The Managerial Setup Of The Xyz Hospital Commerce Essay

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/The managerial setup of the xyz hospital will be scrutinized, formulating a strategy for the implementation of the change in the managerial setup. The theoretical aspects of the management setup and the aspects under consideration during its execution will be studied in this paper. Case studies and module lectures have also been included, which have provided guidance in the structuring of the managerial setup of the hospital .The paper will take the readers through the bureaucratic setup of the hospital, simultaneously explaining the issues attached and present within the operating system currently applied. A detailed analysis of the current issues within the Radiology Department will be provided, highlighting the reasons behind these occurrences. The suggestions will be provided keeping in mind the bureaucratic system of the hospital.


The re-organization and change of a managerial setup is an entirely singular project, specific to the needs of the employees and the characteristics of the situation involved. It should not be addressed on the basis of universal rules, but must be addressed in isolation. The management change is dependent on the will and enthusiasm of the workers involved. Only with their consent involved can this change be implemented. The management change is a very critical and crucial task to overcome the problems and therefore it makes the job of the manager a very crucial one too. The core manager's contribution is up to 40% to 70% in the process. Creativity becomes an important tool in this process while negotiations become the main language of communication between the work groups. Progressing through these working groups is an essential component of management change which will eventually yield positive results (Cameron J. Thomson, 1999)

The dictionary definition of the term management describes it as, a process, act, manner or practice of supervising or controlling. As truly defined, management is to be viewed as such, which also reiterates its aspect of being not a singular entity, but a complex composition of various factors which renders it unstable. Therefore it can be explained as the guiding or controlling of the people and the utilization of the resources and the prevalent characteristics of a system, manipulating them to towards the accomplishment of an organizational goal (Sandi J. Davies, 2007). Therefore it is working in collaboration with the people and through them in achieving the goals individually as well as collectively (Patrick J. Montana, Bruce H. Charnov, 2000)

A change will eventually occur with time, as observed from the previous experiences. These changes can yield either a positive or a negative result depending on the individual perception. Change management seeks to mould these perceptions towards an optimistic approach, providing measures that will aid in the transition phase of an employee from the old setup to the new one. Management changes effects every individual because of its transformatory nature, via physical, spiritual, emotional and mental changes (Blokdijk, 2008).

Management change is executed through three compulsory stages. The first is the reviewing of the authoritative levels of the project manager leading to the second stage, which addresses the environment surrounding the workers. The environment is incorporated with changes that induces positivity and supports the management change. The third aspect is the establishment of an environment, which aids in the formulation of the of management change (Claudia Baca, 2005)

An organized attempt towards a change can only be implemented through management change which is only brought to effect because of the organizational structure, culture within the corporation and the behaviours of every individual within the setup. This change is therefore completed with the corporation of the employees (Christian, Kneer, 2009).

Organizational structure determines the roles and task distribution among the individuals, engaged at the various levels of the organization, therefore establishing a hierarchy within the authorities, who are the coordinating members of the organization (Mats Alvesson, 1995). Organizational structure is born from the regulated and legal order of the tasks being carried out as an organization (Howard Aldrich, 2007)

Bureaucracy is the basic and the first form of organization structures, defining the systematic, rational and specified organization structure which strictly follows a defined set of rules and techniques. All the latter organizational structures are a modification or an extension of the bureaucratic organizational structure (Andrew J. DuBrin, 2008)

Bureaucracy and the hierarchy systems have only been formulated to help in the large scale administrative operations leading to the organization of the many personals involved (Lucita, 2007).

Unfortunately the bureaucratic structure is proving as a failure in the current situation as it has been unable to address the evolving needs of an organization. Frequent complaints of, red tape, delays in the procedures accompanied by frustration, are being heard (Patricia S. Yodet-Wise, 2003).

Diagnosis of the issue involved in the administration of the Radiology Department and the application of management change strategies.

