1. Slide 1 Chapter 4 - - How HSOs Are Organized

2. Slide 2 Historically, the Governing Body (GB), Chief Executive Office (CEO), Professional Staff Organization (PSO) in an acute care hospital were known as a triad (group of three), but the term is rarely used in contemporary discussions. The Triad

3. Slide 3 Legal Status Nongovernmental (privately owned) Sole proprietorships Partnerships Corporations Governmental (State and Local)

4. Slide 4 Organization Structure of HSO.. p156 Governing Bodies: The pressures and need for GBs to be effective will increase, and this means recruiting people who understand health services, are prepared in business matters, and have backgrounds that are important to the HSO.

5. Slide 5 Organization Structure of HSO.. p157 Governing Bodies Roles (AHA’s concept)  [ 責任 ] 組織效率化, 推展及貫徹其政策及流程, 依法理發 展相關規定  [ 責任 ] 選用合格之 CEO 並給予授權  [ 職權 & 責任 ] 確保正確適當之臨床團隊組織及監測其所提 供的服務品質  [ 職權 & 責任 ] 監測並影響關於發展及維繫外部關係之政策  [ 職權 & 責任 ] 決定組織使命並發展策略管理  [ 受託附 ] 妥善資源管理  [ 職權 & 責任 ] 人力資源之組織, 保護及改進  [ 責任 ] 健康 / 醫療教育及研發部門及與組織使命之關聯性

6. Slide 6 Organization Structure of HSO.. p158 Governing Bodies Composition  Business and community leaders  Attorneys  Bankers Committees  Standing committees usually include executive, professional staff, human resources, quality evaluation, finance, planning, public relations and development, investment, capital equipment and expenditures, and nomination.

7. Slide 7 Design Concepts in Building Formal Organization Structures

8. Slide 8 Design Concepts Rumor: Because of their natural affinity for contemporary things and ideas, it is difficult for some people to recognize the importance of old ideas and concepts. Key design concepts: developed by a group of general administrative theorists who worked early in the 20th century. Most influential: Max Weber, Henri Fayol

9. Slide 9 Classical Concepts: bureaucracy Division of Work Authority and Responsibility Relationships Departmentation Span of Control Coordination Building formal organization structures

10. Slide 10 Building formal organization structures Classical Organization Theory This perspective was concerned with structuring organizations effectively. Whereas scientific management studied how individual workers could be made more efficient, organization theory focused on how a large number of workers and managers could be organized most effectively into an overall structure.

11. Slide 11 Major Contributors to Classical Organization Theory Max Weber German Sociologist Proposed a “ bureaucratic ” form of structure based on logic, rationality, and efficiency that was assumed to be the most efficient (universal) approach to structuring for all organizations. Henri Fayol French executive and engineer The contributions were primarily based on his identification of a set of “ principles ” of management.

12. Slide 12 Elements of Weber ’ s Ideal Bureaucracy

13. Slide 13 水平分工的優、缺點 優點為每位員工所需的技能減少；較容易提 供甄選及訓練所需之技能；從事相同的工作 可收熟能生巧之效；主要運用每位員工的最 佳技能使技能可以有效地發揮；允許各項作 業同時進行；倘若某項零組件通常是由同一 工作人員完成，則最終產品的一致性會較高。 水平工作的最主要缺點是會造成員工對工作 有單調枯燥之感，甚至會造成員工的退化。

14. Slide 14 Division of Work Classical View: It’s known about Fayol’s 14 principles of management. The economic benefits derived from the fact that division of work enhanced individuals’ proficiency in performing their work and thus improved the efficiency and effectiveness with which work could be performed. Division of work means dividing the work of an organization into specific jobs, each consisting of specified activities. Functionalization is dividing the HSO’s/HS’s work based on functions to be performed.

15. Slide 15 Division of Work Contemporary View: Increased division of work has a negative side – people who perform specialized work may find it repetitive, monotonous, and unfulfilling. Developments as programs in cross-training, job enlargement, and job enrichment are increasingly important in all types of organizations. The best job enlargement and enrichment programs are consistent with the widely popular quality-of-work life (QWL) movement.

16. Slide 16 權力、職權及責任 權力（ power ）是指影響、命令或運用力量 的能力；權力源自於對資源的控制。 職權（ authority ）係指源自伴隨職位之權利 的權力，它是合法的權力之運用。 責任（ responsibility ）則係對達成目標、資 源的運用及遵守組織政策所應有的擔當。一 旦接受了責任，執行指派的工作就成為義務。

17. Slide 17 Authority and Responsibility Relationships Classical View: It used to be thought that the rights attached to one’s position were the only important sources of power or influence in the organization. Now authority is seen as just on element in the larger concept of power in organizations. Authority and responsibility are delegated downward in organizations from higher levels of management to lower levels, resulting in a scaling or grading of levels of authority and responsibility.

