Organizational Structure and Culture

Organizational Structure and Culture

Every facility has an authority structure within the organization that is the foundation for the oversight of delegating processes and expected outcomes. Without structure there is a potential for chaos to ensue, communication to be inhibited, thereby preventing goals from getting accomplished. Organizational structure is an important tool managers use to increase efficiency within the departments (Sullivan, 2013) and is an important line of communication for employees at the department level as well as throughout the organization. Every organization must have a management design to provide fluid leadership and it should be well documented and broadcast throughout the organization so employees know who to report to as well as what their role in the implementation of that structure plan (Tiller, 2012).

The purpose of this paper is to identify the type of organizational structure used in my facility, describe how that structure creates an environment of support for patient-centered care, use of information systems within the culture and structure of the agency, use of decision-making ability, identify informal and formal reporting lines as well as who the real leaders are in the organization, how social and cultural influences of the community are integrated in the delivery of care, and how generational differences influence the organizational culture of my workplace. Organizational Structure

It is timely for me to be discussing organizational structure in my workplace because our nursing structure has just changed, and we were provided with a new organizational structure chart recently. The type of organizational structure my facility operates within is a combination of a service line structure and a matrix structure. It is not just a one type standard model of structure as seen in other organizations. Service line structures are more commonly seen in Magnet-certified health care organizations today because services are organized around similar departments (Sullivan, 2013). Our entire hospital system is a very large organization consisting of 10 hospitals and the service line model is a preferred structure for large and complex organizations allowing for the same activity to be assigned to many self-contained units, such as orientation of new employees or hiring of employees (Sullivan, 2013). The matrix structure is seen within our organization as it relates to who our managers report to and the varied departments they are responsible for.

For example, our manager of education is also in charge of the outpatient diabetes service personnel and wound care personnel. I also see evidence of the matrix structure in our facility with the occurrence of frequent meetings to resolve problems and conflicts and the necessity of all members at the table not only consider their own functional area or department but also the big organizational picture. If we have an issue within our department or even within our hospital, and a change is proposed, we must consider how this will affect the entire organization and seek approval from all sister facilities before it can be instituted in one hospital or department. This can be time-consuming and frustrating for an area that sees this change as a quick fix to a problem. Client-Centered Care

The service-line structure within our organization creates a positive environment of support for client-centered care by integrating continuity among similar departments. Referencing the leadership of our service-line structure, the director of ICU is also the director of PCU, ED, and Short Stay in my facility. These departments care for similar patients and often our patients move from one of these departments to another during the hospital stay. As the patient moves along the continuum from the ED to the ICU, and then to the PCU, this patient will receive continuity of care based on his or her needs and the training of the staff employed in these departments. Because the goals of the departments are similar and service-oriented, the clients’ service goals take priority throughout the hospital stay. Our facility tends to have high customer satisfaction scores and organizations operating under the service-line structures also tend to have high client satisfaction and improved patient safety because of specializations of the departments (Sullivan, 2013). Information Systems, Communication, Decision-Making Ability

The use of information systems facilitates how an organization functions consistently because it increases the effectiveness of the work done by the members of that organization whether it is related to patient care or any number of other functions necessary to run an organization. Information systems allow for all members of the team to store and process data quickly, accurately, and across the continuum of care. The electronic medical record is just one example of the use of information systems in our organization. There can be issues with security with the use of information systems with concerns surrounding system breaches of confidentiality. Fortunately, the organizations wisely invest in protection through the information systems. All organizations need various forms of communication to function efficiently, whether it is through audio-visual means or telecommunications.

