2.

ORGANIZING RESPONSIBILITY

 The form of every human  The obligation to perform the

association for the attainment of a assigned task
common purpose. (Mooney,1939)
 Act of pulling into systematic ACCOUNTABILITY
relationships those elements and
activities essential to the  Taking full responsibility for the
satisfaction of the purpose. quality of work and behavior while
 Serves as a facilitating agency in engaged in the practice of the
the achievement of a purpose profession.
(Moehlman, 1940)
 Process of identifying and PRINCIPLES OF
grouping the work to be performed ORGANIZATIONAL DESIGN

“Organizing determines what tasks are to

be done, who is to do these, how the tasks 1. Division of labor
are to be grouped, who reports to whom, 2. Unity of command
and what decisions are to be made.” 3. Principle of authority and
responsibility
4. Span of control
CATEGORIES OF ORGANIZATION 5. Contingency factors

1. FORMAL ORGANIZATION
ORGANIZATIONAL
 System of well-defined jobs, with STRUCTURE
the measure of ARA
 Well defined, bounded by  A process in which a group is
delegation and relatively stable formed including its ARA, span of
control and lines
2. INFORMAL ORGANIZATION  Formal structure, official
management of positions or
 Refers to what people do because working relationships that will
they are human personalities coordinate efforts of workers of
 People work together diverse interest and abilities
 Management does not have an  Formal system of task and
option to destroy, harness it for reporting relationships that
constructive ends, controls, coordinates and motivates
employees.
AUTHORITY
FLAT OR DECENTRALIZED
 The right to act or make decisions STRUCTURES
without approval of higher
administrators  A flat organizational structure
 Includes the right to extract features few or no levels of middle
obedience from subordinates management between staff and
executives.
 This structure is often adopted by
smaller or more agile organizations
 that value flexibility and rapid  CAREER PROGRESSION
decision making.
 Employees may have more
KEY CHARACTERISTICS: opportunities for promotion within
a tall structure.
 FEWER MANAGEMENT
LAYERS PATTERNS OF
ORGANIZATIONAL
 Minimal hierarchical levels, often STRUCTURE
just top executives and frontline
employees. 1. TALL OR CENTRALIZED
STRUCTURE
 WIDE SPAN OF CONTROL
KEY CHARACTERISTICS:
 Managers oversee a larger number
of employees, promoting  MULTIPLE LEVELS OF
autonomy. MANAGEMENT

EXAMPLE OF A TALL  There are several layers of

STRUCTURE supervision, often resulting in a
long chain of command.
 HOSPITALS:
 NARROW SPAN OF
 A large hospital often has a tall CONTROL
organizational structure, with many
layers of management, including  Each manager oversees a small
department heads, unit supervisors, group of employees, which allows
and shift leaders, and frontline staff for close supervision.
(nurses, doctors, technicians)
 This helps ensure detailed  CLEAR REPORTING LINES
oversight and strict adherence to
protocols, which is crucial in a  Employees at the lower levels
healthcare environment. report to immediate supervisors,
and decisions and information flow
ADVANTAGES up and down the hierarchy.

 CLOSER SUPERVISION AND  SLOWER DECISION-MAKING

CONTROL
 Because decisions have to pass
 Employees receive detailed through many levels, the process
guidance, and managers have better can be slow and bureaucratic.
oversight of work.
 SPECIALIZATION OF ROLES
 SPECIALIZATION AND
EXPERTISE  Employees at each level have well-
defined roles and responsibilities
 Different levels allow for role
specialization, enhancing
operational efficiency.
DISADVANTAGES  Commonly found in large health
care facilities
 There is clearly defined superior-
 SLOWER COMMUNICATION subordinate relationship
 ARA, power are concentrated at
 The multiple layers create a the top
bottleneck for communication and  As one goes up the administrative
decision-making. ladder, power up or increase

