RAJKUMARI AMRIT KAUR COLLEGE OF NURSING

NURSING MANAGEMENT

-
TOPIC DEVELOPING AN ORGANIZATIONAL STRUCTURE AND
LEVELS
GUIDE: PRESENTED BY:
MRS MADHUMITA DEY HIMANI RAWAT
ASSOCIATE PROFESSOR MSC NURSING II YEAR
RAKCON

INTRODUCTION
As we know organization is one of very important elements of the management process. It is
next to planning. In management, organization is both the process as well as the end-product
of that process which is referred to as organization structure. Sound organization structure is
essential for the conduct of activities in an efficient manner. The success of the management
process is determined by the soundness of the organization structure.
ORGANIZATION STRUCTURE
Concept of Organization Structure
Organization structure refers to the formal established pattern of relationship amongst the
various parts of any organization. It also refers to the way divisions, departments, functions,
and people link together and interact. Whereas 'formal' means deliberately, specified and
adopted and does not evolve at its own; and 'established' means the relationship when clearly
spelled out and accepted by everyone. It is within the framework of the organization that the
whole management process takes place. Structure acts as the foundation on which the whole
superstructure of management is built.
In an organization, managers and employees work together for achieving common objectives.
It is the organization structure which binds them together and brings proper coordination in
their work. The division of work and authority and the establishment of relationship among
individuals or groups are possible due to the organization structure. Every management has to
establish its own organization structure for efficient conduct of its activities. It refers to the
way tasks are divided up, how the work flows, how this flow is coordinated and the forces
and mechanisms that allow this coordination to occur.
Organization structure refers to the sum total of the ways in which an organization divides its
labour into distinct tasks and then coordinates them. (Hodge, Anthony and Gales, 1996).
Structure is the degree of centralization of decision-making, formalization of rules, authority,
and communication, standardization of work processes and skills, and control of output'.
The traditional organization structure for businesses was the bureaucracy, originally defined
by Max Weber. More recent forms include the flat, network, matrix, and virtual organizations,
has come up due to restructuring and developments in technology.
Basic Parts of An Organization
The following are the basic parts of organization:
* Strategic apex
* Middle line
* Operating core
* Techno-structure
* Supporting staff
Strategic apex, Middle line, and Operating core are in a single line of hierarchical authority.
This is functional structure.
Operating Core
It consists of all those who perform the basic work relating to production or services. This is
very important part of organization.
It is the heart of the organization that is concern with the output.
They secure the input for service.
Strategic Apex
It comprises the people with overall responsibilities for the organization, i.e. board, chief
executive and other top level managers. They are concerned with setting goals, plans, and
policies, develop strategies to implement plans and accomplish goals.
Middle Line
It is the linking pin between the strategic apex and the operating core. The chain runs from
superior managers down to first line supervisors.
Elements of Organization Structure
Elements of structure vary in degree from one organization to another. They either
differentiate or integrate the work of an organization.
Elements of Structure that Differentiate the Work of an Organization
* Horizontal differentiation or specialization, refers to the splitting up of work into tasks and
sub-tasks at the same level.
* Vertical differentiation refers to the division of work according to level of authority or
hierarchy.
* Spatial differentiation refers to the geographic location of different organizational activities.
Elements of Structure that Integrate the Work of An Organization Coordinate and
Control Work
* Formalization: It refers to the rules, policies, procedures and other written documents that
organizations produce to regulate behaviour.
* Centralization: It refers to the place of decision making within the hierarchy of an
organization.
* Span of control: It refers to the number of subordinate positions that a higher position
coordinates.
* Standardization: It refers to the mechanisms designed to reduce uncertainty and
unpredictability in the work of an organization.

