Challenges in Health and Social Care Management

Introduction

The recent COVID-19 pandemic has left many scholars and practitioners in the healthcare industry raining concerns and questions about health and social care management. Particularly, the focus has been on the amount of money spent on health and social care, and whether service users are receiving quality care services that are commensurate to those resources. Furthermore, questions are being asked about different managerial challenges such as inadequate workforce, financial constraints and how the skill and number mix of the healthcare workforce are suitable for the provision of quality health and social care. At the same time, scientific advancement continues to uncover new and more effective ways of treating diseases despite the constant evolution of health and social care needs, which in turn increases the cumulative cost of providing these services. Consequently, effective management is an essential element of health and social care delivery as it presents as a prerequisite for maintaining high-quality care to ensure patient needs are effectively met. This essay delves into the concept and practice of management in health and social care, evaluating different aspects of management and how they co-relate with the provision of health and social care. The essay will be divided into three sections. The first section will explore the role of a healthcare manager in a mental healthcare setting while the second section will explain how organizational structure impacts organizational culture. Finally, the essay will identify different organizational structures that are applicable in health and social care.

Role of Healthcare Manager

According to Clay-Wiliams et al (2017), healthcare managers constantly have new managerial demands and requirements. As result, it is only the managers that develop the flexibility and creativity to adapt to constantly changing environment that can thrive in these turbulent times. Thus, the main role of healthcare managers in modern healthcare organizations is simply ‘change management’. On this note, Ivankovic et al (2020) argued that effective initiation and management of change helps healthcare organizations to promote quality care, strengthen the financial position and meeting the demands of patients. But the role of healthcare managers in developing effective change management is vast and entails different stakeholders who play different roles. The managers play a pivotal role in setting the pace for strategic development and implementation of organizational change, with six key roles popularly identified: communication, change advocacy, resource allocation, employee development and training, supervision and liaison.

Communication

As a healthcare manager, it is my role to communicate any impending change and deliver the necessary facts to the employees regarding the necessary steps required in implementing certain changes within the organization (Okonkwo et al, 2020). Failure to effectively communicate the impending change can be detrimental to the entire organization as it impedes the creation of shared meaning, thus leading to change resistance (Herttuala et al, 2020). By communicating, managers provide a clear view of the path ahead and help to articulate the ‘big picture’ about the required change. A typical example is in the Mid Staffordshire case, in which the Francis Report (2013) outlined the lack of effective communication by the facility’s managers as one of the factors that contributed to the scandal.

Change advocacy

It is also my role as a healthcare manager to be a change advocate. According to Hill et al (2018), a change advocate has a serious idea about change, even though they may not wield the power to fully implement the change. Nonetheless, they play the lead role of organizing stakeholders and mobilizing resources for change (Catalyst, 2018). It is also their role to demonstrate support for change and convince employees to fully participate in the change implementation process. As change advocate, healthcare managers acquire and disseminate all the data that supports and acknowledges the downsides of the proposed change. For example, in a bid to introduce new technology in practice, it is the role of a change manager to share data on compliance risk that convince senior managers to finance the new technology.

Training and development

It is also the role of healthcare managers to identify change management training needs for other employees, organize and facilitate the training and participate in training the employees. According to Gutberg & Berta (2017), an effective change implementation requires the employees to learn various buildable and adaptable skills necessary to implement change, creating the need for timely training. Therefore, according to Herttuala et al (2020), it is the role of managers to participate in identifying the training needs by, for example, developing training needs assessment survey that would help develop an effective training curriculum. Similarly, in this case, the manager would play a significant role in identifying the most effective and accessible training solutions, including the necessary planning that accompanies the training (Birken et al, 2018). For example, an external training seminar would require some employees to travel, and therefore it would be the manager’s role to ensure the organization runs smoothly even with the absence of some employees.

Liaison

A key aspect of coordinating a successful change implementation process is liaison. In this case, liaison entails contacting colleagues and senior-level managers about the change, networking with external partners and stakeholders to help initiate the change and generally coordinating activities relating to the change (Birken et al, 2018). Furthermore, Gutberg & Berta (2017) argued that the liaison role also entails coordinating with the project team to deliver back and forth information between employees and the project team. For instance, when introducing a new data management system in a mental healthcare setting, the manager is in the best position to provide employee feedback, design input and usability results on aspects of the new technology back to the project team.

