If the organizational structure is meant to reflect it’s situation, the Limora Hospital and the Community Health Centre’s (LCHC) structures do not do this. The current structure does not reflect the complexity, dynamics, or the environment. There appears to be little consideration given to parameters of design. Organizational design is used to maneuver a series of criterion that determine the division of labor and coordination. The Limora Hospital and the LCHC have weaknesses in their design concerning the decision making system, the lateral connections between the superstructure, the format of the subunits and the individual job positions.
These are integral parts of the structure and seem to be a weakness at both facilities. I would describe the structure of the LCHC as almost non-existent. Although the case study doesn’t provide a lot of information about the actual parts of the for Limora Hospital or the LCHC, it does appear to be somewhat better at the Hospital then at the LCHC. As an initial step, it would help to combine some areas of the two facilities and better utilize its technostructure, support staff and operating core. The strategic apex is weak with no consistent, committed leadership or administration.
There is confusion about the Bishop’s power of authority. He appears to have given his power away, yet some employees indicate otherwise. In fact, there doesn’t appear to be any real management to apply managerial leadership and direction. This kind of confusion and conflict demoralizes the apex and the middle line entirely. A common vision, mission, and active interest in the future must be demonstrated by the Executives if they are to flow down into the core of the organization. This is lacking and is sorely felt by Dr.
Macdonald who cannot pass down anything more than he is capable of, or more, than he is receiving from his superiors. There is a small technostructure in high demand, a large support staff, and an operating core that is clearly not well managed. Most evident is the lack of linkages between management and the operating core. Although not as evident are the weak linkages between the core and the supporting staff. A limited horizontal decentralization might work where the strategic apex shares some power with the technostruture that standardizes everyone’s work and some of these linkages.
A well organized management team and employee links to them are necessary. A strong theoretical point is made in The Classical School of organizational theory by Henry Fayol, a French industrialist. He, and other theorists like Urwick, Gulick, Mooney and Reiley, emphasized the universality of the management function in all kinds of different organizations. Fayol’s theory worked from the board of directors and chief executives down through the organization. He stressed the importance of planning, organizing, coordinating and controlling the administration of an organization from the top down.
The weakness in Limora Hospital and the LCHC can be found in the management of the Apex and he middle line, and the operating core. No serious attention has been given to these areas so they can achieve the leadership and administrative control they need. The parts of the organization do not support the coordinating mechanisms required, and neglect to meet the needs of either facility. They should reflect the configuration for a professional organization that relies on the trained professionals who have a high level of control over their work.
It is safe to assume that the Doctors and nurses have all been trained and have standardized their professional skills before working at the either facility. Coordination is achieved by the virtue of doctors and nurses having learned what to expect from one another. So they do have this basic mechanism of coordination. What is lacking, is the necessary organizational glue to hold it together. Perhaps the standardization of norms as another coordinating mechanism.
The nurses don’t seem to be able to coordinate their activities based on their common goal of caring for the sick and standardizing norms would be helpful. There has been an attempt at coordination by Dr. Macdonald, but the organization has been without strong consistent control for too long. Although there doesn’t appear to be a middle line, Dr. Macdonald has been left to promote coordination and proper design on his own. His leadership attempt is valiant but he needs the help of qualified middle line managers. The missing parameters of design are Behaviour formalization, Training, and Unit grouping.
Behaviour formalization would provide work processes and job descriptions to reduce confusion about what work people should be doing and how they should be doing it. On the surface, one may question whether a group of professionals need stringent rules and regulations. Although these professionals know the essence of their roles, and have a lot of control over what they do, they lack a framework within which to work and make decisions. Behaviour formalization could outline the framework within which they can take control and, identify the boundary where they need the assistance and cooperation of others.
Also very important, is to identify the communication linkages to others inside and outside this framework. This would eliminate much confusion, instill confidence into the operating core, and bring cooperation among managers and workers. It seems to me that when you are dealing with the life, death, and the health of others, the last thing you want is dissension and confusion among those who are caring for you. Aside from the professional skills applied by the doctors and nurses, the simplest procedures in administration of core workers could be a disastrous for the patient.
