Additional Learning Exercises and Applications
DISPLAY 12.1 Leadership Roles and Management Functions Associated With Organizational Structure
12. Continually identifies, analyzes, and promotes stakeholder interests in the organization
Organizational Theory and Bureaucracy
Max Weber, a German social scientist, is known as the father of organizational theory. Generally acknowledged to have developed the most comprehensive classic formulation on the characteristics of bureaucracy, Weber wrote from the vantage point of a manager instead of that of a scholar. During the 1920s, Weber saw the growth of the large-scale organization and correctly predicted that this growth required a more formalized set of procedures for administrators. His statement on bureaucracy, published after his death, is still the most influential statement on the subject.
Weber postulated three “ideal types” of authority or reasons why people throughout history have obeyed their rulers. One of these, legal-rational authority, was based on a belief in the legitimacy of the pattern of normative rules and the rights of those elevated to authority under such rules to issue commands. Obedience, then, was owed to the legally established impersonal set of rules rather than to a personal ruler. It is this type of authority that is the basis for Weber’s concept of bureaucracy.
Weber argued that the great virtue of bureaucracy—indeed, perhaps its defining characteristic—was that it was an institutional method for applying general rules to specific cases, thereby making the actions of management fair and predictable. Other characteristics of bureaucracies as identified by Weber include the following:
There must be a clear division of labor (i.e., all work must be divided into units that can be undertaken by individuals or groups of individuals competent to perform those tasks).
A well-defined hierarchy of authority must exist in which superiors are separated from subordinates; on the basis of this hierarchy, remuneration for work is dispensed, authority is recognized, privileges are allotted, and promotions are awarded.
There must be impersonal rules and impersonality of interpersonal relationships. In other words, bureaucrats are not free to act in any way they please. Bureaucratic rules provide superiors systematic control over subordinates, thus limiting the opportunities for arbitrary behavior and personal favoritism.
A system of procedures for dealing with work situations (i.e., regular activities to get a job done) must exist.
A system of rules covering the rights and duties of each position must be in place.
Selection for employment and promotion is based on technical competence.
Bureaucracy was the ideal tool to harness and routinize the energy and prolific production of the Industrial Revolution. Weber’s work did not, however, consider the complexity of managing organizations in the 21st century. Weber wrote during an era when worker motivation was taken for granted, and his simplification of management and employee roles did not examine the bilateral relationships between employee and
management prevalent in most organizations today.
Since Weber’s research, management theorists have learned much about human behavior, and most organizations have modified their structures and created alternative organizational designs that reduce rigidity and impersonality. Yet, almost 100 years after Weber’s findings, components of bureaucratic structure continue to be found in the design of most large organizations.
Current research suggests that changing an organization’s structure in a manner that increases autonomy and work empowerment for nurses will lead to more effective patient care.
Components of Organizational Structure
Weber is also credited with the development of the organization chart to depict an organization’s structure.
Because the organization chart (Fig. 12.1) is a picture of an organization, the knowledgeable manager can derive much information from reading the chart. For example, an organization chart can help identify roles and their expectations.
In addition, by observing elements, such as which departments report directly to the chief executive officer (CEO), the novice manager can make some inferences about the organization. For instance, reporting to a middle-level manager rather than an executive officer suggests that person has less status and influence than someone who reports to an individual higher on the organization chart. Managers who understand an organization’s structure and relationships will be able to expedite decisions and have a greater understanding of the organizational environment.
Relationships and Chain of Command
The organization chart defines formal relationships within the institution. Formal relationships, lines of communication, and authority are depicted on a chart by unbroken (solid) lines. These line positions can be shown by solid horizontal or vertical lines. Solid horizontal lines represent communication between people with similar spheres of responsibility and power but different functions. Solid vertical lines between positions denote the official chain of command, the formal paths of communication and authority. Those having the greatest decision-making authority are located at the top; those with the least are at the bottom. The level of position on the chart also signifies status and power.