 BUREAUCRACY 2. FLAT ORGANIZATION

 The structure can be rigid and  Is one used for less complex
resistant to change organization, authority
decentralized
 HIGH ADMINISTRATIVE  Also known as horizontal
COSTS organization
 More experienced and well trained
 More managers mean increased nurses becomes productive.
costs related to salaries and  Applicable only in smaller
overhead. organizations or individual units
with larger organizations
 ENHANCED
COMMUNICATION  ADVANTAGE

 Direct communication channels  Minimizes poor feedback

between employees and executives  Communication is more rapid

 FLEXIBILITY  DISADVANTAGE

 Greater adaptability to charges and  Requires a painstaking building of

quicker decision-making personal relationships bet, and
among workers
 BROADER ROLES
3. STAFF ORGANIZATION
 Employees may have more varied
responsibilities, fostering a more  Purely advisory to the line structure
versatile workforce. with no authority to place
recommendations into action.
TITLES OF  Involves specialized personnel,
ORGANIZATIONAL known as staff, who provide
STRUCTURE support and expertise to line
managers and operational teams.
1. LINE ORGANIZATION/  In this structure, staff members do
BUREAUCRATIC/ not have direct authority over the
PYRAMIDAL line employees but instead serve as
advisors, facilitators, consultants to
 Each position has general authority enhance decision-making and
over the lower position in the operational efficiency.
hierarchy
4. FUNCTIONAL project manager (who leads
ORGANIZATION specific projects or initiatives)
 This dual reporting structure aims
 Permits a specialist to aid line to improve flexibility,
position within a limited and collaboration, and efficiency in
clearly defined scope authority managing resources across various
 Employees are grouped based on projects and functions.
their skills and the task they
perform 7. SHARED GOVERNANCE
 Each department is led by a ORGANIZATION
manager who is responsible for
overseeing operations and  Most radical and idealistic type of
coordinating activities within that organizational structure
function  Develop in 1980’s
 This structure facilitates clear lines  Promotes shared decision making
of authority and allows for among nursing staff, leaders and
specialization in each area, making other healthcare team members
it easier to manage complex tasks.  It aims to empower frontline staff
and foster a culture of collaboration
5. AD HOC ORGANIZATION and accountability
 This model can operate within
 Modification of bureaucratic different types of organizational
structure structures depending on how
 Used as temporary basis to authority, communication, and
facilitate completion of a project responsibilities are distributed.
within a formal line organization
 Characterized by its flexibility and 8. LATERAL ORGANIZATION
responsiveness to immediate
challenges or opportunities  One of coordination and
 This structure allows organizations collaboration between and among
to mobilize resources quickly, nursing staff and hospital staff.
assemble diverse expertise, and  Emphasizes horizontal
adapt to changing circumstances communication and collaboration
without the constraints of a formal across departments, teams, and
hierarchy units, rather than following a
traditional top down hierarchy.
6. MATRIX ORGANIZATION  It is designed to foster:
 Coordination, teamwork and
 Designed to focus on both products flexibility
and function  Authority and decision making
 Has both vertical and horizontal power are more distributed, with
chain of command teams working closely together to
 A type of organizational structure achieve common goals.
that combines functional and
project-based structures ORGANIZATIONAL
 Employees report to multiple RELATIONSHIPS
managers- typically both a
functional manager (who oversees 1. FORMAL RELATIONSHIPS
their specific department) and a
 Represented by uninterrupted lines feelings, beliefs, norms an d
between units, showing who costumes.
reports to whom.  Less tangible and difficult to
 STRAIGHT LINE (SOLID measure
LINE)  Identified by Charles Handy and
further expanded by Deal and
 Meaning: represents a direct Kennedy in their book, Corporate
reporting relationship Cultures: The rites and rituals of
 Indicates: formal authority and a corporate life
clear chain of command between
and a subordinate TYPES OF
ORGANIZATIONAL
CHARACTERISTICS: CULTURE