STEPS OF ORGANIZING STRUCTURE

The following steps of organizing structures are:
1. Clear Definition of Objectives: The first step in developing an organizational structure is
to lay down its objectives in very clear terms. This will help in determining the type, stability
and basic characteristics of the organization.
2. Determining Activities: In order to achieve the objectives of the enterprise, certain
activities are necessary. The activities will depend upon the nature and size of the enterprise.
For example, a manufacturing concern will have production, marketing and other activities.
There is no production activity in retail establishment. Each major activity is divided into
smaller parts. For instance, production activity may be further divided into purchasing of
materials, plant layout, quality control, repairs and maintenance, production research etc.
3. Assigning Duties: The individual groups of activities are then allotted to different
individuals according to their abilities and aptitudes. The responsibility of every individual
should be defined clearly to avoid duplication and overlapping of efforts. Each person is
given a specific job suited to him/her and it is made responsible for its execution. Right man
is put in the right job.
4. Delegating Authority: Every individual is given the authority necessary to perform the
assigned activity effectively. The authority mean power to take decisions, issue instructions,
guiding the subordinates, supervise and control them. Authority delegated to a person should
commensurate with his/her responsibility. An individual cannot perform his/her job without
the necessary authority or power. Authority flows from top to bottom and responsibility from
bottom to top.
5. Coordinating Activities: The activities and efforts of different individuals are
synchronized. The coordination is necessary to ensure effective performance of specialized
functions. Interrelationship between different job and individuals are clearly defined so that
everybody knows from whom has to take orders and to whom is answerable.
6. Providing Physical Facilities and Right Environment: The success of an organization
depends upon the provision of proper physical facilities and right environment. Whereas it is
important to have right persons on right jobs, it is equally important have right working
environment. This is necessary for the smooth running and the prosperity of the enterprise.
7. Establishment of Structural Relationship for Overall Control: It is very essential to
establish well-defined clear-cut structural relationships among individuals and groups. This
will ensure overall control over the working of all departments and their coordinated
direction towards the achievements of predetermined goals of business.
Types of Organization structure
The following are the various types of organization structure:
1. line organization
2. functional organization
3. line and staff organization
4. committee organization
5. Project organization
6. Matrix organization

