Efforts to maximize healthcare organizations’ ability to deliver high-quality services developed with reference to patient needs are critically important. Nowadays, multiple types of structures, including client-centered and organic ones, informal hierarchies, and social networks, are regarded as promising tools for care delivery improvement. The purpose of this paper is to review these four approaches to organizational design and explore their potential positive and unwanted influences on healthcare.
Organizational structures vary in terms of the role of healthcare consumers in them and the latter’s degree of influence on care provision processes. 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). In the context of healthcare, such structures deal with the shifting role of service consumers and exemplify the decision to represent this stakeholder group in multi-layered authority hierarchies. Common examples of experiments with this type of structure include the introduction of service line care delivery organization, cross-functional teams, collaborative practice teams, and consumer representatives in hospitals’ governing bodies (Fallon et al., 2013). Thus, the discussed phenomenon has multiple manifestations in clinical practice.
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, whereas diagnosis-related patient grouping emphasizes customers’ experiences, thus leading to better consumer orientation (Roberts, 2021). 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.
The decision to give more power to consumers and involve them in oversight activities does 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). 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 interprofessional 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.
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, employee empowerment, and increased differentiation, which involves departments’ and healthcare providers’ relative autonomy (Fallon et al., 2013). This form of structure finds extensive use in community health centers (Fallon et al., 2013). In this type of setting, patients’ somewhat unpredictable individual needs and complaints act as the basis for decision-making and service customization
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). 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). 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.
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). Thus, 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.
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.
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 issue and incident reporting (Fallon et al., 2013). Based on a review of eleven quantitative studies, Okpala (2020) concludes that open-door and direct communication policies in healthcare address power imbalances in interprofessional teams, thus improving mutual trust and role comprehension. All these effects can foster productivity, more prompt problem resolution, and better teamwork in service provision.
One of the unwanted potential effects of informal hierarchies is the destruction of formal communication procedures, leading to negative influences on the workload and healthcare delivery. For instance, 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. 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.
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.
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.
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.
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.
De Brún, A., & McAuliffe, E. (2018). Social network analysis as a methodological approach to explore health systems: A case study exploring support among senior managers/executives in a hospital network. International Journal of Environmental Research and Public Health, 15(3), 1-11.
Ezeonwu, M. C. (2018). Specialty-care access for community health clinic patients: Processes and barriers. Journal of Multidisciplinary Healthcare, 11, 109-119.
Fallon, L. F., Begun, J. W., Riley, W. (2013). Managing health organizations for quality and performance. Jones & Bartlett Learning.
Hall, A. E., Bryant, J., Sanson-Fisher, R. W., Fradgley, E. A., Proietto, A. M., & Roos, I. (2018). Consumer input into health care: Time for a new active and comprehensive model of consumer involvement. Health Expectations, 21(4), 707-713.
Okpala, P. (2020). Addressing power dynamics in interprofessional health care teams. International Journal of Healthcare Management, 1-7.
Roberts, S. (2021). Service line development serves to support the entire system. Frontiers of Health Services Management, 37(3), 29-34.
Sharma, A. E., Huang, B., Knox, M., Willard-Grace, R., & Potter, M. B. (2018). Patient engagement in community health center leadership: How does it happen? Journal of Community Health, 43(6), 1069-1074.