Dotted or broken lines on the organization chart represent staff positions. Because these positions are advisory, a staff member provides information and assistance to the manager but has limited organizational authority. Used to increase his or her sphere of influence, staff positions enable a manager to handle more activities and interactions than would otherwise be possible. These positions also provide for specialization that would be impossible for any one manager to achieve alone. Although staff positions can make line personnel more effective, organizations can function without them.
Advisory (staff) positions do not have inherent legitimate authority. Clinical specialists and in-service directors in staff positions often lack the authority that accompanies a line relationship. Accomplishing the role expectations in a staff position may therefore be more difficult because formal authority is limited.
Because only line positions have authority for decision making, staff positions may result in an ineffective use of support services unless job descriptions and responsibilities for these positions are clearly spelled out.
Unity of command is indicated by the vertical solid line between positions on the organizational chart. This concept is best described as one person/one boss in which employees have one manager to whom they report and to whom they are responsible. This greatly simplifies the manager–employee relationship because the
employee needs to maintain only a minimum number of relationships and accept the influence of only one person as his or her immediate supervisor.
Unity of command is difficult to maintain in some large health-care organizations because the nature of health care requires an interprofessional approach.
Nurses frequently feel as though they have many individuals to account to because health care often involves an interprofessional approach. Additional individuals the nurse may need to be accountable to include the immediate supervisor, the patient, the patient’s family, central administration, and the physician. All have some input in directing a nurse’s work. Weber was correct when he determined that a lack of unity of command results in some conflict and lost productivity. This is demonstrated frequently when health-care workers become confused about unity of command.
LEARNING EXERCISE
12.1
Who Is the Boss?
I
n groups or individually, analyze the following and give an oral or written report.1. Have you ever worked in an organization in which the lines of authority were unclear? Have you been a member of a social organization in which this happened? How did this interfere with the
organization’s functioning?
2. Do you believe that the “one boss/one person” rule is a good idea? Do hospital clerical workers frequently have many bosses? If you have worked in a situation in which you had more than one boss, what was the result?
Span of Control
Span of control also can be determined from the organization chart. The number of people directly reporting to any one manager represents that manager’s span of control and determines the number of interactions expected of him or her. Thus, there is an inverse relation between the span of control and the number of levels in hierarchy in an organization, that is, the narrower the span, the greater is the number of levels in an
organization (Juneja, 1996–2016).
Theorists are divided regarding the optimal span of control for any one manager. Quantitative formulas for determining the optimal span of control have been attempted, with suggested ranges from 3 to 50 employees.
In reality, the ideal span of control in an organization depends on various factors, such as the nature of the job, the manager’s abilities, the employees’ maturity, the task complexity, and the level in the organization at which the work occurs. The number of people directly reporting to any one supervisor must be the number that maximizes productivity and worker satisfaction.
Too many people reporting to a single manager delays decision making, whereas too few results in an inefficient, top-heavy organization.
Until the last decade, the principle of narrow spans of control at top levels of management, with slightly wider spans at other levels, was widely accepted. Indeed, Juneja (1996–2016) suggests that most modern
management theorists would suggest an ideal span of control as 15 to 20 subordinates per manager, as compared with the 6 subordinates per manager touted in the past. With increased financial pressures on health-care organizations to remain fiscally solvent and electronic communication technology advances, many have increased their spans of control and reduced the number of administrative levels in the organization. This is often termed flattening the organization.
Managerial Levels
In large organizations, several levels of managers often exist. Top-level managers look at the organization as a whole, coordinating internal and external influences, and generally make decisions with few guidelines or structures. Examples of top-level managers include the organization’s Chief Operating Officer or CEO and the highest level nursing administrator. Current nomenclature for top-level nurse-managers varies; they might be called vice president of nursing or patient care services, nurse administrator, Director of Nursing (DON), chief nurse, assistant administrator of patient care services, or Chief Nurse Officer (CNO).
