HOSPITAL ORGANISATION <ul><li>Hospital word has been derived from the latin word ‘HOSPES’ as we know, which means ‘a host or guest’ or ‘hotel’, hostel. </li></ul><ul><li>Some also believe that the origin of the hospital from the word ‘HOSPITUM’ a rest house for travelers or night shelter showing ‘hospitality’ to the guests. </li></ul><ul><li>Hospital. is a social organisation and logical combination of the activities of a number of persons with different level of knowledge and skills for achieving a common goal of patient care through a hierarchy of authority and responsibility </li></ul><ul><li>Organising is a process of grouping the activities in workable units and connected by authority, communication and control. </li></ul>
<ul><li>Organization is the anatomy and Management is the physiology of the process. </li></ul><ul><li>Organization is the systemic bringing together of interdependent parts to form a unified whole through which authority, control and coordination may be exercised to achieve a given purpose. (Dimock) </li></ul><ul><li>Organisational structure represented by a basic organisational chart forming the skeleton of the </li></ul><ul><li>organisation. </li></ul><ul><li> Organisational functions are carried out by Formalisation and supervision which serves as the muscles and nerves. </li></ul><ul><li>. </li></ul>
ORGANISATION STRUCTURE <ul><li>( A) CENTRALISATION </li></ul><ul><li>It implies standardisation ,uniformity, and central authority. </li></ul><ul><li>From one side it ensures better decision making, co-ordination. </li></ul><ul><li>Better authority of control and cost-effective due to less skilled administrators/ </li></ul><ul><li>But it blocks the carrier structure and requires strong adminisrative skills and leader ship. </li></ul>
ORGANISATION STRUCTURE <ul><li>DECENTRALISATION </li></ul><ul><li>It reduces burden on central authority </li></ul><ul><li>It brings decision making closer to people in local context. </li></ul><ul><li>Greater potential for multi sectoral approach </li></ul><ul><li>Increases efficiency of staff due to their participation in decision making </li></ul><ul><li>Decentralisation is exciting but may ruin the organisation ifattention is not paid to:- </li></ul><ul><li>i) degree of decentralisation </li></ul><ul><li>ii) Skill and experience of local manager </li></ul><ul><li>iii) His leadership qualities and team sprit </li></ul>DY. DIRECTOR AO AO S S S S S S
ORGANISATION STRUCTURE <ul><li>MIXED (MATRIX) </li></ul><ul><li>Decentralisation should not be totally free from control of central authority. </li></ul><ul><li>The degree and extent of de centralisation should match organisation function and objective. </li></ul><ul><li>Decentralisation should be within the policy frame work of each organisation and at where needed. </li></ul>
ORGANOGRAM It is a diagrammatic representation of the administrative set up which easily shows the line of command, control and responsibility ,staff relation,job grouping and communication. SCALAR ORGANOGRAM VERTICAL MATRIX OR MIXED TYPE The structure of the organogram is like a pyramid, broader at base taper at appex. Hospital has got a Matrix type of Organogram.
MATRIX ORGANISATION 1. Matrix organisation is a mix of product and function where people with similar skills are grouped together to execute activities to achieve organisational objective. 2. In a hospital some part of the organisation has scalar type of function while others are informally structured. 3. The hospital provides patient care with a multi functional team comprising of people with different level of knowledge and skill. 4. There are therefore dual reporting system at various levels. 5. It is structured in such a way that facilitates horizontal flow of authority in addition to its vertical control.
MATRIX ORGANISATION 6. The matrix structure gets its name for its resemblance to a table which has both rows and columns 7. The functional manager in the matrix work with the project manager to asses the resource requirement 8. And their timely utilisation by the functional manager.. 9. The general manager is at the top and outside the basic matrix net work 10. Information sharing is mandatory in such an organisation 11. The basis for hospital to have a matrix organisational structure to create a synergism through shared responsibility between the administrative and functional departments in the hospital system.
