ORGANIZATIONAL STRUCTURE | NCM 119 | TOPIC 04

UNIT 4 (CHAPTER 12) LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS BY MARQUIS & HUSTON
LESSON OUTLINE v Conversations that occurs in breakrooms, down the halls,
1. Formal and informal organizational structure during carpool etc
2. Organizational theory and bureaucracy
3. Components of organizational structure v Fast and facilitate info upward, downward, and horizontally
a) Span of control v Difficult to stop sometimes becomes rumor or gossip
b) Unity of command
c) Scalar chain ORGANIZATIONAL THEORY &
d) Centrality BUREAUCRACY
e) Managerial levels v Max weber à Father of organizational theory (German social
4. Organizational charts scientist)
5. Types of organizational structures
a) Line structures v Legal rational authority
b) Ad hoc design • Legitimacy of normative rules and the rights of those in
c) Matrix design authority
d) Service line organization
e) Flat designs • Obedience is owed to legally established impersonal rules
6. Stakeholders • Basis of Weber’s concept of bureaucracy
7. Organizational culture v Defining characteristic of bureaucracy à an institutional
8. Shared governance
9. Organizational effectiveness method of applying general rules of specific cases (fair and
10. Magnet designation predictable)
v Bureaucracy was the ideal tool to routinize the energy and
FORMAL AND INFROMAL prolific production of the industrial revolution
ORGANIZATIONAL STRUCUTRE CHARACTERISTICS OF BUREAUCRACIES
v Organizing à process of establishing formal authority to
v Clear division of Labor
accomplish unit objectives
v Well-defined hierarchy of authority
v Organizational structure à the way in which a group is
v Impersonality of interpersonal relationships
formed, its lines of communication and its means for
v System of procedures for dealing with work situations
channeling authority and making decisions
v System of rules covering the rights and duties of each position
v According to Fayol (1949) organization is formed when the
v Selection of employment and promotion is based on technical
number of workers is large enough to require a supervisor
competence
FORMAL
v The emphasis is on organizational positions and formal power COMPONENTS OF ORGANIZATIONAL
v Generally, highly planned STRUCTURE
v Created by Max weber
v Departmentalization and work division
v Framework for defining managerial authority, responsibility and
CHAIN OF COMMAND
v Authority are depicted by solid Unbroken (solid) lines
accountability
• Solid horizontal lines à similar responsibilities and power
v Accountability is the moral responsibility that accompanies a
but different functions
position.
• Solid vertical lines à official chain of command
v Responsibility is related to job assignment and must be
v Staff positions à dotted or broken lines
accompanied by enough authority to accomplish the assigned
v Advisory staff positions do not have inherent legitimate
task.
authority
v Authority is the official power to act and direct the work of
SPAN OF CONTROL
others. v Refers to the number of people directly reporting to any one
INFORMAL manager and determines the number of interactions expected
v The focus is on the employees, their relationships, and the
of him or her.
informal power that is inherent within those relationships
v Inverse relationship between the span of control and the
v Naturally forming social network of employees; Unplanned and
number of levels in hierarchy in an organization
often hidden
v Flattening the organization à increased span of control
v Fills in the gaps with connections and relationships that
and reduce the number of administrative levels in an org.
illustrate how employees’ network with one another to get work
UNITY OF COMMAND
done v Best described as one person or one boss in which
v Based on camaraderie employees have one manager to whom they report and to
GRAPEVINE whom they are responsible.
v Informal structure communication network v Indicated by the vertical solid line between positions
v Heart of informal structure

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Organizational structure NCM 119
v Difficult to maintain in in some large health care orgs because DISADVANTAGES
the nature of health care requires an interprofessional v Shows ONLY formal relationships

approach v Does not show the informal structure of the organization

SCALAR CHAIN v Does not indicate the degree of authority held by each line
v The decision-making hierarchy, or pyramid, is often referred to position
as a scalar chain. v May show things as they are supposed to be or used to be

CENTRALITY rather than as they are

v The extent to which an employee is integrated into the network v Possibility exists of confusing authority with status
of interpersonal relationships within the work system. v Are difficult to keep current
v Middle manager has broader view of organization
TYPES OF ORGANIZATIONAL
v Refers to the location of a position on an organization chart
STRUCTURES
where frequent and various types of communication occur

MANAGERIAL LEVELS LINE/ BUREAUCRATIC STRUCTURES

v In centralized decision making, decisions are made by a
few managers at the top of the hierarchy.
v In decentralized decision making, decision making is
diffused throughout the organization, and problems are solved
at the lowest practical managerial level.
v The larger the organization the greater the need to decentralize
decision making
TOP LEVEL MANAGERS
v Found frequently in large health care facilities
v Look at the organization as a whole, coordinating internal and
v Authority and responsibility are clearly defined à efficiency and
external influences
simplicity of relationships
v Common responsibilities: determining the organizational
v Disadvantages:
philosophy, setting policy, and creating goals and priorities for
• Monotony, alienate workers and make adjusting rapidly to
resource allocation
altered circumstances difficult
v Greater need for leadership skills; not involved in daily
• Adherence to chain of command communication (restricts
operations
upward communication)
v E.g. Board of directors, Chief executive officer, Chief nursing
AD HOC DESIGN
officer, Administrators
v Modification of the bureaucratic structure
MIDDLE LEVEL MANAGERS v Sometimes used temporarily to facilitate project completion
v Coordinate the efforts of lower levels and are the conduit
within a formal line organization
between top and lower level mangers
v Overcomes the inflexibility of the line structure
v Day-to-day operations but still involved in long term planning
v Serves a way for professionals to handle increasing large
and establishing unit policy
amounts of information
v E.g. Nursing supervisors, Nursing director, Department heads
v Uses a project team of task approach and is usually disbanded
FIRST LEVEL MANAGERS
after a project is completed
v Concerned with specific unit work flow
v May result in decreased employee loyalty to the parent
v Immediate problems in the daily operations, organizational
organization
needs, and personal needs of employees
MATRIX DESIGN
v Need good management skills
v E.g. Team leaders, Charge nurses, Primary care nurses, Case
managers

