Organizational Structure

formal organizational structure

• emphasis is on organizational positions and formal power

• provides a framework for defining managerial authority, responsibility, and accountability

informal organizational structure

• focus is on the employees, their relationships, and the informal power that is inherent within those relationships

• has its own leaders and communication channel (grapevine)

span of control

• refers to the number of people directly reporting to manager and determines the number of interactions expected of him/her

• too many people reporting to a single manager delays decision making, whereas too few leads to inefficient, top heavy organization

• the ideal span of control in nursing depends on staff skill levels, patient equity, and workload complexity

• effective leaders delegate wisely and establish clear communication pathways to maintain oversight without micromanagement

• ex: nurse manager with 40 direct reports may struggle to provide individualized feedback while one with only 3 nurses may underutilize the resources

unity of command

• 1 person/boss in which employees have one manager to whom they report and to whom they are responsible 

• indicated by the vertical solid line between positions on the organizational chart

• principle reduces confusion, prevents conflicting orders, and strengthens accountability

scalar chain

• decision-making hierarchy or pyramid

• represents the hierarchy from top executives to bedside staff

• a visual ladder of authority

• establishes the flow of decision, but it can also slow down communication if too rigid

• ex: a bedside nurse who must escalate an urgent concern through 4 layers of management risks losing valuable time

centrality

• extent to which an employee is integrated into the network of interpersonal relationships within the work system

• middle manager often has centrality bc they have a broader view of the organization and communicates in many directions

• in other words, more connections a role has across departments the higher their centrality

• ex: a clinical nurse manager interacts daily with nursing staff, physicians, house keeping → makes them a central figure

• more central a persons position → greater their influence, holds communication together, and can drive change effectively

levels of management

• top level managers

• middle level managers

• first level managers

what do top level managers do?

• set the mission, vision, and long term goals

• focus on policy and strategic direction

examples of top level managers

• board of directors

• chief executive officer

• chief nursing officer

• administrators

what do middle level managers do?

• translate those strategies into unit level objectives

• connect executive vision and daily operations

examples of middle level managers

• nursing supervisors

• nursing directors

• department heads

what do first level managers do?

• work closest to direct pt care

• manage staffing, assign workloads, ensures standards are met

• reveal how decisions are distributed, centralized, or decentralized

• success on bedside relies on leadership at the top and only succeeds when frontline nurses are supported

examples of first level managers

• team leaders

• charge nurses

• primary care nurses

• case managers

centralized decision making

• decisions are made by a few managers at the top of the hierarchy

• creates consistency but slows the responsiveness

• ex: centralized hospitals may require executive approval to change supply vendors

decentralized decision making

• decision making is diffused throughout the organization and problems are solved at the lowest practical managerial level

• empowers staff to make decisions

• improve engagement, innovation, and patient outcomes bc nurses are closest to care delivery, have autonomy, and solve problems quickly

• ex: allow nurse managers to decide based on unit needs

organizational charts

• diagram that visually represents an organization's internal structure, showing reporting relationships and the hierarchy among positions and departments

• helps where authority and communication exist within the structure

advantages of the organization chart

• maps lines of decision making authority

• helps people understand their assignments and those of their coworkers

• reveals to managers and new personnel how they fit into the org

• contributes to sound organizational structure

• shows formal lines of communication

• for new nurses → helps them understand the role and chain of commands

• for leaders → exposes gaps, redundancies, and unclear responsibilities

disadvantages of the organization chart

• does not show the informal structure of the org

• only shows the formal structure

• does not indicate the degree of authority held by each line position

• may show things as they are supposed to be or used to be rather than as they are

• possibility exists of confusing authority with status

• doesn’t capture informal networks/actual flow of influence

• can become quickly outdated

• ex: most trusted problem solver may not appear on the chart

types of organizational structures

• line structures

• ad hoc design

• matrix structures

• service line organization

• flat designs

line structures

• common

• traditional

• hierarchical and rigid

• excellent for control but are less flexible for innovation

ad hoc design

• temporary structure and disbands once goals are achieved

• modification of the bureaucratic structure

• sometimes used temporarily to facilitate project completion within a formal line organization

• overcomes the inflexibility of line structure

• serves as a way for professionals to handle increasingly large amounts of info

• uses a project team or task approach and is usually disbanded after a project is completed

