1. 2
Designing Organizations

2. Learning Outcomes Discuss how organizational theories differ.
Describe the different types of health care organizations.
Explain how health care organizations are structured.
Discuss various ways that health care is provided.

3. Learning Outcomes
Demonstrate how strategic planning guides the organization's future.
Discuss how the organizational environment and culture affect workplace conditions.

4. Organizational Theories
Were unexplored until the Industrial Revolution
Include the following theories:
Classical
Contingency
Humanistic

5. Organizational Theories
Include the following theories:
Chaos
Systems
Complexity

6. Classical Theory Built around four elements:
Division and specialization of labor
Chain of command; hierarchy, line authority, staff authority
Organizational structure describe the arrangement of the work group
Span of control

7. Figure 2-1 Chain of authority.

8. Humanistic Theory Focuses on social aspects of organizational design
Views social relationships, group pressure, and search for personal fulfillment as motivators
Says formal authority only works with willing participants

9. Systems Theory
A system is interrelated parts arranged in a unified whole.
Systems can be open or closed.
Organization is a recurrent cycle of input-throughput-output.
The manager is the catalyst for the process.

10. Contingency Theory
Performance is enhanced by matching the organization's structure to its environment.
Environment includes people, objects, and ideas outside the organization that influence it.
Optimal form of the organization depends on the environment in which it operates.

11. Chaos Theory
Organizations are living, self-organizing systems that are complex and self-adaptive.
Creativity and flexibility are necessary to adapt to change.
The leader's role is to build resilience, maintain balance, and encourage creativity.

12. Complexity Theory Random events interfere with expectations.
No linear cause and effect to explain outcomes.
The system interacts and adapts to change.
Managers must encourage the flow of information in all directions, not just top to bottom.

13. Hospitals Most are acute care facilities
May be classified as general or special-care facilities (e.g., pediatric)
Many are teaching institutions
Role of nurse may differ from teaching to nonteaching hospital
New groups in hospitals include hospitalists and intensivists

14. Long-Term Care Facilities
Provide professional nursing care and rehabilitative services
May be freestanding or part of hospital
Limit length of stay
May be residential care facilities (nursing homes) where care is supervised by RNs and LPNs

15. Home Health Agencies
Provide intermittent, temporary health care in the home by skilled or unskilled providers
May offer services other than nursing such as physical therapy or medical equipment
May offer hospice care

16. Temporary Service Agencies
Provide nurses and other health care workers to hospitals
Provide private duty nurses to patients in the hospital or at home

17. Health Care Networks Deliver a continuum of care
Provide geographic coverage for buyers of health care services
Accept risk in taking a fixed payment for providing health care for all persons in selected group

18. Interorganizational Relationships
Horizontal integration
Organizations in a network provide the same or similar services; e.g., all hospitals provide comparable services

19. Figure 2-6 Horizontal integration.

20. Interorganizational Relationships
Vertical integration
Dissimilar but related organizations in a network provide a continuum of services

21. Figure 2-7 Vertical integration.

22. Interorganizational Relationships
Corporate health care network

23. Figure 2-8 Corporate health care network.

24. Diversification Organization expands into new arenas Two common types
Concentric diversification and conglomerate diversification
Joint venture
Partnership in which each partner contributes different areas of expertise, resources, or services to create a new product or service

25. Accountable Care Organizations
Contract with Medicare to provide care to a group of Medicare recipients
More flexible than Health Maintenance originations because consumers can choose providers outside the network

26. Traditional Organizational Structures
Functional
Employees grouped in departments by specialty
Hybrid
Contains both self-contained and functional units

27. Traditional Organizational Structures
Matrix
Integrates product and functional structures in one overlapping structure
Different mangers, its appropriate in highly uncertain environment.
Parallel
Unique to health care; involves two lines of authority—the authority of the organization and the authority of its medical staff

28. Figure 2-3 Service line structure.

29. Different Types of Health Care Organizations
Private or government
Voluntary (not for profit)
Investor owned (for profit)
Sectarian or nonsectarian

30. Redesign Patient-centered care model Focus on specific service lines
E.g., medical home
Focus on specific service lines
Lean thinking
Flat, decentralized organizational structure

31. Strategic Planning
Philosophy
Vision statement
Mission
Goals

32. Organizational Environment
System-wide conditions that contribute to a positive or negative work setting
Positive environment has a positive effect on patient outcomes
Nurse manager plays a key role in maintaining a positive environment

33. Healthy Work Environment
Skilled communication
True collaboration
Effective decision making
Appropriate staffing
Meaningful recognition
Authentic leadership

34. Organizational Culture
Encompasses basic assumptions and values held by members of the organization

35. Organizational Culture
Varies among institutions, subcultures, and countercultures
Consonance occurs when the subculture's norms and traditions agree with the organization's
Dissonance occurs when they are not in agreement