Among other things, the selection of organizational structure solutions can influence care providers’ success in providing exceptional value to customers and delivering top-notch services customized to clients’ physical, medical, and emotional needs. Nowadays, multiple types of structures, including client-centered and organic ones, informal hierarchies, and social networks, are regarded as promising tools for setting new standards of quality in care delivery. The purpose of this paper is to review these four approaches to organizational design and explore their potential positive and unwanted influences on healthcare.
Client-Centered Structures
In the healthcare field, the degree to which the consumer influences care provision decision-making is among the parameters that depend on the structure type. Client-centered structures refer to the modes of internal organization that exhibit the presence of information-sharing from healthcare consumers “throughout the organization” (Fallon et al., 2013, p. 103). These structures exemplify the decision to represent customers as the separate stakeholder group in multi-layered authority hierarchies. Common examples of experiments with this type of structure include the introduction of service line care delivery models, cross-functional teams, and collaborative practice teams or CPTs (Fallon et al., 2013). The introduction of changes to care institutions’ governing body policies to ensure consumer participation is another manifestation of client-centeredness at the structural level. Considering the abovementioned examples, the elements of customer-centered structures are ubiquitous in real-life practice contexts.
Positive Impact
Attempts to apply the client-centered approach to care provision activities lead to a variety of benefits. Particularly, the adoption of the service line model is associated with increases in provider engagement (Roberts, 2021). More than that, the adoption of diagnosis-based patient grouping practices can facilitate the exploration of each small customer segment’s unique experiences within healthcare, thus strengthening organizations’ customer orientation. Therefore, the adoption of customer-centric structure decisions heralds a new era in consumer-provider relationships and signifies a shift towards the consumer orientation marketing philosophy in the healthcare system. All these outcomes are inextricably linked with healthcare settings’ ability to promote health restoration and make sure that each patient is cared for by narrowly focused specialists.
Negative Impact
The decision to give more power to consumers and involve them in oversight activities would not necessarily improve care delivery effectiveness. For instance, consumer membership on governing boards and committees can be associated with the failure to represent all client populations equally (Hall et al., 2018). The number of members in these bodies cannot be unrestricted, so some ethnic, social, and ability groups are likely to remain underrepresented in any circumstances. Potentially, this situation can prevent the elimination of knowledge gaps pertaining to minority populations’ specific health concerns. Moreover, the creation of collaborative practice teams requires bringing diverse specialists with dissimilar educational achievements together. Experiences and prior knowledge have a bearing on specialists’ approaches to problem-solving, which is why inter-professional conflicts that can hinder progress in quality improvement are likely. For successful performance, each team should be headed by highly professional leaders and receive timely assistance from financial experts, IT analysts, and quality improvement professionals (Fallon et al., 2013). With the required degree of integration, any team disunity problem may lead to disruptions in care delivery.
Organic Structures
Aside from the position of the consumer in relation to diverse parts of the healthcare engine, healthcare institutions’ approaches to the planning of work-related processes differ in terms of the degree of centralization. As opposed to the so-called mechanistic structures of organizational design, organic ones act as an optimal structure type for environments with a high degree of uncertainty and unpredictability. The key characteristics of organic structures in healthcare are decision-making decentralization and employee empowerment (Fallon et al., 2013). As per Fallon et al. (2013), increases in the level of differentiation that involve the growth of particular hospital departments’ and separate healthcare providers’ relative autonomy also belong to organic structures’ essential features. This form of structure finds extensive use in community health centers (Fallon et al., 2013). They can be defined as community-driven organizations that specialize in providing medical services to vulnerable populations or those in geographic areas with too few care providers. In this type of setting, patients’ somewhat unpredictable individual needs and complaints act as the basis for decision-making and service customization.
Positive Impact
Due to flexibility, organic structures can promote client-orientedness and openness to uninsured and high-risk populations. Modern community health centers widely use patient advisory councils and governing boards, which allows considering the client’s perspective and experiences in organizational activities (Sharma et al., 2018). As per Fallon et al. (2013), decision-making decentralization, which is typical for such structures, transforms “openness” into part of organizational policies (p. 107). It might result in the elimination of overly rigid and ineffective hierarchies and improve vulnerable population’s access to at least basic medical services.
With access to adequate funding, healthcare organizations with organic structures, such as community health centers, improve financially disadvantaged populations’ access to primary care, thus supporting the early identification of disease in vulnerable social groups. These structures’ main contribution to care delivery refers to targeting vulnerable and financially disadvantaged populations and improving access to qualified care in underserved areas (Sharma et al., 2018). In the past, expansions of citizens’ eligibility for Medicaid improved community health centers’ care provision capacity, resulting in people’s increased access to preventive healthcare services (Han et al., 2017). Particularly, substantial funding could enable healthcare settings of this type to address or at least reduce critical gaps in the delivery of care to underprivileged consumers. For instance, uninsured and low-income individuals’ limited access to mental health services has been shown to improve as a result of community health clinics’ access to increased federal grants (Han et al., 2017). Considering this, currently used organic structures have a significant potential when it comes to reducing differences in the quality of healthcare received by diverse demographics.
