Chapter 12: Organizational Structure: Leadership Exam #3

formal structure

defined by positions, roles and authority

focus: official chain of command, accountability and policies

informal structure

based on personal relationships, and social networks

grapevine communication, influence and informal leaders

Span of Control

Refers to the number of people directly reporting to one manager.

Too wide: Delays decision-making, weak supervision.

Too narrow: Creates a top-heavy bureaucracy.

-What do you want me to do for you? (manager to employee)

Unity of Command

Each employee reports to one manager only.

Prevents conflicting instructions and confusion.

Scalar Chain

The hierarchical chain of command from top to bottom.

Also called the decision-making pyramid.

-good managers hear what everyone else has to say

Centrality

How connected an employee is within the organization’s communication web.

Middle managers often have the greatest centrality (communicate in all directions).

Top-level managers

CEO, CNO, administrators

Strategic planning, vision, organizational goals

Middle-level managers

Nursing directors, department heads

Coordinate units, implement policies

First-level managers

Charge nurses, team leaders, case managers

Direct patient care and daily operations

Centralized decision making

decisions made by top government, consistent but slower and less empowering

ex: how much is nurse going to get an hour as a raise

decentralized decision making

decisions made at the lowest level, faster, more autonomy, and better morale

-opinion is given in situation

-happens a lot in magnet hospitals

Line Structure

Traditional bureaucratic hierarchy; clear chain of command

Simple but rigid; top-down communication

Ad Hoc Design

Temporary project teams to solve specific problems

Flexible and creative, but may weaken loyalty to parent organization

Matrix Structure

Dual authority (both functional and product-based); vertical + horizontal lines of communication

Promotes collaboration, but causes role confusion and slow decisions

Service Line (Care-Centered)

Divides organization by service (e.g., pediatrics, oncology)

Increases accountability for outcomes; better coordination of care

Flat Design

Fewer layers of hierarchy; decentralized decision-making

Empowers staff but can blur leadership lines; often used in shared governance models

Authority

Official power to direct others and make decisions

responsibility

obligation to perform assigned tasks

accountability

moral and legal ownership of outcomes

Stakeholders

Anyone affected by or affecting the organization’s performance.

Can be internal (staff, managers) or external (patients, community, government).

Organizational Culture

The shared values, history, norms, communication styles, and rituals within an organization.

Often invisible but shapes behavior and expectations.

Can include multiple subcultures (e.g., units, departments).

Organizational Climate

How employees perceive the organization’s environment and leadership.

Can be accurate or inaccurate and vary among staff.

Building or Changing Culture

Usually requires new leadership or outside evaluation.

Change takes time, communication, and alignment of values.

Shared Governance

Empowers nurses at all levels to participate in decision-making that affects their work.

Defined by rules or bylaws (e.g., unit councils).

Nurse managers act as facilitators, not dictators.

Promotes accountability, autonomy, and professional practice.

Participatory Management

Manager allows employees to take part in decision-making.

Different from shared governance: final authority still lies with the manager.

Effective Committees Should Have:

Clear purpose and agenda

Appropriate number of members (6–8 ideal)

Diverse representation

Strong leadership and organization