Post on 17-Jan-2017
Dr. Thin Myat HanHealth Policy and Management Dept.
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Organizing
Referrences:
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BM Sakharkar 2009, Principles of Hospital Administration (2nd Edit) Chapter 9. Organizing
Koontz H, Weihrich H 2001, Essentials of Management (5th Edit) Part 3 – Organizing
Joshi DC, Joshi M, Hospital Administration, Section 2, Organization Behavior
Outline of discussion
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Functions of managersDefinition of organization, organizingAuthority relationsDelegationCommitteeOrganizational chartTypes of organizationOrganizational behavior and realities of
hospital organization
Functions of Managers
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1. Planning2. Organizing3. Staffing4. Leading5. Controlling
Organization
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Rational combination of the activities of a number of people
for the achievement of a common purpose or goal,
by division of labour and function and
through a hierarchy of authority and responsibility
Organizing
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Process of grouping the necessary
responsibilities and activities into workable units,
determining the lines of authority and communication, and
developing patterns of coordination
Structure and role
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Organization structure is to help in creating an environment for human performance
Structure must define the tasks to be done
Roles must also be designed in the light of abilities and motivation of the people available
Role for people
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What people do has a definite purpose or objective
They know how their job objective fits into group effort
They have necessary authority, tools and information to accomplish the task
It is better to fit the personnel to a sound structure rather than to sacrifice sound structure to individual whims of personality
Staffing
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Involves filling, and keeping filled, the position in the organization structure
By - identifying work-force requirements, Inventorying the people available
Recruiting, selecting, placingPromoting, appraising, planning the
careers of, compensating, and training to accomplish their task effectively and efficiently
Leading
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Influencing of people so that they will contribute to organization and group goals
Has to do predominantly with the interpersonal aspect of managing
People tend to follow those who offer a means of satisfying their own needs, wishes, and desires
Involves motivation, leadership styles and communication
Controlling
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Measuring and correcting of activities of subordinates to ensure that events conform to plans
It measures performance against goals and plans, shows where negative deviations exist, and, by putting in motion action to correct deviations, helps ensure accomplishment of plans
Authority relationships
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1. Super ordination / subordination2. Authority and responsibility3. Scalar principle4. Functional authority5. Splintered authority6. Line and staff authority7. Span of management
1. Super-ordination / Sub-ordination
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Hospital / healthcare organization is expected to perform efficiently at all times
Distinct status differences among organizational members
Its performance through directive, quasi-authoritarian controls
Relies upon formal policies, rules and regulations for controlling work relationships of its members
2. Authority and responsibility
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Authority must be equal to responsibility
Absoluteness of responsibility – manager delegate authority but the ultimate responsibility is retained by the manager
decentralization of authority depends on the mgt. philosophy of governing board, size of the health care organization
Authority and power
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Power, a much broder concept than authority,
is the ability of individuals or groups to introduce or influence the beliefs or actions of other persons or groups
Authority in organization is the right in a position (and, through it, the right of the person occupying the position) to exercise discretion in making decisions affecting others
3. Scalar principle and chain of command
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3. Scalar principle
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Individual workers are placed in a specific authority relationship to a superior, whose authority can be traced from the next level of authority, up to top level of hierarchy
Chain of command- shows who reports to who, who has authority over others
Organizational hierarchy pyramid
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Top mgt.
Middle mgt.
Supervisors
Line workers
4. Functional authority
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Functional status is the position held by an individual by virtue of the kind of work he or she performs
e.g. Physicians exercise substantial influence throughout the hospital
5. Splintered authority
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There are limits on each managers authority and greater need for coordination at various level of organization
6. Line and staff authority
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Line refers to those positions and elements of the organization which have responsibility and authority and are accountable for accomplishment of primary objectives
e.g. direct chain of commandStaff elements are those which have
advisory or service function to the line manager in the attainment of primary objectives
e.g. personnel or finance
7. The span of management
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Number of individuals whose activities can be coordinated and controlled effectively by one manager
Depends on : 1. nature and flow of work2. Training and motivation of workers3. Organizational stability4. Dispersal of work units5. Managerial effectiveness6. Availability of staff specialists
Delegation
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How much freedom, scope and power is entrusted to subordinates to act on behalf of manager, utilizing the resources of the organization and for achieving desired result
Most serious symptom of poor organization is unclear authority delegation
Principles of delegation
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1. Delegation according to ability2. Absoluteness of responsibility3. Parity of authority and responsibility –
delegated authority should be commensurate with results expected
4. Definition of results expected5. Unity of command – delegatee should be
responsible to one boss6. Authority levels – decisions within the
authority competence of an individual should be made
Steps in delegation
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1. Selecting and assigning the task2. Selecting the appropriate
subordinate3. Instructing the subordinates4. Maintaining feedback and control
Tenets of delegation
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1. A manager cannot delegate authority which he does not have
2. Cannot delegate all his authorities3. Delegate only operational authority
not authority to make policy and technical authority
4. Delegation of authority is not absolute or permanent – always be recalled by the delegator
What should never be delegated
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1. The power to discipline2. Responsibility for maintaining
morale3. Overall control4. Crisis situation calling for urgent
solution5. Technical task or matter6. Custodianship of trust and
confidence
Barriers to delegation
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Management barriers
