2/22/2016

OrganizationalTheory

OrganizationalTheory
byKathrynBarzilai

ConsiderthefollowingscenarioinanEmergencyDepartmentatQueensHospital
Centerandwhatyoumightdoasapublichealthconsultanttoimprovepatientcare:

Currently83percentofpatientsattheQueensHospitalCenteremergencyroomare
treatedandreleased.Theywaitsixtoeighthoursfortreatment.Thegoalisto
decreasewaitingtimeandthenumberofwalkoutsandtoimprovecareandpatient
satisfaction.CurrentProcedure:(1)Patientseenbytriagenurse.(2)Patientsentto
registration.(3)Patientwaitstobeseenbyphysician.(4)Patientsentforany
necessarylaborxray.(5)PatientwaitsfortestresultstobereviewedbyMD.(6)
Patienttreated,discharged,oradmitted.6

Thisscenariowouldbeachallengetoanypublichealthconsultant.Successatthe
taskwouldmostlikelydependonhowwelltheconsultantgraspedsomebasicprincipals
aboutorganizations.
Anorganizationisastructuredsocialsystemconsistingofgroupsofindividuals
workingtogethertomeetsomeagreedonobjectives."2Organizationaltheory(OT)isthe
studyoforganizationsforthebenefitofidentifyingcommonthemesforthepurposeof
solvingproblems,maximizingefficiencyandproductivity,andmeetingheneedsof
stakeholders.BroadlyOTcanbeconceptualizedasstudyingthreemajorsubtopics:
individualprocesses,groupprocessesandorganizationalprocesses.2
WhyisOTimportantforpublichealthprofessionals?Sinceorganizationspervadethe
fieldofpublichealth:fromfreeclinicstorefugeecrisissupportteamstoresearchinstitutions,
anunderstandingoforganizationsandhowtheywork,helpspublichealthprofessionalsto
bemoreeffectiveparticipantsinandleadersoforganizations.
Thispaperwilltrytoaccomplishtheenormoustaskofsummarizingmajorconceptsin
organizationaltheory.Thethreebroadconceptsthatwillbeexploredinclude:individual
processes,includingmotivationtheory,personalitytheory,androletheorygroupprocesses
includingworkingingroups/communication,leadership,andpowerandinfluenceand
organizationalprocesses,asitrelatestoorganizationalstructure,andorganizational
culture.Intheprocessarudimentaryintroductiontoselectorganizationalmodelswillalso
bepresented.
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

1/13

2/22/2016

OrganizationalTheory

SincethehopeofthepaperistomakeOTrelevanttoworkinthepublichealthfield,
effortshavebeenmadetoendthediscussionofeachbroadtopicwithadiscussionofthat
topicsrelevancetopractice.Followingthelastsection,organizationalprocesses,a
suggestedsolutiontothescenariopresentedatthebeginningofthepaper,willbeprovided.
IndividualProcesses
MotivationalTheory
Whatmakesusdothethingswedo?Whywouldtwoindividuals,insimilar
circumstances,choosetwodifferentoptions?Theanswer,inpart,ismotivation.Motivation
drivesbehavioritistheforcebehindanindividualsdecisiontocommitornotcommitto
certainactsorbehaviors.Theelementsthatmakeupwhatwecallmotivationarecomplex,
uniqueforeachindividual,andgenerallydynamicthroughtime.
Handysuggeststhatmotivationistheintersectionofassessedneedandthe
likelihoodornatureofresults.6AnindividualcalculatesanE(energy,enthusiasm,effort)
theproductofneed,andpredictionforliklihoodofachevingthedesiredresults.Whena
personentersintoacontractwithanorganizationsomecalculationwillbemadeinregards
totheindividualsEputforth.OrganizationsalsoputforthanE,eitherbyresources
alone(salary),orbyotheritemssuchasprestigeandstature.Thisexchangesetsthelimits
ofaphysicalandpsychologicalcontractbetweentheorganizationandtheperson.The
psychologicalcontractcanbedefinedasthesharedandunsharedexpectationsbetweenthe
individualandtheorganizationbasedoninitialagreementsandtheindividualsmotivation
calculations.Whenbothpartiesseethepsychologicalcontractclearly,(i.e.,whenitisfully
understoodandacknowledgedbybothparties),themotivationoftheindividualbecomes
transparent.
Motivationtheorytellsusafewthingsaboutmanaginggroupsofpeople.First,in
ordertofindsuccessfulwaystochangepeoplesbehaviorsinanorganizationyoumust
understandthetermsofthepsychologicalcontractforthoseindividuals.Whenyou
understandthetermsbywhichapersonjoinsanorganization,youcanbettersecure
meetingthatdemandandhopefullysustainanEinputovertime.If,however,an
organizationchangesitsE,orincreasesdemandsontheindividual,Ewillchange
accordingtothepersonsmotivationcalculation.Managementmustcarefullyconsiderhow
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

