Organizational Structure and Culture
Jessica C. Johnson
NUR 492
05/20/2013
Sylvia Ellington

Organizational structure is the framework around which a facility is organized; it functions by telling its employees how the organization is put together, how it works, how leadership is chosen and how decisions are made ("Businessdictionary.com", n.d.). Organizational structure determines how roles, responsibility and power are assigned and how information is shared between different departments as well as management. According to Sullivan, 2013, various structures have been utilized over time and include: functional structures, hybrid structures, matrix structures, and parallel structures; based on the reading I feel the agency I work for functions through a functional organizational structure. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed. * Some argue that functional departmentalization allows for greater operational efficiencies in that employees with shared skills and knowledge are grouped together by functions performed.
Within a functional organizational structure, employees are grouped in departments by specialty, similar tasks are performed by the same people and these groups generally report to the same manager within their department. This type of structure provides greater efficiency in getting tasks completed because employees within the department share the same skills and knowledge and are grouped in a way to enhance performance ("Boundless", n.d.). In a hospital setting a functional structure would operate in such a way that nursing tasks fall under nursing, accounting or billing falls under finances, x-ray or MRI fall under radiology, laboratory services fall under lab, and so on and so forth; each specialty has its own department. Despite having different departments that are ran by different supervisors or managers, when it comes to decision making, the head of the organization is the one who gives the final approval. Nursing has a manager for each unit within the hospital and even though these managers have the authority to make changes within their department, most decisions have to be brought to the attention of our VP of Nursing, K.D. RN. Although the benefits of a functional structure are good, there can be some faults within it as well. Coordination across departments or between managers is poor at times and managers are often overwhelmed with the daily tasks they have to perform. Each department is different in size which means each manager has a different amount of staff and tasks to keep up with ("Boundless", n.d.).
This type of organizational structure provides its employees with support through various ways, one being the promotion of career advancement. When jobs are posted throughout the hospital, employees get first dibs on them and are given the opportunity to get the job before someone outside of the hospital is hired. Of course if an outside source has more credentials and is more qualified for the job then of course that person would get the position but employees are given the opportunity for the job first ("Ehow", 1999-2013). Our hospital’s mission statement revolves around putting patients first and we strive to provide client-centered care for our community. The hospital is a small 200 bed facility and they take pride in its employees and the care that is provided to the people of the community. Nurses are encouraged to continue their education and are required to have yearly education classes to review skills and procedures; the incentive on performing well and providing good care is yearly evaluations which determine how much of a raise we get. Administration provides a monthly newsletter and displayed at the end of the letter is everyone who was acknowledged for doing a job well done or received a REACT star which is an award given to someone who was nominated by a fellow employee for doing an excellent job.
Organization within a facility is usually composed of departments or divisions, management, rules or policies and procedures, as well as committees and sub-committees, all which work together in order to make the organization function as smoothly as possible. I currently work in Clinical Informatics and we work with as well as communicate with everyone in the hospital. There are 6 people in the department and all of us are nurses; we are nurses who work with information systems. Informatics plays a huge role in making sure the hospitals computer system is running and functioning in a manner that makes work flow smooth and user friendly. Communication varies throughout the facility with the use of e-mails, flyers, the intercom, and word of mouth. Every employee has the option of having hospital email but they choose whether they want to set it up or not. Email is the most common way that people communicate through the hospital. Just last week was hospital week and emails were sent out daily reminding staff of what was going on that day; flyers were also posted at the beginning of the week and placed around the facility for those employees who don’t have email set up. My manager is required to attend many meetings during the day/week and she is always really good about letting us know what is going on within the hospital. Other units function the same way and if the manager doesn’t communicate with staff then the clinical supervisors do. Decisions about the organization are ultimately made by administration but input is given and suggestions are made by employees who are a part of different committees.
The community I live in is very rural and consists of people from many different cultures and backgrounds. Most of the population is poor and filled with people who are receiving some sort of government assistance or they have little income and no insurance. The hospital's main source of income is from Medicare, Medicaid and patients who have private insurance. Although the facility provides for a lot of charity cases, they write the bill off or decrease it a huge amount, the community does come together and gives money back to the hospital. The community is really big on giving back and helping with fund raisers for Relay for Life, American Red Cross, community based fund raisers and much more. Every year our facility raises money for Relay for Life by raffling off different prizes and food then donating all the money to the cause. The past 2 years our outpatient, OR, Lab, and PACU areas were completely remodeled and employees helped raise money for different equipment and other things for the facility. The mammography department has been raising money for a digital mammography machine and our community has donated over 100,000 to them for that equipment. The community I live in has many differences, people are racists, poor, and rich, you name it we have it, but I do have to say that despite all the differences the community does come together and helps out in a time of need. The hospital provides care to patients and in return our patients help support the hospital by giving back to us in any way that they can. By being in a small rural community, some of the hospital employees have worked here for 30 plus years so they have seen many changes occur within the organization. Many of the older employees began working when everything was recorded and charted on paper and computers had limited use in the medical field. As medicine has changed over the years so have computers and their integration into health care. The government has now made requirements for reimbursement based on electronic documentation so if organizations don’t have EMRs, they have no way to capture the necessary information, they will not meet requirements and will not receive government funds. Organizations are making major changes to their electronic databases and are now able to capture and transfer pretty much all patient care or patient information from one piece of equipment to the other so that all information is stored into the EMR. Older generations sometimes have a harder time adjusting and learning how to work with new equipment and change within their unit. Generation Y and X are known for being tech savvy, they were born and live through technology so they adapt and adjust better to technological changes within their organization. Older staff/nurses are known for “eating their young” and it is said that they do this because they resent young, new nurses and sometimes feel threatened by them. Younger people can learn a lot from their elders because they have worked for so long and seen so many things, but elders can also learn a lot from those younger than them because new nurses can bring with them new treatments, ideas, and thoughts. Regardless of the way an organization functions within itself they all have a main goal or purpose in common and that is satisfied customers. Hospitals provide different services to patients but they all want to provide the best and they want patients to be happy and satisfied with the care that they receive. Employees must have some sort of structure that keeps things flowing in a manner that works best for them and a hospital cannot provide patient care if they can’t create a supportive, structured work environment for their staff.

Resources
Boundless. (n.d.). Retrieved from https://www.boundless.com/management/organizational- structure-1/common-structures/functional-structure/ BusinessDictionary.com. (n.d.). Retrieved from http://www.businessdictionary.com/definition/organizational- structure.html#ixzz2THtIA3wK EBOOK COLLECTION: Sullivan, E. J. (2013). Effective leadership and management in nursing
(8th ed.). Boston, MA: Pearson/Prentice Hall. eHow. (1999-2013). Retrieved from http://www.ehow.com/about_6134117_functional-
structure-organization.html