Healthcare Organizational Culture Structure Leadership

A healthcare organization has both formal and informal structures that occasionally conflict with one another. Formally, this healthcare organization is approaching that of a service line. It is flatter than a traditional hierarchy, with several of the bureaucratic layers removed. Yet there is a senior leadership team with official, formal authority, presiding over different departments and work groups. Wadsworth (2017) in fact recommends a similar organizational structure and design for focused healthcare organizations like this one, in which performance metrics need to be integrated with issues like billing and reimbursements, patient satisfaction data, marketing, and human resources. There are some ad hoc elements to this organization’s planning procedures, but generally the service line design does help the eldercare institution achieve its goals and objectives.
As a service line structure, the healthcare organization has both centralized and decentralized decision-making processes. Some key decisions are centralized, with little if any input gleaned from other departments outside of senior management. Yet the decisions that apply more directly to patient care considerations are made in a more decentralized manner. In addition to departments, the organization has formal and informal teams, ad hoc and permanent committees, task forces, and councils. Each of these remains focused on their own role within the organization, working towards achieving the status of a high reliability organization which has performance, safety, and quality benchmarks to fulfill (Carroll & Rudolph, 2006). Responsibility for specific issues like quality assurance and patient satisfaction is shared among various departments, and yet there are also specific workgroups within the organization that address specific concerns like these. Members of teams and workgroups will be comprised of individuals whose formal roles are within different departments. The result is the creation of pluralistic teams, which presents both opportunities and challenges for decision-making.
Each department or unit will function differently, with different styles of communication and different sub-cultures. In this way, leadership and decision-making do remain decentralized with the exception of needing to have regular meetings among managers of different departments. Within a specific department or unit, decisions are made according to various expediencies. For example, clinical care makes decisions according to evidence-based practice whereas the patient relations department makes decisions in a more collaborative manner. In the clinical care department, nurse leaders assess clinical guidelines and oversee healthcare staff. Patient care decisions are made in a team-based environment. Patient relations is a smaller department, which only occasionally interacts with other departments like public relations and marketing. Stakeholders in the community sometimes influence decision-makers in patient care, but would rarely have input into clinical care decisions.
Likewise, each department has both formal and informal leadership. Formal leaders have official authority to interact with senior management more directly, but frequently welcome input from other members of their department. Interviews with some departmental leaders indicates that soliciting staff feedback is not universally practiced, showing that some teams function with stronger formal leadership and more centralized decision-making. Other departments within the healthcare organization operate almost purely with informal leadership, with several healthcare workers being empowered to make decisions on a day-to-day basis. As long as patient care outcomes and financial objectives are being met, senior management does not require too much in the way of formal reports except from key departments like billing, financial management, marketing and accounting departments. In each of these cases, informal leadership guides organizational culture and formal leadership has a stronger bearing on organizational practices.




References

Carroll, J.S. & Rudolph, J.W. (2006). Design of high reliability organizations in healthcare. Quality and Safety in Healthcare 5(1): 4-9.
Wadsworth, J. (2017). The best organizational structure for healthcare analytics. Health Catalyst. http://www.healthcatalyst.com/wp-content/uploads/2014/08/The-Best-Organizational-Structure-for-Healthcare-Analytics.pdf