An organisational structure is a system that outlines how certain activities are directed in order to achieve the goals of an organisation. These activities can include power, roles, and responsibilities. The organisational structure also determines how information flows between levels within the company. For example, in a centralised structure, decisions flow from the top down, while in a decentralised structure, decision-making power is distributed among various levels of the organisation. There are many different structures and this depends on the organisation’s objectives and strategy.
Hierarchical – this structure has a longer chain of command, each on a different level one above the other, like a pyramid. The advantages of this is authority and responsibility are clear and well defined, opportunity for promotion motivates employees and employees can specialise and develop expertise in their field. The disadvantages are communication between departments may be less effective, decision making can take longer, it may be harder to be flexible and adapt and change. There may also be rivalry between departments.
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Functional – this is one of the most common especially in larger businesses, it divides its such as sale, marketing, finance, human resources etc. The advantages of this structure is that it is specialised so departments focus on one area of work, productivity may be improved as the staff are specialised and skilled in the tasks they perform, there are clear lines of management and accountability leading to clarity and everyone understands their roles. The disadvantages may be closed communication, co-ordination may become difficult and there may be resistance to change.
Flat – this occurs when there are no management levels, when all staff report to one overall manager mainly seen in small businesses. The advantages to this structure are better communication and relationships between different roles, a simple fast decision making process, adaptability and flexibility are increased. The disadvantages may be that employees are less specialised and it is difficult to maintain this structure as the company grows.
(Management Study HQ 2020)
In the NHS there is and element of hierarchical but also a functional structure. There are separate clinical boards with specialised departments within these clinical boards, so whilst there is clear authority and responsibility is clear and well defined there are specialised teams with expertise in their specific field that can initiate change with the correct permissions.
Change management theories
Business and organisation environments are constantly changing and evolving as new technology and research evolves & improvements are made with products and services. New innovations and developments mean that businesses and organisations have to develop and change to remain relevant and competitive. In healthcare specific changes to an organisation’s current processes can maximise efficiency, improve overall patient and provider satisfaction, and improve security and compliance efforts. However, implementing change in a healthcare organisations requires strong attention to detail regarding patients and service providers, as well as stringent security measures, ensuring that all data and health information is secure and maintained. Change is a key source of competitive advantage and change is key to survival.
Several change management models have been developed over the years, one of the most commonly known is that defined by Kotter (2012) he describes the eight step model for leading change.
Create a sense of urgency - For change to happen, it helps if the whole company really wants it. Develop a sense of urgency around the need for change. This may help you spark the initial motivation to get things moving. This stage involves open and honest dialogue about what's happening currently and why things need to change. If many people start talking about the change you propose, the urgency can build and feed on itself.
Bring everyone together/form a coalition - it is essential to have a strong leader to convince employees that the change is necessary.
Create a clear vision and strategy - having a clear and concise vision that you can articulate easily allows people to remember what your are asking them to do.
Communicate your vision to others - share the visions and make sure all staff understand the change and aim. It is important to talk about the vision often and use it daily to make decisions and solve problems.
Remove obstacles - clear any barriers or obstacles, praise those championing the change and support those resisting it, this will help empower employees execute your vision and move forward.
Motivate with short term wins - this will build confidence and allows staff to achieve short term goals will give them a taste of success. It must be achievable to ensure ongoing motivation.
Build on the change - it is also important to be careful not reward too early and keep moving forward and building on the change.
Change to become the core of the organisation- the change needs to be embedded into the heart of the company.
In order to successfully instigate and maintain change a lot of hard work and collaboration is involved, working through each of the above steps. If change is planned carefully and built on the proper foundation, implementing change can be much easier, and the chances of success are improved.
Since change for many brings about a loss of control, comfort, or territory, effectively working through the emotional elements remains a key factor for the successful implementation of innovative change. One of the best models to explain the human element is the Kübler-Ross Cycle of Grief (Kübler-Ross 1969). This model represents the emotional upheaval of terminally ill patients as they adapt to impending loss. The elements of denial, anger which gradually turn to acceptance and adjustment are reinterpreted in many organisational change methodologies. Kübler-Ross’ (1969) Change Curve is a reliable tool to understand change and the stages associated with it. The following stages are identified by Kübler-Ross:
Denial - Denial is a conscious or unconscious refusal to accept facts, information, reality, etc., relating to the situation concerned. It's a defence mechanism and perfectly natural. Some people can become locked in this stage when dealing with a traumatic change that can be ignored. Death of course is not particularly easy to avoid or evade indefinitely.
Anger - Anger can manifest in different ways. People dealing with emotional upset can be angry with themselves, and/or with others, especially those close to them. Knowing this helps keep detached and non-judgemental when experiencing the anger of someone who is very upset.
Bargaining - Traditionally the bargaining stage for people facing death can involve attempting to bargain with whatever God the person believes in. People facing less serious trauma can bargain or seek to negotiate a compromise. For example 'Can we still be friends?..' when facing a break-up. Bargaining rarely provides a sustainable solution, especially if it's a matter of life or death.
Depression - Also referred to as preparatory grieving. In a way it's the dress rehearsal or the practice run for the 'aftermath' although this stage means different things depending on whom it involves. It's a sort of acceptance with emotional attachment. It's natural to feel sadness and regret, fear, uncertainty, etc. It shows that the person has at least begun to accept the reality.
Acceptance - Again this stage definitely varies according to the person's situation, although broadly it is an indication that there is some emotional detachment and objectivity. People dying can enter this stage a long time before the people they leave behind, who must necessarily pass through their own individual stages of dealing with the grief.
(Based on the Grief Cycle model first published in On Death & Dying, Elisabeth Kübler-Ross, 1969. Interpretation by Alan Chapman 2006-2013.)
It is important to support staff through every stage of change implemented to ensure success, this can be achieved through training and supporting staff to give them the tools they need to achieve the change. Translating this model of managing change may help managers identify their staffs needs at various stages.
During stage one there may be shock or denial to the fact that change needs to occur and staff may need to adapt to something new. Information is key at this stage, it will take time to digest and providing information and developing their knowledge and constantly communicating will empower confidence in the change.
During stage two, once things are more settled and everything becomes clear staff may begin to feel fear of what lies ahead of them. It is natural to panic and believe that change is not possible and may not happen. It can also make staff feel anger or resentful because they may have been comfortable in what they were doing and change means learning something new. This is an important stage to manage and ensure it is controlled so that employees stay with the change process, communication remains key here.
During stage three employees may understand the change and may start to bargain and possibly learn what they think is necessary. This is when training is key and vital to ensure that everyone receives the best information and access to mentoring. It is important not to rush this stage.
During stage four moral and motivation can be low so when providing training and support it is important to be positive and keep focusing the change.
During stage five staff start to embrace the change and will really start moving forward.
There are numerous other theories available when contemplating and discussing change management, the two analysed above demonstrate the differences between the models but also their relevance and importance. In conclusion any change within the organisation requires careful thought, planning and consideration utilising a model or tool such as Kotter’s will ensure that all stages are considered, combining this with something like the Kübler-Ross model will ensure that the human and emotional impact of change are also considered. It is important to ensure everyone involved in the change is on board, educated, supported and enthusiastic about the project in order for it to succeed. Change can not be made to happen by one person it takes the whole team to come together to move forward, therefore it is essential to make sure the change is properly managed and that staff are supported through the process.
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