MATRIX ORGANISATION MS ADDL MS HOD DDA NURSING SUPDT CMO (ACADEMIC) HOU SR CARE TAKER SANITARY SUPDT DNS SISTER S. NURSE NUR. ASST JR ANS 1. FUNCTION 2. HEIRARCHY
MEDICAL SUPRINTENDENT ADDL.MED. SUPRINTENDENT ADMN. SERVICES PROJECT MANAGER CLINICAL SERVICES FUNCTIONAL MANAGER DD(A) N.S. Supportive services A.O. Acc.O. OS OS OS DNS ANS N SISTER STAFF NURSES CMO INCHARGE HOD HOU TECH. STAFF <ul><li>COMMITTEES </li></ul><ul><li>Ethical com. </li></ul><ul><li>Inf. Control </li></ul><ul><li>Medical audit </li></ul><ul><li>Med. Record </li></ul><ul><li>Pharmacy & </li></ul><ul><li>therap. issue </li></ul><ul><li>Death review </li></ul>MATRIX HOSPITAL STRUCTURE
Advantage of organogram <ul><li>It helps to identify in consistencies and complexities in the organisation structure. </li></ul><ul><li>Helps to identify major line of decision making authority. </li></ul><ul><li>It indicates the employees there position, status and role in the organisation. </li></ul><ul><li>It is to identify the services (functional units), span of control, and crossed line authority. </li></ul><ul><li>Chart needs to be modified with change of role and authority. </li></ul>
SUPERVISION AND AUTHORITY SUPERVISION AND CONTROL Integration Co- ordination Hierarchy Or Vertical linkage Grouping Or Horizontal linkage
SUPERVISION AND AUTHORITY 1.Hierarchy i) Hierarchy shows the tire of Superior- Sub-ordinate relation ship. ii) Extent to which it should be tall or short depends on the type and function of the organisation. 2. Span of control i) It expresses the number of persons that a manager can directly control or supervise ii) This depends on type of sctivity,knowledge,skill leadership quality of supervisor. 3. Unity of command i) The basic principle of span of control is unity of command. ii) The sub-ordinate should take direction from one authority only. iii) There by increases efficiency and effectiveness of the organisation iv) Therefore grouping in the organisation is essential.
SUPERVISION AND AUTHORITY <ul><li>4. Grouping </li></ul><ul><li>Grouping depends on task and function. </li></ul><ul><li>Hospital employs people with different skills and functions. </li></ul><ul><li>More centrally it is associated with planning, decision making, and administration </li></ul><ul><li>Peripherali implementation, monitoring and supervision. </li></ul><ul><li>Hence functional grouping is ideal. </li></ul>
SUPERVISION AND AUTHORITY <ul><li>Integration </li></ul><ul><li>Integration is the linking of line function to staff (group) function to make it a unified whole. </li></ul><ul><li>But the problem in the hospital is because of functional groups with different skills and iob responsibility like doctors, nurses, technical and un skilled group ‘D’ staff. </li></ul><ul><li>The group intrests does not always match with organisational interest. </li></ul><ul><li>Further there is a difference between administration and clinicians. </li></ul><ul><li>Hence matrix structure is most suitable. </li></ul><ul><li>Integration then therefore be brought through standardisation of activities, through rules, regulations and clear cut job description in a way that one group have job dependence on the other group. </li></ul>
PECULARITY OF HOSPITAL AS AN ORGANIZATION NO UNITY IN LINE OF COMMAND DUAL AUTHORITY PRODUCT IS A SERVICE & CAN NOT BE QUANTIFIED PROVISION OF SERVICES VARIABLE & UN EVEN AS PER NEED SERVICE IS PERSONALIZED PROFESSIONAL & HIGHLY SKILLED MEET CHALLENGES PATIENTS EXPECTATIONS, MODERN TECHNOLOGY, QUALITY CONTROL NEEDS IMMEDIATE RESPONSE, MATTER OF LIFE & DEATH NATURE OF DUTIES VARIES, DOCTORS, NURSES & OTHER TECH. STAFF PECULARITY OF HOSPITAL AS AN ORGANIZATION
HOSPITAL HOSPITAL PECULARITIES VARIABLE NEEDS DUAL AUTHORITY OF CONTROL LOW INTERDEPENDENCY DEMANDING PATIENTS EXTENSIVE CO-ORDINATION IN ADEQUATE RESOURCE CONCERN FOR QUALITY CONTROL LEGAL BINDINGS
FORMALISATION Formalisation of the organisation is necessary to increase the efficiency and effectiveness by fitting into the organisational structure.
