1. Regency Health Care Group: Contemporary or Classical Structure Carl Wills HCM611-1001B-01 Phase 1 Task 2 Individual Project Professor Jan Carrell Colorado Technical University Online February 22, 2010
2. Organizational Structure: Traditional Division of work, Responsibility and authority, Departmental, Span of control, and Coordination. 2 Contemporary or Classical Structure
3. Contemporary Structure: Patient-Focused Care Empowerment Cross Training Decentralized Patient care teams Computerization Contemporary or Classical Structure 3
4. The Pros and Cons of Traditional and Patient-Focused Care Traditional Activities defined by position. Specialization (KSA). Top-down hierarchy. Communication clearly. defined. Departmentalization. Coordination maximized. Patient-Focused Care Cross Training. Decentralization. Integration of patient care teams. Flexibility. Broader span of control. Coordination Choices. Contemporary or Classical Structure 4
6. References Colorado Technical University Online. (2010). Managing the health care organization: Task list. Retrieved February 17, 2010, from https://campus.ctuonline.edu Coulter, M. (2008). Strategic management in action (4th ed.). Pearson/Prentice Hall. Upper Saddle River, New Jersey Harlingen Medical Center. (2007). Patient-focused care. Retrieved February 20, 2010, from http://www.harlingenmedicalcenter.com Longest, B. Rakich, S. Darr, K. (2004). Managing health services organizations and systems (4th ed.). Health Professional Press. Baltimore, Maryland Shi, L Singh, D. (2005). Essentials of the US health care system. Jones and Bartlett Publishers. Sudbury, Massachusetts Contemporary or Classical Structure 6
Editor's Notes
To the staff of Regency Health Care Group, hello and welcome to today’s presentation on traditional and contemporary organizational structure. As you know our organizational focus has been restructured from the classical or departmental mechanistic approach to a patient-focus care organization and although, there have been some hiccups to our new restructuring, it is my pleasure to present to you the pros and cons of (1) returning to the traditional (classical) structure or (2) staying on course with the contemporary restructuring model of a patient-focus care organization. Furthermore, this presentation will discuss the impacts of the two structures and there affects on management and quality of care (Colorado Technical University Online, 2010).
Today, health care organizations are tasked with providing quality care with minimal resources. The traditional organizational structure is vertical and compartmentalized by function or division and is set-up primarily by specialization (Shi & Singh, 2005). In other words, the top of the vertical structure consist of the Board of Directors, followed down by functional departments such as informational services, support services, diagnostic services, and therapeutic services with each functional department having distinct areas of responsibilities. For example, informational services would include admissions and scheduling, billing and collection, medical records, human resources, health education and so on and so forth. Furthermore, the traditional structure encapsulated a clear chain-of-command and generally authority and responsibility started at the top and filter down through out the organization and/or departments. Thus, giving managers greater leverage in controlling their respective areas of specialization through departmentalization. In the process, planning became repetitive, communication become clearly defined by the chain-of-command, leadership extremely hierarchical with multiple levels of administration, and roles and responsibilities would be defined by job description and position (Longest, Rakich, & Darr, 2004).
Patient-focused care relies on a framework supported by staff member empowerment and cross training, decentralization, patient care teams, and computerization (Harlingen Medical Center, 2007). Decisions are made based on what is best for the patient rather than what is best for the staff. Furthermore, the application of patient-focused care is influenced by the basic structure, beliefs, and values of the organization. By empowering staff members and physicians and creating specialty teams that are crossed-trained allows for greater leverage of care and reduces response times and overtime. In addition, computerized documentation systems enhance departmental efficiency, removes much of the paperwork burden from nurses, and reduces costs. Furthermore, with health care organizations trying to balance cost and quality of care, the patient-focused care in theory, should reduce operating costs, reduce staff turnover, increase productivity, and increase patient and physician satisfaction.
The traditional structure in comparison to patient-focused care clearly defines who does what and when based on specialty and department. Authority and responsibilities are delegated downward and channels of communication are clearly defined per hierarchy. In other words, staff are subject to communicate following the structures defined chain-of-command. Furthermore, by functionalizing specialties into departments allows managers the ability to standardize more efficiently their functions creating a greater leverage of control and coordination of care becomes maximized. On the other hand, patient-focused care address cross training staff to perform more than one function, which reduces costs, minimize patient movement, improves continuity and continuum of care, and empowers staff to plan and execute their work in ways that are more responsive to patient needs. Thus, quality of care improves and patient satisfaction increases. In addition, patient-focused care removes the rigidity of a traditional structure by being flexible based on the needs of the patient as opposed to needs of the organization or it’s employees. Furthermore, adopting a team approach to care maximizes coordination of care with efficiency as defined in the organization’s mission, vision, and values. However, and while the traditional structure is configured by departmentalizing specialties, which in theory conforms to specialized staff learning their job more quickly, over time work can become tedious, dysfunctional, and coordination can become fragmented (Coulter, 2008). Thus, levels of job satisfaction can decrease because the functionality of the job becomes boring. In other words, there’s no challenge for the staff. Furthermore, with the traditional structure being rigid, the ability for the organization to be flexible when change is needed becomes bogged down by bureaucracy due in part to the strict channels of communication. Thus, causing unhappy staff, which eventually affects quality of patient care and staff retention. As for Regency’s restructuring to a patient-focused care organization, the down side is basically associated with how senior management explained why the organization is changing. Buy-in is very important when and organization plans on restructuring and the case of Regency, change has taken place, but some members argue that the organization should go back to a traditional structure. However, from a management perspective, a patient-focused care organizations offers greater flexibility, autonomy, and decentralizes areas of responsibilities in line with patient needs and patient coordination. In other words, by cross training staff such as nurses into teams to assist physicians in neurology, orthopedics, and vascular surgery, any team at any given time can provide care, which reduces costs, enhances improvement, and efficiency by creating a challenging workplace.
Fundamentally, Regency’s restructuring to a patient-focused care organization essentially means that all levels within the organization are focused on the patient perspective, needs, and overall comfort. All operation suites are suited and designed to meet the needs of the patient regardless if surgery is either Neuro, ortho, or vascular in nature. Patient care and services are decentralized and coordinated to ensure high quality of care, which improves access and reduces costs. Furthermore, by cross training staff to perform several tasks the increase in responsibilities becomes challenging and rewarding, thus creating greater job satisfaction and reducing turn-over. In addition, the continuum of care becomes consistent and the patient care team assigned to the patient serves as the patient’s advocate throughout their surgery, and healing process. Finally, by understanding the patient needs and condition allows the patient and family members to be active in the patient’s recovery. Reverting back to a traditional structure, reduces the organization’s ability to integrate and maximize efficiency because of increase levels of bureaucracy. The focus on the patient needs gets lost in translation. Thus, the recommendation is to stay the course and focus on patient-focused care organizationally.
In closing, choosing between types of organizational structures is dependent on the organizations mission, vision and values. It is not to say that one structure is better than another, but to place emphasis on streamlining the functional bureaucracy associated with the traditional structure and facilitating transparency at all levels. In other words, flattening the hierarchy levels and empowering decision-making. Today, and among many other factors, managing health care requires finding ways to reduce costs, improve continuity of care, and increase patient satisfaction. One way to do this is to transform traditional values into a patient-focused platform, which over time will prove invaluable to Regency’s Health Care Group.This concludes the presentation and is now open to questions and comments. Thank you for attending.
