The management of a healthcare organization is a constantly evolving concept. For this reason, there is no definitive answer to the question of the best organizational configuration. For instance, the traditional approach to governance with a strict hierarchy would certainly require a simple structure. However, it is mostly viewed as obsolete by now. Thus, given the recent trends in managerial practices in healthcare, such as shared governance, the shift towards just culture, and favoring of the regionalized and personalized approaches, the organizational configuration that would work best in the modern healthcare organization is the professional bureaucracy.
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There are several reasons for this. First, such a structure empowers individual workers and allows for the decentralization of responsibilities (Longest & Darr, 2014). While the traditional approach to governance implies the clearly defined hierarchy of managers, such a method gradually loses its popularity in favor of what is known as shared governance. Under such a model, individual employees are given a certain degree of freedom in decision-making. This results in improved responsibility and accountability creating a favorable environment for participation in the organizational improvement and has been reported to improve patient outcomes and satisfaction (Morgan & Yoder, 2012).
Another reason for the professional bureaucracy to fit the modern approach to healthcare management practices is the reviewed concept of accountability. The shift towards the “just culture” which views the mistakes of the employees as a possible result of the system imperfection and encourages reporting and analyzing rather than concealing them is only possible through the additional freedom granted by the decentralization of responsibilities. The healthcare providers are not restricted by the unjustified punishment and thus are actively participating in the improvement of the system as a whole.
Finally, the strongest argument for the use of the professional bureaucracy as a predominant design is the possibility to personalize the care and cater it to the needs of individual patients. While the scientific method has defined the development of healthcare in the modern age, the growing body of evidence supports the need for the individual approach depending on the multitude of factors, including social, economic, cultural, and psychological. Some of the factors, especially the latter, only come into play at the individual level, where a specific approach is required for certain patients, and the restrictions of managerial regulations can have adverse results for patient satisfaction and, in some cases, negate the effectiveness of treatment (Morgan & Yoder, 2012). The cultural and social factors, however, usually apply to a larger scale and have already resulted in the introduction of regionalized care. Such phenomenon would either be severely hampered or downright impossible without a certain degree of freedom granted by the lack of restrictions that come, for instance, with the machine bureaucracy.
However, the standardized practices based on the scientific evidence mentioned above also demand the retention of a certain level of control. For this reason, adhocracy can be discarded as having an excessive degree of freedom and decentralization (Longest & Darr, 2014). Similarly, the divisional-sized form is unacceptable as it will inevitably widen the gap between the departments and areas of healthcare instead of unifying the practices.
Thus, while some of the organizational configurations have certain advantages in the field of health care, it is the professional bureaucracy that unites all of the benefits of the current understanding of managing a healthcare organization. It introduces a required degree of freedom without compromising the standards, aligns well with the just culture, and gives individual employees an opportunity to adjust the services to the individual needs of patients to improve outcomes.
Longest, B. B., Jr., & Darr, K. (2014). Managing health services organizations and health systems (6th ed.). Baltimore, MD: Health Professions Press.
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Morgan, S., & Yoder, L. H. (2012). A concept analysis of person-centered care. Journal of Holistic Nursing, 30(1), 6-15.