ANSWER THE DISCUSSION POST WITH A MINIMUM OF 200 WORDS. APA FORMAT. MINMUM OF TWO DIFFERENT REFERENCES.

Week Two: Discussion One

· ‘How would you describe an informal organization?

· Discuss how the informal organization affects managing an HCO (HEALTH CARE ORGANIZATIONS).

· How can HCO managers try to work with, rather than against the information organization?

Instructions:

1. Responses should be of sufficient length (200 words) with proper grammar.

2. Cite two references (one may be your text) using APA format,

3. 200 word minimum.

Link to book is:

Username:Prescottjackson1906@gmail.com

Password: (I will send in message)

https://bookshelf.vitalsource.com/reader/books/9781567936919/pageid/0

Assigned Readings:

· Chapter 4: Organizing: Jobs, Positions, and Departments

· Chapter 5: Organizing: Organizations

· Chapter 6: Organizing: Groups & Teams

· Chapter 7: Staffing: Obtaining Employees

· Chapter 8: Staffing: Retaining Employees

HCA 620

Health Organization Management

Developer Notes: Continue button to continue to next slide. No left-hand menu, please. Menu drop down on top left corner with various topics and notes on top left corner with narration.

Vo: Welcome to the Week Two lecture for HCA 620 Health Organization Management. Click on the continue button to begin.

Week Two
Management

This week we will again start with Management. Click on the continue button to begin.

What Are Organizations?

Organizations are social entities
that are goal-directed,
designed as deliberately structured and coordinated activity systems,
and are linked to the external environment.

Organizations are “social entities that are goal-directed, designed as deliberately structured and coordinated activity systems, and are linked to the external environment”. What does this mean?

An organization is a social entity—it has people.
An organization is goal directed—it pursues a purpose.
An organization is deliberately structured and coordinated—it is intentionally set up, organized, and arranged.
An organization is an activity system—it is alive with people doing things that affect each other.
An organization is linked to the external environment—it connects and interacts with its surroundings.

What Is Organization Structure?

Organization structure is the
reporting relationships,
vertical hierarchy,
spans of control,
groupings of jobs into departments and
an entire organization, and
systems for coordination and communication.

Managers intentionally organize, or structure, the activities, tasks, and work into systems that become the formal organization. This creates the organization structure of jobs, reporting relationships, vertical hierarchy, spans of control, groupings of jobs into departments and an entire organization, and systems for coordination and communication.

This structured activity can involve managers at various levels performing five types of organizing that are explained in chapters 4–6:

Work tasks must be grouped into job positions. Managers at all levels do this for their particular work units and areas of responsibility.
Jobs must be organized (grouped) into work units, such as teams and departments. Middle and top managers do this.
Departments must be organized (grouped) into an entire organization. Top managers do this.
Work must be coordinated among and across job positions and departments. Managers throughout the organization do this.
The organization must be linked to other organizations and people in its environment. Managers throughout the organization do this.

Organizing Jobs into Departments
Organizing jobs into departments creates more organization
structure.
Organize jobs into departments based on jobs that. . .

Perform same activities and tasks
Use same equipment and technology
Serve same type of customers
Create same product or service
Work in same place
Work at same time
Copyright © 2019 Foundation of the American College of Healthcare Executives. Not for sale.

An organization undertakes deliberately structured activity. Managers intentionally organize, or structure, the activities, tasks, and work into systems that become the formal organization. This creates the organization structure of jobs, reporting relationships, vertical hierarchy, spans of control, groupings of jobs into departments and an entire organization, and systems for coordination and communication

This structured activity can involve managers at various levels performing five types of organizing that are explained in chapters 4–6:

Sometimes HCO managers might not first organize tasks into jobs and then jobs into a department. They might first add a department and then decide which jobs and positions are needed for it. Let’s consider a hospital that wants to recruit physicians.

First, suppose the hospital adds one new physician recruiter in its existing medical staff affairs office. That works out well, so another recruiter is added, and then a secretary, and then another recruiter. Eventually, managers organize those four positions into a new, separate department of physician recruitment. Alternatively, suppose that in the strategic planning process, managers decide the hospital must become more active in physician recruiting. They decide to create a new department of physician recruitment. Later, to implement this goal, managers decide which tasks, jobs, and positions are needed for the new department.

