Organising management rumah sakit

8/13/2019 Organising management rumah sakit

1/9

Organising

As a function of management, organizing deals with identifying and grouping various activities,

delegating authority and command to managers and coordination of various activities and

hierarchies in the organization.

The process of organizing can be described as a series of steps as under :

(i) Detailed description of various activities to be performed for achieving organizational goals : For

achieving the predetermined organizational goals, we must know in detail what activities are to be

performed. For example, before a hospital team can actually start treating the sick (organizational

goal), they must know what equipment to buy, how many doctors, nurses and paramedical workers

to hire, where to locate the hospital, how to construct and how many departments to create in

the hospital.

(ii) Grouping of various activities in some meaningful manner : An organization invariably

functions better when activities of a similar nature are grouped together, based on their essential

similarity & difference from other activities. This would be best exemplified in creation of various

departments in a large hospital. For example, all patients requiring surgical intervention (which may

be for hernia, burst abdomen, gun shot wound or a simple abscess requiring incision & drainage)

are referred to & attended in the surgery department (which itself may be further divided into

cardio-thoracic surgery, gastrointestinal surgery, neurosurgery or vascular surgery depending on

the detailed type of surgeries performed).

(iii) Delegation (comprising of authority, responsibility and accountability) : Consists of assigning

each group of activities (departments) to a manager with authority to supervise its functioning

(head of the department). Delegation, thus, is the most important part of organizing since any

manager due to limited individual capabilities, can not carry out all organizational activities alone

and has to delegate work to his subordinates. Successful delegation of work is accompanied

by delegation of authority to take decisions & actions of accountability.

(iv) Coordination (horizontal and vertical) : Makes the organizing process complete. In any

organization, every individual or group of individuals very often start concentrating on performing

only their specific assigned task, often relegating the overall organizational goals to the

background and generating conflicts. For example, in a large multispeciality hospital, the

medicine department may be unwilling to part with their assigned vacant bed in ICU in

anticipation of a case even when the surgery department needs it urgently for a patient of burst

abdomen.

The medical stores may be refusing to issue costly medicines prescribed by a junior

doctor with the aim to curb wasteful expenditure, not realizing that the medicine is urgently

required by the patient. Such occurrences are quite common in medical practice and this is

where the role of the medical superintendent as a manager is of utmost importance. Coordination

between departments and between various hierarchies in organization is thus an essential

requirement to channelise energies towards achieving the overall organizational goals and look

beyond individual or departmental goals.

Principles of organizing : Some important principles of organizing are enumerated below :


2/9

(i) Unity of direction : One leader & one plan for a group of activities having the same objectives.

(ii) Unity of command : A subordinate reports only one boss to avoid conflict of orders.

(iii) Authority : Every individual in an organization has some responsibility commensurate with his

authority.

(iv) Span of control : Number of subordinates supervised by a leader should not be too many for

better control.

(v) Flexibility : Organisational staffing pattern & structure should be able to accommodate

changes in internal & external environments.

(vi) Management by exception : All routine decisions should be taken by subordinates & only policy

decisions and unusual matters should be referred to the leader.

(vii) Scalar principle : Clear lines of authority in hierarchical structure ensures more effectiveperformance.

Formal and Informal Organisations : The organizing process results in a deliberately designed

and thought out organizational structure where it is specified who will do what, with whom and

under whose supervision.

Such an organization is said to have a formal organization where hierarchies and levels of

authority are formally laid down and observed. For example, a large corporate hospital, with its

clearly and formally defined departments and its rigid hierarchy with the CEO at the top is a formal

organization. On the other hand, a volunteer group of specialists who undertake charity work

every weekend at a nearby charitable hospital for the poor would have emerged spontaneously

due to their common likes and dislikes. Such an organization, which was not planned to come into

existence and which has no formal departments or hierarchies, is an informal organization. As a

doctor, one is faced everyday with informal groups, like the village elders, a village self help

group, a youth club etc and we must remember that informal organizations, with expressed shared

values and sentiments of a large majority, can be very effectively utilized for achieving the

organizational goals. The effort to include religious leaders & volunteer groups such as Rotary

Club in the Pulse Polio Immunization in India is an example where such informal groups are

often more successful in achieving organizational goals than the highly formal organization of the

government.

