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Functional Organizations The functional organization structure also called bureaucratic organizational structure splits the organization into departments based on employees expertise. Therefore, a healthcare organization may have various departments, such as the manager or chief executive officer, commercial and marketing, finance, accounting, managerial, facilities, operations, maintenance, safety, environment, housekeeping, nursing, laboratory, pharmacy, etc. This type of structure works best in small to medium size organizations wherein the business environment is stable and predictable and routine tasks are emphasized and practiced to improve quality. Healthcare delivery is typically organized based on functionality, with unitlevel divisions established according to roles, services, tasks, and other relevant factors. This structure includes admissions, pharmacy, accounting, business office, maintenance, food service, housekeeping, nursing, laboratory, radiology, and emergency services. The structure of an organization also encompasses higher levels of supervision comprising a chief executive officer, chief financial officer, chief nursing officer, chief information officer, and other specialized officers. Several advantages and disadvantages exist for functional organizations. One significant advantage is the incorporation of specialized personnel, which increases the organizations quality and efficiency. Units can then be developed based on specialization, such as oncology maternity pediatrics renal medical surgical cardiology orthopedic ears, nose, and throat ENT and other relevant areas. Other advantages include a reduction in duplication of services and an increase in communication within departments. Specialized tasks like finance, marketing, or purchasing can be placed at centralized organizational locations. Because of specialization, departments can often operate in silos, which leads to poor communication and coordination of services Walston, 2017. This situation occurs because of reduced communication between departments, narrowed business perspectives, and a shortterm focus on tasks. Correcting this problem would entail developing key criteria defining the scope of departmental specialization and devising a means of evaluating outcomes based on the organizations overall purpose Bach, 2018. Another method of improving specialization problems is to find out the root cause of the problem by identifying the problem, analyzing it, developing, planning, and implementing the best solutions, and finally evaluating the implemented solution to see if changes are warranted Elsaid, Okasha, Abdelghaly, 2013. The following chart depicts a simple organization chart with a summary of the advantages and disadvantages of the functional structure. Multidivisional Organizations Walston describes a multidivisional organization as one wherein the chief corporation comprises several smaller business units or divisions, which are based on geographic locations, products, or services so that the daily processes or functions occur at the unit or divisional level, thus allowing the separate units or divisions to operate independently. Each division duplicates tasks in this structure, fostering innovation and receptiveness to their specific requirements. This process allows executives at the corporate level to use statistics from each unit to focus on strategies that will propel overall organizational performance through successfully allocating people and resources Walston, 2017. When organizations create divisions based on geography or products, cultures, markets, or laws will vary significantly. Because of this, healthcare organizations, such as Hospital Corporation of America HCA, established an international division to manage its ventures in other countries more effectively and efficiently. This is also true for pharmaceutical and medical device companies. Examples of multidivisional structures in healthcare include cardiology, orthopedics, pediatrics, neurology, and womens services. There are also specialty hospitals geared toward cardiology, such as the Albert Luce Heart Tower at Atrium Health Navicent, specializing in spine surgery, sports medicine, and cancer treatment. Advantages of the multidivisional structure include holding corporate executives accountable for the results of local operations within their control. Each division monitors shifts in the external environment relative to consumer needs and focuses its operating efforts accordingly. A major issue with the multidivisional level is healthcare costs and quality. With the multidivisional organizational structure, duplication of functions, such as products and services across divisions, places the division at a disadvantage, threatening healthcare quality and costs. This process decreases the divisions ability to achieve economies of scale and thereby increases the divisions operating cost. Additionally, the duplication of functions can lead to a lack of standardization and inefficiencies Walston, 2017. Efficiency measures the ability of healthcare resources to attain the best value for the money invested. Inefficiency occurs due to poor resource allocation in the form of spending that can be reduced without decreasing quality and spending that increases overall costs equipment, labor, capital and quality of services. Healthcare leaders should review these inefficiencies to determine if the benefits of decentralization exceed the duplication costs Delaune Everett, 2008.Matrix Organizations Many healthcare facilities operate using the matrix organizational structure, which is most useful when problems need to be solved. This design combines functional and projectbased structures, featuring two managers and multiple reporting relationships. The departmental manager controls vertical relationships, while the project manager handles horizontal relationships. Employees are organized by function and work in both their functional departments and service line teams. An administrator or manager promotes coordination among department personnel in hospital clinical areas. Instead of dismantling the functional structure, the matrix overlays a temporary project structure. In this setup, the project manager and their team independently complete assigned projects, while senior department managers ensure compliance with company policies and service standards. Healthcare delivery is multifaceted and complex. Additionally, rapidly changing operating environments created through increasing market pressure increase the organizations ability to improve information processing and allow faster response times Allcorn, 1990. As a result, many healthcare facilities find the matrix structure useful in assisting the organization to fulfill its quest for continuous quality improvement in providing healthcare services. With the matrix structure, quality patient care is delivered through the development of teams from various departments within the organization. This method aids in coordinating required care with the continued routine use of accountable care organizations Walston, 2017. Advantages of the matrix organizational structure include the following clearly defined project objectives, seamless integration of project and functional objectives, efficient use of limited human resources, and fluid streaming of information throughout the project. Other advantages include the prompt diffusion of team members back into the functional organization upon project completion without organizational disruption and the ability of functional management to handle conflicts arising at the project level Gleeson, 2019. One of the disadvantages of the matrix organizational structure is that it increases the organizations complexity. Other disadvantages include problems due to employees having to answer to many bosses and having conflicting managerial directives. Additionally, establishing priorities suitable to functional and project management may prove difficult. Another disadvantage is the potential delay in managements reaction to problems when both structures must provide solutions. Table 1.1, which follows, gives a comparison of functional, multidivisional, and matrix organizational structures.1