Structure refers to the arrangement of the parts
within a larger whole. In Donabedian’s (1980)
classic quality framework of structure, process,
and outcomes, structure affects process, which
affects outcomes. Organizations are entities that
contain groupings that consolidate smaller
elements into a larger, systematized whole.
Organizational social structure is defined as the
ways in which work is divided and coordinated
among members and the resulting network of
relationships, roles, and work groups (e.g., units,
3. Key Organizational Design Concepts
The structure of an organization can be described
as the overall way work is divided into tasks and
roles, grouped into subunits, and coordinated across
Leaders need to address key elements when they
design an organizational structure: centralization
and decentralization, coordination or integration,
hierarchy (chain of command), span of control,
coordination (integration), centralization and
4. Centralization and decentralization: The degree to
which decision-making is concentrated at a single
point in the organization versus the degree to which
decisions are made by lower-level employees.
Coordination or integration: The coordination of
activities through accountability, rules, and
procedures, roles, committees, task forces, cross-
functional teams, or direct communication
5. Hierarchy (or chain of command): The structure
of authority in an organization The chain of
command is an unbroken line of authority that
extends from the top of the organization to the
lowest level and clarifies who reports to whom
Size: Number of employees in the organization
Span of control: The number of subordinates a
manager can efficiently and effectively direct
Hierarchy also enables organizations to assign
responsibilities based on the complexity and skill
requirements of the work and to ensure individual
Responsibility is the obligation to take on and
accomplish work and to secure the desired
A manager assigns or delegates responsibility to
a subordinate, and thus responsibility flows down
the organizational chain.
In accepting the obligation of an assigned task, the
staff person is accepting responsibility to accomplish
the task, whereas accountability is the liability for task
performance and is determined in a retrospective
analysis of what occurred.
The assignment of responsibility and the granting of
authority create accountability. Accountability flows
upward or outward, from staff to manager or from
provider to client.
Hierarchy creates formal lines of communication
Hierarchy delineates roles and responsibilities
8. Organizational Forms
1.Functional: dividing the work by occupation
leads to a functional organization. Examples are
nursing, respiratory therapy, admitting, and
2.Program: program organizations emphasize
integration of the work by consumer, service, or
geography. In health care, programs may be
managed according to consumer health needs
(e.g., diabetes, cancer), consumer age (e.g.,
elderly, neonates, women), services (e.g.,
9. Organizational Charts
Hierarchy reflects the formal structure of the
organization, which can be identified on an
An organizational chart is a visual display of the
organization’s positions and the intentional
relationships among positions.
Staff positions or advisory bodies may be depicted
on the chart with dotted lines to show consultative
Informal structures do not appear on an
10. Organizational Shapes
1. Flat organization structures 2. Tall organization
Advantages of Tall Organization
1. Increased access to managers and
2. Greater supervisory capability
3. Layers of skill to deal with varying degrees of
4. Layers of responsibility to address short, medium,
and long-term issues and planning
12. Disadvantages of tall
More hierarchical centralization; potential to
micromanage staff activities
Slowed vertical decision-making and distorted
Difficult way-finding for consumers
Greater cross coordination required
Costly management infrastructure
13. Advantages of flat organization
1. Fewer divisions facilitate streamlining of
goals, problem-solving, and resource use
2. Greater hierarchical decentralization; potential
for greater staff autonomy through increased
3. Greater innovation
4. Enhanced responsiveness to consumers at
point of service
5. Less cross-coordination required
15. Disadvantages of flat
Decreased access to managers and
Decreased supervisory capability
Overextension of managers
Vertical communication delays
16. Question #1
All of the following influence the shape of the
A. Formal reporting relationship
B. Span of control of managers
C. Informal and formal power structures
D. Number of management layers
The concept of strategic management includes strategic
planning and strategy implementation.
Additional terms associated with an organization’s use of
strategy include organizational mission and vision, core
values, core purpose, strategy, tactics, strategic plan,
objectives, and stakeholders.
The organizational mission and vision collectively is a
guiding framework that describes the organization’s
purpose and future direction
Core values define the characteristics or beliefs that
underlie the organization’s activities.