Diagnosis is the beginning of any change that needs to be planned for any organization. The diagnosis is carried out systematically through asking logical questions, recording observations, data collection and the interpretation of this data to extract the appropriate information. This data is then analysed and then assimilated into the system. These skills are important in the identification of the issues and require the intellect of the managers, into formulating the right questions that would yield the data required by them. These questions should encompass the current situation and the future expected situation, if the change is not implemented. The opinions of the employees are also important to the process as they will highlight the constraints and hurdles in the effective transformation of the system from the current to the ideal state (Hersey, 2008).

The organizational system of the Radiology department is operating on the conventional diagram, where the BS and the DE occupy the top level of the administration, while the rest of the positions are occupied by the staff of thirty six radiographers, scientists, technical staff and the administrative staff at various levels. This typical arrangement has lead to many harmful results in performance of the department. Especially in relation to the current scenario, organizational setups like these are certain to fail due to separation between the administrative levels and the lower staff. The decision making is the sole right of the administrative block only, which impairs the department from benefitting from the skills and knowledge of the lower staff. Today's era urges the departments to be updated with the latest knowledge of health care technology and the organizational requirements, which are crucial for the decision making process. High level authorities can benefit from the prowess and knowledge of the lower staff, as they are skilled and specialised with respect to different areas of practice and are engaged in these operations on the daily basis (Booyens, 1998).

The realm of control should be widened otherwise it will result in the inconsistent and ill coordinated decisions, hampering the communication between the organizational levels. The lower staff's enthusiasm and motivation can be destroyed by this system (Mullins, 2010, P; 563). A narrow operational span means incorporation of multiple levels of controls, which may increase the cost, increase the decision making time due to vertical levels, result in the isolation of the employees from the management and destroy employee autonomy (Lawrence J. Gitman, Carl McDaniel, 2008).

The hospital management suffered from the same problems as the span of control was reduced. Each staff member had authority over two or three members. Each member became a manger over those who were a level down, resulting in the low autonomy level. Decisions were delayed and the many external events were not responded to.

The bureaucratic structure and a narrow span also results in the production of highly specialised individuals who are restricted to a specific area of department, in order to attain high levels of competence. These setups yield a restricted and a specialised job requirement (Marc Holzer, Seok-Hwan Lee, 2004).

The bureaucratic setup restricts the operational capacity of the individuals according to the set of rules and the job description details, handed to the employee. Each individual is to act according to the details and are fully aware of the responsibilities and expectations required from them. The duties and responsibilities of a manager are also outlined for them defining their limits (Andrew J. DuBrin, 2008). Similar was the case in the radiology department, where evidence existed of the head of department, Brenda Smith, introducing written regulations and procedures, which were to be followed by the employees strictly.

Brenda smith's strategy had lowered the level of motivation in employees more than it was before. Several important employees were looking for a better job opportunity and many preferred to stay absent. Motivated employees are a key asset of any firm, it is how they feel and approach a job, their superiors and their surroundings. Motivation yields loyal, hardworking and dedicated employees. A lowered morale level will lead to abysmal work standard absenteeism and increased turnover rate caused by employees leaving for a better job (William M. Pride. Robert James Hughes, Jack R. Kapoor, 2009).

In case of a change it is imperative that all the employees involved should be aware of the change and the reasons behind it. Lack of information among the employees and the people implementing the change will lead to resistance. Resistance is the deadliest enemy of a change and hence managers seek measures to surmount this enemy before it destroys the changing process. Improved communication techniques will ascertain the removal of any chance of resistance. Well informed employees with a right to provide a feedback to the process will facilitate the process of changing and increase the chances of its success. Organizational culture guru, as termed. Also help in the process by providing the strong divergent unitarist culture among the members. These kinds of people unify the employees and the organization with the similarity of objective and values providing the organization success over the others. this unitarist vision is indicated by Asoff (1990) in his definition of resistance, whereby he explains it as a phenomenon that influences the process of change by hampering its progress and creating hurdles in its execution leading to increased costs (Sharma, 2009).

