Organizational structure is the framework that determines how an institution or company is governed. The framework outlines the channel used in decision making. Each organization has a structure that provides guidelines on how various processes are undertaken. The two types of organizational structures are decentralized and centralized systems. The decentralized system depends on one individual to be the overall decision-maker.
As such, the system is characterized by a hierarchical nature in which all decisions have to be authorized by the highest person in the chain of command; hence, a characterization of bureaucracy. On the other hand, decentralized organizational structures allow team members or employees the autonomy to make decisions without consulting their seniors; as such, the system is characterized by a team environment and empowering of the members.
Based on the description of the case, the organizational structure that Nurse Hartman is evaluating is centralized. This is because it has several levels of hierarchy and all the decisions have to be authorized by the nursing director. This implies that there is no nurse with the autonomy to make decisions without consulting the senior who also has to inquire about the issue. In many health facilities, the centralized structure is very common.
For example, in most health facilities, nurses who are the primary caregivers have to work under the guidelines of the physicians who are their managers. As a result, many health facilities have not been able to achieve total quality management at the clinical level because the autonomy of the health professionals is limited (Glickman, Baggett, Krubert, Peterson, & Schulman, 2007). Glickman et al. (2007) pointed out that highly centralized structures have become cultures of health facilities and have been a key impediment to improved quality and efficiency.
In order to decrease the adverse events and medical errors by developing a risk reduction and safety program, the campaign should involve a change from the centralized organizational structure to a decentralized framework that will empower nurses by allowing them the autonomy to make decisions. According to Duffield, Kearin, Johnston, and Leonard (2006), the reconstitution of the health facilities is inevitable if efficiency is to be realized in all dimensions of health care delivery. For example, in the U.K., the government reconstituted the traditional role of ‘nurse matron’ to enhance decision-making at the ward level. This was a move towards decentralization.
Glickman et al. (2007) noted that decentralized structures promote accountability and solve the conflicts associated with the central control; therefore, a shift from the centralized systems to a more decentralized structure makes the service lines autonomous and more accountable for the purpose of quality improvement. Quality improvement is tantamount to safer practices and reduced medical errors as there is no distortion of facts.
The decentralization effort can be extended to other health facilities if the health stakeholders are sensitized about the benefits related to the structure and the gaps that result due to the highly centralized systems. For instance, there have been increased campaigns to ensure holistic care delivery that takes into consideration the use of evidence-based practices. The EBP cannot be effectively applied in a centralized structured system because nurses need to carry out independent research and apply the recent study evidence without necessarily consulting the directors of the facility.
Therefore, the adoption of such measures in the U.S. and other countries increases the potential of extending decentralized health facilities.
Duffield, C., Kearin, M., Johnston, J., & Leonard, J. (2006). The impact of hospital structure and restructuring on the nursing workforce. Australian Journal of Advanced Nursing, 24(3), 42-46.
Glickman, S. W., Baggett, K. A., Krubert, C. G., Peterson, E. D., & Schulman, K. A. (2007). Promoting quality: the health-care organization from a management perspective. International Journal for Quality in Health Care, 19(6), 341-348.