62 unit 1 | Professional Considerations
The people at the top of the ladder have authority
to issue orders, spend the organization’s money, and
hire and fire people. Much of this authority is del-
egated to people below them, but they retain the
right to reverse a decision or regain control of these
activities whenever they deem necessary.
The people at the bottom have little authority
but do have other sources of power. They usually
play no part in deciding how money is spent or
who will be hired or fired but are responsible for
carrying out the directions from people above them
on the ladder. If there was no one at the bottom, the
work would not get done.
Some amount of bureaucracy is characteristic of
the formal operation of every organization, even
the most deliberately informal, because it promotes
smooth operations within a large and complex
group of people.
More Innovative Structures
There is much interest in restructuring organiza-
tions, not only to save money but also to make the
best use of a health-care organization’s most valu-
able resource: its people. This begins with hiring
the right people. It also involves providing them
with the resources they need to function and the
kind of leadership that can inspire the staff and
unleash their creativity (Rosen, 1996).
Increasingly, people recognize that organizations
need to be both efficient and adaptable. Orga-
nizations need to be prepared for uncertainty, for rapid
changes in their environment, and for quick, creative
responses to these challenges. In addition, they need
to provide an internal climate that not only allows but
also motivates employees to work to the best of their
ability. They need to stop thinking of the managers
as the brains of the organization and employees as the
muscle (Parker & Gadbois, 2000, p. 428).
Innovative organizations have adapted an
increasingly organicstructure that is more dynamic,
more flexible, and less centralized than the static
traditional hierarchical structure (Yourstone &
Smith, 2002). In these organically structured
organizations, decisions are made by the people
who will implement them, not by their bosses.
The organic network emphasizes increased flex-
ibility of the organizational structure, decentralized
decision making, and autonomy for working groups
or teams. Rigid unit structures are reorganized into
autonomous teams that consist of professionals
from different departments and disciplines. Each
team is given a specific task or function (e.g., intra-
venous team, a hospital infection control team, a
child protection team in a community agency). The
teams are responsible for their own self-correction
and self-control, although they may also have a
designated leader. Together, team members make
decisions about work assignments and how to deal
with problems that arise. In other words, the teams
supervise and manage themselves.
Supervisors, administrators, and support staff
have different functions in an organic network.
Instead of spending their time observing and con-
trolling other people’s work, they become planners
and resource people. They are responsible for pro-
viding the conditions required for the optimal
functioning of the teams, and they are expected to
ensure that the support, information, materials, and
funds needed to do the job well are available to the
teams. They also act as coordinators between the
teams so that the teams are cooperating rather than
blocking each other, working toward the same
goals, and not duplicating effort.
Organic networks have been compared with
spider plants, with a central cluster and offshoots of
smaller clusters (Morgan, 1997). Each cluster rep-
resents a discipline (e.g., nursing, social work, occu-
pational therapy) or a service (e.g., psychiatry,
orthopedics). For example, Figure 5.3 shows an
organic network for a wellness center. Each cluster
represents a separate set of services. A patient
might use just one or all of them to develop a per-
sonal plan for wellness. Staff members may move
from one cluster to another, or the entire configu-
ration of interconnected clusters may be reorga-
nized as the organization shapes and is shaped by
the environment.CEO
Administrators
Managers (also medical staff)
Staff nurses
Technicians
(including LPNs)
Aides; housekeeping;
maintenanceFigure 5.1The organizational ladder.