Factors that Influence Organizing Work
How work is organized is influenced by. . .

The organization (internal factors)
Size
Goals
Worker motivation

The external environment (external factors)
Change in the environment

An HCO’s environment (external factors) and the organization itself (internal factors) affect how managers organize work. Prior strategic planning, discussed in chapter 3, analyzed both types of factors. Take a few minutes to jot down examples of how the external environment and the organization itself might affect how work is organized. Then read the following example.

New technology invented in the external environment creates new ways of performing existing tasks—and sometimes entirely new tasks—that must be organized into jobs. The invention of digital communication led to the redesign of jobs to use electronic health records rather than traditional paper records. Digital “writing” slowed down physicians in hospital emergency departments, so many of those departments hired digital scribes. A scribe goes into the emergency room with the physician (and the patient) and writes all the digital medical records in real time while the physician treats the patient. After caring for the patient, the physician reviews, edits, and signs the digital record.

Thus, because of a technological innovation in the external environment, a new digital scribe job was created, and the tasks of the emergency room physician job changed. Artificial intelligence, chatbots, and virtual assistants developed in the external environment are further changing tasks and work in HCOs
6

Environment & Structure:
Mechanistic & Organic

A mechanistic structure fits best with a stable, predictable environment, while an organic structure fits best with an unstable, changing environment. Characteristics of mechanistic and organic organizations are shown above.

These two organization structures are idealized types, and organizations are not entirely one or the other. They blend the two types and could be mostly one type or the other. Many managers feel their environments have become more unstable and unpredictable, so they have reorganized their HCOs to become more organic. The organic model seems more alive and natural than the mechanistic form. On the other hand, elements of mechanistic structure are being used to organize some patient care work

Complications

Possible complications when organizing work:
Informal organization
Contract workers
Union workers
Medical jobs with physicians

Managers can use the methods and principles explained in this chapter to organize work in HCOs. When doing so, they should consider four possible complications—the informal organization, contract workers, unionized workers, and medical jobs with physicians.

Informal Organization

Informal organization: Workers’ own unofficial rules, procedures, and communication networks that coexist and may conflict with those of the formal organization.

Powerful and influential.
Shows how work is really done.
Reflects how employees feel about work.
Can disrupt managers’ official formal jobs and organization structure.
Copyright © 2019 Foundation of the American College of Healthcare Executives. Not for sale.

Managers must realize that after they formally organize work and workers, the workers will not always follow the formal organization. They often create and follow their own unofficial, informal organization, which coexists with the official, formal organization. Employees use their own unwritten and informal rules, work procedures, behaviors, expectations, and communication networks (e.g., the grapevine) to create their informal organization. Managers should understand that the informal organization can support—or disrupt—the formal organization. The informal organization is powerful and influential and often reflects how work is really done and how employees really feel about the organization.

Informal Organization

Informal groups and unofficial arrangements arise from shared interests and social relationships among people who work together.
Informal groups have their own rules, culture, and behavioral norms that specify what members of the group are supposed to do.

Informal groups and unofficial arrangements arise from shared interests and social relationships among people who work together. Groups may form among the third-shift personnel in a skilled nursing facility, the information technology staff in a health insurance firm, or the therapists in a rehabilitation center. Coworkers with common interests or friendships outside the HCO may also create informal groups at work. Members of these groups talk, gossip, share opinions, support each other, and report what they have heard (true and untrue) elsewhere in the organization. They interact both at work and outside of work via social media, informal gatherings, recreational activities, and other opportunities. Group members help each other gain satisfaction and fulfill certain needs, such as the need for friendship, belonging, security, acceptance, status, comfort, emotional support, affiliation, reinforcement of one’s beliefs, sympathy, camaraderie, and collective power.

Informal groups have their own rules, culture, and behavioral norms that specify what members of the group are supposed to do. These expectations may conflict with an HCO’s official goals, job descriptions, and work plans. The groups strongly influence members who want to remain in the group and gain its benefits. The informal leader lacks formal authority yet influences others by using informal reward power and coercive power in the group. If a group member does not support the group’s rules, then the leader and other group members may discipline that member using ridicule, avoidance, rejection, or other punishments.