18. Slide 18 Authority and Responsibility Relationships Contemporary View: There are numerous sources of power and influence in HSOs/HSs. French and Raven conceptualized interpersonal power with five distinct bases: legitimate, reward, coercive, expert, and referent. Other sources of power that are not rewstricted to managers are quite important in HSOs/HSs, and the existence of these other sources often means that power and influence are spread beyond the organization’s managers.

19. Slide 19 Departmentation Classical View: The theorists recognized the relationship between dividing work and the subsequent need to then coordinate divided work to achieve satisfactory results. It is natural consequence of division and specialization of work. Gulick and Urwick noted four reasons for it: purpose, process, persons and things, and place.

20. Slide 20 Departmentation Contemporary View: Increased focus on patients as the basis for departmentation or grouping. Facing significant problems of coordination across departments and other divisions of workers. The bureaucratic form is effective in stable circumstances, but it is a disadvantage when flexibility in response to changing circumstances is more important.

21. Slide 21 Characteristics of Organic Organizations Tasks are continually adjusted as needed through interaction with others involved in the task. Structure of control, authority, and communication is a network. Decisions are made by individuals with relevant knowledge and technical expertise. Communication is vertical and horizontal, among superiors, subordinates, and peers. Communication content is largely information and advice. Emphasis is on commitment to organizational goals and possession of needed expertise.

22. Slide 22 Span of Control Classical View: Managers should have limited numbers of subordinates reporting directly to them, a pragmatic conclusion based on the need for managers to exercise control. Davis distinguished two types of span of control: executive and operative. Executive span refers to senior- and middle- level management positions, operative to first-level management positions. Effective executive span: three to nine, operative span: as many as 30 employees.

23. Slide 23 Span of Control Contemporary View: Level of professionalism and training of subordinates Level of uncertainty in the work being done Degree of standardization of work Degree of interaction required between managers and workers Degree of task integration required in a group/groups

24. Slide 24 Coordination Classical View: Fayol: pulling together all activities of the enterprise to make possible both its working and success. Coordination in the context of several organizations joined together in a HS is “the articulation of elements in a service delivery system so that comprehensiveness, accessibility, and compatibility among elements are maximized.

25. Slide 25 Coordination Contemporary View: Coordination is a critical task for all managers in contemporary HSOs/HSs. It differs with the organizational levels of managers. Figure 3.4 illustrates the coordinating mechanisms.  Mutual adjustment  Direct supervision  Standardization of work processes  Standardization of work outputs  Standardization of workers’ skills

26. Slide 26 Five basic organization designs 加拿大墨基爾大學（ McGill University ）的 明茲伯格（ Henry Mintzberg ） : Simple Structure Machine Bureaucracy Professional Bureaucracy Divisionalized Form Adhocracies

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28. Slide 28 Five basic organization designs Henry Mintzberg 沿續領導大師班尼斯 （ Warren Bennis ）的創見，將其發展為 「變形蟲組織」（ Adhocracy ）主張，以暫 時編組的團隊取代金字塔式的階層組織。 這些團隊各有自己一套行事規則、負責特 定產品、特定顧客或特定專案；它們不但 是組織的改變動力來源，甚至被容許從事 某些對於現狀的破壞性活動。

29. Slide 29 professional bureaucracy Characteristics prime coordinating: standardisation of skills key part: operating core main design: training, horizontal job specialisation, vertical and horizontal decentralisation situational factors: complex, stable environment; nonregulating, nonsophisticated technical system; fashionable Examples universities, general hospitals, craft production firms, law firms, courts, accounting firms

30. Slide 30 No environment of its own stabledynamic Comple x Decentralised Bureaucratic (standardisation of skills) Decentralised Organic (mutual adjustment) SimpleCentralised Bureaucratic (standardisation of work processes) Centralised Organic (direct supervision) Professional bureaucracy Adhocracy Simple structure Machine bureaucracy

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33. Slide 33 Structural configuration Prime coordinating mechanism Key part of organisation Type of decentralisation Simple structure Direct supervision Strategic apex Vertical and horizontal centralisation Machine bureaucracy Standardisation of work processes Techno- structure Limited horizontal decentralisation Professional bureaucracy Standardisation of skills Operating core Vertical and horizontal decentralisation Divisionalise d form Standardisation of outputs Middle lineLimited vertical decentralisation AdhocracyMutual adjustment Support staffSelective decentralisation