Governance, Leadership, and Organizational Structure

Governance, Leadership, and Organizational Structure





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Governance, Leadership, and Organizational Structure

Governance is fundamental and paramount for smooth operation of healthcare organization. An effective governance is efficient, allows a respectful conflict of ideas, is focused, is integrated and has good outcomes. Healthcare organization is governed by a board of directors. The roles of the board are threefold; establishing rules and policies, coming up with strategic decisions and to oversee the organization’s activity. Effective execution of policies ensures that the organization’s vision, mission, objectives, strategies are achieved (Hofstede, 2010). Policies define focus and differentiate responsibilities among the board, the management, and the medical staff. The board makes decisions on matters affecting the organizations operations; this entails making choices about the organization’s vision, mission, and objectives. Another important role of governance is the oversight role, the board is legally responsible for everything that happens within the hospital, whether in the emergency department, a nursing unit, casualty section. Governance ensures that quality services are rendered to patients by acquiring the right medical equipment, ensuring that medical staff adhere to the stipulated code of conduct and by monitoring implementation of policies. The ethical standards of the organization are determined by the board which determines what behavior will and will not be tolerated. It also outlines the disciplinary measures that will be taken whenever the codes are broken.

According to (Huber, 2006), Leadership is the behavior of an individual when directing the activities of a group toward a shared goal; It involves influencing the organization’s activities and coping with change. Health care organizations are made up of several professional groups, departments with nonlinear interactions between them. These groups have multidirectional goals which might support or be in conflict with each other hence the role of leadership is to take the chance to gain advantage from the diversity within the organization and effectively utilize available resources when designing management processes while motivating personnel to work towards common goals. Leadership creates a sense of togetherness and unites different units within the organization by encouraging them to work together toward the implementation of effective practices. Such collaborations promote understanding of different cultures and facilitate integration and interdependency among multiple stakeholders, individuals are unified by shared visions and values and the resulting working practices can achieve outcomes that are greater than the sum of individual efforts. Leadership nurture interdependency between different healthcare practitioners. Leadership involves communicating overall objectives/information to the numerous groups and departments, to allow them to come up with ways of implementing, and achieving the set objectives as they think best; this job satisfaction, job specialization and quality service. Such communication strategies enhance health care management by: encouraging dialogue between multiple stakeholders; sharing knowledge and experiences; and reducing level of complexity within the healthcare organization. Leadership serves the purpose of supervising organization’s operations to ensure that organization’s mission and vision are adhered to (Marquis & Huston, 2006). Individuals with different capacities in the organization need to engage and consult the leadership process constantly so that they are involved in approving and conveying needs and identifying modifications in practices that may be required to address changing demands. In addition, leadership looks for the most appropriate approach for handling conflict at all stages with the aim of creating a positive outcome for all involved. Strategies that can be employed are competition, avoidance, accommodation, bargaining, negotiation, facilitating communication, seeking consensus, collaboration.

Organizational structure defines the character of an organization. It serves as away by which the health care organization communicates, distributes responsibility, achieves coordination, delegate’s authority/ jobs and describes how separate actions of individuals are linked together. An organizational structure establishes lines of authority and decision making while describing where employees from different functional groups are located within the defines the roles and departments that make up an organizations functioning. It is a way of grouping and organizing an organization’s functions to make sure they all get done efficiently and well. Everyone answers to someone. Employees at a particular level in the organization report to their supervisors who in turn report to their supervisors as asserted by (Wager & Lee, 2009). Hence organizational structure helps make clear who answers to whom and where they fit in the chain of command. The goal of an organization’s structure is to make sure that roles and responsibilities of each employee is clearly defined and that there is no duplication of work. This will ensure that the organization achieves all its required and desired functions. The relationship between different positions, their departments and hierarchical management structure make up the organization’s structure.