2/13

2/22/2016

OrganizationalTheory

tomaintainoradjustthepsychologicalcontractinordertokeepthatpersonaproductive
memberoftheteam.Thismaymeananincreaseinsalaryormanpowerand/orincreased
managerialresponsibilities.
RoleTheory
Theroleswecarryshapethewayweseeourselvesandhelptodefinethebehaviors
weshouldexhibit,andthoseweshouldnot.Rolesalsohelpustocommunicate
responsibilitiesandsetexpectationsforappropriateresponsesfromothers.Inan
organizationrolescanhelptoclearlydefineboundariesbetweenindividualsandlocisof
power.
Adjustingtoormeetingroleexpectationscanhowevercreateproblems.Role
ambiguityisonesuchproblem.Roleambiguityoccurswheneitherthefocalpersonor
othersaroundhim/herareunclearaboutthenatureorexpectationsofarole.Roleambiguity
canplagueemployeesendeavoringtosuccessfullyattainandmaintainnewresponsibilities
orgoals.Ontheotherhand,apersonmaynotreachroleobjectivesduetooverloadingof
responsibilitiesorunderutilizationoftalentsandabilities.Roleconflictmayarisewhentwo
rolesintersectcreatingtensionordifficultyfulfillingoneorbothroles.Forexample,whena
motherreturnstoworkandattemptstomaintainbreastfeeding.Managementmaynot
supporttheamountoftimetakenduringthedaytopumpmilk,leavingthemotherata
hazardofnotmeetingbothroleexpectationsfully.Roleincompatibilitymayoccurwhenthe
expectations/natureoftheroleisclearbutisincompatiblewithotherrolesorapersons
senseofself.
Organizationsneedtoacknowledgethatitsemployeesmanagemanyrolesandthat
problemsorconflictscanarisesinceroleconflictscreatetensionsthatcanchangetheability
oftheindividualtoreachtheirgoals.Organizationsshouldbesuretosupporttheirteam
membersinmeetingnewrolesbygivingtimefortransition,orofferingtrainingandsupport.
Inaddition,whenroleconflictarisestheorganizationcannurtureemployeesabilityto
relievetensionbyallowingtimetodevotetocaringforrolesoutsidetheoffice.Anexample
ofthismaybesupportforabreastpumpingstationintheofficeandmanagementsupportof
breaksforpumping.
PersonalityTheory
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