ORGANIZATIONAL CHARTS
ADVANTAGES
v Maps lines of decision-making authority
v Helps people understand their assignments and those of their
v Designed to focus on both the product and the function
coworkers
v Have a formal vertical and horizontal chain of command
v Reveals to managers and new personnel how they fit into the
v Have fewer formal riles and fewer levels of the hierarchy
organization
v Can cause slow decision making due to information sharing
v Contributes to sound organizational structure
v Can produce confusion and frustration for workers because of
v Shows formal lines of communication
dual authority hierarchical design

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Organizational structure
SERVICE LINE ORGANIZATION
v Used in some large institutions to address the shortcomings
that are endemic to traditional large bureaucratic organizations
v Sometimes called care-centered organizations
v Smaller in scale than large bureaucratic systems
FLAT DESIGNS
NCM 119
v Group structures, in the form of joint practice committees, are
developed to assume the power and accountability in decision
making, and professional communication…
v Shared governance requires a substantial and long term
commitment on the part of the workers and the organization
PARTICIPATORY MANAGEMENT
v Participatory management implies that others are allowed
to participate in decision making over which someone has
control. Thus, the act of “allowing” participation identifies
for the participant the real and final authority.

ORGANIZATIONAL EFFECTIVENESS
v Remove hierarchical layers by flattening the scalar chain and v The structure should be clearly defined
decentralizing the organization v The goal should be to build the fewest possible management

v Continue to have line authority, but because the levels and have the shortest possible chain of command

organizational structure is flattened, more authority and
decision making can occur where the work is being carried
out
STAKE HOLDERS
v Those entities in an organization’s environment that play a role
in the organization’s health and performance or that are
affected by the organization.
v May be internal or external stakeholders
v Organization do not choose their stakeholders, Stakeholders
choose to have a stake in the orgs decisions
v Stakeholder analysis
• Need to clarify the consequences of decisions and changes
ORGANIZATIONAL CULTURE
v Organizational culture is the total of an organization’s
beliefs, history, taboos, formal and informal relationships,
and communication patterns.
v Organizational climate is how employees perceive an
organization. The perception may be accurate or inaccurate,
and people in the same organization may have different
perceptions about the same organization.
v Success in building a new culture often requires new
leadership and/or outside analysis.
v The unit staff need to see where their tasks fit
v The structure should enhance communication
v The structure should facilitate decision making
v Staff should be organized
v Nursing service should be organized
v
MAGNET DESIGNATION
v American nurses association (ANA) established american
Nurses Credentialing center (ANCC) in 1990
v 1990 à ANA BOD approved the establishment of Magnet
Hospital recognition program for excellence in nursing services
v Magnet à refers to organizations that were able to attract
and retain professional nurses
v Magnet status is not a prize or an award, rather it is a
credential of organizational recognition of nursing excellence
5 MODEL COMPONETS REQUIRED FOR MAGENT
STATUS
1. Transformational leadership
2. Structural empowerment
3. Exemplary professional practice
4. New knowledge, innovation and improvements

SHARED GOVERNANCE 5. Empirical quality results

CHARACTERISTICS OF MAGENET HOSPITALS

v Autonomous, self managing, self-governing climates that allow
nurses to fully practice their clinical expertise, flexible
staffing, adequate staffing ratios, and clinical career
opportunities
v A professional practice culture in all aspects of nursing care
v Nurses at every level play a role in the decisions that affect v Compliance with standards in the Scope and Standards for
nursing activity throughout the system. Nurse Administrators
v Nurse-managers move out of traditional industrial model roles 14 FORCES OF MAGNETISM FOR MAGENT
into collegial models, becoming moderators of the service HOSPITAL STATUS
1. Quality of nursing leadership
process.
2. Organizational structure
v The stated aim of shred governance is the empowerment of
3. Management style
employees within the decision making systems
4. Personnel policies and programs
v The organization’s governance is shared among board
5. Professional models of care
members, nurses, physicians and management. Its aim is to
6. Quality of care
empower employees within the decision-making system.

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Organizational structure NCM 119
7. Quality improvement
8. Consultation and resources
9. Autonomy
10. Community and the hospital
11. Nurses as teachers
12. Image of nursing
13. Interdisciplinary relationships
14. Professional development

PATHWAY TO EXCELLENCE
v Recognizes health-care organizations with foundational quality
initiatives in creating a positive work environment, as defined
by nurses and supported by research

COMMITTEES
v To be productive committees should have:
• An appropriate number of members
• Prepared agendas
• Clearly outlined tasks
• Effective leadership

GROUPTHINK
v Groupthink occurs when there is too much conformity to group
norms, often resulting in opinions and ideas that may lack
merit.

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