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