1.line organization
It is the oldest form of organization that is known as scalar organization. In this organization,
the authority flows in a vertical manner from top to bottom. Each position in the structure has
an authority over a lower position. Line executives are directly involved in the performance
of the activities of an enterprise and are called the 'doers'. It is of two types:
(1) Pure Line Organization that all perform same type of work at any level.
(ii) Under Departmental Line Organization that each department performs different type of
work.
Merits of Line Organization
* It is simple to understand and easy to establish.
* It provides unit of command.
* It helps in taking quick and effective decisions.
* It ensures personal contact between workers and manager.
* It ensures discipline between the employees and employer.
Demerits of Line Organization
* There is concentration of authority at the top level. It leads to autocratic control.
* There is no participation of workers that communication flows from top to bottom.
* It lacks specialization as a line manager is responsible for both planning and execution of
work.
* Overburdens the top executives and they cannot perform their work properly.
suitability
In spite of these limitations, it is suitable for small concern where there are fewer levels of
authority.
2.Functional Organization
According to FW Taylor, it is based on the functional foremanship. In this organization be
structure of enterprise is classified into different functional areas, Each functional area headed
by a specialist who has full control of that function over the organization and instructions
direct to the personnel, rather than through the chain of command. Each chief manager is the
in-charge of a particular activity for example, the chief finance manager is in. charge of
finance function of all the three unis.
Merits of Functional Authority
- It helps to reap the benefits of specialization.
* The subordinates can make use of the expertise of functional experts.
* The burden of top executive is reduced as each expert looks after only one function.
* It leads to joint supervision by different experts.
* Expert and better control can be exercised by functional experts.
* It provides better scope for expansion and diversification.
Demerits of Functional Organization
* It is against the principle of unity of command as the subordinate i responsible to a number
of superiors:
The lower level to people are not given an opportunity for all round experience and hence
they do not fit into top level positions.
* The complex nature of functional organization with its cross relationship creates a
confusion among workers.
* The decision making is very slow as involvement of many experts is required.
There is a scope of lack of coordination as each specialist thinks of only his function and
ignores other functions.
Suitability
It is suitable to all kinds of organization provided it is applied at higher levels. At lower levels
too, many cross relationships create confusion throughout the organization.
3. Line and Staff Organization
It is a combination of functional and line structure. Line authority flows from top to bottom
and the line executive is directly concerned with the accomplishment of primary objectives.
They are actual doers and generally do not possess specialized knowledge to solve complex
problems. The staff positions are created to provide specialized assistance to line mangers
that means a stick in the hand for support Thus, the staff helps the line executives in their
work to play the role of an advisor.
The other approach views that line and staff are two kinds of authority. According to this
approach, line authority is defined as a direct authority which a superior exercise over his
subordinates to carry out orders an instructions. The exercise of this authority always
downwards, that is, form a superior to a subordinate. Staff authority involves giving advice to
line managers to carry on the operation.
The flow of this authority may be in any direction depending on the need for such advice.
It is common that in actual practice, some variations may exist. The variations are more
pronounced in the case of staff authority.
In line and staff organization, the line authority remains the same in the organization.
But staff executives are attached with line executives who help them by providing necessary
advice on important matters. Staff executives have no power to command subordinates in
other departments. It is clear that PA to Managing Director, Personnel Manager and Budget
Manager play role of staff executives. In most business units, staff executives are used for
collecting data required for taking decisions and to provide expert advice to line managers.
Merits of Line and Staff Organization
* This combination provides for specialized knowledge where staff executives guide and
advise line executives.
* It reduces the burden of line executives because staff carries on detailed investigation of
each activity.
* The better decisions are possible as expertise of the staff is used.
* It is flexible in the sense that staff can be added to line executives.
Demerits of Line and Staff Organization
* It always creates confusion as it is very difficult to define the authority relationship between
line and staff.
always downwards, that is, form a superior to a subordinate. Staff authority involves giving
advice to line managers to carry on the operation.
The flow of this authority may be in any direction depending on the need for such advice.
It is common that in actual practice, some variations may exist. The variations are more
pronounced in the case of staff authority.
In line and staff organization, the line authority remains the same in the organization.
But staff executives are attached with line executives who help them by providing necessary
advice on important matters. Staff executives have no power to command subordinates in
other departments. It is clear that PA to Managing Director, Personnel Manager and Budget
Manager play role of staff executives. In most business units, staff executives are used for
collecting data required for taking decisions and to provide expert advice to line managers.
4.Committee Organization
A committee is a group of persons who are consciously and deliberately formed to discuss a
problem and provide solutions to overcome it. They meet on an organized basis to discuss
and deal with the matter placed before it. The following are the characteristics of a
committee:
* A committee is a group of people. There must be a minimum of two people and there is no
limit for maximum.
* The scope of committee is limited to the extent of task assigned to it.
* Democratic principle of 'One man one vote' is followed.
* It may be executive committee or non-executive committee. Executive committee takes
decisions and implements them. Non-executive committee only provides suggestions and
recommendations.
Merits of Committee Organization
* Pooling of Knowledge and Experience:
Knowledge and experience are pooled together to take joint decisions on the principle of two
heads are better than one.
* Motivation Through Participation:
Members are allowed to participate in the decision making process. It makes them more
committed to the decision.
* Effective and Proper Coordination:
Through coordination of experts bringing together diverse viewpoints, many problems could
be solved effectively.
* Tool for Management Development:
Every member has an opportunity for learning from the experience and mistakes of others.
Thus it helps for management development.
* Representation of Diverse Interest Groups: When different interest groups are
represented in a committee, conflicting views can be easily settled through motivation and
participation.
effective Communication: By convening a committee any information can be easily passed
on the all members of the organization.
- Consolidation of Authority: It enables management to consolidate splintered authority.
This is helpful to a manager who has limited authority with which he cannot solve the
problem without simultaneous exercise of authority by other managers related to the problem.
Demerits of Committee Organization
* It is a costly and time-consuming activity. The cost incurred is far below its benefits.
* Committees do not help in taking quick decisions.
* To arrive at unanimous decisions agreements are arrived at on the basis of a compromise
which may not be really a right decision, compromise is not the solution.
* When unanimous decisions are taken by dominant members, a few persons may accept
them under pressure.
* Committees fix group responsibility where no individual can be made accountable. This
leads to inefficiency.
* Committee is a tool to misuse to delay or avoid or to take unpleasant decision.
5. Project Organization
The use of the project organization has increased in the last few years. It is currently being
employed in numerous undertakings engaged in the execution of construction activities,
runkey projects and research and development projects. The project organization can take
various forms, but the important characteristic that distinguishes it from other forms is once
the project is completed the organization is disbanded or phased out. Project management
involves, "the gathering of the best available talent to accomplish a specific and complex
undertaking within time, cost and quality parameters, following by the disbanding of the team
upon completion of the undertaking".
Merits of Project Organization
* It allows maximum utilization of specialization.
* It is tailor-made to meet specific needs of a particular project.
* It provides more flexibility in handling resources by allocating them when they are needed.
Demerits of Project Organization
* It has a limited time and creates a feeling of uncertainty and insecurity among people in the
organization.
* Lack of proper vertical authority makes the job of a project manager difficult.
He is responsible for the completion of the project but without authority over people in the
project.
* Undue influence of specialists from diverse field makes the decision making very difficult.
6.MATRIX ORGANIZATION
It is a combination of project organization and functional organization. According to Paul R.
Lawrence and Stanley M. Davis, any organization that employs a multiple command system
that includes not only multiple command structure but also related support mechanism and an
associated organization culture and behaviour pattern. It is clear from the above that matrix
organization leads in overlapping of command, control and behaviour pattern.
Merits of Matrix Organization
* It focuses attention on a single project and facilitates better control.
* It is more flexible than traditional organization
* It provides motivation for the people engaged in a project
* It leads to better utilization of services of professionals.
Demerits of Matrix Organization
* People receive instructions and order both from functional and project managers. Thus, it
violates unity of command.
* The complex relationship leads to confusion and makes coordination difficult. Subordinates
are not in a position to identify their superiors.
* In the absence of mutual trust and confidence, in sharing the resources and in taking joint
decisions and conflict arise.

