Organizational Structures and Leadership This paper explains the organization structure (or a combination of organization structures) implemented at a specific organization and how it affects the decision making and other aspects of the organization. For that purpose the health care organization has been taken into consideration.

Organizational structure generally refers to the hierarchical, reporting, authority and leadership set-up of an entity. The structures determine the working, leadership and decision making styles of the management as well as the overall culture of an entity. Organization structures can be of many types like: (Robins and Langton, 2010)

Bureaucratic structure or Line structure: Under this type of organizational structure the roles and responsibilities are clearly defined and it follows a well defined hierarchy, this type of structure is a highly formal organizational structure. A line structure has many levels of hierarchy and authority and the chain of command of the organization is complicated. The head of the organizations (CEO / MD) is at the top of the command, and then comes the Vice Presidents / Board of Directors, followed by General Managers, and then Managers, and then Assistant and Deputy Managers / Line Managers and the structure goes on for each department. The organizations having a line structure does not allow any flexibility and are strictly governed. Many big and highly developed healthcare organizations have implemented line / bureaucratic organizational structure. (Robins and Langton, 2010)

2. Adhoc structure: As evident by the term ad hoc, which means 'for the purpose' this type of organizational structure is implemented on temporary basis for the completion of a specific job or project. Ad hoc committees, teams or groups generally follow this structure. Under this structure the job descriptions, roles and responsibilities are not clearly defined and there are no set communication rules, the hierarchy of the organization is also not explained. This is a highly informal type of organization structure. (Robins and Langton, 2010)

3. Matrix structure: A matrix structure also has a formalized structure but a much simpler chain of command. The levels of hierarchy is reduced and set up on the basis of a product and a function. The hierarchies / chain of command (reporting authorities) under this structure are both horizontal and vertical where the line of command of a service / product is linked with a function. This is also a formal structure and follows a set of standard job descriptions and hierarchy. Flexibility is also not an option under this structure. (Robins and Langton, 2010)

4. Service -- Line structures: They are almost the same as matrix organization structures but are broken into a formalized bureaucratic hierarchy and then a service hierarchy. The line chain of command determines the overall objectives and duties, while the service line of command determines and implements the ways to achieve the overall objectives. This structure is also a formal structure governed by dual authorities. (Robins and Langton, 2010)

5. Flat structure: This is the simplest type of organizational structure having a single or very few lines of authority. The hierarchical levels are cut down and the organizations become decentralized with a few authorities to report to. This is also a step towards reducing the high costs of inducting top tier management. This is an informal type of organizational structure. (Robins and Langton, 2010)

Leadership and Decision Making based on Organizational Structures:

The decision making and leadership styles of the management in any organization are highly influenced by the organizational structures implemented there. The formal and informal type of organizational structure is quite different. (Madden, 2011)

The formal type of organizational structure is well planned and standard job description and chain of command is followed. The set chain of command cannot be breached and because of many layers of hierarchy communication is quite complicated and difficult. There is also a problem of miscommunication. The nurses cannot...

Everything in a formal organization is highly structured and everyone knows their responsibility. The employees are well aware that they are accountable for their responsibilities and they know to whom to report. (Madden, 2011)
Because of many layers of command and hierarchy and set responsibility and accountability, the leadership at a formal organization is more stern and authoritative. They believe in the principle of getting the work done and do that by exercising the power their position grants them. Where decision making is concerned, because of a more centralized structure, the process of decision making is slow. The problem passes through a series of chain of command to the level where decisions are made and then the steps are taken to reach a decision. This is a big problem where critical issues requiring quick solutions are considered. (Madden, 2011)

Informal structures are generally not strict and they do not follow a standard chain of command. The responsibilities and job descriptions are there but not specifically spelled out. In this type of structure although the authorities and chain of command exists, but is never acknowledged and mostly breached by everyone. (Downy and Parslow et al., 2011)

This type of a structure gives the right to everyone to approach the top tier management directly and is more open for communication. The communication and decision making becomes simpler. However, usually it is highly difficult to get the work done and to establish a sense of responsibility and accountability towards work and responsibilities. (Berggren and Carlstrom, 2011)

Many studies and scholars establish a fact that in order to get the work done effectively and for effective patient care in a health organization it is important to in-formalize the organization structure to such extent that the nurses are given a freedom to perform their duties in a way they want and to communicate freely to any level of management to solve the problems and issues they face in treating patients or in adjusting in the organization. (Berggren and Carlstrom, 2011)

Thus there is a need at almost every health organization to in-formalize their strict formal structures to some extent in order to bring quality and effectiveness to the level of services provided to the patients. This step also brings about a positive change in the communication style and that leads to the timely decision making and solution of the critical issues faced by the staff or the customers (patients). (American School of Cardiology, 2011)

As far as the organization I work at is considered, it has a service line structure in which the strategic decisions are made by the Board of the Hospital while the decisions and steps required to attain the goals set up by the top tier management are made by the Doctors / service heads. The system is also closed where all the doctors are not employed by the hospital and are not on the staff, but they participate in the decision making. This has an advantage as it saves costs, but the major disadvantage of the closed system is that these doctors tend to participate in the decision making without knowing much about the mechanics of the hospital.

Sometimes the involvement of these unemployed doctors in the decision making delays the urgent staff because of their non-availability or the lack of in-depth knowledge regarding the culture and working style at the hospital.

The leadership style implemented at the organization I work at is informal style. We are given authority and freedom to work in the way we feel most comfortable with. The implementation of the informal leadership style at my organization has led to many advantages including:

1. Accessibility to the top tier management and easy communication. This has led to more motivated staff. We can easily discuss the problems with top tier management and doctors and communicate our issues to them. They also participate actively in solving the problems,

2. More effective services are provided to the patients as the staff is given freedom to work in their own…