ORGANIZING

Module 7: ORGANIZING
Mind Set: NETWORKING

1. Define key terms.
2. Discuss organizational concepts.
3. Identify the different modes of organizing patients care.
4. Discuss the roles and functions in staffing.
5. Stress the importance of staffing needs and scheduling policies.

COMPONENTS OF ORGANIZATIONAL STRUCTURE:

ORGANIZATIONAL CHART- to depict an organizations structure. Because the organizational chart is a picture of
an organization.
The organizational chart defines formal relationships within the institution, areas of responsibility, persons to
whom is accountable & channels of communication.

1. RELATIONSHIPS AND CHAIN OF COMMAND

Solid Lines (unbroken) shows the formal relationships, lines of communication and authority.
Line position can be shown by solid horizontal or vertical lines.






Vertical lines are referred to as lines of authority and accountability.
Lines of authority represent the responsibility of individuals to supervise others officially and are
identified by moving downward on the chart.
Lines of accountability also called reporting relationships, represent a responsibility to report to
another person.
The level of position on the chart also signifies status and power.

Dotted or broken lines on the organizational chart =represent staff position. These positions are advisory, a staff
member provides information and assistance to the manager but has limited organizational authority.
Advisory (staff) position do not have inherent legitimate authority and staff position often lack the authority
and staff position often lack the authority that accompanies a line relationship.

2. SPAN OF CONTROL = can be determined from the organizational chart.

The number of people reporting to any one manager represents that managerss span of control and
determining the number of interactions expected of him or her.
When determining the span of control in an organization, the managers abilities, the employees maturity, task
complexity geographic location, and the level in the organization at which the work occurs must be considered.

3. MANAGERIAL LEVELS
TOP LEVEL MANAGER: coordinate internal and external influences and generally make decisions with few with
few guidelines or structures.
MIDDLE-LEVEL MANAGER: coordinates the efforts of lower levels of the hierarchy and are the channels
between lower and top-level managers.
FIRST-LEVEL MANAGER: concerned with their specific units work flow. Deals with immediate problems in the
unit daily operation, with organization needs and personal needs of employees.

4. CENTRALITY = refers to the location of a position of an organizational chart where frequent and various types of
communication occurs.
Centrality = is determined by organizational distance.

DECISION-MAKING WITHIN THE ORGANIZATIONAL HIERARCHY

DECISION MAKING Hierarchy or Pyramid is often referred to as Scalar Chain
CENTRALIZED DECISION MAKING- decisions are made by a few managers at the top of the hierarchy
DECENTRALIZED DECISION MAKING diffuses decision making throughout the organization and allows
problems to be solved by the lowest practical managerial level. (Problem are solved at the level to which they
occur)




LIMITATION OF ORGANIZATION CHARTS

ADVANTAGES LIMITATIONS
1. Maps lines of decision-making
authority.
2. Helps people understand their
assignments and those of their
coworkers
3. Reveals to manages and new personnel
how they fit into the organization
4. Contributes to sound organization
structure
5. Shows format lines of communication
1. Shows only formal relationship
2. Does not indicate degree of authority
3. May show things as they are supposed
to be or used to be rather than as they
are
4. Possibility exists of confusing authority
with status.

FIVE MAJOR CHARACTERISTICS OF AN ORGANIZATIONAL CHART

DIVISION OF WORK each box represents the individual or sub-unit responsible for a given task oh the
organizations work load.

CHAIN OF COMMAND lines indicates who reports to whom and by what authority.

TYPE OF WORK TO BE PERFORMED indicated by labels or descriptions for the boxes.

GROUPING OF WORK SEGMENTS shown by the clusters of work groups (departments or single units)

LEVELS OF MANAGEMENT- indicate individual and entire management hierarchy.

HIERARCHY= refers to a body of persons or things organized or classified in a pyramidal fashion according to rank,
capacity or authority assigned to vertical levels with offices ranked in grades, orders or classes one above the other.

AUTHORITY= the right to act or make decisions without approval of higher administrators.


LINES AND STAFF RELATIONSHIPS

LINE AUTHORITY- simplest and most direct type; each position has general authority over the lower positions in the
hierarchy in the accomplishment of the main operations of the organization

RESPONSIBILITY- obligation to perform the assigned tasks; it is a duty or an assignment; it is the implementation of
a job.

ACOUNTABILITY- taking full responsibility for the quality of work & behavior while engaged in the practice of the
profession;

INTERNALIZED RESPONSIBILITY to be accountable means that the individuals agree to be morally responsible
for the consequences of their actions;

POWER- the ability to influence another to behave in accordance with ones wishes.