How organizational structure impacts organizational culture

The concepts of organizational culture and structure are closely intertwined and often confused as the same. However, that can be misleading because the two concepts have separate definitions. As such, it is important to evaluate the relationship between these two concepts to have a better understanding of how one entity influences the other (Buchanan & Huczynski, 2019). Simply defined, organizational culture represents the entity’s big picture. It is how the company performs its business both internally and externally (Klein et al, 2020). On the other hand, Paunković et al (2018) defined organizational structure as to how communication with an organization moves from one functional area to the other. As such, the structure represents the reporting procedure, whereby one member of the organization has more decision-making powers than the other (Winnubst, 2017). As such, according to Hoffman (2018), organizational structure defines how the firm gathers and coordinates its resources to achieve its objectives. Below is an illustration of how a small community hospital that has a hierarchical structure joining Age UK that has a divisional structure can impact the existing cultures within both organizations.

The influence of organizational structure on culture depends on the compatibility of norms and value on one hand, and the modes of completing tasks implied by the implementation of a certain structural model in question (Yoon, 2020). For example, if the small community hospital joins Age UK (a bigger organization) it will get introduced to a new organizational structure that requires its members to behave differently from existing cultural values, thus Age UK’s organization’s structure the small community hospital’s organizational culture – through the process of institutionalization. Every organizational structure gives rise to specific behaviours among organization members regarding the responsibilities they execute daily and the way they execute those responsibilities (Abbasi et al, 2017). On the other hand, according to Iranmanesh (2020), such behaviours have certain cognitive and symbolic implications. The organization members inevitable incorporate in their interpretive schemes the values, assumptions and norms to justify their behaviour. Therefore, if a new organizational structure is introduced that implies a new behaviour that aligns with existing cultural norms, values and assumptions, then these assumptions will be strengthened by the implementation of the new structure (Icoglu & Koyuncu, 2020). Here, the institutionalization of culture represents a process whereby the cultural values, norms and assumptions in one organization (e.g. small community hospital) are built-in another organization’s (e.g. Age UK) structure. By shaping and directing the small community hospital’s organizational member’s behaviour in a manner that is compatible with the cultural norms and value of Age UK, Age UK’s culture shall have been institutionalized.

The other scenario is when the small community hospital’s hierarchical structure prevails, it can change Age UK’s existing culture. In this case, according to Hendriarto & Susanty (2018), the organizational structure deinstitutionalizes culture, leading to a process of transformation. By permanently changing Age UK’s organizational structure into a more hierarchical one, Age UK’s employees will be forced to behave in a certain manner that is not compatible with their dominant cultural norms, assumptions and values. As per Alataş (2018), this will cause Age UK’s employees to be in a state of cognitive dissonance, from which they can be relieved with time and consistent implementation of the new culture.

Against this backdrop, Harrisson (1972) originally suggested that there are 3 main ideologies in the character of an organization that can be used to explain the influence of organizational structure on culture. Handy (1993) further developed these ideologies and from them proposed 4 major types of organisational culture: power culture, role culture, task culture and person cultures. According to Handy (1993), power culture represents a ‘web’ form of organizational culture and represents a control that spreads out like a network from the centre of the organization to the rest of the organization. Power cultures are popular with small entrepreneurial organizations such as finance and trading companies or property companies, which are majorly characterised by minimum bureaucracy and are also highly political (Darmawan et al, 2020). Because the control spreads from the centre to other parts of the organization, decisions in power culture organizations are mainly made through persuasion rather than rational or bureaucratic basis (Handy, 1993).

Role culture refers to organizations that have highly defined structures and employees have specifically delegated authorities – offering predictability and security (Handy, 1993). The highly bureaucratic structures of such organizations imply that they operate in a culture of rationality and logic (Hashemi, 2019). As such, according to Handy (1993), they derive their strengths from their areas of expertise, roles and pillars, which include the finance department and the purchasing departments. Furthermore, according to Handy (1993), the interaction between the finance and the purchasing departments are governed by strict rules and procedures which are the main methods of influence.

On the other hand, in task culture organizations, the structure is task-oriented, and individuals work in teams, with powers derived from expertise only when required (Handy, 1993). According to Handy (1993), such an organization takes the form of a ‘net’, whereby much of the influence and power lies in the ‘interstices’ of the net. Because such organizations focus on getting the job done, they tend to assemble the necessary resources and the right employees at suitable ranks within the organization to enable them effectively to complete their tasks. As a result, a culture of compliance develops within the organization, leading to middle and first-level managers who like to work.