Informal Organization

The basic unit is the small group—a few workers who share contact, interaction, feelings, and friendship. Depending on the size of the organization, there may be dozens of small groups in the informal organization.
Copyright © 2019 Foundation of the American College of Healthcare Executives. Not for sale.

Just as the formal organization has smaller parts, such as departments, so too does the informal organization. The basic unit is the small group—a few workers who share contact, interaction, feelings, and friendship. Depending on the size of the organization, there may be dozens of small groups in the informal organization. Small groups may form in each formal department of an organization and also around specific interests, such as “the parking problem.” An employee may belong to more than one small group in the informal organization that coexists with the formal organization.

The informal organization, its groups, and its leaders can greatly influence employees to support—or oppose—the tasks, jobs, departments, and decisions of the formal organization. For example, the informal organization may support or oppose a change in the work schedule and job tasks at an outpatient therapy clinic. Managers in the formal organization may struggle to implement changes if the informal organization does not support the changes. Formal organization leaders should recognize this fact and work with informal leaders to gain this support. They must figure out who the informal group’s leaders are and understand the group’s norms, viewpoints, and expectations. Then they must develop collaborative working relationships with the informal group and its leaders. The formal leader must turn the informal leader into an ally rather than a rival.

Contract Workers

Some workers might not be hired employees:
Independent freelance contract workers
Staff supplied under contract by a temp agency
Written contract specifies workers’. . .
Job responsibilities
Reporting relationships and supervision
Authority and accountability
Managers have less flexibility to manage contract workers

Sometimes, not all the workers in an HCO are actual employees of the organization. For example, when a hospital is unable to fill vacant nurse positions, it might contract with a staffing agency for nurses. The agency hires its own nurses and contracts with businesses that need temporary nursing staff. The hospital pays the agency a fee, and the agency provides temporary workers (sometimes called travel workers). Temp agencies provide contract workers for dozens of job specialties, sometimes for a day and sometimes for much longer.
12

Union Workers

Employees may join and be represented by a labor union.
Managers and union negotiate contract:
Contract specifies jobs, work, rules, schedules, supervision, other terms of employment
Contract controls how manager and workers communicate, interact, settle disputes
Managers have less flexibility to manage union jobs and workers.

Some workers in HCOs may vote to be represented by a labor union regarding their jobs, work, rules, schedules, compensation, and other terms of employment. For example, some clinical workers, maintenance workers, clerical workers, and others are represented by unions. Although it is not part of the official organization, the union controls unionized workers and their relationship with the employer. Unions obtain authority through employee elections and negotiated contracts (backed by labor laws) to control aspects of who works when, where, and how. After employees vote to be represented by a labor union, HCO managers alone cannot organize the work, tasks, and jobs.

Instead, managers must use collective bargaining and negotiate with the union to jointly decide the terms and conditions of work for the represented workers. Union rules control how HCO managers and employees communicate and interact with each other and how union representatives and HCO managers resolve workplace disputes. Unions complicate how work is organized into jobs and departments because managers must make such decisions jointly with the union.

Medical Jobs with Physicians
Medical jobs require physician with medical training, expertise, and license.
Physicians have power due to medical expertise.
Medical jobs can complicate HCO structure:
Physicians have much autonomy due to medical expertise.
Often do not fit in traditional organization structure.
HCO may have management structure and medical staff structure.
Clinical workers may have 2 bosses: physician and manager
Managers do not supervise physicians the same way as nonphysicians.

In hospitals, medical practices, outpatient surgery centers, health insurance companies, and some other HCOs, certain tasks, jobs, and positions must be performed by a physician. Some of these jobs involve medical work, such as surgeon, radiologist, anesthesiologist, and hospitalist. Others are administrative yet also involve medical work, such as vice president of medical affairs, medical director of quality care, and cardiology medical director.
These jobs require a physician with appropriate medical expertise, a license to practice medicine, and other qualifications that only a physician would have. For these jobs, the HCO may hire and pay a physician, may contract with and pay a physician (see the “Contract Workers” section earlier in this chapter), or may grant the physician privileges to work in the HCO without being paid by the HCO. (In the last case, the physician is paid by patients and their insurance plans.).
Positions that require a physician can make HCOs very different from other organizations. These positions make organization structure and management more complex because they do not fit neatly with the traditional chain of command, organization chart, and use of management authority.