ORGANIZATION CHARTS
Organization chart is a simple diagrammatic method of describing an organization structure.
It indicates how the departments are linked together on the basis of authority and
responsibility. It shows the structure of an organization as well as the relationships and
relative ranks of its positions. The formal relationships described in an organization can be
shown in the form of chart.
Such organization chart provides information of the organization structure at a glance.
Organization chart is like a blue print of a building. It indicates the number and types of
departments, superior-subordinate relationship, chain of command and communication.
Daniel C. McCallum first introduced org charts (as they are popularly known) while
supervising the construction of Erie Railroad in New York in the year 1855.
The term 'chart' refers to a map that helps managers to navigate through patterns in their
employees. According to George Terry, organization chart is 'a diagrammatical form which
shows important aspects of an organization, including the major functions and their
respective relationships, the channels of supervision and the relative authority of each
employee who is in-charge of each respective function'. Organization chart reveals vertical
operational responsibilities and horizontal linkages.
Nowadays software such as Visio, SmartDraw, OrgPlus, etc may be used to draw these charts.
Even Microsoft Word and PowerPoint too have features that help draw an organizational
chart.
Structure of an Organization Chart
The chart has following components:
* The boxes: These represent various important positions
* Title of the position: These are in the box
* Position in the hierarchy: The distance of the box from the top indicates its position in the
hierarchy
* Formal reporting relationship: The lines joining the various positions represent the formal
reporting relationship usually between superior and subordinates.
Features of Organization Chart
The following are the features of organization chart:
1. Organization chart is a diagrammatical presentation.
2. It represents the formal organization structure.
3. It shows the lines of authority in the organization.
4. It indicates the channel of communication.
5. It indicates who supervises whom and how various units are inter-related.
Advantages of Organization Chart
1. Organization chart brings clarity to the organization relationships.
2. A chart serves as a quick method of visualizing an organization or facilitates ready
reference.
3. It is an easy way to visualize a large number of employees.
4. These are useful in familiarizing and training new employees.
5. These provide a lot of information about the organization, i.e. number and types of
departments, superior subordinate relationships, chain of command and communication and
job titles of each employee, both to the employees as well as to the outsiders.
6. Organization charts provide specific departmental information that can be useful for
planning organizational changes.
7. Organizational charts can be used to communicate and solicit feedback from the employees
to build future plans
8. Charts help to organize the workplace while outlining the direction of management control
of subordinates.
9. These provide specific information that can be used as a baseline for planning, budgeting
and workforce modeling.
10. Organization charts are an effective way to communicate organizational, employee and
enterprise information.
11. A clear and concise organization chart is an invaluable management tool.
12. Good charts also allow to organize the teams with clear responsibilities, titles and lines of
authority
13. It enables the management to find out different positions of authority and their
relationships in the Organization structure.
14. It provides proper guidance to managers in executing, their assignments and helps them to
avoid overlapping and duplication of work.
15. It indicates ways to better utilization of available manpower.
16. It points out the consistencies and deficiencies of an organization and enables the
management to correct them.
Limitations of Organization Chart
1. The Organization chart does not provide all the details of organization structure created.
2. It only shows formal relationships' and tells nothing of the pattern of human (social)
relationships that develop.
3. It shows nothing about the managerial style adopted (e.g. autocratic or democratic)
4. The chart shows the position of organization structure and gives a static picture of the
organization.
5. It emphasizes only formal channels of communication.
6. It lacks an element of flexibility.
7. It leads to rank consciousness among the staff and destroys team spirit.
8. Organizational chart very quickly becomes out-of-date, especially in organizations that
change their staff regularly.
TYPES OF ORGANIZATIONAL CHART
1. Hierarchical Organizational Chart
This type of charts indicates the formal structure of an organization. The number of
boxes vertically represents the number or ranks and depicts the power status, while
the horizontal row or boxes represents the number of departments or people in a
particular level. It shows high-level management at the top with formal lines of
authority down the hierarchy, are most common. An executive position may have a
larger rectangle than a subordinate position. Lateral position on a hierarchical
organizational chart indicate a relationship between departments on the same level of
hierarchy in the organization.
2. Matrix Organizational Chart
The organization is divided in such a pattern that the same skilled employees are pooled
together in a group reporting to the respective manager of their group. It shows the high-level
management in the centre with successive positions in circles.it shows outward flow of
formal authority from the high level management.

