Like very few other service organisations a hospital has relationships that are external concern for patients, consumer, community, client environment.
But let us also consider the internal relationships in the organisational model in hospitals.
The organisational process cannot be understood without an understanding of the nature of authority relationship obtaining in all organisations in general.
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The following are intimately connected with authority relationships in organisations.
1. Super ordination/subordination
2. Authority and responsibility
3. Scalar principle
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4. Functional authority
5. Splintered authority
6. Line and staff authority
7. Span of management.
1. Super ordination/Subordination:
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a. The hospital is expected to perform efficiently at all times and to produce automatic response regardless of turnover, absenteeism and workload.
b. The performance (i) is partly attained through directive, quasi-authoritarian controls, (ii) As a formal bureaucratic organisation, the hospital also relies a great deal upon formal policies, rules and regulations for controlling work relationships of its members.
c. This emphasis on directive controls manifests itself in sharp patterns of super ordination/subordination, and in distinct status differences among organisational members.
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2. Authority and Responsibility:
In an organisational set-up, the authority vested in any individual must be equal to the responsibility assigned. This is the principle of parity of authority and responsibility.
It assures that the person given an assignment or a job to perform can carry it out without let or hindrance, without provoking conflict over his right and duty to do so.
At the same time, managers cannot delegate all their authority and then they hold no responsibility. The principle of absoluteness of responsibility recognises that all managers delegate authority, but the ultimate responsibility is retained by the manager.
The manager who delegates authority remains ultimately responsible for the actions of the subordinates. From this concept, the manager receives the right to exercise the necessary controls and extract accountability from subordinates.
The degree of centralisation or decentralisation of authority depends on the management philosophy of the governing board. There has to be more centralisation of authority in small hospital because of their size.
But greater decentralisation becomes a necessity when the size of the hospital’s operations expands. In both the cases, it should be clear that there can never be complete centralisation or decentralisation.
Centralisation or decentralisation is governed by policy, uniformity and size of the organisation.
3. Scalar Principle:
Organisational hierarchy refers to the arrangement of individuals into a series of superiors and subordinates.
Individual workers are placed in a specific authority relationship to a superior, whose authority can be traced from the next level of authority, up to the top level of the hierarchy. This is the Scalar principle.
This flow of authority constitutes a chain of command, the chain of direct authority from superior to subordinate. Scalar status is associated with a position in a hierarchical system in which the position itself implies the authority.
The uninterrupted line of authority from superior to subordinate results in units of command so that each individual reports to one, and only one, superior
The chain of command shows who reports to whom, who is responsible for the actions of an individual, who has authority over others, and results in a pyramidal organisational structure
4. Functional Authority:
In certain hospitals, in the formal organisational chart the medical staff may not be shown as having any direct authority.
Yet, the physicians exercise substantial influence throughout the hospital at nearly all organisational levels, enjoy very high autonomy in their work and have a good deal of functional authority over others in the organisation.
The functional status is the position held by an individual by virtue of the kind of work he or she performs. His or her work and performance are respected, and even revered, to the extent that he or she is regarded as high in status and thereby a person of authority commanding respect. This is the status associated with medical staff at certain levels.
A great many patients believe that the doctor is the healing power. Consequently, this means inherent conflict within the hospital, essentially with lay administrators.
Increased Professionalisation and specialisation have also had the effect of sharpening some of the status differences among the people working in hospitals.
Functional authority is the right which a individual or department has delegated to itself over specified processes, practices, policies, or other matters related to activities in departments other than its own.
Nature of Functional Authority:
If the principle of “unity of command” were followed without exception, all authority should be exercised by line managers.
However, reasons like lack of specific knowledge or experience, or danger of diverse interpretations of policies and plans explain why line personnel are not allowed to exercise this (functional) authority.
It is not restricted to managers of a particular type of department. It may be exercised by line, service or staff department heads—more often the latter two.
Functional authority is usually limited to the areas of how and sometimes when, but seldom to “where”, “what”, or “who”.
Methods of Exercising Functional Authority:
1. Staff man (say, personnel manager) offers advice or recommendations to a line superior, who may issue them as instructions down the scalar chain.
2. Line superior (e.g. manager support services) delegates authority to the staff man (e.g. personnel manager) to transmit information, proposals and advice directly to the former’s subordinates (which saves the superior time and trouble and expedites the spread of information).
3. Line superior (e.g. manager, support services) allows staff man (e.g. finance manager) to consult with operating managers and show them how the information should be used or put into effect.
Pitfalls in Exercising Functional Authority:
1. Failure of functional staff to understand their limitations—if they conduct certain activities for line managers, they tread on the line manager’s authority.
2. Danger of carrying fictionalization to the extreme. Result—destroying line manager’s job
3. Doubt in understanding what should be controlled by the expert and what should be under the jurisdiction of the operating managers. At times there is a thin line separating these.
4. Multiplicity of command on the line manager by many staff or functional positions. Result confusion, dispersal of responsibility, and conflict
5. Splintered Authority:
Managers cannot have unlimited authority. Because there are necessary limits on each manager’s authority, there is a greater need for coordination at various levels of the organisation.
These results in splintered authority, i.e. splinters of the authority of some managers impinge upon the role and functions of other managers. Hospital organisation is quite characteristic of splintered authority giving rise to organisational conflicts.
The problem can be generally tackled in three ways:
i. Managers can pool their authority and make decisions,
ii. The problem is passed on to a higher level where it is resolved by one manager with sufficient authority, and
iii. Reorganising to overcome recurrent situations of splintered authority.
6. Line and Staff Authority:
Line refers to those positions and elements of the organisation which have responsibility and authority and are accountable for accomplishment of the primary objectives.
The term “staff’ has evolved in the military organisation which developed the staff assistant pattern as a means of relieving commanders to details of execution that could be handled by others.
Staff elements are those which have advisory or service function to the line manager in the attainment of primary objectives.
The staff assistant or specialist provides advice and technical support to the line manager, but no direct authority or personnel under him.
Where two or more people work together, the distinction between line and staff is a means of determining who makes decisions directly related to the attainment of the end results, and who provides advice and service in helping in the process.
The essence of line authority is the direct chain (or line) of command, from the top level of authority through each successive level, called scalar chain.
The line manger has the authority to accept, alter or reject the advice and technical expertise of an advisory or technical staff. But whether he accepts or rejects the advice, the ultimate responsibility for the end results is his alone.
It should be remembered that almost every officer who holds a staff position, i.e. in-charge of a staff department (e.g. personnel or finances) also may have charge of several workers within his own department, and exercise line authority within that department.
The line and staff authority relationship is emphasised in organisations in which much reliance is placed on frequent conferences of heads of departments and specialists from other departments. Organisational charts and job descriptions should contain clear statements as to the nature of each position to avoid ambiguity.
In an organisation, a single position might serve as line, staff and functional at the same time but for different phases or activities.
For example, the financial officer gives financial advice (staff) to the chief executive, supervises his own accounts department of a number of personnel (line), and sets specific accounting procedures for all lower levels with his own special authority (functional).
In spite of the confusion about line and staff, the distinction seems important. Line and staff is a matter of authority relationships, the activities do not characterise a department as line or staff. Line organisation is the backbone of the hierarchy. Staff and functional organisation merely supplement the line.
7. The Span of Management:
This concept focuses on the recognition that there is a limit to the number of individuals whose activities can be coordinated and controlled effectively by one manager.
Certain factors which influence the span of management for any superior-subordinate relationship are given below.
However, it is not necessarily true that a smaller span results in better management or vice versa. There are too many underlying variables in a management situation to conclude that there are a particular number of subordinates which a manager can effectively supervise.