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62 unit 1 | Professional Considerations CikguOnline
as the brains of the organization and employees as the
CEO
muscle (Parker & Gadbois, 2000, p. 428).
Administrators Innovative organizations have adapted an
increasingly organic structure that is more dynamic,
Managers (also medical staff)
more flexible, and less centralized than the static
Staff nurses traditional hierarchical structure (Yourstone &
Smith, 2002). In these organically structured
Technicians
(including LPNs) organizations, decisions are made by the people
who will implement them, not by their bosses.
Aides; housekeeping; The organic network emphasizes increased flex-
maintenance
ibility of the organizational structure, decentralized
decision making,and autonomy for working groups
Figure 5.1 The organizational ladder.
or teams. Rigid unit structures are reorganized into
autonomous teams that consist of professionals
from different departments and disciplines. Each
The people at the top of the ladder have authority team is given a specific task or function (e.g., intra-
to issue orders, spend the organization’s money, and venous team, a hospital infection control team, a
hire and fire people. Much of this authority is del- child protection team in a community agency).The
egated to people below them, but they retain the teams are responsible for their own self-correction
right to reverse a decision or regain control of these and self-control, although they may also have a
activities whenever they deem necessary. designated leader. Together, team members make
The people at the bottom have little authority decisions about work assignments and how to deal
but do have other sources of power. They usually with problems that arise. In other words, the teams
play no part in deciding how money is spent or supervise and manage themselves.
who will be hired or fired but are responsible for Supervisors, administrators, and support staff
carrying out the directions from people above them have different functions in an organic network.
on the ladder.If there was no one at the bottom,the Instead of spending their time observing and con-
work would not get done. trolling other people’s work, they become planners
Some amount of bureaucracy is characteristic of and resource people. They are responsible for pro-
the formal operation of every organization, even viding the conditions required for the optimal
the most deliberately informal, because it promotes functioning of the teams, and they are expected to
smooth operations within a large and complex ensure that the support, information, materials, and
group of people. funds needed to do the job well are available to the
teams. They also act as coordinators between the
More Innovative Structures teams so that the teams are cooperating rather than
There is much interest in restructuring organiza- blocking each other, working toward the same
tions, not only to save money but also to make the goals, and not duplicating effort.
best use of a health-care organization’s most valu- Organic networks have been compared with
able resource: its people. This begins with hiring spider plants, with a central cluster and offshoots of
the right people. It also involves providing them smaller clusters (Morgan, 1997). Each cluster rep-
with the resources they need to function and the resents a discipline (e.g., nursing, social work, occu-
kind of leadership that can inspire the staff and pational therapy) or a service (e.g., psychiatry,
unleash their creativity (Rosen, 1996). orthopedics). For example, Figure 5.3 shows an
Increasingly, people recognize that organizations organic network for a wellness center. Each cluster
need to be both efficient and adaptable. Orga- represents a separate set of services. A patient
nizations need to be prepared for uncertainty,for rapid might use just one or all of them to develop a per-
changes in their environment, and for quick, creative sonal plan for wellness. Staff members may move
responses to these challenges. In addition, they need from one cluster to another, or the entire configu-
to provide an internal climate that not only allows but ration of interconnected clusters may be reorga-
also motivates employees to work to the best of their nized as the organization shapes and is shaped by
ability. They need to stop thinking of the managers the environment.