Organizational Structure in

Health Care
Nursing Management & Leadership
Objectives:

At the end of this lecture students will be able to:

• Identify the concept of organization & organizational structure.
• Discuss the organizational Principles
• Recognize the different types of organizational structures
• Discuss the Characteristics of Organizational Chart
• List the principles for drawing an accurate organizational chart
• Recognize the basic elements of formal organizations
• Identify delegation concept
• Discuss the delegation process
• List the five Rights of Delegation
 Introduction

• It is widely accepted fact that groups of people can achieve more than
individuals acting alone. (eg. Health service)
• Organizations are fundamental to our society. They are essential for
the provision of services such as healthcare, education, information
and recreational amenities.
• The National Health Services is one of the largest organizations in the
UK, USA and KSA.
• Many health services employees spend a considerable portion of their
lives working within this very complex organization.
• All healthcare professionals must understand how people behave and
react within the health services.
 Definition of organization

• Organizations are social arrangements for the controlled

performance of collective goals (Buchanan & Huczynski,
1991).
• The nature of organizations of all types and sizes rests with
their shared existence as collections of people working
together in a division of labor to achieve a common
purpose.
• An organization is defined as a social system, purposely
established to carry out some definite mission and
objectives according to some agreed upon rules.
 Important facts about organizations

• First; they are collections of people who relate to each other

because they belong to the same group.

• Second; they have a common purpose in the achievement of

specific tasks or goals.

• Third; their performance is controlled to ensure that goals and

targets are met, and the survival of the organization is assured.

Organization is the foundation of management

 Organizational Principles

Unity of Delegation of
Communication.
command. authority.

Adequate number Division and

Unity of purpose. of qualified specialization of
personnel. labor.

Chain of
command.
 Types of organizational structures:

1. The formal organizational structure:

It describes positions, responsibilities, and relationships among people in
their positions in the different departments in the organization, which will
be presented in a diagrammatic form called an organizational chart.

2. Informal organizational structure:

It describes the personal and social relationships that do not appear on the
organizational chart.
-  It helps members to meet their personal objectives and provides social
satisfaction.
-  It also has its own channels of communication, which may distribute
information more broadly and rapidly than the formal communication
system.
Is informal
organizational
structure important to
management?
Types of Organizational Structure

•Hierarchal Structure including:

Functional & Service line structure

•Matrix
1. Functional Structure:

o It’s a Hierarchical structure, where employees

are grouped in departments by specialty with
similar tasks being performed by the same
group.
o Similar groups operating and reporting to the
same manager...
 Each portion of the
organization is
Functional Structure: grouped according to
its purpose.
 2. Service-line Structure:

o Also called product line or service integrated structures

o All functions needed to produce a product or service are

grouped together in self-contained units

o The units are based on product, service, geographical

location, or type of customer

o A manager is appointed to head a specific clinic service line

and has responsibility and accountability for staffing,
resource acquisition, budget, financial control
 3. Matrix Structure:

o It is unique and complex; it integrates both product and

functional structure into one overlapping structure.
o Different managers are responsible for function and
product.
o It is a permanent organization designed to achieve specific
results by using teams of specialists from different
functional areas in the organization.
o When the expertise of other disciplines is needed on a
continuous basis..
 Matrix Organizational Structure:
• Each project must occur independently. However, it’s important
to have a senior manager of each department (finance,
operations, HR, marketing, etc.) to check if everything is in
accordance with the company’s policies and level of services.
 Organization chart

o Is the diagrammatic representation of the different positions in

the hierarchy of an institution, showing the channels of
communication and the formal lines of authority among these
positions.
o It is a visual representation of the chain of authority, division of
work, levels of management and functional communication
pattern from chief executive to each member of the organization.
 Organizational Chart

o It gives the executives and the employees a clear view of:

 The relationships between various departments and
divisions.
 The relationship between the different positions in the
management levels and first-line level employees in an
organization.
 Characteristics of Organizational
Chart

1. It must be a diagrammatic presentation.

2. It must note the principle lines of authority,
interrelationship between different positions
3. It must show the channels of communication between
the various position and between the executives and the
subordinates.
Characteristics of Organizational Chart

o Great decision-makers and authority are located at

the top; those with the least are at the bottom.
o Dotted or broken lines on the organization chart
represent “supporting staff” positions. Because these
positions are advisory, a staff member provides
information and assistance to the manager but has
limited organizational authority.
 Characteristics of Organizational
Chart

Lines of communication and authority are shown on a

chart by unbroken lines.

-Horizontal ( _ ) unbroken lines represent communication

between individuals with similar scopes of responsibility
and power, but different functions.

-Vertical ( I ) unbroken lines between positions represent

the official chain of command, the formal paths of
communication and authority between position.
 Principles for drawing an accurate
organizational chart:

• The chart should have a clear title.

