Skip to main content

Organization Design and Management

  • Chapter
  • First Online:
Medical Quality Management

Abstract

As healthcare organizations examine how to design and adapt their management structures to ensure quality is being measured and improved, considerations around the functioning of systems and the management of change become crucial. The inherent financial and service-driven complexities of the healthcare industry and its systems require a mosaic approach to organizational structures and processes. Healthcare institutions must develop organizational structures in response to the requirements of dynamic external and internal stakeholders whose interests and motives do not categorically coincide. Organizations must be structured to embody the specific needs of their identity and mission. This chapter discusses the multiple structural approaches that have evolved to accommodate the explicit concerns of organizations whether a large academic medical center, large group practice, smaller community hospital, or an integrated healthcare system.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 49.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 64.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kohn LT, Corrigan JM, Donaldson MS (eds) (2000) To err is human: building a safer health system. National Academies Press, Washington, DC

    Google Scholar 

  2. Institute of Medicine (2001) Crossing the quality chasm: a new health system for the 21st century. The National Academies Press, Washington, DC

    Google Scholar 

  3. Berwick DM (1996) A primer on leading the improvement of systems. BMJ 312:619. https://doi.org/10.1136/bmj.312.7031.619

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Senge PM (1990) The fifth discipline: the art and practice of the learning organization. Random House, London

    Google Scholar 

  5. De Savigny D, Adam T (eds) (2009) Systems thinking for health systems strengthening. Alliance for Health Policy and Systems Research, World Health Organization, Geneva

    Google Scholar 

  6. Greene SM, Reid RJ, Larson EB (2012) Implementing the learning health system: from concept to action. Ann Intern Med 157:207–210. https://doi.org/10.7326/0003-4819-157-3-201208070-00012

    Article  PubMed  Google Scholar 

  7. Frankel AS, Leonard MW, Denham CR (2006) Fair and just culture, team behavior, and leadership engagement: the tools to achieve high reliability. Health Serv Res 41:1690–1709

    Article  Google Scholar 

  8. Marx D (2001) Patient safety and the “just culture”: a primer for health care executives. Trustees of Columbia University in the City of New York. https://www.chpso.org/sites/main/files/file-attachments/marx_primer.pdf

  9. Helmreich RL (2000) On error management: lessons from aviation. BMJ 320:781–785. https://doi.org/10.1136/bmj.320.7237.781

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Cochrane BS, Hagins M, Picciano G et al (2017) High reliability in healthcare: creating the culture and mindset for patient safety. Health Manage Forum 30:61–68. https://doi.org/10.1177/0840470416689314

    Article  Google Scholar 

  11. Baker DP, Day R, Salas E (2006) Teamwork as an essential component of high-reliability organizations. Health Serv Res 41:1576–1598

    Article  Google Scholar 

  12. Weick KE, Sutcliffe KM (2001) Managing the unexpected: assuring high performance in an age of complexity, 1st edn. Jossey-Bass, San Francisco

    Google Scholar 

  13. Pronovost PJ, Berenholz SM, Goeschel CA et al (2006) Creating high reliability in health care organizations. Health Serv Res 41:1599–1617. https://doi.org/10.1111/j.1475-6773.2006.00567.x

    Article  PubMed  PubMed Central  Google Scholar 

  14. Chassin MR, Loeb JM (2013) High-reliability health care: getting there from here. Milbank Q 91:459–490

    Article  Google Scholar 

  15. Koron-Djakovic D, Canamucia A, Lempa M et al (2016) Organization complexity and primary care providers’ perceptions of quality improvement culture within the Veterans Health Administration. Am J Med Qual 31(2):139–146. https://doi.org/10.1177/1062860614559743

    Article  Google Scholar 

  16. Gupta R, Moriates C (2017) Swimming upstream: creating a culture of high-value care. Acad Med 92(5):597–601. https://doi.org/10.1097/ACM.0000000000001485

    Article  Google Scholar 

  17. Nelson EC, Godfrey MM, Batalden PB et al (2008) Clinical microsystems, part 1: the building blocks of health systems. Jt Comm J Qual Patient Saf 34(7):367–378

    PubMed  Google Scholar 

  18. Monitor, Independent Regulator for NHS Foundation Trusts (2009) Service-line management: an overview. Monitor, London. https://www.gov.uk/government/publications/service-line-management-an-introduction-for-nhs-foundation-trusts

    Google Scholar 

  19. Nasrabad RR (2016) Service line management: a new paradigm in health care system. Int J Med Res Health Sci 5(12):208–211

    Google Scholar 

  20. Rangachari P (2010) Knowledge sharing and organizational learning in the context of hospital infection prevention. Q Manage Health Care 19(1):34–46. https://doi.org/10.1097/QMH.0b013e3181ccbd1d

    Article  Google Scholar 

  21. Pronovost PJ, Marsteller JA (2014) Creating a fractal-based quality management infrastructure. J Health Organ Manage 28(4):576–586

    Article  Google Scholar 

  22. Johns Hopkins Medicine (2017) Excellence and discovery: an overview. http://www.hopkinsmedicine.org/about/downloads/jhm-overview.pdf. Accessed 19 Mar 2017

  23. Austin JM, Demski R, Callender T et al (2017) From board to bedside: how the application of financial structures to safety and quality can drive accountability in a large health system. Jt Comm J Qual Patient Saf 43(4):166–175. https://doi.org/10.1016/j.jcjq.2017.01.001

    Article  PubMed  Google Scholar 

  24. Kravet SJ, Bailey J, Demski R, Pronovost P (2016) Establishing an ambulatory medicine quality and safety oversight structure: leveraging the fractal model. Acad Med 91(7):962–966. https://doi.org/10.1097/ACM.0000000000001102