Staffing

The concept of span of control: Depending on the type of organization and objectives to be

achieved, every manager must decide how many subordinates he/she can effectively supervise.

Consequently, a wider span of control (generally found in highly technical organization with

highly motivated subordinates) will result in lesser levels of management than a narrow span of

control (where one subordinate is controlled only by one superior). A flat organisation (with lesser

levels of management) has faster flow of information and greater satisfaction levels for

individual subordinates. Such type of organization, where subordinates are highly motivated


3/9


4/9

command, but when in line capacity (such as a medical superintendent of a large government

hospital), they must make decisions and issue instructions for others to follow.

Line organization: A line organization consists of line personnel, where each position has

direct authority over all lower positions. No subordinate is under more than one superior, and

the scalar principle and principle of unity of command are strictly adhered to. The flow of

authority in line organisation is depicted in Box - 2.

Line and staff organization: When in addition to the line authority of managers, there are

specialists and experts to advise various levels on specialized issues, it is called the line and staff

organization . In the figure below, A, C and D managers are in direct line relationship as discussed

earlier; but B is in staff relationship and advises A and C on important issues. B may have lower

status than A and higher status than C in the organization, but is not in direct line of command.

Generally in any organization, those personnel who develop new ideas, undertake research and

advise on technical matters and fall outside the direct chain of command are staff personnel. It is

important to remember however that even in a staff department (for example, finance department

of a large corporate hospital), the departmental head would still have line control over all

subordinate financial experts. The flow of authority in line and staff organization is depicted in Fig. -

3.


5/9

Functional organization : In the large and complex organizations of the present day, the

traditional principle of one boss and one subordinate (unity of command) is not possible. In such

organizations, different superiors performing different functions (finance, human resource,

inventory control etc) exercise control over a subordinate in respect of their respective functions.

Thus a functional organization is one wherein a worker is accountable to two or more

different executives for a given specific and specialized function. For example a radiographer

in a large corporate hospital may be providing specialized services (radiotherapy) in three

different wards and thus would be accountable or advising their respective Medical Officers in-

charge in addition to being accountable to the Head of Department of Radiology Services. The

advantages and disadvantages are as in Box - 4.

The Matrix Organisation: A combination of the product and functional structures, the matrix

structures are the choice for large and complicated projects where the skills of a functional man(manager) and specialized (technical) knowledge (e.g. finance consultant) are both required.


6/9

Under the matrix structure, an employee is accountable & takes orders from two different superiors

at the same time. For example, a ward nurse is accountable to the Head Nurse of the Hospital as

well as to the ward MO in which she is working. An example of the matrix organization in a large

hospital is as represented in Box - 5.

Directing (Leading)

Leadership can be described as the activity of influencing people to strive willinglyto achieve the

group objectives. This ability may be formal(as in form of formal authority vested with an

individual) or informal (as in form of power and ability to influence people outside the formal

structure of an organization).

Leadership styles : This refers to the way in which a leader would influence the followers. Some of

the leadership styles are described below :

(a) Iowa leadership studies : Lewin, Lippitt and White, in 1939, studied different styles of

leadership among 10 year old boys in three groups. Three main types of leadership whichemerged from their studies were :

(i) Authoritarian leader : Where the leader was directive and did not permit any participation from

team members. Concern for completing the task was of prime importance and each member of

the team was told what to do and how to do.

(ii) Democratic leader : One who encouraged participation and discussions by group members, he

involved all group members in planning and completing the task.

(iii) Laissez-faire leader : Such a leader give complete freedom to the group members, did not

provide any leadership, did not establish policies or procedures to complete the job. Under such

scenario, no member of the group influenced another member.

(b) The Managerial Grid Theory

The Managerial Grid Theory proposed by Black and Mouton in 1978 indicates that leaders can be

oriented towards both tasks and persons. The managerial grid, based on the interaction between

person-orientation and task orientation of a leader, is depicted in Box - 6 : The Managerial Grid

shown here is characterized by the following qualities among the leaders :

The (9, 1) leader is only concerned with task and has least concern for welfare of hissubordinates. Such a leader is called a task-management leader.


7/9

The (1, 9) leader, called the Country Club management leader, is only concerned with

people, to establish good relationship with and among his subordinates such leaders has least

concern for tasks.

The (1, 1) leader (impoverished leader) is neither concerned with welfare of his subordinates nor

with the task. Such a leader does not take any decision and stays out of the

way.