As an example, how is a specific report completed, when is it completed, who are the critical receivers of the report, when must they receive it, and what must be included in it, all involve linkages and cooperation among professionals, staff and management. If these are broken in some way or done incorrectly, outside of the prescribed framework, they can impact a life. Chester Bernard’s book, The Functions of Executives, from the human relations school of thought, emphasized the need for clarity and cooperation among managers and workers to further the interests of everyone.
Bernard said that organizations by their very nature are cooperative systems and cannot survive otherwise. He listed three forces to achieve this cooperation; executive leadership, subordinate acceptance of organizational goals, and the power of informal work groups. Clearly in a hospital there is room for strict rules and processes outlined by the leaders, but because there are also large areas of independent decision making, you must have a cooperation and a balance of both.
Training, another parameter of design, can teach the professionals what the standards, processes, and procedures are, and clearly define the level of performance for each. The Limora Hospital must had some training on the hospitals procedures but when the nurses came over to work at the LCHC, they complained that they were not oriented to these properly. Training at LCHC is lacking in this area. The essence of the work done by the professionals is no different in either the Limora Hospital or the LCHC. What is different is the purpose for each facility and the level of output.
One is a hospital that cares for the people who are already ill, and the LCHC is a community program that focuses on preventative health to try to keep people from ending up in the hospital. The hospital doctors and nurses would likely be prescriptive in their care for very ill patients over a shorter period. The LCHC would also prescribe but would likely be more descriptive in their care over longer periods of time in the community. Teaching these fundamentally different objectives to everyone, and what work is wrapped around them, would facilitate a clear direction for exactly what the jobs are in each facility.
The Scientific Management theory advocates a systematic approach to job design, performance, and training. Not necessarily all of the theory components are applicable the systematic approach to training does apply to a health organization. There is a systematic way of applying medical tests to ensure there are no mistakes. Speed and efficiency are critical. There may be a departure from this theory as it relates to division of work and task specialization, but the scientific selection of training remains useful to our health care situation.
Adam Winslow Taylor and Henry Gantt emphasized the need for systematic training of workers. Taylor particularly advocated that the role of management was to know their employees and to train them to do well. If this was done, it would produce maximum efficiency. Finally, both the LCHC and the hospital are dependent on the same resources. They both need analysts such as accounting and personnel, they both use the same nurses and doctors in their operating core, and both need the use of land rovers in their work. Conflicts have surfaced because the organizational structure does not leverage these like needs well.
For example: Clear and accurate financial accounting for both areas They both need highly qualified doctors and nurses Their primary and supporting staff need similar training They are dependent on each other but the structure does not promote interdependency They both require processes and procedures to perform their jobs well Unit grouping would be the design parameter most required to help facilitate the mutual needs of each unit. Grouping these under the same supervision would encourage cooperation and help to promote a more efficient and cooperative working environment.
Once the needs of each area are clear, you need to establish liaison positions, or roles that can coordinate the work of two units. These liaison positions are missing in the hospital and LCHC structure. Task forces are also missing. Task forces can plan meetings, bring the members of each unit together, and integrate mangers to coordinate what is important to the units. These initiatives would eliminate competition for the best nurses and doctors, and provide a fair an accurate financial accounting for both facilities.
It is difficult to tell how much impact the support staff for either the Limora hospital, or the LCHC have on the operating core and the quality of care. I’m sure the support staff could also be optimized by unit groupings. Unlike the scientific management theory that did not provide a theory of general organizational design, the classical school of organizational theory did. Henry Fayol, from this theory, suggested that all jobs should be regrouped on some common basis to achieve coordination or unity of direction.
Henry Fayol also saw the importance of working from the board of directors down into the organization, different from the scientific management school of thought which worked from the bottom up. Both are useful for our purposes. This regrouping theory and focus on the top levels of the organization are very applicable to the Limora Hospital and the LCHC. There are also some situational factors such as age, size, technical systems, power, and environment that need consideration. Understanding the impact of situational factors can help identify the weaknesses in the structure and how to improve them.
For example, the hospital and the LCHC are only 10 years old and there are only 280 beds. This means they are relatively young and small and that their behaviours aren’t yet formalized. The fact is there is a lack of organizational maturity. As the organization ages and grows in size, the behaviours will become formalized and the more homogeneous. Because the environment in a hospital is complex and decisions cannot be made by one person, one might decentralize the structure and push the decision making down.
