Chapter 1
Organization Theory and
Health Services
Management
Purpose and Overview
• Purpose
– To learn about the major influences affecting
health care organizations
– Discussion of managerial perspectives
– Discussion of managerial theories
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Purpose and Overview
• Overview
– The Changing Health Care System
– Ecology of Health Services Organizations
– Key Dimensions of Health Services
Organizations
– Health Services Organizations as Systems
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4 4
Purpose and Overview
• Overview
– Areas of Managerial Activity
– Major Perspectives on Health Services
Organizations
– Metaphors of Health Services Organizations
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5 5
The Changing Health Care System
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6 6
The Changing Health Care System
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The Changing Health Care System
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The Changing Health Care System
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The Changing Health Care System
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The Changing Health Care System
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The Changing Health Care System
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The Changing Health Care System
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Ecology of
Health Services Organizations
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Ecology of
Health Services Organizations
• Are Health Services Organizations
Unique?
– Defining and measuring output are difficult
– Work is variable and complex
– Work is usually nondeferrable
– Work is often performed under emergency
conditions
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Ecology of
Health Services Organizations
• Are Health Services Organizations
Unique?
– Work must be precise and errorless
– Services are interdependent and require
coordination
– Require extreme degree of specialization
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Ecology of
Health Services Organizations
• Are Health Services Organizations
Unique?
– Professionalized providers
– Lack of managerial control over group
generating work and expenditures
– Dual lines of authority
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Key Dimensions of
Health Services Organizations
•
•
•
•
•
External Environment
Vision
Mission
Goals
Strategies
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Key Dimensions of
Health Services Organizations
•
•
•
•
•
Differentiation
Integration
Centralization
Change
Innovation
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Health Services Organizations
as Systems
• Closed System
– Maximize internal efficiency, predictability, and
order
• Open System
– Openness, adaptability, and innovation
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Health Services Organizations
as Systems
• Production
– Products or services at center of
organizational activities
• Boundary Spanning
– Interface between organization and external
environment
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Health Services Organizations
as Systems
• Maintenance
– Physical and human infrastructure
• Adaptation
– Innovation as tool for change
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Health Services Organizations
as Systems
• Management
– Organizes, directs, and oversees
• Governance
– Provides strategic direction and imposes
accountability
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Areas of Managerial Activity
• Organizational Behavior–Micro Approach
– Examines individuals within organizations
– Motivation
– Leadership
– Conflict management
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Areas of Managerial Activity
• Organization Theory–Macro Approach
– Organization as social system
– Organizational design
– Interorganizational relationships
– Change and innovation
– Performance and strategy
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Major Perspectives on
Health Services Organizations
• Bureaucratic Theory
– Procedures for governing activities
– Hierarchical structure
– Lack of individual freedom
– Rigid behavior
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Major Perspectives on
Health Services Organizations
• Scientific Management School
– Span of control
– Unity of command
– Appropriate delegation of authority
– Departmentalization
– Work rules and methods to improve efficiency
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Major Perspectives on
Health Services Organizations
• Human Relations School
– Individual, group dynamics, and relationships
– Participatory decision making
– Self-actualizing aspects of work
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Major Perspectives on
Health Services Organizations
• Contingency Theory
– Organization is situational
– Continuum that moves toward organic from
bureaucratic structure
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Major Perspectives on
Health Services Organizations
• Resource Dependence Theory
– Obtaining resources from environment
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Major Perspectives on
Health Services Organizations
• Strategic Management Perspective
– Positions organization to environment and
competitors
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Major Perspectives on
Health Services Organizations
• Population Ecology Theory
– Environmental forces "select out" certain
organizations for survival
– Minimizes role of managers
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Major Perspectives on
Health Services Organizations
• Institutional Theory
– Requires conformity to rules to receive
legitimacy and support
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Major Perspectives on
Health Services Organizations
• Social Network Perspective
– Behavior is social in nature
– Successful organizations develop and use
social networks
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Major Perspectives on
Health Services Organizations
• Complex Adaptive Systems
– Interdependent, embedded, and
unpredictable
– Experimentation
– Application of simple rules
– Co-evolution of organization and environment
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Major Perspectives on
Health Services Organizations
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Major Perspectives on
Health Services Organizations
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Major Perspectives on
Health Services Organizations
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Metaphors of
Health Services Organizations
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