• It should be dated.
• The higher management should be shown at the top,
while most junior positions at the end of the chart.
• Positions of equal seniority should be shown at the same
level.
• For clarity, details should be well spaced.
• Colors may be used to distinguish between departments.
 Nursing department chart

DON

Nursing
supervisor

HN ICU HN ER

RN ICU RN ICU RN ICU RN ER RN ER RN ER

Advantages of Organizational Charts

1. Map line of decision-making authority.

2. Helps people to understand their assignments and
those of their coworkers.
3. Shows the managers and new personnel how they fit
into the organization.
4. Shows formal lines of communication.
Disadvantages of Organizational
Charts

1. Does not show an informal relationship.

2. Does not indicate the degree of authority.
3. Possibility exists of confusion, authority with status.
4. Charts become outdated quickly.
5. Does not show duties and responsibilities.
 Comparison

Organizational Chart Organizational Structure

Built around people and titles. Designed around the functions an
organization performs.

Shows each person’s job title and Defines the purpose, accountabilities,
may include HR staff like job and key performance indicators (KPIs)
requirements. for each function and role.

Needs to be updated frequently as Once correctly defined, a structure

people come and go. changes infrequently.
 Basic elements of formal
organizations:

Centralization
Delegation of Span of control
and
authority. (supervision).
decentralization.
 Centralization

Is concentration of decision-making and action at high-level

management.
Advantages of centralization:
• Power is provided to the top manager.
• Uniformity of policies, practices and
decisions are promoted.
• Duplication of function is minimized.
• Extensive controlling procedures and
practices are not required.
Disadvantages of centralization:
• The functions that are usually performed
by middle manager and bedside staff are
neglected.
• Personnel become unmotivated.
• It is difficult for a nursing supervisor to
function as a manager. She becomes
instead, link officer between nursing
director and first-line management.
 Decentralization

Is systematic and consistent delegation of authority to the lower levels where the
work is performed.
Advantages of decentralization: Disadvantages of decentralization:

• Promote interpersonal relationships and • Increased costs. As it requires more managers

motivation. and large staff.
• Relieve high-level management from the daily • It may lead to overlapping and duplication of
administration freeing them for long-range effort.
planning, goal and policy development and • It may lead to lack of uniformity and lowering of
system integration. standards in decision-making.
• Develop managers skills by allowing them to
manage.
• Facilitate actions by lower-level managers
without waiting for approval of their decisions
from superiors.
Delegation of authority:

Delegation:
Transferring responsibility for the performance of an
activity from one individual to another while retaining
accountability for the outcome.

It is “The distribution of responsibility and authority to

others while holding them accountable for their
performance.”(www.lawsoncg.com)
Why Delegate?

To keep from burning out a few leaders.

To build new skills within the group, therefore develop
new leaders.
To get things done through skilled staff in the team.
To prevent the staff become too dependent on one or
two leaders.
To become more powerful as a team.
To involve all to feel a part of the effort and the
success.
 Delegation Process:

Step 1: Know What to Delegate

• In nursing, Not all the tasks can be delegated.
For example, you must think twice before delegating tasks that involve
sensitive or confidential client information. Or before delegating the
responsibility of narcotic medication as head nurse.
• Step 2: Select the Appropriate Person
• It one of the most important and the most difficult steps. It takes a lot of
time to find people you can delegate to that meet all of the necessary
criteria for a successful relationship:
Trust and loyalty, Work ethic
Necessary skills
Adequate availability
Positive performance history.
Step 3: Provide Documentation and Clear Instructions
• Having guidelines that clearly outlines the details of the work and
provides all of the necessary information is important in delegation.
The nurse manager must share all of the necessary information, take
time to review the specifics and answer any questions that may arise.
Step 4: Track Work and Provide Feedback
• Its important to follow up the work to ensure it was done correctly.
The nurse manager supervise the work and provide feedback for
improvements when needed.
Step 5: Maintain Reasonable Control
• A regular evaluation is needed if the delegation occur for a log
period.
Five Rights of Delegation

The right
The right task The right person
situation/circumstance

The right direction and The right supervision

communication and evaluation
Major causes of managers’ refusal to delegate:

1. Tendency to do things personally (i.e. by himself).

2. Desire to dominate the knowledge, information, and/or skills he/she has.
3. Unwillingness to accept risks of wrongs, (that some staff may take
wrong decisions or do it wrong).

Reasons for subordinates’ avoidance of accepting delegation:

4. To avoid the hard work of Decision-making.

5. Fear of making mistakes and blamed.
6. Lack of necessary information and resources to work effectively.
7. Overload of primary work.
8. Inadequate positive benefit/incentive (pay rate, opportunity for promotion).
Span of control (span of supervision):

Refers to the number of staff that can be adequately supervised by one

supervisor.