Ch. 12: Organizational Structure

responsibility and accountability

Another limitation of the organization chart is that although it defines authority, it does not define these two things

Decentralized

As a rule, however, larger organizations benefit from this type of decision making. In general, the larger the organization, the greater the need to use this type of decision making.

Climate

Organizational culture should not, however, be confused with organizational ________—how employees perceive an organization.

Informal

People also rely on _______ structure if the formal structure has stopped being effective, which often happens as an organization grows or changes but does not reevaluate its hierarchy or work groups

Accompanying authority

People frequently have status with little of this

14 Foundational Forces of Magnetism for Magnet Hospital Status

Quality of nursing leadership Organizational structure Management style Personnel policies and programs Professional models of care Quality of care Quality improvement Consultation and resources Autonomy Community and the hospital Nurses as teachers Image of nursing Interdisciplinary relationships Professional development

Organization Chart Limitations

Shows only formal relationships. Does not indicate degree of authority. Are difficult to keep current. May show things as they are supposed to be or used to be rather than as they are. May define roles too narrowly. Possibility exists of confusing authority with status.

Internal stakeholders

for example, may include the nurse in a hospital or the dietitian in a nursing home.

matrix organization structure

is designed to focus on both product and function. Has a formal vertical and horizontal chain of command

Unity of command

organization chart (weber) - is indicated by the vertical solid line between positions on the organizational chart. This concept is best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible.

Organizational structure

refers to the way in which a group is formed, its lines of communication, and its means for channeling authority and making decisions.

Too many people

reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization.

organizational structure minimal requirements

(regardless of type) The structure should be clearly defined so that employees know where they belong and where to go for assistance. The goal should be to build the fewest possible management levels and have the shortest possible chain of command. This eliminates friction, stress, and inertia. The unit staff need to be able to see where their tasks fit into common tasks of the organization. The organizational structure should enhance, not impede, communication. The organizational structure should facilitate decision making that results in the greatest work performance. Staff should be organized in a manner that encourages informal groups to develop a sense of community and belonging. Nursing services should be organized to facilitate the development of future leaders.

Rumor or gossip

Although grapevine communication is fast and can facilitate information upward, downward, and horizontally, it is difficult to control or to stop. With little accountability for the message, grapevine communication often becomes a source for this

Individual assignments

An alternative that will decrease the time commitment for committee work is to make these and gather the entire committee only to report progress.

Upward and downward

Because committees communicate in these directions and encourage the participation of interested or affected employees, they assist the organization in receiving valuable feedback and important information.

Staff organization and bureaucratic designs

Both of these types of organizational structures are found frequently in large health-care facilities and usually resemble Weber's original design for effective organizations. In these structures, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships.

7%

Currently, only about ____ of all registered hospitals in the United States have achieved ANCC Magnet Recognition status

Conformity

Groupthink occurs when there is too much of this to group norms.

Liability

If not properly used, the committee becomes a _________ to the organizing process because it wastes energy, time, and money and can defer decisions and action.

Judging

Integrated leader-managers also refrain from this and encourage all members of a committee to participate and contribute.

Group dynamics

Managers need to be well grounded in these because meetings represent a major time commitment.

Facilitate goals

One of the leadership roles inherent in organizing work is to ensure that committees are not used to avoid or delay decisions but to do this

Supportive of threatening

Stakeholders may have either of influences on organizational decision making.

Factors to Consider When Organizing Committees

The committee should be composed of people who want to contribute in terms of commitment, energy, and time. The members should have a variety of work experience and educational backgrounds. Composition should, however, ensure expertise sufficient to complete the task. Committees should have enough members to accomplish assigned tasks but not so many that discussion cannot occur. Six to eight members in a committee are usually ideal. The tasks and responsibilities, including reporting mechanisms, should be clearly outlined. Assignments should be given ahead of time, with clear expectations that assigned work will be discussed at the next meeting. All committees should have written agendas and effective committee chairpersons.

Role modeling

The leader-manager takes responsibility for ensuring that subordinates also understand the overall organizational structure and the structure at the unit level. This can be done using this method which includes demonstrating accountability and the appropriate use of authority.

characteristics of bureaucracies (Weber)

There must be a clear division of labor (i.e., all work must be divided into units that can be undertaken by individuals or groups of individuals competent to perform those tasks). A well-defined hierarchy of authority must exist in which superiors are separated from subordinates; on the basis of this hierarchy, remuneration for work is dispensed, authority is recognized, privileges are allotted, and promotions are awarded. There must be impersonal rules and impersonality of interpersonal relationships. In other words, bureaucrats are not free to act in any way they please. Bureaucratic rules provide superiors systematic control over subordinates, thus limiting the opportunities for arbitrary behavior and personal favoritism. A system of procedures for dealing with work situations (i.e., regular activities to get a job done) must exist. A system of rules covering the rights and duties of each position must be in place. Selection for employment and promotion is based on technical competence.