One More Time
Organizations are social entities that are goal-directed, designed as deliberately structured and coordinated activity systems, and are linked to the external environment.
Managers structure HCOs by organizing tasks into jobs and organizing jobs into departments and organizations.
Managers structure HCOs using concepts and principles from management theory.
How to organize work, jobs, and departments is contingent on external factors in environment and internal factors in HCO.
When organizing HCOs, managers must consider possible complications from informal organization, contract workers, unionized workers, and medical jobs.

Organizations are social entities that are goal-directed, designed as deliberately structured and coordinated activity systems, and are linked to the external environment.
Managers structure HCOs by organizing tasks into jobs and organizing jobs into departments and organizations.
Managers structure HCOs using concepts and principles from management theory.
How to organize work, jobs, and departments is contingent on external factors in environment and internal factors in HCO.
When organizing HCOs, managers must consider possible complications from informal organization, contract workers, unionized workers, and medical jobs.

Week Two
Organization

Next, we will discuss about Organization.

Organization Structures
Five organization structures used by HCOs:

Functional structure
Divisional structure
Matrix structure
Horizontal structure
Network structure

Many HCOs combine structures to create hybrid structures.

Much of an organization’s structure is reflected in its organization chart. This chapter explains (and illustrates with organization charts) five different forms of organization structure that are used by HCOs:

Functional structure
Divisional structure
Matrix structure
Horizontal structure
Network structure

Each of these general models has pros and cons. Many HCOs mix elements of these structural forms to create their own hybrid form.

Which structural form is best? It depends, as you might have guessed. This chapter’s opening quote suggests that an organization’s form depends on its function or purpose. Just as the form of a building depends on the building’s purpose, the form of an organization depends on the organization’s purpose. That is why managers must first plan the mission, goals, and purpose of the organization. The structural form of a university organization is different from that of a health insurance organization partly because the organizations have different purposes. What else determines the appropriate structural form? Recall from chapter 4 that an organization may be organic, mechanistic, or a mixture of both types, depending on its external environment, mission, goals, size, work technology, and culture.

Organization Structures
Each department is specialized to perform work that differs from other departments’ work.

When determining organization structure, managers must consider differentiation among departments and work units. Each department is specialized to perform work that differs from other departments’ work. The emergency, housekeeping, and administration departments do different work, and each department interacts with different parts of the external environment, pursues different goals, and uses different resources and production methods.

Thus, the departments are organized differently. Further, employees in each department have different knowledge, skills, attitudes, behaviors, values, and ways of thinking. Differentiation—the differences in departments’ structures and how their workers think and feel—helps to achieve specialized types of work. However, differentiated departments eventually must be integrated (coordinated) to work together toward the organization’s overall purpose. Without integration, differentiated workers and departments will work only toward their own department goals and not toward overall organization goals. Integrating departments is explained further in this chapter’s section on coordination.

Functional Structure: Pros & Cons
Pros:

Specialized positions grouped in departments.
Efficiency, economies of scale, and cost control.
Development of in-depth knowledge and abilities.
Most effective with only a few products and low complexity.
Cons:

Slow decision making and innovation.
Slow adaptation to changing environment.
Functional “silos” focus on their own functional work.
Inadequate horizontal department coordination.
Copyright © 2019 Foundation of the American College of Healthcare Executives. Not for sale.

The functional structure organizes departments and positions according to the function’s workers perform and the workers’ abilities. This approach consolidates each kind of expertise into one part of the organization. Specialization is strong, so knowledge and skill are strengthened for finance, for marketing, and for human resources.

However, specialization limits employees’ understanding of the whole organization and requires much coordination. Horizontal coordination methods (discussed later in this chapter) are needed to improve collaboration between workers under different functional VPs. For example, liaisons could be assigned to coordinate the finance and health services functions to help manage the costs of health services.

Divisional Structure: Pros & Cons
Pros:

Ability to adapt to changing environment.

Better patient experience and customer satisfaction.

Decentralized, faster decisions
Coordination of functions within each division.

