MANAGEMENT AND ORGANIZATIONAL DESIGN

STRATEGIC MANAGEMENT IN HEALTHCARE

10 February 2009

MANAGEMENT

• IT IS A PROCESS

• WORKS TOWARD OBJECTIVES

• USES RESOURCES

• OCCURS IN A FORMAL ORGANIZATIONAL SETTING

MANAGEMENT FUNCTIONS

• DECISION MAKING– PLANNING - DECIDING IN ADVANCE– DIRECTING - INITIATING WORK– CONTROLLING - REGULATING

ACTIVITIES– ORGANIZING - INTENTIONAL PATTERNS– STAFFING

MANAGEMENT COMPETENCIES

• SKILLS

• KNOWLEDGE

• ABILITY

• NATIONAL CENTER FOR HEALTHCARE LEADERSHIP – page 250

MANAGEMENT MEASURES

• STRUCTURAL - NUMBER OF BEDS

• PROCESS – PATIENT VISITS

• OUTCOME – READMISSIONS

MANAGEMENT STYLES

• CLASSIC VS CONTEMPORARY

• HEIRARCHICAL VS COOPERATIVE

• LINEAR VS MULTITASKING

• FORMAL VS INFORMAL

• MALE VS FEMALE

HEALTH CARE ORGANIZATIONS

• CONSTANT TENSION BETWEEN MANAGERS AND PROFESSIONAL OR TECHNICAL STAFF

• MANAGER’S JOB SHOULD BE TO SUPPORT PATIENT CARE

WEBER’S BUREAUCRACY

• CLEAR DIVISION OF LABOR• POSITIONS ARE ARRANGED IN A

HEIRARCHY - CHAIN OF COMMAND• FORMAL RULES AND REGULATIONS

GUIDE EMPLOYEES• IMPERSONAL RELATIONSHIPS• EMPLOYMENT BASED ON TECHNICAL

COMPETENCE

JOBS OF A BUREAUCRAT

• COVER YOUR ASS

• CHECK YOUR STATUS

CLASSIC CONCEPTS OF ORGANIZATION DESIGN

• DIVISION OF WORK

• AUTHORITY AND RESPONSIBILITY

• DEPARTMENTATION

• SPAN OF CONTROL

• COORDINATION

DIVISION OF WORK

ROLE OF THE INDIVIDUAL

• BALANCE OF GENERALIZATION AND SPECIALIZATION

• PEOPLE ARE NOT COMMODITIES

GENERALIZATION

• EVERYONE DOES EVERYTHING

• WORK IS INTERESTING & VARIED

• PRIDE AND ACCOUNTABILITY

• THE ORGANIZATION IS FLEXIBLE

• JACK OF ALL TRADES, MASTER OF NONE

SPECIALIZATION

• EVERYONE DOES ONE TASK

• HENRY FORD’S ASSEMBLY LINE

• TENDS TO BE BORING

• LITTLE INDIVIDUAL RESPONSIBILITY

• INFLEXIBLE - SLOW TO RESPOND

• REQUIRES MORE MANAGEMENT

AUTHORITY AND RESPONSIBILITY

AUTHORITY

• POWER DERIVED FROM ONE’S POSITION

• LINE AUTHORITY - CHAIN OF COMMAND

• STAFF AUTHORITY - ADVISORY

RESPONSIBILITY

• OBLIGATIONS DERIVED FROM ONE’S POSITION

• TO PERFORM FUNCTIONS• TO ACHIEVE OBJECTIVES

• THESE TWO OBLIGATIONS MAY CONFLICT

DEPARTMENTALIZATION

PURPOSE OF DEPARTMENTS

• DIVIDE WORK INTO MANAGEABLE UNITS

• COORDINATE WORK AMONG UNITS

BASIS OF DIVISION

• KNOWLEDGE & SKILLS

• PROCESSES OR FUNCTIONS

• TIME OR PLACE

• OUTPUTS

• CLIENTS

SPAN OF CONTROL

CONTROL

• FLAT VS TALL

• EXECUTIVE VS OPERATIVE

• HOW MANY ARE SUPERVISED

• HOW TIGHT IS THE CONTROL

COORDINATION

STRUCTURAL

• ORGANIZATIONAL STRUCTURE

• SUPERVISION

• STANDARDIZATION

LESS FORMAL

ORGANIZATIONAL CULTURE -

PATTERN OF SHARED BELIEFS

INSTITUTIONAL MEMORY -

LAST ONE STANDING