Staff or bureaucratic design disadvantages

They often produce monotony, alienate workers, and make adjusting rapidly to altered circumstances difficult. Another problem with line and line-and-staff structures is their adherence to chain of command communication, which restricts upward communication.

magnet status

To achieve designation as an organization, the organization must create and promote a comprehensive professional practice culture.

Cultural and gender diversity

When assigning members to committees, this should always be a goal.

Max Weber

a German social scientist, is known as the father of organizational theory. Generally acknowledged to have developed the most comprehensive classic formulation on the characteristics of bureaucracy, he wrote from the vantage point of a manager instead of that of a scholar.

Change their roles

a major impediment to the implementation of shared governance has been the reluctance of managers to do this. The nurse-manager's role becomes one of consulting, teaching, collaborating, and creating an environment with the structures and resources needed for the practice of nursing and shared decision making between nurses and the organization. This is foreign to many managers and difficult to accept.

Organizational structure

affects how people perceive their roles and the status given to them by other people in the organization. It is effective when the design is clearly communicated, there are as few managers as possible to accomplish goals, communication is facilitated, decisions are made at the lowest possible level, informal groups are encouraged, and future leaders are developed.

Span of control

also can be determined from the organization chart (weber). The number of people directly reporting to any one manager represents that manager's span of control and determines the number of interactions expected of him or her. Thus, there is an inverse relation between the span of control and the number of levels in hierarchy in an organization, that is, the narrower the span, the greater is the number of levels in an organization

The Pathway to Excellence designation

also conferred by the ANCC, recognizes health-care organizations and long-term care institutions with foundational quality initiatives in creating a positive work environment, as defined by nurses and supported by research.

Informal groups

are present in every organization. They are often powerful, although they have no formal authority. Informal groups determine norms and assist members in the socialization process.

A bureaucracy

as proposed by Max Weber, is characterized by a clear chain of command, rules and regulations, specialization of work, division of labor, and impersonality of relationships.

In decentralized decision making

decision making is diffused throughout the organization, and problems are solved at the lowest practical managerial level.

In centralized decision making

decisions are made by a few managers at the top of the hierarchy.

The organization chart (Weber)

defines formal relationships within the institution. Formal relationships, lines of communication, and authority are depicted on a chart by unbroken (solid) lines. These line positions can be shown by solid horizontal or vertical lines. Solid horizontal lines represent communication between people with similar spheres of responsibility and power but different functions. Solid vertical lines between positions denote the official chain of command, the formal paths of communication and authority. Those having the greatest decision-making authority are located at the top; those with the least are at the bottom. The level of position on the chart also signifies status and power.

Magnet-designated organizations

demonstrate improved patient outcomes and higher staff nurse satisfaction than organizations that do not have Magnet status.

Leaders

demonstrate their commitment to participatory management by how they work with committees. They keep the committee on course.

An organization chart

depicts formal relationships, channels of communication, and authority through line-and-staff positions, scalar chains, and span of control.

Authority, responsibility, and accountability

differ in terms of official sanctions, self-directedness, and moral integration.

Too many committees

in an organization is a sign of a poorly designed organizational structure. They should have an appropriate number of members, prepared agendas, clearly outlined tasks, and effective leadership if they are to be productive.

stakeholder analysis

is an important aspect of the management process. Such an analysis should be performed when there is a need to clarify the consequences of decisions and changes

grapevine communication

is at the heart of the informal organization; it is the conversations that occur in the break room, down the halls, during the carpool, and in between work that allows the relationships of informal groups to develop.

Authority

is defined as the official power to act. It is power given by the organization to direct the work of others. A manager may have the authority to hire, fire, or discipline others.

Function

is described as all the tasks required to produce the product, and the product is the end result of the function.

Unity of command

means that each person should have only one boss so that there is less confusion and greater productivity.

Integrated leader-managers

need to look at organizational structure as the road map that tells them how organizations operate. Without organizational structure, people would work in a chaotic environment. Structure becomes an important tool, then, to facilitate order and enhance productivity

Groupthink

occurs when group members fail to take adequate risks by disagreeing, being challenged, or assessing discussion carefully. If the manager is actively involved in the work group or on the committee, this is less likely to occur.

Shared governance

refers to an organizational design that empowers staff nurses by making them an integral part of patient care decision making and providing accountability and responsibility in nursing practice.

Centrality

refers to the degree of communication of a particular management position.

Leadership role for solving problems

requires that problems are pursued through appropriate channels, that upward communication is encouraged, and that unit structure is periodically evaluated to determine if it can be redesigned to enable increased lower level decision making.