STATUS- the rank a group bestows on a person in accord with the groups estimation a of the persons value and
significance to group goals.

COMMUNICATION- the transmission of information between persons

TYPES OF ORGANIZATION CLASSIFIED BY NATURE OF AUTHORITY

1. LINE ORGANIZATION the simplest and most direct type or organization in which each position has general
authority over the lower position in the hierarchy.

In these structures, authority and responsibility are clearly defined, which leads to efficiency and
simplicity of relationships.

DISADVANTAGES:
Often produce monotony,
Alienate workers
Make adjusting rapidly to altered circumstances difficult
Chain of command restricts upward communication

2. INFORMAL ORGANIZATION refers to horizontal relationships rather than vertical. It is composed of small
groups of workers with similar interest.

3. STAFF ORGANIZATION- purely advisory to the line structure with no authority to put recommendations into
action.
Eg. Training and research

4. FUNCTIONAL ORGANIZATION is one where each unit is responsible for a given part of the organizations
workload. There is clear delineation of roles & responsibilities which are actually interrelated.
Eg. All standing and ad hoc committees

5. AD HOC DESIGN a modification of the bureaucratic structure and is sometimes used in a temporary basis to
facilitate completion of a project within a formal line organization.

DISADVANTAGES:
- Decreased strength in the formal chain of command and decreased employee loyalty to the parent
organization.

6. MATRIX ORGANIZATION STRUCTURE- it is designed as all the tasks required to produce the product, and the
product is the end result of the function.

















7. SERVICE LINE ORGANIZATION- is used in some large institutions address the shortcoming that are endemic to
traditional large bureaucratic organizations
-It is sometimes called Car-centered organization

8. FLAT ORGANIZATIONAL DESIGNS - designed to remove hierarchical layers by flattening the chain of command
and decentralizing the organization
- Many managers resist this type of organization as it increases their work load

- Flat or (decentralized structure) decentralized organization, the chart of relationship shows fewer
levels and a broad span of control.

- Decentralized organization have an opportunity to develop their own abilities and autonomy and often
see the organization as more humanistic.

- Results greater job satisfaction for the majority of individuals.

- Strength: is the simplification of communication patterns, which flow easily from lower levels to higher
levels in direct manner.

SHARED GOVERNANCE:
ORGANIZATIONAL DESIGN OF THE 21
ST
CENTURY

One of the most innovative and idealistic of organization structures
Developed in mid-1980s as an alternative to the traditional bureaucratic organizational structure.
Often describe as a flat type of organizations.
Organizations governance is shared among board members, nurses, physicians, and management
Decision-making & communications channels are altered
Aim: empowerment of people within the decision-making system.
In healthcare system is directed at increasing nurses authority and control over nursing practice by being
accountability based governance system for professional workers.
Participatory mgt. lays the foundation for shared governance they are not the same. Participatory management
implies that the others are allowed to participate in decision making over which someone has control.

PRINCIPLES OF ORGANIZING

1. UNITY OF COMMAND indicated by the vertical solid line between positions on the organizational chart;
Best describe as one person/boss in which employees have one manager to whom they report and
to whom they report and whom they are responsible, Responsible to only one superior

2. SCALAR PRINCIPLE or HIERARCHY- authority and responsibility flows in clear unbroken / solid lines from the
highest executive to the lowest; formal paths of communication and authority
Chain of Command a military term, proper definition and delegation of authority and
responsibility facilitate the accomplishment of work;

THINGS TO BE OBSERVED AND MADE TO UNDERSTAND:

When responsibility for a particular job is delegated to a subordinate , the subordinate should
have authority over resources needed to accomplish the task;
When a particular function is delegated to as subordinate, the superiors own responsibility is in
no way decreased;
When a person is given authority for action, he is accountable and responsible for his actions to
the person who gave him such.

3. HOMOGENOUS ASSIGNMENT OR DEPARTMENTATION workers performing similar assignments are group
together for a common purpose;

4. SPAN OF CONTROL- the number of people directly reporting to any one manger represents that managers span
of control and determines the number of interactions expected of him.

5. FLATTENING THE ORGANIZATION- reduction in numbers of administrative levels.

6. EXCEPTION PRINCIPLE- recurring decisions are handled in a routine manner by lower-level managers whereas
problems involving unusual matters are referred to the higher levels;

MODES OF ORGANIZING PATIENT CARE

1. TOTAL PATIENT CARE NURSING or CASE METHOD NURSING
Oldest mode of organizing patient care. The nurse assumes total responsibility for meeting all
the needs of assigned patient during their time on duty.


