Organizational structure is described as the establishment of authority and the arrangement of the work group. Classical theorists developed the concept of departmentalization as a means to maintain command, reinforce authority, and provide a formal system for communication (Sullivan & Decker, 2009). The design of an organizational structure can be vertical or horizontal. Work is subsequently divided, and perhaps subdivided further. Tasks are specified and assigned to workers who fit into a plan.
Such is the case in the practice of Carey Surgical Associates. The medical director, and in this case, sole practitioner serves as the ultimate authority. Responsibilities are further specified as clerical, administrative, or clinical and assigned accordingly. To that end, there are managers who head up each of those departments and are responsible for the work in those domains.
The highest functioning organizational structure integrates organizational goals, size, technology, and environment. When structure is not aligned with the needs and goals of the organization, poor performance of the organization can result. This misalignment can show itself in the form of low staff morale, delayed decisions, problems or issues getting overlooked and ultimately, conflict. Organization structure is important for the leadership of the practice. The organization must function within the standards set in the mission statement.
In the case of Carey Surgical Associates, these standards, visions and values include: provide patients with the highest quality of cosmetic and reconstructive surgical care, maintaining the highest level of medical proficiency, providing courtesy and helpfulness in patient care, provide a safe environment clinically and security, provide a system of health care that is highly valuable to the community. Executives, medical professionals, managers and office staff, have the responsibility to promote a structure that seeks to improve the quality of life in the practice and the community by providing compassionate high-quality health care that is driven by our stated values and focus on clinical excellence.
Environment of Support
Every member of the management staff is responsible for setting a tone that supports the practice structure in the implementation of patient-centered care. This requires prompting open communication, which simplifies the process of delegation. This practice utilizes a team-player model in an effort to offer the best care to the patient from the clinical side all the way down to the receptionist who schedules the patient’s appointment. Every job within the practice comes with its own responsibility and importance. This model supports effective leadership, collaboration, shared goals, and effective communication. It is also a structure system of tasks, workflows, reporting relationships and communication channels that link among various members of personnel within the practice. The message being that every link in the chain directly affects patient outcomes.
An important aspect of the practice organizational structure is communication. The use of information systems is used to improve the communication between different departments and staff within the practice. Paper charting is still the preferred method within the practice. All workers having an encounter with a patient document on the chart. This creates a flow where anyone can open the chart and follow the story line. Electronic recording is in the form of pathology and laboratory results, and hospital records. The practice has defined the roles and responsibilities for creating, handling, managing, and destroying (as deemed suitable) all practice information to only administrative staff. These defined roles and responsibilities establish the hierarchy for compliance with policy and proper procedures.
A few communication methods are used within the practice. All verbal communication is followed up with an e-mail to reiterate the conversation thus avoiding any miscommunication. Limiting the method of communication has greatly reduced errors and the subsequent finger-pointing that can come afterwards. Communication can either be vertical or horizontal. Although typically, vertical communication follows a chain of command, because Carey Surgical Associates is a smaller organization, the link between clerical staff and CEO can be by-passed for day-to-day operational communication. However, in matters relating to safety, efficacy, patient care or personnel matters, a more formal vertical communication method is followed from staff member, to manager, to CEO.
Within the organization there are formal and informal lines of communication. The practice has a traditional organization chart that displays the hierarchy from top to bottom, illustration of upper management, middle management, and front line employees. Formal reporting lines maintain a chain of command protocol for all instances or issues that require guidance or notification of management or the CEO. Employees should follow the escalation process for these instances in order to properly resolve any occurrences that may warrant assistance from upper management. Informal reporting lines are commonly used between staff and middle management. This line of reporting includes communication between departments about patient care, billing issues, or basic patient-practice communications.
The role of power and control is always the CEO. The front-line staff is fully aware that the office manager and nurse coordinator govern their areas as directed by the CEO. Given that the practice is small, there are not many power struggle issues like those that can occur in a larger setting with various departments. In a larger setting, the departments are set up to work independently, however, given the situation, they oftentimes must work together which is where the power struggle can come into play. In such a small setting with less than fifteen total employees, this is seldom the case.
Communication Integrated Care
The delivery of care can be greatly influenced by the community it serves. While the practice serves a diverse population, a large section of the practice caters to breast cancer survivors who are undergoing breast reconstruction. To better serve those patients, the practice is in close contact with local cancer survivor support groups. Another service offered to patients is inclusion of education regarding non-surgical prosthetic devices such as undergarments with silicone bra inserts. The practice advises every patient of all her options both surgical and non-surgical. The practice also frequently lectures at breast cancer support groups regarding these options.
Generational and cultural differences have the potential to shape and influence the organizational structure. Mutual respect and understand of the unique differences between and among groups will help to minimize conflict and maximize satisfaction for managers and staff. The practice has not experienced a large generation gap among its employees; however, there is a large generational difference between the staff and the patients the practice serves. The generation gap has been a motivational tool for developing a deeper respect and patience for the elderly and those patients dealing with multiple diagnoses. As a result, it has been observed that the staff has greater patience with each other as well.
The development of an organizational structure and processes by which it communicates through all disciplines is important of the success of any health care environment. While Carey Surgical Associates may be a small practice, proper and effective communication is just as important as any large facility. In fact, in a smaller organization, communication in passing can be taken for granted which is how things get forgotten or misconstrued. The best tool that has been implemented thus far has been the email confirmation of phone conversations or meetings. It has served to eliminate any confusion and created a paper trail from which to refer in the event of a mistake.
Sullivan, E. J., & Decker, P. J. (2009). Effective leadership and management in nursing (7th ed.). Upper Saddle River, NJ,: Pearson Education
CAREY SURGICAL ASSOCIATES