Good for larger organizations with several main products/services.
Cons:

Less efficiency and economies of scale.
Product/service “silos” that focus on their own product/service.
Less coordination and synergy among all products/services.
Less development of in-depth functional expertise.
Potential duplication of resources.
Copyright © 2019 Foundation of the American College of Healthcare Executives. Not for sale.

The divisional structure organizes departments and positions to focus on groups of customers, products, or services rather than on (functional) types of workers.

Positions and departments are reorganized into a hospital division, a clinics division, and a long-term care division. Each division is designed to focus on one type of customer, such as customers who need hospital services. Each division is headed by a separate VP who has appropriate stature and authority.
What else do you see? Each division now has its own finance director (and staff), health services director (and staff), human resources director (and staff), and marketing director (and staff). The finance experts are no longer all grouped together as they were in the functional form. Each division now has its own finance knowledge, abilities, and expertise to quickly respond to its own financial affairs and those of its customers.
Changes in the environment do not affect hospital, clinic, and long-term care services the same way. The divisional structure recognizes this and gives each division the staff, resources, and decentralized authority to monitor its environment and adjust itself as needed. Doing so may increase the total expense of staff and other resources. The HCO must evaluate the increased cost compared to improved sales, revenue, patient experience, and market share. The advantages and disadvantages of the divisional form are listed above

Matrix Structure: Pros & Cons
Pros:

Development of both functional and product/service expertise.

Efficient, shared use of staff while improving customer satisfaction.

Ability to adapt to external changes affecting individual products.

Coordination and communication across the organization.
Cons:

No unity of command; each worker has more than one boss.

Potential for confusion, stress, and conflict among workers.

Well-developed skills required for communication and conflict resolution.

Time and expense required to train staff to work in a matrix.

Frequent conflict, requiring time and meetings to resolve.
Copyright © 2019 Foundation of the American College of Healthcare Executives. Not for sale.

The matrix structure combines the functional and divisional forms by superimposing horizontal coordination structure on top of vertical hierarchy structure. This structure can help an organization achieve efficiency (using vertical lines of authority) while also achieving quality and satisfaction for specific groups of customers, products, and services (using horizontal lines of authority). A matrix organization has advantages of both the functional and divisional forms.
21

Horizontal Structure: Pros & Cons
Pros:

Intense focus on creating value for customers.

Flexibility, efficiency, speed, responsiveness to customers.

Focus on the organization. rather than own department.

Much teamwork, coordination.

Integration of varied tasks, activities, and expertise.

Fewer layers of management.

More responsibility and growth for employees.
Cons:

Risk of worse performance if organized around wrong core processes.

Extensive change of organization structure and management.

Resistance by managers and staff specialists.

Much training required for new skills, culture, knowledge.

View the table for a better understanding of Horizontal Structure: Pros and Cons.
22

Most HCOs (except for small ones) have a governing body at the top of the organization structure. It may be called the board of trustees, board of directors, board of governors, or something similar. The board acts on behalf of the organization’s owners to do what is best for the owners. The owners may be investors, shareholders, citizens, a city, a church, or others. They elect or appoint a board to act on their behalf and to ensure the organization fulfills the owners’ responsibilities.

Governing Body
Most HCOs have governing body (e.g., board of directors) at top of organization structure.
Owners elect or appoint board members to. . .
Govern on behalf of HCO’s owners
Do what is best for HCO’s owners
Governing body. . .
Ensures management capability of HCO.
Establishes HCO’s mission, goals, vision, values, strategy.
Approves budgets, implementation plans, major policies.
Monitors HCO’s performance; requires corrective action when needed.
If HCO has medical staff, board approves medical staff bylaws, appoints physicians, monitors performance.
Board members are entrusted with the following responsibilities to govern the HCO for the owners (White and Griffith 2019):

Board members are entrusted with the following responsibilities to govern the HCO for the owners:

The board ensures management capability by hiring and monitoring the performance of the president/CEO, establishing policies for hiring and developing other managers, and maintaining a succession plan.

The board establishes the HCO’s mission, goals, vision, values, and strategy each year. It then approves necessary budgets and implementation plans, including major policies.

The board monitors the HCO’s performance compared to preset plans, budgets, and targets and ensures implementation of plans to achieve goals. When target performance levels are not met, the board requires explanation and corrective action.

