Communication,
Organization and
Management
Complete Summary of Exam Content
(including all lectures and workgroups
notes of 2022)
©2022 A. Arp All Rights Reserved
,HC1 Introduction
Organization = people working collectively for a common purpose/ an organized group of people
with a particular purpose.
2 models organizational design:
1. Mechanistic model = Fayol; organization seen as machines. Emphasized importance of
production and efficiency.
• Formal = extent to which rules, procedures are written and enforced.
• Centralized = extent to which authority makes decisions retained in top
management.
• Complex = number of different jobs and/or units within an organization.
• Stable and simple environment. Hierarchical.
Principles of Fayol:
1) Specialization = specialization is best means of making use of individuals.
2) Unity of Direction = jobs should be grouped according to specialty.
3) Authority and Responsibility = delegation and accountability are key.
4) Scalar chain = route for vertical communication
5) Bureaucracy = Weber; organizational structure characterized by regulatory
procedure, division of responsibility, hierarchy and impersonal relationships. Without
participation by the governed.
Operating principles:
I. Rationalization (work regulated via procedures & rules)
II. Formality (focus on standardization of processes)
III. Specialization → have only one job
IV. Hierarchy → top-down management of low-skilled workers
V. Universal access, but no individual control
Critiques:
• De-humanizing effect on employees, customers and patients.
• Little room for ‘human beings’(powerlessness, meaninglessness and self-
alienation)
• Inflexible / rigid
• Inefficient and viscous
• Differentiation and disintegration
• Limited rationality (goal rationality)
• Limited morality (value rationality)
Why hospitals bureaucratic?
• Standardization of processes: clinical guideline practices, care pathways
• Highly specialized
• Hierarchy: slow, stifles innovation and difficult to provide clear management
directives (misfit cultures of autonomous professionals).
• Universal access, but no individual control → supply-driven vs demand-
driven health care.
1900-1950 = traditionally, health professionals had much autonomy; isolated work.
No external autonomy: ‘butchers inspects his own meat’. Inefficient. No standards or
routines: provided care dependent on individual health professionals.
- Call for more transparency and governance. Voice and choice. From supply-
driven to demand-driven → new public management (market).
New Public Management = strengthening position of healthcare consumers.
Achievements are tangible: in contrast to esoteric professional knowledge.
Accountability not solely horizontal anymore (role of insures). Improvement of
performance.
1
, - (Management of) health care organizations is becoming increasingly important.
Professionals are embedded in an organization.
- Creates tension between relation of professionalism and management. Differ in
how the organization acts and what they think
is important.
Substantial component: scientific knowledge,
skills, experience, service ethics
Political component: professional association,
controlled access, autonomy, horizontal
accountability.
Health care is monitored by inspectorate (government; ministry health and sport).
Consumer choice, competition between insurance companies to compete for
enrollees and negotiation for good quality of good price (between insurers and
health care providers).
Market failure in health care:
- Health care 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.
Health insurance is third party.
- Increased accountability → bureaucracy revisited.
2. Organic model = Gore; emphasizes the importance of adaptability and development.
Relatively informal, decentralized and simple. Tasks, authority and routines are constantly
redefined. ‘flat’ organizations (non-hierarchical). Complex and dynamic environment.
3 key concepts when comparing models:
1. Formalization = extent to which rules, procedures and other guides to action are written and
enforced.
2. Centralization = extent to which authority to make decisions is retained in top management.
3. Complexity = number of different jobs and/or units within an organization. More simple in
organic models.
2
Organization and
Management
Complete Summary of Exam Content
(including all lectures and workgroups
notes of 2022)
©2022 A. Arp All Rights Reserved
,HC1 Introduction
Organization = people working collectively for a common purpose/ an organized group of people
with a particular purpose.
2 models organizational design:
1. Mechanistic model = Fayol; organization seen as machines. Emphasized importance of
production and efficiency.
• Formal = extent to which rules, procedures are written and enforced.
• Centralized = extent to which authority makes decisions retained in top
management.
• Complex = number of different jobs and/or units within an organization.
• Stable and simple environment. Hierarchical.
Principles of Fayol:
1) Specialization = specialization is best means of making use of individuals.
2) Unity of Direction = jobs should be grouped according to specialty.
3) Authority and Responsibility = delegation and accountability are key.
4) Scalar chain = route for vertical communication
5) Bureaucracy = Weber; organizational structure characterized by regulatory
procedure, division of responsibility, hierarchy and impersonal relationships. Without
participation by the governed.
Operating principles:
I. Rationalization (work regulated via procedures & rules)
II. Formality (focus on standardization of processes)
III. Specialization → have only one job
IV. Hierarchy → top-down management of low-skilled workers
V. Universal access, but no individual control
Critiques:
• De-humanizing effect on employees, customers and patients.
• Little room for ‘human beings’(powerlessness, meaninglessness and self-
alienation)
• Inflexible / rigid
• Inefficient and viscous
• Differentiation and disintegration
• Limited rationality (goal rationality)
• Limited morality (value rationality)
Why hospitals bureaucratic?
• Standardization of processes: clinical guideline practices, care pathways
• Highly specialized
• Hierarchy: slow, stifles innovation and difficult to provide clear management
directives (misfit cultures of autonomous professionals).
• Universal access, but no individual control → supply-driven vs demand-
driven health care.
1900-1950 = traditionally, health professionals had much autonomy; isolated work.
No external autonomy: ‘butchers inspects his own meat’. Inefficient. No standards or
routines: provided care dependent on individual health professionals.
- Call for more transparency and governance. Voice and choice. From supply-
driven to demand-driven → new public management (market).
New Public Management = strengthening position of healthcare consumers.
Achievements are tangible: in contrast to esoteric professional knowledge.
Accountability not solely horizontal anymore (role of insures). Improvement of
performance.
1
, - (Management of) health care organizations is becoming increasingly important.
Professionals are embedded in an organization.
- Creates tension between relation of professionalism and management. Differ in
how the organization acts and what they think
is important.
Substantial component: scientific knowledge,
skills, experience, service ethics
Political component: professional association,
controlled access, autonomy, horizontal
accountability.
Health care is monitored by inspectorate (government; ministry health and sport).
Consumer choice, competition between insurance companies to compete for
enrollees and negotiation for good quality of good price (between insurers and
health care providers).
Market failure in health care:
- Health care 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.
Health insurance is third party.
- Increased accountability → bureaucracy revisited.
2. Organic model = Gore; emphasizes the importance of adaptability and development.
Relatively informal, decentralized and simple. Tasks, authority and routines are constantly
redefined. ‘flat’ organizations (non-hierarchical). Complex and dynamic environment.
3 key concepts when comparing models:
1. Formalization = extent to which rules, procedures and other guides to action are written and
enforced.
2. Centralization = extent to which authority to make decisions is retained in top management.
3. Complexity = number of different jobs and/or units within an organization. More simple in
organic models.
2