Some top-level nurse-managers may be responsible for nonnursing departments. For example, a top-level nurse-manager might oversee the respiratory, physical, and occupational therapy departments in addition to all nursing departments. Likewise, the CEO might have various titles, such as president and director. It is
necessary to remember only that the CEO is the organization’s highest ranking person, and the top-level nurse-manager is its highest ranking nurse. Responsibilities common to top-level managers include determining the organizational philosophy, setting policy, and creating goals and priorities for resource allocation. Top-level managers have a greater need for leadership skills and are not as involved in routine daily operations as are lower level managers.
Middle-level managers coordinate the efforts of lower levels of the hierarchy and are the conduit between lower and top-level managers. Middle-level managers carry out day-to-day operations but are still involved in some long-term planning and in establishing unit policies. Examples of middle-level managers include nursing supervisors, nurse-managers, head nurses, and unit managers.
Currently, there are many health facility mergers and acquisitions, and reduced levels of administration are frequently apparent within these consolidated organizations. Consequently, many health-care facilities have expanded the scope of responsibility for middle-level managers and given them the title of “director” as a way to indicate new roles. The old term Director of Nursing, still used in some small facilities to denote the CNO, is now used in many health-care organizations to denote a middle-level manager. The proliferation of titles among health-care administrators has made it imperative that individuals understand what roles and responsibilities go with each position.
First-level managers are concerned with their specific unit’s workflow. They deal with immediate problems in the unit’s daily operations, with organizational needs, and with personal needs of employees. The
effectiveness of first-level managers tremendously affects the organization. First-level managers need good management skills. Because they work so closely with patients and health-care teams, first-level managers also have an excellent opportunity to practice leadership roles that will greatly influence productivity and subordinates’ satisfaction. Examples of first-level managers include primary care nurses, team leaders, case managers, and charge nurses. In many organizations, every registered nurse (RN) is considered a first-level manager. All nurses in every situation must manage themselves and those under their care. A composite look at top-, middle-, and first-level managers is shown in Table 12.1.
One of the leadership responsibilities of organizing is to periodically examine the number of people in the
chain of command. Organizations frequently add levels until there are too many managers. Therefore, the leader-manager should carefully weigh the advantages and disadvantages of adding a management level. For example, does having a charge nurse on each shift aid or hinder decision making? Does having this position solve or create problems?
Centrality
Centrality, or where a position falls on the organizational chart, is determined by organizational distance.
Employees with relatively small organizational distance can receive more information than those who are more peripherally located. This is why the middle manager often has a broader view of the organization than other levels of management. A middle manager has a large degree of centrality because this manager receives information upward, downward, and horizontally.
Centrality refers to the location of a position on an organization chart where frequent and various types of communication occur.
Because all communication involves a sender and a receiver, messages may not be received clearly because of the sender’s hierarchical position. Similarly, status and power often influence the receiver’s ability to hear information accurately. An example of the effect of status on communication is found in the “principal syndrome.” Most people can recall panic, when they were school age, at being summoned to the principal’s office. Thoughts of “What did I do?” travel through one’s mind. Even adults find discomfort in
communicating with certain people who hold high status. This may be fear or awe, but both interfere with clear communication. The difficulties with upward and downward communication are discussed in more detail in Chapter 19.
It is important, then, to be aware of how the formal structure affects overall relationships and
communication. This is especially true because organizations change their structure frequently, resulting in new communication lines and reporting relationships. Unless one understands how to interpret a formal organization chart, confusion, and anxiety will result when organizations are restructured.
Is it ever appropriate to go outside the chain of command? Of course, there are isolated circumstances when the chain of command must be breached. However, those rare conditions usually involve a question of ethics.
In most instances, those being bypassed in a chain of command should be forewarned. Remember that unity of command provides the organization with a workable system for procedural directives and orders so that productivity is increased and conflict is minimized.