Administrating the changes require the following steps to be followed. At first is the identification of the solutions and formulation of adequate strategies, which is then followed by the analysis of these strategies and their outcomes. Finally a strategy suiting the most among all the alternates is chosen for implementation (Hersey, 2008).

In case of the Radiology Department, its administrative structure will have to be specifically addressed. For instance, the structuring of the department will ah veto be changed as it was limiting the work flow. Some informal techniques could be applied to apply the change. In some cases application of power for implementing a change is effective, as it controls any effort to resist the change. Although an advisable method would be to improve the means of communication among the employees and the department, who could convey the motifs behind the change and its reasons, thus creating a sense of acceptance among the employees. The system could be incorporated with a rewards scheme that could help in increasing the morale and the level of motivation among the employees, leading to the implementation of the change.

Many intellects have researched on the effective measures to implementing a change. Kotter and Cohen are among these people who have listed the eight steps, which according to them will ensure the success and sustain the change applied within an organization.

The related people within an organization, irrespective of the size or nature of the organization, should be having within them the sense of urgency and should regard the process of change as a crucial step towards development.

A team of credible, skilled, authoritative, reputed and well connected people should be formed to lead the people through the change.

A guiding vision should be created that should be clear, adequate, sensible and motivational. The vision should provide the basis of all the future strategies.

Conveyance of this vision to the rest of the members is imperative for the acceptance and consent of the employees.

All the hindrances should be eliminated and authority should be given to react to such situations.

Short term rewards should be planned that would induce motivation, momentum and credibility to the overall process.

The level of momentum and motivation should be maintained and changes should be assimilated with the planning of a continuous chain of changes.

Maintaining these changes is essential and should be done wisely through establishing a culture and creating shared values and group norms of behaviour (Mullins, 2010, p:760).

The primary issue with the Radiology Department was with the administrative structure which was following the bureaucratic setup. The organizational setup should be designed following other setups and various other organizational structures should be created. The bureaucratic structure of the department consists of many layers of governance which in turn have too many employees. The system can be simplified by downsizing, outsourcing and creating a flat structure. By eliminating excessive layers of administration the problem can be overcome (Andrew J. DuBrin, 2008).

The informal structure of management might prove to be a better option than the formal management system. The informal structure arises due to the personal and social relationship between the people. These connections may not be a part of the organizational chart but are formed due to the sharing of interests. These groups may be of people having lunch together, working on a similar assignment or having classes together. The authorities involved in this structure can gain recognition even they have no informal status. The informal structure evolves from the personal relationships instead of the respect of the authority. This system helps in nurturing social connections among people meeting personal objectives. Organizational structure does not define the authority level but it springs up from the employee's respect for the colleague's abilities and knowledge. As it is based on social behaviour, the system provides effective channels for communication, control over social behaviour and conveys information much better among the staff (Ann Marriner-Tomey, 2004).

Re-engineering process results in the horizontal structuring of the administration. Re-engineering or redesigning is the process in which the verticals structure of the organization is developed along the horizontal workflows and processes. Horizontal structuring places the jobs according to the team responsible for it (Andrew J. DuBrin, 2008). This approach arranges the employees around the core processes. By processes one would refer to the organization of relevant tasks that are executed to achieve outputs from inputs creating value for customers (Richard L. Draft, 2009).

OB strategies are positive as they prefer incentives such as shared purpose, strong culture, bottom up change and involvement as the primary aspects of a change instead of financial incentives (John Hayes, 2007).

On the other hand Sirkin el al (2005) was inclined on finding an appropriate reason behind the structured implementation of a change. These reasons were backed up by the presence of the need for information, empowerment and the motivation to change. Therefore the OD was explained in the best summarised way possible. Later OD approaches, although do not emphasize on top down management and approach owned by management also promoting the concept of involvement of a lot of personal in the changing process. Therefore the need of decision making process with collaboration becomes important to the process of change management. OD has earned a reputation of cultivating a flexible structure, the capacity of facing all sorts of implications in the organizational structure, human resource policies and a culture of learning and support. Previously this structure was carried out by external interventions but due to its results people are now inclined towards this system. The OD is perceived as a set of appropriate techniques that guarantee's success. It helps in the improvement many aspects such as communication, job satisfaction level, progress, motivation and the overall organizational status (Lyndon Pugh, 2007).

