Final dis

SV-OrganizingFundamentals.pptx

HSMP 3200

Organizing Fundamentals

Now that we have investigated the first of the five essential functions of management, planning, and you know that planning defines the mission, goals and objectives of your organization.

Let’s now consider the second of the five functions of management.

Organizing

Organizing refers to:

The process of grouping related organizational activities and resources to best achieve your organization’s mission.

What do you have when you complete the organizing function?

Organizational types

Tall organizations (multi-hospital system)

More complex, multiple layers of management

May be more expensive

Communication may be challenging

Flat organizations (community hospital)

Tend to have higher employee morale and productivity

Fewer layers of management

Easier communication

Decentralized organizations (specialty clinic)

Micro-system consisting of a subpopulation of patients (for example, by diagnosis or by demographic characteristics) and their multidisciplinary team of health professionals

Formal organizational theory aka “Organizational Design”

Consider these things when designing an organization:

Authority distribution- “chain of command/hierarchy”

Span of supervision- maximum number of subordinates a manager/supervisor can effectively supervise.

Division of work- position/job design.

Formal structure- e. g. departmentalization is one common model.

Unity of command- “each employee has only one boss”

Coordination of activities and resources- Tasks/ assignments, manpower, materials, space, financial support etc.

Formal Organization Structure

Organizational structure refers to:

The formal arrangement of jobs (functions) and managerial accountability (leadership) within the organization.

Often displayed in the form of an organization chart or table (Positions, titles, schematic layout of authority and responsibility

Organization Chart

Authority and Span of Control

Authority

The right to direct others and to give orders

Parity principle

The concept that individuals who are given responsibility for a function must be given enough authority to carry out that function

Span of management

Another dimension of organizing: the scope of supervision, or the number of people who report to a particular manager

Authority is essential

It is the lifeblood of supervision.

It is the means of granting formal or official power to influence decisions and to obtain the compliance of the subordinate.

Authority is granted to a person and position. However, if the person leaves the position, they forfeit that authority.

Authority is a “license to lead…NOT a license to abuse”.

Nature of Authority

Authority is the basis for managers to give orders.

It clarifies that subordinates are not to disregard or disobey orders.

Traditional authority

Arises from the subordinates’ belief in organizational order.

Rules and regulations

(supporting basis for authority)

Charisma

(personal basis for authority)

Chain of Command

This term refers to the belief that authority originates at the top of an organization and is delegated downward from superiors to subordinates. Also called Formal Authority.

Authority has limits

External limitations on authority

Include such factors as cultural mores, community practices, values and lifestyle

Internal limitations on authority

Set mainly by formal organization’s documents such as articles of incorporation, bylaws, and organization policies

“Tapering” concept of authority

The lower the rung on the administrative ladder (chain of command), the narrower the area in which authority can be exercised

Tapering Concept of Authority

Authority Acceptance Theory

This is the notion that a leader’s authority originates at the bottom of the organizational pyramid and is determined by his subordinates’ willingness to comply with that authority.

A leader’s authority is only effective to the degree his/her subordinates are willing to accept it.

Realistically speaking, what recourse does an employee have if they are not able or willing to accept authority?

Formal Authority Vs. Authority Acceptance

Differences between Formal Authority and Authority Acceptance can have significant influence on the practice of supervision and the attitudes of the supervisor.

Today no one wants to rely on the formal weight of their authority only to motivate workers. At times, they must use their authority and power, but this is hopefully the exception, not the rule. The manner in which this is done will make a difference if it is accepted or resented.

“Being in power is like being a lady. If you have to remind people that you are, you aren’t.” – Margaret Thatcher

Types of Authority

Line authority

Is based on superior to subordinate relationships in the chain of command (“rank”)

Positional authority

Is based on the supervisor’s position on the organization chart not the person; and is impersonal

Staff authority

Resides in those with particular expertise who provide counsel or assist those who possess line authority.

Functional authority

Granted to individuals with unique expertise in specialized areas and is generally limited to addressing particular situations.

This is an exception to the unity-of-command principle

Terminology clarification

Before we look at The authority of doctors, it is important we clarify the term Medical Staff.

“Medical staff” refers exclusively to licensed physicians/doctors.