Audio-visual communication is typically for the purpose of staff education and meetings. Telecommunications takes the form of phones, pagers, intercom systems, and these days telehealth. Telecommunication allows for rapid access to various health care professionals in the event of patients needing urgent medical assistance, allowing the health care professional to gain extensive information about the patient and his or her health problems. Efficient and timely communication assists in closing the gaps between health care providers and other members of the organizations’ departments. Decision-making is based on the professional communication and discussion that takes place in reference to current issues. These discussions allow the most efficient decision to be made in the best interest of the party involved. Informal and Formal Reporting

The formal reporting lines refers to the communication between directors, managers, and those employees under them in the organizational structure while the informal reporting line refers to the communication that occurs between health care professionals in the course of the decision-making process, i.e. nurse to physician discussing a patient. Informal communication also can be peer to peer regarding conflict, policy, or safety issues. If a decision is made between the peers, the formal reporting line can be entered in with the peers taking the information up the chain to the managers and directors. Often informal reporting becomes formal reporting. In my organization our formal reporting line starts with the unit charge nurse, proceeding to the team coordinator, the director and finally ends with the CNO of our organization. This seems to be a typical reporting structure in health care (Sullivan, 2013).

Formal reporting lines are in place to maintain control over the work environment and foster responsibility and accountability of each individual in the organization. Our organization has many formal leaders identified by the location in the organization structure chart and title; however, we have many informal leaders as well who report to the formal leaders. Staff who report to the informal leaders as the first reporting line may not see themselves as a leader; however, all nurses are leaders, and within my organization we attempt to help our nurses recognize they are leaders and there are many issues they face daily that they can control. Social and Cultural Influences

Evidence of the integration of various social and cultural influences of our community is in the care of our patients by the methods we use to be culturally sensitive and socially aware of each individual’s needs. It starts when the patient arrives at our facility with the social and cultural assessment done on admission. The location of our facility is in a popular tourist and retirement area and that leads to a somewhat diverse culture and patients with certain social needs. Our interdisciplinary team approach allows us to meet the needs of those individuals who may be struggling with affording medications or various other health care issues. We are a “Safe Haven” facility, meaning babies can be left at our facility without repercussion to the mother. We also have an indigent drug program to help with medication assistance. For our non-english speaking patients we use a language line phone system to accurately communicate with our patients. Although there is always room for improvement with individualized care being mindful of the social and cultural differences, we make every effort to be sensitive to the patients’ needs and desires related to their health care. Generational Differences

A health care organization can employ numerous generations simultaneously, from the young nursing assistant just out of high school working his or her way through nursing school, to the senior nurse and or physician who has been in the profession for 40 years or more. Effectively leading a group of multigenerational employees can be challenging because of the different expectations of those employees (Lester, Standifer, Schultz, & Windsor, 2012). Nurses from various generations may have different views and expectations about what they want or need from the workplace and may approach it differently. What motivates one from a younger generation to value their profession and work environment may not be important or a motivating factor for a more senior employee (Lester, et al, 2012). Obviously the younger employee is likely to be more technologically knowledgeable than the senior employee, while that senior employee will have more life experience that can be helpful to the younger generation.

Although generational differences can cause gaps in communication, these gaps can be bridged and often closed with cooperation and leadership of representatives from each generation. With the integration of the electronic medical record, I witnessed, and was involved in the mentoring and leadership of helping the senior generation, nurses and physicians with learning the use of the electronic medical record. Organizational structure is key in the daily operation and management of any facility or business. Every employee of an organization should have access to and understand the structure for reporting and accountability purposes, and to identify his or her formal leadership.

I have identified my organization’s structure as that of a service-line model and matrix model, how these models are integrated in client-centered care with the leadership in charge of units that care for similar type of patients, how modern technology influences our communication and decision-making abilities, our social and cultural assessment of our patients to allow for individualized care, and how we mentor each other to close the generational gaps within our organization. Organizational structure and an organization’s mission helps the employee understand their role in maintaining a high performing environment and culture.


Lester, S. W., Standifer, R. L., Schultz, N. J., & Windsor, J.M. (2012). Actual

versus perceived generational differences at work: An empirical

examination. Journal of Leadership and Organizational Studies, 19(3), 341-

354. doi:10.1177/1548051812442747

Sullivan, E.J. (2013). Effective Leadership and Management in Nursing (8th ed.).

Retrieved from The University of Phoenix eBook Collection Database. Tiller, S. R. (2012, january). Organizational structure and management

systems. Leadership and Management in Engineering, 12(1), 20-23.



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