Managers

serve as members of committees and as leaders or chairpersons of committees.

management role

this type of role is needed to evaluate the types of organizational structure and governance and to implement those that will have the most positive impact in the department.

important management function

to see that appropriate work is accomplished in committees, that they remain productive, and that they are not used to delay decision making

Dotted or broken lines

(weber) on the organization chart represent staff positions.

Formal relationships

Because organization charts show only these, what they can reveal about an institution is limited.

Dynamic

Because organizations are these environments, an organization chart becomes obsolete very quickly

Autonomy and empowerment

Current research suggests that changing an organization's structure in a manner that increases these 2 things for nurses will lead to more effective patient care.

Role confusion

If authority is not commensurate to the responsibility, this occurs for everyone involved.

Pathway to excellence program

In addition, ANCC established this in 2003, based on findings from the Texas Nurse-Friendly Program for Small/Rural Hospitals. This designation recognizes health-care organizations and long-term care institutions for positive practice environments where nurses excel

RN

In many organizations, every one of these is considered a first-level manager. All nurses in every situation must manage themselves and those under their care.

Forewarned

In most instances, those being bypassed in a chain of command should be ________. Remember that unity of command provides the organization with a workable system for procedural directives and orders so that productivity is increased and conflict is minimized.

Supposed to be

It is also possible that the organization chart may depict how things are __________________, when in reality, the organization is still functioning under an old structure because employees have not yet accepted new lines of authority.

4 year period

Magnet status is awarded for how long, after which the organization must reapply.

Expedite decisions

Managers who understand an organization's structure and relationships will be able to do this and have a greater understanding of the organizational environment.

Organization Chart Advantages

Maps lines of decision-making authority. Helps people understand their assignments and those of their coworkers. Reveals to managers and new personnel how they fit into the organization. Contributes to sound organizational structure. Shows formal lines of communication.

principal syndrome

Most people can recall panic, when they were school age, at being summoned to the principal's office. Thoughts of "What did I do?" travel through one's mind. Even adults find discomfort in communicating with certain people who hold high status. This may be fear or awe, but both interfere with clear communication.

Examine the number of people

One of the leadership responsibilities of organizing is to periodically do this in the chain of command.

Degree of authority

Organization charts are also limited in their ability to depict each line position's ________ ___ _________.

Grapevine

The informal structure even has its own communication network, known as this

Centralizing expertise

The primary advantage of this in the matrix design is frequently outweighed by the complexity of the communication required in the design.

Staff organizations

Those with staff authority may be referred to as

Five Model Components Required for Magnet Status

Transformational leadership, Structural empowerment, Exemplary professional practice, New knowledge, innovation, and improvements, and Empirical quality results

Large organizations

Unity of command is difficult to maintain in some of these because the nature of health care requires an interprofessional approach.

applying rules to specific cases

Weber argued that the great virtue of bureaucracy—indeed, perhaps its defining characteristic—was that it was an institutional method for doing this, thereby making the actions of management fair and predictable.

Flattening the organization

With increased financial pressures on health-care organizations to remain fiscally solvent and electronic communication technology advances, many have increased their spans of control and reduced the number of administrative levels in the organization

Flat organizational designs

are an effort to remove hierarchical layers by flattening the chain of command and decentralizing the organization. Thus, a single manager or supervisor would oversee a large number of subordinates and have a wide span of control

Bureaucratic organizational designs

are commonly called line structures or line organizations

First-level managers

are concerned with their specific unit's workflow. They deal with immediate problems in the unit's daily operations, with organizational needs, and with personal needs of employees.

Informal leaders

are frequently found among long-term employees or people in select gatekeeping positions, such as the CNO's secretary.

Stakeholders

are 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. have interests in what the organization does but may or may not have the power to influence the organization to protect their interests

decision making with matrix structure

can be slow because of the necessity of information sharing, and it can produce confusion and frustration for workers because of its dual-authority hierarchical design.

Pathway designation

can only be achieved if an organization's nurses validate the data and other evidence submitted, via an independent, confidential survey

Middle-level managers

coordinate the efforts of lower levels of the hierarchy and are the conduit between lower and top-level managers. They carry out day-to-day operations but are still involved in some long-term planning and in establishing unit policies.

Ad hoc disadvantages

decreased strength in the formal chain of command and decreased employee loyalty to the parent organization.

legal-rational authority

developed by Weber - was based on a belief in the legitimacy of the pattern of normative rules and the rights of those elevated to authority under such rules to issue commands

Decentralized decision making

diffuses decision making throughout the organization and allows problems to be solved by the lowest practical managerial level.

Advisory (staff) positions

do not have inherent legitimate authority. Clinical specialists and in-service directors in staff positions often lack the authority that accompanies a line relationship.