3/13

2/22/2016

OrganizationalTheory

Personalityistheuniqueandenduringtraits,behaviorsandemotionalcharacteristics
inanindividual.3Personalitycaneitheraidorhindermeetingworkgoalsdependentonfit.
Forexample,perhapsthebestwellknowpersonalitytypesareTypeAvs.TypeB.TypeA
personalitiesarecompetitive,impatient,seekersofefficiencyandalwaysseemtobeina
hurry.TypeBpersonalitiesarelaidbackandpossessmorepatienceandemotional
stability,buttendtobelesscompetitive.InaworkenvironmentTypeAstendtobemore
productiveintheshorttermandpursuemorechallengingwork.However,theyalsohavea
greatertendencytowardshealthrisksandarelesslikelythanTypeBstobeintopexecutive
positions.3
Thelaterfactmightbesuprising.WhywouldTypeAstendtobeintopexecutive
positionsmorefrequentlythanTypeBs?DanielGolemanmightsuggestthatthedifference
inperformancebyclassicTypeAvs.TypeBpersonalitiesislessduetofixedpersonality
traitsastheyareforpropensitiestograsptheconceptofemotionalintellect(EQ).4Unlike
IQ,EQisthecapacityforrecognizingourownfeelingsandthoseofothers,formotivating
ourselves,andformanagingemotionswellinourselvesandourrelationships.(Referto
AppendixAforapresentationofGolemansEQEmotionalCompetenceFramework.)
Anotherpossibilityisthatthesetrendsarelesstheproductofaninnatecharacterasit
istheinteractionofexperience,personalityandcircumstance.Ifthisisthecase,apersons
abilitytoworkingroupsorpropensityforcertaintypesofworkmaybetaskandtime
dependent,butcanbechangedwithmotivationandeffort.
Organizationscanplayaroleindevelopingtheirstaffforsuccess.Workshops,
seminars,evenbookclubsthatfocusondevelopingEQanstrengthenorganizational
success.Allowingforadiversesetofexperiences,withappropiratesupportcanmaximize
andexpandthecapabilitiesofeachemployee.
Discussion
Domotivation,roletheoryandpersonalityfactorintoourdaytodayexperiencesinan
organizationinasignificantway?Threetheoristswouldsuggestindividualprocessesare
veryimportanttothesuccessofanyorganization.TheHumanResourceModel,as
developedbythecontributionsofLikertin1967,McGregorin1960andArgyrisin19573,6,8,
proposesthattheindividualisthemostimportant,indeedthecentralconsiderationfor
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

4/13

2/22/2016

OrganizationalTheory

maximizingthesuccessofanorganization.AccordingtoTheHumanResourceModeleach
employeeasanuntappedwellofcreativity,talentandmotivation,andthesuccessofan
organizationdependsonhowwellhumanresourcesaretapped.Asanemployeeisplaced
inanenvironmentwheretheybecomestheoriginatorandleaderoftheirwork,the
organizationsgoalsandtheirindividualgoalsbecomeone.Whenorganizationgoalsare
internalizedtheindiviudalssatisfactionincreases,aswellastheamountofmotivationtobe
efficientandproductive.Thereforethemotivationoftheemployeeiskeybecausetalentand
creativityflowswhenthepersonismotivatedtodosobyinternalizationoforganizational
goals.7
Accordingtothehumanresourcemodel,thechallengeofgrowthandproductivityin
anorganizationisthechallengeofassistinghumanresourcesinreachingtheirmaximum
potential.Themultipledimensionsofindividualprocesses,thecalculationofmotivation,role
developmentanddevelopmentofinnatetalentandabilities,areallfactorsthatmustbe
consideredseriouslyandchanneledappropriatelyforachevingsuccess.
GroupProcesses
Leadership
LeadershipisanimportanttopicthatisdiscussedatlengthinChapter14oftheOn
LineTextbook.Pleaserefertothatchapterforanindepthdiscussionofthistopic.

PowerandInfluence
Oneneedsonlytosuperficiallyexaminethetabloidsandothermediaoutletstosee
theactionofpowerandinfluence:Moviestarspromotingeverythingfromprostateexamsto
weightreductionpillsorpopularhealthguruspreachingcuresforallills.Theseindividuals,
andotherslikethem,wieldgreatpowerandinfluence.Withinthewallsofanorganization,
powerandinfluencealsomakeanimpactonindividualsandgroups.Althoughonemay
oftenthinkofpowerandinfluenceintermsofhowitisabused,itcanalsobeusedtodo
positiveworkwithinanorganizationtodriveproductionandtomeetgoals.Tothatendwe
willconsideritsrolewithinorganizationsandimplicationsforchange.
Influenceistheactionorforcebyanindividualthatmodifiesanotherpersonsactivity
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