• may result in decreased employee loyalty to the parent org

• ex: committee to implement a new medication bar coding system

matrix organizations

• designed to focus on both the product and the function

• have a formal vertical/horizontal chain of command

• have fewer formal rules and levels of the hierarchy

• can cause slow decision making due to information sharing

• can produce confusion and frustration for workers because of dual authority hierarchical design

• ex: a nurse educator reports to both the education director and clinical director → can create collaboration but also create role confusion

flat organizational designs

• remove hierarchical layers by flatting the scalar chain and decentralizing the organization

• fewer management layers

• continues to have line authority but bc the organizational structure is flattened, more authority and decision making can occur where the work is being carried out

• despite being very flat, often retain many characteristics of a bureaucracy

• efficient but requires clear communication and accountability

• most modern health care systems combine these structures to remain efficient and adaptable

• empowers frontline nurses to act autonomously

organizational structure

• total of an organizations beliefs, history, taboos, formal/informal relationships, and communication patterns

• much of organizations culture is not available to staff in a retrievable source and must be related by others

organizational climate

• how employees perceive and organization or culture

• perception may be accurate/inaccurate and people in the same org may have diff perceptions about the same org

• people can see it supportive/punitive, open/closed

• ex: 2 nurses can work same hospital but have very diff perceptions of climate based on leadership behaviors

building a new culture in an organization

• often requires new leadership/outside analysis

• involves listening to all stakeholders

• healthy culture requires transparency, collaboration, and consistency

how can leaders rebuild trust in an organization?

• modeling openness

• setting clear expectations

• inviting staff participation and problem solving

what are stakeholders?

• entities in an orgs environment that play a role in the orgs health and performance or that are affected by the org

• may be both internal/external

• every org should be viewed as being part of a greater community of stakeholders

• engaging stakeholders builds ownership and accountability

• essential element of participatory leadership

accountability

moral RESPONSIBILITY that accompanies a position

responsibility

related to job assignment and must be accompanied by enough authority to accomplish the assigned task; refers to assigned duties/tasks to do

authority

• official power to act and direct the work of others

• without the right balance, errors and frustration occur

• giving responsibility without authority sets nurses up for failure

shared governance

• allows everyone to have a voice in decisions affecting practice

• shifts from command/control to collaboration

• nurses at every level play a role in the decisions that affect nursing activity throughout the system

• nurse managers move out of traditional model roles into collegial models, becoming moderators of the service process

• usually defined by a structure of rules/by laws

participatory management

• lays the foundation for shared governance

• implies that others are allowed to participate in decision making over which someone has control

• act of allowing participation identifies for the participant the real and final authority

• hallmark of magnet hospitals

• leadership transparency, flexible staffing, and nurse autonomy support professional growth

• encourages

• ownership

• when nurses help make the rules they are more likely to uphold them

what makes a hospital a magnet hospital?

• well-qualified nurse executives in a decentralized environment

• organizational structures that emphasize open participatory management

• autonomous, self managing, self governing climates that allow nurses to fully practice their clinical expertise

• staffing: flexible, adequate

• clinical career opportunities

what does it mean to be magnet?

hospitals are able to attract and retain professional nurses

not a prize/award but a credential/recognition

5 model components of magnetism within an org

1. transformational leadership

2. structural empowerment

3. exemplary professional practice

4. new knowledge/innovation and improvements

5. 5 empirical quality results

top 14 forces of magnetism for magnet hospital status

1. quality of nursing leadership

2. organizational structure

3. management style

4. personnel policies and programs

5. professional models of care

6. quality of care

7. quality improvement

8. consultation and resources

9. autonomy

10. community and the hospital

11. nurses as teachers

12. image of nursing

13. interdisciplinary relationships

14. professional development

pathway to excellence

• recognition of health care orgs with foundational quality initiatives in creating a positive work environment as defined by nurses and supported by research

• established shared governance structure that values nurses contribution in everyday decisions

• respect and continuous improvement

committees within an org

• too many is a sign of poorly designed org structure

• to be productive committees, they should have an appropriate number of members, prepared agendas, clearly outlined tasks, effective leadership

• ex: pressure injury prevention committee that audits charts, monitors trends, and recommends policy changes directly will contribute to quality improvement