¶ … health organisation's vision, mission, strategic goals/objectives organisational structure (As attached). Using documents literature analyse followings:- - type organisational structure adopted relates vision, mission goals organisation - advantages limitations type structure health care delivery. Structure of a health care organisation

The health care organisations of today are no longer only requested to provide quality medical services, but they have to ensure this medical act within a growingly complex and demanding context. For instance, the ageing of the baby boomers puts additional strains on the health care institutions as the demand and the level of pretensions increases. Then, the cost of the medical act is also a stringent issue, specifically in the context of the internationalised economic crisis, but also the ongoing dispute over health care provision and coverage by the state and the private institutions.

Furthermore, the health care providers must also respond to the advancement of technology by integrating the latest innovations and enhancing the quality of the medical act. In this increasingly complex setting, the health care providers are forced to complement their medical act with strategies of organisational management. They for instance have to respond to issues such as cost management, personnel management, creation of an organisational mission, vision, strategy, as well as an organisational structure to support the institution in the attainment of its objectives.

In such a setting, the current project sets out to assess the organisational structure at Duke Medicine. The first step is represented by the brief presentation of the institution, followed by the analysis of its structure. The scope of the analysis to be conducted is that of assessing whether the organisational structure implemented by the institution is aligned with and able to support the company to attain its pre-established objectives. In order to retrieve such a conclusion, a fivefold analysis would be implemented.

2. The institution

Duke Medicine is an umbrella institution focused on medical education, clinical care, as well as research in the field of medicine. These three distinctive activities are developed by three specific institutions within Duke Medicine, namely the Duke University Health System, the Duke University School of Medicine and the Duke University School of Nursing.

Prior to 2006, the three institutions had been functioning and being managed as rather separated facilities. Starting with 2006 however, the three institutions were better integrated and the executives focused on the creation of a shared mission and vision to represent the goals of the entire Duke Medicine. Duke's mission then is that of creating a better world through better health care provision and education. In their own and more elaborate words:

"As a world-class academic and health care system, Duke Medicine strives to transform medicine and health locally and globally through innovative scientific research, rapid translation of breakthrough discoveries, educating future clinical and scientific leaders, advocating and practicing evidence-based medicine to improve community health, and leading efforts to eliminate health inequalities" (Website of Duke Medicine, 2012).

In terms of its vision, this is revealed in terms of the institution's commitment to create benefits for the society by transforming the provision of health care, health care teaching and health care related research. The values by which the institution stands include excellence, safety, integrity, diversity and team work.

In order to attain these ambitious objectives, Duke Medicine develops and implements a comprehensive strategy focused on the important role played by the people to advance knowledge, foster care and education. Aside from the focus on people, Duke Medicine's strategy also includes:

The pursuance of academic and clinical facilities to take advantages of the new technologic and innovation opportunities

The continuous integration of information technology within all three domains of activity at Duke Medicine

Aligning the organizational structure to fit the institution's goals, and last

Restructuring the financial management plans in order to best support the institution in attaining its objective in an effective manner (Duke Medicine).

3. Analysis of the organisational structure

As of September 2012, the organisational structure at Duke Medicine is as revealed in the chart below:

Source: Duke Medicine, 2012

This structure centres on the Chancellor for Health Affairs, President and CEO, to whom various functions and responsibilities are attributed. Some examples in this sense include human resources, strategic planning, patient safety, health systems innovation, communications and so on. The CEO is also in charge of the Duke University Health System, the Duke Cancer Institute, the School of Medicine, the Duke NUS Graduate Medical School and the School of Nursing. Aside from the Duke Cancer Institute, each of the other four...

In other words, there are five specific lenses through which to assess the health care institution's structure. These refer to the following:
The link between the chosen organisational structure and the institution's vision, mission and goals

The advantages and disadvantages presented by the selected organisational structure for the provision of health care services

The utility of the organisational mission relative to the institution's attainment of its goals and mission

The authority lines within the structure which safeguard the attainment of the institutional objectives, and last

Structural aspects which impede or facilitate institutional performance.

At the level of the organisational structure's link with the company's mission, vision and goals, it has to be noted that the structure partially reflects the institution's long-term goals. For instance, it reveals the commitment to teaching and education through its several divisions (such as the Graduate Medical School or the School of Nursing). Furthermore, the organisational structure has suffered some recent changes in the specific scope of alignment with the mission, vision and goals and it is possible for new modifications to be added. According to the Duke Medicine executives, one specific strategy to be implemented in the future is represented by:

"Aligning the organizational structure for our academic, research, and clinical missions, and, as appropriate, shifting from the traditional departmental structure to a disease or process-oriented structure to develop interdisciplinary teams and to accelerate discovery and translation of discoveries" (Duke Medicine).

Relative to the actual provision of health care services, the presented structure reveals a threefold focus on research, education and clinical care. At this level then, it is revealed that the primary shortage of the structure is represented by the fact that the executives' attention and the institution's resources are divided into three parts and they do not exclusively focus on health care provision. The advantage nevertheless relies on the fact that the provision of health care within the given structure is based not only on the already existent knowledge, but also on the knowledge created by the research centre at Duke Medicine. In other words, the health care services at the organisation are innovative as a result of the integrated structure.

At the level of the utility of the structure to attain the institution's mission and goals, it is stated that this utility is increased. This is due to the fact that the structure is constructed in such a manner that it supports the equal pursuit of all three sets of mission and goals in terms of health care provision, education and research.

In terms of authority, it has to be noted that the supreme leader of Duke Medicine is Victor Dzau, the Chancellor for Health Affairs, President and Chief Executive Officer. He is the superior of all departments and managers and he is the ultimate authority within the health care institution. All the divisions and constructions at Duke Medicine (the Duke University Health Systems, the Duke Cancer Institute, the School of Medicine, the Duke Graduate Medical School and the School of Nursing) are subordinated to the Chancellor in a vertically integrated structure of authority. Relative to each other however, the divisions and horizontally integrated, not revealing relationships of authority and subordination (Hill and Jones, 2012).

Overall, based on the analysis conducted, it is concluded that the organizational structure which has been devised and implemented at Duke Medicine is well designed and able to support the institution in the attainment of its objectives, vision and mission. One specific example of a facilitator is represented by the horizontal integration of the institutional divisions, which ensures equality and adequate goal attainment efforts at all levels of education, patient care and research. A notable impediment however is revealed by the lack of a direct and solid collaboration between the five divisions within the institution. The shortage at this specific level is represented by the fact that the five divisions operate in a rather isolated manner. This then translates in a decreased ability for the four divisions, for instance, to integrate and capitalize on the new discoveries made by the fifth division. In order to mitigate this shortage, it is recommended for the institution to further emphasize on the integration of the five divisions and to also promote higher communications among the representatives of the divisions.

4. Conclusions

In the growingly complex setting, the health care institutions are forced to better integrate health care decisions with decisions pertaining to the management of organisations. At Duke Medicine, this effort has materialised in the construction of solid objectives, mission, vision…