However, with the problems at the Limora Hospital and the LCHC, it would be wise to centralize some of its structure temporarily. Taking this action in the right areas would eliminate the current hostile environment. As the organization matures, selective vertical and horizontal decentralization can be applied where the power over different decisions is spread over different parts of the organization more readily. Finally we have the operating core, the key part of the organization that is composed of professionals.
Although the basic coordinating mechanism of standardization of skills exists, standardization of processes, and outputs are weak. These together with the lack of leadership, have politicized the organization and the people are in conflict. Consequently, the structure of Limora Hospital and LCHC has become a professional bureaucracy, not uncommon in Hospitals. A view of Professionals is that they are attached to the organization, but still have extensive autonomy and freedom. This gives them the best of both worlds. From an organizational perspective, however, this environment is very difficult to control and measure.
The hospital and the LCHC need to discover then prescribe, when and how the attachment to the organization is essential, and when autonomy is necessary. As stated earlier, as the organization matures, professionals will perfect their own skills and repeat what works for the overall success of their jobs. For right now, framework and guidance are required. Guidance, communication and leadership would maximize the professional’s output, efficiency and morale. Another item that may be an issue for the hospital and the LCHC is professional incompetence in its core operations.
Although incompetence is not indicated in the case study, it may be an undiscovered issue because it is difficult to identify it in a professional organization that has lots of autonomy. Hence one measure of control is to ensure you hire competent professionals, and you continue to upgrade and train them. The standardization of skills and norms will help, but does not address incompetence. In summary, the weakness in the organizational structure of the Limora Hospital and the LCHC are challenging, but fixable. It is important to step back and look at what parameters of control or freedom a health care organization requires.
It seems a portion of a hospital operations needs a very stringent scientific approach to its organization, yet another portion demands that the professional skilled people to have the authority and power to assert their knowledge independently. Theoretically, I would apply Max Weber’s Bureaucracy theory as an approach. This structure would ensure that there are clear lines of power, orderly procedures and rules that would remove any randomness and unpredictability from the hospital system. The interactions are based on standards Vs the personal feelings of peers and managers.
It would add fairness and equity of evaluation. It is a rational and formal-structural response to organizational problems. The immaturity must be aided by making some structural changes. The superstructure appears to need the least amount of work. There is an existing Apex (which needs some focus), a middle line (which needs to grow), a small technostructure (which should be combined for both facilities to use), and an ill managed operating core. I hesitate to say too much about the support staff. Unfortunately, the case does not provide enough information about this unit for comment..
I must assume there is a support staff functioning at the hospital since they could not possibly continue without the support of a support staff. Most of the organizational changes need to be done in the essential design parameters of the subunits. Standardization of skills has already been achieved and the remaining would include: Behaviour formalization to help standardize work processes and procedures Training to teach the standards and procedures and achieve standardization Unit groupings to group jobs under one supervision for maximum efficiency and cooperation
The structural changes will also facilitate more effective communications, enhance the ability of the leaders to lead, and increase intrinsic and extrinsic motivation. The complexities of organizational structure and organizational behaviour are huge. Because of these complexities, generally one theory, one behavioural model, or one method of structure does not always meet all the needs of the organization. There is no doubt, however, that guiding principles and basic fundamental models work and would work for Limora Hospital and the LCHC. 2.
What are the effects on motivation, leadership and communication because of the weaknesses identified in your answer to Question #1 at the Limora Communication Health Centre? The weakness in the organizational structure at LCHC hampers leadership, communication, and motivation. In reverse, the lack of leadership, communication and motivation have impacted the organizational structure. The definition of each of these explains the importance of their interrelationship to one another. Leadership is based on the ability to influence others to achieve organizational goals.
Formal leaders hold a high rank in the hierarchy and informal leaders are recognized for outstanding skills and abilities. Managing is sometimes mistaken for leadership. The difference is that a manager brings order to the employees, and a leader makes useful changes in the organization. Communication is the process of two or more people exchanging information. The sender is the initiator of the message and the receiver is the one that the message is direct to. Effective communication is achieved when the message from the sender is received as it was intended.
Motivation can be understood as a force within us that is triggered by various needs. This force then drives us to satisfy an unsatisfied need. There are basically two different categories of motivation. One is intrinsic and the other extrinsic motivation. Intrinsic motivation comes from inside ourselves and extrinsic from outside ourselves. All three of these are lacking at the LCHC. Some of them are highly impacted by the weaknesses in the organizational structure, and some are lacking in the individuals’ as skills.