 The person at the top of the straight 1. THE TOUGH-GUY MACHO

line has primary control over the CULTURE
subordinate’s work.
 Responsibilities and expectations  Characterized by a high-risk, rapid
are well defined – feedback environment where
 Performance evaluations, goal employees thrive on excitement,
setting, and decision making competition and the ability to take
typically fall under the straight-line quick action.
manager’s purview  Commonly found in industries
where high stakes and swift
decision- making are the norm,
2. INFORMAL RELATIONSHIPS such as finance, advertising, sports,
entertainment, and sales.
 Represented by a broken or dotted  Strong emphasis on individual
line, where power relationships are performance, autonomy, and
coordinated achieving personal goals.
 Heroes or “star performers” are
 BROKEN LINE (Dotted line) celebrated, and competition among
peers is encouraged.
 Meaning: represents an indirect or  Requires a high tolerance for risk
secondary reporting relationship. and a willingness to operate under
 Indicates: less formal authority, constant pressure.
typically used to show a
supportive, advisory, or 2. THE WORK HARD/ PLAY
collaborative relationship rather HARD CULTURE
than direct supervision.
 Characterized by few risks being
taken, all with rapid feedback
ORGANIZATIONAL  Characterized by a strong focus on
CULTURE both hard work and having fun,
creating a lively and energetic
 Personality of the organization atmosphere
comprised of assumptions, values,  The emphasis is on providing high-
norms and tangible signs of the quality service or products while
corporation as well as its attitudes, simultaneously fostering a
 supportive and enjoyable work  Process includes: induction and
environment. orientation of the new staff on the
goals, mission, vision, objectives
and philosophy of the organization

3. THE BET YOUR COMPANY STEPS IN STAFFING

CULTURE
1. DETERMINE THE NUMBER
 Defined by high risk, long term AND TYPES OF PERSONAL
decision making where the results NEEDED
of strategic actions may not be
visible for years  Can be done thru interviews or
 Employees in such organizations daily observations of needs of
must be patient, curious, and clients.
comfortable with high- stakes
decisions that can either make or 2. RECRUIT PERSONNEL
break the company
 It is common in industries that  Can be done thru word of mouth or
involve large investments, long formal advertisement
project, timelines, and high levels  Opportunity to attract the brightest
of uncertainty. applicants to fill in the personnel
needed in the organization.
4. THE PROCESS CULTURE
3. INTERVIEW
 Formed on organizations where
there is little or no feedback  Resumes or CV with pictures help
 Emphasizes the importance of in the identifying the interviewees.
established procedures, protocols,  Should be scheduled properly,
and systems in achieving bring out the best and worst in the
organizational goals. applicant.
 Particularly effective in
environments where consistency, 4. INDUCT OR ORIENT THE
compliance, and reliability are PERSONNEL
paramount
 It thrives in industries such as  Allows both parties to see whether
manufacturing, finance, and they would be able to work with
healthcare, where established each other, understand the
procedures are crucial for organizational culture, learn the
operational success and risk background of the organization.
management.
5. JOB OFFER
STAFFING
 Pre employment testing and PE
 Is the process of assigning before any contract is signed by all
competent people to fill the roles parties
designated for the organizational  If pre employment requirements
structure. are accomplished – officially
 It is thru recruitment, selection and becomes and employee
development
 STAFFING PATTERN
FACTORS AFFECTING TIME
 A plan that articulates how many REQUIREMENT OF NURSING
and what kind of staff are needed CARE
by shift and day
 Ways of developing a staffing 1. Acuity of the patient’s illness
pattern: 2. Degree of dependence of the
 Determining the nursing care hours patients on the caregivers
needed for specific patient 3. Communicability of the ailment
 Staff to patient ratio needed to 4. Rehabilitation needs and special
provide the care. treatments and procedures.