Shared governance

egalitarian organizational governance shared among board members, committees, staff, and management, impacting decision making and communication. Thus, decision making and communication channels are altered

Line structures

example of a bureaucratic organizational design

Organizing

follows planning as the second phase of the management process. In this phase, relationships are defined, procedures are outlined, equipment is readied, and tasks are assigned.

Examples of external stakeholders

for an acute care hospital might be the local school of nursing, home health agencies, and managed care providers who contract with consumers in the area.

Quantitative formulas

for determining the optimal span of control have been attempted, with suggested ranges from 3 to 50 employees. In reality, the ideal span of control in an organization depends on various factors, such as the nature of the job, the manager's abilities, the employees' maturity, the task complexity, and the level in the organization at which the work occurs.

Each organization

has a formal and an informal organizational structure

A middle manager

has a large degree of centrality because this manager receives information upward, downward, and horizontally.

Participatory management

implies that others are allowed to participate in decision making over which someone has control. Thus, the act of "allowing" participation identifies the real and final authority for the participant.

Group structures

in the form of joint practice committees, are developed to assume the power and accountability for decision making, and professional communication takes on an egalitarian structure.

Examples of middle-level managers

include nursing supervisors, nurse-managers, head nurses, and unit managers.

Examples of first-level managers

include primary care nurses, team leaders, case managers, and charge nurses.

Examples of top-level managers

include the organization's Chief Operating Officer or CEO and the highest level nursing administrator.

Status

influenced by skill, education, specialization, level of responsibility, autonomy, and salary accorded a position.

A responsibility

is a duty or an assignment. It is the implementation of a job.

The ad hoc design

is a modification of the bureaucratic structure and is sometimes used on a temporary basis to facilitate completion of a project within a formal line organization. A means of overcoming the inflexibility of line structure and serves as a way for professionals to handle the increasingly large amounts of available information

Informal structure

is generally a naturally forming social network of employees. Hartzell (2003-2016) suggests that it is this that fills in the gaps with connections and relationships that illustrate how employees network with one another to get work done.

Accountability

is similar to responsibility, but it is internalized. It means that individuals agree to be morally responsible for the consequences of their actions.

The stated aim of shared governance

is the empowerment of employees within the decision-making system.

Organizational culture

is the total of an organization's values, language, traditions, customs, and sacred cows—those few things present in an institution that are not open to discussion or change. A system of symbols and interactions unique to each organization. It is the ways of thinking, behaving, and believing that members of a unit have in common.

Top-level managers

look at the organization as a whole, coordinating internal and external influences, and generally make decisions with few guidelines or structures.

Committees

may be advisory or may have a coordinating or informal function. They generate ideas and creative thinking to solve operational problems or improve services and often improve the quality and quantity of work accomplished.

Astute leaders

must always be cognizant of who their stakeholders are and the impact they may have on an organization.

Managers

must be able to assess their unit's culture and choose management strategies that encourage a shared culture. Such transformation requires both management assessment and leadership direction.

The leader

must take an active role in creating the kind of organizational culture that will ensure success.

Knowledgeable leaders

never underestimate its importance because the informal structure includes employees' interpersonal relationships, the formation of primary and secondary groups, and the identification of group leaders without formal authority. Their ability to determine a unit's norms and acceptable behavior has a great deal to do with the socialization of new employees.

The distance from the top

of the organizational hierarchy usually determines the degree of status. i.e. the closer, the higher the status.

decision-making hierarchy

or pyramid, is often referred to as a scalar chain. a few managers at the top of the hierarchy make the decisions and the emphasis is on top-down control. In other words, the vision or thinking of one or a few individuals in the organization guides the organization's goals and how those goals are accomplished. Execution of decision making in centralized organizations is fairly rapid.

Centrality

or where a position falls on the organizational chart, is determined by organizational distance.

Subcultures

shape perceptions, attitudes, and beliefs and influence how their members approach and execute their particular roles and responsibilities.

Service lines

sometimes called care-centered organizations, are smaller in scale than a large bureaucratic system. For example, in this organizational design, the overall goals would be determined by the larger organization, but the service line would decide on the processes to be used to achieve the goals.

3-50

suggested range of employees for optimal span of control in an organization

Fayol (1949)

suggested that an organization is formed when the number of workers is large enough to require a supervisor. Organizations are necessary because they accomplish more work than can be done by individual effort.

formal organization

the emphasis is on organizational positions and formal power

informal organization

the focus is on the employees, their relationships, and the informal power that is inherent within those relationships

Effectiveness of first level managers

this directly affects the organization

consensus decision making

this takes more time than autocratic decision making, and not all nurses want to share decisions and accountability

Formal structure

through departmentalization and work division, provides a framework for defining managerial authority, responsibility, and accountability. When well-defined formal, roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident.

The term Magnet

was used to denote organizations that were able to attract and retain professional nurses. "Magnet status is not a prize or an award. Rather, it is a credential of organizational recognition of nursing excellence".