific project or task. The project " team of various specialists is put together under direction of the project manager. Here there is emphasis on direct horizontal relations among specialist. Communication rarely goes up. It offer greater flexibility and response to innovative ideas.

40. Matrix organization: when project organization is superimposed on a functional, hierarchical organization the result is matrix one. At this point it is enough to say that matrix organization incorporates some of the best aspects of project organization and functional organization.