The document discusses the concepts of organizing and organization in healthcare settings. It defines organizing as the process of grouping responsibilities and activities into workable units and establishing lines of authority and communication. The key points are: - Managers have five main functions: planning, organizing, staffing, leading, and controlling. - An organization rationality combines activities of people for a common goal through division of labor and a hierarchy. - Organizational structures must define tasks and roles to facilitate human performance. - Hospitals have challenges with multiple lines of authority and independent decision-making between clinical and administrative staff. - Effective organization requires coordination between formal and informal structures through tools like organizational charts, committees,

1. Dr. Thin Myat Han
Health Policy and Management Dept.
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Organizing

2. Referrences:
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 BM Sakharkar 2009, Principles of Hospital
Administration (2nd Edit) Chapter 9.
Organizing
 Koontz H, Weihrich H 2001, Essentials of
Management (5th Edit) Part 3 – Organizing
 Joshi DC, Joshi M, Hospital Administration,
Section 2, Organization Behavior

3. Outline of discussion
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 Functions of managers
 Definition of organization, organizing
 Authority relations
 Delegation
 Committee
 Organizational chart
 Types of organization
 Organizational behavior and realities of hospital
organization

4. Functions of Managers
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1. Planning
2. Organizing
3. Staffing
4. Leading
5. Controlling

5. Organization
5
 Rational combination of the activities of
a number of people
 for the achievement of a common
purpose or goal,
 by division of labour and function and
 through a hierarchy of authority and
responsibility

6. Organizing
6
Process of
 grouping the necessary responsibilities
and activities into workable units,
 determining the lines of authority and
communication, and
 developing patterns of coordination

7. Structure and role
7
 Organization structure is to help in creating
an environment for human performance
 Structure must define the tasks to be done
 Roles must also be designed in the light of
abilities and motivation of the people
available

8. Role for people
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 What people do has a definite purpose or
objective
 They know how their job objective fits into
group effort
 They have necessary authority, tools and
information to accomplish the task
 It is better to fit the personnel to a sound
structure rather than to sacrifice sound
structure to individual whims of personality

9. Staffing
9
 Involves filling, and keeping filled, the
position in the organization structure
 By - identifying work-force requirements,
Inventorying the people available
 Recruiting, selecting, placing
 Promoting, appraising, planning the
careers of, compensating, and training to
accomplish their task effectively and
efficiently

10. Leading
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 Influencing of people so that they will
contribute to organization and group goals
 Has to do predominantly with the
interpersonal aspect of managing
 People tend to follow those who offer a
means of satisfying their own needs,
wishes, and desires
 Involves motivation, leadership styles and
communication

11. Controlling
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 Measuring and correcting of activities of
subordinates to ensure that events
conform to plans
 It measures performance against goals
and plans, shows where negative
deviations exist, and, by putting in
motion action to correct deviations,
helps ensure accomplishment of plans

12. Authority relationships
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1. Super ordination / subordination
2. Authority and responsibility
3. Scalar principle
4. Functional authority
5. Splintered authority
6. Line and staff authority
7. Span of management

13. 1. Super-ordination / Sub-ordination
13
 Hospital / healthcare organization is
expected to perform efficiently at all
times
 Distinct status differences among
organizational members
 Its performance through directive, quasi-
authoritarian controls
 Relies upon formal policies, rules and
regulations for controlling work
relationships of its members

14. 2. Authority and responsibility
14
 Authority must be equal to responsibility
 Absoluteness of responsibility – manager
delegate authority but the ultimate
responsibility is retained by the manager
 decentralization of authority depends on
the mgt. philosophy of governing board,
size of the health care organization

15. Authority and power
15
 Power, a much broder concept than
authority,
 is the ability of individuals or groups to
introduce or influence the beliefs or actions
of other persons or groups
 Authority in organization is the right in a
position (and, through it, the right of the
person occupying the position) to exercise
discretion in making decisions affecting
others

16. 3. Scalar principle and chain of command
16

17. 3. Scalar principle
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 Individual workers are placed in a
specific authority relationship to a
superior, whose authority can be traced
from the next level of authority, up to top
level of hierarchy
 Chain of command- shows who reports
to who, who has authority over others

18. Organizational hierarchy pyramid
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 Top mgt.
 Middle mgt.
 Supervisors
 Line workers

19. 4. Functional authority
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 Functional status is the position held by
an individual by virtue of the kind of work
he or she performs
 e.g. Physicians exercise substantial
influence throughout the hospital

20. 5. Splintered authority
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 There are limits on each managers
authority and greater need for
coordination at various level of
organization

21. 6. Line and staff authority
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 Line refers to those positions and elements
of the organization which have
responsibility and authority and are
accountable for accomplishment of primary
objectives
e.g. direct chain of command
 Staff elements are those which have
advisory or service function to the line
manager in the attainment of primary
objectives
e.g. personnel or finance

22. 7. The span of management
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 Number of individuals whose activities can be
coordinated and controlled effectively by one
manager
 Depends on :
1. nature and flow of work
2. Training and motivation of workers
3. Organizational stability
4. Dispersal of work units
5. Managerial effectiveness
6. Availability of staff specialists

23. Delegation
23
 How much freedom, scope and power is
entrusted to subordinates to act on behalf
of manager, utilizing the resources of the
organization and for achieving desired
result
 Most serious symptom of poor organization
is unclear authority delegation

24. Principles of delegation
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1. Delegation according to ability
2. Absoluteness of responsibility
3. Parity of authority and responsibility –
delegated authority should be
commensurate with results expected
4. Definition of results expected
5. Unity of command – delegatee should be
responsible to one boss
6. Authority levels – decisions within the
authority competence of an individual
should be made

25. Steps in delegation
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1. Selecting and assigning the task
2. Selecting the appropriate subordinate
3. Instructing the subordinates
4. Maintaining feedback and control

26. Tenets of delegation
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1. A manager cannot delegate authority
which he does not have
2. Cannot delegate all his authorities
3. Delegate only operational authority not
authority to make policy and technical
authority
4. Delegation of authority is not absolute or
permanent – always be recalled by the
delegator

27. What should never be
delegated
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1. The power to discipline
2. Responsibility for maintaining morale
3. Overall control
4. Crisis situation calling for urgent
solution
5. Technical task or matter
6. Custodianship of trust and confidence

28. Barriers to delegation
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29. Management barriers
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1. Unwillingness to give subordinate a
chance (Manager feels he can do the
job better, faster)
2. Unwillingness to let subordinates make
decision
3. Fear of subordinates making mistakes
4. Unwillingness to trust subordinates
5. Unwillingness to let go power

30. Management barriers
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6. Disinclination to develop subordinates
7. Fear of taking risks
8. Uncertainty over tasks
9. Failure to establish effective control
10.Lack of organizational skill – confusion
about authority and responsibility

31. Subordinate barriers
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1. Lack of aptitude for work
2. Feeling of insecurity, lack of self-
respect
3. Fear of failure, of making mistakes
4. Lack of initiative
5. Lack of experience
6. Avoidance of responsibility

32. Multiple pyramid of hospital
organization
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 Governing board – ultimate authority
 CEO (administrator)
 Charged with the responsibility for
effectively managing the admin.
components of institution
Delegates authority to each dept. head
in admin. component
 Chief of Med. service

33. Difficulties in absence of single line of
authority
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 Coordination difficult
 apportionment of authority, responsibility and
accountability is unclear
 difficulties in communication
 Dominations:
 Trustee domination
 Medical domination
 Administrator domination
 Multiple domination

34. Committee as part of organization
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 A group entrusted with dealing with a
specific problem
 for group decision making
 formal (finance or development
committee) or informal
 Line or staff

35. Why committees become
necessary
35
1. Group deliberation and judgment
2. Representation of varied interests
3. Coordination of department policies
and plans
4. Sharing information
5. Consolidation of splintered authority
6. Avoidance of action

36. Drawbacks of committees
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1. High cost in time and money
2. Compromise and watering-down of
decisions
3. Indecision
4. Forcing the decisions

37. Committees are success when:
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 Formally organized
 Have assigned specific jobs to do
 Have a leader acceptable to all
members
 Keep written records of their
deliberations
 Know that recommendations are
accepted

38. Effective committee management
Checklist
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 Purpose and scope
 need
 size
 How often to meet
 Committee members
 Subject matter
 Committee chairman
 Minutes and conclusion

39. Organizational chart
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 Line or scalar chart, showing each layer
of organization in sequence
 Line relationship
 Staff position ----------
 Master chart and supplementary chart

40. Organizational chart
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 Three types : Skeleton, personal and
functional
 Skeleton: Merely present the major units of
the organization
 Personal : show in addition, the major
positions and often the names of those
persons occupying them
 Functional : Not only depict the major units
but also describe briefly the functions,
purposes, duties, and activities of each

41. Advantages
41
 It depicts major lines of decision-making and
authority - can review it to determine any
inconsistencies and complexities
 Orient employees as to where they fit into the
organization, where each job fits in relation to
other jobs in the department
 Tool for managerial audit: span of control,
crossed lines of authority
 Conveys information about the chain of
command, supervisory relationship, channels of
communication, and line of decision making

42. Limitations
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 Important lines of informal communication
and significant informal relationships
cannot be shown
 become obsolete easily if not periodically
update on occurrence of change

43. Matrix organization
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 The existence of both hierarchical
(vertical) coordination through
department and formal chain of
command, and simultaneously lateral
horizontal coordination across
departments
 e.g. cardiac emergency team

44. Types of organization
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 Two types of organization: formal &
informal
 Formal organization: Intentional structure
of roles in a formally organized enterprise
 If organized well - individual performance
contribute most effectively to
organizational goals

45. Formal organization
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President
Division Managers
Vice-Presidents
Dept. Managers

46. Informal organization
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 A network of personal and social
relations not established or required by
formal organization but arising
spontaneously as people associate with
one another
 Relationship not appearing on an
organization chart

47. Informal organization
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President
Division Managers
Vice-Presidents
Dept. Managers
Bowling team
Chess group
Morning coffee regular

48. Span of control
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 The number of persons a manager can
supervise effectively
 Organization level Vs. span of control
 4-8 subordinate at upper level of
organization
 8-12 at lower level (up to 20)
 Depends on nature of work and
environment

49. Hierarchy and spans of control
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50. Organization with narrow spans
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Advantages
 Close supervision
 Close control
 Fast
communication
bet. subordinates
and superiors
Disadvantages
 Superiors tend to get
too involved in
subordinates work
 Many levels of mgt.
 High cost due to many
levels
 Excessive distance
bet. lowest and top
level

51. Organization with wide spans
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52. Organization with wide spans
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Advantages
 Supervisors are
forced to delegate
 Clear policies
must be made
 Subordinate must
be carefully
selected
Disadvantages
 Tendency to
overloaded
supervisors to become
decision bottlenecks
 Danger of supervisors
loss of control
 Requires exceptional
quality of managers

53. Organizational behavior
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 A field of study that investigates the impact
that individuals, groups and structure have
on behavior within organization, for the
purpose of applying such knowledge
towards improving an organization’s
effectiveness

54. Dependent Variables of OB
Model
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1. Productivity
2. Absenteeism
3. Turnover
4. Job Satisfaction

55. Independent Variables
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 Individual level variables
 Biographical character (age, sex, marital
status), personality, value and attitude, ability
 Group level variables
 Group structure, gp. Decision making,
communication, other groups and inter-gp
relationship (conflict, power and politic)
 Organization system variables
 Human resource policies, cultural system,
organization structure

56. Realities of hospital organization
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 There are a number of important people who
consider themselves as heads
 Absence of single line of authority and with two
chains of command
 High interdependence
 Timing of the movement of patients through the
system is largely controlled by chance or by a set
of un-coordinated, individual decisions
 Individual goals of staff coincide more with
hospital goals

57. Realities of hospital organization
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 Complex work of health care has a high risk
of serious or deadly error, which necessitates
highly reliable systems of practice at all
organization level
 Complex technical and medical systems
demand sophisticated technical expertise,
which require educated, efficient, and well co-
ordinated workforce
 Authoritative and permissive, highly
formalised yet loose-knit

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