This paper aims to discuss the changes in organizational structure of healthcare institutions. In particular, it is necessary to show how workplace hierarchy in these hospitals was restructured and how the administration modified means of coordinating and monitoring work of healthcare professionals.
Furthermore, we need to evaluate the efficiency of these changes and the improvements they brought. Overall, it is possible to argue that the majority of hospitals attempt to become less bureaucratic and turn themselves into adhocratic organizations. This means that they try to eliminate formal barriers between the top managers and their subordinates in effort to improve the quality of healthcare and remove time-consuming red tape (Mintzberg & Ghoshal, 2003, p 464).
One of the most common changes, underwent by many hospitals nowadays is the creation of interdisciplinary teams (Aikman et al, 1998). The members of these teams may belong to different departments or units, yet, they focus on the needs of a certain group of patients.
To better illustrate this concept, we can draw such an example as Toronto East General Hospital (TEGH); the administration of this institution decided to form workgroups that would address the needs of a specific population, namely pregnant women. These workgroups included obstetricians, counselors, midwifes, psychologists, and nurses; in turn, the decisions about healthcare were formed within these teams (Aikman et al, 1998, p 29).
To some degree, the formation of this mix groups can be regarded as a step toward a matrix management. The key principle of matrix management is that a healthcare professional can work under direction of several managers and support organizational activities. The main objective of this organizational change in TEGH was to provide medical workers with a higher degree of autonomy and better opportunity for decision-making (Aikman et al, 1998, p 34).
Another form of organizational change is the delayering of the workplace hierarchy. This policy is based on the premise that a medical worker, who is supervised by many layers of management, cannot perform his duties efficiently because he has to constantly ask for the authorization of the superior manager and other authorities in order to take any decision about patient care (Mintzberg & Ghoshal, 2003, p 172).
This argument is particularly relevant, if we are speaking about nurses who are closely monitored by head nurses, unit-directors, and case managers at the same time. Due to this continuous supervision they are virtually powerless. Therefore, the purpose of delayering is to make senior management more close their subordinates and ensure that both sides are able to quickly share information with one another.
To better explain the process of delayering, we need to refer to such organization as Saint Fransis Community Hospital. In this organization, the front-line workers are accountable only to the heads of interdisciplinary teams (Saint Fransis, 2010, unpaged). Subsequently, these heads of multi-disciplinary teams report to unit directors and vice presidents. The key issue is that members of these multi-disciplinary teams do not have to wait for the approval of head nurses and unit-directors.
Judging from these examples, it is possible for us to argue that modern healthcare organizations attempt to erase bureaucratic borders by relaxing supervision over healthcare workers and by reducing workplace hierarchy. To some degree, this tendency can be described as the move toward adhocracy. Yet, this process is far from being complete, even despite the fact that the necessity for organizational change in healthcare organizations became evident several decades ago.
Reference List
Aikman. P. , Andress I. Goodfellow I. & LaBelle N. (1998). System Integration: A Necessity. The Journal of Nursing Administration. 28 (2), p 28-34.
Mintzberg. H. & Ghoshal S. (2003). The strategy process: concepts, contexts, cases. NY: Pearson Education.
Saint Fransis Community Hospital. (2010). The official website. Web.