LEARNING EXERCISE
12.2
Change Is Coming
T
his Learning Exercise refers to the organization chart in Figure 12.1. Because Memorial Hospital is expanding, the board of directors has made several changes that require modification of the organization chart. The directors have just announced the following changes:The name of the hospital has been changed to Memorial General Hospital and Medical Center.
State approval has been granted for open-heart surgery.
One of the existing medical–surgical units will be remodeled and will become two critical care units (one six-bed coronary and open-heart unit and one six-bed trauma and surgical unit).
A part-time medical director will be responsible for medical care on each critical care unit.
The hospital administrator’s title has been changed to executive director.
An associate hospital administrator has been hired.
A new hospital-wide educational department has been created.
The old pediatric unit will be remodeled into a seven-bed pediatric wing and a seven-bed rehabilitation unit.
The Director of Nursing’s new title is Vice President of Patient Care Services.
A S S I G N M E N T:
If the hospital is viewed as a large, open system, it is possible to visualize areas where problems might occur. In particular, it is necessary to identify changes anticipated in the nursing department and how these changes will affect the organization as a whole. Depict all of these changes on the old organization chart, delineating both staff and line positions. Give the rationale for your decisions. Why did you place the education department where you did? What was the reasoning in your division of authority? Where do you believe there might be potential conflict in the new organization chart? Why?
Limitations of Organization Charts
Because organization charts show only formal relationships, what they can reveal about an institution is limited. The chart does not show the informal structure of the organization. Every institution has in place a dynamic informal structure that can be powerful and motivating. Knowledgeable leaders never underestimate its importance because the informal structure includes employees’ interpersonal relationships, the formation of primary and secondary groups, and the identification of group leaders without formal authority.
These groups are important in organizations because they provide workers with a feeling of belonging.
They also have a great deal of power in an organization; they can either facilitate or sabotage planned change.
Their ability to determine a unit’s norms and acceptable behavior has a great deal to do with the socialization of new employees. Informal leaders are frequently found among long-term employees or people in select gatekeeping positions, such as the CNO’s secretary. Frequently, the informal organization evolves from social activities or from relationships that develop outside the work environment.
Organization charts are also limited in their ability to depict each line position’s degree of authority.
Authority is defined as the official power to act. It is power given by the organization to direct the work of others. A manager may have the authority to hire, fire, or discipline others.
Equating status with authority, however, frequently causes confusion. The distance from the top of the organizational hierarchy usually determines the degree of status: the closer to the top, the higher the status.
Status also is influenced by skill, education, specialization, level of responsibility, autonomy, and salary accorded a position. People frequently have status with little accompanying authority.
Because organizations are dynamic environments, an organization chart becomes obsolete very quickly.
Grover (1999–2016) suggests that most organizations are constantly changing, with people taking on new jobs, getting hired, and getting fired, so trying to keep an organization chart current is almost impossible.
It is also possible that the organization chart may depict how things are supposed to be, when in reality, the organization is still functioning under an old structure because employees have not yet accepted new lines of authority.
In addition, organization charts may too rigidly define the jobs of people working in that organization (Grover, 1999–2016). Some employees may look at the organization chart and determine that the
responsibilities there are their only responsibilities, when the reality is that most employees will on occasion have to assist with work that is not a formal part of their job description.
Another limitation of the organization chart is that although it defines authority, it does not define
responsibility and accountability. A responsibility is a duty or an assignment. It is the implementation of a job.
For example, a responsibility common to many charge nurses is establishing the unit’s daily patient care assignment. Individuals should always be assigned responsibilities with concomitant authority. If authority is not commensurate to the responsibility, role confusion occurs for everyone involved. For example,
supervisors may have the responsibility of maintaining high professional care standards among their staff. If the manager is not given the authority to discipline employees as needed, however, this responsibility is virtually impossible to implement.
Accountability is similar to responsibility, but it is internalized. Thus, to be accountable means that