A strategic plan is a document that specifies a plan for
actualizing the mission.
19. Strategic Planning Process have
1. Creating strategic mission and vision
2. Assessing the environment
3. Setting objectives
4. Developing strategies to achieve the objectives
5. Planning for implementation
6. Planning for evaluation
20. 1.Creating strategic mission and
The first step of the strategic planning
process is to formulate or review and update
as needed the organization’s mission and
vision in alignment with the organization’s
core purpose and values. The mission
delineates what the organization does, while
the vision articulates the preferred future
state of the organization
21. 2. Assessing the Environment
A key component of the strategic planning process is
to assess the environment. This assessment, called
environmental scanning, consists of analyzing both
internal and external environmental factors. A SWOT
analysis is often used in the environmental
assessment and reviews four key areas:
22. 3. Setting Objectives
Defines the who, what, and where of the
strategies to be implemented
Identifies where the organization is, where it
wants to go, and how long it will take to get there
Objectives may be written in terms of financial
outcomes that relate to improvements in an
organization’s fiscal health and result in a
stronger position for the institution in the
24. 5. Planning for Implementation
Strategies must be implemented:
In a timely manner
25. Implementing Strategy
Implementing strategy is closely linked to
organization’s operations and involves:
26. 6. Planning for Evaluation
Determines if strategic plan has been achieved
If strategy is not successful, further evaluation
(SWOT analysis) is needed
27. Question #1
All of the following are true about strategic
A. It involves establishing goals and setting targets.
B. It allows an organization to obtain and maintain a
C. It includes only financial goals.
D. It requires implementation and evaluation.
28. Question #2
The statement “As a member of a progressive health
care system, we deliver high-quality comprehensive
services to the local and extended community with
excellence, compassion, and competence” is an
example of which part of a strategic plan document?
A. Executive summary
D. Goals and strategies
Notas del editor
See Table 12.1 Dimensions of Organizational Design
Data from Charnes and Tewksbury (1993).
See Figure 12.1 Continuum of organizational configurations.
See Figure 12.5 Simplified tall organizational structure.
See Figure 12.6 Simplified flat organization structure.
See Table 12.2 Comparison of Flat and Tall Organization Structures.
Correct answer: c
Rationale: The shape of an organization structure can be described as relatively tall or flat. Several structural factors influence the shape of an organization. The formal reporting relationships among positions, which ensure the assignment of responsibility, authority, and accountability, result in hierarchical levels. The span of control of managers, which is the number of employees reporting directly to a management position, also influences organizational shape (Meyer, 2008). For instance, when managers on average have fewer direct-report staff, the organizational shape is relatively taller. Another structural factor involves decisions about the number of management layers in the hierarchy (i.e., scalar principle). Increased layers of management help the organization cope with increasing work complexity and extended time lines (Jaques, 1990). A tall organization structure assumes a pyramidal shape with multiple management layers (Figure 13-5). In contrast, a flat organization structure has minimal management layers.
Figure 14.1 Strategic planning process.
A SWOT analysis is often used in the environmental assessment and reviews these four key areas.
Table 14.1 SWOT Analysis Template
Correct answer: c
Rationale: Although the strategic plan can include financial goals, it does not exclusively contain these items. Strategic management (Coulter, 2009; Dess et al., 2011; Pearce & Robinson, 2012; Sare & Ogilvie, 2009) involves conducting an environmental scan, knowing the competition, establishing goals, setting targets, developing an action plan, implementing the plan, and evaluating success. Organizations require strategic management to obtain and maintain a competitive advantage. Strategic planning involves developing a strategic mission or vision; setting objectives; developing strategies to achieve the objectives; implementing the strategies; and evaluating the results.
Correct answer: c
Rationale: The mission, vision, and values statement should describe the philosophy of the organization. The executive summary is a two- to three-page encapsulation of the essence of the plan, written in language understandable by all potential readers, since many will not venture beyond the first few pages of the document. The background is a description of the institution, its history, and current state, including its accomplishments, as well as the situation that prompted the strategic planning process. Goals and strategies describe the target objectives and the strategies identified to ensure achievement of the objectives.