Topics

• Evolution- From Inpatient to Outpatient
• Organizational Structure
• References

NURS 410 - Health Care Delivery Systems & Informatics

Module 5: Healthcare Operations and Work Force

Organizational Structure

Organizational structure refers to how an organization arranges staff or individuals to help perform the work of the organization. The goal of an organization is to develop a process and structure to help attain the mission and purpose of that organization. When we think of a “structure”, we think of a visual diagram that communicates who does what type of work and how different units or divisions report to and communicates with other units and divisions. That diagram may be referred to as an organizational chart. When a work group is very small and face-to-face communication is frequent, formal structure may be unnecessary, but in a larger organization decisions have to be made about the delegation of various tasks.  A hospital or integrated health system would be very complex and would demand a clear organizational structure and chart.

With structure come procedures, and lines of responsibility. Procedures are established that assign responsibilities for various functions. It is these decisions that determine the organizational structure. In an organization of any size or complexity, employees' responsibilities typically are defined by what they do, who they report to, and for managers, who reports to them. Over time these definitions are assigned to positions in the organization rather than to specific individuals. The relationships among these positions are illustrated graphically in an organizational chart. The best organizational structure for any organization depends on many factors including the work it does; its size in terms of employees, revenue, and the geographic dispersion of its facilities; and the range of its businesses (the degree to which it is diversified across markets).

As you have read in your text, there are a variety of types of healthcare organizations. How they work together and how the connection changes over time are important. We are witnessing today how healthcare is moving forward in redesigning and redefining how delivery of care directly because of economic drivers. Many hospitals have taken steps or are taking steps to merge with other hospitals or facilities such as skilled care facilities, labs, and dialysis units. Mergers result in more goods and services under the control of an organization. Consider Medstar Health. Medstar Health is an integrated healthcare organization that through mergers and acquisitions has grown to cover a very large service area and is able to offer a tremendous variety of services. Take a look for yourself on http://www.medstarhealth.org/mhs/our-locations/

Singer (2012) explains several forces that are driving the market pushing hospitals to merge for survival.

• Reimbursement methods and amounts are changing,
• The cost of installing and using electronic systems for health records and,
• These systems have to meet the requirements of Center for Medicare and Medicaid Services (CMS) which has increasing constraints on reimbursements for care. Hospitals require capital cash flow and access to cash to keep doors open for business.

End this section of the module by reviewing a few organizational charts. First, review the organization chart for University of Virginia Medical Center on http://uvahealth.com/about/health-system-info/media-assets/mcorganization.pdf

You can see this chart has several layers under the chief executive officer specifically Nursing, hospital Operation, Marketing, etc. This organization might be considered tall and this chart does not show all of the units under, for example, the Associate Chief for children’s hospital.

Next open the link to the National Institutes of Health Division of Cellular Biology on https://dcb.nci.nih.gov/About/Pages/Organization.aspx.  This structure is flat which means there are very few levels between the top, or the Director, and the units below. This organizational type might be reference to as function which means the unit or departments below the Director are organized into specific functions such as cancer etiology, cancer cell biology, etc.