The (9, 9) leader (Team Management leader) has maximum concern both for people andfor task.

Though an ideal situation, such a leader wants to achieve the goals through committed people.

The (5, 5) leader (middle-of-the-road leader) attempts to compromise between high production

and satisfaction of the subordinates.

Summary

Management is the art of getting things done through and with people in formally organized

groups. It is the art of creating the environment in which people can perform and individuals can

cooperate towards attainment of organisational goals.

It is the art of removing blocks to such performance and a way of optimizing efficiency

in reaching goals. It is a process consisting of planning, organizing, actuating and controlling,

performed to determine and accomplish stated objectives, by the use of resources like men,

material, machines, methods, money and markets. The basic principles of management are Division

of work according to the ability, capacity and aptitude of the workers; Well-defined responsibility;

Discipline; Orders only from one superior; Preference of Organisational goals to individual goals;

Pre-determination of remuneration in form of pay and allowances for all personnel;

Centralization of important policy decisions and key matters; Functioning in well defined functional

chain of senior-subordinate relationships (scalar chains); Unity of direction; Equity; Stability of

working period (tenure); Initiative among employees; and the Team spirit.

Administration can be defined as those functions in an organisation, which are concerned

with policy formulation, finance, production, distribution and ultimately control all key activities


8/9

for meeting the organisational objectives. It can thus be assumed that policy-making, planning

and decision making are the basic components of administration whereas supervision,

implementation and operational aspects are considered components of management.

To successfully attain the objectives with optimum resources, requires a series of Managerial

processes which are Planning, Organising, Staffing & directing, Decision making, Controlling and

Feedback. Planning is the fundamental and initial process in any activity. Setting the objectives is

a major function of planning. The basics of planning process in the health sector consists of

deciding Where are we at present (situational analysis), Where do we finally want to reach

(objectives & goals), How do we get there (resources & constraints),

How effectively we have performed the required activities (evaluation, monitoring &

feedback), what new problems do we face and how do we overcome them (re- planning). Various

types of plans can be classified as Mission of an organization (described as the very reason why

that organization exists),

Strategy (any decision, plan or action which takes into consideration the actions of

competitors and other factors in external environment, with the aim of achieving the

objectives), Policies (guide to decisions), Rules (guides to action), Procedures (chronological

steps involved in performing any action or taking any decision), Program (a series of actions

performed for achieving the organizational objectives within the scheduled time).

As a function of management, organizing deals with identifying and grouping various

activities, delegating authority and command to managers, and coordination of various activities

and hierarchies in the organization. The process of organizing can be described as a series of

steps which include Detailed description of various activities to be performed for achievingorganizational goals, Grouping of various activities in some meaningful manner, Delegation

(comprising of authority, responsibility and accountability), and Coordination (horizontal and

vertical). Some important principles of organizing are Unity of direction, Unity of command,

Authority, Span of control,

Flexibility, Management by exception and Scalar principle. Depending on the type of

organization and objectives to be achieved, every manager must decide how many subordinates

he/she can effectively supervise. Consequently, a wider span of control will result in lesser levels

of management. Seven important factors which determine the frequency and duration of superior-

subordinate interaction are Training levels of subordinates, Clear delegation of authority,Clarity of plans, Objectivity in standards, Rate of organizational change,

Communication techniques and amount of personal contact required.In line and staff

relationship, there is a direct relationship of command between superior and subordinate,

whereas staff functions are advisory nature to line managers whom they support. A line

organization consists of line personnel, where each position has direct authority over all lower

positions.

No subordinate is under more than one superior, and the scalar principle and principle of

unity of command are strictly adhered to. A functional organization is one wherein a worker is

accountable to two or more different executives for a given specific and specialized function. A


9/9

combination of the product and functional structures, the matrix structures are the choice for

large and complicated projects where the skills of a functional man (manager) and specialized

(technical) knowledge (e.g. finance consultant) are both required. Under the matrix structure, an

employee is accountable & takes orders from two different superiors at the same time. Leadership

can be described as the activity of influencing people to strive willingly to achieve the group

objectives. This ability may be formal (as in form of formal authority vested with an individual) or

informal (as in form of power and ability to influence people outside the formal structure of an

organization).

Organising management rumah sakit

Documents

Transcript of Organising management rumah sakit