Lastly, in a person culture organization, individuals believe to be superior to the organization (Handy, 1993). therefore, a group of employees who are in harmony with the organization tend to follow the objectives and goals of the organization. As such, the organizations lack management hierarchies and control systems, except when there is mutual approval to have them. Therefore, such organizations are characterized by mutual influence, with an expert oriented power base – meaning that the individuals do what they are good at. Consequently, this structure contributes to an organizational culture whereby individuals are difficult to manage and there is little influence that can be conveyed to them to make them tolerable. As per Handy (1993), this is because such individuals can easily find alternative employment as they are highly specialised.

Types of organizational structures

Apart from the complex buildings that house healthcare organizations, its structure consist of the employees help to deliver the services and an elaborate division of work that dictates what each employee is supposed to do. According to Onono (2018), this entails developing an organizational structure of senior and junior employees with well-defined roles, responsibilities and spans of control, in a hierarchical fashion. Furthermore, Dekoulou & Trivellas (2017) observed that the organizational structure may also entail the reporting relationships, the relationships between different employees and different posts as well as how different activities are coordinated to achieve the overall organizational goals. There are various forms of organizational structures that a health awareness promotion organization in the borough of Lambeth may take. But before settling on one, there needs to be a critical evaluation and consideration of the advantages and disadvantages of each structure to identify the suitable one. The following section evaluates some of the forms of organizational structure that may be selected, their advantages and disadvantages. Ultimately, I will select one organizational structure and justify the selection.

Functional organizational structure

Considered one of the oldest and widely used forms of organizational structure, functional organizational structure divided organizations into strictly differentiated job functions, whereby, for example, all employees performing roles related to marketing operate within the marketing department while all employees responsible for people management operate within the HR department (Hopej & Kandora, 2018). As such, this organizational structure divides entities, jobs, departments and other roles into clearly demarcated areas of responsibility.

A typical advantage of functional organizational structure is that they are easily scalable, and employees can effectively focus on their area of responsibility, thus leading to efficiency (Meri et al, 2018). Furthermore, Morozenko (2018) argued that the demarcated area of responsibility prevents the duplication of activities (e.g. marketing) across various departments. More importantly, as per Dekoulou & Trivellas (2017), the functional structure facilitates quicker decision-making, and therefore are suitable for smaller organizations that have a small range of goods or services to offer. Due to its characteristics, the functional organizational structure is often associated with Handy’s (1993) role culture, which is characterised by a high degree of control, bureaucracy and power derived from a person’s position.

On the flip side, a significant disadvantage of this form of structure is that various forms of barriers can arise between the functional areas in case a rigid division is formed (Hopej & Kandora, 2018). ideally, as per Onono (2018), the more a department works by itself, the less it can communicate with other departments or understand what they are doing (a scenario also known as departmental selfishness). This can lead to a situation of conflict of interest and consequently inhibited productivity.

Divisional organizational structure

Also known as business area organizations, the divisional organizational structure is often popular with growing organizations that are structured in a more differentiated manner (Meri et al, 2018). according to Meri et al (2018), organizations divisionally structured are subdivided into the following areas: product/services, sales areas/region, and markets/target groups. As such, these structural elements are also known as divisions and each represents a functional area (Hopej & Kandora, 2018).

Companies that adopt this structure divide their functions according to their geographical areas, with each department reporting to its sales, marketing and production team (Meri et al, 2018).

A significant advantage of this structure is that each department can effectively concentrate on its respective activity and thus work more strategically, with efficiency, and in a more coordinated manner. Similarly, Dekoulou & Trivellas (2017) acknowledge that the resultant departmental autonomy contributes to better employee motivation while at the same time, the more differentiated responsibility allocation makes it more possible for the individual business activities to be executed in a more transparent manner.

A significant disadvantage of divisional organizational structures is that they are more differentiated and thus need more specialised managers. According to Dekoulou & Trivellas (2017), this greater coordination efforts makes it costly to manage such organizations. There is also the threat of divisional selfishness (due to geographical separation) that promotes duplication of activities, impedes effective communication and coordination (Hopej & Kandora, 2018).

Matrix organization

This organization structure takes advantage of the benefits of both divisional and functional models of organizational structure and packages them in a three-dimensional matrix. As per Hopej & Kandora (2018), it divides departments and jobs first by function then by division. This implies that employees are always under two instructional relationship at any given time, being answerable to the departmental head and the respective product manager (Meri et al, 2018). as such, the relationships exist in both vertical and horizontal lines illustrated below:

One of the advantages of this organizational structure is that it can be easily adapted to suit the capacity fluctuations within the company. According to Morozenko (2018), the always available shorter communication channels allow for more flexible decision-making and information dissemination. As such, according to Handy (1993), this kind of organizational structure allows for a task culture, whereby teams are formed to solve specific problems and power is mostly derived from expertise, as well as depending on the status of the problem being solved. The tasks determine the team dynamics, and therefore it can also be effective in organizations that have a task culture (Meri et al, 2018).

Nonetheless, a significant disadvantage of matrix organizational structure is that it is too complex and therefore requires high planning and implementation costs (Hopej & Kandora, 2018). Similarly, Onono (2018) complained that its complexity might cause confusion among employees. The dual management characteristics can lead to conflicts of competence and make it difficult to achieve effective decision-making, communication and performance assessment.

Having evaluated the various forms of organizational structures that healthcare organizations can consider, the functional organizational structure presents as the best choice for a public health awareness organization within Lambeth. This is because it is easily scalable (Meri et al, 2018) and therefore is flexible enough to allow the organization’s growth. Furthermore, the functional organizational structure is suitable for the proposed health awareness organization because it allows quick decision-making, thus suitable for such an organization that has a narrow range of services to offer and a relatively low budget of operation.

Conclusion

A healthcare manager has many responsibilities within their practice to ensure that patients receive quality mental health and social care services. However, effective change management is an essential element of health and social care management as it presents as a prerequisite for maintaining high-quality care to ensure patient needs are effectively met. While exercising their managerial responsibilities, healthcare managers operate under different organizational cultures and structures that influence their duties. This paper has established through institutionalization and deinstitutionalization, organizational structures can significantly influence organizational culture. However, regardless of whether the health and social care organization operate in a functional, divisional or matrix organizational structure, a pragmatic approach to their managerial duties, as well as taking an analytical stance to their decision-making can help them effectively execute their managerial roles.

References

Abbasi, A., Mosleh Shirazi, A.N. and Hosseini, F., 2017. Developing Human Resource Strategy Coherent with Business Strategies, Culture and Organizational Structure. Journal of Research in Human Resources Management, 9(2), pp.21-46.

Alataş, E., 2018. The impact of organizational culture and structure on enterprise resource planning success.

Birken, S., Clary, A., Tabriz, A.A., Turner, K., Meza, R., Zizzi, A., Larson, M., Walker, J. and Charns, M., 2018. Middle managers’ role in implementing evidence-based practices in healthcare: a systematic review. Implementation Science, 13(1), pp.1-14.

Buchanan, D.A. and Huczynski, A. 2019. Organizational Behaviour 10th Edition. Harlow, Pearson

Catalyst, N.E.J.M., 2018. What is risk management in healthcare?. NEJM Catalyst.

Clay-Williams, R., Ludlow, K., Testa, L., Li, Z. and Braithwaite, J., 2017. Medical leadership, a systematic narrative review: do hospitals and healthcare organisations perform better when led by doctors?. BMJ open, 7(9).

Darmawan, D.C., Widagdo, S. and Yusuf, H.F., 2020. The influence of organizational structure, leadership style, management control systems, and organizational culture toward behaviour decision making. MBA-Journal of Management and Business Aplication, 3(1), pp.245-253.

Dekoulou, P. and Trivellas, P., 2017. Organizational structure, innovation performance and customer relationship value in the Greek advertising and media industry. Journal of Business & Industrial Marketing.

Edition

Gutberg, J. and Berta, W., 2017. Understanding middle managers’ influence in implementing patient safety culture. BMC health services research, 17(1), pp.1-10.

Hashemi, M.S., 2019. The effect of infrastructure, corporate culture, organizational structure and information technology on Competitive Intelligence in Organizations. International Academic Journal of Organizational Behavior and Human Resource Management, 6(1), pp.32-39.

Hendriarto, Y. and Susanty, A.I., 2018. The Influence Of Organizational Culture And Organizational Structure On The Implementation Of Knowledge Management Process In Corporate University Of PT. XYZ. Sustainable Collaboration in Business, Technology, Information and Innovation (SCBTII), 1(1).