5/13

2/22/2016

OrganizationalTheory

orbehavior.Poweristheforcebehindinfluencetomakeiteffective.6Therearethree
fundamentalprinciplesregardingpower.First,forpowertobewieldeditmusthavean
identifiableandcrediblesourcepowerwouldhavenobearingonindividualswithout
evidencetoshowthatitcanbeused.Sourcesofpowerarethosesubstances,physicalor
not,thatcanbemobilizedtohaveinfluence.Thereareatleastfivebroadsourcesofpower:
resource,position,expert,personalandnegativepower.Resourcepowerderivesfromthe
controlofwealthandresources:forexample,theboywhoownsthesoccerballgetstosayif
therewillbeagame.Positionpoweristhepoweridentifiedwithfulfillingcertainroles.A
ChiefExecutiveOfficereasilywieldsdecisionmakingpowerbecauseitstemsfromhis
appointmentresponsibilities.Expertpoweristhepowerarisingfromknowledgeand
experience.Personalpoweristheinnatecharismaapersonmaypossess,atypeof
magnetism.Finallynegativepoweristheabilitytonotdosomething,andinsodoing
preventanotherperson(s)fromgainingwhattheywant.
Second,powerisabalancebetweenbothparties.Boththepersoncommanding
influenceandthepersononwhomthepowerisbeingexertedcommandspower,thelater
commandingatleastnegativepower.Finally,powerisrelative.Powercanbeexertedonly
whenthosetowhomyouaretryingtowieldpowerrecognizethesourceofit.Takefor
exampletheconundrumaprofessoroftheartswouldbeintryingtoguidedecisionsmade
byaMedicarepolicyreviewboard.Hiscredibilityasleaderisdiminishedbecausethe
professionalsourceofpowerstemsfromexpertiseintheartsnotpublicpolicy.
Onceapowersource(orsources)areestablished,influencemustbecommunicated
throughrecognizablemethods.Eachmethodchosenpredisposesindividualstocertain
typesofresponses.Dependingonhowindividualsrespond,theirnewbehaviormayormay
notbesustainableovertime.Influencemethodsinclude,butarenotlimitedto:theuseof
forceandcoercion,rulesandprocedures,exchange(bargaining,negotiating),
persuasion/logic,andecology.6Anexampleofecologywouldbechangingtheenvironment
peoplearein.Chattyemployeesmovedtodifferentfloorswillquicklyinfluencetheir
behaviorbychangingtheamountoftalkingthatcanbedoneintheworkday.
Ifthegoalofpowerandinfluencesistoincreaseproductivityandthequalityof
servicesdeliveredbychangingemployeebehavior,thenthecentralmeasurementof
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

6/13

2/22/2016

OrganizationalTheory

outcomesuccessisindividualresponse.Dependingonsourcesofpower,certainindividual
responsesaremoredesirablefororganizationalstrategybecauseofthewaytheycorrelate
withsustainabilityoftheresponseovertime.Complianceistheagreementtoabehavior
becauseofforcetheIhavetoresponse.Thisimpliesthelackofselfinitiatedbehavior
becausethepersonhastoratherthanwantsto.Generallycompliancewillbetheresult
ofmethodsofforce,rulesandprocedureandsometimesexchangemethods,andmustbe
maintainedwithcontinualsupervision.Unlikecompliance,identificationandinternalization
havesomedegreeofacceptanceofthenewbehavior,howeverthesustainabilityofthe
behaviorsarenottheequal.Identificationisabehavioradoptedoutofadesiretopleaseor
admirationforthepersonwieldingthepower.Themanagerexertingthistypeofpowerhas
greatmagnetismbutmustconstantlybepresentforthebehaviortocontinue.The
organizationbecomesdependentonthepowerfigure,makingtheemployeeactionnot
sustainableindependently.Internalizationisformostsituationsthemostdesirableresponse
becauseitisindependentofthesourceofinfluenceandisselfsustaining.6
WorkinginGroups
Inthe1930sand40sasetofexperimentsweredoneattheWesternElectrics
Hawthorneplant.6Theinitialroundofexperimentsinvolvedaselectgroupoffemale
employees,whomconstructedtelephoneequipment,placedinavarietyofenvironments
(changesinlighting,quotademands,restperiodfrequentandduration)inordertomeasure
theireffectonproductivity.Totheirastonishment,theresearchteamfoundthatthe
environmenthadlittletonoeffectonproductivity.Inallsimulatedenvironmentchangesthe
levelofproductivityincreased,andoncebackintheiroriginalenvironmentstheproduction
leveloftheemployeescontinuedtoremainathigherthanpreexperimentlevels.Theteam
hypothesizedthatthemajorcauseforincreasedproductivitywastherelationshipsformed
betweentheemployeesandbetweentheemployeesandthemanagement.
Asecondroundofexperimentswereconductedonmaleemployeesthatinvolvedin
wiringandsmolderingoftelephoneequipmentatthesameplant.Nochangeofenvironment
wasmadeasinthefirstexperiment,excepttoplacethemenunderobservation.The
researchteamfoundwhattheycalledtheHawthorneEffect8:Regardlessofquotasetby
thecompany,theempoyeesneitherundernoroverproduced.Inaddition,workoutputwas
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

7/13

2/22/2016

OrganizationalTheory

equalforallmembersofthegroup.Theresearchteamhypothesizedthattheworkers
createdinformalgroupsbetweenthemselvesandtheirsuperiors,whichtightlyregulated
productioninordertomaintainagroupidentifywherenomanexcelledbeyondtheothers.
Thiswellknownexperimentdemonstratedforthefirsttimeinacontrolledsettingthe
roleofinformalgroupsonproductivity,andthattheeffectsofgroupcultureinwork
environmentscouldhavepositiveornegativeconsequences.
Outsideoftheinformalgroupscreatedbyemployees,administratorsformgroupsin
ordertomeetorganizationgoals.Thenatureofthesetypesofgroupsalsodeservessome
discussion.Motivationforutilizinggroupsmayinclude:(1)improveddecisionmaking,(2).
Morerisktaking,(andthereforepresumablymoreinnovation),and(3).Satisfyingtheneedof
individualstobeinagroup.6
Groups,likechildren,gothroughstagesofgrowth.AccordingtoHandy,thereare
fourstagesofgrowth:forming,storming,normingandperforming.6Asmanagersyoumust
besensitivetotheneedsofthegroupateachstageinordertohelpthegroupreachits
goalssuccessfully.Intheformingstagerelationshipsarebeingbuiltthroughthe
establishmentofgoals,roledefinitionandtimelineformation.Quicklygroupsmoveintothe
stormingphase,whereroles,proceduresandgoalsarequestioned.Itisvitalatthisstage
thatconflictsberesolvedeffectivelyandefficiently.Inthethirdphase,norming,members
establishaformalorinformalsetofrulesandproceduresforgroupmemberstoincorporate
intotheirwork.Opencommunicationisvitalforthenormsdefinedtobeacceptedand
uniformlyapplied.Onlywhentheforming,stormingandnormingphasesarecompletedwill
groupsbeabletomoveintoaperformingstageofgrowth.
Afewthoughtsongroupsremain.AsdiscussedintheleadershipchapteroftheOn
LineTextbook,groupsbyanticipatingtheneedsofthegroup,leaderscanmoitvateacitivites
accordingtothestagesthegroupisin.Duringtheformingandstormingstagesleaders
shouldassistgroupmembersbyencouragingparticipationandviablecommunication.
Leadersarekeyinmaintaininggroupstabilitythrougheffectivenegotiationduringthe
stormingphases.Asthegroupmatures,reachingthenormingphasetheleadersshould
practiceforesight,promotingthenextlevelofactionbyintroducingeffectiveevaluation
methodsandstandardsettingadjustmentsasnecessary.
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

8/13

2/22/2016

OrganizationalTheory

Perhapsoneofthegreatestchallengesforworkingingroupsistheelementthatcan
beitsgreateststrength,diversity.Thosewhohavestudiedgroupsacknowledgethat
diversityincertaincombinationscanbekeytosuccess.RMBelbin1agrees,findingthat
teamsdonotneedbrilliancebutbalanceforsuccess.Specificcharacterroles,notedin
appendixB,canprovidetherecipeforsuccess.
Discussion
Workingingroupsarebuildingblocksformeetingorganizationgoals.Managers
shouldconsiderwaystodevelopleadershipinteammembers.Trainingforversatilityin
leadershipstylesthroughworkshopscouldencouragethisgrowth.Encouragingselfgrowth
throughconceptsofEQorevenCoveysSevenHabitsofHighlyEffectivePeople2canalso
providethegroundworkforleadershipgrowthbymasteringinterpersonalskills.Managers
shouldalsobeproactiveaboutidentifyingandcultivatingtalentofhis/herstaff.When
committeesmustbeformedmanagerscanhelpselectindividualstocreategroupsthathave
thebalanceofpersonalitiesandtalentstomaximizethelikelihoodofsuccess.
Eachmanagermustalsoconsiderdiversifyingtheirowntalentsbyanalyzingspheres
ofsocialcompetenceandgoalsthoughwhichtoimprovetheseabilities,butalsoseekingto
diversitysourcesofpowerandmethodsofinfluence.Forexampleinanenvironmentthatis
strictlymanagedwithrulesandprocedures,implementingademocraticprocesscan
broadeninfluencebyexample.Thismethodhoweverwouldrequireagreatdealoftime,
effortandmustbeapproachedwithfocusedinvestment.
OrganizationalProcesses
OrganizationalStructureandDesign
Ifweweretolookatanyorganizationfromabirdseyeviewwecouldobserveits
structureanddesign.Inthebiologicalsciencesstructuredefinesfunction,sotooforhuman
organizations.Importantconceptstoconsiderinthestudyingoforganizationalstructureare
theflowofinformationandsourcesofpower.Considerthefollowingdiagrams:
Infigure1AallinformationflowsthroughtheCEeitherdirectly(beforeintersecting
withanonCEsphere)orindirectlywith12intersectionspreceding.Inthisenvironment
powerisverywellcentralizedandcommunicationwellcontrolled.Figure1Bisavariationof
acentralizedmodel.Themanagerialstyleinthismodelismorefunctionalwithformalized
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