    Article  PubMed  Google Scholar 

  25. Interview with Johns Hopkins leaders, April 5–7, 2017

    Google Scholar 

  26. Nancarrow SA, Booth A, Ariss S et al (2013) Ten principles of good interdisciplinary team work. Hum Resour Health 11:19. https://doi.org/10.1186/1478-4491-11-19

    Article  PubMed  PubMed Central  Google Scholar 

  27. Institute for Healthcare Improvement (2019) Science of improvement: forming the team. http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementFormingtheTeam.aspx. Accessed 14 May 2019

  28. Agency for Healthcare Research and Quality (2019) About Team STEPPS. Rockville, MD. http://www.ahrq.gov/teamstepps/about-teamstepps/index.html

  29. Shanafelt TD, Gorringe G, Menaker R et al (2015) Impact of organizational leadership on physician burnout and satisfaction. Mayo Clin Proc 90(4):432–440. https://doi.org/10.1016/j.mayocp.2015.01.012

    Article  PubMed  Google Scholar 

  30. Weiner BJ, Shortell SM, Alexander JA (1997) Promoting clinical involvement in the hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res 32:491–510

    CAS  PubMed  PubMed Central  Google Scholar 

  31. Berwick DM, Nolan TW, Whittington J (2008) The triple aim: care, health, and cost. Health Aff 27(3):759–769. https://doi.org/10.1377/hlthaff.27.3.759

    Article  Google Scholar 

  32. Bodenheimer T, Sinsky C (2014) From triple to quadruple aim: care of the patient requires care of the provider. Ann Fam Med 12:573–576

    Article  Google Scholar 

  33. Ziegenfuss JT (1997) Five responsibilities of medical quality leaders. Am J Med Qual 12(4):175–176. https://doi.org/10.1177/0885713X9701200401

    Article  PubMed  Google Scholar 

  34. Ashkenas RN, Francis SC (2000) Integration managers: special leaders for special times. Harv Bus Rev 78(6):108–116

    CAS  PubMed  Google Scholar 

  35. Nackel JG (1995) Breakthrough delivery systems: applying business process innovation. J Soc Health Syst 5(1):11–21

    CAS  PubMed  Google Scholar 

  36. Hutchins D (2008) Hoshin kanri: the strategic approach to continuous improvement. Gower Publishing Co, Burlington. https://www.henryford.com/hcp/academic/pathology/production-system/wednesdays-words/2011-articles/march-9-2011

  37. Goeschel CA, Wachter RM, Pronovost PJ (2010) Responsibility for quality improvement and patient safety: hospital board and medical staff leadership challenges. Chest 138(1):171–178. https://doi.org/10.1378/chest.09-2051

    Article  PubMed  Google Scholar 

  38. Alexander JA, Lee SY (2006) Does governance matter? Board configuration and performance in not-for-profit hospitals. Milbank Q 84(4):733–758. https://doi.org/10.1111/j.1468-0009.2006.00466.x

    Article  PubMed  PubMed Central  Google Scholar 

  39. Orlikoff JE, Totten MK (2003) Trustee workbook 2: best practices in governance: what makes great boards great. Trustee 56(4):15–18

    PubMed  Google Scholar 

  40. Prybil LD (2006) Size, composition, and culture of high-performing hospital boards. Am J Med Qual 21(4):224–229. https://doi.org/10.1177/1062860606289628

    Article  PubMed  Google Scholar 

  41. Prybil LD, Peterson R, Brezinski P et al (2010) Board oversight of patient care quality in community health systems. Am J Med Qual 25:34–41. https://doi.org/10.1177/1062860609352804

    Article  PubMed  Google Scholar 

  42. Jha AK, Epstein AM (2010) Hospital governance and the quality of care. Health Aff 29:182–187. https://doi.org/10.1377/hlthaff.2009.0297

    Article  Google Scholar 

  43. Pronovost PJ, Sexton B (2005) Assessing safety culture: guidelines and recommendations. Qual Saf Health Care 14(4):231–233. https://doi.org/10.1136/qshc.2005.015180

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Pross C, Geissler A, Busse R (2017) Measuring, reporting, and rewarding quality of care in 5 nations: 5 policy levers to enhance hospital quality accountability. Milbank Q 95(1):136–183. https://doi.org/10.1111/1468-0009.12248

    Article  PubMed  PubMed Central  Google Scholar 

  45. Pronovost PJ, Miller M, Wachter RM (2007) The GAAP in quality measurement and reporting. JAMA 298(15):1800–1802. https://doi.org/10.1001/jama.298.15.1800-2

    Article  CAS  PubMed  Google Scholar 

  46. Reinertsen JL, Gosfield AG, Rupp W et al (2007) Engaging physicians in a shared quality agenda. IHI Innovation Series white paper. Institute for Healthcare Improvement, Cambridge

    Google Scholar 

  47. Shanafelt T, Goh J, Sinsky C (2017) The business case for investing in physician well-being. JAMA Intern Med 177(12):1826–1832. https://doi.org/10.1001/jamainternmed.2017.4340

    Article  PubMed  Google Scholar 

  48. Shanafelt TD, Noseworthy JH (2017) Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clin Proc 92(1):129–146

    Article  Google Scholar 

Additional Reading

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 American College of Medical Quality (ACMQ)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

McLean, R., Hooks, J., Guttman, C. (2021). Organization Design and Management. In: Giardino, A., Riesenberg, L., Varkey, P. (eds) Medical Quality Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48080-6_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-48080-6_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48079-0

  • Online ISBN: 978-3-030-48080-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics