Ammar Hyder

Unit I: Management /Organizational Theories, Structure and Culture

MANAGERS
Encarta World English Dictionary (2009, para 1) defines management as “the act of handling or
controlling something successfully” or “the skillful handling or use of something such as
resources.”
Management: is the process of leading and directing all or part of an organization through the
deployment and manipulation of resources.
Managers then typically:
 Have an assigned position within the formal organization
 Have a legitimate source of power due to the delegated authority that accompanies their
position
 Are expected to carry out specific functions, duties, and responsibilities
 Emphasize control, decision making, decision analysis, and results
 Manipulate people, the environment, money, time, and other resources to achieve
organizational goals
 Have a greater formal responsibility and accountability for rationality and control than
leaders
 Direct willing and unwilling subordinates
LEADERS
From Chapin’s (1924) technical defi nition of leadership as “a point of polarization for group
cooperation” to Ward’s (2009, para 1) defi nition of leadership as “the art of motivating a group
of people to act towards achieving a common goal,”
Leaders are in the front, moving forward, taking risks, and challenging the status quo
Leadership Roles
 Decision maker  Coach  Forecaster
 Communicator  Counselor  Advocate
 Evaluator  Influencer  Role model
 Teacher  Change agent  Energizer
 Creative problem  Risk taker Buffer  Visionary
solver  Diplomat  Innovator
 Facilitator  Mentor
 Critical thinker

1. Discuss various theories of management.

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Theorists’ views of what successful management is and what it should be have changed
repeatedly in the last 100 years.
Scientific Management (1900–1930)
Frederick W. Taylor, known as the "father of scientific management," was a mechanical engineer
in Pennsylvania. He observed "systematic soldiering," where workers did the minimum work
required. Taylor proposed that teaching workers the "one best way" to perform tasks would boost
productivity. His principles of scientific management include:
1. Scientific Methods Over Rule of Thumb: Use time and motion studies to design
efficient work methods.
2. Scientific Personnel System: Hire, train, and promote workers based on their skills and
abilities.
3. Worker Integration: Align workers' roles with organizational goals and reward them
financially based on productivity.
4. Cooperative Manager-Worker Relationship: Managers plan and supervise, while
workers execute tasks.
Impact: Productivity and profits increased significantly. Although some criticized Taylor's lack
of humanism, his methods provided a rational approach to leveraging industrial revolution
energy.
Organizational Theory by Max Weber
Max Weber, a German social scientist, is considered the father of organizational theory. In the
1920s, he developed a comprehensive formulation on the characteristics of bureaucracy,
predicting that large-scale organizations would need formalized procedures. Weber identified
three "ideal types" of authority, with legal-rational authority being the basis for his concept of
bureaucracy. This type of authority relies on a belief in established rules and the legitimacy of
those in authority to enforce them, making actions fair and predictable.
Characteristics of Bureaucracy (Weber):
1. Clear Division of Labor: Tasks are divided among individuals or groups competent to
perform them.
2. Hierarchy of Authority: A defined structure where superiors oversee subordinates,
determining remuneration, recognition, privileges, and promotions.
3. Impersonal Rules: Systematic control over subordinates, limiting arbitrary behavior and
favoritism.
4. Procedural Systems: Established methods for dealing with work situations.
5. Rules for Positions: Defined rights and duties for each position.
6. Technical Competence: Employment and promotion based on skills.
Impact: Weber's bureaucracy was an ideal tool for the Industrial Revolution, promoting
efficiency and productivity. However, his model didn't account for the complexities of modern

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organizational management and human behavior. Despite these limitations, many large
organizations today still incorporate elements of Weber's bureaucratic structure.
Management Functions Identified (1925)
Henri Fayol (1925) first identified the management functions as planning, organization,
command, coordination, and control. Luther Gulick (1937) expanded these into the "seven
activities of management" using the mnemonic POSDCORB: planning, organizing, staffing,
directing, coordinating, reporting, and budgeting. These functions form the basis of the
management process, which includes:
1. Planning: 4. Directing:
 Determining goals, objectives,
policies, procedures, and rules. Motivating and managing
 Making long- and short-term conflicts.
projections.  Delegating tasks and
 Setting a fiscal strategy. communicating effectively.
 Managing planned changes.  Facilitating collaboration among
2. Organizing: staff.
 Establishing the structure to 5. Controlling:
execute plans.  Conducting performance
 Choosing the best patient care appraisals.
delivery method.  Ensuring fiscal accountability.
 Grouping activities to meet unit  Maintaining quality control.
goals.  Enforcing legal and ethical
 Understanding and using power standards.
and authority.  Upholding professional and
3. Staffing: collegial norms.
 Recruiting, interviewing, hiring,
and orienting staff.
 Scheduling and developing staff.
 Facilitating employee socialization
and team building.

Human Relations Management (1930–1970)

During the 1920s, worker unrest led to a shift in focus towards worker satisfaction. This era
introduced participatory and humanistic management, emphasizing people over machines.
Key Contributors and Concepts:
1. Mary Parker Follett (1926):
 Advocated for participative decision making.
 Believed managers should have authority with employees, not over them.
2. Hawthorne Studies (1927-1932):

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 Conducted by Elton Mayo and Harvard associates at Western Electric Company.

 Discovered the "Hawthorne effect": productivity increases when workers receive
special attention.
 Highlighted the importance of informal work groups and a socially supportive work
environment.
3. Douglas McGregor (1960):
 Introduced Theory X and Theory Y.
 Theory X: Managers view employees as lazy and needing constant supervision.
 Theory Y: Managers see employees as self-motivated and enjoying their work.
4. Chris Argyris (1964):
 Supported the need for employee participation and flexibility.
 Argued that managerial domination discourages workers, reducing their motivation
and causing issues.
Impact:
 The human relations era emphasized understanding worker motivation and the importance of
employee participation in decision making.
 However, by the late 1960s, the approach faced criticism for being time-consuming and not
always compatible with bureaucratic environments.
 This led to a recognition of the need to integrate management and leadership.

Traditional Organizational Theories

The early philosophies are traditionally labeled classical theory and humanistic theory while later
approaches include systems theory, contingency theory, chaos theory, and complexity theory.
Classical Theory
The classical approach to organizations focuses on efficiency through design, emphasizing a
well-structured formal organization. Key elements include:
1. Division and Specialization of Labor:
 Work is divided into specific tasks, increasing efficiency and specialization.
 Managers can standardize tasks, enhancing control.
2. Organizational Structure:
 Describes the arrangement of work groups to maintain command, authority, and
communication.
 Departmentalization helps reinforce authority and formal communication.
 Max Weber's concept of bureaucracy defines the most efficient organizational form.
3. Chain of Command:

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 Hierarchy of authority and responsibility within the organization.

 Authority is the power to direct activities; responsibility is the obligation to achieve
objectives.
 Line authority directs activities, while staff authority offers advice.
4. Span of Control:
 Refers to how many employees a manager can effectively supervise.
 Complex organizations have many small, specialized departments with centralized
authority (tall structure).
 Less complex organizations have decentralized authority with larger work groups
(flat structure).

Humanistic Theory
Humanistic theory emerged as a response to criticisms of classical theory and is associated with
the human relations movement of the 1930s. It emphasizes the social and psychological needs of
workers.
Key Concepts:
1. Social Relationships:
 People desire social interactions and respond to group pressures.
 Workers seek personal fulfillment and a sense of belonging.
2. Hawthorne Studies:
 Conducted at Western Electric's Hawthorne plant to study the effect of illumination on
productivity.
 Found no direct relationship between illumination and productivity.
 Revealed that productivity increased due to the special attention workers received during
the study, known as the Hawthorne effect.

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3. Focus on Social Aspects:

 Emphasized the importance of social settings and relationships in the workplace.
 Highlighted the need for considering psychological factors in organizational design.
4. Authority and Participation:
 Asserted that individuals cannot be coerced or bribed to perform unreasonable tasks.
 Effective management requires willing participants rather than relying solely on formal
authority.
Systems Theory
Organizational theorists with a systems perspective view productivity as influenced by the
interaction of structure, people, technology, and environment.
Key Concepts:
1. Definition of System:
 A set of interrelated parts arranged in a unified whole.
 Systems can be closed (self-contained) or open (interacting with the environment).
2. Organizations as Open Systems:
 Organizations interact both internally and with their environment, similar to living
organisms.
 They import resources (employees, materials, money) from the environment, transform
them through processes, and export products or services back to the environment.
3. Input, Throughput, Output:
 Resources are input into the organization, transformed through processes (throughput),
and result in outputs (products or services).
 This forms a recurrent cycle of input, throughput, and output.
4. Healthcare Organization Example:
 Healthcare organizations import human, financial, and material resources and provide
various services.
 Throughput involves processes like patient movement, bed availability, and readmissions.
 Bed management systems using information technology help manage throughput and
meet accreditation standards.

Contingency Theory

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Contingency theory suggests that organizational performance improves when the structure aligns
with its environment. The environment includes external factors like patients, payers, regulators,
and competitors.
Key Points:
1. Environment Definition:
 Encompasses people, objects, and ideas outside the organization that influence it.
 In healthcare, includes patients, payers, regulators, competitors, and suppliers.
2. Unique Environment of Healthcare:
 Shaped by economic, social, and technological factors.
 Varied services and patients result in diverse organizational needs.
3. Adaptation to Environment:
 Organizational structure must match the specific circumstances faced by the
organization.
 No one-size-fits-all approach; optimal structure depends on the situation.
Chaos Theory
Chaos theory challenges traditional organizational thinking by suggesting that nature's processes,
including those within organizations, are nonlinear and dynamic. Key points include:
1. Nonlinear Nature:
 Inspired by quantum mechanics, chaos theory proposes that nature's processes do not
follow straight lines but rather move in circular, ebbing patterns.
2. Self-Organizing Systems:
 Organizations are seen as living, self-organizing systems that adapt to changes in their
environment.
 They tend to grow, stabilize, and develop formal standards, but may lose adaptability
over time.
3. Flexibility and Adaptability:
 Permanent organizational structures are viewed as ineffective.
 New principles emphasizing flexibility, fluidity, speed of adaptability, and cultural
sensitivity are needed.
Complexity Theory
Complexity theory originated in the computational sciences when scientists noted that random
events interfered with expectations. The theory is useful in health care because the environment
is rife with randomness and complex tasks. Patients’ conditions change in an instant; necessary
staff are not available; or equipment fails, all without warning. Tasks involve intricate

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interactions between and among staff, patients, and the environment. Managing in such
ambiguous circumstances requires considering every aspect of the system as it interacts and
adapts to changes. Complexity theory explains why health care organizations, in spite of
concerted efforts, struggle with patient safety.

2. Discuss different terminologies related to management

1. Leadership: The ability to inspire and 9. Communication: The exchange of
guide individuals or teams towards information, ideas, and feedback between
achieving common goals. individuals or groups within an
organization.
2. Strategy: A plan of action designed to
achieve a long-term goal or overall aim of 10. Motivation: The factors that drive
an organization. individuals to initiate and sustain
behaviors towards achieving goals.
3. Organizational Culture: The shared
values, beliefs, and norms that influence 11. Strategic Planning: The process of
the behavior and attitudes within an setting goals, determining actions to
organization. achieve those goals, and allocating
resources accordingly.
4. Change Management: The process of
transitioning individuals, teams, and 12. Human Resource Management: The
organizations from a current state to a function within an organization
desired future state. responsible for managing employee
recruitment, training, performance
5. Performance Management: The process
evaluation, and compensation.
of ensuring that goals are consistently
being met in an effective and efficient 13. Stakeholder Management: The process
manner. of identifying, analyzing, and engaging
with individuals or groups who have a
6. Decision Making: The process of
vested interest in the success of the
selecting the best course of action from
organization.
among multiple alternatives.
14. Quality Management: The process of
7. Conflict Resolution: The process of
ensuring that products or services meet or
resolving disagreements or disputes
exceed customer expectations and
between individuals or groups within an
organizational standards.
organization.
15. Risk Management: The process of
8. Team Building: The process of creating a
identifying, assessing, and mitigating risks
cohesive and high-performing team
that could impact the achievement of
through various activities and
organizational objectives.
interventions.

3. Identify different types of health care organizations

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Organizations are further divided by the setting in which they deliver care. These include
primary care, acute care hospitals, home health care, and long-term care organizations.
Primary Care
Primary care is considered the patient’s first encounter with the health care system. Primary care
is delivered in physician’s offices, emergency rooms, public health clinics, and in sites known as
retail medicine.
Acute Care Hospitals
Hospitals are frequently classified by length of stay and type of service. Most hospitals are acute
(short-term or episodic) care facilities, and they may be classified as general or special care
facilities, such as pediatric, rehabilitative, and psychiatric facilities. Many hospitals also serve as
teaching institutions for nurses, physicians, and other health care professionals
Home Health Care
Home health care is the intermittent, temporary delivery of health care in the home by skilled or
unskilled providers. The primary service provided by home care agencies is nursing care;
however, larger home care agencies also offer other professional services, such as physical or
occupational therapy, and durable medical equipment, such as ventilators, hospital beds, home
oxygen equipment, and other medical supplies
Long-Term Care
Long-term care facilities provide professional nursing care and rehabilitative services. They may
be freestanding, part of a hospital, or affiliated with a health care organization. Usually, length of
stay is limited. Residential care facilities, also known as nursing homes, are sheltered
environments in which long-term care is provided by nursing assistants with supervision from
licensed professional or registered nurses.

4. Identify various types of organizational structures

The optimal organizational structure integrates organizational goals, size, technology, and
environment. Various organizational structures have been utilized over time.
Functional Structure
Description: Employees are grouped by their specialty or function (e.g., nursing, finance,
marketing). Each functional area operates as a separate unit, reporting to a top-level manager.
 Strengths:
 Specialized expertise within departments.
 Clear lines of authority and communication within functions.
 Efficient use of resources.
 Weaknesses:

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 Poor coordination and communication across different functions.

 Decision-making can become centralized and slow, with senior managers
overwhelmed by the volume of decisions.
 Limited opportunities for employees to gain cross-functional experience.
 Slow response to external changes requiring cross-functional coordination.
 Example: All nursing tasks fall under the nursing department, which reports to the chief
nursing officer.
Hybrid Structure
 Description: Combines elements of both self-contained units (e.g., product lines or
geographic regions) and functional units. This structure aims to leverage the strengths of
both.
 Strengths:
 Provides flexibility to adapt to changes in the environment.
 Enhances coordination within product or service lines.
 Balances efficiency with alignment to corporate goals.
 Weaknesses:
 Potential for conflict between top administration and divisional managers over
authority and responsibility.
 Can lead to large corporate staffs to ensure coordination, adding complexity.
 Example: A healthcare system that has separate units for different service lines (e.g.,
cardiology, oncology) while maintaining centralized departments for HR, IT, etc.
Matrix Structure
 Description: Integrates functional and product structures, creating a dual chain of command.
Employees report to both a functional manager and a product or project manager.
 Strengths:
 Facilitates efficient use of resources across projects.
 Enhances flexibility and adaptability in a changing environment.
 Promotes collaboration across functional and product lines.
 Weaknesses:
 Dual reporting relationships can cause confusion and conflict.
 Requires high levels of communication and strong interpersonal skills.
 Frequent meetings and coordination efforts can be time-consuming.
 Risk of one side (functional or product) becoming dominant, undermining the
balance.

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 Example: A nurse manager in an oncology clinic reports to both the vice president of nursing
and the vice president of outpatient services.
Parallel Structure
 Description: Specific to healthcare, this structure features two distinct lines of authority: one
for the managerial structure and one for the medical staff. The medical staff operates
autonomously from the managerial hierarchy.
 Strengths:
 Allows for specialized governance of clinical and administrative functions.
 Respects the autonomy and expertise of medical professionals.
 Weaknesses:
 Dual lines of authority can lead to conflicts and lack of coordination.
 Decision-making can be complicated and slow due to the need to reconcile clinical
and managerial perspectives.
 Less effective in integrated healthcare models.
 Example: A hospital where the CEO oversees administrative staff while the medical staff has
a separate governing body, with intersecting decision-making in departments like nursing.

5. Differentiate between formal and informal structure within the

organization
Organizational structure refers to the way in which a group is formed, its lines of
communication, and its means for channeling authority and making decisions. Each organization
has a formal and an informal organizational structure.
Formal Organizational Structure Informal Organizational Structure
1. The formal structure is generally highly 1. Informal structure is unplanned and often
planned and visible hidden.
2. Deliberately designed and visible, 2. Emergent and hidden, based on social
providing clear guidelines and procedures. interactions and personal connections.
3. Clear hierarchy with defined roles and 3. Fluid and flexible, with shifting lines of
responsibilities. influence and accountability.
4. Communication is Structured and follows 4. Communication is spontaneous and free-
official channels. flowing, often bypassing formal routes.
5. Decisions made according to established 5. Decisions and influence can be driven by
procedures and hierarchies. informal relationships and social
6. Examples: Organization Charts & Job networks.
Descriptions 6. Example: Social Networks

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6. Define staff and line relationship

Line and Staff Organisation Structure: Line and staff organization is an organization in which
line managers make decisions, and staff personnel provide advice and support
Line and Staff Relationships
Line and staff relationships refer to the interaction and interdependence between line managers,
who are responsible for core business functions and achieving organizational goals, and staff
managers, who provide specialized advice, guidance, and services to support line managers.
Role and Responsibility of Line and Staff Managers
The line managers are responsible for:
 The formulation of objectives, plans and policies.
 Making decisions for the implementation of plans and policies and attainment of objectives.
 Providing supervision and leadership, achieving coordination and exercising control.
The staff managers have the responsibility to:
 Advice, help and guide the line managers in the performance of the abovefunctions.
 Provide specified administrative services.
 Interpret objective plans and policies.
 Make the best tools available for the implementation of plans and policies.
 Help in the selection and training of employees.
 Measure organizational effectiveess.
 Report result to top management and suggest measures for improvement

7. Describe the importance of organizational structure

The organizational structure in healthcare plays a critical role in improving the quality of
healthcare services and patient outcomes. Let’s explore why it’s so important:
1. Clarifying Roles and Responsibilities: When everyone knows their specific duties, it
promotes efficient teamwork and reduces confusion. For instance, clinical staff,
administrative personnel, and support staff all have distinct roles that contribute to patient
care.
2. Facilitating Coordination and Collaboration: A well-designed structure ensures effective
communication and collaboration among different departments.
3. Establishing Decision-Making Authority: Organizational charts outline decision-making
authority. Knowing who has the final say on specific matters ensures timely decisions and
prevents bottlenecks. For example, clinical decisions may rest with medical directors, while
administrative decisions involve department heads or executives.
4. Efficient Resource Allocation: Healthcare facilities deal with limited resources such as staff,
equipment, and finances. An organizational structure helps allocate these resources
effectively.

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5. Promoting Accountability and Transparency: Transparency is crucial in healthcare.

Patients, staff, and stakeholders need to understand how decisions are made. An
organizational structure ensures accountability by specifying who is responsible for what. It
also promotes transparency in administrative processes and decision-making.
6. Leadership and Quality Improvement:. Leaders set the tone, drive change, and create a
culture of continuous improvement. They engage staff, monitor performance, and address
any barriers to quality care

8. Describe different levels of management.

In large organizations, management is typically divided into three primary levels: top-level,
middle-level, and first-level managers. Each level has distinct roles, responsibilities, and areas of
focus.
Top-Level Managers
Roles and Titles:
 Top-level managers include positions such as Chief Executive Officer (CEO), Chief
Operating Officer (COO), and in healthcare, the highest-level nursing administrators like
Chief Nurse Officer (CNO) or Director of Nursing.
 Titles can vary widely and include vice president of nursing, nurse administrator, and
assistant administrator of patient care services.
Responsibilities:
 They look at the organization as a whole, coordinating internal and external influences.
 They make strategic decisions, often with minimal guidelines or structures.
 Their primary tasks involve determining the organizational philosophy, setting policies, and
creating goals and priorities for resource allocation.
 They focus more on leadership and less on daily operations.
Middle-Level Managers
Roles and Titles:
 Middle-level managers include nursing supervisors, nurse managers, head nurses, and
unit managers.
 In many healthcare organizations, they may also be called directors to reflect expanded
responsibilities.
Responsibilities:
 They serve as a link between top-level and first-level managers, coordinating the efforts of
lower levels and ensuring communication flows upward and downward.
 They are involved in day-to-day operations while also participating in long-term planning
and policy establishment.

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 They help implement the policies and plans set by top-level management.
First-Level Managers
Roles and Titles:
 First-level managers include primary care nurses, team leaders, case managers, and
charge nurses.
 In many healthcare settings, every registered nurse (RN) may be considered a first-level
manager, responsible for managing themselves and their direct reports.
Responsibilities:
 They are primarily concerned with the workflow within their specific unit.
 They handle immediate problems in daily operations, address organizational needs, and cater
to the personal needs of employees.
 Their effectiveness greatly impacts the organization’s overall performance.
 They need strong management skills and have opportunities to practice leadership roles that
influence productivity and employee satisfaction.

9. Describe redesigning and restructuring in the organization

REDESIGNING HEALTH CARE
Health care is a dynamic environment influenced by numerous factors such as the
implementation of accountable care organizations, demands for safe and quality care, Magnet
standards promoting decentralized organizational structures, and an aging population with
multiple chronic conditions. These factors necessitate the continuous redesign of health care to
ensure it remains safe, efficient, and of high quality.
Key Redesign Strategies:
1. Patient-Centered Care Model:
 This model focuses on providing care that is respectful of, and responsive to, individual
patient preferences, needs, and values.
 It includes strategies such as the adoption of the medical home model, where a primary
care provider coordinates continuous and comprehensive care for patients, often through
a network of care providers.
 Challenges include the lack of electronic medical records, managing chronic health
conditions, and promoting electronic communication between providers and patients.
Solutions involve implementing electronic medical records, using nurse practitioners for
chronic conditions, encouraging patient self-management, and improving provider-patient
electronic communication.

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2. Service Line Focus:

 Health care organizations may choose to concentrate resources on specific service lines,
known as "big-dot" focus areas, to achieve both quality and cost-effective goals.
 For example, an organization might prioritize cardiology, cancer, and neuroscience while
maintaining other services.
3. Lean Thinking:
 This approach emphasizes improving outcomes by focusing on system-wide
interventions and eliminating those with little or no effect.
 Lean thinking aims to enhance efficiency and quality by streamlining processes and
reducing waste.
4. Decentralized Organizational Structure:
 A flat, decentralized structure promotes decision-making closest to the problem,
encouraging unit-based decision-making and empowering staff to implement process
improvements promptly.
 This structure facilitates better communication, collaboration, and a robust quality
improvement infrastructure.
Challenges of Redesign
Redesigning health care presents several challenges, including:
 Job Security Concerns: Staff may fear changes in their roles or job loss.
 Authority and Performance Issues: Administrators may worry that losing authority
could lead to poor performance.
 Quality and Cost-Effectiveness: There are concerns that measures to reduce costs might
compromise the quality of care, leading to significant stress among employees.
Role of Nurse Managers
Nurse managers play a crucial role in redesign efforts by:
 Initiating and managing change while balancing cost reduction and quality maintenance.
 Coaching, mentoring, and team building in a dynamic and often ambiguous environment.
 Expanding their responsibilities to meet the demands of a restructured health care
organization.
Reference
 Eleanor J. Sullivan - Effective leadership and management in nursing-Pearson (2013)
 Bessie L. Marquis, Carol J. Huston - Leadership Roles and Management Functions in
Nursing_ Theory and Application , Seventh Edition -Lippincott Williams & Wilkins (2011)

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