To date: used in hospitals and home health agencies
Provides nurses with high autonomy and responsibility

2. FUNCTIONAL NURSING or CARE THROUGH OTHERS
History: functional nursing care evolved primarily as a result of world war II and the rapid
construction of hospitals as a result of the Hill Boston Act.



MAJOR ADVANTAGE OF FUNCTIONAL
NURSING:
LIMITATIONS:
Efficiency- tasks are completed
quickly with little confusion
regarding responsibilities
A. May lead to fragmented care and the
possibility of overlooking priority
patients needs.
B. Some workers may feet unchallenged
and under stimulated in their roles; it
may result in Low Job Satisfaction.
C. Functional nursing may not be cost
effective due to the needs for many
coordinators Employees often
focus only in their own efforts with
less interest in overall results.

3. TEAM NURSING/ MODULAR NURSING
Was developed in the 1950s in an effort to decrease the problems associated with the functional
organization of patient care.
In team nursing, ancillary personnel collaborate in providing care to a group of patient under the
direction of a professional nurse.






















TEAM NURSING ORGANIZATION STRUCTURE


ADVANTAGES DISADVANTAGES
Group members are given as much
autonomy as possible when performing
assigned tasks although the team shares
responsibility and accountability
collectively.
Team nursing allows members to
contribute their own special expertise or
skills;
High job satisfaction= if given the
autonomy and recognizing individual
worth
Improperly implementation rather than with the
philosophy itself
Insufficient time is allowed for team care
planning and communication
Can lead to blurred lines of responsibility errors
and fragmented patient care.

4. PRIMARY NURSING
Developed in the early 1970s uses some of the concepts of total patient care and brings the registered
nurse back to the bedside to provide clinical care.
Primary nursing- requires a nursing staff-RNs
This method is quite difficult to implement because of the degree of responsibility and autonomy
required of the primary nurse.









PRIMARY NURSING STRUCTURE





CHARGE NURSE
TEAM LEADER TEAM LEADER TEAM LEADER
NURSING STAFF
PATIENTS
NURSING STAFF
PATIENTS
NURSING STAFF
PATIENTS
PRIMARY NURSE

PATIENT

PHYSICIAN

CHARGE NURSE

HEALTHCARE
ORGANIZATIONS
RESOURCES

ASSOCIATE NURSE
(EVENINGS)

ASSOCIATE NURSE
(NIGHTS)
ASSOCIATE NURSE
(AS NEEDED)
(DAYS)








5. CASE MANAGEMENT
Latest work design prepared to meet patients needs.
Defined as collaboration process that assesses, plans, implements, coordinates, monitors & evaluates
options and services to meet an individuals health needs through communication & available resources to
promote quality cost-effective outcomes
Focus of case management=is an individual clients
Case management handles each case individually.
DOWELL (1996) IDENTIFIES THREE BASIC MODELS OF CASE MANAGEMENT
BROKERAGE CASE MANAGEMENT MODELS:
The case manager identifies needed services and makes referrals to various sources but does not
directly provide the services.
SERVICE MANAGEMENT MODEL:
The case manager manages both the clients service budget and directly provides most if not all
services.
MANAGED CARE MODEL:
Providers are paid for services prospectively. Thus, services provided are cost centers, not revenue
producers.
In all these models, the case manager works to see that client receives appropriate resources in a time- and
cost effective manner and ensures continuity of care.
3 TYPES OF ORGANIZATIONAL CULTURE:
1. COOKE AND LAFFERTY (1989) POSITIVE CULTURE = constructive culture in which members are encourage to
interact with others and to approach tasks in proactive ways that will help them to meet their satisfaction
needs.
2. PASSIVE AGGRESSIVE
3. AGGRESSIVE DEFENSIVE = members interact in guarded and reactive ways and approach tasks in forceful ways
to protect their status, and security.
These 2 cultures are based on approval, conventional, dependent and avoidance norms and
oppositional, power, competitive and perfectionistic norms.
Discuss the structure and relationships of an organization by using an organizational chart; include type
of structure, span of control, chains of command, channels of communication and lines of authority and
accountability.

ADVANTAGES DISADVANTAGES
The primary nurse assumes 24 hours
responsibility for planning the care of one
or more patients from admission or the
start of treatment to discharge or the
treatment ends.
During work hours, the primary nurse
provides total direct care for the patient.
When the primary nurse is not on duty,
associate nurses who follow the care plan
established by the primary nurse provide
care.
Improper implementation (same in team nursing)
Inadequate in preparation or incompetent
prepared nursing-may incapable of coordinating
a multidisciplinary team or identifying complex
patient needs and condition changes.