CONSIDERATIONS IN THE
DEVELOPMENT OF A PATIENT CLASSIFICATION
STAFFING SYSTEM

PATTERN:  Is a measurement tool used to

articulate the nursing workload
1. BENCHMARKING  For a specific patient or group
patients over a specific period of
 Management tool for seeking out time
the best practices in one’s industry  Patient acuity- measure of nursing
so as to improve performance workload that is generated for each
patient.
2. REGULATORY
REQUIREMENTS PATIENT CARE
CLASSIFICATION
 As mandated by RA 5901

3. SKILL MIX 1. “Self care” or minimal care

patients
 Percentage or ratio of professionals 2. Intermediate or moderate care
to non-professionals 3. Total care patients
4. Intensive care patients
4. STAFF SUPPORT

 Support in the place for the NURSING CARE MODELS

operations of the unit or
department 1. THE CASE METHOD OR
 The less support available to the TOTAL PATIENT CARE
staff, more nursing hours have to
be built in the staffing pattern.  Original model of nursing care
delivery
5. HISTORICAL INFORMATION  RN is responsible for all aspects of
the care of one or more patients
 Keep intact the effective ways of  Complete care model: treatment,
doing tasks medications, NCP
 Be knowledgeable about the  Goal: have 1 nurse give all care to
presence or absence of equipment the same patients for the entire shift
and supplies.
Advantages:

 RN can better see and attend to the Advantages:

total needs of the clients & the
continuity of care can be facilitated  Constant group work fosters a
with ease. feeling of participation and
 Client’s interaction and rapport belongingness.
with the RN are well- developed,  Workload is balanced and shared
clients needs are monitored with the division of labor.
carefully.  Each member of the team has the
2. THE FUNCTIONAL METHOD opportunity to learn from
colleagues.
 Also called task nursing  There is a variety in the daily
 Was developed in response to a assignments.
national nursing shortage in the  Helps maintain interest in client's
1940’s well being and is cost effective.
 RN give away to widespread use of  Patient is able to identify personnel
LPN’s, UAP’s to deliver nursing due lo the continuity of care.
care  Barriers between the nurses and
 Task and procedure oriented clients can be minimuzed.
 RN learns to works fast, activities  Everyone gets to contribute to the
are repetitious, technical skills care plan.
amplified.

ADVANTAGES: 4. PRIMARY NURSING

METHOD
 RN who are oriented this way
become skilled in performing  Designed to place RN back at the
assigned tasks patient's bedside.
 Individual aptitude and experience  Decentralized decision making by
improves staff RN, core principle of this
 Less equipment is needed method with ARA
 Time is saved  Represents total nursing care
 Task oriented approach improves directed by RN on a 24 hour basis
both productivity and organization.
Advantages:
3. TEAM NURSING
 RN sees the client and family as
 A team of nursing personnel one system and ARA is 1.
provides total patient care to a  RN uses wide range of skills
group of patients knowledge and expertise and
 A team maybe assigned to a certain develops creativity
number of patients  There is excellent communication
 Patient’s may be grouped by between the primary nurse and
diagnoses or provider services associate nurses.
 RN leads a large group of many  Primary RN are able to hold
people, including students associate nurses accountable for
 Comprehensive nursing care implementing the nursing care as
becomes the responsibility of the prescribed.
entire team.
 Disadvantage:  model for identilying, coordinating
and monitoring the implementation
 Critically ill patients may have of services.
several promary care nurses.  Care is directed by a case manager
focused on achievement of
outcome and appropriate time
frame & resources.
 Focuses on an enhire episode of
illness and method
5. PROGRESSIVE CLIENT  Used to organize patient’s care
CARE according to diagnosis or other
related groups.
 different areas or units provide
various levels of care. 9. MODULAR METHOD
 Clients are evaluated with respect
to the level or intensity of care  RN provides direct nursing care
needed with assistance of aides.
 Modified team & primary nursing
6. MANAGED CARE METHOD method where RN provides
leadershup, suppert and instruction
 involves unit- based care that is  geographic proximity
organized to achieved specific  assign teams based on patient
patient outcomes. acquity and the slalls or
experienced of the providers can be
7. PRACTICED PARTNERSHIP matched to the patient care needs.

 RN and assistant (UAP, LPN or

less experienced RN) agree to be
practice partners.
 Work together with the same
schedule and same group of
patients.
 Efficient way of using a mixture of
akills and professionals & non-
professional staff.

 Compared to team nursing

 offer more continuity of care and
accountability for patient care.

 Compared to primary nursing:

 less expensive for the organization
and more satislying personally for
the partners.

8. CASE MANAGEMENT
METHOD