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1. Unwillingness to give subordinate a chance (Manager feels he can do the job better, faster)
2. Unwillingness to let subordinates make decision
3. Fear of subordinates making mistakes
4. Unwillingness to trust subordinates
5. Unwillingness to let go power
Management barriers
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6. Disinclination to develop subordinates
7. Fear of taking risks8. Uncertainty over tasks9. Failure to establish effective
control10.Lack of organizational skill –
confusion about authority and responsibility
Subordinate barriers
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1. Lack of aptitude for work2. Feeling of insecurity, lack of self-
respect3. Fear of failure, of making mistakes4. Lack of initiative5. Lack of experience6. Avoidance of responsibility
Multiple pyramid of hospital organization
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Governing board – ultimate authority
CEO (administrator) Charged with the responsibility for effectively managing the admin. components of institution
Delegates authority to each dept. head in admin. component
Chief of Med. service
Difficulties in absence of single line of authority
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Coordination difficultapportionment of authority, responsibility
and accountability is uncleardifficulties in communicationDominations:
Trustee dominationMedical dominationAdministrator dominationMultiple domination
Committee as part of organization
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A group entrusted with dealing with a specific problem
for group decision makingformal (finance or development
committee) or informalLine or staff
Why committees become necessary
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1. Group deliberation and judgment2. Representation of varied interests3. Coordination of department
policies and plans4. Sharing information5. Consolidation of splintered
authority6. Avoidance of action
Drawbacks of committees
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1. High cost in time and money2. Compromise and watering-down
of decisions3. Indecision4. Forcing the decisions
Committees are success when:
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Formally organizedHave assigned specific jobs to doHave a leader acceptable to all
membersKeep written records of their
deliberationsKnow that recommendations are
accepted
Effective committee managementChecklist
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Purpose and scopeneedsizeHow often to meetCommittee membersSubject matterCommittee chairmanMinutes and conclusion
Organizational chart
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Line or scalar chart, showing each layer of organization in sequence
Line relationship Staff position ----------Master chart and supplementary
chart
Organizational chart
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Three types : Skeleton, personal and functional
Skeleton: Merely present the major units of the organization
Personal : show in addition, the major positions and often the names of those persons occupying them
Functional : Not only depict the major units but also describe briefly the functions, purposes, duties, and activities of each
Advantages
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It depicts major lines of decision-making and authority - can review it to determine any inconsistencies and complexities
Orient employees as to where they fit into the organization, where each job fits in relation to other jobs in the department
Tool for managerial audit: span of control, crossed lines of authority
Conveys information about the chain of command, supervisory relationship, channels of communication, and line of decision making
Limitations
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Important lines of informal communication and significant informal relationships cannot be shown
become obsolete easily if not periodically update on occurrence of change
Matrix organization
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The existence of both hierarchical (vertical) coordination through department and formal chain of command, and simultaneously lateral horizontal coordination across departments
e.g. cardiac emergency team
Types of organization
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Two types of organization: formal & informal
Formal organization: Intentional structure of roles in a formally organized enterprise
If organized well - individual performance contribute most effectively to organizational goals
Formal organization
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President
Division Managers
Vice-Presidents
Dept. Managers
Informal organization
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A network of personal and social relations not established or required by formal organization but arising spontaneously as people associate with one another
Relationship not appearing on an organization chart
Informal organization
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President
Division Managers
Vice-Presidents
Dept. Managers
Bowling team Chess groupMorning coffee regular
Span of control
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The number of persons a manager can supervise effectively
Organization level Vs. span of control
4-8 subordinate at upper level of organization
8-12 at lower level (up to 20)Depends on nature of work and
environment
Hierarchy and spans of control
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Organization with narrow spans
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AdvantagesClose
supervisionClose controlFast
communication bet. subordinates and superiors
DisadvantagesSuperiors tend to get
too involved in subordinates work
Many levels of mgt.High cost due to many
levelsExcessive distance
bet. lowest and top level
Organization with wide spans
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Organization with wide spans
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AdvantagesSupervisors are
forced to delegate
Clear policies must be made
Subordinate must be carefully selected
DisadvantagesTendency to
overloaded supervisors to become decision bottlenecks
Danger of supervisors loss of control
Requires exceptional quality of managers
Organizational behavior
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A field of study that investigates the impact that individuals, groups and structure have on behavior within organization, for the purpose of applying such knowledge towards improving an organization’s effectiveness
Dependent Variables of OB Model
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1. Productivity2. Absenteeism3. Turnover4. Job Satisfaction
Independent Variables
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Individual level variablesBiographical character (age, sex, marital status), personality, value and attitude, ability
Group level variablesGroup structure, gp. Decision making, communication, other groups and inter-gp relationship (conflict, power and politic)
Organization system variablesHuman resource policies, cultural system, organization structure
Realities of hospital organization
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There are a number of important people who consider themselves as heads
Absence of single line of authority and with two chains of command
High interdependenceTiming of the movement of patients through
the system is largely controlled by chance or by a set of un-coordinated, individual decisions
Individual goals of staff coincide more with hospital goals
Realities of hospital organization
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Complex work of health care has a high risk of serious or deadly error, which necessitates highly reliable systems of practice at all organization level
Complex technical and medical systems demand sophisticated technical expertise, which require educated, efficient, and well co-ordinated workforce
Authoritative and permissive, highly formalised yet loose-knit
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Thank You