Negative Impact
Organic structures’ potential negative influences on service delivery are related to the hidden risks of insufficient standardization and formalization. Due to the characteristics of their organizational structures, community health clinics are capable of customizing and adjusting services to patients’ unique health needs. As a result, service provision processes, modes of care delivery, and anticipated healthcare outputs depend heavily on the details of specific issues (Fallon et al., 2013). Therefore, in such structures, guidelines for support workers and providers display a substantial degree of flexibility. However, this flexibility does not always maximize providers’ ability to address as many health concerns as possible. For instance, at least every fourth patient present to community health clinics needs interventions that these organizations cannot provide at all (Ezeonwu, 2018). Thus, organic structures’ flexibility is fraught with barriers to specialized and standardized care.
Informal Hierarchies
Rigid hierarchies have long been seen as the vital instrument of order in organizations and the only source of power. In healthcare, differently from formal hierarchies that prescribe the use of specific channels and ways of action to achieve particular goals, informal ones give priority to links and processes that take place in reality. Popular attempts to strengthen informal hierarchies are the elimination of job titles that involve inequality and inflexibility, including hospital CEOs, and the introduction of more neutral roles, for instance, facilitators (Fallon et al., 2013). Other examples are changes to healthcare organizations’ cultures and norms, such as promoting the use of open-door policies by administrative staff (Fallon et al., 2013). These and similar measures are aimed at promoting better intra-organizational communication.
Positive Impact
Informal hierarchies can promote quality in care delivery directly or vicariously. The very idea of prioritizing actual over prescribed hierarchies can be helpful in simplifying overly complicated decision-making processes in healthcare organizations (Fallon et al., 2013). Its positive results include but are not limited to increased employee engagement and job satisfaction and reduced barriers to reporting workplace issues and incidents (Fallon et al., 2013). These effects can foster productivity, more prompt problem resolution, and better teamwork in service provision.
By facilitating the destruction and optimization of artificial barriers between those employed by one healthcare organization, informal hierarchies can also promote task and role distribution decisions that eliminate unnecessary communication and reduce employee inequality. Based on a review of eleven quantitative studies, Okpala (2020) concludes that open-door and direct communication policies in healthcare address power imbalances in inter-professional teams, thus improving mutual trust and role comprehension. These possible benefits could support care delivery due to the emergence of professionals that feel valued at work regardless of their formal position and are not affected by structural barriers to workplace role comprehension.
Negative Impact
One of the unwanted potential effects of informal hierarchies is the destruction of formal communication procedures, leading to negative influences on healthcare delivery. For example, open-door policies can eliminate “extra” steps in issue reporting, such as discussing concerns with one’s immediate supervisor to have this information communicated to the executive management. In many instances, this understanding of openness could create an excessive workload on top management teams and require senior managers to devote time to complaints that could be addressed at the lower levels. The decision to strengthen informal hierarchies in the healthcare field might result in interfering with clear lines of reporting in an organization, thus creating an imperfect understanding of who should report to whom. In a similar manner, de facto hierarchies can destroy clear and formalized employee supervision processes. The absence of formal hierarchies can maximize the power of professional subcultures in healthcare, which sometimes adds to the risks of information security violations in the workplace (Sarkar et al., 2020). If poorly controlled, policies emphasizing openness can create instances in which unverified or incomplete information is delivered directly to the executive management, thus requiring extra investigations.
Social Networks
The use of social networks in the healthcare system involves the application of knowledge about informal groups to internal activities and problem-solving. As opposed to formalized hierarchical structures, social networks create a unique type of power that stems from being “at the center of many relationships” (Fallon et al., 2013, p. 106). In healthcare, the phenomenon of social networks can be used to facilitate and speed up information exchange by identifying the most influential individuals and organizations in the network.
Positive Impact
Similarly to informal hierarchies, social networks can help to maintain the quality of healthcare services if it is affected by rigid formal structures and their essential limitations. Such networks’ key benefit in terms of care delivery is the opportunity to communicate information in a quicker manner (Fallon et al., 2013). Increases in the speed of information exchange enable organizations to react to care quality-related complaints and concerns as soon as possible, which can prevent poor patient outcomes (Fallon et al., 2013). The social network analysis approach involves collecting and evaluating data on one- and two-way links between particular employees or teams (De Brún & McAuliffe, 2018). Those fulfilling administrative tasks can evaluate the density and shape of the institution’s network and generate takeaways regarding the shortest routes of communication to achieve certain goals and create awareness.
Negative Impact
Social networks’ negative impacts on the provision of healthcare services are relatively unobvious. Presumably, the lack of specific network evaluation standards for healthcare organizations can lead to data misinterpretation and limit social networks’ potential by the production of purely theoretical takeaways (De Brún & McAuliffe, 2018). Instead of optimization, decisions stemming from the incorrect identification of key individuals could make intra-organizational communication processes even more complicated.
Conclusion
As the paper demonstrates, each structure has unique advantages and disadvantages in terms of care delivery, but not all of them find extensive coverage in today’s peer-reviewed literature. The discussed structures’ positive impacts include improving information exchange within organizations and employee satisfaction, thus promoting healthcare quality. However, any innovative system is associated with hidden hazards, ranging from poor standardization to the risks of conflicts.
References
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