FORMALISATION <ul><li>PARTICIPATION </li></ul><ul><li>Participation provides a feeling of ownership leading to increase commitment, morale, and motivation </li></ul><ul><li>But participation be restricted only to issues directly concerning the individual or group like carrier development, personal welfare, and their task and activities. </li></ul><ul><li>If the suggestion is relevant should be accepted. </li></ul><ul><li>The participant must have adequate knowledge of the subject in which participating. </li></ul>
FORMALISATION <ul><li>DELEGATION </li></ul><ul><li>It is the most difficult part of formalisation or job designing </li></ul><ul><li>Delegating authority must choose the level of delegation, extent of power and authority to be given. </li></ul><ul><li>Superior to chose sub-ordinate for delegation. </li></ul><ul><li>Territory of authority to be clearly defined. </li></ul><ul><li>There has to be mutual trust between delegator and delegant. </li></ul><ul><li>Delegator must have full control over end result and give regular feedback to delegant. </li></ul><ul><li>Those authority to be delegated which is within the power of the delegator. </li></ul>
FORMALISATION <ul><li>JOB ENRICHMENT/DEFINATION </li></ul><ul><li>Enrichment depends on nature of job. </li></ul><ul><li>It is formalised to match the rules , job description and procedure manual. </li></ul><ul><li>High skilled persons like doctors, nurses, technical staff requires low job description while low skilled and un skilled staff need high job definition. </li></ul><ul><li>Job enrichment is required to make it interesting, attractive, interlocking and inter dependable </li></ul><ul><li>There should be scope for carrier advancement, innovation ,appreciation, reward and motivation. </li></ul>
ORGANIZATIONAL EFFECTIVENESS Effectiveness of an organization is a measure of its ability for goal attainment. ORGANIZATION EFFECTIVENESS CORE VARIABLES PRODUCTIVITY POWER ADAPTABILITY TO CHANGE FLEXIBILITY IN STRUCTURE & STRATEGY
FACTORS LEADERSHIP CENTRALIZATION CONFORMITY TO NORMS MOTIVATION COMMUNICATION AUTONOMY MOBILITY FACTORS INFLUENCING CORE VARIABLES
MODELS OF ORGANIZATION EFFECTIVENESS S. NO HUMAN RELATION MODEL ACTIVITIES RESULTS 1. Discussion Participation Team Function Employee Development (Hospital Organization Development) High Morale Better Cohesion Good Commitment Better Human Resource 2. OPEN SYSTEM MODEL HELPS IN Management Goals Growth of Organization Resource Acquisition Adoptation Willingness Realness (Hospital feed back from patients & community) RESULTS Organisational Creativity Marching Ahead Assist in getting External Support Motivation Helps in situation analysis
3. INTERNAL PROCESS MODEL ACTIVITIES Information Management Two way communication Standardization Decision Making (Systematic transformation of hospital procedures) RESULTS Timely action Stability and better understanding Increase Efficiency Appropriate 4. RATIONAL GOAL MODEL ACTIVITIES Goal Clarification Issue Directions Decision Making Planning Achievements Evaluate (To the extent hospital goal is attended through patient satisfaction feed back) RESULTS Staff support Objective achievement Best strategy Increase Productivity To ward the goal Re-planning
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