3.flat or horizontal organizational

This type of organizational chart is possible only in small or individual unit organizations.it
shows high level management at the left with lower positions to the right. Shows relative
length of formal lines of authority, helps simplify understanding the lines of authority and
responsibility. This kind of structure encourages employees in being a part of decentralized
Decision-making process by increasing their level of responsibility.

RESEARCH ARTICLE
Organizational structures influencing timely recognition and acknowledgment of end-
of-life in hospitals – A qualitative study of nurses' and doctors’ experiences (2023)
Janet Bakken, Gry Ciekals Wallgren
Abstract
Purpose
Healthcare personnel's timely recognition and acknowledgment of end-of-life (EOL) is
fundamental for reducing futile treatment, enabling informed decisions regarding the last
days or weeks of life, and focusing on high-quality palliative care. The aim of this study is to
explore and describe nurses' and doctors' experiences of how organizational structures in
hospitals influence timely recognition and acknowledgment of EOL.
Methods
A qualitative explorative design was applied, with data collected through 12 individual in-
depth interviews using a semi-structured interview guide. A total of 6 nurses and 6 doctors
were strategically recruited from medical and surgical wards in a Norwegian hospital.
Qualitative content analysis was used.
Results
The analysis revealed the theme The importance of hospital organizational structures in
timely recognition and acknowledgment of EOL and a subtheme comprising three areas of
organizational structures influencing timely recognition and acknowledgment of
EOL; Challenges to and demands of continuity, collaboration, and time.
Conclusions
The study's results show challenges in identifying when cancer patients approach the last
weeks and days of life within hospital wards. For nurses and doctors to be able to recognize
and acknowledge EOL, continuity of care, collaboration, and time is needed. A fragmented
healthcare system, with a predominant focus on treatment and cure, may prevent cancer
patients from receiving timely palliative, care causing unnecessary suffering.