Herttuala, N., Kokkinen, L. and Konu, A., 2020. Social-and healthcare managers' work wellbeing–literature review and key informant interviews. International Journal of Workplace Health Management.

Hill, M., Gluyas, H., Sandy, M. and Wingate, A., 2018. Healthcare managers’ perceptions of managing poor performance. Journal of health organization and management.

Hoffman, G.R., 2018. A case study examining how stakeholders experience and perceive changes in organizational structure and culture throughout the paradigm switch from traditional to hybrid secondary education. Indiana University of Pennsylvania.

Hopej, M. and Kandora, M., 2018, September. The Simplification of Organizational Structure: Lessons from Product Design. In International Conference on Information Systems Architecture and Technology (pp. 188-200). Springer, Cham.

Icoglu, H.I. and Koyuncu, A.G., 2020. Effects of Leadership and Organizational Structure on Institution Culture in Affiliated Hospitals in Turkey. Revista de Cercetare si Interventie Sociala, 70.

Iranmanesh, M., Kumar, K.M., Foroughi, B., Mavi, R.K. and Min, N.H., 2020. The impacts of organizational structure on operational performance through innovation capability: innovative culture as moderator. Review of Managerial Science, pp.1-27.

Ivankovic, D., Poldrugovac, M., Garel, P., Klazinga, N.S. and Kringos, D.S., 2020. Why, what and how do European healthcare managers use performance data? Results of a survey and workshop among members of the European Hospital and Healthcare Federation. PloS one, 15(4), p.e0231345.

Klein, C., Lester, J. and Nelson, J., 2020. Leveraging organizational structure and culture to catalyze pedagogical change in higher education. Transforming Institutions: Accelerating Systemic Change in Higher Education.

Meri, A., Hasan, M.K. and Safie, N., 2018. The Impact of Organizational Structure and System Settings on the Healthcare Individuals’ Perception to Utilize Cloud Services: A Theoretical Literature Survey. Journal of Engineering and Applied Sciences, 13(4), pp.888-897.

Montanari, F., Della Torre, E., Bonti, M. and Martinez, M., 2017. Introduction to the Special Issue The Dance of Structure and Culture in Organizational Change. Introduction to the Special Issue The Dance of Structure and Culture in Organizational Change, pp.9-14.

Morozenko, A., 2018. Reflex-adaptive organizational structure in the implementation of large-scale projects. In Organizational Culture (pp. 107-121). London: IntechOpen.

Newington, L., Alexander, C.M. and Wells, M., 2020. What is a clinical academic? Qualitative interviews with healthcare managers, research‐active nurses and other research‐active healthcare professionals outside medicine. Journal of Clinical Nursing.

Okonkwo, U., Ekpeyoung, B., Ndep, A. and Nja, G., 2020. Managerial Competencies-A Survey of Healthcare Managers in A Tertiary Hospital in Calabar, South-South Nigeria. Nigerian Journal of Clinical Practice, 23(7), pp.988-994.

Onono, E.O., 2018. The impact of organizational structure on performance at General Electric Africa (Doctoral dissertation, United States International University-Africa).

Paunković, J., Jovanović, V. and Žikić, S., 2018. Relationship between the organizational structure and culture: Case studies of the mining companies in Serbia. Mining and Metallurgy Engineering Bor, (1-2), pp.137-144.

The Francis Report 2013. Findings from the Francis Report. NMC.

Van Campen, D.N., 2021. Foresight Leadership Theory: A Grounded Theory Study of the Conflict Management Experiences of Healthcare Managers with Remote Employees (Doctoral dissertation, Nova Southeastern University).

Vveinhardt, J. and Andriukaitiene, R., 2017. Management culture as part of organizational culture in the context of corporate social responsibility implementation. Economics & sociology, 10(3), pp.294-320.

Vveinhardt, J. ed., 2018. Organizational culture. BoD–Books on Demand.

Winnubst, J., 2017. Organizational structure, social support, and burnout. In Professional burnout (pp. 151-162). Routledge.

Yoon, S., 2020. Organizational Culture, Organizational Structure and Emotional Labor of Dental Workers Impact of Convergence on Job Satisfaction. Journal of Convergence for Information Technology, 10(1), pp.187-194.