Organizational structures

Question 1

Describe the common features that define organizational structures #1

Answer 1

1. Chain of command
   • Path of authority and accountability of the organization (who reports to who and when)
   o Scalar process
    Vertical growth (the more steps there are the more centralized the decision making is)
   o Functionalization
    Horizontal growth (different kinds of duties at the same level)

Question 2

Describe the common features that define organizational structures #2

Answer 2

2.	Span of control
•	Refers to number of people a manager is supervising 
o	Narrow/short
	Few people/tasks
	3-5 subordinates
	Allows for more control
o	Broad/wide
	Many people/tasks
	Decreased control

Question 3

Describe the common features that define organizational structures #3

Answer 3

3. Service line features
   a. Line function (solid lines)
   • Hierarchy of personnel that is from executive to workers at bottom
   • Involves direct responsibility to meet objectives
   • Have authority for decision making
   b. Staff function (broken lines)
   • May assist line positions, provide support, advise and control

Question 4

Understand the implications of a decentralized organizational structure vs a centralized structure (centralized)

Answer 4

1. Centralized
   Location where decisions are made
   Usually only by a few individuals at the top of the organization
   Decisions made by a few people and communicated down
   Authority is formalized
   • Advantages – allows for close coordination and control of workers – highly productive – works well where close coordination and rapid change is occurring
   • Disadvantages – communication can be very slow and difficult due to number of levels it has to go through – workers tend to get boss oriented – very little individual thinking – adjustment to change is very slow and implementation can be very difficult – very expensive structure because so many managers

Question 5

Understand the implications of a decentralized organizational structure vs a centralized structure (decentralized)

Answer 5

2. Decentralized
   Decisions are made by the professionals that are doing the work
   Fewer layers to work through
   Decision making more delegated and spread out
   Easier to work within group
   Short administration distance
   • Advantages – worker is usually primary one who receives advantage of this situation – communication channels shorts – messages you get are less confusing or distorted – workers happier – decision making processes run smoother
   • Disadvantages – may have less contact with supervisor – may be lack of knowledge of operations in which they’re responsibility – workers need education in how to make good decisions – larger organizations find it difficult coordinating and getting consensus
   Ex school of nursing at UFV

Question 6

Compare and contrast the various types of organizational theories #1

Answer 6

1.	Classic
•	1900s goal was high production, efficiency and profit
•	Communication – top to bottom
•	Very impersonal
•	Very simple relationships
•	Key features – centralized control, well defined superior subordinate, rewards accomplishments, promoted on basis of competency 
•	Division of labour on basis of skills
•	Each worker does 1 task
•	Rule governed 
•	Organization is very important 
•	Focus is on task
•	Worker is of little importance

Question 7

Compare and contrast the various types of organizational theories #2

Answer 7

2. Humanistic
   • 1930s goal was economic, productivity, profit job satisfaction led to improved production
   • Communication was vertical
   • Participation of workers
   • Wanted to be of equal value
   • Higher productivity
   • Felt if they involved workers in planning and decision making they got more out of it
   • Focus is more on individual than organization or work although organization still remains important

Question 8

Compare and contrast the various types of organizational theories #3

Answer 8

3. Modern
   • 1950s strive to meet a common goal, communication was horizontal and vertical
   • Organization and worker are seen as a whole
   • Continues to evolve
   • Open system
   • Team concept arose from this
   • Focus is on individuals and organizations as well as roles
   • Status and context is important

Question 9

elements of organizational structure

Answer 9

1. Complexity
2. Size
3. Geographical dispersion
4. Formalization
5. Centralization

Question 10

Explain the purpose of healthcare delivery models

Answer 10

To organize nursing care for patient care delivery

Question 11

Compare and contrast the advantages and disadvantages of various nursing care delivery systems

Answer 11

1. Total patient care or case method
2. Functional method
3. Team method
4. Primary method
5. Nursing case management

Question 12

What is the focus of organizations?

Answer 12

To assist individuals to work together to achieve a common purpose

Question 13

what is an organizational structure?

Answer 13

Framework for the working relationships among members of the system

Question 14

what is structure?

Answer 14

How a group is formed and is the formal relationship within each organization

Question 15

What is the goal of an organization?

Answer 15

Seek a structure that is efficient and provides maximum cost effectiveness

Question 16

What is the goal of a structure?

Answer 16

Achieve the mission, vision and philosophy of the organization

Question 17

mission, philosophy and values

Answer 17

Mission
• Purpose of the organization
• Outlines organizations primary plans or driving forces
Vision
• Provides a conceptual view of what the future of the organization desires to look like
Philosophy
• General imbedded into mission statement
Values
• Largely describe the organizations boundaries while pursuing the vision

Question 18

organizational designs

Answer 18

• Classified by their characteristics of complexity, formalization and centralization
• How the labour is organized will have a direct bearing on how the mission of the organization is achieved
• Must consider the complexity of an organization and the division of labour
• Clear division of labour
• System of procedures to deal with work situations must exist
o What must be accomplished in a day/shift

Question 19

characteristics of an organization

Answer 19

1. Common goal
2. Coordination of effort
3. Division of labour
4. Established delegation of authority

Question 20

models of care delivery #1

Answer 20

1.	Total patient care/case method
•	Oldest known model
•	Nurse patient ratio 1:1
•	Predominant model of care in high acuity settings
o	Advantages
	Consistent, holistic care
	Needs met very quickly
	Subtle changes noted quickly
	Very useful with complex patients
o	Disadvantages
	Expensive
	Not ideal with nursing shortage

Question 21

models of care delivery #2

Answer 21

2.	Functional method
•	Each employee has a designated set of tasks, skills and activities 
o	Advantages
	Efficiency 
	Unskilled workers can be trained to do specific tasks (tasks done very well)
	Give care to large number of patients
	Fewer nurses
	Expectations very clear
o	Disadvantages
	Fragmentation of care
	Nurses have little satisfaction/growth
	Patients get overlooked
	Confusion for patients
	Critical changes may go unnoticed
	Poor communication lines

Question 22

models of care delivery #3

Answer 22

3. Team method
   • Based on the basis that each unit will have 2 or more teams to provide care to a geographic location of patients
   • Each team has various educated care providers (RN, LPN, care aid etc)
   o Advantages
    Improved patient satisfaction
    Using each person to the highest of their ability
    Less fragmentation of care
    Cost effective
    Works with multiple levels of health care
   o Disadvantages
    If team leader has poor communication/leadership skills
    Duplication of care
    Need time for conferencing
    Legal risks if poor communication or patient declines

Question 23

models of care delivery #4

Answer 23

4. Primary method
   • One nurse functions as the patients primary caregiver throughout their entire length of stay
   • RN plans and delivers all the care
   o Advantages
    Noted increased quality of care
    Nurses further their education and knowledge to provide optimal care of their patients
    Increased job satisfaction
    Establish relationship with patient and family
    Decreases number of unlicensed personnel
    Increased knowledge of your patient
   o Disadvantages
    Lack of experience or education of RN
    Shorter stays
    Large number of part time RNs
    RNs are held accountable even if not physically present for 24 hour responsibility of care
    Costly

Question 24

models of care delivery #5

Answer 24

5. Nursing case management
   • System in which healthcare services are controlled and monitored
   • Identification of a critical pathway for care and treatment
   • RNs most often act as a case manager
   o Advantages
    Patient receives more services and have fewer unmet needs
    Cost effective
    Better patient monitoring
    Decreased complications
    Nurse satisfaction
    Decreased hospital stays
   o Disadvantages
    Duplication of services
    Turf wars between services (RN and social worker etc)