TRADITIONAL AND EMERGING ORGANISATIONAL DESIGNS

It is not unreasonable to expect that some changes to organisation structure might
be expressions of the influence of powerful individuals or coalitions. Efforts to change
the existing perceived distribution of power or reduce the perceived power of some
groups might lead a new CEO to implement a structure in which some positions
(or groups of positions) have new reporting relationships, changed responsibilities,
are reclassified or disappear altogether. Colloquially this is often referred to as ‘a
new broom sweeping clean’ to destabilise existing power structures and remove
some of the barriers to new strategy or policy implementation. (See Chapter 13
for further discussion of the influence of power in the design of service delivery
systems.)
When strategic and structural changes are being mooted and alternatives are being
discussed, it is worthwhile considering the power structure of the organisation and
the influence of varipus stakeholders (internal and external) on the decisions. From
this it is possible to determine the level of support (presence or absence) for various
change options as well as the likely implications for the various groups and individuals
affected by the changes. For example: How is power exercised? Which individuals
or groups have power in which circumstances? Who is lobbying for: what and why?
Who benefits or loses from the proposed changes?
TRADITIONAL AND EMERGING ORGANISATIONAL DESIGNS
Influences on organisational structure and performance
Alternative theoretical perspectives on organisations have been discussed broadly in
Chapter 4. Here we address primarily the relationship of organisational structure to
performance. Organisational structure is concerned with the relationships between
groups of people within the organisation. However, organisational design is about
designing or organising a structure that facilitates communication, integration,
sharing of resources, and overall recognition of the value and worth of these within
the organisation. Daft (1992, cited in Griffiths 1995, p 217) proposes that ‘organi.,.
sational structure is influenced by culture and values, as well as human processes
and leadership’. The structure will be a reflection of the culture and the purpose of
the facility.
The study of organisational structure and performance is a phenomenon that
became of increasing importance in the early 1900s. Theorists such as Frederick W
Taylor and Max Weber began to conceptualise ideas of organisational design that
would optimise productivity (Bolman & Deal 2003, p 45). Focus then turned to
management practices that delineated the clear division of labour, chain of command,
rules and regulations, decision-making processes, remuneration, job design and
specialisation and coordination of activities that would ultimately enable the product
or service to be delivered in the most cost-effective and efficient manner.
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PART FOUR: HEALTH SERVICE ORGANISATIONS
WebeJ”s ideal bureaucracy formed the blueprint on whic’~ many organisations
based their structure (Robbins et al 2003, pp 41-2). The main characteristics of a
Weber bureaucracy (Hosking & Gardner 1996, p 20) are as follows:
• clearly defined jobs and specialisation with delegated authority;
• rules and regulations to maintain control;
11 hierarchical structure;
• recruitment and promotion on the basis of expertise;
11 well-defined and impartial performance management processes; and
11 job security via loyalty.
In more recent times organisations are attempting to divest themselves of heavy
bureaucratic frameworks. Changes in government policies, the finite health care
dollar and industrial restructuring within health care organisations have seen the
focus move from centralised management practice to devolution of decision-making
closer to the client. This has enabled some organisations to genuinely shed a tier of
management. Others have merely added one or more management levels (Griffiths
1995, p 219).
The types of organisational structures most commonly described are derived
from tne classifications of Mintzberg, who starts with the premise that organisatio’ns
require six major functional parts (Mintzberg 2003a, p 209). These include:
1 the operating core which is performing the major role of the organisation;
2 the strategic apex which plans and manages overall functions;
3 the middle line which provides the link between the former;
4 the techno-structure which ensures technical standardisation across the
organisation;
5 the support staff who support those involved in the major service provision
areas; and
6 the ideology which refers to the organisational culture.
Mintzberg (2003a, pp 220-6) also proposes that most organisational” structures
may evolve from seven basic specifications, which relate to the comparative degree of
power, influence or pressures exerted by the various parts (described above):
1 The simple structure with two levels: a centralised authority (or strategic apex)
and an operating core.
2 The machine bureaucracy which is very complex, requires a large technical
infrastructure and is usually structured according to function. There are many
layers between the strategic apex and operating core.
3 The professional bureaucracy which has a large operating core. This
organisation is very complex and formal but has a flat, decentralised profile.
Professionals are grouped within their own functional units (i.e. nursing,
medicine etc) and have significant autonomy.
4 The divisional structure which features decentralised decision-making within
semi-autonomous units.