9/13

2/22/2016

OrganizationalTheory

relationships.Theseorganizationalstructuresworkbestwhenthetaskisuniform,and
predeterminedandenvironmentpressuresarelessenedsuchasifacompanyhascornered
andmarketandorhasastableproduct.Inhealthcarethismightoccurwhenalargetertiary
carecenterthathascorneredthemarketforacityorisolatedregion.
Incontrast,considerfigure1Cwherethedivisionofdutiesishighlyspecialized
leadingtotwoseparatefunctionalunits.Inthismodelworkandthedivisionofdutiesis
highlyspecializedsopoweriswidelydistributed.Communicationflowsinacentralized
fashionwithinunits,butnooneunitcontrolsallcommunicationorhasallpower,making
powerdecentralized.Thismodelmayservebestinthesituationwhereinnovationandthe
abilitytorespondtoenvironmentalchangequicklyiskey.
Thechallengeforallmanagerswillbetobalancetheneedforuniformitywiththe
demandsfordiversity.Uniformityguaranteeseaseofcontrolandsupervision,easeof
integratingworkofmultiplesubgroupsorteams(suchasbetweenoffices)andeconomy
sinceitiseasiertopayforandmaintainonesystemratherthanmany(onetypeofform
versemultipleforms).Howevertheenvironmentinwhichtheorganizationisbased,andfor
whichtheproductisbeingdelivered,isconstantlychangingmakingitunpredictable.
Organizationsmustthanmanageresponsestothesechangesdiversifyingtheirprocesses
andthinking.
Organizationsmaytendtoseektoomuchuniformity,followingtheclassicfutilefight
againstthelawofentropythatallthingsmovetowardsgreaterdisorder.Anorganization
shouldrecognizethemanydemandsfordiversityclassifytheirimportanceanddecideon
whichtopursue,maximizingthecostofdiversitywiththeachievementofgoalscarefully.5
OpenSystemsTheory(OST)hasintegratedtheseconflictingpressures.According
toOSTorganizationslivewithindynamicenvironmentsandareshapedbythem.The
organizationisanorganismwithexternal(resourceavailability,changesofneedsand
demand)andinternal(employeecharacteristics,adaptationtoorganizationalchangeteams
andindividuals)environmentalinfluences.Theorganizationevolvesaccordingtothe
pressureexertedbythesesourcesandthereforeisevolvingbysuccessfuladaptationwithin
thisdynamic,changingandanopensystem.Thechallengestomanagersaretoidentify
appropriatesourcesofinfluencebyprioritizingthem,andtoguidesuccessfuladaptationby
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

10/13

2/22/2016

OrganizationalTheory

theorganization.7
OrganizationalCulture
Organizationalcultureisacognitiveframeworkconsistingofattitudes,values,
behavioralnorms,andexpectationssharedbytheorganizationsmembers.9Organizational
cultureshelptoestablishasenseofidentityforemployeeswithintheorganizationand
thereforecanfacilitatecomfortandagreaterlikelihoodofinternalizingorganizationgoals.
Organizationalculturealsoprovidesastatusquoandmaintainsstabilityinprocesses,
communicationandroleinteraction.
Cultureisenforcedinanumberofways,suchasbyceremony,symbolsand
language.Ceremoniesthatcommemorateemployeesdemonstratingexcellenceas
evidencedbyexemplifyingorganizationalvaluesdemonstrateinfrontofalargeaudience
thosevaluestobecelebratedwhilealsoreinforcingthem.Symbols,suchasmission
statementsorencouragementsloganscanconstantlyreinforcethevisiontheorganization
wantseachindividualtobeguidedby.Speciallanguagecanalsohelptodefineaculture
andallowanindividualtoidentifywithit.
Thepresenceofculturedemandsuniformity.Managersmustconsiderthe
consequenceofparadigmshiftsandplanindetailimplementingchanges.Implementnew
paradigmsrequirethecompletesupportoftheadministration,andshouldbeabletoaddress
theneedsoftheemployeeworkingbody.
Discussion
Thetwomajororganizationalprocessesdonotstanddiaposedendoforganizational
theoryinpractice.Infact,organizationalstructureandculturemustreflectoneanotherin
ordertoreinforcethegoalsandmissionoftheorganization.Imagineaninternational
refugeemissionseekingtoinitiateprogramsformaternalchildwellnessinwhichpeopleat
thefrontlinesarentinthecommunitywiththeindividualsdivvyingtheresources.Although
thegoaloftheorganizationvaluesmaybetorespondtotheneedsofthecommunity,
administers,isolatedfromcertainstaff(organizationalstructure)leadstotheinabilityto
reachgoals.
ReviewofCaseStudy
Referingbacktothescenariopresentedatthestartofthepaper,QueensHospital
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

