Hospital Organizational Structure and Patient-Centered Care

Organization Overview

The nursing organizational structure examined in this paper comes from UNM Hospitals, obtained from their official website. The organization is formally known as University of New Mexico Hospitals (UNM Hospitals). The nursing division is designed to identify and solve the most significant questions concerning human health within the community through care, service, scholarship, and education. As a hospital that is part of a university system, UNM serves a dual mission: teaching students and serving the surrounding community.

The hospital's organizational structure includes various sections dedicated to specialized services, including Nursing Education, Children's Psychiatry, Progressive Care Units, and Surgical Services. The organizational chart reveals multiple departments dedicated to both research and nursing education, as well as departments focused directly on patient care. This multifaceted approach reflects the institution's commitment to comprehensive healthcare delivery alongside academic advancement.

Types of Organizational Structure

Organizations establish structure within their facilities in specific ways to achieve particular objectives. The structure of an organization either assists in or delays its progress toward achieving these objectives. Organizations of all sizes can accomplish higher sales and other forms of profit by correctly matching their requirements with the structure they use to function.

UNM's Hierarchical-Divisional Model

There are three central types of organizational structure: divisional, functional, and matrix. Each structure offers distinct advantages and is chosen based on organizational goals and operational needs. Understanding these fundamental models provides a foundation for analyzing how specific institutions, such as UNM Hospitals, arrange their operations.

UNM Hospitals employs a divisional structure that can also be labeled hierarchical. This structure features a chief executive officer and administrator at the top, with authority flowing downward through executive directors and area directors. Hospitals in general favor this kind of organizational structure because people can be easily recognized based on their position within it. The structure also allows for faster communication between each section of the organizational hierarchy.

Patient-Centered Care and Decision-Making

A characteristic organizational structure of a hospital combines divisional and hierarchical elements. While chains of command exist with some levels situated under another, employees are also placed in divisions or departments tasked with their own schedules and job duties. At the top of such a structure are administrators, followed by information services and therapeutic services existing at the same level. Diagnostic services and support services occupy similar hierarchical positions, creating a structure that resembles a pyramid.

This design enables clear role definition and accountability while maintaining the flexibility of departmental specialization. The hierarchical nature ensures that decisions flow through established channels, while the divisional aspect allows each department to maintain some operational autonomy in addressing their specific responsibilities.

Information Systems and Communication

Patient-centered care requires precise action and effective communication. The organizational structure set up within a hospital facilitates both of these critical elements. This approach to care recognizes that the perspectives and information provided by families, children, and young adults are essential components of high-quality clinical decision-making, and that patients and families are integral partners with the healthcare team. The core principles of patient- and family-centered care include recognizing recent literature linking this approach to improved health outcomes, along with various other benefits expected when engaging in patient- and family-centered pediatric practice.

Effective decision-making lies at the heart of patient-centered care. However, one cannot make effective decisions if they remain unsure of their tasks and responsibilities. Clear organizational structure ensures that all team members understand their roles and can contribute meaningfully to clinical decisions. Whether a doctor decides what prescription to prescribe, a receptionist books specialist appointments, or a nurse manages shift assignments, these individual decisions collectively shape the quality of patient care.

Information systems help maintain an organizational structure like that seen in a hospital because they make transactions and record-keeping easier. People assigned tasks to obtain patient information and relay it to other departments can do so quickly and easily. As demonstrated in annual healthcare surveys, a significant percentage of hospitals and health systems have deployed technologies that improve patient documentation, advance clinical decision support and evidence-based protocols, reduce the likelihood of medication errors, and rapidly restore access to data in case of a disaster or outage. This means that hospitals and people working in hospitals may communicate and perform their job duties faster and without wasting resources like paper and time. Information systems provide a more effective mode of delivery and communication for hospitals.

Formal and Informal Structures in Healthcare

Communication methods within organizational structure exist through several channels. Modern methods include email, which has largely replaced the outdated fax system. Phone calls remain important for urgent matters, and in-person communication continues to play a vital role in complex discussions and relationship-building. All of these methods promote easier transfer of knowledge and encourage teamwork, though their appropriate use depends on context and urgency.

Formal structures existing within healthcare are primarily concerned with the relationship between subordinate and authority. A common organizational chart shows the formal structure within an organization and displays a hierarchical format. An informal structure commonly forms around project or social groups and is based more on camaraderie. Informal structures prompt an immediate response in individuals because they operate through trusted relationships rather than official channels. Most people find it easier to work in informal structures.

Research demonstrates that although a great deal of formal power in the distribution of healthcare resides with organized healthcare systems, clinical administration, and physicians, nurse participants in studies have shown they communicatively exercise informal power strategies in the performance of their role as patient advocates. This highlights an important organizational reality: people within hierarchical structures often develop informal networks that complement, supplement, or sometimes work around formal channels. Understanding and leveraging these informal structures can enhance organizational effectiveness and improve patient care.

Cultural and Generational Influences

A place like UNM may serve a population that speaks only Spanish. This may require the hospital to adapt to the need for translators, hiring Spanish-speaking staff to facilitate communication. This is a perfect example of how cultural and social influences integrate into the delivery of care. Translators ease communication between staff and patients, directly prompting better care and reducing medical errors caused by miscommunication.

Generational differences may also influence organizational structure because older generations are not accustomed to conducting everything on computers. Younger generations use technology more extensively and feel more comfortable emailing documents, whereas older generations might prefer phone calls. Modern times mean that increasingly everything is online, unlike in the past, creating potential friction between generations if organizational processes do not accommodate diverse communication preferences.