Lecture 9 Organizational structure

Question 1

Organizational structure

Answer 1

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

Question 2

Formal organizational structure

Answer 2

Highly visible plan that defines roles and functions, managerial authority, responsibility, and accountability; rank and hierarchy are evident.

Question 3

Informal organizational structure

Answer 3

Unplanned and hidden structure that is generally social, with blurred or shifting lines of authority and accountability.

Question 4

Bureaucracy

Answer 4

An institutional method for applying general rules to specific cases, thereby making the actions of management fair and predictable; includes clear division of labor, a well-defined hierarchy of authority, impersonality of interpersonal relationships, and a system of rules covering the rights and duties of each position.

Question 5

Chain of command

Answer 5

The formal paths of communication and authority.

Question 6

Span of control

Answer 6

1. The number of people directly reporting to any one manager or officer.
2. Usually about 3-50 people, but this number can be highly variable.

Question 7

Organizational “flattening”

Answer 7

1. Historically, the span of control was narrow at the top (fewer managers) and wider at the bottom (more subordinates).
2. Financial pressures and electronic communication have increased the span of control, resulting in “flattening of the organization.”

Question 8

Top-level managers

Answer 8

1. Managers who look at the organization as a whole.

2. Examples: Chief executive officer (CEO), chief operating officer (COO), chief nursing officer (CNO).

Question 9

Mid-level managers

Answer 9

The department directors, who integrate their units’ day-to-day needs with the organizational needs.

Question 10

First-level managers

Answer 10

The charge nurses and team leaders, who focus on day-to-day unit needs.

Question 11

Centrality

Answer 11

1. The location of a position (on an organizational chart) where frequent and various types of communication occur.
2. A middle manager has a large degree of centrality (i.e., the broadest view of the organization) because this manager receives information upward, downward, and horizontally.

Question 12

A limitation of an organizational chart is that _

Answer 12

It defines authority but does not define responsibility and accountability.

Question 13

Responsibility

Answer 13

The obligation to accomplish work; a duty or an assignment.

Question 14

Accountability

Answer 14

Internalized responsibility whereby an individual agrees to be morally responsible for the consequences of his actions.

Question 15

Authority

Answer 15

The official power to act.

Question 16

Line structure

Answer 16

1. Organizational structure in which authority and responsibility are clearly defined; typical bureaucratic structure.
2. Found in large health care facilities.
3. Going outside the chain of command for upward communication is inappropriate.

Question 17

Ad hoc structure

Answer 17

A loose bureaucratic structure; usually used on a temporary basis to complete a project (e.g., committee formation).

Question 18

Matrix structure

Answer 18

Organizational structure with a formal vertical and horizontal chain of command that focuses on function (the tasks required to produce the product) and product (the end result of the function).

Question 19

Service line organization

Answer 19

1. Similar to the matrix design; can be used in some large institutions to address the shortcomings that are endemic to traditional large bureaucratic organizations.
2. Overall goals are determined by the larger organization, but the service lines decide on the processes to achieve the goals.

Question 20

Flat organizational designs

Answer 20

1. An effort to remove hierarchical layers by flattening the scalar chain and decentralizing the organization.
2. Under these designs, decisions are made where the work is being carried out.
3. This is the more contemporary approach being used by many hospitals.

Question 21

Organizational chart

Answer 21

1. Vehicle that depicts the formal relationships, lines of communication, and authority within an organization.
2. Advantages: Maps lines of authority and communication; helps people understand assignments; contributes to organizational structure.
3. Disadvantages: Shows only formal relationships; does not indicate degree of authority; shows things as they “should be” not as they are; confusion of authority with status; may not be kept up-to-date.

Question 22

In centralized decision making, decisions are made by _

Answer 22

A few managers at the top of the hierarchy.

Question 23

In decentralized decision making, decisions are made by _

Answer 23

People on the level where the problem occurs; this diffused form of decision making is better in large organizations.

Question 24

Stakeholders

Answer 24

1. Those entities in an organization’s environment (internal or external) that play a role in the organization’s health and performance, or that are affected by the organization.
2. They have interests in what the organization does, but may or may not have the power to influence the organization to protect those interests.

Question 25

Examples of internal stakeholders include _

Answer 25

Hospital employees; physicians; patients and their families; union shop stewards; and the board of directors.

Question 26

Examples of external stakeholders include _

Answer 26

Local businesses; area colleges and universities; insurance companies and HMOs; unions; and professional organizations.

Question 27

Organizational culture

Answer 27

Set of symbols and interactions that defines an organization’s ways of thinking, behaving, and believing as well as its values, language, tradition, customs, and “sacred cows” that are absolute and not open to discussion or change.

Question 28

Organizational climate

Answer 28

How employees perceive an organization.

Question 29

Shared governance

Answer 29

1. Egalitarian organizational governance shared among board members, committees, staff, and management, impacting decision making and communication.
2. Analogous to a democratic decision-making style.

Question 30

The aim of shared governance is _

Answer 30

The empowerment of employees within the decision making system.

Question 31

In shared governance, _ are developed to assume power and accountability for decision making.

Answer 31

Joint practice committees.

Question 32

Magnet status

Answer 32

1. Credential of organizational excellence bestowed by the Magnet Hospital Recognition Program of the American Nurses Credentialing Center (ANCC) for excellence in nursing services.
2. These organizations employ a decentralized structure that emphasizes participatory management.

Question 33

Committee

Answer 33

1. A group of interested or affected employees, formed to assist the organization in receiving valuable feedback or important information.
2. Communication occurs both upward and downward.

Question 34

Committees should be composed of enough members to accomplish assigned tasks, but not so many that discussion cannot occur; therefore, _ members are usually ideal.

Answer 34

6 to 8.

Question 35

Informal groups should be encouraged by management, because these provide _

Answer 35

A sense of community and belonging.

Question 36

Nursing services should be organized to facilitate the development of _

Answer 36

Future leaders.

Question 37

Unity of command

Answer 37

1. The idea that each person should have only one boss so that there is less confusion and greater productivity.
2. Difficult to maintain in some large health care organizations, because the nature of health care requires an interprofessional approach.