Stakeholders are involved in the healthcare system and would to a great extent affected by changes to the system. The major stakeholders are:

Physicians-they are the providers of medical care. They ensure that patients receive appropriate medications;

Government-it regulates the healthcare organization by ensuring that the organization offers quality services and that all the laws in the constitution are adhered to with regard to rights of patients and staff. The government may offer health insurance coverage for the elderly, disabled and the poor;

Pharmaceutical firms-they develop and market medications which are prescribed by medical practitioners to their patients. Almost all the patients rely on their products;

Insurance companies-prices for drugs are rising and this will make the drugs unaffordable to most patients once they reach extravagant prices. Insurance companies sell health coverage for various risks either to patients directly or indirectly to employers. This way patients can afford expensive medications (Marquis & Huston, 2006).

Patients-are the recipients of medical care offered at the healthcare Centre. They are responsible for their own health. Patients expected to be shown compassion and given proper medication;

Employers-they want to keep medical cost for their employees down as much as possible and to have their employees to recover quickly so that they may report to their work stations. They offer health insurance coverage for their employees and are concerned with employees’ health because bad health affects their productivity and efficiency;

Payers-they insist on cost effectiveness of medical care

Services the organization will deliver are: pediatrics, laboratory and x-ray services, dental care, diabetes support program, immunizations, outpatient medical treatment, in-patient services, medical follow-ups, health screening and public awareness, pharmaceutical services, radiology and diagnostic imaging, center for advanced orthopedic and spine center, maternity services, emergency services, surgical services, chemotherapy, endoscopy.

As per (Huber, 2006), Roles and functions of board of directors are to establish policies, to make significant and strategic decisions, and to oversee the organization’s activity. The board of directors is accountable to shareholders for the performance of the organization. The boards overall objective is to increase shareholder value while ensuring that the organization’s overall activities are properly managed. They provide strategic direction and approving corporate strategies. They monitor management and financial performance. Appoint the CEO, managing directors. They ensure the business is conducted ethically and transparently. They delegate authority for operational management of the business to the CEO and senior is headed by a chairman

Advisory committee only advices the board and the CEO.

CEO also oversees the implementation of strategies approved by the board and is responsible for providing the accurate and relevant information to enable the board of directors to perform its responsibilities. The CEO possesses the responsibility and authority to articulate the strategy, vision, goals and resource constraints. With the support of the board, CEOs set the stage for transformation of an organizations culture and fuel clinical and business process reengineering by encouraging and if necessary, forcing collaboration between the strong disciplinary and departmental divisions found in healthcare systems according to (Hofstede, 2010). The CEO creates a future destination for the organization, establish a viable set of strategies to reach it and engage a talented team of professionals to make it happen. The CEO also engages and empower employees at all levels to take ownership of their work and feel proud of what they are doing to help improve health on all levels. CEO is answerable to the board of directors and plays a key role in ensuring patient safety, maintaining financial health and stability, promoting quality of health care, promoting patient satisfaction, developing hospital policies and procedures, recruitment, compliance, communication and relationships (Wager & Lee, 2009)..

Commercial manager supervises the following: employee relations manager, human resource, maintenance officers, supply manager, contractors, and consultancy services.

Director of clinical services supervises: infection control manager, quality manger, research, pharmacy, catering and housekeeping manager

Organizational chart

Board of governors

Advisory committee


Executive assistant

Hospital managerdirector of medical director of director of clinical commercial

Servicefinance services manager

Human resource




Hofstede, G. (2010). Cultures and organizations: Software of the mind : Intercultural cooperation and its importance for survival (3.rd ed.). Maidenhead: McGraw-Hill.

Huber, D. (2006). Leadership and nursing care management (3rd ed.). Philadelphia: Saunders Elsevier.

Marquis, B., & Huston, C. (2006). Leadership roles and management functions in nursing: Theory and application (5th ed.). Philadelphia: Lippincott Williams & Wilkins.

Wager, K., & Lee, F. (2009). Health care information systems a practical approach for health care management (2nd ed.). San Francisco, CA: Jossey-Bass.

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