Generally the top most levels of the organization are expected to initiate this change, as power is involved in the change. Although the lower levels of the organizations can also initiate this change but it is more likely for the authoritative figures to go on with the process. Hence it is also more likely for them to opt for power than the rewards scheme to implement a change. Change through force requires surveillance in order to ensure that it is followed through. Organizations are also perceived as collaboration between the powers. Specialists have the benefits, enabling them to take initiatives for the implementation of a change, exercising power, following a vision. Task priorities, functionality, new skills and new members lead to the shift in the authority. Power must be accompanied with a sense of direction and purpose. Inducing change through power directly relates to the rewards of this change. Individual benefits whether intrinsic or extrinsic, always fasten the process of change. Rewards address the needs of the people and therefore they will favour change (John W. Hunt, 1992).

Controlling is essential to direct the people along the course of the change implemented, following the set standards. This control can yield positive results through the offering of rewards according to the performances, which will stimulate the people in performing better (Tulsian, 2008).

Cooperation and consent of the staff, colleagues and unions is imperative for the success of the management change. Change can only be implemented through working and for the people to work, their perceptions and attitudes need to be altered (Mullins. 2010. P; 762).

Employee commitment can increase the effectiveness of the change. Dialogue with the employees, engaging them in the decision making process, making them aware of the rationale and the context of the change, will help in attaining their commitment. Employees can participate in data collection, generating options, suggesting recommendation and the implementation of the process. This will automatically make them committed to the outcome. Involving people will negate the sense of being controlled and increase commitment (David Ulrich, 1997).

Resistance should be expected by the managers of change in any sort of situation. Resistance is not a worse scenario; it is the inappropriate reaction to the resistance that can create trouble. In fact managers should positively approach these resistance as from these resistance can emerge a constructive idea. It is not necessary that a change is always the right course for the organization. If that is not the case, then resistance will be the source to point that out. According to Waddell and Sohal, resistance can indicate aspects that are neglected by the authority. They may be the saviour of the organization from decisions and implementations formed as a result of miss -informed senior management (Sharma, 2009).

Communication among the employees is essential and should be a continuous and an ongoing process, to convey the correct information to the correct people at the appropriate time. These people should be informed about the operational changes that will be implemented in the future (Esther Cameron, Mike Green, 2004).

The ADKAR model incorporates the five pillars of the management change, realized by an individual. First, they should be aware of the reasons behind he change; secondly, they should be willing to support the change; thirdly, they should be equipped with the knowledge of change; , they should have the capacity to accommodate behavioural changes and lastly, they should reinforce these changes for their sustenance (Gerard Blokdijk, 2008).

According to Hargie and Tourish (2000), communication should be regularly audited. Communication objectives should be clarified involving inquiries such as, the people communicating with them, the issues talked about, issues frequently asked about, the extent of information acquired, the extent of comprehending of this information by the people, the amount of trust in these information, source of information and the most effective channels of information (John Hayes, 2007).


There are no definite rules for reference in case of successful management change. Managers implementing the change should be aware of the vitality of balance between the organizational stability for functionality and generation of momentum for a change for the implementation to occur (Stephen P. Osborne, Kerry Brown, 2005).

The Radiology Department, if subjected to a change, can improve its performance, as most of the issues are owing to the organizational structure of the department. Once the structure is modified, the employees will undergo an attitudinal change, leading them to better performance. The change in the department could include both bottom up and up down strategies. Communication among the employees and the administration can eliminate any chances of resistance and boost their morale by including them in the process of planning and implementing the change.