Definition of Organization
1- The term organization refer to " any collection of persons, materials, procedures, ideas or facts so managed & ordered that in each case the combination of parts makes a meaningful whole that at achieving organization objectives.
2- In other words the process of organization implies the arrangement of human & nonhuman resources in an orderly fashion to make a meaningful whole that accomplishes organizational objectives.
Organizational Chart Structure
Definition: an organization is a collection of people working together under division of labor and a hierarchy of authority to achieve a common goal.
– the organizational structure should provide an effective work system, a system of communication identity to individuals and to the organization…. and should consequently foster job satisfaction.
– Agencies contain both formal and informal structures.
– Formal structure appears on the organization chart.
– Informal structure comprises personal and social relationship that don’t appear on the organization chart (it is based on personal relationship rather than positional authority)
– Formal relationship between people in various position in the organization.
– They shown who supervises whom & how various jobs& departments are linked together to make achieve coordinated system.
– Main channels of communication (downward, upward , horizontal, and diagonal)
– Downward flow of authority (orders & commands) from superior to subordinate to = chain of command.
– Upward flow of communication (accountability) from subordinates to superior.
– Horizontal flow of communication between employees of the same level.
– Diagonal communication flow between employees of different level have different functions (e.g. between nursing station and pharmacy )
– In a chart solid lines denotes lines of command (line of authority) whereas dotted lines denotes counseling or advisory line.
Types of Normal Organizational Structures:
– A formal structure describes position, task responsibility and relationship.
– Most nursing departments utilize one of the following structural patterns.
1. Line organization
2. Functional structure
3. Dual Structure
4. Self-contained unit structure
5. Matrix Structure
1- line organization:
– Most common structure in health care facilities.
– Line positions can be shown either horizontal or vertical unbroken line
A. Horizontal unbroken line:
– represents communication between individual with similar spheres of responsibility and power but different functions
B. Vertical Unbroken Line:
– represents communication between individuals with different positions.
– Those having the greatest decision-making and authority are located at the top, and those with the least at the bottom.
2- Functional Structure:
– Employees are group in departments by task.
– Similar task in the same group … similar group in the same departments … and similar departments report to the same manager.
– All nursing task are under nursing service and the same is true for other functional areas.
• Use resources efficiently.
• Do not duplicate tasks.
• Simplify training because common tasks are grouped together.
• coordination across function is poor and difficult.
• Response time is slower
3- Dual Structure:
– separates technical and administrative responsibilities.
– It has one hierarchy for technical professionals who make technical decisions and control technical matters … and another administrative hierarchy for supervisory management who make decisions about issues such as personnel and budget.
– Give equal status to technical and administrative managers
4- Self-contained unit structure:
– All functions needs to produce a product or service are grouped together in an autonomous division.
– Large health care organizations that acquire a smaller clinic may operate it as a self-contained unit.
– high client satisfaction can be achieved.
– High coordination across function occurs ( employee collaborate with other unit functions to meet unit goals and reduce conflict.
– divisions operate independently and often compete each service line which is independent has its own nursing staff and compete with other service lines.
– This structure has a formal vertical as well as horizontal chain of command.
– Separate executives are responsible for each side of the matrix.
– Heads of department report to both the functional and product manager.
– Motivation to staff members.
– Strong contact between staff of different divisions
– Need excellent interpersonal skills for involved managers.
– Dual authority can be frustrating and confusing.
– Time consuming because frequent meetings are required to resolve problems and conflict.
How to keep Organized ?
– Every plan should be flexible enough to allow for changes if the need arise, So if rearrangement of duties become necessary, you need to evaluate the situation, change as a little possible in order to minimize confusion and chance for error.
Help Your Team to keep organized by:
– Giving each person time and opportunity to pal the work.
– Have all necessary supplies available.
– Avoid interrupting your team except emergency.
– Encourage and help each member to improve his work habit.
– Help team to evaluate their work.
– Evaluate the effectiveness of you plan.
– Decide whether the work had been completed on time.
– Determine if yours are satisfied with the care are received.
– Determine your team member’s satisfaction.
Organizing and delivery of nursing care:
– Nursing care delivery system refers to the manner in which nursing care is organized and provided.
– Effective delivery of nursing care promotes efficiency in an organization through high productivity and adequate staffing.
– Effective delivery of nursing care helps in increasing job satisfaction.
– The type of patient’s care delivery system used reflecting the organization structure, philosophy, it also depends on nursing staffing.
Types of nursing care delivery systems:
A- Case Method:
– Involves one-to-one nurse patient ratio.
– One nurse is responsible for caring for one patient and providing all the care required.
– The responsible nurse reports to the head nurse.
– Although this approach is expensive, it continues to be used in critical care units.
– Based on holistic philosophy of nursing.
– The nurse is fully responsible about the patient and gives him full accountability.
– Direct contact with the patient.
– Continuity of patient’s care.
– Good nurse-patient relationship.
– Allow the nurse to coordinate patient’s care (authority).
– Lack of educational development.
– Very expensive.
B. Functional Method:
– Fragmented approach, focuses on task and procedure.
– Tasks are assigned to various personal based on complexity and required skills.
– Each staff is responsible only for assigned task …. One nurse for medication …. An other one for dressing …. An other one for vital signs ….
– The charge nurse is responsible for coordinating the activities and report to the nurse manager.
– Based on task-oriented philosophy of nursing.
– Not expensive in comparison with case method.
– Efficient because tasks are completed in reasonable amount of time.
– Staffs do only what they are able to do and trained to do.
– Helpful in critical shortage of nurses / emergency.
– Fragmented nursing care.
– Patients do not know their nurses.
– Nurses do not have enough time to communicate with patients.
– There is a little time for psychological care.
– Deals with patients in a mechanistic way rather than humanistic.
– Poor job satisfaction.
– Reflects bureaucracy and centralized organization.
C. Team Method:
– Based on group philosophy.
– Reflect decentralization …attempt to support goal action through group action.
– The team leader is responsible for managing the care of group.
– Working with the team leader various qualified personnel, they report to the team leader, who then report to the head nurse.
– The team leader assigns personnel based on qualification and client needs.
– The team leader is responsible for planning and evaluating the nursing care provided by the team members.
– The nurse manager remains responsible for major management, decisions, communication and coordination.
– High job satisfaction.
– Nurses have enough time to communicate.
– Patients know their nurses.
– Required efficient team leader skills.
– Rotation of team leader is frustrating.
D. Primary Method:
– Reflect decentralized structure and based on comprehensive philosophy.
– A primary nurse is assigned to care for group of patients 24hrs a day through their stay in the hospital.
– He has 24hrs responsibility for assigned patients.
– Responsible for assessing, planning, implementing and evaluating the nursing care.
– Associate nurse carry out the plan of care when the primary nurse is not available.
– The nurse manager is responsible for assigning primary nurses, coordinating the activities of primary nurse on all shifts and assigning associate nurses for periods when primary nurses are of duty.
– Provide satisfaction for nurses and patients.
– Nurses get self esteem for providing complete nursing care.
– Good communication between patients and nurses.
– Increase accountability and facilitate continuity of care.
– Efficient method which decrease the number of people in the chain of commands. (reduce error).
– Patient know their nurses and times they are available.
– Primary nurse confines a nurses talents to her own patients, other patients can’t get benefit.
– More professional staff and fewer non-professional staff are required for successful implementation.
– Complicates doctors rounds because no single nurse in the unit knows al the patients.