11/13

2/22/2016

OrganizationalTheory

hospitalwantsyourinputonhowtoimprovetheEmergencyDepartmentspatientcare,and
tomaximizeefficiencyandquality.UtilizingOTthereareafewquestionswemightwantto
asktodiagnosistheproblem.
Staffrelatedissues:Howwelldoesstafffeelsupportedandabletopursuework
relatedissues.Whatarestaffinglevels?Aretheseratiossufficientforpatientworkload?If
staffinglevelsarelowthiscancontributetotheproblemofefficiencyandquality.Ifthis
seemslikelytobeaproblem,furtherquestionsshouldinclude:Whatisstaffturnover,and
whatisthewaittimeforobtainingnewstaff?Howwellarehumanresourcesretainingstaff,
whataretheproblemareas?Whataretheincentivesmotivatingworkparticipation,and
whatpoolsareapplicantsareapplying?Whom,whattalentsandskillsdowewanttoaim
for?
OrganizationalIssues:Howwelldothedifferentunitsofcaredeliveryfitwithone
another?Forexampleifthelaboratorywascontractedouttoalabthreemilesaway,the
hospitalmaybelimitedbythetimeittakesforbloodtobecollected,transported,analyzed
andtransportedback.Thisprocessmayalsobeonaschedule,(onthehourorhalfhour)
whichthenaddsthewaittimefortransportation.Aninhouselabstaffmightbeconsidered,
althoughcostofoverheadandstaffingwouldhavetobeconsideredforitscost.Whatalso
istheclimateintheorganization,areworksoverallsatisfied,dedicated,feelempoweredto
deliverexcellentcare?Hastheorganizationbuildandsupportedacultureofexcellence?
Whereisdecisionmakingcentralized,andwhatwouldbethebenefitsand
disadvantagesofdiversifyingsourcesofpower?Inlightofthepatientpopulationneeds,
whattypesofproblemsaremostcommonlyseen?Uniformvs.diversitypressureshelpto
guidemodesofaction.Ifalotofnonacuteconditionsarepresentedtothehospitalwe
mightwanttoconsidertheutilizationofanUrgentcaremodelancillarytomaintainingtheER
foracuteconditions.
Considerothermore"acute"conditionsaswell:Whatglitchestothestafffrequently
commentasaproblem?Maybethecomputersystemisarchaicandredundant.Maybe
therearefrequenterrorsinobtainingandreportinglabs,consults,andobtainingpatient
records.Oneglitchcouldcreateamyriadofsmall,butrecurrentproblems,troublingstaff
andoverallefficiencyofthepractice.
http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

12/13

2/22/2016

OrganizationalTheory

Wewillassumethatacuteissues,andstaffrelatedissuesarenottheproblem,since
resolvingthemwouldbeselfexplanatory.Wewillconsideronlyadjustmentsin
organizationalstructureanddesignforthesakeofrelevancetothetopicofOT.Isuggest
thatQueensHospitalconsideranewmodelofcaredelivery,inwhichtheEmergency
Departmentdiversifiestoadecentralizedmodelofmanagementandaddsnewmodesfor
caredelivery.Thenewprocesswouldlooksomethinglikethis:Whenapatiententersthe
hospitaltheyareseenimmediatelybyaTriagenurse.Thenursehastheoption,after
registrationiscomplete,tooneofthreeroutes:thenursecanchannelapatientthroughthe
traditionalmethod,tobeseenbyEmergencyroomphysiciansaccordingtopriority.The
nursecanalsodecidetotransfernonacutepatientstourgentcarecenter(aninitiativeof
thishospitaloraclosecenter),ortoinitiatepreapprovedprotocolsforcommonillnesses,
(suchasasthma)priortovisitationfromthephysician.
Utilizingthismodelhasafewadvantages.Byincreasingthestructuralcomplexity,
patientscanhavetreatmentinitiatedandcompletedatafasterrate.Thisnotonlyallowsthe
hospitaltoseemorepatients,butitwillimprovepatientsatisfaction.Redesigningjobroles
andresponsibilitiesmayalsoincreasethemotivationofstaffbymaximizingtheircontrolof
patientcare.Nursescanmoreeffictivelyutilizietheirtriageskillsanddoctorscanfocuson
patientswithconditionsorcomplicationsthatrequiretheirskillandtraining.

http://www.cwru.edu/med/epidbio/mphp439/Organizational_Theory.htm

13/13