Page 395 - Encyclopedia of Nursing Research

362 n ORGANIzATIONAL DeSIGN

nurses continue to work in diverse organi- referral (e.g., consultation with nurse special-
zational types as the delivery of care shifts ist); and mutual adjustment through infor-
O among public health, military, industry, long- mal communication (e.g., multidisciplinary
term care, home care, and acute care sectors patient rounds), direct supervision (e.g.,
in response to sociopolitical, economic, geo- preceptoring of new nurses), and boundary
graphic, technological, and epidemiologic spanning activities (e.g., case managers). At
trends. the organizational level, the division and
The basis of organizational structure coordination of labor influences the degree of
is the division and coordination of labor centralization and the organizational form.
among organizational members to achieve Centralization reflects the extent to which
a common purpose. When work activities decision-making authority is concentrated
are divided and assigned to formal, interde- at the top levels of the hierarchy versus dis-
pendent, and interrelated roles, the result is persed down through the hierarchy (Hatch,
a social structure composed of individuals 2006). In health care, clinical decision making
and work units. By delineating responsibil- is typically decentralized to front-line profes-
ities and accountability for each role in the sionals, whereas corporate strategy rests with
organization, a hierarchy or reporting struc- the executive team. Organizational forms
ture with formal lines of communication is (e.g., functional, matrix, and program) reflect
created. An organizational chart visually a trade-off between differentiation by func-
displays the formal relationships of the social tion (i.e., division of work by occupation) and
structure. Organizational performance is integration by program (i.e., coordination
typically evaluated in terms of effectiveness of work around the delivery of products or
and efficiency (Hatch, 2006). effective design services; Charnes & Tewksbury, 1993). Since
enables each member to accomplish his or the 1980s, health care organizations have
her assigned work activities while ensuring increasingly shifted from functional to pro-
the overall integration of work flow across gram forms to deliver services on the basis of
the organization. efficiency is achieved by client needs rather than occupational bound-
design that minimizes the use of organiza- aries (e.g., nursing, medicine).
tional resources (e.g., materials, personnel, Modernist theories of organization
time) in accomplishing work. design have focused on improvements to
In larger organizations, work activ- organizational performance and employee
ities that are divided among roles (e.g., motivation. The rise of industrialism and
job descriptions), teams (e.g., nursing care large-scale manufacturing processes near the
delivery models), and work units (e.g., nurs- turn of the twentieth century saw the advent
ing units or departments) must be coordi- of three fundamental theories: bureaucratic
nated to meaningfully direct group activity theory, the Scientific Management School,
toward shared goals (e.g., volume, quality). and classic management theory. These early
Coordination mechanisms bring together theories conceptualized the organization as a
and connect smaller work activities among stable entity with a formalized structure and
individuals and work units. At the work unit as a closed system isolated from its external
level, coordination involves programming environment. According to bureaucratic the-
and feedback devices such as standardiza- ory, organizations sought to achieve tech-
tion of worker skills (e.g., mandated nurs- nical and economic efficiency using legal,
ing certification), work content (e.g., nursing rule-bound authority (rather than author-
care map), work outputs (e.g., managed care ity based on kinship or personality) among
objectives), or communication methods obedient and status-seeking workers (e.g.,
(e.g., electronic health record); hierarchical Weber, 1978). Using a bottom-up approach,