Medical staff does not include other clinical personnel (nurses, technologists, therapists etc. these personnel are hospital employees )

This makes healthcare organizations unique

In most cases, medical staff (doctors) are not hospital employees. (We will look at a few exceptions in a moment)

Medical staff do, however have designated authority within the hospital organization

Referred to as “Captain of the ship”

As a result, hospital employees follow a dual chain of command:

Administrative management

Medical staff

Medical staff that may be hospital employees

Hospitalists: physicians that exclusively provide care to patients who are admitted to a hospital (inpatient care) and typically do not have their own private medical office practice.

Radiologists: a physician who Interprets results of radiologic tests (x-ray, CT scans, MRIs, Ultrasounds, etc.) for other physicians and is clinically accountable for hospital’s the radiology/imaging department.

Pathologists: a physician who examines tissues, checks the accuracy of lab tests and is clinically accountable for the hospital’s clinical laboratory department.

Emergency Room doctors: physicians who provide emergency medical care in the hospital’s emergency department.

Power

Power refers to ability to influence others to act in a certain way.

Coercive power

Based on fear

Reward power

Based on the ability to distribute something of value

Referent power

Based on the personal attraction of an individual or the desire of other people to be like that person

What’s the difference?

Line Personnel

Have direct responsibility for achieving goals through subordinates.

Straight chain of command from the top of an organization to the bottom

May be advised by staff personnel but line personnel “make the decisions”.

Staff Personnel

Refers to an individual or individuals who serve in an advisory capacity to the manager(s) of an organization

A group of people who perform similar jobs, such as nurses, physicians, and maintenance engineers

Unity of Command

This means each employee has a single immediate supervisor, who in turn is responsible to her immediate superior, and so on, along the chain of command.

Why do we say “a single immediate” supervisor?

Span of control

This term refers to:

The number of people a manager can effectively supervise.

Also referred to as “Span of Management”

You should consider many factors

1. Competence/skills of the supervisor and her employees,

2. Physical proximity of employees to each other and their supervisor,

3. Extent of time spent by the manager performing non-supervisory duties,

4. Frequency of required interaction between employees and the employees and their supervisor,

5. Extent of standardized procedures,

6. Similarity and complexity of tasks being supervised,

7. Frequency of changes in process, and

8. Ability to use technology to monitor performance

Flow of control

The senior administrator delegates authority to the managers.

The manager in turn re-delegates authority to subordinate supervisors.

Supervisors supervise only a limited number of employees. What’s this called again?

As you go down the managerial hierarchy, the span of direct control generally increases.

Expanding the Span of Control

Teams can help you do this

Are “organizations within organizations”

Useful to expand organizational capacity.

Are empowered with some of the traditional supervisory duties and authority.

Are often assembled on an ad hoc (temporary) basis.

Require clearly defined objectives.

Require adequate resources and administrative support to succeed.

When New Teams are Formed

When new teams are formed (for any reason), they will go through the Stages of Team Development.

Forming

Storming

Norming

Performing

Forming

First stage of development.

Sometimes referred to as “pick up sticks”

This stage comes with high, unrealistic expectations. There is anxiety about how all will fit in, what roles they will play, etc. Team members are unclear about norms, timelines, etc.

Enthusiasm/Morale: High

Skill Level: Low

Leader: Explain

Storming

Sometimes called “at odds”.

As experience grows, there is a dip in morals as they begin to experience difficulties. It is difficult to work together and find out where each person fits. Subgroups form, which polarizes the team. The primary issues of this stage concern power, control and conflict.

Enthusiasm/Morale: Low

Skill Level: Low

Leader: Demonstrate

Norming

Sometimes called “Coming Around”

As conflicts are resolved, the team begins to understand the goals established and gain some technical skills at working toward them. The feeling is positive, even euphoric. Trust and cohesion grow as communication becomes more open and task oriented. They begin thinking “we” instead of “I”.

Enthusiasm/Moral: Increasing

Skill Level: Increasing

Leader: Guide

Performing

Sometimes called “As One”

Both productivity and morale are high. The team reinforces one another. There is a sense of pride and excitement. Standards are high and there is CQI. They are proud of their work and working together.

Enthusiasm/Morale: High

Skill Level: High

Leader: Enable/Empower