Motivation, leadership and communication are dependent on one another and cannot function very well in an organization on their own. Leadership generally deals with the complexities of humans and human behaviour. There are many approaches to leadership, each with theories and models. The Traits theories would look at leaders and explore their traits or characteristics. Behavioural leadership theories centre around the behaviours demonstrated by effective leaders. Lastly, the contingency approach puts forward the notion that “it depends” on both behaviour and traits. Situations can effect what traits and behviours are most useful..
The most suitable leadership approach for the LCHC would be the contingency approach since it offers ways to look at behaviour and traits. It also lends itself to approaches for leading tasks and people. There are task issues and relationship issues at LCHC that need leadership. Paul Hersey and Ken Blanchard’s situation leadership model offers different behaviours suited to either a task situation or a relationship situation. Some of the leadership weakness at LCHC are: The lines of authority for the division of labor between the apex and the middle line are not clear.
This makes leadership difficult. The Bishop is not motivated to take on this leadership, or he does not have the leadership expertise to lead. It is the Bishop that should set forth the proper leadership characteristics, and develop the triggers that will motivate his organization. There seems to be no communication from him about the mission, strategy, or goals of either facility. If this is missing at the top, it cascades down throughout the organization very quickly. It is evident that the professionals in the operating core are confused, and don’t have clear goals to follow.
These goals would help pull all of them in the same direction. The middle line, where Dr. Macdonald is managing, needs qualified managers. When there are no qualified managers, and management systems are in chaos, leadership is compromised for the strongest of leaders. The above points in the structural weaknesses involve task and volatile relationships issues. The application of the Hersey / Blanchard model of leadership will help both the task and relationship concerns. . Regarding communications, the LCHC does not adequately provide the network for good communications among all its employees.
Unit groupings are weak and management does not seem to have a lot of integrity in their communications. Its important to have a place that can determine what communications vehicle should be used to gain the highest impact for any given message. Rich communication demands face to face interaction, next is the telephone, and the poorest is via memo or letter. There are no liaison positions in place at the LCHC. These positions could determine communication vehicles, disseminate information and improve upward, downward and horizontal communications.
A very large part of good communications is also about listening and knowing how to communicate. Communication involves giving and receiving feedback. These skills are generally part of a good training program. The LCHC does not have a good training program in place that could help them increase harmony, efficiency and mutual understanding. When good communications are in place, feedback is at an optimum, therefore, managers and employees could actively participate in formal and informal evaluations processes.
If the managers and employees are involved in the evaluation process, they are most apt to be fair and equitable in their assessment of each other. The employees at LCHC are not motivated. The lack of motivation is a direct result of the lack of leadership and effective communications. It can also be linked to the organization of the subunits. Grouping different jobs under common supervision can pull them together to achieve similar goals thus triggering motivation.. Employees also need, and are more likely driven by intrinsic motivators.
These can come from reaching personal career goals, making enough money to buy a new house, or simply feeling good when a patient gets well as a direct result of their care. Putting a Human Resources management in place could provide rewards programs in the form of money, recognition, and promotion. These are all triggers for employees to set themselves goals to reach these rewards. Locke’s goal setting theory says setting clear, challenging, realistic and acceptable goals raises performance. Goals invoke motivations since our thoughts and actions are directed by our goals.
It is much easier for the LCHC employees to set their personal work related goals if they have been given short term departmental goals or milestones and long term organizational goals. Each department would work in a cooperative setting to reach these goals. When employees don’t see or feel a sense of purpose, there is often conflict, competition, and behaviour is based on the fear of not knowing where they are headed. Consequently, this leads to low morale and demotivated employees. The LCHC should consistently communicate the rewards and results of effort and hard work. This will encourage employees to expect a reward for their work.
Vroom’s expectancy theory supports this idea. He says that if you put effort in, you will get a positive outcome. Individuals will look at a given situation in this way…. increased effort will lead to good performance, good performance will lead to certain outcomes, and then… are the outcomes worthwhile. If they are, the effort will be put forth. In summary, leadership, communication, and motivation are a must for an organization’s success. If the structure is aligned to support all three, there is increased productivity, high level of efficiency and high morale among the employees.