COM summary
Lecture 1:
Healthcare organisations are very bureaucratic. Focused on:
- Standardisation
- Specialisation
- Hierarchy
- Universal access, no individual control: supply driven vs demand driven health care
Regulated market: market organised by the government.
Organisation:
- People working collectively for a common purpose
- An organised group of people with a particular purpose
Market failure in healthcare:
- Healthcare is not a business
- Insufficient competition to offer high quality care at best price
- No direct interaction between supply and demand, but mediated by third party
- Increased accountability → bureaucracy revisited
Professionalism:
The conduct, aims, or qualities that characterize or mark a profession or a
professional person.
Centralisation: Dictatorship
- Easier to implement
- Consistency with strategy
- Easier to achieve coordination and control
- Faster decision making
- Control
Decentralisation: Democracy
- More responsive to local circumstances
- Opportunities for staff development
- Sense of control good for staff motivation
- Autonomy
Differentiation:
- division of tasks
a.m.spook©2021
,Integration:
- Collaboration
- Holistic view of patients and care delivery
Functional structure:
- differentiation
- Us vs. them culture
- Fragmentation
- Hierarchy → no lateral communication
Matrix structure:
Advantages:
- Combining functional and program/service line
- Flexibility
- Efficient use of resources and skills
- No changes in organisational structure needed
- Helps personal commitment and development
Disadvantages:
- Fight about resources
- Employees become loyal to team, not to their department
Flat organisation:
- Wide span of control
- More flexibility
- Work more in projects
- Fast decision making
Tall hierarchy:
- Narrow span of control
- Slows down decision making
- Control
- Large overhead → costly
Mechanic vs. Organic:
Bureaucratic, machine-like:
Contingency → stable environment
- Control
- Centralisation
- Tall hierarchy
Flexible, organic management
Contingency → unpredictable environment
- Autonomy
a.m.spook©2021
,- Decentralisation
- Flat hierarchy
a.m.spook©2021
, Lecture 2:
Part 1:
Classical management theory
Historical context:
- industrial revolution:
- Industry → work
- Revolution → rapid change
- From farms to factories
- From small shops to large companies
Primary sparks:
- Power: Power to run machines, faster
- Machinery innovations: Faster, less employees
- Transportation: Railroads, steamboats
Issues:
- Large groups of people working together
- People working alongside machinery
- Increasing pace of industry
- Companies were looking for answers for challanges
How to organize?
How to maximize productivity?
How to manage all those people?
Max Weber (Bureaucracy):
- Organisations should look like the government and the legal system
- A “legal-rational” approach
- Not traditional, family-based leadership
- Not charisma-based leadership
- Big picture
Bureaucracy:
- One’s authority should be tied to the official position he or she occupies
- Clear rules should govern performance
- Standardized guidelines should determine hiring and firing
- Was against favoritism
Frederick Taylor (scientific management):
- “applying science to work
- Saw customized, self-styled work as a serious productivity problem
- Popularized time and motion studies
- Wanted to find the “one right way” to do every single task
a.m.spook©2021
Lecture 1:
Healthcare organisations are very bureaucratic. Focused on:
- Standardisation
- Specialisation
- Hierarchy
- Universal access, no individual control: supply driven vs demand driven health care
Regulated market: market organised by the government.
Organisation:
- People working collectively for a common purpose
- An organised group of people with a particular purpose
Market failure in healthcare:
- Healthcare is not a business
- Insufficient competition to offer high quality care at best price
- No direct interaction between supply and demand, but mediated by third party
- Increased accountability → bureaucracy revisited
Professionalism:
The conduct, aims, or qualities that characterize or mark a profession or a
professional person.
Centralisation: Dictatorship
- Easier to implement
- Consistency with strategy
- Easier to achieve coordination and control
- Faster decision making
- Control
Decentralisation: Democracy
- More responsive to local circumstances
- Opportunities for staff development
- Sense of control good for staff motivation
- Autonomy
Differentiation:
- division of tasks
a.m.spook©2021
,Integration:
- Collaboration
- Holistic view of patients and care delivery
Functional structure:
- differentiation
- Us vs. them culture
- Fragmentation
- Hierarchy → no lateral communication
Matrix structure:
Advantages:
- Combining functional and program/service line
- Flexibility
- Efficient use of resources and skills
- No changes in organisational structure needed
- Helps personal commitment and development
Disadvantages:
- Fight about resources
- Employees become loyal to team, not to their department
Flat organisation:
- Wide span of control
- More flexibility
- Work more in projects
- Fast decision making
Tall hierarchy:
- Narrow span of control
- Slows down decision making
- Control
- Large overhead → costly
Mechanic vs. Organic:
Bureaucratic, machine-like:
Contingency → stable environment
- Control
- Centralisation
- Tall hierarchy
Flexible, organic management
Contingency → unpredictable environment
- Autonomy
a.m.spook©2021
,- Decentralisation
- Flat hierarchy
a.m.spook©2021
, Lecture 2:
Part 1:
Classical management theory
Historical context:
- industrial revolution:
- Industry → work
- Revolution → rapid change
- From farms to factories
- From small shops to large companies
Primary sparks:
- Power: Power to run machines, faster
- Machinery innovations: Faster, less employees
- Transportation: Railroads, steamboats
Issues:
- Large groups of people working together
- People working alongside machinery
- Increasing pace of industry
- Companies were looking for answers for challanges
How to organize?
How to maximize productivity?
How to manage all those people?
Max Weber (Bureaucracy):
- Organisations should look like the government and the legal system
- A “legal-rational” approach
- Not traditional, family-based leadership
- Not charisma-based leadership
- Big picture
Bureaucracy:
- One’s authority should be tied to the official position he or she occupies
- Clear rules should govern performance
- Standardized guidelines should determine hiring and firing
- Was against favoritism
Frederick Taylor (scientific management):
- “applying science to work
- Saw customized, self-styled work as a serious productivity problem
- Popularized time and motion studies
- Wanted to find the “one right way” to do every single task
a.m.spook©2021
