Organizational structure at Oklahoma State University Medical Center

University Degree Business and Administrative studies

ORGANIZATIONAL STRUCTURE

Organizational Structure

Joy Upshaw

Wesleyan University

Organizational Structure

“Organizational design is the process of constructing and adjusting an organization’s structure to achieve its business strategy and goals” (Nelson & Quick, 2011, p. 518). The organization’s structure gives it the form to be able to fulfill its function in the environment. The structural configuration is determined by the organization’s mission and purpose. An organization must look at its contextual variables and adjust itself to meet the demands and functions.

There are six basic design dimensions that must have a desired level of each structural dimension in order to meet the desired configuration of the organizations. The first dimension is formalization. As a nurse it doesn’t matter where you work the role of the nurse is highly regulated by the States Nurse Practice Act. The Nurse Practice Act regulates the scope of practice of a nurse. Oklahoma State University is also regulated by other state and federal authorities such as Centers for Medicare and Medicaid Services (CMS), The Joint Commission, and Healthcare Facilities Accreditation Program (HFAP). These governing bodies place standards of care that must be met by the hospital, often defining an employees’ role. Oklahoma State University also has job descriptions for each employee that defines the employees’ role in a broad manner. The hospital also has many policies that help define the roles of the employees. Oklahoma State University Medical Center has reference books for each area of the hospital that defines processes and procedures.

The second dimension is centralization. Centralization is the extent to which lower levels of an organization are able to make decisions (Nelson & Quick, 2011). At Oklahoma State University Medical Center there are some decisions that have to be made from the CEO or Board of Trust down, but employees are encouraged most of the time to place input in or make decisions whenever possible. The strategic planning at the hospital is decided on by the CEO and Board of Trustees. The hospital has created shared governance by establishing committees of nursing to help make the decisions in areas that ...

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The third dimension is specialization. Specialization is the degree to which jobs depend on unique expertise (Nelson & Quick, 2011). Organizational task at Oklahoma State University Medical center are highly subdivided into separate jobs. Many jobs throughout the hospital require a certain degree and certain license. You have doctors who require a medical degree and license to practice, nurses who require a nursing degree and license, pharmacists requiring a license, engineers who require license, and many more. Also these jobs are broken down by specializations requiring separate certifications or expertise.

Standardization is the degree to which work activities are completed in a routine fashion. At Oklahoma State University Medical Center we strive to keep routines as standard as possible throughout the hospital and within departments. We keep order sets, routines, and processes standard for all floors. We believe by standardizing processes there is less room for error to occur.

The fifth dimension is the degree to which many different activities occur within the organization or the complexity (Nelson & Quick, 2011). In any hospital there are a large amount of different positions. Some hospitals are more complex than others. At Oklahoma State University Medical Center we have everything from dietary, housekeeping, security, nurses, physicians, maintenance, secretaries, volunteers, staffing coordinators to education specialist. All of the roles in the hospital have different job functions, but no matter what job you are in each position is crucial for the patient’s care. It is one big multidisciplinary approach to caring for the patients.

The last dimension is the hierarchy of authority, which is the degree of vertical differentiation across the levels of managements (Nelson & Quick, 2011). Oklahoma State University Medical Center is governed by a Board of Trustees. The Chief Executive Officer (CEO) reports to this Board. In our organization we have a Chief Nursing Officer (CNO), Chief Financial Officer (CFO), and a Senior Director of Operations that all directly report to the CEO. Under the CNO is the Director of Nursing, Director of Quality, Director of Surgery, Director of Wound Care, Laboratory Manager, Director of Pharmacy, and Director of Radiology. The Director of Nursing oversees all of the nursing departments. The Senior Director of Operations oversees all non-nursing operations, and the Chief Financial Officer oversees all financial departments of the hospital. The organization tries to keep the span of control limited as much as possible.

Henry Mintzberg characterizes Oklahoma State University Medical Center as a professional bureaucracy, noting that organizations can be bureaucratic without being centralized (Nelson & Quick, 2011). This type of organization has its operating core of professionals, highly trained and with considerable authority over their own work activities. The technical and support staff are there to serve the professional (Nelson & Quick, 2011).

The prime mechanism of coordination in a professional bureaucracy is the standardization of skills (Nelson & Quick, 2011). Significant parts of the management process are characterized by self-governance and collegial behavior. In teaching hospitals, the operating core is the faculty, skills are standardized by the requisite terminal degrees, and self-governance is seen within the activities of the Professional Nurse Councils. Even with the considerable autonomy of the operating core, the organization is still also hierarchical. Decision-making authority regarding many vital issues flows downward from a CEO and a Board of Trustees through a chief nursing officer throughout the facility. In a traditional hierarchy, each level of management as a class is responsible for the control of lower levels and is charged with making decisions and enforcing them with those lower levels as "commanded" from above. Higher levels in an organizational hierarchy are generally seen as being more concerned with long-range strategic issues, middle levels with more tactical issues, and lower levels with operating issues.

The contextual variable that has significantly impacted Oklahoma State University Medical Center, although has greatly improved over the last year, is environmental uncertainty. The organization had not been touched in several years and had very scarce resources. The organization at one time was operating solely in survival mode and was literally seconds from closing the doors. The hospital had lost key physicians, did not have an acting Chief Executive Officer, had very old technology and space, had lost its whole education department, and had not had any maintenance done to the facility in years. Technology was also another variable affecting the hospital. The hospital is now making improvements since being bailed out by the state and city of Tulsa. The hospital has strategic plans in place and is remodeling the hospital, adding up to date technology, and hiring new physicians.

Oklahoma State University Medical Center has similar design dimensions and structural configuration as most other hospitals. Oklahoma State University Center seems to be more decentralized than others in the Tulsa area and are different in the fact the hospital is a teaching hospital providing a different environment than most. Because of the population the organization cares for the employees have to strive hard to be more resourceful than other facilities might. It is important for an organization to know how each of these variables can affect the organization and be able to adjust accordingly.

References

Nelson, D. L., & Quick, J. C. (2011). Organizational Behavior (7th ed.). Mason, OH: South-Western Cengage Learning.