If an HCO has a medical staff, the board approves medical staff bylaws, appoints physicians, and monitors their performance.

The board reviews its own performance and that of individual members. It ensures that board governance is effective.

Most boards have some members from outside the HCO, such as a realtor or banker, and some from inside the HCO, such as the CEO (and chief of staff if there is a medical staff). The board chooses and appoints its own members. A board might seek people who can bring a certain perspective to the board, such as a physician or a patient. Boards also seek people who can contribute particular expertise, such as in strategic planning or fundraising. To fulfill its responsibilities, the board appoints members to committees, such as for finance, strategic planning, and quality.

Hospital Organized Medical Staff

A hospital has an organized medical staff structure.
Physicians organize into medical staff, departments, divisions based on medical specialties.

Medical staff structure coexists with management structure to form total hospital organization.
Historically, both structures were somewhat separate.

Medical positions and physicians can complicate how managers organize HCOs. In this chapter, we study another aspect of physicians in HCOs: the organized medical staff of a hospital. Although hospitals are not all alike, the following discussion offers a general explanation of the medical staff structure.

A hospital has a bureaucratic structure designed by managers using the organizing principles explained in this chapter. It also has a medical staff structure comprising physicians (and, if hospital bylaws allow, dentists and other clinical professionals). Together, these structures are sometimes referred to as a dual structure. The medical staff is organized into departments and divisions for medical specialties (e.g., oncology) and subspecialties (e.g., dermatologic oncology). The hospital board of directors’ delegates to the medical staff the authority and responsibility for medical care in the hospital. The board of directors also dictates that physicians and the medical staff must comply with hospital bylaws, policies, and standards. These are generally based on laws, regulations, accreditation requirements, national or state guidelines, professional norms, and other external criteria. Physicians design their medical staff structure and expect some degree of autonomy.

The organized medical staff is essential to fulfill the hospital’s goals and mission. Yet, the medical staff structure may or may not be shown in detail on a hospital organization chart.

Hospital Organized Medical Staff

In recent years, hospitals more tightly integrating medical and management structures for better interaction and cooperation.

Medical–management committees
Physician–administrator dyads
Appointment of managers to medical staff committees
Liaisons between the medical staff and administration

Boundaries between medicine and management are fuzzy.

In recent years, the trend has been to combine the clinical and management structures more tightly for better interaction and accountability. This combination enables physicians and hospitals to improve patient care, strengthen finances, manage population health, and adapt to the external environment and demands of stakeholders. The medical staff and the management team appoint liaisons to each other’s committees, councils, and departments to help coordinate their work.

The chief of the medical staff and a few other physicians may serve on the board of directors. Administrative representatives attend meetings of the medical staff and its departments and committees. In the administrative structure, some departments or service lines have a nonphysician administrative manager and a physician as codirectors (in a dyad model). A hospital might assign codirectors to specific problems that involve both medicine and administration, such as patient safety or patient care quality. Disagreements are inevitable, so leaders of the medical staff and management team (sometimes with the board of directors) must be ready to resolve conflicts. These two structures—the traditional organization hierarchy and the medical staff hierarchy—coexist and together form the total hospital organization.

Within the medical staff are physicians with different relationships to the hospital, as mentioned in chapter 4. Some physicians are based in the hospital, such as radiologists, emergency physicians, and hospitalists. Others are based in the community in their physician office practices. They all must obtain hospital privileges to perform medical work in the hospital. Some physicians work in the hospital’s administrative structure—such as a VP of medical affairs—and are employed and paid by the hospital.

Confused? If so, you are not alone. Even experienced hospital managers sometimes feel a bit confused

One More Time

To form whole organization, HCOs often use functional, divisional, matrix, horizontal, or network structure.
Multiple types of structure may be blended to create hybrid structure to fit HCO’s situation (contingencies).
HCO internally coordinates workers, departments, and other parts of the HCO.
HCO externally coordinates with elements of external environment.
In most HCOs, governing body acts on behalf of owners with final responsibility for HCO.
Contract departments and medical staff structure complicate how HCOs are managed.
Copyright © 2019 Foundation of the American College of Healthcare Executives. Not for sale.

You have concluded with the Week Two Interactive Presentation. Please proceed back to Week Two in Blackboard to continue the curriculum for Week Two.

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